Elsevier

Contraception

Volume 77, Issue 3, March 2008, Pages 147-154
Contraception

Original research article
Being strategic about contraceptive introduction: the experience of the Standard Days Method®

https://doi.org/10.1016/j.contraception.2007.11.001Get rights and content

Abstract

Background

Many national and institutional family planning policies explicitly include fertility awareness-based methods among the method options that should be made available, but these methods are often not offered for a variety of reasons. After testing the efficacy of the Standard Days Method® (SDM), which is a fertility awareness-based method that identifies Days 8–19 of the menstrual cycle as fertile for women with cycles lasting between 26 and 32 days, pilot studies were conducted to introduce it into programs.

Study Design

Through 14 pilot studies around the world, ministries of health, family planning associations and community development organizations introduced the SDM. Follow-up interviews with users and other data collection methodologies were used to track user characteristics and experiences. Supervision data and simulated clients assessed the effects on service delivery.

Results

The SDM appeals to a broad range of women throughout the world. Clients report using abstinence or condoms to manage the fertile days. Both men and women report high levels of satisfaction with the method. The cross-study first-year failure rate of 14.1 pregnancies per 100 woman-years of use is similar to typical-use rates found in the SDM efficacy trial.

Conclusions

The results of the pilot studies offer guidance for scaling up service delivery of the SDM. Condom counseling can help many users manage the fertile window effectively. Because out-of-range cycles can lead to method failure, users must understand the importance of tracking cycle length and be willing to switch to another method when the SDM is contraindicated. Community providers can offer the method; within clinical settings, SDM counseling typically takes no more time than allowed in most program norms. Training providers to address alcohol use and gender-based violence improves SDM method use and contributes to better quality of care.

Introduction

Successful introduction of a new family planning method must be done in a systematic and strategic way. According to the World Health Organization (WHO), the introduction of contraceptive methods should focus not on a technology-driven approach, but rather on how a new method responds to peoples' needs and rights, as well as on how it enhances overall quality of care and broadens the options available to clients [1]. The WHO strategic approach uses a client-centered systems framework to examine the acceptability and sustainability of innovations — such as a new family planning method — as a function of three elements: (1) people and services, (2) technologies and (3) policies and institutional capacities [2]. This article uses elements of the client-centered systems framework to describe the Standard Days Method® (SDM) pilot studies, which assessed the feasibility and acceptability of introducing the method into different service delivery settings. These studies represent the first systematic introduction of the SDM into service delivery settings outside the context of the clinical trial.

Section snippets

The SDM

Many national and institutional family planning policies explicitly include fertility awareness-based (FAB) methods among the method options that should be made available.1 Yet, programs rarely fully implement those

Results

The WHO client-centered systems framework focuses on critical issues related to (1) people, services and technologies, (2) policy and (3) institutional capacities, and how these three elements affect the acceptability and sustainability of a new family planning method. The following discussion focuses on the elements of people and services.

Discussion

The experience and results of these introduction studies provide insight into the feasibility and acceptability of the SDM in diverse service delivery settings and offer guidance for SDM expansion. Implications for the integration process, provider training and supervision, and service delivery protocols are discussed below.

Data on user characteristics from the 14 studies indicate that the SDM reached a group of women with unmet need but who did not want to use any kind of contraceptive

Acknowledgment

This research was funded by the United States Agency for International Development under Cooperative Agreement #HRN-A-00-97-11100-00 with the Institute for Reproductive Health, Department of Obstetrics and Gynecology at Georgetown University, Washington, DC. The authors would like to acknowledge the commitment to innovation and service demonstrated by the organizations and principal investigators that participated in the first introduction of the SDM: ABFP (Mamatou Djossou, Lahanatou Biomama);

References (10)

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