FAMILY PLANNING COUNSELING The Women 's Health Safe Motl1erhood Project 2 reports.. As tlie 2003 NDHS nwca/s, the acnml total fertility rate (TFR) of 3. 5 is lriylw,· thmi 1oanted. (ati/ity of 2. 5. a,1d unmet family pfa1111i11g 11ced exists Jo,· one 0111 of. fii. 'C' women (19. 8~t,}. The 200. ; Family Planning Suruey shows tlrnt this co11/'in11cs to be: rhe mse.,dth :Jo.,'J;; total unmet need, of which 10. 9% is for spacing bir-tlts um/ 9. 2\"\5Ji:i1· /imi11·11g /Jirt'l,s. naecl to make a decision on family planning is dnne cluring preg11n11cy. (2007. p. Ci) (21) Family plannin g aru. 1 fertility awareness are part of whal. is uisc:ussed in I he firs L prcn. it,11 visit and the subseque11t visits. After delivery, the benclits elf family pl:rnnin~. 1isks of a pregnancy too soon and most ;;uitahle family planning methods for a breastfeeding woman,Lre discussed. The choices offered nre IUD. condom. prvi;csleronc unly p UI. natural family plannin g, spermicides,111d pern1anent methods. (9) 1\s:sistuncc is i:;iven to tl1e couple to help them decide on a choice of n family plnnni11g mctbocl. STD/HIV/AIDS PREVENTION AND MANAGEMENT The WHO standard aims for nil women seen during prcg11. 1ncy. c:hilclbinh and the poshia. tal period lo be given appropr Late inform:1tinn on the pr C'vcntion ~111d recognition of sexually tr,rnsmillcd inl"ettion::; (STls) and rcprnd11clivc tmt·t infections (RTls). They should be :1ssessed for ST!s/R,Tls :,ml, when rcquin:d, pro\'idetl with prompt and effecth·e trcatmenl for themselves :incl. in the case nf STls. their partners. Effective managem ent of STls is key to their cnntrnl, :,,: it prc,·cnts the development of complication s and sequelae, reduces the s1iread of these dise:iscs in the community and offers a unique opp01i:uni ty for targeted ed11catinn on I I IV prcvt:ntion. The prevalence of STls is increasingly becnming a source of concern in the country. A May 2002 su. rvey nf the general populntion showeci n relatively hig,h prevalence of chlamydia1 infections (5. 75% for women, 4,4% for men. 7. 7'X, for female youth and 9% for male youth), rrichomonias is (3. 18% for women) and p,nnonhca (0. 75% for women, 4-4% for men. 0. 7% for female youth and 1. 7% for mnlc-youth). The !-lituaticm :1. mong h1gh-1;sk groups is more disttll'bi11 g. Peliollic sl Udics from L994·:!. 00:!. t'Ollducled in 18 sites sho..,,,· that amon~ high-risk females. hacteri. il rnp,ino,;is is t J1c mo:st predominant, reaching 70%, followed by chlamydinl infections fup to 36%), gonorrhca (up to 31%) and syphilis (up to 7%).. 1-\mong high-risk males, chlatnydia leas lhl:! highest pre,·ulcnce (up to 16%), then syphilis (up to 11%) o1nd gonorrhe(I (up to 3'X,). The problcm is cowpounued by the emergenc e of antibiotic resistant strains. Ncnrly all gonorrhea isolates were found resistant to penic. illin iu L997 while 63% wl!rt! found rl. 'sistant to quinolones in 1998. ) (21). The health services for STls include !>creening. hc:ilth edltcation and referrals for lhose who need management and treatment. STANDAROS IN HOME DELIVERY A plan for birth and ways of dealing with uncxpeded adverse events, :-uch as complications or emergencies, lhat may occur dming r1·cgnnncy. d1ildbirth or the immediate postn<1tal period should always l>e avail,1ble. This pbn is Hrn H. :thin~ that is done with tl1e bealth earc provider at each antenatal visit ancl nt least cine month prior to the expected date of birth. Historical e..,,;denceshows that nu counlry has managed to bring its maternal mortality ratio below l OC> per 100 ooo live birlhs "~lhout cnsu1;ng that all women are attended by an appropriately skilled health professional during labour, birth and the period immediate ly afterwards (24) In focus-group discussions, midwives and hilots consi<lcr ed the delay in rt!femd 297 