Academic journal article International Family Planning Perspectives

Client-Provider Communication in Postabortion Care

Academic journal article International Family Planning Perspectives

Client-Provider Communication in Postabortion Care

Article excerpt

Many medical workers who treat women experiencing complications of induced or spontaneous abortion readily acknowledge that such women need "counseling," but they often view counseling as a nonmedical function requiring specific training, a specially designated time apart from the provision of other postabortion services and a separate, private facility. Thus, providers of postabortion care often believe that counseling is not one of their job responsibilities and that they lack the training and facilities to do it.

However, if counseling is defined as two-way communication conducted to help clients make decisions and to deal with their feelings about their circumstances, (1) providers should routinely integrate counseling into all aspects of postabortion care. Such communication can help providers assess the client's needs and her feelings about her situation, and can help facilitate the client's decision-making following the procedure. Postabortion counseling can also provide a client with information and emotional support that can help make the procedure more comfortable for her and easier for the provider.

COUNSELING NEEDS

When a women seeks medical attention from health care providers for abortion complications, her needs often go beyond immediate treatment. A woman who has had an induced abortion may be concerned about the conditions or circumstances that led to the unwanted pregnancy, and she may fear the legal, physical or social consequences of having ended a pregnancy. Although the client may need a contraceptive method to prevent future unwanted pregnancies, she may place greater importance on other needs--such as tending to her overall health, keeping her situation confidential or protecting herself from a partner, family members or legal authorities.

Women seeking care after a spontaneous abortion may not be interested in preventing future pregnancies, but they may have concerns about the medical treatment that they are about to receive and its potential effects on their health and their ability to carry a future pregnancy to term. Some of these women may feel ashamed that they "lost" the pregnancy. Others may fear that they will be accused of inducing the abortion.

The text box outlines the areas that should be addressed in counseling during postabortion care and provides guidelines on when to discuss these topics (before, during or after the procedure). However, what is said between the provider and the client, and when, can vary according to the client's circumstances and needs.

KEY COUNSELING TASKS

To meet the needs of postabortion clients, health care providers must perform several basic tasks.

Assessing the Client's Readiness for Counseling

In working with a client experiencing a complication of abortion, service providers must first assess the severity of her condition and schedule or provide the necessary medical care. After doing so, and before initiating counseling or any in-depth discussions, the provider must assess the client's readiness to talk. The client's main concerns at that moment may be pain, confusion or fear, which the provider should address immediately. Until these feelings have been dealt with, the client may be unable to concentrate on other issues. After her needs and concerns have been acknowledged and, if possible, addressed, the client may be ready for counseling.

Dealing with the Client's Feelings

A woman who seeks care for postabortion complications is likely experiencing numerous, and sometimes conflicting, emotions. After developing an understanding of the client's feelings, the provider must consider what kind of response will be most helpful.

Providers cannot be expected to act as therapists or social workers: During the delivery of postabortion care, they can deal effectively with only a limited range of emotional needs. Yet a client may find even such limited support to be of significant help. …

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