The Balanced Counseling Strategy Plus
A Toolkit for Family Planning Service Providers
Working in High STI/HIV Prevalence Settings
TRAINER’S GUIDE
Third Edition, 2015
,© 2008, 2011, 2015 The Population Council, Inc.
The Population Council confronts critical health and development issues—from stopping the spread of HIV to improving
reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public
health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and
technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a nongov-
ernmental, nonprofit organization governed by an international board of trustees.
Any part of this publication may be photocopied without permission from the publisher provided that copies are distributed
without charge and that full source citation is provided. The Population Council would appreciate receiving a copy of any materi-
als in which the text is used.
Suggested citation: Population Council. 2015. Balanced Counseling Strategy Plus Trainer’s Guide Third Edition, part of The Balanced
Counseling Strategy Plus: A Toolkit for Family Planning Service Providers Working in High STI/HIV Prevalence Settings, Third Edition,
Washington, DC.
Note: This publication is part of a larger publication titled The Balanced Counseling Strategy Plus: A Toolkit for Family
Planning Service Providers Working in High STI/HIV Prevalence Settings. The Balanced Counseling Strategy Plus Toolkit
includes the following:
▪▪ Algorithm
▪▪ Counseling cards
▪▪ Method brochures
▪▪ User’s Guide
▪▪ Trainer’s Guide
▪▪ WHO Medical Eligibility Criteria Wheel
If any part is missing, please contact the Population Council at .
, Preface to Third Edition
The Balanced Counseling Strategy Plus (BCS+) toolkit, developed and tested in Kenya (2005 to 2007)
and South Africa (2004 to 2006) because both countries have high rates of STIs, including HIV, and
their contraceptive prevalence rates are relatively high for the region. The BCS+ provides the infor-
mation and materials that healthcare facility providers need so they can offer complete, high-quality
family planning counseling to clients living in areas with high rates of HIV and STIs. The BCS+
was adapted from the Balanced Counseling Strategy (León 1999; León et al. 2003a, b, c; León, Ver-
non, Martin, and Bruce 2008). First edition of the Balanced Counseling Strategy and Balanced Counseling
Strategy Plus toolkits are products of the Population Council’s FRONTIERS program, supported
by the United States Agency for International Development (USAID), Cooperative Agreement
HRN-A-00-98-00012-00.
The Second Edition was updated based on the 2010 WHO Medical Eligibility Criteria (MEC) as
well as recommendations from authors and partners who have experienced and evaluated imple-
mentation of the tool in settings and scenarios around the world and validated through the Integra
Initiative, supported by the Bill and Melinda Gates Foundation. It included additional counseling
cards on cervical cancer screening, postpartum and infant health.
This Third Edition of the BCS+ includes content updated according to the latest WHO Medical
Eligibility Criteria (2015). It incorporates the most up-to-date evidence on clinical indications for
the provision of family planning methods, including new methods (Caya®/SILCS diaphragm and
Progesterone Vaginal Ring), and includes five new counseling cards that address Adolescent Coun-
seling, Male Services, Post Abortion Care, and Women’s Support and Safety. The updated cards
include instructions for providers, guiding them through supplemental counseling and services that
family planning clients may need. Development of this Third Edition of the BCS+ toolkit was
funded by the Evidence Project, USAID Cooperative agreement AID-OAA-A-13-00087 and the
Bill and Melinda Gates Foundation supported Integra Initiative at the Population Council.
| iii |
, Acknowledgments
Development of The Balanced Counseling Strategy Plus (BCS+) could not have been possible without
the invaluable support of the service providers who tested the toolkit and the program directors
who authorized and supervised its application. The authors wish to thank the Department of
Health in South Africa and the Division of Reproductive Health and the National AIDS and STD
Control Program of the Ministry of Health in Kenya. We would also like to thank the trainers at the
Reproductive Health and HIV Research Unit (RHRU) of the University of Witwatersrand for their
contribution to the study in South Africa.
Development and production of the third edition of The Balanced Counseling Strategy Plus was sup-
ported by the Population Council. Authors would like to acknowledge the following individuals
for providing their technical expertise and invaluable contributions to this updated edition of the
BCS+: Megan Christofield, Heather Clark, Mychelle Farmer, Kamlesh Giri, Joanne Gleason, Mark
Hathaway, Anushka Kalyanpur, Maggie Kilbourne-Brook, Karen R. Kirk, Ricky Lu, Ruth Merkatz,
Charity Ndigwa, Anne Pfitzer, Saumya RamaRao, Naomi Rijo, Elizabeth Rochette, Jill Schwartz,
Leigh Stefanik, John Townsend, Chi-Chi Undie, Katie Unthank, Anneka Van Scoyoc, Charlotte
Warren, Ellen Weiss, and Kelsey Wright.
| iv |
A Toolkit for Family Planning Service Providers
Working in High STI/HIV Prevalence Settings
TRAINER’S GUIDE
Third Edition, 2015
,© 2008, 2011, 2015 The Population Council, Inc.
The Population Council confronts critical health and development issues—from stopping the spread of HIV to improving
reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public
health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and
technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a nongov-
ernmental, nonprofit organization governed by an international board of trustees.
Any part of this publication may be photocopied without permission from the publisher provided that copies are distributed
without charge and that full source citation is provided. The Population Council would appreciate receiving a copy of any materi-
als in which the text is used.
Suggested citation: Population Council. 2015. Balanced Counseling Strategy Plus Trainer’s Guide Third Edition, part of The Balanced
Counseling Strategy Plus: A Toolkit for Family Planning Service Providers Working in High STI/HIV Prevalence Settings, Third Edition,
Washington, DC.
Note: This publication is part of a larger publication titled The Balanced Counseling Strategy Plus: A Toolkit for Family
Planning Service Providers Working in High STI/HIV Prevalence Settings. The Balanced Counseling Strategy Plus Toolkit
includes the following:
▪▪ Algorithm
▪▪ Counseling cards
▪▪ Method brochures
▪▪ User’s Guide
▪▪ Trainer’s Guide
▪▪ WHO Medical Eligibility Criteria Wheel
If any part is missing, please contact the Population Council at .
, Preface to Third Edition
The Balanced Counseling Strategy Plus (BCS+) toolkit, developed and tested in Kenya (2005 to 2007)
and South Africa (2004 to 2006) because both countries have high rates of STIs, including HIV, and
their contraceptive prevalence rates are relatively high for the region. The BCS+ provides the infor-
mation and materials that healthcare facility providers need so they can offer complete, high-quality
family planning counseling to clients living in areas with high rates of HIV and STIs. The BCS+
was adapted from the Balanced Counseling Strategy (León 1999; León et al. 2003a, b, c; León, Ver-
non, Martin, and Bruce 2008). First edition of the Balanced Counseling Strategy and Balanced Counseling
Strategy Plus toolkits are products of the Population Council’s FRONTIERS program, supported
by the United States Agency for International Development (USAID), Cooperative Agreement
HRN-A-00-98-00012-00.
The Second Edition was updated based on the 2010 WHO Medical Eligibility Criteria (MEC) as
well as recommendations from authors and partners who have experienced and evaluated imple-
mentation of the tool in settings and scenarios around the world and validated through the Integra
Initiative, supported by the Bill and Melinda Gates Foundation. It included additional counseling
cards on cervical cancer screening, postpartum and infant health.
This Third Edition of the BCS+ includes content updated according to the latest WHO Medical
Eligibility Criteria (2015). It incorporates the most up-to-date evidence on clinical indications for
the provision of family planning methods, including new methods (Caya®/SILCS diaphragm and
Progesterone Vaginal Ring), and includes five new counseling cards that address Adolescent Coun-
seling, Male Services, Post Abortion Care, and Women’s Support and Safety. The updated cards
include instructions for providers, guiding them through supplemental counseling and services that
family planning clients may need. Development of this Third Edition of the BCS+ toolkit was
funded by the Evidence Project, USAID Cooperative agreement AID-OAA-A-13-00087 and the
Bill and Melinda Gates Foundation supported Integra Initiative at the Population Council.
| iii |
, Acknowledgments
Development of The Balanced Counseling Strategy Plus (BCS+) could not have been possible without
the invaluable support of the service providers who tested the toolkit and the program directors
who authorized and supervised its application. The authors wish to thank the Department of
Health in South Africa and the Division of Reproductive Health and the National AIDS and STD
Control Program of the Ministry of Health in Kenya. We would also like to thank the trainers at the
Reproductive Health and HIV Research Unit (RHRU) of the University of Witwatersrand for their
contribution to the study in South Africa.
Development and production of the third edition of The Balanced Counseling Strategy Plus was sup-
ported by the Population Council. Authors would like to acknowledge the following individuals
for providing their technical expertise and invaluable contributions to this updated edition of the
BCS+: Megan Christofield, Heather Clark, Mychelle Farmer, Kamlesh Giri, Joanne Gleason, Mark
Hathaway, Anushka Kalyanpur, Maggie Kilbourne-Brook, Karen R. Kirk, Ricky Lu, Ruth Merkatz,
Charity Ndigwa, Anne Pfitzer, Saumya RamaRao, Naomi Rijo, Elizabeth Rochette, Jill Schwartz,
Leigh Stefanik, John Townsend, Chi-Chi Undie, Katie Unthank, Anneka Van Scoyoc, Charlotte
Warren, Ellen Weiss, and Kelsey Wright.
| iv |
