SFP 36.2 Leon

At the time this study was conducted, Federico R. León and Carlos Brambila were Program Associates, and Marisela de la Cruz was Project Coordinator, Frontiers in Reproductive Health Program, Population Council. Julio García Colindres was Director, Carlos Morales was Family Planning Specialist, and Benedicto Vásquez was Chief of Family Planning, Reproductive Health Division of the Guatemalan Ministry of Public Health and Social Welfare. Correspondence should be directed to Federico R. León, Avenida Javier Prado 7427, Lima 3, Peru. E-mail: [email protected]. Requests for the job aids and administration manual of the strategy can be sent to the Frontiers in Reproductive Health program, Population Council, 4301 Connecticut Avenue, NW, Suite 280, Washington, DC 20008. E-mail: English: [email protected]; Spanish: [email protected]. A recent literature review classified the interventions designed to improve the quality of family planning care into three types: systemwide interventions, interventions to expand contraceptive choice, and interventions relying on specific tools (RamaRao and Mohanam 2003). This article describes an effort to refine and assess a novel intervention of the third type. This new intervention is known as the balanced counseling strategy. The strategy was developed to meet the challenge revealed by the findings of a study of client–provider interactions at Peru Ministry of Health (MOH) clinics in which the questions asked by providers were medical in nature and ignored the client’s reproductive intentions and whether her partner cooperated with her in regard to family planning. The providers, using a flipchart, behaved as though they had to describe to the client the attributes of all the methods offered by the program, regardless of the client’s particular needs (León et al. 2001). The client was expected to make a contraceptive choice by evaluating the full set of attributes, an expectation that implied an underlying linear decisionmaking model that placed exaggerated demands on her informationprocessing capabilities. People do not make such complex calculations, but rather make choices by means of sequential decisionmaking (Simon 1955 and 1978). Because most of the session time was spent describing all method options, the client obtained as little information about the method she chose as about methods that were irrelevant to her (León 1999). To address this problem, the balanced counseling strategy reorganizes the family planning consultation with the aid of two techniques that, by means of sequential decisionmaking, help to simplify the client’s task of choosing a method (León 2002). First, the consultation is reorganized around a process of elimination. At the outset, needs assessment works as a process for discarding those methods that the client and the provider identify as inappropriate in her case (for example, sterilization, if the client wishes to have children later). In the Providers’ Compliance with the Balanced Counseling Strategy in Guatemala