HELP—

Key Help from a Few Questions

In GATHER, H stands for “Help.” The client and provider discuss the choices, their different results for the client, and how the client would feel about these results. In this way the provider helps the client reach a decision. Often the choice is what family planning method to use. Other choices could be how to protect oneself from STDs or, for a young person, whether to begin having sex.

Choosing a family planning method

Most clients who answer “no” to all 3 questions below can consider any available family planning method. Ask further questions as needed to help each client choose.

If a client answers “yes” to any of these three questions, see the advice below:

Is the client breastfeeding a baby? If so, for how long?

Breastfeeding less than 6 weeks:

• Avoid hormonal methods. Combined oral contraceptives and monthly injectables can reduce milk supply. Progestin-only oral contraceptives, long-acting injectables, and Norplant implants in theory might affect the new baby’s growth.
• All other methods can be considered. Fertility signs, used for fertility awareness-based methods, may be hard to interpret.
• Between 7 and 42 days after childbirth, postpone female sterilization.

• Avoid combined oral contraceptives and monthly injectables.
• All other methods can be considered, including progestin-only oral contraceptives. Fertility signs may be hard to interpret.

• Can no longer use Lactational Amenorrhea Method (LAM) (see Family Planning for the Breastfeeding Woman).
• All other methods can be considered, but combined oral contraceptives and monthly injectables are not the best choices. Fertility signs may be hard to interpret.

• Couple should not choose vasectomy or female sterilization. These methods are permanent.

• Should always use condoms to protect against STDs.
• Can also use another method at the same time for extra protection against pregnancy.
• Should avoid IUD.

Other good questions

Suggested exercises:

*1. Some clients may not want to answer the question about sex partners. Discuss ways to let clients know about STD risk and about condoms for STD protection without forcing them to answer directly.

2. Imagine a client’s answers to the 3 questions, and discuss how to help that client. For example, a client is breastfeeding for 3 months. She and her husband want more children later. They have no other sex partners. What methods can they consider?

A woman should try not to start certain family planning methods while pregnant.

Asking questions usually is enough to find out if a woman might be pregnant. Pregnancy tests and physical examinations usually are not needed, and they discourage clients.

If the woman answers “Yes” to any of these 6 questions, it is reasonably certain she is not pregnant. (Once she answers “yes” to a question, you can skip the other questions.)

___ 1. Did she give birth in the last 6 months, and is breastfeeding often, and has not yet had a menstrual period?
___ 2. Has she abstained from vaginal sex since her last menstrual period?
___ 3. Did her menstrual period start in the last 7 days?
___ 4. Has she been using family planning effectively and was her last menstrual period less than 5 weeks ago?
___ 5. Did she give birth in the last 4 weeks?
___ 6. Did she have an abortion or miscarriage in the last 7 days?

Source: Adapted from Family Health International and Technical Guidance/Competence Working Group.

If the client answers “No” to all of these questions, the woman might be pregnant; pregnancy cannot be ruled out. Has she noticed signs of pregnancy? If so, try to confirm by physical examination.

If her answers cannot rule out pregnancy, the client should either have a laboratory pregnancy test or wait until her next menstrual period before starting combined or progestin-only oral contraceptives, injectables, Norplant implants, IUDs, or female sterilization. She can use condoms or spermicide until then. If she wishes, she can be given oral contraceptives, too, with instructions to start them when her menstrual period begins.

Often young adults face more and different reproductive health issues than older clients. Thus counseling young adults requires being even more open, more flexible, more knowledgeable, and more understanding. Counseling young adults can be challenging, but it can be very rewarding to help young people make wise and healthy decisions.

• Be open. Let young people know that no question is wrong, and even embarrassing topics can be discussed.
• Be flexible. Talk about whatever issues the young person wants to discuss.
• Give simple, direct answers in plain words. Learn to discuss puberty and sex comfortably (see Can You Talk About Sex?).
• Be trustworthy. Honesty is crucial to young clients. You—and the information you give—need to be believable. If you do not know an answer, say so. Then find out.
• Stress confidentiality. Make clear that you will not tell anyone else about the client’s visit, the discussion, or the client’s decisions.
• Be approachable. Don’t get upset or excited. Keep cool.
• Show respect, as you do for other clients. Do not talk down to young clients.
• Be understanding. Recall how you felt when you were young. Avoid judgments.
• Be patient. Young people may take time to get to the point or to reach a decision. Sometimes several meetings are needed.

Young adults are special clients. Keep this in mind: Young adults often need skills as much as facts. They need to learn how to deal with other people—including older people. For good reproductive health, important skills are knowing how to say no, how to negotiate, and how to make decisions. Young people often want to know how social relationships and sexual relationships fit together. Often, this is more important to them than facts about reproductive health. Young people often focus on the present. They find it hard to make long-range plans or to prepare for the distant future. Young people often find it hard to understand the idea of risk or risky behavior. Sexually active young adults often face more STD risk than older clients. A young person’s sexual behavior may be forced or pressured—possibly by an older person. A young person may have sex only once in a while. A young person may plan not to have sex again but still do so. Young adults of the same age may have very different levels of knowledge and different sexual attitudes, behavior, and experiences. Suggested discussion: How do these points affect how you counsel young adults?

GATHER Elements:	Greet	Ask	Tell	Help	Explain	Return	Charts	Contents

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