Don’t Take it on Faith – Evidence for the Standard Days

Method as a Tool for Repositioning Family Planning

Victoria Jennings, Ph.D. Director, Institute for Reproductive Health

What is the Standard Days Method?The SDM is a fertility awareness method that…

Identifies days 8-19 of the cycle as fertile

Is appropriate for women with menstrual cycles between 26 and 32 days long

Helps a couple avoid unplanned pregnancy by knowing which days they should use a condom or abstain

Helps a couple plan pregnancy by knowing which days they should have sex

Is used with CycleBeads™

What are CycleBeads™?

The SDM is used with CycleBeads™, a color-coded string of beads that helps a woman:

Track her cycle days Know when she is fertile Monitor her cycle length

How can this method help reposition family planning?

Repositioning focuses on:

• Offering family planning at the community level• Offering family planning through non-traditional channels• Expanding social marketing• Including men• Improving contraceptive security• Strengthening and implementing family planning policies• Expanding contraceptive prevalence

The SDM can be offered equally well by clinical and community providers

Women Associations

Catheshists Volunteers

Pharmacies

Agricultural Cooperative

The SDM can be offered successfully through non-traditional channels

The SDM can be added to a range of social marketing

products

The SDM includes men

There is increased continuation and satisfaction when men are informed

Governments are including the SDM in policies and norms

• Benin

• Bolivia

• Burkina Faso

• Ecuador

• El Salvador

• Guatemala

• India

• Mali

• Nicaragua

• Philippines

• Peru

• Rwanda

SDM increases contraceptive prevalence

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Percent of New Users 2 Years After Introducing SDM in Rwanda

Source: Ministry of Health, Rwanda

SDM expands method mix

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Percent of New Users by Method

Source: Ministry of Health, San Martin, Perú

SDM is offered as a method choice

Panel PresentationPanel leader: Bernard Balibuno, IRH Program Officer

Panel participants: Arsene Binanga (D.R.Congo)

Candide Dahoun-Agbobatinkpo (Benin)

Priya Jha (India)

Marie Mukabatsinda (Rwanda)

Foufa Keita Toure (Mali)

Jeremie Zoungrana (Burkina Faso)

Mitos Rivera (Philippines)

Luisa Sacieta (Peru)

Democratic Republic of Congo

SDM entry point to FP:• Over 10,000 users

representing 20,000 CYPs• 12 secular and faith based

partners have integrated SDM into programming

• Method provided in over 393 clinics and 112 pharmacies

SDM offered in:• Public and private clinics• PSI Pharmacies• CBD programs• Conservation programs• Social Marketing programs

Democratic Republic of Congo

Committed SDM partners include:• USAID/DRC• MOH/PNSR• GTZ• PSI• CARE• SANRU III• FBOs• IPPF affiliate• Jane Goodall Institute

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141 SDM Sites

BeninSDM entry point to FP:

• more than 7000 SDM users • 90-95% are new FP users• 12-18% of “all methods” use

Raising FP awareness through SDM programs:

• Over 6000 clients reached through community distribution (Benin - OSV/Jordan)

• 48% referred to other methods

SDM offered through non-traditional channels:

• Orphanage and child protection • Family life and marriage counseling • Peace Corps Volunteers• Peer educators (20+ schools)

SDM training has reached:• 24 champion journalists• 291 community and religious

leaders• 57 community distributors• 248 clinic providers• 125 voodoo priests• 6 universities and training

schools • 103 pharmacists

44 pharmacies selling CycleBeads (with men mostly buying)

Benin

IndiaSDM entry point to FP: – More than 5,000 SDM users

– 90% are first time FP users

– 4% of all new FP users select SDM (Jharkhard)

– 7% of young married couples in a pilot study chose the SDM

SDM mobilizes commitment for Birth Spacing:– 38 journalists trained

– Introduces birth spacing as topic in high level GOI meetings

– 500 providers trained in FP

– Catholic Bishops Conference of India, serving 100m people annually

Getting the SDM in the community: 90% of new SDM users reached through CHWs Wall paintings, slogan writing, miking, village meetings, street theatre and posters Village meetings Media coverage Interactive satellite telecast reached 800 women from rural desert communities

SDM services provided by:• Village pharmacies• Community (male & female) health workers• MCH nutrition workers (Anganwadi workers)• Traditional birth attendants • Child survival and child sponsorship programs• Malaria prevention programs• Services for newly married youth• 39 social marketing outlets (RMPs)

India

Rwanda

SDM entry point to FP: -offered at 110 sites-total of 5,000 SDM continuing users (Mar ‘03-July ’06) -96% are first-time FP users-SDM contributes 9% of method mix (faith-based and public health services)-28 SDM sites alone comprised 0.5% of the 10.3% of population using modern methods (2005 DHS)

SDM commitment comes from:•Ministry of Health•IntraHealth (Prime II, Twubakane, Capacity)•PSI•JSI (Deliver)•FBOs•NGOs (IPPF affiliate, Doctors without Borders)

RwandaA Timeline of SDM

Programming:• Introduction in 13 pilot sites (‘02) • Training trainers and IEC/BCC

activities & media work• Assessment of pilot phase after 1st

year (IRH and MOH) • Expansion to 15 sites (Feb ’04)• Expansion to 20 intervention sites

via an Impact Study (3rd year)• Expansion to 19 control sites of

Impact Study• Additional providers trained in 41 sites

with Twubakane Project • Technical assistance to partners

interested in integrating the SDM

RwandaCommunity Outreach:• 1,932 community health

mobilizers trained to refer interested clients

• Local leaders oriented on SDM; deliver SDM messages at community meetings

• Establish links between religious communities and health centers

Mali

2% Traditional Methods

6% Modern Methods

92% No methods

2006 Population Reference Bureau

Building support for SDM and FP:• The MOH • ToT of 50 regional and national

trainers• Involving multi-sectoral stakeholders

Expanding the cadre of service providers:

• Community distribution• Madrasa• Markets • Associations

Mali

Future Plan – Mali

• Training of providers in all Circles (districts) covered by USAID (30-40% of the country)

• Training of providers in about 300 CSCOMs (health clinics at the district level)

• National advocacy conference for religious and community leaders

• Information workshop for journalists

Burkina FasoSDM entry point to FP:

• Over 3000 SDM users • 80-90% are new FP

users

SDM integrated into non health programs:

• Adult literacy programs• Micro credit and

agriculture programs• Refugee relief programs• FBOs (Saint Camille)

SDM mobilizes commitment for RH:

• MOH • UNFPA

• US embassy

Expanding the cadre of providers:

• Over 300 Catéchistes trained (Commission Diocésaine de la Pastorale Familiale)

• Volunteers in Refugee Camps (World Neighbors)

Burkina Faso

Philippines

SDM entry point to FP:-- 1,455 providers trained -- SDM registered 10% awareness among

women of reproductive age and 0.1% use in the Family Planning Survey without any national promotional effort

-- In one area in Mindanao, 66% of the 1,453 users of NFP are SDM users

SDM raised awareness for FP in general:-- Department of Local Government circular

on SDM (2003)-- Approved by Catholic Bishops’

Conference (2004)-- SDM in DOH Clinical Standards (2006)

Mobilize commitment with partners:

– Central and Local Government units, including Mindanao (90% Muslim)

– Department of Health (DOH) Regional Offices

– Private Sector Mobilization projects- private doctors/midwives- agriculture cooperative- Prudential Life Insurance- Social Welfare agencies

– Colleges and Associations of Nursing/Midwifery

– 6 diocese

Philippines

PerúSDM integrated into services:– Ministry of Health services in 3

departments• Over 9000 SDM users • 80-95% are new FP users• 6-11% of “all methods” use

- NGOs and for-profit private providers and clinics

- Non-traditional service delivery programs:• religious organizations• military health training

PerúTowards technical sustainability:• SDM taught to midwifery students of 5 public and private

universities.• National Federation of Midwifery Schools in the process of

incorporating SDM into curricula of all 19 affiliated universities.

• National Association of Midwives training its 19,000 affiliated midwives in the SDM.

You are the director of family planning for the

MOH in Mangura, a West African country with 10

million population, a TFR of 5, and 7%

contraceptive prevalence.  You would like to

include the SDM in your program. 

• What are your top 2 concerns?  • What are 3 actions that you need to take right

away to get the process started?

You are the Program Officer for the CA implementing a cooperative agreement with USAID in

Baruvia.  The scope of work includes the SDM and focuseson expanding family planning through the public and privatesectors.  Currently, SDM services are available through a

family planning NGO in one of the five health regions of thecountry.  The SDM is included in the MOH norms, and theministry wants to offer the method but doesn’t have trained

providers yet.  You have 12 months to get the method scaledup in two more regions.  

• What are your top 2 concerns?  • What are 3 actions that you need to take right away to get

the process started?   • What will be 2 indicators of success?