Konseling Keluarga Berencana

Tujuan Di akhir seminar, peserta mampu untuk: Memahami arti informed choice Memahami sikap seorang konselor KB yanf baik Menjelaskan tahap konseling KB dengan metode GATHER Suggested script: The learning objectives for this session are based on input from various stakeholders <insert who provided input: participants, supervisors, health officials>. The objectives of this session are as follows: By the end of this training session, participants will be able to: █ <click the mouse to advance through the objectives, reading each objective aloud; then go to the next slide>. █

Apa itu Informed Choice? Semua calon akseptor KB harus memahami bahwa mereka memiliki informed choice: Kesempatan untuk secara bebas memilih satu diantara beberapa pilihan metode KB yang sesuai dengan kondisi kesehatannya Informasi lengkap dan akurat serta mudah dipahami tentang berbagai metode KB yang ada What do we mean by informed choice? <allow participants to respond; use responses to help define informed choice>

Mari kita lihat video berikut

Jadi... Konseling KB bukanlah tentang: Menyelesaikan masalah klien Memilihkan untuk klien metode KB apa yang paling tepat Menghakimi, menyalahkan dan menguliahi klien Menginterogasi klien Memaksakan kehendak Anda/memaksa klien untuk memakai metode KB yang Anda pilihkan Ask participants to partner with someone sitting near them. Ask participants to reflect on a negative counseling experience and to share with their partner what made the experience negative and one or two characteristics of the counselor or health worker involved in the negative experience. Ask the participants to talk about what the counselor did or said that was not productive or did not help the situation. If participants have difficulty thinking of a negative counseling experience, give them an example. Allow two or three minutes for this discussion. In the larger group, ask the participants to share what they discussed about their negative experiences. Click the mouse to reveal the list on this slide, and relate the bullet points to the participants’ responses. Discuss. Give examples from your experience of how clients have been treated and how that influences their behaviors and use of services; if possible, use quotes from clients about their experiences, without identifying the client. Remind participants that sometimes we are not aware of how we affect clients by things we say and do, therefore it is helpful to get feedback from each other during the training and from our supervisors when we return to our communities. Inform participants that next we will look at our own beliefs and attitudes and how they may get in the way of effective, informed choice counseling if they are not managed properly.

Tehnik Konseling KB dengan GATHER Penelitian menunjukkan bahwa konseling KB dengan metode GATHER bermanfaat  lebih banyak klien memilih menggunakan metode KB dan mereka menggunakan metode tersebut dalam jangka waktu yang lebih lama

Langkah-langkah konseling KB dengan metode GATHER 1 2 3 4 Menjalin hubungan dan menilai kebutuhan klien akan KB (Greet and Ask) Memberikan informasi tentang kebutuhan klien akan KB (Tell) In this section of the training we will review the stages of counseling during a client visit and how we can use the counseling tool to help guide our discussion with the client. There are four stages of the family planning counseling session. The title of each stage describes the primary task or tasks of that stage: In Stage 1, you establish rapport and assess the client’s needs and concerns. In Stage 2, you provide information to address the client’s needs and concerns. In Stage 3, you help the client make an informed decision or decisions about FP or help them decide how to address a problem. And, in Stage 4, you help carry out the client’s decision. The communication and counseling skills that you have learned and practiced are important in all of these stages. Though we will discuss each of these stages separately, in actual practice the stages flow one into the other and the boundaries between them are not distinct. To give you an idea of how a family planning counseling session works, I will demonstrate a counseling session that moves through all of these stages. Watch and see if you can identify when I am in each of these stages. I will stop the demonstration at certain points and ask you what stage you think I am in. Conduct a brief FP counseling session demonstration using Roleplay Scenario 1 in the Facilitator’s Guide. Ideally, arrange for two co-facilitators to conduct the demonstration so you may comment on the interaction. If necessary, conduct the demonstration with your co-facilitator. Stop the demonstration at several points to give participants the opportunity to identify each stage, correcting their responses as needed. Note the use of the counseling tool and other job aids used during the demonstration that participants will be using at their workplace, (i.e., Balanced Counseling Strategy method cards, or a method selection sheet) and inform participants that they will use these during practice role plays. Inform participants that next they will review the counseling tool. Distribute a counseling flip chart of counseling tool used in the country or The Community Health Worker Tool for Family Planning , which is one of the handouts in this module. If no local tool is available use WHO’s Counseling Tool for FP Clients and Providers or WHO’s A Guide to Family Planning for Community Health Worker’s and Their Clients (also a handout) or the Population Council’s Balanced Counseling Tool. If none are Available, use the Fact Sheets for each FP method. * Note, links to these tools can be found on the Training Resource Package Website. Membantu klien membuat informed choice untuk metode KB yang diinginkan (Help) Membantu melaksanakan keputusan klien (Explain and Return)

LANGKAH PERTAMA: Menjalin hubungan dan menilai kebutuhan klien akan KB (Greet and Ask)

Menjalin hubungan dan menilai kebutuhan klien (GREET dan ASK) 1 Menjalin hubungan dan menilai kebutuhan klien (GREET dan ASK) Sapa dengan ramah Yakinkan bahwa percakapan bersifat rahasia Tanyakan alasan klien untuk datang Tanyakan tentang suami, kehidupan di rumah, keluarga, masalah kesehatan, risiko PMS, status HIV Tanyakan tentang jumlah anak yang diinginkan, dan keinginan untuk mengikuti KB Suggested script: The first stage of FP counseling has three main purposes: 1) To establish a good connection with the client, 2) to find out why the client has come to see you, and 3) to gather basic information about the client’s situation so you can help them. To do this, you will complete these six tasks during this stage of counseling. Look at page 2 of your job aid to see these steps. <read list of tasks on slide; click the mouse to reveal each bullet> As we saw in the roleplay, it is very important to establish a good connection with the client at the beginning of the visit by greeting them appropriately. Make sure that you are in a private space where others cannot see you or overhear your conversation, and assure the client that everything he or she says will be kept confidential. Also make sure that the client is seated comfortably. After greeting your client, ask “How may I help you today?” What is another way to ask about the reason for the visit? <allow participants to answer> <give an example, such as “What do you hope that I can do for you today”> Then gather information about these areas of the client’s life: home life, ideal family size, health, partner or partners, sexual behavior and HIV status. Ask a brief series of questions to gather this information. The amount of detail discussed at this point depends on the client’s needs and whether or not the client is new or is a returning client. Ask about a client’s plans to have children and desire for family planning—to delay or prevent pregnancy, or to become pregnant. Next, help the client consider their STI risk. When assessing STI risk, ask questions and then listen closely to the client. Respond in a way that helps them explore their own risk and decide for themselves if they are at risk. You should not tell them that they are at risk, even if you think they are. The information gathered at this stage should be used to tailor the rest of the counseling session to the client’s individual needs. Each session will be different.

LANGKAH KEDUA: Memberikan informasi tentang kebutuhan klien akan KB (Tell)

Memberikan informasi tentang berbagai metode KB yang tersedia Vasectomy or Female Sterilization Condoms (Male or Female) Vaginal Methods LAM Fertility Awareness-Based Methods IUD The Pill The Mini-Pill Long-Acting Injectable Monthly Injectable Implants

Memberikan pilihan metode KB yang cocok untuk klien Apakah masih ingin memiliki anak lagi? Apakah masih menyusui anak yang berusia < 6 bulan? Apakah suami mau bekerjasama dalam menggunakan metode kontrasepsi yang diinginkan? (pantang berkala, kondom) Apakah memiliki pengalaman tidak menyenangkan dengan metode KB sebelumnya? The second stage of FP counseling is about providing your client information and options to address their identified needs and concerns. <read the list of these tasks on the slide> What you say to your client in this stage is based upon what you learned during the first stage, when you asked questions to find out about the client’s needs and situation, such as about their home life, partners and HIV status. For example, what did we learn about Sarah during my demonstration of Stage 1? <allow participants to answer, record responses on flip chart, summarize the information learned about the client and point at the relevant information on the flip chart> To summarize, we learned about Sarah that she is 21 and married, she is interested in injectables but also wants to learn about other FP methods, she is still breastfeeding her eight- month-old baby, her menses returned two months ago, her husband was treated for an STI recently, and she wants to delay pregnancy for at least several years. <The information in this paragraph applies only if participants are community health workers.> If during Stage 1, or during any part of the counseling session, your client tells you about a need or concern that you have not been trained to respond to, it is important to tell them that you can not deal with that issue and refer them to the local health center or to a clinical provider. <give name of local health center or provider> The first task in this stage is to advise the client how to prevent STIs, if the client believes he or she is at risk for STIs or HIV infection. This advice should flow naturally from your assessment of STI risk. Do you recall how I helped the client assess her STI risk at the end of Stage 1? What are the ways you can advise your clients to prevent STIs including HIV? <allow for several responses> <affirm and highlight correct answers; refer to any relevant pages of the counseling tool> What do you say to your client at this point? <allow for several responses> Yes, that’s correct, what you say is based on the goals they described in Stage 1. If they said they want to become pregnant, you describe things they should do or consider when thinking about becoming pregnant. <review any relevant counseling tool pages> <continue on next slide>

LANGKAH KETIGA: Membantu klien membuat informed choice untuk metode KB yang diinginkan (Help)

Setelah pasien memilih metode kontrasepsi yang diinginkan sesuai dengan 4 pertanyaan yang kita ajukan, giliran kita sebagai petugas kesehatan untuk melihat apakah metode yang dipilih sesuai dengan kriteria kelayakan medis/ medical eligibility criteria (MEC)

Bagaimana jika ternyata klien tidak bisa menggunakan metode yang dipilih? Membantu memilih metode kontrasepsi alternatif yang bisa digunakan

Ceklis untuk skrining apakah klien sesuai memakai AKDR Ceklis untuk menyingkirkan kehamilan Pertanyaan saat Anamnesis apakah klien sesuai memakai AKDR Ceklis bagi tenaga kesehatan saat pemeriksaan ginekologi untuk menilai apakah klien cocok memakai AKDR

Kriteria Kelayakan Medis

Categories for IUDs, Hormonal and Barrier Methods WHO’s Medical Eligibility Criteria Categories for IUDs, Hormonal and Barrier Methods Kategori Penjelasan Keputusan 1 Tidak ada batasan dalam penggunaan Gunakan metode kontrasepsi tersebut 2 Manfaat > kerugian Pada umumnya dapat menggunakan metode tersebut 3 Risiko > manfaat Penggunaan metode tersebut tidak dianjurkan kecuali tidak ada metode KB lain yang tersedia 4 Risiko kesehatan besar Metode KB tersebut sama sekali tidak bisa digunakan Source: WHO, 2010.

When clinical judgment is available WHO’s Medical Eligibility Criteria Categories for IUDs, Hormonal and Barrier Methods Category When clinical judgment is available 1 Use the method 2 3 Do not use the method 4 Source: WHO, 2010.

Kategori WHO Kondisi Kategori 1 Kategori 2 Siapa saja yang bisa menggunakan IUD Kategori WHO Kondisi Kategori 1 ≥20 tahun, serviks ektropion, myoma uteri tanpa distorsi kavum uteri, perdarahan irregular tanpa perdarahan banyak Kategori 2 Menarche <20 tahun, nullipara, perdarahan banyak dan lama, dismenorea berat, anemia Source: WHO, 2010.

Siapa saja yang tidak boleh memakai IUD Kategori WHO Kondisi Kategori 3 48 jam s.d. <4 minggu postpartum, kanker ovarium pada awal pemakaian, risiko tinggi penyakit menular seksual Kategori 4 Kehamilan, perdarahan vaginal yang tidak diketahui sebabnya, sedang menderita penyakit radang panggul atau cervicitis, kanker serviks atau endometrium pada awal pemakaian Source: WHO, 2010.

LANGKAH KEEMPAT: Membantu melaksanakan keputusan klien (Explain and Return)

Dalam EXPLAIN petugas kesehatan: Menjelaskan/mendemonstrasikan penggunaan yang tepat (cara minum pil KB, bagaimana bila lupa minum pil) Meminta klien menjelaskan kembali Mengingatkan klien tentang efek samping, alasan untuk kembali

Alasan untuk kembali (Return) Ingin memakai metode yang berbeda Meminta solusi untuk efek samping Ada tanda bahaya Butuh kontrasepsi darurat Kontrol untuk IUD

Points to remember in FP Counseling Menyapa pasien, pastikan kenyamanan dan kerahasiaannya Perhatikan Bahasa tubuh saat berinteraksi dengan pasien G A T Menanyakan alasan pasien untuk datang? Saat menjelaskan tentang metode KB, pastikan efektivitas, keuntungan dan kerugian serta efek samping (bisa dengan bantuan lembar balik konseling KB). Membantu klien menentukan pilihan KB sesuai keinginannya dengan 4 pertanyaan

H Mengecek apakah metode KB pilihan klien sesuai dengan kriteria kelayakan medis E Setelah mengecek bahwa metode KB yang dipilih tidak ada kontraindikasi, jelaskan tentang cara penggunaan, efektivitas, efek samping, dan alasan harus kembali

R Jadwalkan kunjungan berikutnya Jelaskan kondisi yang mengharuskan klien control kembali R