WHO Tiered-Effectiveness Counseling Is Rights-Based Family Planning

Improving access to long-acting, reversible methods of contraception (LARCs)—which provide highly effective, long-term, and easy-to-use protection against unintended pregnancy—is of crucial importance to the lives of countless individual women. Yet, among family planning experts, consensus remains elusive on the important issue of whether and how client counseling should emphasize this top tier of highly effective contraceptive methods. Research consistently shows women believe effectiveness is one of the most important factors—usually the most important factor— when choosing a contraceptive method, but accurate knowledge of contraceptive effectiveness remains poor. In this paper, we argue for proactive counseling based on the World Health Organization (WHO) tieredeffectiveness chart that begins with the relative effectiveness of various methods as a way to provide truly informed choice. All contraceptives are not created equal. Counseling that does not focus on effectiveness can lead to ‘‘misinformed choice,’’ which may undermine rights-based approaches.