1. Standard Days Method(SDM)
Session III:
Counseling on SDM

2. Once a Woman and Her Partner Have Decided to Use the SDM
Teach client how to use SDM with CycleBeads or the paper-based method
Confirm client knows how to use the method and when to return to the provider
After screening for cycle length and possible special circumstances, the next step is to explain to the client how to use the methods and how CycleBeads or the paper-based version of the SDM work.
Asking clients to explain back is a good way to determine whether the instructions are clear and clarify them as needed.
Remind clients that the instructions for use also are included in the insert that accompanies the beads.
Hand out the Competency-based Checklist for SDM. Explain that This checklist contains the detailed steps that a service provider should follow in counseling and providing client instructions for SDM Counseling and Support.

3. Practice Teaching Cycle Beads to Clients
Note: Ask participants to turn to the person next to them and take turns explaining each other how to use CycleBeads relying on the instructional insert or the provider Cue Card.

4. The Paper Version of SDM
Refer to Handout #3 on the paper-based version of SDM. Explain that the paper version can be used when Cycle Beads are not available. The principles are the same, just using paper rather than Cycle Beads

5. Monitoring Cycle Length
Periods must always come between darker brown bead and last bead.
If period comes early (before darker brown bead) or late (does not start the day after the last bead) more than once in a year, switch to another method.
Note to facilitator:
Both the video animation of how CycleBeads work and the script for a demonstration mention how a woman can continue to monitor that her periods come on time. However, emphasis on this aspect is critical to ensure the method is appropriate for her in the future. While a woman’s cycle may be within the correct range to use the Standard Days Method, it is possible that over time her cycles may change. Thus, she needs to continue to know that her periods should always come between the dark brown bead and the last brown bead (show that section of the necklace).
To the extent possible avoid language about “needing to have cycles within 26 to 32-day range”. Rather, show on the necklace when she must get her periods to know they’re coming on time and be able to have this method work for her. Explain that:
• If you start your period before you put the ring on the DARK BROWN bead, it means it has come too soon to use the method.
• If you have not started your period by the day after you put the ring on the last BROWN bead, it means your period is too late to use this method.
• Contact your provider if you have more than on cycle out of range.
Ask participants:
<How can you help clients remember to move the ring every day?>
<Why is it important that she moves the ring daily?>
<How will the women be sure her cycles are within the right range for the method to work for her?>

6. Supporting Couple’s use of SDM
During counseling:
Encourage women to discuss SDM use with their partners
Identify possible challenges and solutions
Role play talking with her partner
Invite partner to meet with provider
BE SURE SHE LEAVES WITH A PLAN!
Ask participants how they think they can best support the couple’s use of SDM

7. 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 will 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?
Do you also know about other methods of family planning?
Encourage women to talk with their husbands or partners about SDM use and what kind of problems might come up during the fertile days. Brainstorm with her what problems she and her husband might have using the method, and how she might solve them. Do a role play to provide her the opportunity to practice talking with her husband. If necessary, offer to meet with her husband.
The provider can help women plan how to manage the fertile days by asking questions such as:
Have you talked about this method with your partner?
How will you communicate about your fertile days?
How might you and your partner handle the fertile days?
Have you and your partner used condoms?
How do you and he feel about using them?
Perhaps the most important thing is to be sure that she leaves with a plan for talking with her partner and for handling her fertile days.

8. Managing Fertile Days
How can you help clients identify possible challenges to using the SDM?
What are possible ways the couple can handle the fertile days? Are these options feasible and appropriate in your community?
What are ways in which you think men users can participate in SDM use in this community?
Note to facilitator:
Ask participants to share ideas on possible approaches for helping women engage their partners in a conversation about using the SDM and managing the fertile days.
Refer to the Handout #5 Introduction to Sexuality and Couple Communication for tips on helping clients manage fertile days. Emphasize the need for the woman to discuss method use with her partner as soon as possible and determine how they will handle the fertile days. A key objective of SDM counseling is to have the client leave with a plan on how she and her partner will manage the fertile days. If the client decides to use condoms, also offer to explain how they are used.

9. Key Messages for the Client
Return to your provider:
If you had unprotected sex on a white-bead day when you can get pregnant
If you/your partner are having difficulty handling the fertile days
If your period starts before placing ring on the darker brown bead (short cycle) or if your period did not start after moving ring to the last brown bead (long cycle)
If your period has not returned and you think you might be pregnant
If you would like to use another method
Note to Facilitator: Before disclosing the bullets, ask participants for examples of when would they advise clients to return.
Ask participants to describe how they would counsel a client who comes to the clinic after having unprotected sex on a white-bead day.
Discuss with participants if emergency contraception is available and steps for screening and counseling clients in using it.

10. Counseling Clients on SDM Practice, Observe, Offer Feedback
If time allows, organize participants in groups of three and ask them to take turns counseling a client on the SDM. Participants rotate the role of client, counselor and observer.
Refer to Handout “Standard Days Method – Role Play” for the role play case and questions.

11. Key Counseling Topics for SDM Users
Efficacy (depends on the woman’s ability to track her cycle days as well as avoiding unprotected sex on fertile days.)
How SDM works
Remembering to move the ring daily and continue monitoring cycle length/regularity
Importance of couple’s discussing how to avoid unprotected sex with partner.
Informing SDM does not protect from STIs/HIV
When to return
Review the key topics to be included when counseling SDM clients

12. Providing Support for Continuing Users “Come Back Any Time”
Come back if:
You get your period early (it starts before you put the ring on the dark brown bead)
You get your period late (it does NOT start by the day after you put the ring on the last brown bead)
You have unprotected sex on a fertile “white bead” day
If menstrual bleeding started before reaching the dark brown bead, her cycles are shorter than 26 days.
Show where the dark brown bead is and explain what it means.
If menstrual bleeding has not started by the day after moving the ring over the last brown bead, her cycles are longer than 32 days.
If she has more than one cycle shorter than 26 days or longer than 32 days, the method may be less effective. She may need to choose another method.
If she has unprotected intercourse on these days, she can consider using emergency contraception as soon as possible
Remember to offer condoms for dual protection and/or back-up!

13. Thank You!
Here is a link to multiple versions of the instructions for SDM in several languages.