Description of health product/service offering:
The Standard Days Method (SDM) or "m?thode du collier" is a fertility awareness-based method of family planning that requires users to avoid unprotected intercourse during cycle Days 8 through 19. The SDM is appropriate for settings where there is high use of traditional contraceptive methods, high levels of unmet need, and a chronic shortage of contraceptive supplies because it is a low-cost alternative and does not require re-supply. Benin is an appropriate country in which to offer the SDM. The unmet need for family planning has led to many unintended pregnancies in Benin, which poses risks for women, their families, and society. The estimated unmet need for family planning is 27% in Benin, with most of it related to birth spacing (PRB 2005). Modern contraceptive prevalence is only 7% and 12% of women of reproductive age using contraception are using natural or traditional methods. The SDM is a simple fertility awareness-based method which relies on a "standard rule" or a fixed "window" of fertility that makes it easy for women to know when they are likely to become pregnant. The SDM was developed through scientific analysis of the fertile time in the woman?s menstrual cycle. More than 95% effective for women with cycles between 26 and 32 days long, the SDM is easily provided by a wide variety of programs. To use the SDM, a couple tracks the woman?s menstrual cycle and avoids unprotected intercourse on fertile days 8 through 19 ? if they want to avoid a pregnancy. Most users of the SDM rely on CycleBeads, a color-coded string of beads, to help them track their cycle and identify the days when pregnancy is most likely. CycleBeads are made with 32 oblong plastic beads. A small black ring slides along the tool starting on red bead, which represents the first day of a period; through brown beads, which represent non-fertile "safety" days when pregnancy is unlikely to occur; to white beads that glow in the dark, which represent the days when a woman is most likely to conceive if she has unprotected sex. CycleBeads are a small, one-time investment that can yield years of effective protection from unwanted pregnancies.
Description of innovation:
The SDM is an exciting development in the field of mainstream family planning and is an important addition to the contraceptive method mix. Years ago, the natural family planning options available to couples in Benin were widely regarded by many providers and by some family planning programs as ineffective, complex and time- consuming. Access to and information about these methods was limited, making it especially difficult for hard-to- reach groups to use them ?especially women with less education and rural women, among whom levels of unmet need are highest. The SDM is innovative because, although a natural method, it is modern, it is easy to provide and easy to use, it is of low cost, and it serves the hard to reach rural community. It can be offered as part of a multi-method program and does not require long training periods for either the provider or the client. A provider can usually be trained to offer the method in one day, while a client requires about 20 minutes. The SDM is a modern method of family planning: it is 95% effective as determined by the Institute for Reproductive Health at Georgetown University through a prospective multi-center efficacy study that was published in the scientific journal Contraception. With a first year pregnancy rate of less than 5% with correct use, it is comparable to other user-controlled methods currently available through reproductive health and other programs. The method is now included in reference documents such as the WHO?s Medical Eligibility Criteria for Contraceptive Use, the IPPF Medical Bulletin, and Contraceptive Technology. The SDM is easy to use and easy to provide: The SDM can be included in a wide variety of programs and offered by different levels of providers without significant additional resources. It has the potential to expand contraceptive prevalence by bringing new users to family planning. In Benin, the SDM services are provided through a variety of public and private sector programs, including those offered by the Ministry of Health (MoH), community based family planning programs, non-governmental organizations, faith- based groups and non health programs such as micro credit and fishing programs. Because the SDM involves using condoms or abstaining from intercourse on days 8?19 of the cycle, it necessarily involves men. This has given the Benin program an opportunity to involve men in family planning. The SDM is low in cost: Given the increasing demand for family planning in Benin, the need for reaching a growing population, and the limited donor resources to fund the needed supplies, a low-cost, effective method like the SDM is becoming an addition welcomed by policy makers, program managers, and clients. The supplies required for the Standard Days Method are relatively inexpensive. Recent figures indicate that the U.S. Agency for International Development pays 6.6 cents per condom, 22 cents per cycle of pills, 97 cents per injection of Depo-Provera and $1.45 per IUD. In contrast, the one-time cost of a set of CycleBeads, which can be used for several years, is about $1. Once a woman has learned to use the SDM, she can rely on it whenever supplies for other methods are unavailable. Hence, the method could be introduced as a stopgap measure for returning clients during times of stock depletion. In programs that are chronically out of stock, the SDM is both an alternative option and a solution to an ongoing problem that can undermine program efforts. In addition to being a low-cost, the SDM serves hard to reach populations and is attracting people who previously had not used family planning. More than 90 percent of the method acceptors in Benin had never used any method of family planning. In Benin, providers had never seen so much interest in family planning among men until the SDM was introduced.
The AWARENESS Project/Benin has used the ?Maximizing Community Outlets? model to disseminate the SDM. This model capitalizes on improving access and the quality of services at the same time. The quality of counseling, informed choice, and the attitudes of providers toward their clients are key elements of access and quality. Access: in Benin, many rural residents do not use family planning services because of unnecessary or inappropriate requirements for examinations and tests, eligibility exclusions, and provider biases that constrain the client's choice of methods. The SDM program has helped solve these problems by developing simple guidelines and simplifying clinic procedures, by making more use of nonmedical programs, and by providing more distribution modes and outlets. The AWARENESS Project/Benin works with 8 major partner organizations with presence in rural and hard to reach areas. For example, The Fondation Regard d?Amour (FRA), a faith-based organization that protects abandoned children and promotes family wellbeing has introduced the SDM into their clinic in Abome-Calavi and into their community- based distribution program serving the Tofinu people, a hard-to-reach population living in a floating village of the Ganvi lake. FRA workers, who understand the community dynamics of this unique fishing village, are agents of change moving by canoe from one household to another to educate women and men about family planning. Those eligible for the SDM are given the method and others are referred to nearby clinics. The AWARENESS Project/Benin trained SDM trainers pooled from these partner organizations at the initial stage of the program. These trainers trained providers. Quality of services: In order to improve the quality of services, the AWARENESS Project/Benin chooses and works with partners who understand the social, physical and administrative environment in which their grassroots level providers work, function and provide the services. In the SDM training we stress the importance of respect for all clients. Every client visiting the program has a right to access, choice, safety, privacy, confidentiality, dignity, and comfort. In addition, the client has the right to information from the program and to express an opinion.
The AWARENESS Project/Benin has one locally-recruited country representative who has a public health background and a Washington DC based backstop Program Officer. In addition, more than 30 trainers from NGOs, FBOs, and the MoH and 303 providers from partner organizations have been trained on the SDM. The project has focused on building local capacity to ensure sustainability.
Key operational partnerships:
The SDM expansion project in Benin has been carried out by a strategically-chosen core of non governmental organizations, faith-based organizations, and public clinics selected through consultations among the MoH and its in-country family planning cooperating agencies. Seven partners, including the MoH, OSV/Jordan, ABPF, HOMEL, PSI, FRA, and ProFam are involved in the SDM expansion. These partners come from both primary health care programs, as well as from organizations that have no experience providing family planning and reproductive health services and together they have introduced the method into 131 clinics, pharmacies and community distribution channels. The AWARENESS Project/Benin primary partner is the Ministry of Health. The Ministry of Health/Benin has included the SDM in 21 government clinics throughout the country and made it an essential part of its family planning service because it meets the needs of large traditional subgroups that prefer natural methods over hormonal family planning methods.