Dear HIFA colleagues, I learned about this paper from the [WHOguidelines] discussion forum, with thanks to Moazzam Ali (co-author)
BMJ Open: Closing the counselling gap: a qualitative study to strengthen rights-based family planning in Pakistan https://bmjopen.bmj.com/content/16/8/e116059
Extracts:
Quality-of-care frameworks identify method choice, information provision, interpersonal relations, technical competence, follow-up and continuity as core elements of FP service quality.
The WHO explicitly frames contraceptive information and services as human rights obligations, emphasising non-discrimination, informed choice, privacy, accountability and freedom from coercion.
In Pakistan, public-sector FP services are intended to provide contraceptive information and selected methods through government health facilities and community-based workers, although availability, privacy, counselling quality and follow-up vary across sites.
Across both sectors, clients and providers equated ‘counselling’ primarily with method-focused information sharing rather than with a structured, preference-sensitive, rights-based decision-making process.
Even when providers attempted to invite questions, clinical pressures often resulted in compressed, one-way information delivery rather than genuine shared decision-making.
Conclusion: This formative phase shows that contraceptive counselling is widely recognised and generally valued by clients in the participating facilities in Pakistan, but it often functions as method information rather than as a structured, rights-based process supporting autonomous reproductive decision-making.
COMMENT (NPW): Family planning and reproductive health are the only areas of health SDGs that specifically recognise access to reliable healthcare information. The above paper emphasises that provision of information on different methods is important but is only one aspect of 'genuine shared decision-making'. I would be interested to learn how frontline health workers navigate this.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org