WORKSHOP 2- Contraception Counselling

7/27/2019 WORKSHOP 2- Contraception Counselling

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WORKSHOP 2 : ContraceptiveCounselling on Side Effect

BY:-DR NOR HUDA BT MAT ALIClinical SpecialistHospital Tengku Ampuan Afzan


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Objectives

Importance of ContraceptivecounsellingLearn more about side effectsConsider side effects from clientscultural & personal contextUnderstand side effects impact onuse & continuation


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Adherence to contraception

pregnancies unintended(Hatcher,R.A,Contraceptive Technology 19 th ed 2009)

Some research suggest that actual

method failure may be responsible for


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CONTRACEPTIVECOUNSELLING

No contraceptive agent is PERFECT

Satisfaction is enhanced when appropriatepreutilization counseling is offered and whenside effects are successfully managed


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Informed choices

Identify Medical EligibilityCriteria (MEC) andcontraindications

Identify Non-contraceptivebenefits

Selected Practice Recommendations

(SPR)


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ReproductiveAge

ReproductiveGoal

Medicalconditions Lifestyle

Logistic &

cost


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Effective Contraceptive Counselling

The best method of contraception forpatients is one that will be in harmonywith their wishes, fears, preferences

and lifestyle; A method that is morelikely to be used correctly

(Hatcher,R.A.,et al, Contraceptive Technology 19 th ed 2009, p 41)


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REASONS FOR NOT USING/DISCONTINUATION

Reason 1994 2004

Peninsular M Sabah Sarawak

To conceive 53 39.3 52.5 44.1

Fear of SideEffects

10.3 26.8 26.4 27.5

Husband issue 8 12.6 4.8 9.6

Medical factors 3.4 5.4 4.8 4.2Others 25.4 15.9 11.6 14.6

Total 100.00 100.00 100.00 100.00

Source: NPFDB, MPFS 1994 & 2004


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Fear of Side Effects

Age Group (years old) Total (%)

25-29 22.730-34 24.435-39 33.240-44 28.345-49 34.4

Source: NPFDB, MPFS 2004


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Negative impacts are reducedby:

Discussing side effects before methodselectionManaging side effects promptlyAllowing method switching


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Side Effects vs.Complications

SIDE EFFECTS : symptoms orconditions that pose no significant

health risk

COMPLICATIONS : serious health problems or conditions


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HeadacheIncreasedmenstruationLight or nomenstruationMenstrual cramping

Severe headachesVery heavybleeding (twice as

long or as much )Severe, constantpain in the chest, legor belly


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Weight gain or lossNausea

Vaginal drynessLocal skin irritation

Skin or eyes thatbecome unusuallyyellow (jaundice)Loss of sensation inarms or legs


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Clinic Follow up:Observation of Side Effects

Most contraceptives have some sideeffectsSome side effects are common andmild; others are rareSome improved over timeSome are easily treated


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Clients may experience one or several

Side effects can vary by brand

Type & severity vary by method & user

Clinic Follow up:Observation of Side Effects


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The truth about side effects

Important to distinguish side effects fromrumors or misinformation

Challenge:Exp: Clients believe that certain methods will

render a woman sterile Solution:Exp: Always discuss returning to fertility as a

significant issue


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Positive or negativeconsequences of side effects:

clients responses Feel unwell Feel too weak toworkUnable toparticipate inreligiouscommunityactivitiesUnable to cookFeel unattractive ormore attractive

Limit sexualactivity or enhancesexual pleasureDiscontinuecontraceptive

method or use itirregularly


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Important to pay attention to concernsof clients partner

E.g. , Counseled husbands of Implantusers reassured regarding partnersspotting

Side effect counseling & methoduse


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Reassure that counseling can be brief. Provide Pamphletes.Too Busy

Reassure that side effect counseling increases use & continuation.

Provide literature.

Worried thatclients may

reject method(s)

Give providers training on

common side effects

Unaware offrequency of

sides effects

Provide simple written &AV materials for providers

Lack of supportmaterial

Why providers may not inform clients

about side effects ?


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Helping clients knowwhat to expect

Say that many clients experience noside effects

Give information regarding how tomanage side effects

Make clients feel comfortablereturning for assistance, if needed


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Helping clients choose amethod

Describe side effects of variousmethods, their frequency & durationReassure regarding safety of methodsEmphasize client satisfaction withmethods in generalElicit & answer questions; correctmisinformation courteously


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Helping clients know what toexpect: reminders

Elicit and respond to client concerns

Be concise & clear

Be honest regarding frequency orseverity of side effects

Provide support material


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Why help clientsmanage side effects?

Increase clients comfort, satisfactionwith & continuation with the method

Discover if side effect is due to incorrectmethod use

Discover if side effect signals a moreserious condition


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Steps to managing sideeffects

Ask how/why the side effect concernsclientRespond in clear languageExplain usual duration of side effectExplore with client what to do if itpersists


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Steps to managing sideeffects

Help client weigh contraceptive &non-contraceptive benefits versus sideeffect

If client still wants another method,help explore options


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Case Study

29 years old woman with 2 kidscomplain of prolonged bleeding for 2months since implanon was inserted

and her husband requested her tohave the implanon removed.


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Case Study

35 years old woman with 5 kids andpoor spacing was referred to you forFP. Shes not keen for implanon as she

hear rumors related to weight gainwhen using the method.


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Case study

29 years old, Para 3 with history of 1previous scar in 2007. Mirena inserted2 month post partum. 1 year after that

no IUD string felt. Had regular selfcheck up for IUD string before that.Whats the next step


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Documents

WORKSHOP 2- Contraception Counselling