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Pride
in Parenting: Training Curriculum for Lay Home Visitors
Linda
T. Diamond, M.S. and Marion H. Jarrett, Ed.D., editors.
Unit 9
Family Planning Options
| Objectives | By the
end of this unit, participants will be able to:
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| Time | 5 hours |
| Outline | A. Climate and
Attitudes |
| Materials |
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| Advance Preparation |
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A. CLIMATE
AND ATTITUDES (45
minutes)
| Rationale: | In order for PSS to feel more comfortable discussing family planning, it is important that they feel somewhat comfortable discussing sexual issues in general. The purpose of this "ice-breaker" exercise is for PSS to understand the impact of socialization practices on an individual's level of comfort/discomfort in discussing sexual issues, and how society discourages open communication about sexuality. |
| Procedure: |
1. Ask the trainees to form groups of three. 2. Ask each person in the group to take one to two minutes to discuss this question: "What was the prevailing sexual climate and what were the prevailing sexual attitudes as you were growing up? [Note: The content of those small group discussions will usually be that accurate information and open communication about sexuality was often lacking.] 3. Ask each person in the group to take another one or two minutes to discuss: "What are three messages you received as a child that might affect your ability to talk with a client about sexuality and family planning?" 4. Ask the trainees to discuss the next question, "What do you see to be the prevailing sexual climate and the prevailing sexual attitudes now, as young people are growing up; how is it similar/different; better/worse; harder/easier than when you grew up? Suggest that participants expand the concept of "sexual climate and sexual attitudes" beyond that of simply reproduction or romantic/erotic, boy/girl issues, and focus on such topics as STDs, marriage and divorce, birth control and abortion, sexuality and the media, etc. 5. Large group discussion: ask the participants whether they think it is better or worse for people growing up now. How? What kinds of things are clients facing today in terms of sex and sexuality that are different or the same as the issues women and men faced a generation ago? How do these issues affect family planning choices? 6. Points to conclude with: in order to talk about sexuality and family planning it is important to recognize one's social, cultural and personal barriers to communicating about sexuality. |
B. Introduction/DEFINITIONS
(1/2 hour)
| Rationale: | Although Parenting Support Specialists will not be making specific recommendations for clients, it is important that they have a basic knowledge of family planning options so they can provide accurate information to clients for their decisions about family planning. |
| Procedure: | 1.
Mini-lecture and discussion. Find out what the words "family
planning," "birth control," "contraceptives," "conception," "contraception,"
"informed choice," and "menstrual or reproductive cycle" mean to trainees.
You may want to put some definitions on the board, so trainees can
refer to them throughout this unit. You will probably learn that people
use some of these terms interchangeably, and indeed their meanings
are often synonymous, or at least very similar. Some points you --
or the group -- will want to cover follow.
Informed choice means that a client makes a decision about having children after getting appropriate and correct information through many different channels. (PSS's have an opportunity to be one of these "channels." You may want to come back to this idea later on.) Clients must also have access to a variety of options. Informed choice means making a decision about family size, deciding whether to use family planning, and deciding what methods to use. [Note: You should refer back to the previous unit on postpartum planning, where trainees looked at ways to help their clients set postpartum goals for themselves. Point out that clients need to take their own goals and personal life situations into consideration as part of making an informed choice.] Ask why informed choice is important. One response you are looking for: When women (and men too) have an opportunity to make their own decisions about family planning and spacing their children, they are more likely to be satisfied with their choice. Tell trainees that studies from around the world show that when people have an opportunity to choose to use a contraceptive method, and when that method is properly explained to them, they are more likely to do three things: (1) follow instructions accurately for using the method, (2) continue using some method of family planning over time, and (3) recommend family planning to friends and relatives. 2. Before discussing, in depth, what people can do to control their own fertility, find out what trainees know about how conception occurs. See Training Aid #1, on reproductive physiology, for some key points that you may want to share with the group. Drawings are included, in case you wish to make a transparency for use when discussing both conception and contraception. There is much confusion as to when in a woman's monthly menstrual cycle she can get pregnant. Emphasize that this is because the exact day is different for different women, and even for the same woman in different months. All women should have some idea as to when they ovulate (when an egg is released). If a woman does not want to conceive, she must refrain from sexual intercourse during those days before, during, and after ovulation, or she (or her partner) must protect themselves by using contraceptives. In most women, ovulation occurs at mid-cycle, about 10 to 16 days before their next menstrual period. 3. Before beginning the next exercise, ask trainees when they think is a good time to discuss family planning options with their clients. Possible responses might include:
Discuss the pros and cons of their suggestions. |
C. METHOD CHOICE EXERCISE (1/2 hour)
| Rationale: | This brainstorming activity is to identify all the methods and products used by American women (couples). The exercise that follows should demonstrate the fact that a PSS's perception of a family planning product or method can influence her clients perception and use of a method. This can have both positive and negative ramifications. | ||||||||||||||||||||||||
| Procedure: |
1. Begin by asking everyone to brainstorm all methods of family planning they have ever heard of. Have someone write out each method in large letters on 8 x 11 sheets of paper for future use. Be sure to include those practices that some consider family planning but that truly are not effective at preventing pregnancy. 2. Exercise. Break into groups of two or three. Use 'Methods' chart on pg.9-8. Cut apart. Distribute two or three methods to each group. For each method, ask the groups to list advantages and disadvantages. Give the groups 15-20 minutes to complete this exercise. Ask for one person in each small group to be the recorder and spokesperson. 3. While the group is doing this, prepare a chart, like the one below, on the board or newsprint. 4. Go around the room and ask participants to name the method and one or two advantages and disadvantages. As they do this, ask for comments from all members of the small and large groups and record information. 5. As participants give their opinions, everyone should begin to note that, what is an advantage to one person may be perceived as a disadvantage to another. For example, one woman may like the birth control pill (combined oral contraceptives) because "there's nothing to remember at the time of sex," while another may say it's not desirable because you have to remember to take it everyday. Discuss the following questions with trainees:
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D. UNDERSTANDING AND EXPLAINING AVAILABLE CONTRACEPTIVES (1-1/2 hours)
| Rationale: | Instead of having someone come in to lecture to participants about all available family planning (or contraceptive) methods, PSS' will remember more if they are involved in the compilation of the information. It is still a wise idea to invite an "outside expert" to come, not to lecture, but to mediate any discussions, settle disputes, and answer any questions that arise about a method or procedure. |
| Procedure: | 1.
Team Activity. Divide trainees into two or three teams, depending
on the size of the training group. If possible, each team should have
at least three members.
2. Give
each team two or three large sheets of newsprint and two different
colored marker pens.
3. Ask
each group to share all they remember about two or three family planning
methods. Without opening their Handbook or using other reference
materials, each team will create a chart showing the advantages, disadvantages,
contraindications, and the types of women (couples) who are good candidates
for the methods they are covering. After they have written down all
they remember, they can look to their Handbook or other material
for help. But they should then change markers, so the information
they add will appear on their chart in another color. This way you
can have a little "competition" or contest at the end, by directing
everyone's attention to the changes in ink color and determining which
team had the greatest recall of accurate information prior to consulting
any reference material.
4. Assign
-- or let teams volunteer for -- the methods they will present. You
want to make sure that all major methods are covered, so the number
assigned to each team will depend on how many teams you have. Assignments
should include: natural family planning methods, birth control pills,
intrauterine device or IUD, Norplant, Depo-Provera (the new injectable),
condoms, Today® sponge, diaphragm, spermicides, and sterilization.
5. When
the teams have completed their charts, they will take turns presenting
this information to the large group, explaining everything as they
might explain these methods to clients. For variety, you might ask
the spokesperson from one team to talk as though she was working with
a teenager, another as though her client was a woman in her 30's with
three children, another as though her client was a woman whose baby
had just been born HIV-positive, etc. Be creative. There's much you
and the trainees can do with all this wonderful information they have
assembled.
6. Be sure
to advise trainees that no matter how much information on family planning
they impart to their clients, they should also encourage them to discuss
this topic further with their health care provider.
7. Ask
your invited guest (the outside expert) to provide constructive feedback,
pointing out any omissions and correcting any misinformation. Also
encourage participants to ask your guest any questions they have about
any aspect of available contraceptive choices. Use this opportunity
to also discuss some related topics, such as:
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E. EXERCISE ON HELPING CLIENTS MAKE FAMILY PLANNING DECISIONS (1 hour)
| Rationale: | PSS's are not trained to give out medical advice, but they need to have baseline knowledge to help women make informed choices. PSS's won't decide what are medical contraindications. They may help a woman decide what lifestyle factors make a choice less desirable. |
| Procedure: |
1. Before this exercise begins, you should cut up and fold the various case study scenarios provided in Training Aid #2 and make up additional ones based on the cultural norms of the community. 2. Explain that trainees are going to work together as a group and practice helping clients make appropriate family planning choices. Put folded case studies into hat and ask someone to choose one and read only the top part to the other participants. 3. Then ask the following questions, which you will want to put on newsprint or the board, as trainees will answer these same questions for each subsequent case study. Have trainees discuss them and arrive at some sort of consensus. Questions: a. What
do you see in this situation? 4. When trainees have agreed on the above, point out that their clients will have heard of various methods, and may already have a particular method in mind. At the bottom of each case study is the method that this person plans to use. Ask the trainee reading the case study to read the last line; it tells which method the client has in mind. 5. Ask if the group feels that this method is appropriate for this client. If so, why? If not, why not? If the group feels that it is inappropriate, how would they explain this to the client and encourage her to use another method? 6. When trainees have finished discussing this case, ask another volunteer to select a case and, again, read only the top portion. Discuss the same questions as before. Then the trainee reads the client's choice, and the group discusses whether or not they agree, and how they would counsel the client. Repeat this process until all cases have been discussed (or until you feel that enough time has been spent on this exercise). 7. Before proceeding, trainer should summarize this exercise by saying it points out that there is no "one best method" for all women (couples) at all times. Different methods are appropriate for people at different times in their lives. If any woman (trainees as well as clients) finds that one method is not pleasing to her, for any reason, then her health care provider can help her find another method that is more suitable. Point out that such "method switching" should not be discouraged. PSS's can help their clients find a family planning method that they will feel comfortable using and will use effectively. Answer any lingering questions, deal with any doubts, etc. |
F. ASK THE EXPERT (1/2 hour or longer)
| Rationale: | Trainees may be shy about asking questions in particular about a topic like sex and family planning. This exercise provides an opportunity to ask "all you want to know, but were afraid to ask." |
| Procedure: |
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G. PRACTICE
SESSION: PROVIDING INFORMATION TO CLIENTS
(3/4 hour)
| Rationale: | Participating in role plays will assist the PSS in integrating the information presented by putting it into 'real life' situations. |
| Procedure: |
1. Role plays. Go around the room and ask trainees to count off: 1,2,1,2,1 etc. All the "1's" will begin this exercise playing clients and the "2's" will be the Parenting Support Specialists. After completing one role play, they will switch roles. Now ask each "1" to select a "2" as her partner. Preferably someone with whom she has not partnered with before. [Note: This is just a slight variation on the oft-repeated request to break into teams of two.] 2. Have each team role play two different scenarios, so each gets practice and gains experience advising and counseling a client. If possible, have someone video tape their efforts, so trainees can replay the tape at some other time, critique their own "performances," and discuss with their team mate how they might improve their message and/or communication techniques. Remind the group of all the exercises they have done on both verbal and non-verbal communication techniques. They should be practicing these skills whenever they are asked to interact with an imaginary client. 3. Ask each team to select two of the case study scenarios that were used in the previous group exercise. But this time, the PSS will advise and counsel the "client," who will base what she says on the information provided in the scenario. The person playing the PSS should use some appropriate support materials to reinforce her verbal messages. 4. Before they begin, ask trainees to review what kinds of information about contraceptive methods or products they want to give to the "clients." Possible responses should include:
5. Trainer -- and the outside expert -- should move about while teams are role playing, both to offer encouragement and to gently correct any misinformation. 6. If time allows, ask for volunteers to present one of their role plays to all the other trainees. When they finish, get comments and feedback from the others. Be sure to give everyone a big round of applause at the end of this session. They worked hard! |
H. Summary and Review (15 minutes)
| Procedure: |
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Unit 9 Handout #1
AIDS INFORMATION
AIDS (Acquired Immune Deficiency Syndrome) is a deadly disease that is spread by sexual intercourse. Because family planning clients are sexually active, they may be at risk of catching AIDS. Therefore, family planning clients need to know (1) how AIDS is spread and (2) how to avoid AIDS.
HOW AIDS IS SPREAD
Tell your clients:
- The main way a person gets AIDS is by having sex with someone who is infected with the AIDS virus.
- Most people who are infected with the AIDS virus do not look or feel sick. They may not know that they are infected. But they can still spread AIDS to others during sex.
- Men and women with genital sores or infections are more likely to catch AIDS or give it to other people.
- AIDS is also spread by blood or blood transfusions from people who are infected.
- Sharing any kind of dirty needles spreads the AIDS virus.
- A woman who is infected can give AIDS to her sexual partners and to any baby she has in the future.
- AIDS is not spread by kissing, touching, sharing foods or toilets, or taking care of a person with AIDS.
- To limit the number of sexual partners. The surest way to avoid AIDS is to abstain from sex. Another good way is to have sex with only one partner who is not infected and who has no other sexual partners.
- To use condoms all the time unless they are sure that they and their partner are not infected. (If it is possible as part of your program, give your client some condoms to try.) Condoms provide considerable protection against AIDS. Condoms and spermicides together are probably the best protection. No other family planning methods, including vasectomy, protect against AIDS.
- To use condoms to prevent AIDS even when they use other family planning methods to prevent pregnancy.
- To talk with their sexual partners about AIDS and agree on ways to protect one another from AIDS.
Unit 9 Trainering Aid #1
REPRODUCTIVE PHYSIOLOGY
[Note to trainers: The information that follows is only the basics and supplements pages 193-194 of the Resource Mothers Handbook. Use what seems applicable for your group of trainees; augment the information, if needed, by using reference material such as Chapter Four of Hatcher et al, Contraceptive Technology 1990-1992, 15th Revised Edition, Irvington Publishers, Inc, New York, 1992. If a word in the following text is underlined, it means it is further defined at the end of the general description.]
Menstrual or Reproductive Cycle
The term menstrual cycle refers to the entire cycle of "physical changes from the beginning of one menstruation (day one of menstrual bleeding) to the beginning of the next. The reproductive or menstrual cycle is regulated by hormones. During a woman's childbearing years, monthly changes in the levels of hormones determine the timing of her ovulation and menstrual periods. This cycle prepares a woman's body for the possibility of pregnancy.
Each month one egg (or ovum) in the woman's ovaries matures. It makes the hormone estrogen, which causes the uterine lining to grow thick and rich in blood supply. Usually sometime between days 13 and 16 of the reproductive cycle, an ovary releases an egg into a fallopian tube.
If the egg is met and fertilized by a sperm, it implants itself into the uterine wall (called the endometrium). Hormones signal the uterine lining to secrete substances to nourish a fertilized egg and a fetus develops. If conception does not occur, the blood and tissue of the lining are then discharged. This is the menstruation (or the menstrual period). It lasts for about five days. Then a new ovum begins to mature and the cycle begins again.
Conception
During sexual intercourse a man deposits semen, filled with sperm, in the woman's vagina. The sperm pass through the cervix and the uterus (also called womb) and reach the fallopian tubes. There, if sperm encounter an egg, conception (pregnancy) can occur. If sperm do not reach and fertilize the egg, the egg passes through the woman's uterus and leaves the woman's body during her menstrual period.
Vocabulary:Ovulation: The process in which the ovum (egg) is released from the mature ovary. Ovulation usually occurs 10 to 16 days before the next menstruation. The egg is capable of being fertilized for about 10 hours after ovulation, but probably no more than 24 hours.
Ovaries: The female sex glands above the uterus that produce eggs (ova) and hormones that control female reproduction. (See Figures 1 and 2).
Fallopian tubes: Two tubes that extend toward the ovaries from the upper sides of the uterus. After ovulation, the ovum (egg) passes from the ovary into the fallopian tubes. Following intercourse, sperm travel through the uterus and into the fallopian tubes, where fertilization normally occurs. The fertilized egg normally travels through the fallopian tube and implants in the uterus. (See Figures 1 and 2).
Fertilization: The process of uniting the sperm and ovum (egg). Fertilization normally occurs in the fallopian tubes.
Implantation: The normal process in which the fertilized egg becomes attached to the lining of the uterus (endometrium).
Sperm: Mature male reproductive cell. Sperm are produced in the testicles, located in a man's scrotum (balls). Sperm (along with a fluid, semen) are ejaculated through the penis during intercourse.
Menstruation: The cyclic discharge of the lining of the endometrium (menstrual blood, cellular debris, and mucus) that occurs about two weeks after ovulation if the woman is not pregnant. (Also called menses or period.)
Menstrual Cycle: The number of days from the first day of menstrual bleeding. The cycle usually lasts from 22 to 35 days, but this may vary more for some women.
Except when they are pregnant or postpartum, most women will menstruate (or have periods) from menarche (the time of first menstruation) to menopause (the end of menstruation).
Side view of female reproductive organs:
Frontal view
of female reproductive organs
(enlarged to show detail):
Unit 9 Trainering Aid #2
CASE STUDY Scenarios
CASE STUDY A
I am a 35 year old school patrol and live with a mechanic. I have four children and wish to stop having children. My partner is in agreement.
I would like to use the foaming tablet.
CASE STUDY B
I am a 26 year old mother of 1 year old healthy twins. My boyfriend wants more children, but I want to wait until they are in first-grade. My boyfriend recently went to the Red Cross to give blood, and he learned he was HIV-positive.
I would like to use Norplant.
CASE STUDY C
I am 21 years old and have a 3 year old child from my first husband. We're now divorced. I am pregnant with my boyfriend's child. He wants a large family but I want to finish my education and get a good job first. I am in good health, although I've put on lots of weight with this pregnancy.
I would like to use my old diaphragm after the baby is born. It's still in good condition, as I didn't use it regularly in the past.
CASE STUDY D
I am 29 years old and work at a bank. My boyfriend and I have two children and would like to wait for a few years before having another child.
I would Like to use the IUD.
CASE STUDY E
I had a baby three months ago and am still nursing three or four times a day. I am a secretary and will soon return to work.
Since I am breast feeding, I do not yet need another family planning method.
CASE STUDY F
I am 35 years old and married to a cab driver. We have three children but I have been very sick at each birth. I have high blood pressure and was recently found to be diabetic.
My husband and I would like to use condoms.
CASE STUDY G
I am 30 years old and work at a restaurant. I live with a good man but he wants me to have more children. I would like to wait until my youngest child is three years old, but I do not want my partner to know that I am using a family planning method.
I would like to use Depo-Provera.
CASE STUDY H
I am 19 years old, work at K-Mart, and am married to a musician. I have no children. I would like to save some money and wait a year - maybe two years - before starting a family.
I would like to use Norplant.
CASE STUDY I
I am a 20 year old woman with one child. I dropped out of high school and never returned. I receive an AFDC check each month. I've never been married, but I have several boyfriends.
I'm not interested in using any family planning method. If I get pregnant, I'll have an abortion just like I did two years ago.
CASE STUDY J
I am 18 years old and just started college. My boyfriend has just received his diploma as an engineer. We would like to wait until I graduate from the university to have children.
We would like to use "natural" family planning, either calendar rhythm or the cervical mucus method.
CASE STUDY K
I am 22 years old and married to a government employee. We have one child. I am weaning the baby now and my partner and I have agreed to wait two years before our next child.
I would like to use the birth control pill (oral contraceptives).
CASE STUDY L
I am 36 years old and have always been a heavy smoker. My three children are all in school and doing well. Neither my partner nor I want any more children.
I would like to use the birth control pill (oral contraceptives).
Adapted From: Egyptian Ministry of Health and PATH, "Training of Trainers Workshop in Face-to-Face Communication", Cario, Egypt, mimeo, 1988.
Unit 9 Post -Unit Test
UNIT 9
POST-UNIT TEST
- Condoms
- Norplant
- The Pill
- IUD (Intrauterine Device)
- Depo-Provera
- Vasectomy
- Diaphragm
- Sponge
- Tubal Ligation
- How does it work?
- Who uses the method?
- How is it used?
- Advantages
- Disadvantages
Unit 9 Overhead #1
Role Play Feedback
- What do you think you the Parenting Support Specialist did well?
- What could the Parenting Support Specialist have changed or done differently?
- What other things do you think the Parenting Support Specialist might say or do to help a mother in this situation?
Unit 9 Post-Unit Evaluation
Post-Unit Evaluation
Unit Covered: _____
Date: _____
- Do you feel we covered all the information in this unit that we said we were going to?
- What did you like best about the unit?
- What did you like least about the unit?
- Was the information in this unit presented clearly? If not, please explain.
- In which skill areas do you feel you need more practice or help?
- How can we make this unit better?
- Any additional comments?
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University of Illinois at Urbana-Champaign