A Strategic Approach to Standard Days Method Introduction: Expanding FAM Availability and Use 2008-2011

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

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 26-32 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

7. SDM User Profile 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

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.

10. 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 SDM is offered worldwide

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

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

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

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

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): 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 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): 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.