Trainers Guide For CBD

Family Planning Service: Refresher Training
(VHW and MCHW)
Trainers Guide
Second Edition
Government of Nepal
Ministry of Health and Population
National Health Training Center
Mansir 2066 (December 2009)
FP Service Refresher Training (VHW and MCHW) Trainers Guide 1

TABLE OF CONTENTS
SECTION ONE: PARTICIPANT HANDBOOK
Subject Page No
Brief Introduction of the Training
Course Introduction
 Training Goal and Objectives
 Course Objectives
 Methods of Training Learning
 Training Materials
 Criteria for Participant Selection
 Participant's Evaluation
 Duration of the course
 Training Facilitators
Time Table
Pre Training Questionnaire
Exercise
 Three Types of Family Planning Communication
 Examples for Detail Explanation
 Role Play Exercises
Number Game
Exercise for Home Work
 Family Planning Status in Nepal
 Interpersonal Communication and Family Planning Counseling
 Client assessment
 Condom
 Combined Oral Contraceptives(Pills)
 Depo Injection
 Emergency Contraception
 Infection Prevention
 Lactational Amenorrhea Method
 IUCD
 Implant
 Voluntary Surgical Contraception
 Maternal and Newborn Care
Learning Guide for Family Planning Counseling
 FP service Refresher Training Counseling Learning Guide( Steps of
GREET)
 DMPA clinical skill Learning Guide
Course and Training Program Evaluation Forms
Training Registration Forms

SECTION TWO: GUIDE FOR TRAINERS
Subject Page
No
Trainers to Mind Things for conducting Training
Training Approach Used In The Course
Using Anatomic Models for Clinical Training
Role Play
Group Discussion
Training Course
Precourse Questionnaire Answer-Key
Using the Individual and Group Assessment Matrix
Group Assessment Matrix
Class Room Exercises – Family Planning Communication Answer-Key
Three Types of Family Planning Communication
Exercise for Three Types of Communication
The Emergency Contraceptive (EC) Game
Sita's Case Study
Kabita's Case Study
MIDCOURSE QUESTIONNAIRE
Using the Midcourse Questionnaire
TAKE-HOME EXERCISE ANSWER-KEY

 Family Planning Status in Nepal
 Interpersonal Communication and Family Planning Counseling
 Client assessment
 Condom
 Combined Oral Contraceptives(Pills)
 Depo Injection
 Emergency Contraception
 Infection Prevention
 Lactational Amenorrhea Method
 IUCD
 Implant
 Voluntary Surgical Contraception
 Maternal and Newborn Care
Mid Course Questionnaire Answer-Key
Checklist for Family Planning Counseling

Checklist for DMPA Clinical Skills
COURSE/WORKSHOP INFORMATION FORM

Before Training
This clinical training is based on the Adult Learning Principles. These Principles are based on the
assumption/hypothesis that the participants will participate in the training due to following
reasons:
 Interested in the training subjects

 Desire to improve their knowledge and skills for better work performance
 Desire to active participation
Therefore, all the course is designed concentrating on the clients need For example t is has been
expected that
Training methods used in the course
Key Features
Mastery Learning Approach is based on the Adult Learning Principles
 Uses Behavior Modeling

 Competency Based
 Humanistic Training Approach

Course Introduction
In the course of refresher training to the service providers (VHW and MCHW) following process
are used
 On the first day of the training, trainees describe their knowledge related to counseling
and family planning through written examination ( Precourse Questionnaire)
 Training classes and clinical sessions concentrate on the important aspects of the service
provisos (for example counseling to clients, how to provide service, and management of
common side effects and other health problems.
 The Progress of the knowledge based learning is examined through written examination
in the middle of the training (midcourse questionnaire).
 Clinical skills related training is prepared based on the past experience of family planning
clinical skills of triteness. Firstly, participants practice on the human anatomic model and
thus learn immediately the essential skill for giving depo injection.
 The progress of learning new skills is written using the detail counseling and clinical
skills learning activity guideline.
 In order to make the learning easier, all the participants are given home work and next
day trainer clarifies the answers after discussion.
Two Days Exercise:
 Clinical Trainers evaluate the skill based performance of each participants using related
checklist
 Simple counseling Skills
 Techniques for Depo injection

Goal of the Training
The overall goal of this clinical training is to update and increase the current knowledge of the
participants related to family panning for the provision of quality services.
Objectives of the Training
 Provide communication skills for counseling service to the participants
 Influence positive attitude towards different family planning methods.
 Provide the participant with un-biased, client focused counseling skills to assist client in
making informed choice.
 Provide essential knowledge and skills to the participants on combined oral contraceptive
pills, condom and depo.
 Provide essential knowledge and skills to the participants to manage common side effects and
health problems related to temporary and permanent methods of family planning and refer to
the appropriate health facility as required.
 Provide quality updated information related to family planning to the participants.
 Provide basic family planning management knowledge to the participants.
 Participants will be able to provide pregnancy and postpartum care information and
management
Evaluation
This clinical training course is prepared to prepare counseling and family planning service
providers. At the end of the training, successful participants will be given a certificate from the
National Health Training Center.
The successful completion of the course will be based on three types of evaluation as follows:
 Knowledge: For knowledge Midcourse Training Questionnaire minimum score 85%

 Skills: Counseling and clinical skills satisfactory performance
Exercise: Participants can demonstrate the clinical skills for providing depo injection in any
clinic for example - practice room

Objectives of the Course
Lesson: 1 Population and RH status
Primary Objective:
At the end of this session the participants can explain the status of family planning, in Nepal,
population education and family planning based on the concept of RH
Specific Objectives:
 Can explain the population status of Nepal

 can describe the elements of population growth
 Can tell the effects of population growth
 Can define reproductive health
 Can describe about the integrated reproductive health services
Lesson: 2: Female and Male Reproductive System
Primary Objective:
At the end of this session participants can describe the basic facts about menstrual cycle.
 Participants will understand the physical functions of the female and male reproductive
system
 Participants will get basic information of female and male reproductive system
 Participants will describe the ovulation function and role of hormones.
Lesson: 3: Interpersonal Communication and Family Planning Counseling
Primary Objective:
At the end of this session participants will providing family planning counseling service using
effective communication skills through GREET approach
 Can describe types and elements of communication.

 Can describe elements of behaviour change, media and steps
 Can describe interpersonal communication , advantages, characteristics and importance
 Can describe effective communication skills
 Can clarify the relations and difference of motivation, information and counseling

 Can describe the important elements of family planning counseling
 Can describe important aspects of principles of informed choice and its hindrances
 Can know the individual characteristics, knowledge and skills of the counselors
Lesson: 4: Client Assessment
Primary Objective:
By the end of the session, the participant will be able to assess, screen the client before providing
any family planning methods.
 Describe the indications, contraindications and precautions according to the client

 Assess the client to rule out pregnancy prior to providing a family planning method
 Evaluate and assess the client’s appropriateness for specific methods using Reproductive
Health Protocol flow chart.
Lesson: 5: Infection Prevention
Primary Objective:
By the end of the session, the participant will have knowledge and skills for effective and safe
infection prevention.
 Demonstrate hand washing following step by step procedure.

 Demonstrate the appropriate disposal of syringe, puncture proof in the tin and bucket.
Lesson: 6: Breast-Feeding for Lactation Amenorrhea Method
Primary Objective:
By the end of session, participant will be able to counsel on LAM
 Explain the process of prevention through LAM

 Describe the advantages and disadvantages of ALM
 Can tell three important conditions for the effectiveness of LAM

Lesson: 7: Condom
Primary Objective:
By the end of the lesion, participant will be able to explain the advantage of condom use and
demonstrate how to use it properly.
 Can explain the advantages, disadvantage and effectiveness of condom use

 Provide condom after the instructions on demonstration of usage, storage, and disposal of
condoms.
Lesson: 8: Combined Oral Contraceptives
Primary Objective:
By the end of the lesson, participant will be able to counsel for and provide COCs.
29544. Screen appropriate clients for COCs

29545. Identfyclients for medical conditions or problems that may be a precaution to the use of
oral contraceptives or require more frequent follow-up, and correctly identify those
clients that should not use this method.
29546. Provide a client with oral contraceptives and give instructions for use.
29547. Educate client about what to do if they forget one or two pills.
29548. Provide counseling to a woman using oral contraceptives, including the management of
simple side effects and referral for more serious complications.
Chapter-10: EMERGENCY CONTRACEPTION
Primary Objective:
By the end of the session, participant will be able to counsel for and provide Emergency
Contraception.
Enabling Objectives:
30136. Participant will state dosage of Emergency Contraceptive.

30137. Participant will describe side effects of Emergency Contraception.
30138. Participant will demonstrate counseling and information giving needed for Emergency
Contraceptive.

Chapter-11: DMPA/DEPO-PROVERA
Primary Objective:
By the end of the chapter, participant will be able to counsel for and administer DMPA.
30728. Using cue-cards provide counseling to a client about DMPA/Depo-Provera.

30729. Screen clients for medical conditions or problems that may be a precaution to the use of
DMPA/Depo-Provera or require more frequent follow-up, and correctly identify those
30730. Inject a client safely with DMPA/Depo-Provera using appropriate infection prevention
practices.
30731. Provide counseling to clients using DMPA/Depo-Provera, including management of
simple side effects and referral of more serious complications.
30732. Participants will answer questions regarding DMPA
Chapter 12-14: IUCD, Implant, VSC
Primary Objective:
By the end of the session participants will be able to provide counseling, manage minor side
effects, recognize and refer serious complications of Norplant, IUCD and VSC).
11576. Provide counseling to a client about IUCD, Implant, Minilap and Vasectomy
11577. Screen clients for medical conditions or problems from history that may be a precaution
to the use of the clinical method chosen, and correctly identify those clients and refer for
the clinical method of their choice.
11578. Provide follow up counseling to a client for each of the clinical methods, including
management of simple side effects and referral for more serious complications.
11579. Participants will answer questions regarding IUCD
Chapter 15-16: Management of Sexually Transmitted Infections/HIV AIDS
Primary Objective:
By the end of the session, participant will be able to screen for and treat STIs (using the
syndromic approach).
12152. Identify the four main symptoms of STIs that are used in the diagnostic flowcharts
provided in the Reference Manual.

12153. Identify the appropriate treatment of STIs using the syndromic diagnostic flowcharts or
refer as appropriate.
12154. Demonstrate infection prevention practices used in the clinic to prevent the spread of
STIs to both client and service provider.
12155. Discuss how STI and HIV/AIDS is correlated in spreading the diseases and its mode of
transmission.
12156. Identify prevention strategies for STIs/AIDS, including the use of condoms.
12157. Participants will answer questions regarding STIs/HIV AIDS
12158. HIV related common infection and procession
12159. Care support and treatment
Chapter 17: Family Planning Counseling and Service Management
Primary Objective:
By the end of the session, participant will be able to provide quality of services using checklists
with verification criteria of quality of service.
1. Clinical set up for providing FP services
2. Find out gaps between desired performance and actual performance and prepare action
plan to address the gaps identified to ensure quality services.
3. Practice filling the checklist and finding out gaps
TRAINING LEARNING METHODS
• Illustrated lectures and group discussions

• Individual and group exercises
• Role plays
• Simulated practice with Depo Arm Model
• Guided clinical activities (counseling and Depo administration)
• Take home exercises
• Three days practicum
Training Materials
• This course handbook is designed to be used with the following materials:
• Reference Manual ( Comprehensive Family Planning and Counseling Course)

• Trainers Notebook and Participants Handbook ( Comprehensive Family Planning and
Counseling Course).

• Training Videotape: COFP and Counseling
• Infection Prevention Videotape (Infection Prevention for Family Planning Service
Programs
• Depo Arm Model
• Condom Model
Participant Selection Criteria
Participants for this course should be individuals with health background such as Public Health
Nurse, Staff Nurse, Health Assistant, Auxiliary Nurse Midwife, Auxiliary Health Worker, and
Community Medicine Assistant. The facility should have an anticipated caseload sufficient to
support the provision of Family Planning Services. Preference should be given to those staff
working in family planning clinics, VSC, PHC, Health Post and Sub-Health Post location.

Before Training
This clinical training is based on the Adult Learning Principles. These Principles are based on
the assumption/hypothesis that the participants will participate in the training due to
following reasons:
 Interested in the training subjects

 Desire to improve their knowledge and skills for better work performance
 Desire to active participation
Therefore, all the course is designed concentrating on the clients need For example t is has
been expected that
Training methods used in the course
Key Features
Mastery Learning Approach is based on the Adult Learning Principles
 Uses Behavior Modeling

 Competency Based
 Humanistic Training Approach
Course Introduction
In the course of refresher training to the service providers (VHW and MCHW) following
process are used
 On the first day of the training, trainees describe their knowledge related to
counseling and family planning through written examination ( Precourse
Questionnaire)
 Training classes and clinical sessions concentrate on the important aspects of the
service provisos (for example counseling to clients, how to provide service, and
management of common side effects and other health problems.
 The Progress of the knowledge based learning is examined through written

examination in the middle of the training (midcourse questionnaire).
 Clinical skills related training is prepared based on the past experience of family
planning clinical skills of triteness. Firstly, participants practice on the human
anatomic model and thus learn immediately the essential skill for giving depo
injection.
FP Service Refresher Training (VHW and MCHW) Trainers Guide

14
 The progress of learning new skills is written using the detail counseling and clinical
skills learning activity guideline.
 In order to make the learning easier, all the participants are given home work and next
day trainer clarifies the answers after discussion.
Two Days Exercise:
 Clinical Trainers evaluate the skill based performance of each participants using related
checklist
 Simple counseling Skills
 Techniques for Depo injection
Goal of the Training
The overall goal of this clinical training is to update and increase the current knowledge of
the participants related to family panning for the provision of quality services.
Objectives of the Training
 Provide communication skills for counseling service to the participants
 Influence positive attitude towards different family planning methods.
 Provide the participant with un-biased, client focused counseling skills to assist client in
making informed choice.
 Provide essential knowledge and skills to the participants on combined oral contraceptive
pills, condom and depo.
 Provide essential knowledge and skills to the participants to manage common side effects
and health problems related to temporary and permanent methods of family planning and
refer to the appropriate health facility as required.
 Provide quality updated information related to family planning to the participants.
 Provide basic family planning management knowledge to the participants.
 Participants will be able to provide pregnancy and postpartum care information and
management
Evaluation
This clinical training course is prepared to prepare counseling and family planning service
providers. At the end of the training, successful participants will be given a certificate from
the National Health Training Center.

15
The successful completion of the course will be based on three types of evaluation as follows:
 Knowledge: For knowledge Midcourse Training Questionnaire minimum score 85%

 Skills: Counseling and clinical skills satisfactory performance
Exercise: Participants can demonstrate the clinical skills for providing depo injection in
any clinic for example - practice room
Objectives of the Course
Lesson: 1 Population and RH status
Primary Objective:
At the end of this session the participants can explain the status of family planning, in Nepal,
population education and family planning based on the concept of RH
 Can explain the population status of Nepal

 can describe the elements of population growth
 Can tell the effects of population growth
 Can define reproductive health
 Can describe about the integrated reproductive health services
Lesson: 2: Female and Male Reproductive System
Primary Objective:
At the end of this session participants can describe the basic facts about menstrual cycle.
 Participants will understand the physical functions of the female and male reproductive
system
 Participants will get basic information of female and male reproductive system
 Participants will describe the ovulation function and role of hormones.
Lesson: 3: Interpersonal Communication and Family Planning Counseling
Primary Objective:
At the end of this session participants will providing family planning counseling service
using effective communication skills through GREET approach

16
 Can describe types and elements of communication.
 Can describe elements of behaviour change, media and steps
 Can describe interpersonal communication , advantages, characteristics and importance
 Can describe effective communication skills
 Can clarify the relations and difference of motivation, information and counseling
 Can describe the important elements of family planning counseling
 Can describe important aspects of principles of informed choice and its hindrances
 Can know the individual characteristics, knowledge and skills of the counselors
Lesson: 4: Client Assessment
Primary Objective:
By the end of the session, the participant will be able to assess, screen the client before
providing any family planning methods.
 Describe the indications, contraindications and precautions according to the client

 Assess the client to rule out pregnancy prior to providing a family planning method
 Evaluate and assess the client’s appropriateness for specific methods using Reproductive
Health Protocol flow chart.
Lesson: 5: Infection Prevention
Primary Objective:
By the end of the session, the participant will have knowledge and skills for effective and safe
infection prevention.
 Demonstrate hand washing following step by step procedure.

 Demonstrate the appropriate disposal of syringe, puncture proof in the tin and bucket.
Lesson: 6: Breast-Feeding for Lactation Amenorrhea Method
Primary Objective:
By the end of session, participant will be able to counsel on LAM
 Explain the process of prevention through LAM

 Describe the advantages and disadvantages of LAM
 Can tell three important conditions for the effectiveness of LAM

17
Lesson: 7: Condom
Primary Objective:
By the end of the lesion, participant will be able to explain the advantage of condom use and
demonstrate how to use it properly.
 Can explain the advantages, disadvantage and effectiveness of condom use

 Provide condom after the instructions on demonstration of usage, storage, and disposal of
condoms.
Lesson: 8: Combined Oral Contraceptives
Primary Objective:
By the end of the lesson, participant will be able to counsel for and provide COCs.
28360. Screen appropriate clients for COCs

28361. Identify clients for medical conditions or problems that may be a precaution to the use
of oral contraceptives or require more frequent follow-up, and correctly identify those
28362. Provide a client with oral contraceptives and give instructions for use.
28363. Educate client about what to do if they forget one or two pills.
28364. Provide counseling to a woman using oral contraceptives, including the management
of simple side effects and referral for more serious complications.
Lesson 9: Emergency Contraception
Primary Objective:
By the end of the session, participant will be able to distribute COCs in the community as an
emergency contraceptive method
 Participant will state dosage of Emergency Contraceptive.

 Participant will describe side effects of Emergency Contraception.
 Participant will demonstrate counseling and information giving needed for Emergency
Contraceptive.
Lesson 10: Depo Provera
Primary Objective:
By the end of the lesson, participant will be able to counsel for and administer DMPA.

18
 Can explain the facts about Depo to the clients.

 Can tell how to assess appropriate client for Depo injection
 Identify the common side effects for management of side effects and refer for depo
injection.
 Can demonstrate sequence of depo injection using proper method of administration for
depo
Lesson 11- 13: Clinical Methods (IUCD, Implant, VSC)
Primary Objective:
By the end of the session participants will be able to explain clinical methods of family
planning (IUCD, Implant and VSC).
 Describe the facts on clinical methods (IUCD, Implant and VSC)

 Identify referral conditions of the client using methods.
 Provide management of simple side effects of the clients using methods
 Can tell the name of the health institutions in the working district where clinical service is
available
Lesson 14: Maternal and Newborn Health
Primary Objective:
By the end of the session, participant will be able to counsel and service in pregnancy and
postpartum.
 Will know the status of maternal and newborn health

 Will know the direct causes of maternal and newborn deaths
 Will know the place of maternal deaths and Three Delays
 Will know about pregnancy care, examination, provision of services and birth
preparedness
 Will know about pregnancy care, provision of services, possible danger signs and
provision of essential care
 Will know the use, indication and service of family planning method after delivery

19
TRAINING LEARNING METHODS
 Interactive lectures and group discussions

 Individual and group exercises
 Role plays
 Practice for Depo administration
 Training Learning Activities
o Guided clinical activities (Counseling and Depo administration)
 Take home exercises
 Two days clinical practice
Training Materials
The following books will be used in the training:
 Reference Manual
 Trainers Guide
 Participants Handbook
 Trainer can use clinical protocol as required in addition to the above mentioned
booklets.
Participant Selection Criteria
 Permanent VHW and MCHW

 Basic training received by VHW and MCHW
 Completed 1 year after receiving basic training
 Physically fit to provide service and committed
PARTICIPANTS EVALUATION
 Pre-and Mid-course Questionnaires

 Training Syllabus Learning Guideline
 Training Syllabus related cellists
COURSE DURATION
 Training duration 7 days

 Each day 2 sessions average 7 hours per day
 45 minutes lunch time
Training Facilitators

20
 3 trainers in 1 group
 12- 16 participants in 1 group
 Compulsory 3 trainers trained in CTS skills (preferably 1 Nurse trainer among 3)

21
Time Table
Time Day 1 Day 2 Day 3
9.00 - 1.00  Registration Agenda /Warm-up Agenda /Warm-up
 Welcome Sharing of take home exercises Sharing of take home exercises
 Introduction Client Assessment
 Review of the course Materials Interpersonal communication and FP  Use of FP method
 Participants Expectation Counseling  Client assessment ad evaluation
 Precourse Questionnaire  Communication and Interpersonal Condom
Communication  Effectiveness, advantages and disadvantages
 Effective Communication Skills  Common side effects and management
 Individual Characteristics and Skills COCs
of Counselor  Effectiveness, advantages and disadvantages
 Clients Right  Common side effects and management
 Effects of on Counseling by counselor Depo Injection
values and behavior  Effectiveness, advantages and disadvantages
 Common side effects and management
01.00-1.45
1.45-5:00 Population Status of Nepal/FP  Informed Choice  Management of common side effects and health problems
Program  Steps of ABHIBADAN  Preparation for practice in Arm Model and demonstration
 Current status of FP service,  Pregnancy and Birth Interval  Role Play using counseling /inter personal communication
advantages skills
Male and Female Reproductive
System
 Information on female and male
reproductive system
 Menstrual Cycle and
Conception
Precourse Questionnaire
Evaluation
FP Service Refresher Training (VHW and MCHW) Trainers Guide 22 22

Review of days activities Review of days activities Review of days activities
Home work Lesson 1 and 2 Home work Lesson 3 Home work Lesson 4, 7, 8
Family Planning Service Refresher Training for VHW and MCHW (Day-7, Lesson
-14)
Time Day 4 Day 5 Day 6 Day 7
10.00- Agenda Maternal and Agenda Agenda
1:30 Newborn Health
Sharing of Take Discussion Before Midcourse
Home Exercises Primary Objective: Clinic Practice Questionnaire
Discussion
Emergency Clinic Practice Discussion
Contraception (EC)  Status of
Before Clinic
maternal and  Depo Injection Practice
 EC methods newborn health  Counseling
available in Nepal in Nepal  COCs/Condom Clinic Practice
 Direct causes of distribution
Lactational maternal and  Depo Injection
Amenorrhea Method newborn deaths  Counseling
(LAM)  Causes of  COCs/Condom
 Advantages & maternal deaths- distribution
Disadvantages Three Delays
IUCD/Implant  Pregnancy care,
 Advantage and pregnancy
disadvantage, examination,
Effectiveness provision of
 Injecting time and services in
Indication for use pregnancy and
preparedness
1.00-1.45 LUNCH BREAK

01.45- Voluntary Surgical  Postpartum care, Sharing of clinical Sharing of take
5:00 Contraception postpartum practice home exercises
examination,
 Male Voluntary provision of Midcourse Work Plan
Contraception Questionnaire
services in
 Female Voluntary Training
postpartum
Contraception Evaluation
period, Danger
 Preparation for
Practice on model sign during
and postpartum
Demonstration period, essential
 Counseling:/Role care and advice
Play using  Use of FP in
interpersonal skills postpartum period
 Need of FP in
postpartum period
 Family Planning
Service

23
Review of days Review of days Review of days CLOSING
activities activities activities
Home work Lesson 5, 6, Home work Lesson 14 Home work Lesson
9, 11, 12 and 13 4, 7, 8 and 10

24
PRECOURSE QUESTIONNAIRE
HOW THE QUESTIONNAIRE WILL BE USED
The main objective of the Precourse Questionnaire is to assist both the clinical trainer and
the participant as they begin their work together in the course by assessing what the
participants, individually and as a group, know about the course topic. This allows the clinical
trainer to identify topics which may need additional emphasis during the course.
The questions are presented in the TRUE/FALSE format. A special form, the Individual
and Group Assessment Matrix, is provided to record the scores of all course participants.
Using this form, the trainer and participants can chart quickly the number of correct answers
for each of the 34 questions. By examining the data in the matrix, the group can easily
determine their collective strengths and weaknesses and jointly plan how best to use the
course time to achieve the desired learning objectives.

PRE-COURSE QUESTIONNAIRE
In the space following each question, write the letter "T" if the statement is true and the letter
"F if the statement is false.
FAMILY PLANNING STATUS IN NEPAL

1 According to Annual report 2006/2007, the total population of Nepal is __________
2,32,00,000
2 In Nepal, 39% of married women of reproductive age have used family __________
planning contraceptives. In other word, Family Planning user rate is
39%.
COMMUNICATION AND FAMILY PLANNING COUNSELING

3 The process of transmission of knowledge, information, message, __________
feelings, experience, opinions and directives to a person or mass through
verbal, non-verbal or writing mode giving similar meaning and
understanding is called communication.
4 Interpersonal communication helps to develop rapport, find out the __________

reason, make decision and only bring change in knowledge, attitude and
practice.
5 Family planning counseling is two-way communication between __________

counselor and client that focuses on the client's needs, feelings and
opinions and that helps the client make a decision about the best
method of contraception.
6 The Bhi step in the ABHIBADAN approach stands for asking clients __________
about themselves, assessing their family planning needs, and assessing
how much they know about contraceptive methods.
7 The length of time between two successive live births is less than 24 __________
months
MENSTRUAL CYCLE
8 Ovulation usually happens between days 4-7 of her menstrual cycle. __________
CLIENT ASSESSMENT
9 The primary objective to client assessment is to decide what birth control __________
method you think the client should use.
CONDOM
10 If a woman should absolutely not get pregnant for medical reasons, her
first choice of contraceptive method should be the condom.
11 One advantage of condoms is that they encourage the husband to take an
active role in family planning.

COMBINED ORAL CONTRACEPTIVES
12 __________
A new oral contraceptive user should begin taking her first pack of pills on
fifth days of her menstrual cycle.
13 A woman who is taking oral contraceptives should return to her service __________
provider immediately if she has severe lower abdominal pain, severe
headaches, or severe chest pain with difficulty breathing.
DEPO-PROVERA
14 The most common side effect of Depo-Provera is changes in the menstrual __________
cycle, especially no bleeding at all (amenorrhea).
15 One of the optimal times for the first DMPA injection is within 7 days of __________
the menstrual cycle.
EMERGENCY CONTRACEPTION
16 EC can prevent pregnancy, but it will not abort an established pregnancy. __________
17 Nausea and menstrual spotting can be common side-effects of EC pills. __________
INFECTION PREVENTION
18 The first most important practice in infection prevention is hand washing. __________
19 To properly dispose of disposable needles and syringes after they are __________
used, the needle should first be bent or broken.
20 Contaminated waste materials such as gauze or cotton that are soaked __________
with blood should be burned or buried.
LAM
21 If a woman is less than six months postpartum, is amenorrheic (her __________

menses has not returned) and is fully or nearly fully breastfeeding her
child, she is 98% protected against pregnancy.
22 Combined oral contraceptive should be the first choice for lactating __________
mothers if FP method is necessary
IUCD __________
23 __________
Never insert IUD during menstruation
24 The main mechanism by which the Copper T 380A prevents pregnancy __________
principally by preventing fertilization of the egg by the sperm.
IMPLANT
25 __________
Jadelle Implant rods provide protection from pregnancy for 8 years.
26 __________
Implants starts preventing within 24- 48 hours of insertion.

VOLUNTARY SURGICAL CONTRACEPTIVE
27 __________
The characteristic of voluntary sterilization that should be stressed in
counseling is that it is a permanent procedure.
28 Post vasectomy pregnancy is mostly due to failure to use contraceptives __________

during 3 months after surgery.
MATERNAL AND NEWBORNE CARE

29 At least 3 blood donors should be identified during birth preparedness __________
30 Spotting during pregnancy is normal __________
31 It is not necessary to use any family planning method if mens not return __________
after delivery
32 We should not be anxious if newborn does not suck breast milk. __________
HMIS FORM
33 HMIS Form Number 12 is used to keep the record of individual _________
description of the FP clients
34 Village Health Worker and Maternal Child Health Worker can fill only _________
HMIS Form 13 and 31 to keep the record for services provided through
outreach clinic(Gaown Ghar Clinic)

THREE TYPES OF FAMILY PLANNING COMMUNICATION
Read each event given below. The event describes some types of communication. Write "P" if it is
Motivational or Promotional, "I" if it is Information and "C" if it is counseling.
----------1. A woman comes to a clinic for depo injection I will tell her the advantages,
disadvantages and dangers of all the FP methods including depo and I will
ask her to choose a methods making sure whether she has understood them or
not.
----------2. A nurse tells a postpartum woman that this is the appropriate time to go form
minilap operation to avoid the fear for pregnancy again.
---------- 3. A doctor in a delivery room tells postpartum women how different family
planning methods work?
---------- 4. A health worker tells the advantages of using pills and the neceesity to use pills
to a woman coming for abortion on health ground
---------- 5. A client shows her anxiety to health worker that she might have an irregular
bleeding after Implant insertion. Health worker tells her that irregular bleeding
is mild side effect of Implant and probably it will stop after some time.
---------- 6. A doctor discusses with a vasectomy client having concern that operation will
have no negative side effects on sexual performance.
--------- 7. A village health worker tells clients how to use pills and what to do if she
forgets to take the pills.
---------- 8. A counselor re counsels client to take informed decision, rethinking reasons to

choose sterilization after initial counseling.
---------- 9. A nurse shows a film on pregnancy care service and tells about the use of
family planning methods after delivery.
---------- 10. A factory supervisor talks about the advantages of condom use and its
necessity.
---------- 11. A counselor tells the clients visiting family planning clinic to use Implant
because of its effectiveness.

Examples for Paraphrasing
This lead lines that follow are quotations from imaginory clients. You can use them as the
basis for creating situations for paraphrasing exercises, or creating situations for
paraphrasing exercises, or create your own.
Ganga: My husband doesn’t want to use anything because he is out most of the time. And
I don’t know what to do.
Bina: I don’t want anymore children right now. But I was taught that it’s wrong to use
birth control. Some of my friends do it, though.
Bharat: We can’t afford another baby and my wife has had trouble with the pill and the
other methods she has tried. I know I could use something but if anyone ever
found out.
Sita: I have friends who use the IUCD. But one of them got pregnant. I don’t want to
get pregnant.
Examples for Clarifying
The lead lines that follow are quotations from imaginatory clients. You can use them as the
basis for creating situations for clarifying exercises, or create your own.
Sulochana: My husband’s other wife just had a child. I don’t know what to do. I am
thinking of having my IUCD removed. I don’t know if I want another child
or if we can afford one. But maybe if i have one he’ll spend more time here.
Janaki: Well, I am going to start taking the pill this month. But what if my mother-
in-law found out? What if I can never have children?
Syam: I am not going to get a vasectomy because my wife disagrees. We both

think that after vasectomy it will be hard for me to do physical work.
Bhagawati: Actually, I do not have enough time to listen to all what you are saying. I
want Depo-Injection. Please give me soon. I have many things to do in the
house.

ROLE PLAYS FOR PRACTICE
1. A 34-year-old woman with three children (her youngest is 12 years old) is not sure if
she wants another child. She is currently using the pill but wants a method that
requires less effort on her part. She wants to consider a long-term method.
A 22-year-old woman with three children born within three years of each other wants to
delay having another baby for three years. She has never used family planning.
A 21-year-old woman with one child wants to wait three years before having another
one. She has never used family planning and knows nothing about contraception.
A 34-year-old woman with six children has decided that she wants no more children.
Her husband agrees. She has used the IUCD and the pill. The IUCD had to be removed
because of excessive bleeding, and the pill made her gain weight. She knows a lot
about the pill and the IUCD, but she knows nothing about sterilization.
2. A 32-year-old woman with two children is not sure if she wants another child. She is
currently using DMPA and is coming for her third shot. She is having no problems.
3. A 25-year-old woman with two children wants to wait at least five years before she has
another child. She has chosen the IUCD.
4. A 21-year-old woman wants to wait three years before having another child. She has
never used a family planning method and knows nothing about contraception. She has
chosen the pill.
5. A 23-year-old woman with two children (two girls) wants to delay childbearing until
her youngest daughter is in school for one year. She has used the injectable but she did
not like the menstrual disturbances. Her husband lives outside and comes home
sometimes. They are requesting for a alternative method..
6. A 39-year-old woman with six children has decided that she wants no more children.
Her husband agrees. She has never used contraception and knows nothing about
sterilization. She has requested sterilization but knows nothing about it.
7. A 38-year-old woman with four children (three boys and one girl) has used pill but
experienced some trouble with nausea and weight gain. She wants to have another
child in about five years. She has asked for the IUCD.
8. A 21-year-old woman in her second year of post graduate college has one child and she
wants to have more when she finishes her education in three years. She has never used
a family planning method and has requested DMPA.
9. A 23-year-old woman with two children (two girls) wants to delay childbearing until
her youngest daughter is in school next. She has used the IUCD in the past but she did
not like it. She would like to use DMPA.
10. A 25 year old woman having lower abdomen pain and vaginal discharge, she wants to
insert the I.U.C.D.

The Number Game
(Estimated time: 15 minutes)
9The game must be played within 1-3 days)
The purpose of this activity is to demonstrate the importance of practice in learning a skill.
Instructions to Clinical Trainer: Participants should be given three copies of the Number
Game. Ask them to place the sheets face down so that they cannot see the placement of the
numbers. Tell them this is a simple hand-eye coordination exercise in which they are to
work as fast as they possibly can within a given time period. Then tell the participants to
start by turning over the top sheet and with pen or pencil, draw a line from #1 to #2 to #3,
etc., until they are told to stop.
Allow 60 seconds. Then ask them to stop. They are to circle the highest number reached.
Repeat this exact procedure two (2) more times, each time allowing 60 seconds. Make
certain each sheet is numbered in the sequence in which it was completed (#1, #2, #3).
Discussion questions:
1. In all honesty, how did you feel when you were going through the exercise? (Note:
Responses may range from excited and challenged to nervous, frustrated, upset, mad,
etc.)
2. “Practice makes perfect.” If this is really true, we all should have shown a consistent
increase in the number attained with each attempt. Is it true for each of the participants?
If not, why?

1
28 40 6
27
52
41 14
23 34
43
45

1
28 40 6
27
52
41 14
23 34
43
45

1
28 40 6
27
52
41 14
23 34
43
45

TAKE HOME EXERCISE
Day 1:
POPULATION AND REPRODUCTIVE HEALTH STATUS
 What is the total population according to Annual Report, DoHS 2007/2008?

_______________________________________
 What is the total fertility rate according to NDHS 2006?
_______________________________________
 What is the total maternal mortality rate according to NDHS 2006?

_______________________________________
 What are the effects of population growth?
A.____________________
B ___________________
C. ___________________
D.____________________
E.____________________
 What are the advantages of family planning?
A.____________________
B ___________________
C. ___________________
D.____________________
E.____________________
6. What are major indicators for monitoring of family planning?
A.____________________
B ___________________
C. ___________________
D.____________________
E.____________________

TAKE HOME EXERCISE
Day 2:
Interpersonal Communication and FP Counseling
1. What is FP counseling?
FP Counseling is a process of communication whereby the counselor gives _________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
1. What is informed choice?

_________________________________________________________
_________________________________________________________
_________________________________________________________
2. If done effectively, what are five benefits of counseling in family planning clients?
1. _________________________________________________________
2. _________________________________________________________
3. _________________________________________________________
4. _________________________________________________________
5. _________________________________________________________
2. Name 5 principles of counseling :

1) _________________________________________________________
2) _________________________________________________________
3) _________________________________________________________
1. _________________________________________________________
2. _________________________________________________________
2. Three personal qualities of an effective counselor are:

1) _________________________
2) _________________________
3) _________________________

 What are the four skills required to be an effective counselor?
1) ________________________
2) ________________________
3) ________________________
4) ________________________
 What are the four knowledge required to be an effective counselor?
1) ________________________
2) ________________________
3) ________________________
4) ________________________
 Why is it necessary to take informed consent of the client for permanent sterilization :
1) _______________________________________________________________
2) _______________________________________________________________
3) _______________________________________________________________
 List the elements of communication
1. ___________________ 3. ___________________
2. ___________________ 4. ___________________
3. Interpersonal communication is the _____________ between __________________,
___________, is the process.
7. What are the signs of negative nonverbal communication?
a. _________________________________________________________
b. _________________________________________________________
c. _________________________________________________________
d. _________________________________________________________
e. _________________________________________________________
8.What are the signs of positive nonverbal communication?
1. _________________________________________________________
2. _________________________________________________________
3. _________________________________________________________
4. _________________________________________________________
5. _________________________________________________________
9. To ask client why he/she came to the clinic falls under _____ step.

10. Taking medical history of the client falls under _______ step.
11. In “ABHIBADAN”approach, explaining the client as per his/her need about

contraceptive methods falls under _______ step.
12. The ‘Ba’ step in the ABHIBADAN” approach stands for:

1. how the method protects pregnancy
2. risks and benefits
3. side effects of contraceptives
4. all of the above.
13. In “NA” step tell the client _______________________________ and provide

supplies if needed and
__________________________________________________

TAKE HOME EXERCISE
DAY 3:
Client Assessment
1. What are the questions to be asked to the clients coming for follow-up?
1. _________________________________________________________
2. _________________________________________________________
3. _________________________________________________________
4. _________________________________________________________
Condom
2. What are the 2 major advantages using condom? (Put √ in any 2)
1. This is an effective contraceptive
2. This can be used without knowledge of a classmate
3. It prevents sexually transmitted Infections.
4. It encourages husband to take the responsibility related to family planning
3. Which methods of family planning are effective in preventing STI, HIV/AIDS and
Hepatitis transmission?
1. Both IUCDs and condoms
2. Both condoms and COCs.
3. Condoms only.
4. List three indications for condom use:

1____________________________
2___________________________
3___________________________
5. If a woman has five children, her last pregnancy was very difficult, and she and her
husband want no other children, which of the following methods would you
recommend? (Circle the answer)
1. condoms
2. IUCD
3. Norplant implants
4. Minilap
6. List two places where can clients get condoms.
1) ______________________________
2) ______________________________

1. Combined oral contraceptives contain the hormones and

which prevent pregnancy by:
1) _____________________________
2) _____________________________
3) _____________________________
2. Side effects of COCs include (list 4):
1. ________________________
2. _________________________
3. ___________________________
4. ____________________________
Generally these side effects occur for only and then disappear.
3. A new pill user should begin her first pack of pills within the first days of her
menstrual cycle. If she begins after the day, she must
______________________ for seven days to avoid pregnancy.
4. The pill packages available in Nepal contain pills. are white pills
that contain and are brown pills that contain
. The user will have her period while she is taking the pills.
5. The client should take (how many?) pill a day, at the same time each day. If
she misses one pill, she should . If she misses two or more pills in a row,
she should __________________________________
6. The five warning signs that mean a woman who is using COCs should return to the
clinic are:
1) _________________________________________
2) __________________________________________
3) _________________________________________
4) _________________________________________
5) __________________________________________
7. The health conditions for which potential COC users should be screened are:
1) ________________________________________
2) _________________________________________
3) _________________________________________
4) _________________________________________
5) __________________________________________
8. There are some drugs that interfere with COCs if taken together with them and decrease
the effectiveness of the COCs. Write two.
______________________________________________________________________
______________________________________________________________________
9. The objective of screening clients before giving a family planning method is to

determine:
1) if there are any conditions requiring precaution for use of a specific
contraceptive method
1. if there are any problems that may require more frequent follow-up during use
of a specific contraceptive method.
10. You can be reasonably sure a client is not pregnant if : (Circle all correct
answers)
10. it is 10 days since the start of her menstrual period this month.
11. she is 4-6 months postpartum, has had no menses since delivery and is fully
breastfeeding.
12. she has been correctly and consistently using an effective contraceptive methods.
13. Assessing a client’s medical and reproductive history is necessary for which family
planning methods :
1. hormonal methods (COCs, Norplant, Depo-Provera)
2. IUCD
3. VSC
DMPA/DEPO-PROVERA
1. Depo-Provera is the brand name for , the only

injectable contraceptive available in Nepal, and contains the
hormone________________________
2. Optimal times for giving the first Depo-Provera injection are:

1) ____________________________
2) ____________________________
3) ____________________________
3. A DMPA injection is effective for . The next injection
can be given up to before and within her next
appointment.
4. The most common side effect of Depo-Provera is which

includes
1) __________________________
2) ___________________________
3) ___________________________
4) ___________________________
5. List four medical conditions for which potential DMPA clients should be screened
because they require special precautions if DMPA is used.
1) _______________________________
2) _______________________________
3) _______________________________
4) _______________________________
6. If a Depo-Provera client has heavy bleeding, the medical regimen is
_______________________________________________________________________
______________________________________________________________________.
7. The hormone in DMPA prevents pregnancy by:
1) _______________________________
2) _______________________________
3) _______________________________
8. DMPA has a failure rate of , making it one of the most effective

temporary family planning methods.
9. A DMPA user should return to the clinic if she experiences the following 2 warning
signs.
17736. _______________________________________________________________
_______________________________________________________________
17737. _______________________________________________________________
10. After the first injection, Depo-Provera is effective within ; when

injections are stopped, the return of fertility is ________________________________
11. After giving a Depo-Provera injection, what is the appropriate way to dispose of the
used needle and syringe?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

TAKE HOME EXERCISE
DAY 4:
EMERGENCY CONTRACEPTIVE
1. List 4 common side effects of emergency contraceptive method
1_________________________________________________________
2________________________________________________________
3________________________________________________________
4________________________________________________________
2. List the name of 3 types of emergency contraceptives methods available in Nepal 1.
1_________________________________________________________
2________________________________________________________
3________________________________________________________
INFECTION PREVENTION TAKE HOME EXERCISE
1. The two major objectives of infection prevention for family planning service programs
are:
1)_______________________________________________________________
________________________________________________________________
2)________________________________________________________________
________________________________________________________________
2. What id the goal of bacteria free or preventing infection?
______________________________________________________________________
______________________________________________________________________
3. The single most important procedure in preventing infections is __________________
______________________________________________________________________
4. Name the two infection prevention measures that must be performed before giving a
Depo-Provera injection.
1) _______________________________________________________________
2) _________________________________________________________________
5. Write 3 preventive methods for infection prevention.

1) _______________________________________________________________
2) _________________________________________________________________
3) _________________________________________________________________

BREASTFEEDING/LACTATIONAL AMENORRHEA
1. The 3 conditions that must be fulfilled for breastfeeding to be effective as a

contraceptive method are:
a. __________________________________________
b. __________________________________________
c. __________________________________________
2. Please provide the definition of "Exclusive Breastfeeding"?

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
3. Which of the following is not an appropriate method for a breastfeeding mother who is
6 weeks postpartum?
a. IUCD
b. Depo-Provera injections
c. combined oral contraceptives
d. condoms
4. The Lactational Amenorrhea Method is % effective in preventing pregnancy

within the first 6 months postpartum.
5. If client’s breastfeeding infant is 6 months or older and begins other supplemental

foods, what should you do?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
IUCD
1. The Copper T 380A, the IUCD most commonly used in Nepal, is effective in
preventing pregnancy for years, after which it must be replaced.
2. The main mechanism by which the Copper T 380A IUCD prevents pregnancy is
______________________________________________________________________
___ __________________________________________________________________
3. List three advantages of the Copper T 380A IUCD.
1) ______________________________________
2) ______________________________________
3) ______________________________________
4. The most common side effect of the Copper T 380A IUCD is

, which continues for (how long?) ____
.
5. An IUCD is most commonly inserted during (what part of the menstrual cycle?)
, but can also be inserted 1) _______________________________,
2) and ______________________
3) ____________________________________________________________________
6. The IUCD is effective (how soon?) after it is inserted, and

when it is removed a woman's fertility returns
.
7. List three warning signs that mean that a woman who has an IUCD should return to the
clinic.
1) ____________________________________
2) ____________________________________
3) ____________________________________
8. Give three reasons that a woman may have her IUCD removed.
1) ____________________________________
2) ____________________________________
3) ____________________________________
9. An IUCD is an appropriate contraceptive method for a woman who (list four):
1) ____________________________________
2) ____________________________________
3) ____________________________________
4) ____________________________________
IMPLANTS

1. The implant contraceptive method consists of containing
the hormone , which are implanted
.
2. Implants provide protection against pregnancy for ________________________
3. Implants prevent pregnancy by

1) ____________________________________
2) ____________________________________
4. Optimal times for inserting implants are:
1) ____________________________________
2) ____________________________________
3) ____________________________________
4) ____________________________________
5. The most common side effect of implants is ________________________ which
includes:
1) ____________________________________
2) ____________________________________
3) ____________________________________
4) ____________________________________
6. Implant user should return to the clinic where here capsules were inserted if she has any
of the following medical problems.
1) ____________________________________
2) ____________________________________
3) ____________________________________
4) ____________________________________
5) ____________________________________
6) ____________________________________
7 List the medical conditions for which potential implant clients should be screened
because they require special precautions if Implants are used.
1) ____________________________________
2) ____________________________________
8. The effectiveness of implants in preventing pregnancy is reduced if the woman

is taking the medications and
at the same time is using Norplant capsules as her contraceptive method.
9. List four advantages of implants.
1) ____________________________________
2____________________________________
3) ____________________________________
4) ____________________________________
10. A Norplant user can have the implants removed in the following conditions:
1) ____________________________________
1) ____________________________________
2) ____________________________________
3) ____________________________________
VOLUNTARY SURGICAL CONTRACEPTION
1. Which of the following would make a suitable voluntary sterilization clients?

a. A woman who decides to have VSC while she is in labour.
b. A couple with three children and think they probably do not want any more
children, but are not completely sure.
c. A couple that has two children, the youngest being four years of age, who want no
other children.
2. What should you say to a client who is concerned that having a vasectomy will affect
his ability to work? (Circle all appropriate answers)
a. Don't be foolish! That's just a stupid rumor.
b. Three days after the vasectomy, the man will be able to return to his usual work.
c. If you have to work hard, its best not to have a vasectomy.
3. What are three advantages of voluntary sterilization?
1) ___________________________________
2) ___________________________________
3) ___________________________________
4. Of the methods listed below, which is the most effective method?
a. IUCD
b. COCs
c. Depo Provera
d. VSC
e. condoms
5. When are the three best times that female voluntary surgical contraception can be
performed?
1) ___________________________________
2) ___________________________________
3) ___________________________________
6. What are the two types of voluntary surgical contraception procedures available?
1 ___________________________________
2 ___________________________________
3 ___________________________________
4 ___________________________________
7. Fill in the blanks in the sentences below with the words listed:
VSC is one type of ___________ sterilization. It is a _____________ method of
contraception and requires __________ before the procedure is done.
a. temporary
b. confidential
c. permanent
d. client consent
e. voluntary

Exercise for Home work
Fifth Day:
MATERNAL AND NEWBORN HEALTH
1. What are the main causes of maternal mortality in Nepal?
a. _______________________________________
b. _______________________________________
c. ________________________________________
2. How many times a pregnant woman should have in health institution?
a. ___________________________
b. __________________________
c. ___________________________
d. ___________________________
3. How many times a mother and her newborn should have examination in health
institution?
a. ___________________________
b. __________________________
c. ___________________________
d. ___________________________
4. What are the postpartum danger signs for mother?

a. ___________________________
b. __________________________
c. ___________________________
d. ___________________________

CHECKLIST FOR FAMILY PLANNING “ABHIBADAN”
TECHNIQUE
(To be completed by Clinical Trainer)
Instructions: Place a  in case box if step/task is performed satisfactorily, an X if it is
not performed satisfactorily, or NO if not observed.
Satisfactory: Performs the step or task according to standard procedure or guidelines
Unsatisfactory: Does not perform the step or task according to standard procedure or
guidelines
Not Observed: Step or task not performed by participant during evaluation by trainer.
PARTICIPANT Course Dates

CHECKLIST FOR FAMILY PLANNING “ABHIBADAN” TECHNIQUE
STEPS/TASKS OBSERVATIONS
Counseling Communication Skills
1 Maintains eye contact with the client
 Uses an appropriate tone of voice.
 Exhibits appropriate body language.
 Listens attentively.
 Uses language to be understood by the client
6. Asks open-ended, closed and probing questions when
required
7. Corrects rumors and misinformation
8. Uses the family planning flipchart effectively
SKILL/ACTIVITY PERFORMED SATISFACTORILY
“A” Step
1. Greets the client and introduces herself.
2. Offers the client a seat.
3. Assures confidentiality
4. Asks why she has come to the clinic.
“BHI” Step
·1 Assesses client’s FP medical and obstetrical history.
·1 Assesses the client’s reproductive needs (short, long term
and permanent)
·2 Assesses the client’s risk of contracting an STD and HIV
infection (if indicated)
·1 Assesses what the client knows about family planning
methods and asks client what method she is interested in.
Revisit Client
“BA” and “DA” Step
·2 Tells the client about the methods available based on the
client’s previous knowledge of family planning.
·2. Helps the client make a decision by focusing on the

potential side effects of the method she is considering
·3. Correctly explains to the client how to use the chosen
method and warning signs.
·4. Asks the client to repeat all instructions in her own words
“NA” Step
1. Discuss return visit and follow up with the client:
* where to go for more supplies
* early identification of the problems
· when to return to the HP or Health Facility.
2. Encourage the client to return at anytime if they have a
question or problem.
3. Politely say goodbye to the client and invite her/him to
return again.
Sterilization Clients
·4. Explains the informed consent form
·5. Tells the client that there are other methods that she can
use to meet her reproductive needs
·6. Tells the client when to return for routine follow-up
·7. Refers the client for methods or services not offered at this
site
Participant is qualified not qualified to give “ABHIBADAN”

technique.
Trainer's signature Date _____________________

CHECKLIST FOR DMPA CLINICAL SKILLS
(To be used by Clinical Trainer)

not performed satisfactorily, or N/O if not observed.
Satisfactory: Performs the step or task according to standard procedure or

guidelines
guidelines

________
STEP/TASK OBSERVATIONS
Getting Ready
1. Checks expiry date on DMPA single dose vial.
2. Adequately prepares client for injection (positioning etc.)
Preparing the Injection Site
1. Washes hands with soap and water.
2. Cleans skin with clean cotton and rectified spirits (alcohol) or
Betadine wiping with a circular motion outward from the
injection site and allows skin to dry.
Preparing the Injection
1. Shakes vial of DMPA thoroughly but gently
2. Draws DMPA into the syringe and expels air bubbles without
contaminating needle or vial.
Giving the Injection
1. Inserts the needle deep into the muscle (deltoid in arm or
upper, outer quadrant of gluteal area) and injects DMPA
slowly.
54
COFP and Counseling Trainer’s Notebook
Post-Injection Tasks
1. Applies pressure to injection site with cotton, but does not rub.
2. Discards assembled needle and syringe in a puncture proof
container without recapping or breaking or bending the needle.
3. Washes hands thoroughly with soap and water.
Post-Removal Counseling/Client Instructions
1. Instructs client to return for another injection in 12 weeks;
gives exact appointment date.
2. Explains side effects (changes in menstrual pattern,
headaches/dizziness, weight gain, breast tenderness).
Encourages client to return if she has side effects or problems
with bleeding.
3. Instructs client about warning signs and need to return to clinic
(heavy bleeding, delayed menstrual periods after interval of
regular periods).
Participant is qualified not qualified to give DMPA injections.
Trainer's signature Date

______________________
COFP AND COUNSELING COURSE EVALUATION

(To be completed by Participants)
Please indicate your opinion of the course components using the following rate scale:
4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree
55
COURSE COMPONENT RATING
4. The Precourse questionnaire helped me to study more effectively.
5. The role plays on counseling skills were helpful in improving my

counseling skills.
6. There was sufficient time scheduled for practicing counseling
skills in the classroom using role plays
7. There was sufficient time scheduled for practicing counseling
skills with clients in the clinic.
8. The practice sessions with the Depo-Provera model arm made it
easier for me to give Depo injections to clients.
9. There was sufficient time scheduled for practicing Depo injections
in the classroom with the model arm.
10. There was sufficient time scheduled for practicing Depo injections
with clients in the clinic.
11. I am now confident in giving Depo-Provera injections.
12. I am now confident in counseling clients and providing them with

pills, condoms and Depo-Provera.
13. I now feel comfortable doing a STI risk assessment with a client.
14. I am now able to use the infection prevention practices

recommended in the course.
15. I am now confident in counseling clients on long term and
permanent FP methods.
16. The training approach used in this course make it easier for me to
learn how to provide family planning services.
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COFP AND COUNSELING COURSE EVALUATION
Please indicate your opinion of the course components using the following rate scale:
4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree

COURSE COMPONENT RATING
11. The trainers clearly stated their learning objectives.
11. The trainers communicated clearly and effectively.
11. The information presented in the course was new to me.
11. The trainer used a variety of audiovisual materials.
11. The trainers were interested in the subjects they taught.
11. The course content (or the content of the sessions) had sufficient
theoretical knowledge.
11. The sessions were well organized.
11. The trainers asked questions and involved me in the sessions.
11. The content of the course was useful to my work.
11. The course made me feel more competent or skillful in my work.
11. The trainers use a variety of training methods.
ADDITIONAL COMMENTS (use reverse side if needed)

3. What topics if any should be added (and why) to improve the course?
4. What topics (if any) should be deleted (and why) to improve the course?
5. The course length (8 days) was: (circle one)
1) Too long
2) Too short
3) Just right
MID-COURSE QUESTIONNAIRE
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Instructions: Put a (√) the single best answer to each question in the blank next the
corresponding number on the attached answer sheet.
STATUS OF FAMILY PLANNING IN NEPAL
1. According to Annual Report, DoHS 2007/2008, total population of Nepal is ( in

million)
A. 2.32
B. 2.42
C. 2.52
D. 2.68
2. Annual Report, DoHS 2006/2007, Family Planning user rate is (in percentage)
A. 15
B. 20
C. 25
D. 30
INTER PERSOANL COMMUNICATION FP COUNSEIING
3. Communication means
A. programs aired from Radio and television.
B. the discussion on what kind of programs, news prints or
entertainments should be done.
C. the exchange of information, message, feelings, knowledge and
opinions with a person or group.
D. a program which gives knowledge & skills on family planning
methods.
4. One of the important advantages of interpersonal communication
A. enables to gather detailed information on a particular subject that a

person wishes to know
B. advocacy for reducing population growth can be done
C. build understanding & community development activity can be
done
D. promote the use of family planning service
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COUNSELING
5. Family planning counseling is:
·1 objective and honest advice from the provider about what method
the client should use.
·2 a two-way communication between counselor and client that
focuses on the client’s needs, feelings, and opinions and that helps
the client make a decision about the best method of contraception.
·3 promoting the use of family planning methods.
·4 giving information regarding the benefits of family planning.
6. The Bhi step in the ABHIBADAN approach stands for:
a. asking clients about themselves and advising them about the

method that is best for them.
b. asking clients about themselves and advising them of the methods
that are available to them.
c. asking clients about themselves, assessing their family planning
needs, and assessing how much they know about contraceptive
methods.
d. asking clients about their family planning knowledge and telling
them what they need to know.
7. After a live birth, the recommended interval before attempting the next pregnancy is
at least
A. 24 months
B. 20 months
C. 36 months
D. 48 months
8. Ovulation pattern is not affected by which of the following methods
1. Minilap
2. Depo injection
3. COC
4. Implant
CLIENT ASSESSMENT
9. The one purpose of client assessment before giving a birth control method is to:
A. decide what method the client should use.

B. decide if the client is competent to choose a birth control method.
C. determine physical conditions that may require management.
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D. perform a physical exam before giving a birth control method.
CONDOM
10. If a woman should absolutely not get pregnant because of medical reasons, her first
choice of contraceptive method should be:
A. condom
B. oral contraceptive pills
C. voluntary surgical contraception
D. IUCD
11. One of the advantage of condoms is:
A. they never break or tear

B. they are inexpensive and generally available
C. they are highly effective in preventing pregnancy regardless of
how they are used
D. any type of lubricant can be used with them
COMBINED ORAL CONTRACEPTIVE
12. A new oral contraceptive user should begin taking her first pack of pills:
A. 5th day of her menstrual cycle

B. Only on the first day of her menstrual bleeding
C. when she finishes her menstrual period
D. whenever it is convenient for her
13. A woman who is taking combined oral contraceptives should return to her service
provider immediately if she has:
A. severe leg pain or visual problems such as vision loss or blurring

B. backache and menstrual cramping
C. an itchy rash over her body
D. excessive hair loss
DEPO PROVERA
14. The most common side effect of Depo-Provera is:
A. changes in the menstrual cycle

B. severe migraine headaches
C. high blood pressure
D. jaundice and liver damage
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15. Of the following which is the best time for giving Depo-Provera injection:
A. just before the menstrual period begins

B. anytime that the woman is able to get to the clinic
C. halfway between two menstrual periods (midcycle)
D. 6 weeks postpartum
16. Which one of the following statement is not true emergency contraception
A. a high dosage of estrogen

B. 4 white birth control pills taken within 72 hours of unprotected sex
and 4 more taken 12 hours later.
C. an IUCD inserted within 5 days of an episode of unprotected sex.
D. can stop an established pregnancy
17. Which of the following is not a possible side effect of emergency contraception?.
A. nausea
B. amenorrhea
C. menstrual spotting
D. vomiting
18. Handwashing:
A. is the most important practice in infection prevention

B. is not necessary after removing gloves
C. cannot be done if there is no running water in the clinic
D. should be done only with special antiseptic soap
19. To properly dispose of disposable needles and syringes after they are used, the
needles should be :
A. recapped and thrown into the garbage

B. bent or broken
C. disposed of in a puncture-proof container
D. be flushed with water and removed from the syringe for disposal
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20. One of the objectives of infection prevention is:
A. Reduce infection from micro organisms
B. Reduce cost of health service
C. Increase trust for the health institution
D. Reduce time of hospital stay
LAM
21. A mother who is less than 6 months postpartum and amenorrheic (her menses have
not returned after delivery) is protected from pregnancy as long as she breastfeeds her
baby:
A. on demand, day and night, at least 6-10 times per day with very
little or no other food or fluids given
B. 2 or 3 times each day
C. during the day and the baby sleeps through the night
D. at night and expresses breast milk during the day
22. Choice of FP method for less than 6 months postpartum and amenorrheic mother(her
menses have not returned after delivery) :
A. IUCD
B. Depo Injection
C. Combined oral contraceptive
D. Condom
IUCD
23. For IUCD insertion
A. can be inserted during menstruation

B. can be inserted any time provided it is sure that she is not pregnant
C. immediately within 7 days of abortion (if there is no infection)
D. All of the above
24. The Copper T 380A IUCD prevents pregnancy principally by:
A. plugging the Fallopian tubes with its arms so eggs cannot get into
the uterus
B. preventing the sperm from fertilizing the egg
C. causing an infection in the uterus
D. preventing the release of eggs from the ovary
IMPLANTS
25. For Implant insertion
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A. is inserted deeply into muscle through injection in the upper arm
B. 4 soft capsules
C. is inserted just beneath the skin of woman's upper arm
D. can be seen by all
26. Jadelle Implants provide protection against pregnancy for:
A. 10 years
B. 8 years
C. 7 years
D. 5 years
VSC
27. The characteristics about voluntary sterilization that should be most stressed to
the client is:
A. it is a permanent method
1) there is a risk of failure
2) reversal is possible
3) there are other methods available
28. Pregnancy after vasectomy is mostly due to:
A. not using contraceptives for 3 months or 20 times ejaculations after

surgery
·1 spontaneous re-canalization of vas
·2 starting sexual activity too soon after surgery
·3 presence of a third vas deferens missed during surgery
MATERANL AND NEWBORN HEALTH
29. Mother can do the following activities during pregnancy.
·1 carry heavy bundles of grass

·2 drink alcohol
·1 dally bath
·2 take medicines without health workers advice
30. Total number of iron tablets to be taken in pregnancy and after delivery
A. 180
B. 225
C. 120
D. 250
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31. Which of the following are not the danger signs of pregnancy?
A. blurring of vision
B. even mild vaginal bleeding
C. weight gain
D. swollen leg and face
32. Which is not the danger sign of newborn?
·3 Unable to suck breast milk

·4 Fever
·1 Cold injury
·2 mild jaundice
HMIS FORM
33. HMIS Form to be filled by VHW and MCHW for family planning service
A. HMIS 31 , 12, 13, and 17

B. HMIS 17, 31, 15 and 27
C. HMIS 11, 13, 17, and 29
D. All of the above
34. HMIS Form to be filled in outreach clinic(Gaown Ghar clinic) for family
planning service
A. HMIS 13
B. HMIS 17
C. HMIS 28
D. HMIS 12
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65
THREE TYPES OF FAMILY PLANNING COMMUNICATION
Read each event given below. The event describes some types of communication. Write "P" if it
is Motivational or Promotional, "I" if it is Information and "C" if it is Counseling.
----------1. A woman comes to a clinic for depo injection I will tell her the
advantages, disadvantages and dangers of all the FP methods including
depo and I will ask her to choose a methods making sure whether she has
understood them or not.
----------2. A nurse tells a postpartum woman that this is the appropriate time to go
form minilap operation to avoid the fear for pregnancy again.
---------- 3. A doctor in a delivery room tells postpartum women how different family
planning methods work?
--------- 4. A health worker tells the advantages of using pills and the neceesity to use
pills to a woman coming for abortion on health ground
---------- 5. A client shows her anxiety to health worker that she might have an
irregular bleeding after Implant insertion. Health worker tells her that
irregular bleeding is mild side effect of Implant and probably it will stop
after some time.
---------- 6. A doctor discusses with a vasectomy client having concern that operation
will have no negative side effects on sexual performance.
--------- 7. A village health worker tells clients how to use pills and what to do if she
forgets to take the pills.
---------- 8. A counselor re counsels client to take informed decision, rethinking

reasons to choose sterilization after initial counseling.
---------- 9. A nurse shows a film on pregnancy care service and tells about the use of
family planning methods after delivery.
---------- 10. A factory supervisor talks about the advantages of condom use and its
necessity.
---------- 11. A counselor tells the clients visiting family planning clinic to use Implant
because of its effectiveness.
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THREE TYPES OF COMMUNICATION EXERCISE
Review the answer with the participants. The correct answers are:
Answers
1. C
2. P
3. I
4. P
5. C
6. C
7. I
8. C
9. I
10. P
11. P
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Relationship between three types of communication
Motivation
Information
Counseling
Write this figure in the newsprint , discuss with the participants and
clarify giving examples of interdependent relations between them
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THE EMERGENCY CONTRACEPTION (EC) GAME
To play the EC game, let each participant choose a piece of paper with either a question
or an answer on it. Half of the participants get a piece of paper with a question written
on it. The other half of the participants get a piece of paper with an answer on it. Tell the
group to stand up and talk with each other to find the matching question/answer. They
should keep their original papers after 5 minutes, call the group together have the
individuals with questions and read them out loud starting with question number 1.
When that person asks the question, the person with the correct answer should stand and
read the answer out loud. If there are more questions than participants, give people 2
papers.
The questions for the Emergency Contraception Game:
Write the questions in one color, and the answers in a different color. Only put numbers
on the questions.
Questions Answers
1. There are 2 different kinds of Emergency * One kind of EC is high doses of COCs.
Contraception. What are they?
* The other kind of EC is the insertion of
an IUD within 5 days of sex.
2. What are some common reasons a 2. She ran out of COCs

woman needs EC? 3. She is more than 2 weeks late for Depo
shot
4. Condom broke
5. IUD came out
6. She was raped
7. Unprotected sex for ANY reason
3. How long after unprotected sex can EC can be used up to 120 hours after
EC be used? unprotected sex . But within the first 12
hours is better.
4. What is the dose for EC? The dose for EC is 4 white COC’s within
120 hours of unprotected sex then 4 more
white COC’s 12 hours later.
5. How does EC work? EC works by delaying ovulation.
No, EC prevents pregnancy and will not end
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6. Will EC end an established an established pregnancy. EC is not
pregnancy? abortion.
7. Who can use EC? Any woman who is concerned she had
unprotected sex and does not want a
pregnancy can use EC.
8. How effective is EC? Only 2% of woman using EC will become

pregnant.
9. How often can a woman use EC? A woman cannot use EC as often as needed
but it is better to start a more effective
continues method like COCs, Depo, IUD,
Implant or VSC.
10. What if a woman vomits after taking * If a woman vomits one hour after
EC? taking EC, she should re-take that dose after
taking an anti-emetic like perinorm.
* If a woman vomits in more than 2 hours

after taking EC, there is no need to retake
that dose.
11. Can a woman use EC for more than one Yes, unless she has a known pregnancy.
time after unprotected sex in the last 72
hours?
12. What should a woman do if she She should see a health worker to rule out
takes EC and then does not have a pregnancy
period for 3 weeks?
13. What if menses come 2 or 3 days It is NOT a medical problem if a woman’s

early or late after taking EC? period comes 2 or 3 days early or late after
taking EC.
14. 30-50% of women report this non- NAUSEA

dangerous side effect of EC?
15. What should a woman do to prevent * To prevent nausea, have a woman

Nausea when taking EC? take EC with food
or
* Take perinorm 10 mg ½ hour before
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taking EC
TAKE-HOME EXERCISES ANSWER KEYS
First day
POPULATION AND REPRODUCTIVE HEALTH STATUS
1. What is the total population according to Annual Report, DoHS 2007/2008?
Total population is 2, 68, 05, 469
2. According to NDHS 2006, what is the total fertility rate?
Total fertility rate is 3.1.
3. According to NDHS 2006, what is the total maternal mortality rate?
Maternal mortality rate is 281/100000
4. What are the effects of population growth?
A Division of agricultural land

B Due to unemployment there is high chance of people getting involved
in social crimes such as drinking, gambling, using drugs etc.
C. Difficult to provide chance for education to all equally.
D. Problems such as landslide, earthquake due to deforestation
E. Increment in expenditure for basic health services
5. What are the advantages of Family Planning?
 Support to decrease neonatal mortality and child mortality rate

 Support to decrease maternal mortality rate
 Support to build a small and organized family
 Support to control population growth
6. What are the major Indicators of monitoring of Family Planning Program?
 New Acceptor
 Current or continues user
 CYP
 CPR-Contraceptive Prevalence Rate
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 Total Fertility Rate
72
TAKE-HOME EXERCISES ANSWER KEYS
Second Day
Interpersonal Communication and FP Counseling
1. What is FP counseling?
FP counseling is a process of communication whereby the counselor gives accurate
and complete information to a client based on reproduction needs and assist them to
make informed and voluntary decisions about their fertility and contraceptive options.
1. What is informed choice?

 he process by which an individual makes him or her own decision about
family Planning
 based on full understanding of all necessary information, including risk
& benefits about all the options.
 free of stress and without pressure, correction or incentives from others.
2. If done effectively, what are five benefits of counseling in family planning clients?
 increased acceptance
 choice of appropriate method
 longer continuation
 effective method use
 counters rumors and misconceptions
3. Name 5 principles of counseling :

 focus on the needs of the client
 informed voluntary choice of client’s fertility behavior
 empowerment
 confidentiality
 consent
4. Personal qualities of an effective counselor are:
 empathy for clients

 respectful
 honest with client
 trustworthy
 knowledgeable
 supportive attitude towards clients
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 uses non-judgmental approach
 able to maintain confidentiality
 comfortable in discussing issues like human sexuality
5. What are the four skills required to be an effective counselor?

 listen and observe clients attentively
 present information clearly
 asks questions appropriately to encourage the client to share
information and feelings
 create appropriate environment for the client
 speaks the clients' language.
 guide the counselor-client interaction.
6. What are the four knowledge required to be an effective counselor?

 Knowledge on family planning client
 Knowledge on family planning contraception
 Knowledge on family planning counseling
 Knowledge about one’s country FP policy program
7. Why is it necessary to take informed consent of the client for permanent

sterilization
 the client will no longer to be able to have children

 there are risks and benefit associated with the procedure.
 the effect of this procedure is meant to be permanent
 permanent sterilization is a small surgical procedure
 temporary methods of contraception are also available to the client or
the client’s partner.
 the client has the option to decide against the procedure without
sacrificing the right to other services. The client may change his or
her mind at any time before the operation.
8. List the elements of communication

1. Source 3. Message
2. Receiver 4. Medium
9. Interpersonal communication is the process of exchanging information, ideas,

feelings and messages between two or more persons.
74
9. What are the signs of negative nonverbal communication?
17738. reading from the chart
17739. Looking at the watch
17740. yawning, reading newspapers or looking out of the
windows
17741. frowning
17742. not maintaining eye contact
10. What are the signs of positive nonverbal communication?

a. leaning towards the client
b. smiling and don’t show any tension or stress.
i. avoiding nervous or inappropriate mannerisms.
j. presenting facial expressions that inspire trust
k. maintaining eye contact with the client
l. making encouraging gestures such as nodding one’s head
11. To ask client why he/she came to the clinic falls under "A" step.
12. Taking medical history of the client falls under " Bhi" step.
13. In “ABHIBADAN”approach, explaining the client as per his/her need about

contraceptive methods falls under _"BA"_ step.
14. The ‘Ba’ step in the ABHIBADAN” approach stands for:

5. how the method protects pregnancy
6. risks and benefits
7. side effects of contraceptives
8. all of the above.
In ‘Na’ step tell the client when to come for routine follow up and
provide supplies if needed and if not available refer the client
where it is available.
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TAKE HOME EXERCISE ANSWER KEY
DAY 3:
Client Assessment
1. What are the questions to be asked to the clients coming for follow-up?
Condo. m
2. What are the 2 major advantages using condom? (Put √ in any 2)
a. This is an effective contraceptive
b. This can be used without knowledge of a classmate
c. It prevents sexually transmitted Infections. √
d. It encourages husband to take the responsibility related to family
planning √
3. Which methods of family planning are effective in preventing STI, HIV/AIDS and
Hepatitis transmission?
5. Both IUCDs and condoms
6. Both condoms and COCs.
7. Only condoms only. √
4.List three indications for condom use:
1) single people who need occasional contraception

2) couples who want to space children
3) couples who have agreed together to use condoms so that contraception
is the man's responsibility
4) couples who are worried about side effects of other methods
5) couples who have sex only once in a while
6) individuals who might have or might get an STD, including AIDS, even
if they are using another family planning method
7) pregnant woman with, or at risk for, STDs during pregnancy
8) individuals with more than one sexual partner
9) women who are fully breastfeeding and less than 6 months postpartum
10) as a backup method (for example, if a woman forgets to take her COCs
for 2 or more days)
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5. If a woman has five children, her last pregnancy was very difficult, and she and her
husband want no other children, which of the following methods would you
recommend? (Circle the answer)
1. condoms
2. IUCD
3. Norplant implants
4. Minilap
6.. List two places where can clients get condoms.
1) health posts or sub health post
2) medical shops
1) hospitals
2) family planning clinics
3) local health workers
4) NGO health programs
5) outreach clinics
1. Combined oral contraceptives contain the hormones estrogen and progesterone

(progestin) which prevent pregnancy by:
1) suppressing ovulation (preventing the release of an egg from the
ovary)
2) thickening the cervical mucus so sperm cannot get through it
3) preventing implantation of a fertilized egg
2. Side effects of COCs include (list 4):
1) nausea
2) breast tenderness
3) intermenstrual bleeding/breakthrough bleeding
4) dizziness
5) headaches
6) weight gain
7) acne
Generally these side effects occur for only the first three months of pill use and
then disappear.
3. A new pill user should begin her first pack of pills within the first 5days of her
menstrual cycle. If she begins after the fifth day, she must use a backup method
of contraception or abstain from sexual intercourse for seven days to avoid
pregnancy.
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4. The pill packages available in Nepal contain 28 pills. Twenty-one (21) are white
pills that contain hormones and 7 are brown pills that contain iron. The user will
have her period while she is taking the brown pills.
5. The client should take one pill a day, at the same time each day. If she misses one
pill, she should take the pill when she remembers it, even if that means taking
two pills in one day, and continue on the pack. If she misses two or more pills
in a row, she should take 2 pills a day for as many days as she has missed (for
example, if she missed 3 pills, she should take 2 pills each day for 3 days,
beginning on the day she remembers) and use a backup method of
contraception or abstain from sexual intercourse for 7 days.
6. The five warning signs that mean a woman who is using COCs should return to
the clinic are:
1) severe lower abdominal pain or pelvic pain
2) severe chest pain, cough, or shortness of breath
3) severe headaches
4) eye problems (vision loss or blurring)
5) severe leg (calf or thigh) pain
7. The health conditions for which potential COC users should be screened are:
1) known or suspected pregnancy
6) if taking tuberculosis or epilepsy medications
3) if is a heavy smoker and over 40
4) blood clots in legs, eyes or lungs, or a history of blood clots
5) severe high blood pressure (more than 180/105)
6) active liver disease, jaundice
8. There are some drugs that interfere with COCs if taken together with them and
decrease the effectiveness of the COCs. What are they?
1) rifampin for tuberculosis
1) anti-convulsants for epilepsy
2) Depo injection
DMPA/DEPO-PROVERA
Depo-Provera is the brand name for depot-mexdroxyprogesterone acetate or DMPA,
the only injectable contraceptive available in Nepal, and contains the hormone
progesterone.
1. Optimal times for giving the first Depo-Provera injection are:

1) During menstruation: within seven days from the onset
2) Postabortion: Immediately or within first seven days
3) Postpartum: Immediately or when postpartum mother brings
her infant for immunizations (6 weeks postpartum)
78
2. A DMPA injection is effective for 3 months (12 weeks). The next injection can
be given up to 2 weeks before and within 2 weeks of her next appointment.
3. The most common side effect of Depo-Provera is changes in the menstrual

cycle which include:
1) prolonged bleeding for more days that a woman would normally
experience during the first months of use
1) bleeding or spotting between periods during the first few months
of use
1) no bleeding at all (50% of women after one year of use and 66%
after two years)
1) a combination of these patterns
4. List the medical conditions for which potential DMPA clients should be screened
because they require special precautions if DMPA is used.
1) current pregnancy (the only absolute contraindication to
DMPA use)
1) unexplained vaginal bleeding
387) active liver disease
1) breast lumps and known or suspected breast cancer
5. If a Depo-Provera client has heavy bleeding, the medical regimen is ibuprofin

400 mg three a day for one week. If that doesn’t stop bleeding, give one
cycle of COCs.
6. The hormone progesterone in DMPA prevents pregnancy by:
1) causing thick scanty cervical mucus
2) ovulation
3) cases thin endometrium
7. DMPA has a failure rate of less than 1%, making it one of the (circle one)
most/least effective temporary family planning methods.
8. A DMPA user should return to the clinic if she experiences the following 2
warning signs.
1) heavy bleeding twice as long as or twice as much bleeding as

normal menses between periods
1) delayed menstrual period after a long interval of regular periods
(possible periods)
2) passing blood clots
9. After the first injection, Depo-Provera is effective within 24 hours; when

injections are stopped, the return of fertility is delayed for several months.
This delay is usually about 6 months from the first missed injection, or 9
months from her last injection.
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10. After giving a Depo-Provera injection, what is the appropriate way to dispose of
the used needle and syringe?
The needle and syringe are NOT disassembled after use to prevent
needlestick injuries.
Needles are NOT bent or broken before disposal to prevent injuries.
The needle and syringe are placed in a puncture proof container made of
cardboard, metal, heavy plastic or glass.
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TAKE HOME EXERCISE ANSWER KEY
DAY 4:
EMERGENCY CONTRACEPTIVE
2. List 4 common side effects of emergency contraceptive method
1 nausea
2 tiredness
3 headache
4 lower abdominal pain
2. List the name of 3 types of emergency contraceptives methods available in Nepal

1 combined oral contraceptives
2 only progesterone oral pill
3 IUCD
1. The two major objectives of infection prevention for family planning service
programs are:
1) to minimize infections due to microorganisms causing serious

wound infections, abdominal or scrotal abscesses (e.g., following
surgery or Depo-provera injection), pelvic inflammatory disease
(e.g., after an IUCD insertion), gangrene and tetanus.
2) to prevent the transmission of serious diseases such as hepatitis
B (HIV) and aids (HIV) and to protect both client and family
planning provider from becoming infected with such diseases
during clinical procedures.
2. What is the goal of preventing infection?
3. The single most important procedure in preventing infections is handwashing.
4. Name the two infection prevention measures that must be performed before
giving a Depo-Provera injection.
1) washing hands
2) cleaning the client's skin with an antiseptic solution
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5. Write 3 preventive methods for infection prevention
1) washing hands
2) use of gloves
3) use of antiseptics
BREASTFEEDING/LACTATIONAL AMENORRHEA
1. The 3 conditions that must be fulfilled for breastfeeding to be effective as a

contraceptive method are:
1) the mother is less than six months postpartum

2) the mother's menses have not returned
3) the mother is fully or nearly fully breastfeeding her baby
2. What is the definition of "fully breastfeeding"?
This means that the mother is breastfeeding her baby on demand (whenever
the baby cries), at least 6 times a day including night feeds and the mother is
not supplementing the child's diet regularly with non-breastmilk foods.
3. Which of the following is not an appropriate method for a breastfeeding mother

who is 6 weeks postpartum?
1) IUCD
2) Depo-Provera injections
3) combined oral contraceptives
4) condoms
4. The Lactational Amenorrhea Method is 98% effective in preventing pregnancy

within the first 6 months postpartum.
5. If breastfeeding client’s infant is 6 months or older and begins other supplemental

foods, what should you do? Recommend another family planning method
IUCD
1. The Copper T 380A, the IUCD most commonly used in Nepal, is effective in
preventing pregnancy for twelve (12) years, after which it must be replaced.
2. The main mechanism by which the Copper T 380A IUCD prevents pregnancy is
by interfering with fertilization of the egg by the sperm. It also decreases the
number of sperm reachng the oviduct and inactivates the sperm.
82
3. List three advantages of the Copper T 380A IUCD.
a. Highly effective. First year pregnancy rate 0.3 - 1.0 per 100 women per
year
b. Immediately effective, long term protection (up to 10 years or more)
c. Immediate return to fertility upon removal
d. Few method related side effects (local only)
e. Does not interfere with intercourse
f. Convenient, requires only monthly checking for strings
g. No extra supplies needed by client
h. Cost effective
i. It is suitable for breastfeeding woman
j. It is a suitable method for a woman of any age provided she is at low risk
for sexually transmitted diseases (STDs)
4. An IUCD provides no protection against STIs or AIDS/HIV, so it should not be

the first choice of a contraceptive method for woman who have a recent history
of STDs or PID (in the last three-four months) or who are at high risk for
acquiring a STD (they or their partner has multiple sexual partners).
5. The most common side effect of the Copper T 380A IUCD is heavier and longer
menstrual bleeding intermenstrual bleeding and spotting, and more
cramping which continues for the first few months after insertion.
6 An. IUCD is most commonly inserted during or toward the end of menstruation,
but can also be inserted 1) any time during the menstrual cycle if it is certain
that the woman is not pregnant, 2) 6-8 weeks postpartum, and 3) immediately
or within 7 days postabortion.
7. The IUCD is effective immediately after it is inserted, and when it is removed a

woman's fertility returns immediately.
8. List three warning signs that mean that a woman who has an IUCD should return
to the clinic.
1) Her menstrual period is late and she has signs of pregnancy
2) persistent or crampy lower abdominal pain, especially if she is not
feeling well and has fever and chills
3) the strings of her IUCD are missing or the plastic tip of the IUCD
can be felt when she is checking her strings
4) Either the woman or her husband begin having sexual relations
with other partners without using condoms
5) Signs of STIs, abnormal discharge
83
9. Give three reasons that a woman may have her IUCD removed.
1) she wants to become pregnant
2) because of side effects or other health problems
3) to change to another contraceptive method
4) because she wants to- for any reason
10. An IUCD is an appropriate contraceptive method for a woman who (list four):
1) prefers a highly effective, long-term method but does not want a
permanent method
2) prefers a method that does not require taking contraceptive action
daily or before sexual intercourse
3) has one or more children
4) is breastfeeding and needs a contraceptive
5) prefers not to use a hormonal contraceptive, such as COCs, or is a
heavy smoker who is over 40 years old or has high blood pressure
6) has successfully used an IUCD in the past
7) is at low risk of contracting a STI (i.e., is in a mutually faithful
relationship)
IMPLANTS
1. The Implant contraceptive method consists of two, flexible rods made of a soft
rubber-like material, containing the Levonorgestrel harmone, which are
implanted just under the skin of the inner, upper arm.
2. Jadelle Implants provide protection against pregnancy for five years.
3. Implants prevent pregnancy by

1) causing thick scanty cervical mucus which decreases the ability of
sperm to travel through the cervix into the uterus where
fertilization would take place
2) stopping the woman's body from releasing eggs
4. Optimal times for inserting Implant capsules are:

1) During menstruation: within seven days from the onset
2) Postabortion: Immediately or within first seven days
3) Postpartum: Immediately or when postpartum mother brings her
infant for immunizations (6 weeks postpartum)
4) If exclusively breastfeeding and has not started menstruating,
insertion of Implant capsules can be delayed up to 4 months
postpartum
5. The most common side effect of Implants is changes in the menstrual cycle
which include:
1) prolonged bleeding for more days that a woman would normally
experience during the first months of use
84
2) bleeding or spotting between periods during the first few months
of use
3) no bleeding at all for small months or, for a few women, for a year
or longer
4) a combination of these patterns
6. A Implant user should return to the clinic where here capsules were inserted if she
has any of the following medical problems.
1) severe lower abdominal pain
2) heavy vaginal bleeding
3) pus or bleeding at the insertion site (this may indicate infection)
4) expulsion of an implant (this rarely occurs with proper placement)
5) episodes of migraine, repeated bad headaches, or blurred vision
6) suspicion of pregnancy
7) delayed menstrual period after a long interval of regular cycles
7. List the medical conditions for which potential Implant clients should be screened
because they require special precautions if Implant capsules are used.
1) current pregnancy (the only absolute contraindication to use of

Implants)
2) unexplained vaginal bleeding
3) active liver disease
4) breast lumps and known or suspected breast cancer
8. The effectiveness of Implants in preventing pregnancy is reduced if the woman is

taking the medications Rifampin for tuberculosis and medications for epilepsy
at the same time is using Implant capsules as her contraceptive method.
9. List four advantages of Implants.
1) highly effective
2) rapidly effective, in less that 24 hours after insertion
3) long-term protection (five years)
4) immediate return of fertility when removed
5) pelvic exam not required
6) few method-related health risks because it contains no estrogen
7) does not interfere with intercourse
8) effectiveness does not depend on the actions of the user
9) no supplies needed
10) easy to use - once inserted the woman only has to return to the
clinic for follow-up visits and to have them removed
11) offers continuous protection
12) convenient: does not interfere with normal activities, sexual desire
or intercourse
13) does not adversely affect breastfeeding
85
14) reversible
15) comfortable and unobtrusive
16) can be removed (at a health facility) at any time for any reason
17) useful for women who do not want more children but who do not
want to be sterilized
18) may be used by postabortion clients
10. A Implant user can have the implants removed:

1) at any time for any reason
2) if she wants to become pregnant
3) because of side effects or other health problems
4) to change to another contraceptive method
VOLUNTARY SURGICAL CONTRCEPTION
1. Which of the following would make a suitable VSC clients?
1. A woman who decides to have a VSC while she is in labour.

2) A couple with three children and think they probably do not want any
more children, but are not completely sure.
3) A couple that has two children, the youngest being four years of
age, who want no other children.
2. One of the prinicipal aims of counseling for VSC is to identify clients who are
likely to adjust poorly or change their minds after undergoing VSC.
3. The main counseling point for VSC is:

that the procedure is considered permanent (irreversible).
4. What should you say to a client who is concerned that having a vasectomy will
affect his ability to work? (Circle all appropriate answers)
1) Don't be foolish! That's just a stupid rumor.

2) Three days after the vasectomy, the man will be able to return to
his usual work.
3) If you have to work hard, its best not to have a vasectomy.
5. What are three advantages of VSC?

1. minimal side effects
2) very effective
3) permanent
1) no further worry or expense about contraception
1. no change in sexual function
6) does not interfere with sexual intercourse
7) simple surgery usually done under local anesthesia
86
6. Of the methods listed below, which is the most effective method?
1) IUCD
2) COCs
3) Depo Provera
4) Voluntary Sterilization
5) condoms
7. When are the three times that female VSC can be performed?
1) immediately postpartum (within 48 hours)
2) 6-8 weeks postpartum and not pregnant
3) anytime in the menstrual cycle when its certain the woman is not
pregnant; it is preferable to do the procedure at the end of the
menstrual period or shortly thereafter to be sure she is not
pregnant
2. What are the two types of VSC procedures available

1. vasectomy
2. minilaprotomy
3. laparoscopy
4. No-Scalpel Vasectomy
87
Exercise for Home work
Fifth Day:
MATERNAL AND NEWBORN HEALTH
1. What are the main causes of maternal mortality in Nepal?
1. high blood pressure during pregnancy, urine infection, swelling of hand and facr
pre eclampsia/eclampsia
2. postpartum heavy bleeding
3. complications of unsafe abortion
4.
2. How many times a pregnant woman should have in health institution?
1. First – 4 month
2. Second- 6 month
3. Third – 8 month
4. Fourth- 9 month
3. How many times a mother and her newborn should have examination in health
institution?
___________________________
__________________________
___________________________
___________________________
4. What are the postpartum danger signs for mother?
___________________________
__________________________
___________________________
___________________________
88
MID-COURSE QUESTIONNAIRE ANSWER KEY
STATUS OF FAMILY PLANNING IN NEPAL
1. According to Annual Report, DoHS 2007/2008, total population of Nepal is ( in

million)
a. 2.32
b. 2.42
c. 2.52
d. 2.68
2. Annual Report, DoHS 2006/2007, Family Planning user rate is (in percentage)
a. 15
b. 20
c. 25
d. 30
INTER PERSOANL COMMUNICATION FP COUNSEIING
3. Communication means
a. programs aired from Radio and television.
b. the discussion on what kind of programs, news prints or entertainments
should be done.
c. the exchange of information, message, feelings, knowledge and opinions
with a person or group.
d. a program which gives knowledge & skills on family planning methods.
4. One of the important advantages of interpersonal communication
a. enables to gather detailed information on a particular subject that a

person wishes to know
b. advocacy for reducing population growth can be done
c. build understanding & community development activity can be done
d. promote the use of family planning service
COUNSELING
1. Family planning counseling is:
a. objective and honest advice from the provider about what method
the client should use.
89
b. a two-way communication between counselor and client that
focuses on the client’s needs, feelings, and opinions and that
helps the client make a decision about the best method of
contraception.
c. promoting the use of family planning methods.
a. giving information regarding the benefits of family planning.
2. The Bhi step in the ABHIBADAN approach stands for:
a. asking clients about themselves and advising them about the

method that is best for them.
b. asking clients about themselves and advising them of the methods
that are available to them.
c. asking clients about themselves, assessing their family
planning needs, and assessing how much they know about
contraceptive methods.
d. asking clients about their family planning knowledge and telling
them what they need to know.
3. After a live birth, the recommended interval before attempting the next pregnancy is
at least
a. 24 months
b. 20 months
c. 36 months
d. 48 months
4. Ovulation pattern is not affected by which of the following methods
a. Minilap
b. Depo injection
c. COC
d. Implant
CLIENT ASSESSMENT
5. The one purpose of client assessment before giving a birth control method is to:
a. decide what method the client should use.

b. decide if the client is competent to choose a birth control method.
a. determine physical conditions that may require management.
90
c. .perform a physical exam before giving a birth control method.
CONDOM
11. If a woman should absolutely not get pregnant because of medical reasons, her
first choice of contraceptive method should be:
A. condom
B. oral contraceptive pills
C. voluntary surgical contraception
D. IUCD
12. One of the advantage of condoms is:
A. they never break or tear

B. they are inexpensive and generally available
C. they are highly effective in preventing pregnancy regardless of
how they are used
D. any type of lubricant can be used with them
COMBINED ORAL CONTRACEPTIVE
13. A new oral contraceptive user should begin taking her first pack of pills:
A. 5th day of her menstrual cycle

B. Only on the first day of her menstrual bleeding
C. when she finishes her menstrual period
D. whenever it is convenient for her
14. A woman who is taking combined oral contraceptives should return to her service
provider immediately if she has:
A. severe leg pain or visual problems such as vision loss or

blurring
B. backache and menstrual cramping
C. an itchy rash over her body
D. excessive hair loss
DEPO PROVERA
15. The most common side effect of Depo-Provera is:
A. changes in the menstrual cycle

B. severe migraine headaches
91
C. high blood pressure
D. jaundice and liver damage
16. Of the following which is the best time for giving Depo-Provera injection:
A. just before the menstrual period begins

B. anytime that the woman is able to get to the clinic
C. halfway between two menstrual periods (midcycle)
D. 6 weeks postpartum
17. Which one of the following statement is not true emergency contraception
E. a high dosage of estrogen

F. 4 white birth control pills taken within 72 hours of unprotected sex
and 4 more taken 12 hours later.
G. an IUCD inserted within 5 days of an episode of unprotected sex.
H. can stop an established pregnancy
18. Which of the following is not a possible side effect of emergency contraception?.
E. nausea
F. amenorrhea
G. menstrual spotting
H. vomiting
19. Handwashing:
E. is the most important practice in infection prevention

F. is not necessary after removing gloves
G. cannot be done if there is no running water in the clinic
H. should be done only with special antiseptic soap
20. To properly dispose of disposable needles and syringes after they are used, the
needles should be :
A. recapped and thrown into the garbage

B. bent or broken
C. disposed of in a puncture-proof container
92
D. be flushed with water and removed from the syringe for disposal
21. One of the objectives of infection prevention is:
A. Reduce infection from micro organisms

B. Reduce cost of health service
C. Increase trust for the health institution
D. Reduce time of hospital stay
LAM
22. A mother who is less than 6 months postpartum and amenorrheic (her menses
have not returned after delivery) is protected from pregnancy as long as she
breastfeeds her baby:
A. on demand, day and night, at least 6-10 times per day with very
little or no other food or fluids given
B. 2 or 3 times each day
C. during the day and the baby sleeps through the night
D. at night and expresses breast milk during the day
23. Choice of FP method for less than 6 months postpartum and amenorrheic
mother(her menses have not returned after delivery) :
A. IUCD
B. Depo Injection
C. Combined oral contraceptive
D. Condom
IUCD
24. For IUCD insertion
A. can be inserted during menstruation

B. can be inserted any time provided it is sure that she
C. immediately within 7 days of abortion (if there is no infection)
D. All of the above
25. The Copper T 380A IUCD prevents pregnancy principally by:
A. plugging the Fallopian tubes with its arms so eggs cannot get into
the uterus
B. preventing the sperm from fertilizing the egg
C. causing an infection in the uterus
93
D. preventing the release of eggs from the ovary
IMPLANTS
26. For Implant insertion
A. is inserted deeply into muscle through injection in the upper arm

B. 4 soft capsules
C. is inserted just beneath the skin of woman's upper arm
D. can be seen by all
27. Jadelle Implants provide protection against pregnancy for:
A. 10 years
B. 8 years
C. 7 years
D. 5 years
VSC
28. The characteristics about voluntary sterilization that should be most stressed to
the client is:
A. it is a permanent method
4) there is a risk of failure
5) reversal is possible
6) there are other methods available
29. Pregnancy after vasectomy is mostly due to:
A. not using contraceptives for 3 months after surgery

·4 spontaneous re-canalization of vas
·5 starting sexual activity too soon after surgery
·6 presence of a third vas deferens missed during surgery
MATERANL AND NEWBORN HEALTH
30. Mother can do the following activities during pregnancy.
·5 carry heavy bundles of grass

·6 drink alcohol
·7 daily bath
·8 take medicine without health workers advice
94
31. Total number of iron tablets to be taken in pregnancy and after delivery
A. 180
B. 225
C. 120
D. 250
32. Which of the following are not the danger signs of pregnancy?
A. dizziness
B. mild vaginal bleeding
C. Weight gain
D. Swollen leg and face
33. Which is not the danger sign of newborn?
·9 Unable to suck breast milk

·10 Fever
k. Cold injury
l. Jaundice
HMIS FORM
34. HMIS Form to be filled by VHW and MCHW for family planning service
E. HMIS 31 , 12, 13, and 17

F. HMIS 17, 31, 15 and 27
G. HMIS 11, 13, 17, and 29
H. All of the above
35. HMIS Form to be filled in outreach clinic(Gaown Ghar clinic) for family
planning service
A. HMIS 13
B. HMIS 17
C. HMIS 28
D. HMIS 12
95
CHECKLISTS FOR FP SERVICE REFRESHER TRAINING
The following FP service refresher training Checklists are used by the trainer to evaluate
each participant’s competency in:
 “ABHIBADAN” Technique
 DMPA Clinical Skills
The trainer uses the checklists to evaluate the performance of each participant in 3
categories
 Satisfactory: Performs the step or task according to standard procedure or

guidelines
 Unsatisfactory: Does not perform the step or task according to standard

procedure or guidelines
 Not Observed: Step or task not performed by participant during evaluation by

trainer
In determining whether the participant is qualified, participant’s performance should be

satisfactory. The goal of this training is to enable participant to be qualified enough tip
provide (i.e., “ABHIBADAN” counseling and Technique DMPA clinical skills)
Therefore, if if any staff is not found qualified and additional practice is needed,
sufficient extra time should be allocated during the course to ensure that the participant is
qualified. Finally, once qualified, each participant should have the opportunity to apply
her/his new knowledge and skills as soon as possible. Failure to do so quickly leads to
loss of provider confidence and ultimately loss of competence.
96
Sita's Event
Sita was a daughter of simple farmer. She had an opporturvity to study up tp call V. It was
nit difficult to have a a notrmal food and clothing. She was married ina neighbouring
village with Ramesh who aeas an SLC passat the age of 20 . Ramesh family had alos no
problem for food anf clothing. Sita ' slife was happier due after getting married with
Ramesh because of lovibg husabanf and helpful husband and fsthe and mother in 0lawa.
Within few months of marriage Sita got pregnanat. The family was pleased after knowing
about her preganancy. they did not prepared for prpeganancy thinking that it is noramal
event despitere they were happy that new member is coming in the family.
They did not have prepared prepare for anything for eaxamaple e where to go for
delivery , whom to contact, where to go, znd any problem how to go and manage for
money..
Immediately after Sita has dekivery pain she called a experienced women form the
community. She also sat with her and gave assurance . Ramesh and his father were
waiting outside tensed. Suddenly, every body outside home became happy after hearing
baby cry. The health of Sita and newborne was good. But within 24 hours of giving birth
Sita had a heacvy nbleeding . Everybone was anxious seeing her condition. However,
they were waiting that she will be fine. Sita ' father in law axalled a faith healer afert
seeing no improvement for sometime. Faith healer treated hear slashing red hen thninking
that god is angry. Even afyer that there was no improvement in Sita' s health/ When she
did nit improve her husbad went to Mahile Bhauju for help. The neborne baby had a cold
injury when they were abbnxious of rimprovment about her month. Mahile Bhuju
suggested theem take her to hospital They started looking for transportaion and money
yot ake her to hospiytal . Father in lwaa started looking for the mean of rttansportaion
for taking her to hospital . He was not able to find any means of transportaion. Ramesh
also went o the cvilalge to look for money. He went to borrow money with Kailai dai due
to lack of sufficient money. Since Kaila baje did not had enough money he had to to go
his friend ,Pawan After going heare and there he returened home with some amount of
money. But In the meantime sita had died.
1. Why Sita died?

2. How Sita could have been saved?
3. Whether any such event like Sita has occurred in your village? If yes, please tell
about such events.
4. What could be done for preventing such events to occur?
Possible answers
1. Heavy blood loss
97
2. Sita could have been saved if everything such as money and means of
transportation were planned before on time.
3. Share the experiences among the participants
4. Discuss the following points on the basis of true stories narrated by the
participants and above mentioned story.
a. Identify individuals for borrowing money and institutions

b. Means of transportation
c. Appropriate health institutions/selection of skilled health worker
d. Mange possible blood donors
e. Timely identification of danger signs of pregnancy
f. Need for going to appropriate health facility
Kavita's Event
Kavita is the wife of Kamal. Everyone loves her because of her friendly nature. It has
been 11 month since she has given birth to a lovely daughter. She has put on weight
because of good postpartum care. Menstruation did not return after the delivery of her
child. She and her husband think that it is safe even without using family planning
methods until the return of mens. Due to gaining weight and bulging of her abdomen she
suspected for preganancy and told about it to her husband and others. Everyone told that
it is due to previous pregnancy. Since she was not convinced sahe went for examination
to the health facility. She was surprised to know that she has been prpegant for last 3
months. Many questions camed e to her mind. Can one become pregnant after delivery
and without return of mens? I can not think of another bbay when my child is so small
etc.
After narraing the Kavita's event, rainers should proceed the session by asking following
questions
 Do such problems are seen in our villages as like Kavita's ?

 How Kabita got this problem?
 What Kavita will do now?
 What will be effect on Kavita and her two babies if she gives birth to next child?
98
Things to be taken care by the trainers during training session
Eacch particapnts should be provided with Reference Manual, Exercise book,

pencil, pen and eraser. After reading the booklets and solving the questions
answers and exercises and should be cleat Triners should be clear that the
participants will fain the knowledge and skills read the Trainiung Hand book
questions and anseerrs and exercises and find out the answers of the question
particapnts an can fain the knowledge and skills should be clear gain the
The role of the trainer in this training will be as follows
1. Introduction is very important among the participants. Therefore, trainers

should encourage the participants to introduce themselves.
2.
1.
99
CHECKLIST FOR FAMILY PLANNING “ABHIBADAN”
TECHNIQUE
(To be completed by Clinical Trainer)
not performed satisfactorily, or No if not observed.
Satisfactory: Performs the step or task according to standard procedure or guidelines
guidelines
PARTICIPANT Course Dates ______________

Counseling Communication
1 Maintains eye contact with the client
 Uses an appropriate tone of voice.
 Exhibits appropriate body language.
 Listens attentively.
5. Corrects rumors and misinformation
6. Uses the family planning flipchart effectively
“A” Step
1. Greets the client and introduces herself.
2. Offers the client a seat
3. Asks why she has come to the clinic.
“BHI” Step
1. Assesses client’s FP medical and obstetrical history.
2. Assesses the client’s reproductive needs (short, long term
and permanent)
3. Assesses what the client knows about family planning
methods and asks client what method she is interested in.
“BA” and “DA” Step
1. Tells the client about the methods available based on the
client’s previous knowledge of family planning.
2. Helps the client make a decision by focusing on the

potential side effects of the method she is considering
3. Correctly explains to the client how to use the chosen
method and warning signs.
100 COFP and Counseling for Trainer’s Notebook

4. Ask client id she has any question and if , then provide
answer
5. Asks the client to repeat all instructions in her own words
“NA” Step
2. Discuss return visit and follow up with the client:
* where to go for more supplies
* early identification of the problems
· when to return to the HP or Health Facility.
2. Encourage the client to return at anytime if they have a
question or problem.
3. Politely say goodbye to the client and invite her/him to
return again.
Sterilization Clients
·8. Explains the informed consent form
·9. Tells the client that there are other methods that she can
use to meet her reproductive needs
·10. Tells the client when to return for routine follow-up
·11. Refers the client for methods or services not offered at this
site
Participant is qualified not qualified to give “ABHIBADAN” technique.
Trainer's signature Date _____________________
COFP and Counseling for Trainer’s Notebook 101

(To be used by Clinical Trainer)

not performed satisfactorily, or No if not observed.
Satisfactory: Performs the step or task according to standard procedure or

guidelines
guidelines

________
Getting Ready
3. Checks expiry date on DMPA
4. Adequately prepares client for injection (positioning etc.)
Preparing the Injection Site
3. Washes hands with soap and water.
4. Cleans skin with clean cotton and rectified spirits (alcohol)
wiping with a circular motion outward from the injection site
and allows skin to dry.
Preparing the Injection
3. Shakes vial of DMPA thoroughly but gently
4. Draws DMPA into the syringe and expels air bubbles without
contaminating needle or vial.
Giving the Injection
2. Inserts the needle deep into the muscle (deltoid in arm or
upper, outer quadrant of gluteal area) and injects DMPA
slowly.
Post-Injection Tasks
4. Applies pressure to injection site with cotton, but does not rub.
5. Discards assembled needle and syringe in a puncture proof
container without recapping or breaking or bending the needle.

6. Washes hands thoroughly with soap and water.
Post-Removal Counseling/Client Instructions
4. Instructs client to return for another injection in 3 months;
gives exact appointment date.
5. Explains side effects (changes in menstrual pattern,
headaches/dizziness, weight gain, breast tenderness).
Encourages client to return if she has side effects or problems
with bleeding.
6. Instructs client about warning signs and need to return to clinic
(heavy bleeding, delayed menstrual periods after interval of
regular periods).
Participant is qualified not qualified to give DMPA injections.
Trainer's comment
Trainer's signature Date

______________________
COFP and Counseling for Trainer’s Notebook 103

PERFORMANCE ASSESSMNET SCORE
55
50
45
40
35
30
25
20
15
10
5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
NUMBER OF PARTICIPANTS

Trainers Guide For CBD

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Family Planning Service: Refresher Training

(VHW and MCHW)

FP Service Refresher Training (VHW and MCHW) Trainers Guide 1

FP Service Refresher Training (VHW and MCHW) Trainers Guide 2

TAKE-HOME EXERCISE ANSWER-KEY

FP Service Refresher Training (VHW and MCHW) Trainers Guide 3

FP Service Refresher Training (VHW and MCHW) Trainers Guide 4

 Interested in the training subjects

Training methods used in the course

 Uses Behavior Modeling

FP Service Refresher Training (VHW and MCHW) Trainers Guide 5

Two Days Exercise:

FP Service Refresher Training (VHW and MCHW) Trainers Guide 6

Objectives of the Training

 Provide communication skills for counseling service to the participants

 Influence positive attitude towards different family planning methods.

 Provide quality updated information related to family planning to the participants.

 Provide basic family planning management knowledge to the participants.

 Knowledge: For knowledge Midcourse Training Questionnaire minimum score 85%

FP Service Refresher Training (VHW and MCHW) Trainers Guide 7

Lesson: 1 Population and RH status

 Can explain the population status of Nepal

Lesson: 2: Female and Male Reproductive System

Lesson: 3: Interpersonal Communication and Family Planning Counseling

 Can describe types and elements of communication.

FP Service Refresher Training (VHW and MCHW) Trainers Guide 8

Lesson: 4: Client Assessment

 Describe the indications, contraindications and precautions according to the client

Lesson: 5: Infection Prevention

 Demonstrate hand washing following step by step procedure.

Lesson: 6: Breast-Feeding for Lactation Amenorrhea Method

By the end of session, participant will be able to counsel on LAM

 Explain the process of prevention through LAM

FP Service Refresher Training (VHW and MCHW) Trainers Guide 9

 Can explain the advantages, disadvantage and effectiveness of condom use

Lesson: 8: Combined Oral Contraceptives

29544. Screen appropriate clients for COCs

Chapter-10: EMERGENCY CONTRACEPTION

30136. Participant will state dosage of Emergency Contraceptive.

FP Service Refresher Training (VHW and MCHW) Trainers Guide 10

30728. Using cue-cards provide counseling to a client about DMPA/Depo-Provera.

Chapter 12-14: IUCD, Implant, VSC

Chapter 15-16: Management of Sexually Transmitted Infections/HIV AIDS

FP Service Refresher Training (VHW and MCHW) Trainers Guide 11

Chapter 17: Family Planning Counseling and Service Management

TRAINING LEARNING METHODS

• Illustrated lectures and group discussions

• This course handbook is designed to be used with the following materials:

• Reference Manual ( Comprehensive Family Planning and Counseling Course)

FP Service Refresher Training (VHW and MCHW) Trainers Guide 12

Participant Selection Criteria

FP Service Refresher Training (VHW and MCHW) Trainers Guide 13

 Interested in the training subjects

Training methods used in the course

Mastery Learning Approach is based on the Adult Learning Principles

 Uses Behavior Modeling

 The Progress of the knowledge based learning is examined through written

FP Service Refresher Training (VHW and MCHW) Trainers Guide

Two Days Exercise:

Goal of the Training

Objectives of the Training

 Provide communication skills for counseling service to the participants

 Influence positive attitude towards different family planning methods.