SDM Implementation Guidelines
 

Assessing Need and Preparing to Integrate the SDM into Programs

Assessing Need

SDM introduction is most sucecessful in areas where there is a potential demand and where there is likely to be high acceptability. Worldwide, millions of women report that they are using “periodic abstinence” to avoid pregnancy, although the majority of them do not know when they are most likely to get pregnant. Additionally, millions of women who do not want to get pregnant are not using any method of family planning, while others are using a method inconsistently.

Key Actions

  1. Determine the contraceptive prevalence rate and number of women using periodic abstinence, traditional methods or no methods at all, in areas where SDM introduction is being considered.
    SDM introduction has been particularly successful in areas where contraceptive prevalence is low and where there is potential demand, such as large numbers of women who are either using no method of family planning or using some form of periodic abstinence. Even countries with high prevalence have areas where contraceptive use is lower, and thus where interest in the SDM could be strong.
  2. Assess the appropriateness of introducing the SDM
    SDM may not be an appropriate method in places where HIV/AIDS is highly prevalent, where attitudes support having many sexual partners, and women are powerless to negotiate the timing of intercourse and/or the use of condoms.
  3. Assess the feasibility of introducing the SDM
    The feasibility of introducing the SDM will depend on whether there is a supportive policy environment for offering a new natural method, interest on the part of potential implementing organizations, and financial support that is likely to be sustained. Many national family planning policies and norms already include natural methods. Others mention more generally offering a wide variety of methods to ensure informed choice. The SDM can be included in these policies. Public and private sectors programs can be appropiate implementers of SDM introduction. In many settings, an NGO initiates the method and documents its experience to help the government programs make decisions about strategies for method introduction. In their settings, the ministry of health will introduce the SDM in one or two pilot areas before expanding nationally.
  4. Identify the capacities of the organizations involved in the introduction.
    Although a large variety of organizations can successfully introduce the SDM, the nature of the organization and its mission will affect what the organization needs to do to prepare for the introduction. For example, organizations that have not previously offered family planning will require a lot more preparation than groups familiar with family planning services. Non family planning community development organizations, for example, will need to consider how family planning services fit within their mission and activities, and how the SDM will be integrated into other activities.

    An Assessment Checklist provides a list of questions that can be used to assess the political environment and the capacity and readiness of organizations for introducing the SDM. It is also a tool that managers can use to review their programs to determine how the SDM can be effectively integrated into existing services.

Preparing to integrate the SDM into your program

The successful integration of the SDM requires preparation and follow-through. Decisions need to be made about where the SDM should be offered and by whom. Support among key “influentials” and program decision-makers must be developed and a supportive policy environment established. Support materials and training for service personnel are required as well as communication strategies for inform the community about the availability of the method. . In addition, CycleBeads must be available, and providers need to be supported in offering the method. All of these steps are a critical part of the integration process, though their sequence may vary from site to site. The following sections address these topics and include references that will help personnel establish SDM as an integral part of the family planning program.

  • Norms and Guidelines
  • Training
  • Counseling
  • Information, Education, Communication
  • Assuring Quality
  • Procurement and Logistics
  • Other Service Delivery Issues

To assist program managers integrate the SDM successfully, a list of key actions related to each of these program elements is provided in the SDM Programmatic Framework that follows. The actions are not necessarily sequential, but all need to be considered, and those appropriate to the particular program carried out. These actions are discussed in the chapters that follow.

Copyright 2006 Institute for Reproductive Health