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
counseling is designed to be simple and straightforward.
It is based on three key elements:
- 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.
- 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.
- 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.
- 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.
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
- 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.
- 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.
on the Behavioral Aspects of SDM Use
- 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.
- 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
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 www.irh.org
in English, Spanish, and French, includes the following provider
- 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.
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.
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.
- Other useful materials providers can use as reference
or to facilitate counseling clients on the SDM are: