Role and Function of

the Midwife
 I. Counselor/ Motivator
Family Planning Counselor
Provides individual counseling to female, male and
adolescent family planning clients regarding basic
anatomy and physiology, human reproduction,
contraceptive methods, pregnancy testing,
pregnancy options, and appropriate referral(s).
Provides information to clients about establishing
and maintaining optimum health practices, safe sex
practices, HIV/AIDS prevention, violence
prevention and intervention, and routine health care
and screening recommendations.
 Counselor Characteristics:
Believes in and is committed to the basic values
and principles of family planning and client rights
Is accepting, respectful, non-judgmental and
objective when dealing with clients
Is aware of her/his own values and biases and does
not impose them on clients
Understands and is sensitive to cultural and
psychological factors (such as family or
community pressures) that may affect a client's
decision to adopt family planning
Always maintains clients' privacy and
confidentiality
 Counselor Skills
An effective counselor possesses strong technical
knowledge of contraceptive methods:
Knows all technical aspects of family planning
methods thoroughly
Is prepared to answer contraceptive and non-
contraceptive questions comfortably on subjects such as
myths, rumors, sexuality, STDs, reproductive and
personal concerns
Is able to use visual aids and explain technical
information in language that the client understands
Is able to recognize when to refer the client to a
specialist or other provider
 An effective counselor possesses and is able to
apply good interpersonal communication skills
and counseling techniques:

Relates/empathizes
Listens actively
Poses questions clearly, using both open- and
close-ended questions
Answers questions clearly and objectively
 An effective counselor possesses and is able to
apply good interpersonal communication skills
and counseling techniques:

Recognizes nonverbal cues and body language

Interprets, paraphrases, and summarizes client
comments and concerns
Offers praise and encouragement
Explains points in language the client understands
in culturally appropriate ways
 Counseling

An important prerequisite for the initiation and

continuation of an FP method.
An interactive process between the service
provider and client; it allows for information
exchange and support, so that clients can make
decisions, design a plan, and take action to
improve their health.
 Essentials of Good Counseling
A good counselor is trained to:

Understand and respect the clients rights.

Earn the clients trust.
Understand the benefits and limitations of all
contraceptive methods.
Understand the cultural and emotional factors that
affect a clients (or a couples) decision to use a
particular contraceptive method.
 Essentials of Good Counseling
A good counselor is trained to:
Encourage the client to ask questions.
Use a nonjudgmental approach, which shows
respect and consideration to the client.
Present information in an unbiased, client-sensitive
manner.
Actively listen to the clients concerns.
Understand the effect of nonverbal
communication.
Recognize when she or he cannot sufficiently help
a client and refer the client to someone who can.
 To be effective, counseling must be based
on the establishment of trust and respect
between the client and counselor. All clients
have certain rights, including:

The right to decide whether to practice FP

The freedom to choose which method to use
The right to privacy and confidentiality
The right to refuse any type of examination
The freedom to choose where to seek services
 The Counseling Process

When discussing contraceptive options with

clients, service providers should briefly review all
available methods of FP. Service providers should
be aware of a number of factors about each client
that could be important when selecting a method.
These factors might include:
 The Counseling Process

The reproductive goals of the woman or couple

(i.e., the spacing, timing, or limiting of births)
Personal factors, including the time, travel costs,
pain, or discomfort likely to be experienced
The need for protection against STIs and HIV
 Steps in FP Counseling

The GATHER Approach

GATHER is a useful memory aid to help us to

remember the basic steps in the counseling
process and to add structure to a complex activity.
It can be adapted to meet each individual clients
needs.
 Steps in FP Counseling
The following are elements of a successful
counseling session:
G = Greet client in a friendly, helpful, and respectful
manner.
A = Ask client about family planning needs,
concerns, and previous use.
T = Tell client about different contraceptive options
and methods.
H = Help client to make decision about choice of
method s/he prefers.
E = Explain to client how to use the method.
R = Return: Schedule and carry out return visit and
follow-up of client.
 II. Service Provider

Should be competent in counseling for all methods

of FP and should have basic counseling skills
appropriate to individual client needs.
Who are counseling for and providing FP might
encounter clients who are coming for FP services,
but have other needs as well.
Shouldbe prepared to counsel clients about sex
and sexuality, fertility, childbearing, prevention of
HIV and other STIs.
 Provision of Contraceptives
Contraceptives should be provided to clients in
accordance with approved method-specific
guidelines and job-aids, by providers who have
been trained to provide that method. A
supermarket approach should be adopted; that is,
clients should have a wide range of methods
(method mix) from which to choose. These
guidelines recognize task-shifting as an important
mechanism for increasing access to services
(especially at levels 1, 2, and 3), and specify which
cadre of service providers may provide which
method, subject to appropriate training.
 Follow-up and Referral System

All clients who choose an FP method must be

informed of the appropriate follow-up
requirements and encouraged to return to the
service provider if they have any concerns. Clients
that require or choose a method that is not
available at a facility must be advised where they
can obtain the method. Providers should follow
the established referral system.
 Record Keeping

All FP providers should maintain proper records on each

client and the distribution of contraceptives. Non-
governmental organizations (NGOs) and the private sector
also should follow the Ministry of Healths record-keeping
and service provision guidelines.
 Supervision

Supervision is an essential component of program

monitoring and evaluation; it ensures that
guidelines are being followed and clients needs
are being met. Facilitative (supportive)
supervision should be encouraged, and the
supervisor should be seen as a team member who
motivates staff and guarantees the rights of
providers and clients. Supervision activities
should extend to private-sector.
 Logistics

Service providers are expected to have a

consistent supply of methods available in order to
offer a choice to clients.
 Categories of FP Service Providers

Many categories of people can be involved in the

provision of FP services after they have received
the necessary training and instruction. Similarly,
FP services can be provided at various levels of
the health care system (e.g., from community to
tertiary care levels) and within facilities that are
operated by varying providers (e.g., public, faith-
based, private). However, certain standards must
be met before providers can offer a particular FP
method.
 Values and Attitudes
Attitudes, opinions, and beliefs (including
misconceptions among health service providers)
can affect the way providers interact with clients.
Everyone has a right to her or his own beliefs, but
health care providers have a professional
obligation to provide care in a respectful and non-
judgmental manner. Every interaction between
health care staff and clientsfrom the moment
clients enter the health care setting until they leave
the facilityaffects the clients and has an impact
on their:
 Values and Attitudes
Willingness to trust and to share personal
information and concerns
Ability to listen and to retain important
information
Capacity to make decisions that accurately reflect
their situation, needs, and concerns
Commitment to adopt new health-related
behaviors
Willingness to continue using the facility
Ability to be agents of positive change in the
community
 Clients Rights

Information

Service providers should ensure that clients receive

adequate information regarding the services
provided. Clients need to be informed about the
workings of the SDPstheir opening hours,
services provided, and costs involved (if any
 Clients Rights

Information

Clients interested in a particular method need to

know how it works and how to obtain/ use it, the
importance of follow-up, information about
potential side effects and how to manage them,
warning signs, and the protection from STIs
(including HIV/AIDS) that it may or may not offer.
 Clients Rights

Information

Clients also need to be informed about how to

switch to another method if they so desire.
 Access to Services

All clients, including adolescents and PwDs, have

the right to FP services at all levels of care. The
SDPs should be clean, well-organized, and
adequately supplied with quality contraceptives.
Clients should not have long waiting times and
should be able to obtain the contraceptive of their
choice.
 Informed Choice

Clients should be counseled on the range of

contraceptive options and methods that are
available at all levels of care, and should be
provided with accurate and complete information
to enable them to make an informed decision.
 Safety of Services

Service providers should adhere to infection-

prevention practices and client instructions for
effective use of the contraceptive method.
 Privacy and Confidentiality

Care should be individualized and discrete. Clients

should be protected from both auditory and visual
exposure. Client information should be protected
from access by anyone who is not directly
involved in his or her care.
 Dignity, Comfort, Expression of
Opinion

Clients should be treated with dignity and

friendliness. Precautions should be taken to
ensure minimal discomfort. Clients
opinions should be sought and their wishes
and perspectives respected.
 Continuity of Care

The clients records and follow-ups should be

accurately and completely documented to ensure
appropriate client management and clinical safety.
 Provider Staffs Needs

Supportive Supervision and Management

The work environment and facilitative
supervisory system should be supportive and
emphasize mentoring and joint problem
solving. The system should help staff provide
the best possible FP services.
 Information, Training, and
Development

Staff should be knowledgeable and skilled in

providing FP, and have ongoing opportunities for
training to update and maintain a high level of
performance.
 Supplies, Equipment, and
Infrastructure

Staff should have sufficient and appropriate

supplies, instruments, and logistics infrastructure
to ensure uninterrupted FP services and the safety
of service providers.