| The study found that out of an exhaustive
list of items to cover during family planning
counseling, providers idiosyncratically select
different areas to focus on during counseling.
In India and Peru, providers focused on use instructions,
while Rwandan providers focused on contraindications.
Not even those guidelines deemed essential by
the authors were addressed by a majority of providers.
It is likely that providers cannot remember the
full set of guidelines during counseling, nor
do they usually have time to cover everything
in a brief counseling session. Moreover, providers
have not been provided adequate guidance on which
elements to focus on, thus they select items to
address based on personal preference rather than
empirical evidence of their relevance to improving
method use and continuation.
This article provides a good explanation of the
simulated client methodology, discusses aspects
of service delivery in India, Peru, and Rwanda,
reviews the literature on service delivery guidelines
and contributes to an understanding of barriers
to implementing best practices in family planning
counseling. A practical outcome of the preparation
of this article was the development of a list
of 15 essential elements to cover during SDM counseling
in India. (Full
article)
The Institute for Reproductive Health's FAM
project focuses on increasing access to and use
of fertility awareness methods – in particular
the Standard Days Method® (SDM), the TwoDay
Method® (TDM) and the Lactational Amenorrhea
Method (LAM) – within the framework of informed
choice. (More information about the FAM
Project)
SDM Online Training
Accredited for 2.0 CEUs or 2.0 CMEs
The Accreditation Council for Continuing Medical
Education recently approved continuing education
credits for the completion of the SDM
online training. This self-paced
module takes approximately 2 hours to complete
and accounts for 2.0 CEUs for nurses, nurse practitioners
and nurse midwives. For physicians, 2.0 AMA PRA
Category 1 CME credits will be available soon.
Africa: Making
Strides to ensure SDM sustainability
The Institute for Reproductive Health, in collaboration
with the DELIVER II PROJECT, is making strides
in securing Standard Days Method sustainability
in Burkina Faso, Rwanda and Mali by successfully
integrating CycleBeads in each country’s
Contraceptive Procurement Table (CPT). Part of
this collaboration consisted of assisting country
contraceptive logistics teams to forecast and
integrate CycleBeads into their CPTs. The Institute
will continue to work with the DELIVER II project
to assist country teams in determining the most
cost effective and efficient ways to integrate
CycleBeads into their procurement and logistics
systems. Similarly in Madagascar, the Institute
and the SanteNet project have assisted the Ministry
of Health and Family Planning in integrating CycleBeads
into their CPT.
Democratic Republic
of Congo: Expanding Access to LAM and SDM
To expand access to the Standard Days Method
(SDM) and the Lactation Amenorrhea Method (LAM)
to men and women in the rural areas of the Democratic
Republic of Congo, the Georgetown University Institute
for Reproductive Health, in collaboration with
the AXxes Project, integrated both methods into
a nation-wide family planning training initiative.
Activities started with the training of 281 trainers
who will then train provider and community health
workers in 60 districts throughout the country,
an area covering approximately 7.3 million people.
India: Research shows
SDM Integration a success
The Institute for Reproductive Health, in collaboration
with Government of Jharkhand (GOJ), convened two
dissemination meetings in May to share the experiences
of a study to assess the impact of integrating
the Standard Days Method (SDM) into existing reproductive
health and family planning programs. The SDM was
integrated into two blocks of the Ranchi district
of Jharkhand over a period of two years and was
offered by multiple types of providers including
government medical officers, auxiliary nurse midwives,
and community-level workers.
The meetings, held in Ranchi (Jharkhand state)
and Delhi, featured the presentation of study
findings and discussions about key issues on scaling
up SDM. Highlights of the meetings are detailed
below:
- Key results of the study
and showcased in the meetings are as follows:
- 88% of SDM users were first
time family planning users
- 30% of new birth spacing users
were SDM users
- 82% of providers had correct
knowledge of the SDM 7-12 months after training
- All types of providers can
offer the SDM; community level workers were
key to expanding access
- Introducing the SDM improved
family planning counseling overall, especially
for condoms
- The meetings drew active participation
from representatives of the Ministry of Health
and Family Welfare from the central level and
the state of Jharkhand, national and international
developmental and civil society organizations,
technical bodies such as the Indian Medical
Association, research agencies, and community
representatives.
- Following the positive results
of the study, the Government of Jharkhand made
the commitment to scaling up the SDM throughout
the entire state. Delhi meeting participants
proposed the formation of a core committee to
discuss key issues for SDM scale-up throughout
India.
Zambia: SDM Building
Bridges between family planning groups
The Standard Days Method can serve to bridge
barriers between faith-based organizations and
more mainstream family planning organizations
as evidenced by findings of the Population Council’s
Pilots to Regional Programs (PRP) initiative in
the Copperbelt district in Zambia. The Georgetown
University Institute for Reproductive Health participated
in this two-year effort, which sought to expand
contraceptive choice and improve quality of care.
The Population Council provided training, materials,
commodities and technical assistance to MOH and
other facilities, with the Standard Days Method
included in the package. In its final report,
the Population Council shows that the SDM attracted
a large number of first time users of family planning.
The SDM also had an unexpected secondary benefit:
it opened doors to work with organizations which
viewed the PRP initiative with suspicion. After
hearing about the SDM, two Catholic hospitals
in the Copperbelt sought out assistance from the
PRP to introduce the method. After experiencing
significant demand for the SDM, one hospital felt
compelled to offer additional methods of family
planning to the community, including other modern
methods.
SDM and TDM included
in Key Family Planning Publications
The Standard Days Method® and the TwoDay
Method are included in state-of-the-art publications
on family planning. In addition to their inclusion
in the WHO Medical Eligibility Criteria for Contraceptive
Use, both methods are described in the 18th edition
of Contraceptive Technology, Managing Contraception,
and the SDM is included in IPPF’s Medical
and Service Delivery Guidelines. As a result,
both methods are now widely recognized as an appropriate
component of reproductive health programs in a
growing number of countries.
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