Personal interaction between client and provider is the key to good counseling. To counsel women effectively, providers themselves need to know a lot about the pill, to have good interpersonal communication skills, and to work in an environment that promotes good-quality interaction and supports follow-up with clients. When family planning providers have the skills, resources, and support to be good counselors, clients make better informed decisions, use methods more effectively and longer, and make more appropriate changes among methods.

Lauren Goodsmith

A health worker in Morocco counsels a woman, describing various family planning methods with the help of a demonstration kit. Tailoring information to the needs of clients and presenting information in different ways, including take-home print materials, encourages effective OC use.

GATHER, a six-step process, can help service providers counsel family planning clients. The letters in the word GATHER stand for Greet-Ask-Tell-Help-Explain-Return. Each step of the GATHER process covers a different element of counseling and helps guide provider-client interaction. Following these steps helps clients to make informed decisions about their family planning options (175). GATHER has been translated into at least 10 languages and adopted by training programs around the world (103). (See Population Reports, GATHER Guide to Counseling, Series J, No. 48, December 1998.)

Counseling often can help the client both choose and use a method. Most clients already have a method in mind when they meet with a provider. In this case, the provider's responsibility is to make sure that the client's choice is based on accurate understanding of the method and awareness of other options. The provider can help the client consider whether the method she prefers suits her own needs and situation.

Since in some places OCs are better known than other methods—almost synonymous with family planning itself—counselors may need to check especially that clients who ask for OCs are aware of other options. Also, the provider needs to check whether the client has any medical condition that would rule out use of the client's preferred method (see checklist).

Once the client confirms her choice, the provider's responsibility is to help her use her method effectively and with satisfaction. If a woman chooses OCs, the provider discusses how to take the pill, what to do if one or more pills are missed, what to do if common side effects occur, when and how to use back-up methods, and what symptoms indicate a need to seek immediate care from a doctor or nurse.

At the first meeting the provider needs to assure that the client's understanding of the pill is accurate (111, 235). It usually is difficult to correct misperceptions about a contraceptive method after the client has started using it (20). Thus the first meeting should convey key messages about effective pill use (see side-bar, Key Counseling Messages About the Pill).

Women who receive good counseling are less likely to discontinue using the pill. In Colombia, for example, a study found that women who rated their health promoter “very effective” at communication were more likely than other women to continue using the pill (62). Other research shows that a client's perception of the quality of interaction with a provider is consistently among the most important factors in effective pill use (176).