Empowering Contraceptive Choice through a Client-Centered Counselling Approach: An Experimental Study in Family Planning Centres of Rawalpindi, Pakistan

Enhanced Counseling Protocols (Intervention Arms) This experimental study introduces two structured, client-centered counseling interventions aimed at strengthening informed contraceptive decision-making among women attending family planning centers in Rawalpindi, Pakistan. The interventions are grounded in principles of respectful care, autonomy, and shared decision-making, with an emphasis on ensuring that women feel supported, well-informed, and empowered throughout their contraceptive journey. The two interventions tested in this study are the GATHER Approach and the Balanced Counseling Strategy (BCS). 1. GATHER Approach The GATHER approach provides a structured, sequential model for engaging clients in meaningful contraceptive counseling. It is designed to create a respectful and interactive environment where the client’s individual needs, values, and reproductive goals are acknowledged and prioritized. This method includes six core steps: Greet – Establishing a welcoming, respectful, and non-judgmental atmosphere to build rapport and trust. Ask – Exploring the client’s reproductive intentions, concerns, and preferences related to contraception. Tell – Providing evidence-based, comprehensible information about a full range of contraceptive methods, including benefits, side effects, and effectiveness. Help – Guiding the client in aligning contraceptive choices with her reproductive needs and personal context. Explain – Offering detailed instructions on method use, managing side effects, and follow-up. Return – Encouraging continued engagement, return visits, and access to future support. In this study, each client will receive a single counseling session under this model, lasting between 15 to 25 minutes. Sessions will be conducted in a private space, respecting the confidentiality and dignity of each client. To aid understanding and decision-making, clients will be given culturally adapted visual job aids and information leaflets based on WHO’s GATHER framework, translated into local languages and simplified for low-literacy populations. These materials were either adapted from existing WHO content or developed specifically for the local context of this study. Counseling will be delivered by trained healthcare providers, including family welfare workers, nurses and midwives, and physicians currently engaged in family planning service delivery within the participating facilities. Quality assurance mechanisms will be embedded into the intervention through the use of: Structured supervision checklists Client exit interviews to assess satisfaction, comprehension, and recall WhatsApp-based peer support groups for real-time supervision, knowledge sharing, and ongoing reinforcement of key counseling principles. The WhatsApp-based peer support groups will be moderated by trained healthcare personnel, and they will remain active for a duration of 6 months from the enrolment of the first participant. Quick Investigation of Quality (QIQ) indicators to monitor fidelity to the counseling model and measure key process and outcome metrics Follow-up reinforcement will be provided during clients’ subsequent visits, ensuring continuity of care and addressing any emerging needs or concerns. 2. Balanced Counseling Strategy (BCS) The Balanced Counseling Strategy (BCS) is an evidence-informed, decision-support tool that simplifies and standardizes family planning counseling. It helps providers efficiently deliver tailored contraceptive information while ensuring clients play an active role in the decision-making process. BCS is delivered in three key phases: Pre-choice Stage – The provider briefly assesses the client’s reproductive goals and medical history to identify and exclude methods that may not be medically appropriate or acceptable. This step ensures safety and aligns counseling to the client’s context. Method-choice Stage – The client is presented with visual cards for eligible contraceptive methods. The provider discusses each option concisely, highlighting only relevant information regarding effectiveness, use, side effects, and acceptability. The client is encouraged to compare and ask questions to facilitate an informed choice. Post-choice Stage – Once a method is selected, the provider offers clear, practical guidance on method use, possible side effects, management strategies, and follow-up planning. The aim is to promote method adherence and continued satisfaction. Each session using the BCS model will last approximately 20–30 minutes and will be conducted in a supportive and respectful environment. Clients will receive method-specific brochures and decision-support cards developed for this study, designed for clarity and cultural appropriateness. As with the GATHER arm, trained healthcare personnel—primarily nurses, midwives, and family planning counselors—will deliver the sessions. These providers will receive additional supervision and monitoring to ensure the standardized application of BCS protocols across sites. Performance monitoring and quality assurance will include: Use of BCS checklists and cue cards Exit interviews assessing client understanding, satisfaction, and confidence in their chosen method Peer-support forums using mobile-based platforms for discussing case challenges and sharing best practices Provider Training for Intervention Delivery A comprehensive provider training program will be implemented to ensure high-quality and consistent delivery of both the GATHER and BCS interventions. The training is designed to build counseling competencies, strengthen communication skills, and promote client-centered attitudes among service providers. The training will be modular and participatory, delivered over 3 full days, with an additional 1-day refresher session conducted midway through the study period. Training modules will include: Foundations of Family Planning and Reproductive Rights Principles of voluntary choice, confidentiality, and non-discrimination Overview of modern contraceptive methods Counseling Skills and Interpersonal Communication Active listening Empathy building Handling myths and misconceptions Cultural sensitivity and managing bias Intervention-Specific Protocols Hands-on training in the GATHER and BCS models Use of counseling aids, cue cards, and decision-support tools Simulated role plays and scenario-based discussions Documentation and Data Recording Accurate use of checklists and client records Integrating counseling notes into routine service registers Quality Assurance and Supervision Mechanisms Understanding QIQ indicators Participating in peer-learning via WhatsApp groups Use of supervision feedback tools Trainers will include senior reproductive health specialists and master trainers certified in rights-based counseling. Training will be delivered in Urdu and Punjabi, with a combination of lectures, practical exercises, group discussions, and real-time feedback. Each participant will receive a training manual, job aids, and a counseling toolkit tailored to their intervention arm. Post-training, providers will be mentored through monthly supervisory visits, and their performance will be reviewed using structured observation checklists. Feedback will be shared in supportive, non-punitive formats to encourage continuous professional development and adherence to intervention standards.