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

Abstract

Background and methodology The Standard Days Method ® (SDM) is a fertility awareness-based method of family planning that helps users to identify the fertile days of the reproductive cycle . To prevent pregnancy users avoid unprotected sexual intercourse during these days. A cross-sectional communitybased study was conducted from December 2007 to June 2008 in four operational areas of Pathfi nder International Ethiopia. A total of 184 SDM users were included in the study. Quantitative and qualitative methods of data collection were used. The aim of the study was to examine the experience of introducing the SDM at community level in Ethiopia. Results Of the 184 participants, 80.4% were still using the SDM at the time of the survey, with 35% having used it for between 6 and 12 months, while 42% had used it for more than a year. The majority (83%) knew that a woman is most likely to conceive halfway through her menstrual cycle, and nearly 91% correctly said that the SDM does not confer protection from sexually transmitted infections/AIDS. A substantial majority (75%) had correctly identifi ed what each colourcoded bead represents in the CycleBeads ® , and an aggregate of 90.5% of women practised all the elements of correct use. Discussion and conclusions This study demonstrates the importance of the SDM in increasing the availability and accessibility of family planning, and the potential to improve family planning method choice and method mix by expanding use of the SDM.

Response to Letters to the Editor from Irit Sinai “Standard Days Method Effectiveness: opinion disguised as scientific review” and Kelsey Wright, Karen Hardee, and John Townsend “The pitfalls of using selective data to represent the effectiveness, relevance and utility of the Standard Days Method of contraception”

“…Sinai says that we "ignored at least eight relevant articles" that oppose our views. Not one of the citations she provides opposes our findings, and six do not even contain information about effectiveness: four are studies already mentioned above [2][3][4][5]; two more by Lundgren et al do not measure effectiveness, one measures uptake of SDM in three sites [6], and one knowledge and attitudes [7]. One article [8] provides figures from intervention studies, not typical use (see also point 7 below).…”

“…They say we miss two independent studies "on SDM integration" from Ethiopia, by Bekele et al [4] and Nigeria by Ujuju et al [5]. But these do not contain information on effectiveness, which is the reason why we did not include them.…”

“…As an author, Sinai will be aware that the study design (retrospective interviews with clinic users and clinical records review in two provinces in Peru) precludes population measurement of pregnancies and hence of effectiveness. Indeed, the authors of the original, longer report [10] of the same study explicitly warn "The study design would not allow calculation of accurate pregnancy rates" (p. 4) 4. Sinai also suggests we should have included the qualitative study by Ujuju et al [5] Yet this paper simply reports that some participants believed SDM was effective.…”

The role of the Standard Days Method in modern family planning services in developing countries

“…In addition, international and local organisations other than IRH have led efforts to introduce SDM in their programmes, as illustrated by Pathfinder International's recent SDM introduction in community-based service delivery settings in Ethiopia 10 . Although the previously described natural FP methods have been tested and introduced in various countries, to our knowledge, they have not been expanded widely in existing FP service delivery settings, as has SDM.…”

Implementation and Scale-Up of the Standard Days Method of Family Planning: A Landscape Analysis

“…17 In the pilot studies that asked about changes to male involvement and couple's communication after the SDM introduction, nearly all participants reported an improvement in joint decision making and male involvement. [8][9][10][11]15,18 National Scale-Up of the SDM Sixteen countries had conducted some level of national standardization and institutionalization effort for the SDM (Table 2) SDM in national health information measurement services, and integrating the SDM into national family planning protocols and policies. In studies examining the results of scale-up efforts, IRH also tracked the number of service delivery points providing the SDM, number of registered SDM users, and number of service providers trained in the SDM.…”