International Family Planning Perspectives in Ecuador, Uganda and Zimbabwe, fewer than 75% of clients in each country were given any information about the contraceptive method they re c e i v e d . 5 Results are no diff e rent when the specific content of counseling is examined. For example, to probe how well clients w e re being counseled about when and how to switch methods, a study carried out in the coastal province of Santa, Peru , used simulated clients who had recently initiated pill use and who complained of headaches. Of the 54 Ministry of Health p roviders who were approached, more than 25% failed to tell the client that the headaches might be a side effect of pill use, and more than 30% did not tell her that they might disappear shortly. 6 In a similar study based on a national sample of 25 hospitals and 74 clinics in Ecuador, 47% of providers failed to tell the client that her headaches might be a side effect of the pill, and 61% neglected to inform her that they might go away with time. 7 When confronted with such evidence of incomplete counseling, providers generally attribute their shortcomings to causes beyond their control. In rural areas of Federico R. León is program associate with the Fro n t i e r s in Reproductive Health program of the Population Council, Lima, Peru. At the time this re s e a rch was conducted, Rosa Monge was a consultant, Adriana Zumarán was an intern, Ingeborg García was an intern and Alex Ríos was a re s e a rch assistant, all at the Population Council, Lima. The authors thank Lucy López for her comments on the study tools, Jorge Parra for his help in facilitating access to the health centers and John Townsend and Cynthia G reen for their useful comments on earlier drafts of this article. The re s e a rch upon which this article was based was made possible by funding from the U.S. Agency for International Development (USAID) under cooperative a g reement HRN-A-00-98-0012-00 with the Population Council. The opinions expressed herein are those of the authors and do not necessarily re flect the view of USAID. Length of Counseling Sessions and the Amount Of Relevant Information Exchanged: A Study in Peruvian ClinicsBy Federico R. León, Rosa Monge, Adriana Zumarán, Ingeborg García and Alex Ríos T he concept of "informed choice" in family planning counseling implies that providers assist clients in selecting the method that best satisfies their needs, and that clients leave the session knowing about the side effects of their chosen method and how to use it safely and eff e c t i v e l y. 1 Worldwide, however observational findings suggest that actual counseling is far from meeting these requirements.Audiotaped counseling sessions in Kenya, for example, revealed that only 57% of clients receiving the injectable and 32% of those getting the pill were provided with information on their method's side eff e c t s . 2 A situation analysis of Nairobi clinics showed that fewer than 50% of new clients w e re provided with information on contraindications to or side effects of thei...

As a preparation for its quantization in the loop formalism, the two-dimensional gravitation model of Jackiw and Teitelboim is analysed in the classical canonical formalism. The dynamics is of pure constraints as is well known. A partial gauge fixing of the temporal type being performed, the resulting second class constraints are sorted out and the corresponding Dirac bracket algebra is worked out. Dirac observables of this classical theory are then calculated.

This study was funded by the U.S. Agency for International Development (USAID) under the terms of the Frontiers in Reproductive Health Program Cooperative Agreement Number HRN-A-00-98-00012-00 and Population Council Subagreement number AI02.09A with the Escuela de Administración de Negocios para Graduados (ESAN). The opinions expressed herein are those of the authors and do not necessarily reflect the view of USAID. One-Year Impacts of Improved Quality of Care in Peru EXECUTIVE SUMMARY Context. A study with 24 health directorates of the Peru MOH as units of experimentation and analysis that was conducted in 2000-2001 showed that two-day provider training plus one-day retraining on the job aids-assisted Balanced Counseling Strategy resulted in significant enhancement of the quality of care, an increase of four minutes in session length, and improved client knowledge of the method chosen when this was an IUD or hormonal method. This study presents results of a one-year follow-up. Methodology. New-event family planning clients were recruited as they exited counseling sessions at treated and control clinics. The clients had chosen a contraceptive method and stated intentions to use contraception for at least one year. A questionnaire that included the calendar module of DHS was applied twice in home interviews to tap six and 12-month outcomes. Twelve-month data from 215 clients were analyzed in depth. Results. Knowledge of the method chosen when this was the IUD or a hormonal method was greater in the treated cohort (p < .05, one-tailed, df = 18) at the end of the follow-up period. Mean monthly (k = 12) family planning use rates over health-directorates (n = 12) were obtained for each cohort. The latter months showed less use of needed contraception (p < .01, df = 11,11) and the treated cohort greater use (.81) than the control cohort (.78, p < .01, df = 1,11) when contemporaneous perceptions of need were considered. Cumulative continuation rates from life tables did not differ significantly between cohorts according to the Wilcoxon (Gehan) statistic. Proportions of method shifting were similar in both cohorts. Attainment of contemporaneous reproductive goal was significantly greater in the treated cohort (.96) than the control cohort (.95, p < .01, df = 1,11). Conclusions and Recommendations. The intervention caused consistent, yet small, improvements in client outcomes. Correlational findings suggested that better impacts can be achieved in provincial primary health facilities than in larger settings like clinics or hospitals in capital cities. The results are important because: 1) other studies have failed to show significant impacts of controlled quality-of-care improvements on the use of contraception; and 2) the Balanced Counseling Strategy was not implemented to its full extent. Greater impacts can be expected when the Strategy's potential is fully realized.

This study investigated the effects of introducing a family planning counseling model at clinics of Peru's Ministry of Health. Providers trained in the model presented greater quality of care and longer counseling sessions than did controls. The main effects, however, were misleading. Nearly all of the quality improvements were contributed by 37% of the trained providers; they had already been better performers at the pretest and complied with the new counseling model's requirement of job aid use at the posttest. The recognition that a majority of trained providers did not profit from training posed a challenge that led to improvements in the model. Training x Trainee Interactions should be explored in evaluations.

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