Pressed for time: providing the Standard Days Method and oral contraceptives in India

Abstract

Many of this Journal's older readers will be familiar with the Oxford-Family Planning Association (Oxford-FPA) contraceptive study and will, indeed, have made important contributions to data collection. Accordingly, I was delighted that the Journal Editor had chosen the most recent publication from the study 1 as the subject for a Journal Review. I am also grateful to Dr Mills for taking so much trouble to produce a succinct summary of a complex paper. 2 There are, however, one or two points about the review to which I would like to draw readers' attention. First, I would like to stress that the majority of the women in the study were followed up individually until mid-1994, although individual follow-up for a substantial subgroup of women ceased earlier than this. With regard to cancer registrations and death notifications, all women (save for those who emigrated) were followed up until the end of 2004 using information provided by the National Health Service Central Registries to supplement data collected during the course of individual follow-up. Second, the Journal Review does not include any confidence intervals for the rate ratios (no doubt in the interests of saving space). This is, perhaps, of concern mainly for invasive cervical cancer where the Oxford-FPA findings were considerably more unfavourable than has been described in most other studies. As the Oxford-FPA study included only 59 cases of this disease (with only six cases in the reference group who never used oral contraceptives), confidence intervals around the rate ratios were wide. Finally, while the population studied was certainly of higher social class than the general population, it was not "predominantly Social Class I". The paper only gives the proportion of women from Social Classes I and II combined and this figure was 41%. These are relatively minor points that do not detract from the substance and conclusions of the careful review prepared by Dr Mills.

The Standard Days Method®: an addition to the arsenal of family planning method choice in Ethiopia

“…However, some of the providers had complained that the SDM necessitated time-consuming counselling sessions. Studies conducted in India (SDM 10 minutes vs Pill 8 minutes),17 Rwanda (SDM 44 minutes vs Pill 38 minutes)18 and Peru (SDM 23 minutes vs Pill 15 minutes)19 demonstrated that the SDM can be offered with a similar length counselling session as required for the oral contraceptive pill. The amount of time needed to counsel new SDM users typically did not exceed what is generally allocated in respect of new family planning consultations 10.…”

Provider Selection of Evidence-Based Contraception Guidelines in Service Provision

“…In Peru, according to simulated clients trained to choose the medroxyprogesterone acetate injectable (DMPA) in the consultation, 84% of providers correctly told clients that menstruation might stop, but only 15% mentioned that temporary infertility might follow discontinuation of the method (León, Monge, Zumarán, García, & Ríos, 2001). Provider deficiencies in implementing service guidelines have been documented for the most frequently used methods-sterilization (Visaria, 1999), intrauterine devices (IUDs; Viberga, Odlind, & Zodzika, 2006), pills (Kim et al, 1998;León, Ríos, & Zumarán, 2005), and injectables (León et al, 2001), as well as emergency contraception (Ngoc, Ellertson, Surasrang, & Loc, 1997) and the Standard Days Method (León, Arévalo, et al, 2007;León, Lundgren, Huapaya, Jha, et al, 2007).…”