Standard Days Method

A Simple Fertility Awareness-BasedApproach to Family Planning

Learning ObjectivesAt 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

0%

5%

10%

15%

20%

25%

30%

35%

-9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2

Pre

gn

an

cy

Ra

te

Ovu

lati

on

Source: Wilcox et al. 1998

Cycle Days

Probability of Ovulation Relative to Midpoint of the Cycle

Source: IRH analysis of WHO 1981 data

%

of

cycl

es

Peak day used as proxy of ovulation

4.3

8

12.1

18.4.

30.1

11.9

5.62.4

0.9

><0

5

10

15

20

25

30

35

-4 -3 -2 -1 MidptDays

1 2 3 4

Day 8 Day 19

Determining the Fertile Window

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

Correct Use Typical Use

No Method 85 85

Spermicides 18 29

Diaphragm 6 16

Condom 2 15

OC .3 8

Standard Days Method 5 12Adapted from Contraceptive Technology, 18 th edition, 2004

% of women who became pregnant during 1st year of use

Contraceptive Failure of Natural Methods

Correct Use Typical Use

Symptothermal Method 2 – 5 18 - 22Billings Ovulation

Method3 – 5 20 - 22

Standard Days Method 5 12

Sources:Guida M., et al. Gynecological Endocrinology 1997.: Arévalo M., et al. Contraception May 2002World Health Organization, Fertility and Sterility, 1981Trussell, et al., Family Planning Perspectives, 1990

% of women who became pregnant during 1st year of use

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?

Begin SDM today26 – 32 days? yes

no

Offer other method

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?

Begin SDM when period starts

26 – 32 days? yes

no

Offer other method

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

Are her cycles between 26 and 32 days long?

Screening to See if the SDM is Appropriate for the Woman

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?

Begin SDM when period starts

26 – 32 days? yes

no

Offer other method

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 longAsk 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/breastfeedingWait until for 4 periods

Start after 2 most recent are about

a month apart

3-month InjectionWait 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™

Can they avoid unprotected sex days 8 -19?

Screening to See if the SDM is Appropriate for the Couple

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

Posters, flyers, radio and television

Community networks Male providers/outreach

workers Materials brought home

by their partners

Counseling men is ideal, but men can also be taught about the method through:

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

1 Interviews with users in 6 countries2 Survey of internet purchasers

Six Countries1 U.S.2

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%

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 with users in 6 countries2 Survey 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 15-20 minutes.

• Offering the SDM helps programs reach new clients.

• Many couples use condoms on fertile days

• The SDM is cost effective.

SDM Services WorldwideAngola

Azerbaijan

Bangladesh

Benin

Bolivia

Burkina Faso

DR Congo

Ecuador

El Salvador

Ethiopia

Ghana

Guatemala

HondurasIndia

MauritiusNicaragua

PeruPhilippinesRomaniaRwanda

Tajikistan

TurkeyUnited States

ZambiaZanzibar

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 Universityirhinfo@georgetown.edu

or visit:

www.irh.org