1. OFP NFP Research Grantee Meeting, January 2009
A Strategic Approach to Standard Days Method Introduction: Expanding FAM Availability and Use
OFP NFP Research Grantee Meeting, January 2009

2. Rationale
Despite their efficacy and safety, the availability and use of FAM are low in Title X clinics.
Integrating the SDM, an effective FAM that is feasible for programs to offer, into FP services could help increase FAM availability and use.

3. Purpose
To evaluate the effect on programs and clients of introducing the SDM through WHO’s Strategic Approach
Identify factors which constrain and facilitate FAM availability and use
Develop and test a process to introduce the SDM within a framework of expanded choice
Assess acceptance, correct use, and satisfaction

4. Partners IRH/GU Southwest Community Health Center, Santa Rosa
Center for Health Training (Region IX)
Southwest Community Health Center, Santa Rosa
Planned Parenthood Mar Monte, Modesto
JSI
(Region I)
Health Quarters, Lawrence & Beverly
Study direction
Research and Training
Service Delivery

5. Standard Days Method
95% effective with correct use and 88% with typical use
Identifies a fixed fertile window in the menstrual cycle (days 8-19) when pregnancy is most likely
Appropriate for women with cycles between days long
Used with CycleBeads®

6. Why Offer SDM? Increases choice
Provides non-hormonal option/ no side effects
Helps women learn about their bodies and fertility
Involves men
Promotes couple communication
Easy for programs to offer
Any time we consider adding a new method to our program, we need to think seriously about what we expect to gain by offering this particular method.

7. SDM User Profile Six Countries1 U.S.2 29 27 2.8 .4 52% 38% 33% 10%
Mean Age 29 27
Mean Parity
2.8 .4
Previous use of: Nothing/ineffective method
Condom (inconsistent) Pills/injection
IUD
52% 38% 33% 10%
0% 87% 96% 2%
Some interesting differences between the U.S. and other countries in terms of previous contraceptive use. The countries included here are Ecuador, El Salvador, Honduras, Benin, India, and the Philippines. Whereas about half of women in other countries had never used any method and about 1/3 had ever used condoms, pills, and injections, in the U.S., all women had contraceptive experience. 87% had used condoms and 96% hormonal methods. It appears that in the U.S., some women who have used other methods may be looking for a different kind of method.
1 Interviews with users in 6 countries
2 Survey of internet purchasers

8. Experience at Tri-City Health Center – Fremont, CA
117 users in 1 year
Most providers felt that CycleBeads were:
Easy to teach
Easy to use
Useful for involving men
Effective enough
The providers also wanted to continue offering CycleBeads and the educational materials that were developed to go with them

9. SDM/CycleBeads Availability
California Southwest CHC PPMM – Modesto Tri-City Health Center Davis Community Clinic Riverside Community Health Agency Golden Valley Health Centers PP Golden Gate - Promotores
Massachusetts Health Quarters – Lawrence & Beverly ABCD Health Services East Boston Neighborhood Health Center Whole Foods Markets – Brighton, Cambridge, Framingham, etc.
This is just a sample list – you can search for providers and retailers by state on

10. SDM is offered worldwide
Albania
Angola
Azerbaijan
Bangladesh
Benin
Bolivia
Burkina Faso
DR Congo
East Timor
Ecuador
El Salvador
Ethiopia
Ghana
Guatemala
Honduras
Kyrgyzstan
India
Madagascar
Mali
Mauritius
Mozambique
Nicaragua
Peru
Philippines
Romania
Rwanda
Tajikistan
Turkey
Ukriane
United States
Uganda
Zambia
Zanzibar
Since publication of the SDM efficacy study in 2002, there has been a growing interest in the method in many, very different, countries. These are some of the countries where it is available – through public, private, and non-profit family planning providers. In some of these countries it is widely available – in others it’s available in very limited settings. But demand and use are growing.
Around the world, a number of different service delivery strategies are being implemented.

11. WHO Strategic Approach
Decision to offer new method should be based on needs perceived by stakeholders
Strategy should be developed through a participatory, transparent process that focuses on client needs and quality services
Can increase the likelihood of sustainable, replicable services (Simmons 2007)

12. WHO Strategic Approach
Phase I: Needs assessment Phase II: SDM integration and evaluation (Research phase) Phase III: Use of research results for policy and planning

13. Summary of Activities Use of research results for policy and planning
Phase I
Needs assessment
Phase II
SDM integration and evaluation
Phase III
Data elements
Pre SDM integration
Process
evaluation
Outcome
eval.
Use of research results for policy and planning
Site assessment √
Tailor SDM integration activities
Integrate the SDM into existing services
Modify integration activities
Provider & staff interviews
Client focus groups
Simulated clients
Waiting room questionnaire
Client follow up
Service statistics

14. Phase 1: Needs assessment
Potential clients’ knowledge, needs, and desire for FAM
Provider knowledge, attitudes, and practices regarding FAM
Service delivery systems and outreach activities
Opportunities and challenges to adding SDM to method mix

15. Participatory Approach
Review of clinic structure, client flow, materials used, etc.
Provider interviews
Focus groups with potential clients
Waiting room questionnaire
Review of service statistics from previous year
Results of the needs assessment will be used to tailor the integration plan to the specific context.

16. Phase II: Evaluation of SDM integration
SDM integration activities
Simulated client visits
Evaluation activities
Collection of service statistics
Interviews with SDM clients
Post-integration interviews with providers, staff and other key stakeholders
Interviews with SDM clients to assess correct use, knowledge, satisfaction, etc.
SDM integration activities include provider training and integration into clinic systems, protocols, and outreach activities
Simulated (“mystery”) client visits are to ensure successful integration of the method into services

17. Phase III: Use of Research for Policy and Planning
Share lessons learned with organizations and networks across the country
Design strategies that can be used to broadly introduce the SDM into Title X programs & expand FAM availability and use
Develop and disseminate implementation guide / toolkit for integrating the SDM
This phase focuses on dissemination and utilization of study results
Sharing lessons learned – conferences, meetings, presentations, web, even video

18. Completed Activities
Orientation visits / kick-off meetings at each site conducted
Year 1 implementation plans with each region finalized
Needs assessment tools & consent forms prepared and translated
IRB application submitted
JSI & CHT oriented on Phase I data collection

19. Upcoming Activities
Needs assessment activities / data collection - Jan-Feb, 2009
Analysis of needs assessment data – March 2009
Develop/tailor SDM integration plan, including adaptation of materials – April-May 2009
Train providers in SDM counseling and integrate into systems – June-July 2009

20. Thank you! For more information: www.irh.org

21. References (1)
Gribble, JN. “The Standard Days Method of Family Planning: A Response to Cairo.” International Family Planning Perspectives 2003; 29(4):
Gribble, JN., Lundgren, R., Velasquez, C., Anastasi, E., Being Strategic about Contraceptive Introduction: the Experience of the Standard Days Method. Contraception 2008; 77:
Johri, L. and R. Lundgren. Introduction of the Standard Days Method into CARE India’s Community-based Reproductive Health Programs. Final report for the Institute for Reproductive Health, 2003.
Institute for Reproductive Health. Final Report: Improving Family Planning Services for Women and their Partners: A CAPACITIES Approach. Forthcoming.

22. References (2)
Ministry of Health, Family Planning Service Statistics: San Martin Province, Peru, 2003.
Mukabatsinda, M. Mid-term Assessment of Standard Days Method Introduction in Rwanda. Final Technical Report prepared for the Institute for Reproductive Health, 2004.
Simmons, R., Hall, P., Diaz, J., et al. The Strategic Approach to Contraceptive Introduction. Studies in Family Planning 1997; 28(2):
Simmons R, Fajans P, and R Ghiron Scaling up health service delivery from pilot innovations to policies and programmes. World Health Organization, ExpandNet: Switzerland.
WHO & CCP. Family Planning: A Global Handbook for Providers, 2007.