Informed Choice and Decision-Making in Family Planning Counseling in Kenya

Context: Family planning programs have long endorsed the principle of informed choice as a way of ensuring that clients select a method that best meets their needs. There has been little research, however, that examines how, or whether, family planning clients make informed decisions. Methods: Interactions between female family planning clients and clinic- and community-based providers at 25 service delivery sites in Kenya were audiotaped over a 9-15 day period. Transcripts of 176 counseling sessions were analyzed to identify key counseling behaviors and assess the completeness of information provided to the clients. Results: Providers collected information about a new client's marital and reproductive history in 60% of counseling sessions, but asked women about their childbearing intentions in only 7%. In 55% of sessions with continuing clients, providers asked whether the woman was experiencing any problems with her current contraceptive method; providers raised the issue of switching methods in 27% of these sessions, and inquired about a continuing client's reproductive intentions in 17%. Providers discussed an average of four contraceptive methods with new clients, while with continuing clients they typically discussed fewer than two. Providers seldom tailored their discussion of contraceptive methods to the client's reproductive intentions, prior knowledge of family planning, contraceptive preferences, personal circumstances or heatlh risks. In addition, while they emphasized a woman's right to make the final decision as to method choice, they rarely assisted women in fully weighing alternatives or ascertained that they understood completely the personal implications of their choices. Conclusions: Family planning providers could enhance the quality of women's contraceptive decision-making if they took a more active role in contraceptive counseling - for example, by relating information on specific methods to women's personal circumstances and helping clients weigh the advantages and disadvantages of various methods.