Assessing Need and Preparing to Integrate
the SDM into Programs
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.
- 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.
- 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.
- 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
- 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
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
- 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.