• Summary
• Credits

1. Promoting Dialogue
2. Supporting the Client’s Role
• Box: Client-Centered Counseling
3. Improving Providers’ Performance
• Table: Activities to Improve CPI
• Box: Supervisors Can Improve CPI
4. Best Practices in Training
5. Evaluating the Quality of CPI
• Box: Evaluating Training Programs
6. Moving Beyond Family Planning
• Focus STI Counseling on the Individual
• Family Planning Providers Can Aid Victims of Violence
• Good CPI Benefits Sexual and Reproductive Health
• CPI Principles Apply to Integrated Services
7. Bibliography

• INFO Project
• Order
• Online Reports
• Upcoming Reports
• POPLINE

This issue was prepared in collaboration with the Maximizing Access and Quality (MAQ) Initiative of the United States Agency for International Development's Office of Population and Reproductive Health. The MAQ Initiative supports research and evidence-based interventions to promote access and quality of reproductive health and family planning services.

Published by the Information & Knowledge for Optimal Health (INFO) Project, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.

The integration of family planning and other sexual and reproductive health services creates the opportunity to adapt and apply CPI principles and lessons learned in family planning to other health services. Potential benefits are twofold: increased recognition and protection of clients’ rights and improved quality of care.

The right of the client to make and carry out reproductive decisions has driven much of the work on CPI in family planning. The ICPD Programme of Action recognizes the right of couples and individuals to make such decisions freely, without discrimination, coercion, or violence (157).

Attention to client’s rights is even more important in the broader arena of sexual and reproductive health. For example, a breach of confidentiality carries greater risks of stigma and violence when it concerns postabortion care or HIV/AIDS than when it concerns contraception (126). Also, concerns for the health of others, such as the partner of a client with an STI, may create pressures against the client’s right to make her or his own decisions. If these rights are not protected, clients will avoid seeking health care, which ultimately defeats the greater public health cause and, in effect, denies the client access to services.

Good CPI can improve the quality of care in other sexual and reproductive health services as it has in family planning. Interpersonal communication and counseling by providers can help address a wide range of clients’ needs—for example, by:

• Providing emotional support during delivery, postabortion care, or HIV testing,
• Establishing a trusting relationship that allows a woman to disclose domestic abuse or an adolescent to explain why she needs family planning services,
• Building a client’s self-confidence so she feels able to ask her partner to use condoms,
• Ensuring that a client understands why STI treatments must be continued even after symptoms have disappeared, and
• Clearly explaining that an STI client will be reinfected unless her or his partner also is treated for the infection.

These positive outcomes of good CPI benefit individual clients and their partners, help to prevent and treat disease, and establish health care facilities as places where people are respected and their needs are met.

Providers may question whether clients’ rights and other CPI principles developed in family planning apply to other reproductive health services. Family planning clients are, on the whole, healthy individuals making elective decisions. In contrast, clients who come to health care providers for other reproductive health services may need immediate treatment, requiring providers to make medical decisions.

It may help to think of the relationship between clients and providers in sexual and reproductive health care as a dynamic interaction that depends upon:

• The urgency of the health care need,
• The potential health impact of the decision,
• Whether the decision to be made is primarily medical or primarily based on the client’s personal preferences and situation,
• The availability of multiple treatment options or method alternatives with the same or comparable outcomes,
• Broader health implications for other individuals or the community in general, and
• The likelihood that providers’ or clients’ values and attitudes will adversely influence communication and decision-making (6).

The timing and exact nature of CPI varies, based on these factors. Even—or especially—in life-and-death situations, however, a client’s right to make her or his own decisions and have access to relevant information remains important.

Programs should prepare reproductive health care providers to weigh all of these factors when interacting with clients with varying needs and in various states of wellness or illness (42). As family planning is merged into broader reproductive health services, providers are becoming responsible for offering more services. Even when providers are assigned solely to family planning services, their clients are likely to have other reproductive health needs and concerns that can best be identified and often addressed during family planning visits.

Providers should be prepared to elicit, assess, and address clients’ interrelated sexual and reproductive health concerns, whatever service a client needs or requests, by referral, if necessary. CPI training for integrated services emphasizes seeing the client as a whole person and making a comprehensive assessment of each client’s needs, while relying on the same repertoire of essential counseling skills used to deliver family planning services (42). When communication is truly “client-centered” and providers feel comfortable discussing issues other than the clinical aspects of family planning, clients can guide the interaction and counseling so that their broader needs are met.

Disclaimer: The information provided on this web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.