Background
Client information and counselling form a very important
aspect of the reproductive healthcare and family planning programmes. Counselling
is a process of face to face communication between a counsellor and an individual
or couple, whereby the counsellor gives accurate and complete factual information
to the clients and assists them in making an informed and voluntary decision about
their fertility and contraceptive option. In helping clients to choose a suitable
method, account is taken of their social and cultural background. Besides making
an informed choice, clear instructions are also crucial for successful use of
a user-dependent method like emergency contraception. The counsellor must not
go into unnecessary personal details but focus on safe and appropriate usage.
Training in counselling and communication skills is an essential component of
training in Emergency Contraception.
Questions to be answered A.
How much information should be given to the clients?
B. How to remove misconceptions about EC? C.
How to involve the male partner? A need was
also expressed to provide user guidelines emphasizing on timing, side-effects,
cautions, emphasis on one-time use and need for follow-up and counselling for
regular method. Views
of the Group It
was felt that a new programme should be started properly. The discussion Group
identified following guidelines for information and effective counselling:
• Develop a rapport with client •
Maintain confidentiality • Written informed
consent • Explain about EC method
• Screening for suitability for specific method
• Provide accurate information (written in local language/pictorial)
including - indications
- mode of action - type of methods available
- dosage
- drug regimen - failure rate
- side-effects and management - next menstruation
- follow-up • Counselling for regular contraception
and EC not a substitute for regular method. •
Need for abstinence/barrier method subsequently till periods. •
To report if periods delayed. • Information
regarding no protection from STI/HIV. • EC not
an abortifaciant. • EC not effective for multiple
exposures. Discussion
There was a heated debate on the issue of informed
consent. The discussion Group recommended that the consent should be taken in
duplicate with one copy given to the client. But the Expert Forum felt that it
might not be very practical, and it may hamper people from coming forward for
EC use. Besides, no written consent is required for COC use. A verbal consent
is obtained whenever a prescription is given. A few suggested having a consent
form in regional languages. Most disagreed with having the need of an informed
written consent, especially when OTC availability is being considered. Dr Peter
Fajans informed the Forum that no written consent is obtained in other countries
having EC programme. In fact, obtaining consent will result in women getting suspicious
of something serious. • It was also suggested
that the information about EC should not only be told to the patient, but also
given to her along with the prescription. It needs to be very clearly explained
that it is ineffective after missing a period. Schedule of pill-taking is to be
explained and, usually, the first dose is given in front of the doctor in the
clinic and the client can be made to wait for about 2 hours to watch for side-effects.
Consuming pill empty or full stomach or with food is immaterial.
• Counselling should also include willingness for MTP in case
of failure. The issue of teratogenesis was debated. Though there are no adverse
reports if pregnancy is continued in case of failure, but caution is warranted.
• As regards screening for suitability, except for exclusion
of pregnancy, no other test is required for providing EC pills. Even a pelvic
examination is not considered necessary. • Initially,
the EC delivery should be restricted to existing RCH services where trained staff
for contraceptive counselling is already available. Client information should
be in a simple, easily understandable language including regional languages.
Unresolved issue
None Recommendations
2.5.1 Appropriate counselling is a must for safe and effective use of EC.
2.5.2 Written consent is not required. 2.5.3 Only contra-indication for
EC use is pregnancy which should be excluded. 2.5.4 Proper information
about the EC should be provided to the client in a format that she can understand,
along with the tablets. 2.5.5 No protection from STI/AIDS as well as any
subsequent sexual exposure should be clearly told to the client. 2.5.6
Client should be informed about the potential side-effects and how to cope with
them. 2.5.7 Risk of failure should always be explained and the client asked
to report if menstruation does not start within one week of the expected period.
2.5.8 In case of failure, if pregnancy continuation is desired, she should be
informed about no adverse effect of EC on pregnancy. |
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