A Strategic Approach to Standard Days Method Introduction: Expanding FAM Availability and Use 200820

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A Strategic Approach to Standard Days Method
Introduction Expanding FAM Availability and
Use2008-2011

• OFP NFP Research Grantee Meeting, January 2009

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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.

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Purpose

• To evaluate the effect on programs and clients of
  introducing the SDM through WHOs 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

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Partners
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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 26-32
  days long
• Used with CycleBeads

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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

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SDM User Profile
1 Interviews with users in 6 countries 2 Survey
of internet purchasers
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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

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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.

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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

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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)

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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

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Summary of Activities
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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

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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

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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

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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

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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

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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

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• Thank you!
• For more information
• www.irh.org

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References (1)

• Gribble, JN. The Standard Days Method of Family
  Planning A Response to Cairo. International
  Family Planning Perspectives 2003 29(4) 188-191
• Gribble, JN., Lundgren, R., Velasquez, C.,
  Anastasi, E., Being Strategic about Contraceptive
  Introduction the Experience of the Standard Days
  Method. Contraception 2008 77 147-154.
• Johri, L. and R. Lundgren. Introduction of the
  Standard Days Method into CARE Indias
  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.

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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) 79-94.
• Simmons R, Fajans P, and R Ghiron. 2007. 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.