*Healthy women :

1. *Healthy women : • -has energy to fulfill many roles ,in family ,& community . • -build satisfying relation-ship with others . • *every woman has the right to complete her health care throughout her life in all areas. • *woman health is community issues. • *health of the woman is affected by :- • -1-her body ,how made . • -2-social status . • -3-cultural believes. • -4-economic status.

2. *There are basic in-equality between women and men :- • A-women are suffering of poverty more than men. • -B-have low chance for education than men. • -C-more women than men lack control over their basic health decision. • -D-lack of important health information and services

4. Health problems affect women • *1-poor nutrition: • -common health problem. • -less food provided to girl than boy, so this problem worsen with age because of( the need for good food increase ,work load increase, monthly bleeding ,pregnancy ,&breast feed). • -Many women suffer from poor health in-form of exhaustion, weakness &anemia. • -male nourished women, when become pregnant liable to complication as (bleeding ,infection ,small babies ).

5. *2-Reproductive health problem:- • -a-STD(sexually transmitted disease) include HIV \AIDS. • -this problem is social problem. • -STIs can cause: • *pain, sever pelvic inflammatory disease, infertility ,problem during pregnancy, increase risk for cervical cancer*

6. -b-frequent pregnancies: • -in many part of world woman become mother before 20 yrs old • -without family planning ,risk for poor health ,&complication during pregnancy &child birth can developed . • -Education and learning skills is affected . • -c-complication from pregnancy &birth :- • -infant death ,maternal death . • -d- un-safe abortion : • -dangerous for her life . • -result in health problem*infertility ,pain, infection*

7. -f-female circumcision:- • -lead to serious health problem as: • *pelvic and urinary system infection . • *sexual and emotional problem. • *3-general medical problems : • -medical health problem rejected by her husband ,as TB,smoking ,alcohol problem . • -woman are less likely to seek &receive treatment until they are seriously ill. • *4-work hazards : • -inside work hazard comes from home ,cooking lead to burn &lung disease. • -outside working (long hours of work ,double work day )exhaustion increase risk for illness.

8. 5-mental health problem :- • -women &men have the same risk of developing mental health problem. • -sever depression affect woman than men . • -woman are less likely to get help than men ,if suffer from mental health problem. • *6-violence : • -lead to: • **serious injury . • **mental health problem . • **physical disabilities. • **death . • -sexually abuse by family members, friends. • -physical abuse ,by partner . • -Rape . • -most violence not reported ,men are not punished ,&women are blamed .

9. *causes of poor health in women :- • -1- poverty : • -girls take less food than boy ,their growth &development become slowly . • -little or no education . • -work at un-skilled job. • -receive fewer salary than men . • -poverty often forces woman to be dependant on men . • -poverty cause many physical &mental problem as: • a-bad housing , no sanitation ,&no clean water . • b-lack of good food . • c-expose to dangerous work ,or for long hours . • d-cant use medical care . • e-feeling of inferiority .

10. -2-low status of the woman:- • -women's lower status lead to discrimination ,&being treated poorly. • -lack of legal rights or power ,to make decision ,e.g. travel .

11. **Counseling • -through counseling ,mid-wife help clients make &carry out their own choice . • -counseling is more widely used in reproductive health ,&family planning . • ** principles of counseling :- • 1-treat each client well : • -the care provider is polite ,show respect for every client . • -build trust . • -speak openly . • -answer question . • -maintain confidentiality

12. 2-Interact : • -care provider listen ,learns ,&responds to client . • -care provider can help client ,by under-standing her needs ,concerns ,&situation . • 3-give information to client : • -care provider learn what information each client need . • -the stage of person life ,suggests what information is important • -information should be given accurately . • -language should be simple &clear .

13. 4-avoid too much information : • -it make hard to remember . • -information overload . • -let the client to make their informed choice . • -what client choice should be respected . • -explain advantages &dis-advantages of the subject .

14. **Informed choice : • -person freely make decision ,based on accurate ,useful information . • -the goal of family planning counseling is to help clients make informed choice . • *Informed: • -client has clear ,accurate ,specific information . • -information overload should be avoided. • *choice: • -clients make their own decision without pressure

15. **Topics of counseling:- • -Effectiveness: • -experience of the client ,good or bad . • -How well family planning method prevent pregnancy . • 2-advantages &dis-advantages: • -it is important to remember that dis-advantages for some people are advantages for other . • 3-side effects &complications: • -the client needs to know side effect of each method ,especially serious sign . • -client need to know when to see the Dr,or Midwife ,and to return to clinic .

16. -Effectiveness: • -experience of the client ,good or bad . • -How well family planning method prevent pregnancy . • 2-advantages &dis-advantages: • -it is important to remember that dis-advantages for some people are advantages for other . • 3-side effects &complications: • -the client needs to know side effect of each method ,especially serious sign . • -client need to know when to see the Dr,or Midwife ,and to return to clinic .

17. -How to use : • -clear instructions are important , what to do in case of mistake ,special matters as remembering. • 5-STIs prevention : • -how to prevent STIs\AIDS through use of condom. • 6-when to return: • -return to clinic to get more supplies (pills ,condom). • -return for follow up in case of IUD. • -client is always welcome back for any reason.

18. Steps in counseling new client • -counseling new clients about family planning is process. • -the process consist of 6 steps remembered with GATHER: • *1-Greet clients in open respectful manner , privacy & confidentiality should be maintained . • -ask client how you can help ,&explain what the clinic can provide . • *2-Ask clients about themselves : • -let client talk about their family planning ,&reproductive wishes ,her concerns ,need ,knowledge . • -ask them about family planning method in mind . • -put your-self in client place .

19. *3-Tell client about choices : • - depending on clients need ,tell here what reproductive health choices might make . • -focus on method that most interest client ,& briefly mention other available method . • *4-Help clients make an informed choices : • -the provider should help client to express feeling &ask question • -consider medical eligibility for methods that interest client . • -ask if partner will support client decision . • *

20. 5-Explain fully how to use the chosen : • -after client chooses family planning method give her supplies . • -explain method of use , encourage questions ,&answer them openly . • -give condom to any one at risk of STIs . • *6-Return visit should be well come : • -discuss& agree when the client will return for follow up ,&more supplies . • -always invite client to come back any time for any reason