Informed choice and decision-making in family planning counseling in Kenya.

This study analyzed client interviews and observations of interactions between female family planning (FP) clients and staff from clinic and community-based providers in Kenya. Audiotapes were made of 176 counseling sessions over a 9- to 15-day period in 1993 at 17 service delivery sites: 24 community-based distributors (CBDs) and 37 clinics. The authors identified four key processes that assure informed and knowledgeable decision-making about FP: understanding personal circumstances considering alternatives choosing the best option and implementing the decision. Specific client and provider behaviors were associated with each of the preceding four steps in decision-making. Findings were aggregated per counseling session. 88% of clients were aged 20-34 years. Providers had an average of 7 years of FP experience. 78% of providers were nurses and the rest were doctors and counselors. Data on contraceptive methods was available for 153 women of whom 59 left with pills and 41 left with injectables. The 25 remaining women were asked to return after completion of menses. New clients left more often with condoms or foaming tablets. Findings suggest that FP staff can play a more active role by relating contraceptive information to a womans personal circumstances and by assisting women in considering options. Information on reproductive and marital history was collected in only 60% of the counseling sessions. Only 55% of counseling sessions asked continuing users about side effects. Sessions included discussions about four methods with new clients and two methods with continuing clients.