Standard Days Method of contraception: Evidence on use, implementation, and scale up

Abstract

Since the early 2000s, the Standard Days Method (SDM) of family planning has been tested, introduced, and scaled up in countries around the world. SDM is a fertility awareness-based method for avoiding unprotected intercourse during the fertile period, days eight through 19 of a woman's menstrual cycle (for women whose cycles range from 26 to 32 days). Most SDM users utilize a visual aid-CycleBeads ®-to assist their correct use of SDM. In a 2002 trial, the method's first year failure rate (5 per 100 woman years with correct use and 12 per 100 woman years for typical use) was established, commensurate with certain other modern methods of contraception; since then, SDM has been introduced as well as studied in a variety of low and middle income countries (LMIC), and has been scaled up in some. This working paper summarizes the results of a structured review on SDM by the Evidence Project in 2014. This review utilized standardized search strings and systematic screening and abstracting criteria for reviewing available peer-reviewed and grey literature reports on SDM outcomes. Fifty-two reports and peer-reviewed articles were included and abstracted for data and information on client outcomes, provider outcomes, SDM service delivery characteristics, cost effectiveness, and implementation and scale up documentation. The included literature covered SDM implementation, scale up, social marketing, provider training, costing, and studies of most significant change in 23 countries from 1999 to 2014. This review of evidence on SDM tells us that the method appeals to a specific tranche of womenthose with unmet need, who desire to use non-hormonal contraception, and who are new to the use of effective modern FP methods. SDM as a method has correct and typical failure rates on par with some other modern methods of contraception (diaphragms, female condoms, and male condoms) and its prevalence is similar to some other modern methods that have been around for longer periods of time (female condoms, implants, IUDs, and male sterilization). SDM is easy to use and satisfying to users, it increases knowledge about the fertile period among both women and men, and it promotes male engagement in FP. It can be offered by a range of public and private providers throughout the health system. Scale up of SDM use requires stakeholder buy in and participation, early introduction of SDM into policies, guidelines, norms and curricula, inclusion of SDM into HMIS, procurement, and training systems, supportive supervision and refresher training, and publicprivate partnerships. In order to facilitate sustainable and systematic scale-up, particular attention needs to be to the procurement and availability of CycleBeads ® , agreement within the international community that SDM is a modern method, inclusion of SDM in national surveys, and the expansion of cadres providing SDM. IRH SDM Implementation and Scale up Studies Special studies undertaken within IRH Implementation and Scale up Studies 2 Other 3 Efficacy Trial Method Working Paper ▪ 45

Men as contraceptive users: Programs, outcomes and recommendations

“…When used correctly, the failure rate is only 5 per 100 woman years (Arevalo et al, 2002). Positive attributes of SDM, according to women, are that it does not have health risks or side effects, it is effective, simple to use, affordable, does not involve medication, and involves partners in family planning (Bekele and Fantahun 2012;IRH 2013b;Kursun et al, 2014, Blair et al 2007, Capo-Chichi and Anastasi 2005Wright et al, 2015).…”

Does the evidence support global promotion of the calendar-based Standard Days Method® of contraception?

“…1 The SDM has been researched, developed, promoted and marketed through the Institute of Reproductive Health (IRH) at Georgetown University, USA, and Cycle Technologies, a for-profit company, which sells CycleBeads® and CycleBeads® Online (web-based application), and produces iCycleBeads® and DOT™ ("Dynamic Optimal Timing") (mobile phone applications) [7][8][9]. SDM introduction, scale up, and other activities have involved a wide range of international organisations, 2 largely funded by the United States Agency for International Development (USAID) [10,11]. The Bill and Melinda Gates Foundation has also provided support for pilot efforts in two countries [10].…”

“…SDM introduction, scale up, and other activities have involved a wide range of international organisations, 2 largely funded by the United States Agency for International Development (USAID) [10,11]. The Bill and Melinda Gates Foundation has also provided support for pilot efforts in two countries [10].…”

“…The highest recorded national prevalence of SDM is low (0.3% of 15-49 year old women reported current use in the 2010 Rwanda DHS [10]), although 15-20% of women using family planning have been reported to use SDM in districts in the Democratic Republic of Congo where the method has been promoted [10,20,21].…”

Assessing the Competency and Acceptability of Community Health Worker Provision of Standard Days Method® in Family Planning Services in Gisagara District, Rwanda

“…Expanding family planning options has been shown to increase contraceptive use, as a wider choice of methods improves the ability to meet women's and couples' needs (Ross and Stover 2013). SDM has been introduced and assessed in different facility and communitybased service delivery settings for over 15 years (Gribble et al 2008;Wright, Iqteit, and Hardee 2015). A number of studies have demonstrated an overall increase in contraceptive prevalence rates where SDM has been made available, including in Rwanda Blair et al 2007;Gribble et al 2008;Arévalo et al 2010).…”