Predisposing Factors And Students Attitude Towards Counselling

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What is in this session?

This session focuses on some of the different factors that can affect or influence counselling for MNH. These include the larger social and cultural context, including socio-economic conditions, cultural and social norms, gender roles, and household decision-making processes.

These diverse factors will impact upon your counselling session; therefore a deeper understanding of their influence is required. This session also considers specific situations such as couple counselling, and counselling on sensitive issues such as sexuality.

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What am I going to learn?

By the end of this session you should be able to:

  1. Explain the key contextual factors which have an impact on counselling for maternal and newborn health.
  2. Analyse the effect these factors may have on the counselling relationship.
  3. Explain the importance of couple counselling and counselling on sensitive issues.
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The counselling context

The term ‘counselling context’ does not refer here to the physical location where counselling takes place (which we call the counselling environment) but relates to the social, cultural, economic, religious and political factors of the place where you work, and the communities in which the people you will counsel, live. This section examines how these different factors may influence the counselling context.

It is important for you to be aware of the different factors that have an effect on the counselling context within the community you work. In the previous sessions we highlighted how important it is to assess and understand the woman’s own knowledge, skills and individual situation. It is also important to assess and understand the wider cultural and social context in which you work.

Economic conditions

Economic status refers to one’s financial status and is strongly related to health and educational status. So in general, most people with a low economic status (e.g. a low income) are also likely to have a lower educational and health status.

On the other hand, those with a higher economic/financial status will have better access to education and health services and will have higher status in these areas. It is important to take into account the socio-economic status of a woman, couple or family because this status will affect the decisions they have to make as well as the needs they have. For example, a woman who is poor may not have money to attend a health facility (either for child care, transport or where she must pay user fees). Similarly if a woman has a low educational status she may not appreciate the benefits of birth in a health facility and her low health status may mean she is at higher risk of poor health outcomes for both her and her baby. Educational status is also related to literacy. You need to know the literacy level of people that you counsel so that you do not give them complex advice or instructions in words which are unfamiliar to them, materials that they cannot read, or forms which they are unable to understand or complete.


Be aware that this may be a sensitive topic for some women.

Try open-ended questions as you try to form an alliance:

“I’d like to get to know you a little more; perhaps you can tell me something about yourself and your home situation?”

At other times you will have to be more direct e.g. “What level of education did you finish?”

How does your household earn its income?”

It can help you to form an alliance with the woman if you are open with her about why you want to know this information. Tell her that knowing this type of information will help you to tailor the service you provide to her specific needs.

Social and cultural context

Culture is a term we use to describe the values, beliefs, practices and ways in which a community or society lives. It also includes the way the people express themselves, communicate, and interact with one another. The social context refers to how people are organized, in terms of family groupings (do they live in extended or nuclear /traditional families? or do husbands have several wives?) It also refers to group interactions and hierarchies within communities. For example, are there group leaders, chiefs, or headmen or women, and what role do they play? The cultural and social context affects all aspects of life, from how people greet one another, to how they interact in the household and how they make decisions.


Being aware of the social and cultural context will help you form an alliance with the woman or couple you are counselling and will help you decide appropriate ways to communicate in terms of how you ask questions, how you approach sensitive issues, and how you facilitate the process of problem-solving. It will also enable you to tailor your counselling to their specific needs.

Issues such as religion or social status affect peoples’ ideas or feelings and this can influence communication and counselling. The cultural and social context can be expressed differently depending on the setting such as the home, schools, the workplace, or the health service. Your professional training took place within a particular perspective on health and you may feel it is the most appropriate way of approaching health issues. Other communities and cultures have their own ways of talking about health which may be different from yours. Thus it is important to reflect on what these different beliefs and values are, as they will have an impact on the way in which you interact with women and their families and the way they interact with you.

Pregnancy and birth are normally very social and cultural events and thus tied to many specific beliefs and practices. In order to better support a pregnant woman and her family, it is important to know these beliefs and practices. Some may be very good for the woman and her baby, others may not be beneficial but also do no harm; you can build upon these beliefs and practices, and try to incorporate them into your practice and service. Other beliefs and practices may cause harm. You will need to discuss these with the women and her family and the broader community to see how they can be changed.

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