Population Council Research that makes a difference

The Balanced Counseling Strategy:
A Toolkit for Family Planning Service Providers

The Balanced Counseling Strategy (BCS) is an interactive, client-friendly counseling strategy that uses three key job aids to guide comprehensive and high-quality family planning counseling to clients.

The BCS toolkit incorporates international family planning norms and guidance as recommended by the World Health Organization, including the 2004 Medical Eligibility Criteria for Contraceptive Use and the 2007 Family Planning Global Handbook. The process, tested and refined in several countries, involves a set of steps to determine the method that best suits the client according to her/his preferences and reproductive health intentions. The BCS toolkit includes:

1. An algorithm that summarizes the 11 steps needed to implement the strategy (PDF);
2. Counseling cards with basic information about 15 family planning methods, plus a card with the checklist to be reasonably sure a woman is not pregnant; (PDF); and
3. Brochures on each of the methods for the client to take once a method is chosen;  (PDFs below):
   

	The pill	Emergency contraception	Female condoms
	Tubal ligation	Hormonal implants	Intrauterine device
	Progestin-only injectables	Monthly injectable	Spermicides
	Minipill	TwoDay Method®	Vasectomy
	Standard Days Method®	Male condoms	Lactational amenorrhea method

The BCS approach is easy to adapt to local contexts, and the toolkit includes instructions for adaptation as well as a CD-ROM with electronic copies of the materials that can be modified for the local context. The BCS has been adopted by many programs in countries around the world, translated into multiple languages (French and Spanish versions are available), and further modified for each specific service-delivery strategy in many settings. For example, the Extending Service Delivery project has included the BCS as a "best practice" for providing counseling on family planning and adapted it slightly to address healthy timing and spacing of pregnancy and to help providers identify women who are most at risk of a high-risk pregnancy.

In addition to the original toolkit, the BCS was revised and tested by the Population Council in Kenya and South Africa to facilitate integration of counseling and testing for sexually transmitted infections (STIs), including HIV, in settings with high prevalence. The Balanced Counseling Strategy Plus (BCS+): A Toolkit for Family Planning Service Providers Working in High HIV/STI Prevalence Settings is a tool to improve the quality of family planning services and to strengthen the integration HIV prevention, detection, and care into family planning, such as the risk assessment of STIs.

Population Council staff are currently working to update the counseling tool and further adapt it for use in different settings, such as postpartum clinics; by other health professionals, such as community health workers; and in new and more technologically advanced formats, such as mobile phones and SMS.