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 Percent of New Users 2 Years After Introducing SDM in Rwanda Source: Ministry of Health, Rwanda

SDM expands method mix Percent of New Users by Method Source: Ministry of Health, San Martin, Perú

SDM is offered as a method choice

Panel Presentation Panel 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

141 SDM Sites Benin SDM 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

India SDM 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)

Rwanda A 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

Rwanda Community 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 Faso SDM 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

Perú SDM 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

Perú Towards 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 focuses on expanding family planning through the public and private sectors. Currently, SDM services are available through a family planning NGO in one of the five health regions of the country. The SDM is included in the MOH norms, and the ministry wants to offer the method but doesn’t have trained providers yet. You have 12 months to get the method scaled up 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?