Standard Days Method (SDM) Session II: Who Can and Cannot Use SDM

1. Standard Days Method (SDM) Session II: Who Can and Cannot Use SDM

2. Medical Eligibility What are medical eligibility criteria? Define the conditions related to temporary methods of family planning. Define the conditions related to fertility awareness methods

3. Conditions Relating to Fertility Awareness Methods WHO Category Conditions A= Accept Vaginal discharge Diseases that elevate body temperature Age: post menarche or perimenopause Taking drugs that affect cycle regularity* C= Caution Breastfeeding< 6 weeks postpartum Breastfeeding > 6 weeks postpartum Postpartum not breastfeeding Postabortion D=Delay *Delay until drug’s effect has been determined, then use caution Source: Family Planning A Global Handbook for Providers 2011

4. Who Should Delay or Use Caution in Beginning SDM Circumstances that can affect cycle length and regularity are recent pregnancy or recent use of a hormonal method of contraception

5. When is SDM Most Successful? SDM is most successful at preventing pregnancy when: • Women have regular menstrual cycles (26 to 32 days long) • Couples are motivated to avoid intercourse or use condoms during fertile days **SDM does not protect against STIs or HIV/AIDS. Use condoms (for men and women) every time you have sex, to help protect yourself from these diseases.

6. Screening to See if SDM is Appropriate for the Woman • Is her cycle between 26 and 32 days long? • Ask simple questions to assess cycle length and regularity: • Does your her period come about once a month? • Does it usually come when you expect it? • When was the first day of your last period?

7. Is SDM Appropriate for the Couple? Can they use condoms or avoid sex on days 8 through19 of the cycle?

8. Using SDM with Partner’s Support It is important to: Approach clients to inquire about the couple’s relationship in a careful and sensitive way. Engage your client in talking about sexuality and her couple relationship? Inquire about possible domestic violence or alcohol/drug use that can affect correct SDM use? Discuss condom use during the fertile days.

9. When to Start SDM User knows the first day of her last period. User does not remember the first day of her last period Postpartum or breastfeeding. 3-month injection user. Hormonal method user (the pill, 1-month injection, or implant) Had a miscarriage or abortion in the past month OR used emergency contraception. Start today Start the first day of the next period Wait until you have had 4 periods since baby was born. Start after last two periods have been about a month apart Wait until 90-day protection ends, and last three periods have been about a month apart After discontinuing method, start SDM if her last three periods have been about a month apart Start on the first day of her next period

10. Case Study 1SDM Eligibility Criteria – Cycle Regularity Case 1 - Fatima Date last menstrual period: April 8 Date of visit to clinic: April 14 Your client has regular periods that come each month, when she expects them. She and her husband are both interested in a natural method. She is not breastfeeding and has never used a hormonal method of family planning. • Can she use Standard Days Method? Yes • If suitable, when could she start using it? • What are some recommendations to offer this client? Immediately. Monitor cycle length over time, discuss with partner. Place ring on correct bead.

11. Case Study 2SDM Eligibility Criteria – Cycle Regularity Case 2 - Sarah Date last menstrual period: Does not remember; beginning of month Date of visit to clinic: May 20 Your client and her partner are interested in SDM because it is natural and there are no side effects. She does not know the exact date of her last period but her periods come around the same time each month. She has not been using a method and has been married only a few months. • Can she use Standard Days Method? • If suitable, when could she start using it? • What are some recommendations to offer this client? Yes. Wait until next period starts Use condoms or abstain until she starts SDM. Discuss with partner method use. If she had sex this month, she may already be pregnant.

12. Case Study 3SDM Eligibility Criteria – Cycle Regularity Case 3 - Emma Date last menstrual period: May 12 Date of visit to clinic: May 28 Emma breastfeeds her 15-month old son. She started getting her periods regularly about eight months ago. Her husband travels often, at least twice a month and for several days at a time. Sometimes they abstain and other times they use withdrawal. They both have decided to use a natural method. • Can she use Standard Days Method? • If suitable, when could she start using it? • What are some recommendations to offer this client? Yes. Immediately. Discuss with partner method use. If she had sex this month, she may already be pregnant..