MODULE 3

FP Client Assessment
OVERVIEW

This module provides the necessary knowledge and

skills to assess the health needs and status of FP
clients and document these using standard forms.
OBJECTIVE

At the end of this module, participants must be able

to perform a complete FP client assessment based
on evidence-based global standards
SESSIONS

Session 1 - The use of FP Service Record or Form 1

in client assessment

Session 2 - WHO Medical Eligibility Criteria for

contraceptive use
SESSION 1

The Use of FP Form 1 in

Client Assessment
Learning Objectives

At the end of the session, the participants must be

able to:

•Define client assessment.

•Explain the purpose of client assessment in FP

service provision.

•Describe the steps of FP client assessment.

•Describe the FP Service Form 1.

•Demonstrate use of the FP Service Form 1.

 Learning Objectives

• Explain the guidelines on physical examination in FP

service provision.

• Enumerate the steps in physical examination of FP

clients.

• Explain the purpose of laboratory examinations in FP

service provision.

• Describe commonly performed laboratory examinations

in FP/RH service provision.
Client Assessment in Family Planning

The Family Planning Client Assessment

Definition

• Is a process by which the health worker learns

about the health status and the FP needs of the
client.

• Initial step is to take the clinical history.

• Data obtained are documented and evaluated.

Purpose

• Establishes the client’s health status.

• Determines the client’s eligibility for using a

contraceptive method.

• Determines whether the client is in good health,

needs further examinations and management
including closer follow-up and/or referral.

• Identifies the need for additional procedures and/or

laboratory examinations.
Steps of FP Client Assessment

1. Prepare the client.

• Greet her cordially and ensure comfort.
• Establish rapport with the client.
• Establish the purpose of the visit.
• Explain to the client procedures to be performed
(including physical and/or laboratory
examinations, if needed.)
• Encourage the client to ask questions openly.

2. Take and record the client’s health history using the

FP Service Form 1.
Steps of FP Client Assessment

3. Discuss with the client:

• Findings based on the history.

• Need to perform further examinations like physical
and/or laboratory examinations.
• Need for referral of laboratory examinations or
further management.
• Need and schedule of follow-up visit(s).
The Family Planning Service Form 1
(FP Service Form 1)
Components

1. Personal data

2. Medical history (past and family)

3. Reproductive history

• Menstrual history
• OB history
• FP history
• Risk for STIs
• VAWC

4. Present illness or health concern

1. Personal Data

1. Complete name of client

2. Name of husband

3. Client’s age, sex

4. Occupation, average family monthly income

5. Educational attainment

6. Address
2. Medical History

• Past illnesses
• Hospitalizations
• Accidents/Injuries
• Allergies
• Surgeries

• Immunizations

• Habits (smoking, drinking, substance

abuse, etc.)

• Family History (CVA, heart disease)

3. Reproductive History

Menstrual History

• Menarche - age of onset of menstruation

• Last Menstrual Period (LMP) - first day of last

menstrual period including the number of
days, character (scanty, moderate, or heavy) of
menstrual flow and accompanying symptoms

• Previous Menstrual Period (PMP) - first day of

menstrual period prior to the mentioned LMP
3. Reproductive History

Obstetrical History

• Gravidity (G) – number of pregnancies

regardless of outcome

• Parity (P) - number of pregnancies reaching

viability (>20 weeks AOG)

• Other information (F-P-A-L)

• Full-term pregnancies
• Pre-term pregnancies
• Abortions
• Living children
3. Reproductive History

FP History

• FP method currently being used

• duration of use
• satisfaction with use

• FP method previously used

• duration of use
• reason/s for discontinuation or shifting

• Reproductive goals/ intents

• to achieve desired number of children
• to limit or to space
3. Reproductive History

Risk for STIs

Ask the client the following questions:

• Do you suspect your partner to have another

sexual partner?

• Do you think your sex partner might have an

STI?

• Have you or your partner ever been treated for

STIs?
3. Reproductive History

Risk for STIs

• Do you or your partner experience the

following:

• Unusual (pus-like, foul smelling) discharge

from the vagina/urethra?

• Itching and/or sores around the genital

area?
3. Reproductive History

VAWC

Ask the client the following questions:

• How is your relationship with your husband or

partner?

• Does he know about your coming to the clinic?

• Is he willing to cooperate or support you in using

a FP method?
4. Present health status or concerns

• Present complaint or concern

• Onset, nature, and duration of present complaint or

concern

• Accompanying symptoms and

precipitating/aggravating factors

• Measures or medications taken to relieve

symptoms and precipitating/aggravating factors

• Prior consultations or medications

Exercise on filling up the form 1

• Role Play

• Part 1 – Personal Data

• Part 2 – Medical History

Physical Examination
Guidelines

• It is not always necessary to ensure the SAFE USE

of a FP method.

• The WHO Applicability of Procedures can serve as

the guide that will tell which of the procedures or
examinations may be necessary.

• Performed during the initial visit only to confirm

conditions suspected or noted during the client
history-taking.
Guidelines

• Performed at any time to evaluate client’s

complaints related to the use of an FP method. This
is to ensure that the client has not developed
conditions which are precautions to the continued
use of the method.

• Performed to identify complications which may have

arisen from the use of an FP method.
Steps

Remember
• Proceed from head to toe
• Inspect first, palpate later

1. Take vital signs.

• Blood Pressure

• Pulse Rate

• Respiratory Rate

• Temperature
Steps

2. Prepare client.

• Make the client comfortable.

• If doing an internal exam: Ask client to void/empty

bladder and wash perineum.

• Assure privacy and confidentiality.

• Explain the procedures (what is going to happen

and why).
Steps

3. Prepare needed instruments and supplies.

• Prepare the instruments and supplies ahead of

the actual Physical Examination especially
when there is no knowledgeable assistant
around.

4. Conduct the physical examination.

• If the health provider is a male, the female client

may request a companion while the physical
examination is being conducted/performed.
Other Physical Examination that
may be done when necessary
• Breast Examination
• Abdominal Examination
• Pelvic Examination
- detect any abnormality or pathologic
condition
- Obtain specimens for lab.exam
Laboratory
Purpose

• Laboratory tests are NOT ALWAYS REQUIRED

(refer to WHO Applicability Chart)

• Performed to further investigate abnormal

findings on history taking and/or physical
examination
Hemoglobin Determination

• To confirm and determine severity of anemia

in a pale client.

• Normal ranges depend on age and sex of

client.

• Normal ranges are:

• Adult males: 14-18 gm/dl

• Adult women: 12-16 gm/dl

Other Laboratory Examinations

• Wet Smear - to find the causative agent of existing vaginitis-

monilia, trichomonas or gardnerella

• Gram Stain - to determine the microorganism causing the STI-

gonococci or chlamydia

• Pap Smear - cervical secretions collected examined under a

microscope in order to look for pre-malignant or malignant
changes

• Acetic Acid - abnormal cells may be identified by applying

acetic acid to areas of suspected cervical lesions
Summary
SESSION 2

WHO Medical Eligibility

Criteria (MEC)
Learning Objectives

At the end of this session participants must be

able to:

• Explain the use of the WHO-MEC.

• Demonstrate the use of the MEC Wheel.

WHO Medical Eligibility Criteria (MEC) for contraceptive use

• WHO MEC is an available reference tool for

assessing clients on their eligibility for starting or
initiating and continuing the use of a specific
contraceptive method based on certain criteria
developed from evidence-based standards.
Simplified MEC categories for temporary methods

Wit h Li m it ed
Wit h C l ini cal
C at egor y C l in ical
Jud gm ent Jud gm ent

U s e t he m et hod in U s e the met hod

1
any c ir c um st ances
Gene ral ly us e t he U s e t he m ethod
2
m ethod
U s e of t he met hod D o no t use the
not us uall y m ethod
r ec omm ended
3
unles s ot her , mor e
appr opr iat e
m ethods are not
av ailabl e or
ac c eptable
M ethod not to be D o not us e t he
4
us ed m ethod
Simplified MEC categories for fertility awareness-based methods
Simplified MEC categories for permanent methods
WHO MEC Wheel for contraceptive use- NEW!

• Contains the medical eligibility criteria for starting use of

only 9 of the contraceptive methods

• Tells FP service providers if a client with a known

medical condition can use a particular contraceptive
method safely and effectively in a convenient and
handy way by just matching the medical condition with
the chosen method through movement of the wheel
WHO MEC Wheel for Contraceptive Use –NEW!

Recommendations on NINE common types of contraceptives:

• Combined oral contraceptives, low dose COC

• Combined contraceptive patch, P
• Combined contraceptive vaginal ring, CVR
• Combined injectable contraceptive, CIC
• Progestogen-only pills, POP
• Progestogen-only injectable, DMPA (IM/SC)/NET-EN
• Progestogen-only implant, LNG/ETG, PSI
• Levonorgestrel-releasing IUD, LNG-IUD
• Copper-bearing IUD, CuIUD
How the 2015 WHO MEC Differs? NEW!

Addition of:
• New methods:
• CVR- Combined Vaginal
Ring
• DMPA SC
• LNG IUD

• Emergency
Contraception:
• EC Pills
• IUD
How the 2015 WHO MEC Differs? NEW!

Addition of:
• Category:
• HIV Stage 3 or 4

• Post-partum and
Breastfeeding
(Expanded):
• <48 hours
• 48 hours to 4 weeks
• 4 weeks to <6 weeks
• 6 weeks to < 6 months
 How the 2015 WHO MEC Differs? NEW!

• Deletion of :
• 40 years and older under AGE
category
• Past PID (Category 1 for all
methods)

• MEC Update:
• Cervical Intra-epithelial Neoplasia
• LNG IUD (Category 2)

• DVT replaced by Venous

Thrombosis (Deep or Superficial)
Exercise on Using the MEC Wheel
Applicability of Different Laboratory Tests
and Procedures
How to be Reasonably Sure the Client is not
Pregnant
How to be reasonably ensure the client is not pregnant

• A health provider can usually tell if a woman is not

pregnant by asking a few questions.

• A pregnancy test and physical examination are

usually not needed.

• A woman should not use an FP method while she is

pregnant.
WHO MEC for contraceptive use

• Specified examinations/procedures are required for

only a few of the FP methods

• The use of the WHO MEC on applicability of various

procedures and tests shows that a THOROUGH or
COMPLETE physical examination MAY NOT BE
WARRANTED, if the client is decided on a FP
method.
Summary and Key Learning Points

• The health provider needs to have the necessary

knowledge and skills to be able to adequately and
accurately assess the health needs, as well as the
health status, of clients seeking to improve the
quality of their lives.

• Client assessment is the first stage common to any

health care service, and an important step prior to
the provision of FP services.
Summary and Key Learning Points

• Client’s FP needs and data on medical status and

conditions are obtained to ensure that they are
medically eligible for their chosen FP method.

• Client Assessment involves the following

components:

History-taking

Physical and Laboratory

Examinations
Summary and Key Learning Points

• The WHO Medical Eligibility Criteria is an available

reference tool for assessing clients on their eligibility
for initiating and continuing the use of a specific
contraceptive method based on certain criteria.