Transcript The TwoDay Method A Simple Approach to Natural Family Planning

Standard Days Method
A Simple Fertility
Awareness-Based
Approach to Family Planning
Learning Objectives
At the end of the workshop, participants
will be able to:
 Describe how the SDM works
 Summarize the scientific basis and
efficacy of the method
 Identify the method eligibility criteria
 Explain how to use the SDM with
CycleBeads
 Identify key issues in SDM service
delivery
Standard Days Method
 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 not have unprotected sex
 Helps a couple plan pregnancy by
knowing which days they should have sex
CycleBeads
The SDM is used with CycleBeads™, a
color-coded string of beads to help a
woman:
 Track her cycle days
 Know when she is fertile
 Monitor her cycle length
What Is the Scientific Basis of
the Standard Days Method?
Probability of Pregnancy from
Intercourse on Days Relative to
Ovulation
35%
30%
25%
Ovulation
20%
15%
10%
5%
0%
-9
-8
-7
-6
-5
-4
-3
Cycle Days
Source: Wilcox et al. 1998
-2
-1
0
1
2
Probability of Ovulation Relative
to Midpoint of the Cycle
35
30.1
% of cycles
30
25
18.4.
20
15
12.1
10
11.9
8
5.6
5
0
2.4
4.3
< -4
-3
-2
-1
Midpt
Days
1
2
3
Peak day used as proxy of ovulation
Source: IRH analysis of WHO 1981 data
0.9
4
>
Determining the Fertile Window
Day 8
Day 19
How Effective Is the
Standard Days Method?
Efficacy Study of the SDM
• Multi-site prospective
study
• Services provided
through existing
programs
• Clients followed
monthly for 13 cycles
SDM Efficacy Study Results
• Couples used the method correctly in
97% of cycles
• Of the 478 women in the study, 43 got
pregnant
• With correct use, the failure rate is 4.8
• With typical use the failure rate is 12.0
Contraceptive Failure of
User-Directed Methods
% of women who became pregnant during 1st year of use
No Method
Spermicides
Diaphragm
Condom
OC
Standard Days Method
Correct Use
Typical Use
85
18
6
2
.3
85
29
16
15
8
5
12
Adapted from Contraceptive Technology, 18th edition, 2004
Contraceptive Failure of
Natural Methods
% of women who became pregnant during 1st year of use
Correct Use
Typical Use
2–5
3–5
18 - 22
20 - 22
5
12
Symptothermal Method
Billings Ovulation
Method
Standard Days Method
Sources:
Guida M., et al. Gynecological Endocrinology 1997.:
Arévalo M., et al. Contraception May 2002
World Health Organization, Fertility and Sterility, 1981
Trussell, et al., Family Planning Perspectives, 1990
How Is the Standard Days
Method Offered to Clients?
Offering the SDM
 Determine client interest in the SDM
 Screen for cycle length, ability to avoid
unprotected intercourse on fertile days and
STI risk
 Explain SDM
 Demonstrate CycleBeads
 Have client demonstrate
 Verify understanding/acceptance
 Provide CycleBeads, other materials
What is Involved in SDM Counseling?
 Screening – Help client determine if
the SDM is appropriate for her.
Calendar and Screening Checklist
 Teaching – Provide information and
instructions to use the SDM correctly.
Cycle Beads Cue Card
 Supporting – Explore and discuss
couple issues and support correct
method use. Screening Checklist
Screening
Who Can Use the SDM?
 Women with cycles 26 to 32 days long
 Couples who can avoid unprotected sex
on days 8-19
Couples not at risk of STIs
Screening to See if the SDM is
Appropriate for the Woman
 Is her cycle between 26 and 32 days long?
Most women have a general idea of:
 When their last period started
 When their next period will start
 Whether it usually comes when they expect it
 Simple questions to assess cycle length and
regularity.
 Women who know when their last period started
can use the SDM right away.
 Women who do not know can begin the SDM
when their next period starts.
Screening: Cycle Length
(Start date of last period known)
 What day did your last period start?
 When do you expect your next period to start?
26 – 32 days?
no
Offer other method
yes
Begin SDM today
Screening: Cycle Length
(Start date of last period not known)
 Do your periods come about when you expect them?
 Do your periods come about a month apart?
 Does your period often come later or earlier than you expect it?
26 – 32 days?
no
Offer other method
yes
Begin SDM when
period starts
Criteria for Starting the SDM
Date of the last period
known
Start immediately
Date of last period
unknown
Start on first day of next
period
Screening to See if the SDM is
Appropriate for the Woman
 Are her cycles between 26 and 32 days long?
Screening: Special Circumstances
Oral contraceptive, Patch, Implant, IUD/IUS,
EC, Abortion or Miscarriage


Before using this method or before pregnancy, did your
periods come when you expected them?
Were they about a month apart?
26 – 32 days?
no
Offer other method
yes
Begin SDM when
period starts
Current/Recent Injection User
Needs to wait:
 until she stopped using injection (3 months since
last injection) and periods are back to normal
 most recent cycle was 26 to 32 days long
Ask the client:
 When did you have your last injection?
 When were you supposed to get your next injection?
 How many periods have you had since your last injection?
 Do your periods come when you expect them?
 Were your last two periods about a month apart?
Post-partum/Breastfeeding Woman
Needs to wait:
 until she has had 4 consecutive periods (i.e. 3
cycles)
 most recent cycle 26 to 32 days long
Ask the client:
 Has your period returned?
 How many periods have you had since your baby was born?
 Are your periods regular? or, Do they come when you expect
them?
 Were your last two periods about a month apart?
Criteria for Starting the SDM
(Special Circumstances)
Postpartum/breastfeeding
Wait until for 4 periods
Start after 2 most recent are about
a month apart
3-month Injection
Wait 90 days after last injection
Start after 2 most recent periods are
about a month apart
OC, patch, implant, EC,
IUS, miscarriage or abortion
Cycles before using method or
pregnancy were 26 to 32 days long
Start on first day of next period
Teaching
How to use the SDM
• Teach client how to
use the SDM with
CycleBeads
• Confirm client knows
how to use the
method and when to
return to the provider
CycleBeads™
Screening to See if the SDM is
Appropriate for the Couple
 Can they avoid unprotected sex days 8 -19?
SDM: a Couple Method
 If men understand the
method, couples are
more likely to use it
correctly.
 Special efforts should
be made to involve
men.
 CycleBeads is a visual
communication tool
that men appreciate.
Involving Men: Community Outreach
Counseling men is ideal, but men can also be
taught about the method through:
 Posters, flyers, radio and
television
 Community networks
 Male providers/outreach
workers
 Materials brought home
by their partners
Involving Men: During Counseling
Encourage women to discuss SDM use with their partner:
 Identify potential problems and solutions
 Role play talking with her partner
 Offer to talk with her partner
Ask the client:





Have you talked about this method with your partner?
How will you communicate about the fertile days?
How might you and your partner handle the fertile days?
Have you and your partner ever used condoms?
How do you and he feel about using them?
BE SURE SHE LEAVES WITH A PLAN!
Experience with the SDM
 Why offer the SDM?
 Who chooses the SDM? Why?
 How do couples manage fertile days?
Why Offer the SDM?
 Increases choice
 Expands coverage
 Addresses an unmet need
 Empowers women
 Involves men
 Offers a low-cost method
SDM User Profile
Six Countries1
U.S.2
Mean Age
29
27
Mean Parity
2.8
.4
52%
38%
33%
10%
0%
87%
96%
2%
Previous use of:
Nothing/ineffective method
Condom (inconsistent)
Pills/injection
IUD
1
2
Interviews with users in 6 countries
Survey of internet purchasers
Reasons for Choosing the SDM
Six Countries1
U.S.2
Doesn’t affect
health
70%
80%
No side effects
20%
30%
Economical
30%
5%
Easy to learn/use
10%
45%
1 Interviews
2 Survey
with users in 6 countries
of internet purchasers
How Couples Manage the Fertile Days
Abstain
Condom
Rural India
70%
30%
Urban India
13%
87%
Philippines
70%
30%
U.S.
15%
85%
Project reports and U.S. Survey
Lessons Learned
• Providers’ attitudes toward the SDM
improve with training and experience.
• The SDM can be offered by different
kinds of providers.
• The SDM can be taught in clinic and
community settings.
• Involving men increases method
satisfaction and continuation.
Lessons Learned (cont.)
• Women can learn to use the SDM in 1520 minutes.
• Offering the SDM helps programs reach
new clients.
• Many couples use condoms on fertile
days
• The SDM is cost effective.
SDM Services Worldwide
Angola
Azerbaijan
Bangladesh
Benin
Bolivia
Burkina
Faso
DR Congo
Ecuador
El Salvador
Ethiopia
Ghana
Guatemala
Honduras
India
Mauritius
Nicaragua
Peru
Philippines
Romania
Rwanda
Tajikistan
Turkey
United States
Zambia
Zanzibar
Introducing the SDM
 Service Delivery
 Resources
 Training
 Procurement/Reimbursement
 MIS and supervision
 Information and Education
State of the Art Guidelines
Resources for SDM
Implementation
Reference Materials
 Links to scientific
articles
 Technical Briefs
 SDM Service
Protocol
 SDM Service
Delivery Guidelines
Training Materials




Trainers’ Manual
Participant Handbook
Training Video
Online Training
www.irh.org
Standard Days Method
For more information contact:
Institute for Reproductive Health
Georgetown University
[email protected]
or visit:
www.irh.org