SDM Implementation Guidelines

Counseling Clients

High quality counseling of SDM users is one of the most critical steps to ensuring correct use of the method. The counseling methodology has been tested and refined in diverse settings and can be easily adapted to the needs of different programs. One advantage of the SDM is that it can be offered by a wide variety of healthcare providers and community workers. In most cases, a counseling session can be completed in approximately 20 minutes—and most women can effectively learn to use it in one session. A follow-up visit may be appropriate after one month of use to ensure that the woman understands the method and is using it correctly.

SDM counseling is designed to be simple and straightforward. It is based on three key elements:

Key Actions

  1. Determine which providers will be directly responsible for SDM counseling and how other staff will support them.
    The SDM can be offered successfully by community health workers as well as by auxiliary nurses, nurses, midwives and physicians. In clinic-based programs, midwives, nursing and auxiliary nursing personnel are usually responsible for SDM counseling, while other staff provide introductory information about the method and refer clients to a trained SDM counselor. All program personnel, however, should be comfortable providing basic information about the SDM to ensure that women who are interested in the SDM have their basic questions answered and that there is a systematic mechanism for referrals. Determining how SDM services will be offered is the first step in identifying which providers should be trained in counseling on the method.
  2. Define the counseling protocol and whether it will involve one or two counseling sessions.
    Research conducted by IRH has shown that most women can learn to use the SDM correctly in one counseling session and follow-up sessions are not usually necessary. However, clients should be encouraged to return if they have questions or concers. Nevertheless, some programs at least initially, continue to suggest two visits: an initial and follow-up visit. When deciding if scheduling a follow-up visit is necessary for SDM clients, programs should follow their protocol for other client-dependent methods such as the pill and condoms.
  3. Make counseling job aids and other SDM counseling tools available to providers.
    Tools to facilitate SDM counseling include a Screening Checklist to help providers apply the method criteria, a Provider Calendar to calculate the client’s cycle length, and a Cue Card to show clients how to use CycleBeads. These tools are particularly useful for new SDM providers and are helpful as refresher materials for experienced SDM providers.

  4. Provider Job Aids

  5. Ensure that providers understand the importance of screening and monitoring the cycle length of SDM users.
    Following established guidelines will help select for whom the method is appropriate and screen out women with a history of frequent irregular cycles. Simple questions applied during the counseling session can identify with a high degree of accuracy the women who are likely to have most cycles in the 26-32-day range. Monitoring to ensure that a user who has 2 cycles out of the 26 to 32-day range does not continue to use the method should also be emphasized. Women can easily be taught to monitor their cycle length using CycleBeads, to help them know if their cycles fall out of the range required for the method and seek assistance in finding another method that will work for them.

    Service Delivery Issues

    Addressing barriers to the SDM
    Although the SDM has been successfully introduced into programs around the world, barriers to offering it have been observed in some settings. These barriers deny clients the method they seek, or they delay providing the method by causing women to return for service at another time, when that is unnecessary and cannot be scientifically justified. A Screening Checklist for assessing method eligibility can help providers screen for eligibility – namely, that the woman has regular cycles between 26 and 32 days. The checklist, which is easy to use, suggests questions for the provider to ask so the woman’s eligibility can be assessed.

    SDM Initial Visit Screening Checklist

  6. Ensure that counseling also includes strategies on how to avoid unprotected intercourse during the fertile days.
    Provider’s support to women in establishing a plan for discussing method use and strategies for handling the fertile days with her partner should be part of the counseling process, as it is an important first step in ensuring successful method use by the couple. Providers need to be aware of the strategies that couples use for coping with the fertile days. Many couples choose to avoid intercourse altogether on these days —and develop strategies for dealing with the fertile days, such as sleeping apart, having their children sleep with them, or working different shifts. Other couples choose to use a barrier method or alternative forms of sexual intimacy.
  7. Consider strategies for involving men in counseling.
    Providing information and counseling to men can have a positive impact on correct use and continuation of the SDM, and many programs have worked to include men in counseling. Strategies for involving men include training male counselors to counsel men directly, offering counseling in the home, and setting up specific times to talk to the man and the woman as a couple. While it is ideal to counsel men directly, it is not always easy to reach them. Oher strategies for reaching men include providing written information for women to take home, group educational sessions at work sites, or making information widely available in the community. [14].

    Counseling on the Behavioral Aspects of SDM Use
  8. Provide clients with avilable take-home materials such as the CycleBeads instructions. See a list of options for client materials in the IEC section that follows.
  9. Address reluctance among providers to discuss couple relationship issues with the client. This aspect of the counseling involves dealing with issues that are highly personal in nature and exploring them requires sensitivity and skill. Provider skills in interviewing and counseling will help in making the client comfortable in sharing information and in actively participating in the counseling process. Providers should use the screening job aid to ensure that the behavioral requirements for successful use of the SDM are covered during counseling.

Key Counseling Materials:

A set of provider job aids designed to support the counseling process are available in several languages and for different literacy levels. These materials are ready to use and can be adapted to local contexts. Electronic versions are available for this purpose.

  • Standard Days Method of Family Planning: Provider Job Aids Packet, 2005.
    This comprehensive guide for providers explains how to appropriately counsel women and couples on the Standard Days Method using CycleBeads. The guide, which is available at in English, Spanish, and French, includes the following provider job aids:
    • Screening Checklists for Initial Visit and Follow-up Visit help the provider apply the method eligibility criteria to determine if the SDM is appropriate for the woman and her partner.
    • Provider Calendar used to estimate the length of the woman's menstrual cycle. A provider marks on the calendar the start date of the woman's most recent period, asks her to estimate the start date of her next period, and then counts the days between her last period and the next.
    • CycleBeads Cue Card reminds the provider of the key points to cover when providing method instruction. It includes general information on CycleBeads, how to use them correctly, and when the woman should contact her provider.
Copyright 2006 Institute for Reproductive Health