Counseling is the process of helping clients confirm or make informed and voluntary decisions about their individual care. It is a two-way exchange of information that involves listening to clients and informing them of their options. Counseling is always responsive to each client's individual needs and values. All providers, regardless of their professional background and educational credentials, need special training in counseling and informed choice.

EngenderHealth publishes a number of client-education materials and job aids for providers, trainers, and managers. These include client-education brochures, a curriculum on family planning counseling, a curriculum on counseling for postabortion care (PAC) services, and publications on the special counseling needs of clients interested in sterilization. For more information, see EngenderHealth's publications on counseling, informed choice, and informed consent and our client-education materials.

Informed choice is a voluntary, well-considered decision that an individual makes on the basis of options, information, and understanding. The decision making process should result in a free and informed decision by the individual about whether or not he or she desires to obtain health services and, if so, what method or procedure he or she will choose and consent to receive.

EngenderHealth publishes a number of materials on counseling and informed choice, including publications on family planning and the special needs of sterilization clients. For more information, see EngenderHealth's publications on counseling, informed choice, and informed consent.

Informed consent is the communication between client and provider that confirms that the client has made an informed and voluntary choice to use or receive a medical method or procedure. Informed consent can only be obtained after the client has been given information about the nature of the medical procedure, its associated risks and benefits, and other alternatives. Voluntary consent cannot be obtained by means of special inducement, force, fraud, deceit, duress, bias, or other forms of coercion or misrepresentation.

Health care providers are often required by law or institutional policies to obtain informed consent before administering certain medical procedures, including experimental methods or procedures. Although informed consent is often equated with a signed written form used to document an individual's decision, written consent is neither inherently necessary nor sufficient. Regardless of the presence or absence of written documentation, informed consent requires providers to ensure that a client receiving a method or treatment has knowingly and voluntarily agreed to be treated. Whether informed consent is written or verbal, however, it cannot replace the informed choice process, which is dependent on counseling and the information exchange between providers and clients.

Informed Consent and Voluntary Sterilization
Informed and voluntary client consent is especially important before a medical procedure that has a permanent or long-acting effect or that requires the skills of a trained provider. In family planning, voluntary sterilization is unique in that it involves a surgical procedure to end fertility permanently. Therefore, many providers and funding agencies that support sterilization services specify the elements for informed consent and require written documentation of the client's consent. Although the purpose of informed consent should be to ensure the client's right to make a voluntary and informed decision, written consent is often required to provide evidence of provider compliance with informed consent requirements and to reinforce the importance of this client right.

• Information
• Access to services
• Informed choice
• Safe services
• Privacy and confidentiality
• Dignity, comfort, and expression of opinion
• Continuity of care

Adapted from: Huezo, C., and Diaz, S. 1993. Quality of care in family planning: Clients' rights and providers' needs. Advances in Contraception 9:129-139.