Studying Alternative Tools to Teach the SDM

The Institute is undertaking research in Guatemala to compare correct use and continuation among women using CycleBeads and a leaflet with illustrations of the beads, both of which are designed to help women track their cycle days.

Offering the SDM Through Social Marketing Programs

This multi-site study, taking place in Ecuador, Benin and the Democratic Republic of Congo, is testing social marketing efforts to increase access to the SDM. Issues explored include:

• Feasibility of adding the SDM to the current family planning method mix provided by selected health facilities and pharmacies.
• Extent to which providers accept this new method and their willingness to offer it to their clients.
• Provider performance in SDM provision, including their ability to counsel clients to use the method correctly.
• A comparison of correct use between SDM users who receive their method at a clinic vs. those who purchase it at a pharmacy.

Impact of SDM Scaling up Interventions

In September 2004, the Institute initiated a study in India, Rwanda and Peru to test the effects of scaling up interventions to include the SDM in service delivery systems and making communities aware of it as a family planning option. Key research questions include:

• What is the effect of SDM introduction on the number of new family planning users and method mix in family planning programs?
• Does SDM introduction increase contraceptive prevalence?
• What is the cost of adding the SDM into ongoing services? How does this compare to introduction of oral contraceptives?
• Do providers offer the SDM in a non-biased manner?

Testing Strategies for provider Knowledge Improvement

The Institute developed the Knowledge Improvement Tool (KIT) to help maintain and improve provider competence in SDM counseling, especially among low-literacy community health workers. The KIT has been implemented in different SDM services throughout the world, and data gathered using the KIT have been used to identify the areas of SDM counseling that need strengthening in follow-up trainings. Existing data from three countries where the KIT was administered (El Salvador, Honduras and India) demonstrate that 12 months following training, providers (including volunteers and clinicians) have an 87% accuracy rate in skills and knowledge for counseling clients on the method.

The KIT can be used in diverse sites and in either an individual or group setting. A research study comparing provider skills using the KIT to those receiving traditional refresher training without the use of the KIT is underway in Guatemala.

Studying Long Term Use of the Standard Days Method

In addition to following up participants in the SDM efficacy trials, data is being collected of women who completed the SDM OR studies. This 24-month follow-up study is being conducted in conjunction with private and public organizations in selected OR study sites including CEMOPLAF in Ecuador, the Ministry of Health and CEVIFA in Honduras, CASP and CARE in India, and OSV-Jordan, ABPF, and HOMEL (formerly Maternité Lagune) in Benin. A total of 559 women are participating in this study that seeks to:

• Learn about SDM use and program effectiveness in regular service delivery settings
• Determine continuation rates
• Learn whether people are using the SDM to prevent or achieve pregnancy, and
• Explore how experienced SDM users track their cycles.

Study results will help to better understand the contribution of the SDM in country programs and enable us to more accurately calculate a CYP for the method, provide long-term user and program effectiveness measures and understand factors that influence continuation.