• Editors' Summary
• Credits

1. Why Informed Choice Matters
2. Making Family Planing Decisions
3. Policies for Informed Choice
4. Communication for Choice
5. Improving Access
6. Managing for Informed Choice
• Program Leadership
• Improving Performance
• Monitoring and Evaluation
• Permanent and Provider-Dependent Methods
• Choice in Low-Resource Settings
7. Client-Provider Communication

• Figures
• Table
• Side-bars
• Bibliography

• What can be done?
• Women know what they want
• Why communities matter
• Eliminating targets
• More methods, more choices
• "Your health is in your hands"
• Do clients have choices?
• Please Ask!
• How much guidance?
• Active clients, better choices
• Counseling continuing clients

• POPLINE
• Media/Materials Clearinghouse
• Other Reports
• To Order
• CCP Home Page

Published by the Population Information Porgram, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.

Managing for Informed Choice

For family planning programs, improving the management of service delivery can improve clients' ability to make informed choices. Managing for informed choice requires commitment by leadership and an environment designed to give clients what they want. Ensuring that clients are able to make informed choices requires attention to such key managerial areas as analyzing and improving performance, providing effective supervision, training staff members, and evaluating results.

Management should take special care that clients who choose permanent or long-term methods—sterilization, IUDs, and implants—are making informed decisions. Also, managing for informed choice is particularly important in low-resource settings, where staff members may be few, contraceptives in short supply, and informational material scarce.

Strong leadership can establish a program environment that facilitates informed choice (386). If top managers set an example of ensuring informed choice, other staff will follow. Mentioning informed choice in the program's mission statement and in official policy guidelines can help staff members and clients become aware that the program is committed to the principle of informed choice and to clients' rights (209, 220).

For example, the International Planned Parenthood Federation (IPPF) policy on informed choice states that all IPPF-affiliated Family Planning Associations (FPAs) shall facilitate access to a broad range of sexual and reproductive health services, including counseling, for all individuals who request them. Also, FPAs are to ensure that services are provided in a noncoercive manner, that the provision of services is not linked to financial incentives, and that no service is conditioned on the acceptance of another service. All FPAs must agree to this policy as a responsibility of membership in IPPF (192).

In programs where the concept of informed choice is new, leadership can make sure that all staff members at all levels of the organization understand it (106). Program leaders can ensure that no program targets, incentives, or disincentives for contraceptive use remain (see Chapter 3.4). Even though targets, incentives, and disincentives are rarely official national policy, and donors generally do not support family planning programs that maintain targets, a target-oriented work culture sometimes remains (253, 398). Programs can establish clients' ability to make informed choices as a major indicator of program success, alongside or even instead of such conventional indicators as growth in the number of new clients (25, 212) (see Chapter 6.3).

Program leadership can support the principle that all clients should receive the contraceptive method they want if it is medically appropriate, in keeping with up-to-date national medical guidelines. Leaders can help remove the barriers that prevent certain groups, such as young people, from using some family planning services or methods (see Chapter 7.1).

When guidelines promoting informed choice are clear and understandable, and they are widely followed, they can increase people's contraceptive options. For example, after Tanzania developed new family planning service delivery guidelines in 1994 and carried out a year-long dissemination process that included training, service providers began to offer injectables to all women. Previously, many providers had seen injectables as a dangerous drug that should be prescribed only by doctors and reserved for women with many children (451).

In Kenya, after a similar process of guidelines dissemination in 2000, the percentage of providers recommending dual protection—using condoms alone or together with another method to protect against STIs as well as against pregnancy—to continuting clients increased from 9% to 23%. The percentage of new clients who were denied family planning services because they were not menstruating declined from 19% to 2% (237).