• Access to a choice of methods (see Lesson 2 Access and Lesson 3 Choice of Method);
• Provider competence (see Lesson 6 Well-Trained Providers);
• Information given clients, including counseling (see Lesson 5 Communication);
• Interpersonal relations between provider and client;
• Appropriate constellation of services, meaning the availability of related health care services as well as family planning (see The Challenge of Reproductive Health Care); and
• Follow-up and continuity of services.

Counseling. Personal contact with a family planning provider is at the heart of client-centered quality. Often it is the crucial step in a person's decision-making process about family planning (126) (see Population Reports, Counseling Makes A Difference, J-35, November 1987).

In counseling, clients and providers meet face-to-face to discuss reproductive health choices and practices. Service providers not only inform their clients but also listen to them and help them to understand their own feelings and needs and thus to make more appropriate choices. In a good counseling situation the provider establishes a relationship of trust and confidence with the client. This relationship is established by expressing empathy (that is, putting oneself in the other person's position), being respectful, and telling the truth (50). Counseling is a special form of interpersonal communication, and most people require training and practice to become proficient counselors (50).

Informed choice. Family planning programs are responsible for ensuring their clients' right to make their own decisions about family planning (50). Programs that offer client-centered care help people make informed decisions about reproductive health and contraception (18, 31).

To make an informed choice, clients need accurate, clear, unbiased, and useful information and advice about reproduction, family planning, and correct use of contraceptive methods. Many people discontinue using contraception because they lack accurate information, while others never adopt contraception at all for want of information (18).

Service providers should inform clients about both the advantages and the disadvantages of contraceptive methods. Providers should not discourage or promote particular methods at the expense of others that might interest a client (180, 220, 221). Once clients have chosen a specific method, they also need information about proper use, potential side effects and complications, and the follow-up services that are available (98).

Family planning programs provide clients with information in many different ways, including the broadcast media, print materials, and videos, as well as person-to-person discussion (31, 81). Mass-media and interpersonal communication play complementary roles in ensuring that clients can make an informed choice (see Lesson 5 Communication). Many people can learn about family planning in the mass media, and some visit family planning providers as a result. Then, at the clinic or other service delivery point, provider and client discuss the client's individual questions, needs, and concerns (129).

When clients make their own informed choices and get the contraceptives they want, they are more likely to be satisfied and to continue use. Studies in a variety of countries have found that women who did not obtain their first choice of contraceptive method were more likely to discontinue use than women who received their first choice (71, 119).