The Standard Days Method is a simple fertility awareness-based method of family planning that helps women identify the days each cycle when they are most likely to conceive. Couples who wish to prevent pregnancy avoid unprotected intercourse on these days. The method was introduced in 13 sites in Rwanda, a nation with a high level of unmet need for family planning. This was the first time the method was introduced into regular service delivery, without the rigorous follow-up of a study setting. Users of the Standard Days Method were identified from clinic records and participated in interviews and focus groups. Community workers were also interviewed. Results confirm that the Standard Days Method is easy for providers to teach and for clients to learn and correctly use. The method attracts couples who are new to family planning, and is a valuable addition to the method mix offered in Rwanda.

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Scaling-up lessons included: (1) simplifying provider training and client materials; (2) ensuring core aspects of the intervention, for example, that the CycleBeads client tool was integrated into the supply chain system; (3) addressing provider-generated medical barriers; and (4) managing threats from changing political and policy environments. A focus on systems, the use of multiple M&E data sources, maintaining fidelity of the innovation, and ongoing environmental scans facilitated scale-up success.

BackgroundIntroducing a new method into family planning programs requires careful attention to ensure it meets an actual need and has a positive effect on program goals. The Standard Days Method® is a fertility awareness-based method of family planning that is being introduced into family planning programs in countries around the world. It is different from other methods offered by programs, and may bring new couples into family planning, and increase contraceptive prevalence. The study assesses the effect on contraceptive use and prevalence of Introducing Standard Days Method into existing family planning services in whole regions of India, Peru, and Rwanda.MethodsIn collaboration with the Ministry of Health, health providers were given a contraceptive update on all methods, then trained in counseling on Standard Days Method. Efforts were made to promote demand in the context of informed choice. Routine monthly service statistics in control and intervention areas were used to assess the effect of Standard Days Method introduction at the clinic level; baseline and endline household-based surveys were undertaken to obtain results at the community level (n > 3400 women at endline).ResultsDemand for the method is evident in countries with different levels of contraceptive prevalence. The method attracts couples new to family planning, and introducing it into services may increase overall contraceptive prevalence.ConclusionsIntroducing Standard Days Method into existing family planning has the potential of benefiting men and women in diverse settings and populations. This study illustrates the critical role of evidence in scaling up a health innovation.

Background and methodology Replicating a Peruvian study, this research introduced the Standard Days Method (SDM) into Rwanda Ministry of Health clinics and evaluated client counselling on the new method against that given for contraceptive pills. Providers received technical reinforcement concerning established methods in addition to SDM training. To evaluate their quality of care, simulated clients implemented a service test in visits to 20 clinics.Results As in Peru, providers exchanged significantly more relevant information with clients who chose SDM than with those who chose pills. Also, a minority of providers posed barriers to SDM access by refusing to give SDM tools to the client until she brought her partner for consultation. ConclusionsThe findings of this study confirm that SDM counselling is generally satisfactory, although SDM training needs adjustment, and that the rigour of providers' pill counselling remains below capacity. G The requirement that the partner be present during SDM counselling must be removed.G The less detailed counselling received by pill clients shows that providers perform below capacity when they deliver this contraception method.