SDM Implementation Guidelines

Why Introduce the SDM?

Expanding contraceptive choice increases contraceptive prevalence

The success of a family planning program depends on its ability to meet the family planning needs of the populations it serves, including their need for specific methods, whether they are for spacing or limiting births. Research shows that when people can choose among several different contraceptive methods they are more likely to find – and use – a method that appeals to them [9]. With the introduction of the SDM in Peru, for example, approximately 5% of all new family planning users in areas served selected the SDM in the first year the method was introduced [10].

Most couples using periodic abstinence do not have correct information on how to avoid pregnancy

It is estimated that 27 million couples worldwide, representing 2.6% of all couples in reproductive age, use periodic abstinence to avoid pregnancy [11]. The majority of them, however, do not know when they are most likely to get pregnant – often making their efforts to avoid pregnancy unsuccessful.


Key Reasons for Making the SDM Part of Your Program

Additionally, millions of women who do not want to get pregnant are not using method family planning. Others using a method inconsistently, switching methods frequently or discontinuing a method after just a few months of use. Many of these women could benefit from simple, accurate information about their fertility – to help them know when to avoid unprotected intercourse to prevent pregnancy.

SDM can be offered easily and effectively by a wide range of organizations

Incorporating the SDM helps programs expand informed choice, reduce unmet need and increase contraceptive prevalence. It is easy for organizations to offer the SDM because the method does not require special equipment or infrastructure. In fact, a wide range of organizations – ministries of health, family planning associations, faith-based groups and NGOs – are now offering the SDM. It has been offered successfully by community volunteers, community-based health workers and NGO outreach workers as well as by auxiliary nurses and physicians. In El Salvador, for example, the SDM was successfully incorporated into rural programs addressing health, water and sanitation, education, and micro-enterprise by Project Concern International and the Reconstruction Committee of El Salvador (CIRES).

SDM offers a strategy to bridge the gap between contraceptive commodity needs and donor commitment

The growing demand for family planning services and funding levels that do not match the growing need are resulting in a major gap. One alternative to alleviating this donor gap is the introduction of low-cost, simple, and effective methods of family planning, such as the SDM. The SDM may be particularly important in settings where there is a high reliance on traditional methods, high levels of unmet need for family planning, and chronic depletion of contraceptive commodities. In most developing countries, contraceptives and the educational materials that support them are heavily subsidized and often are distributed to users at no cost or at a very low fee [12]. The only “commodity” cost associated with the SDM is CycleBeads—the device that women use to track their menstrual cycle—which represents a low-cost one-time purchase. In Burkina Faso, CycleBeads were sold to SDM users at 500 CFA (approximately US$1)—and the majority of users reported that this price was reasonable [13].

The SDM has been accepted by clients and providers in a variety of settings and programs worldwide

Around the world, approximately 90% of women participating in operations research studies reported that the SDM is easy to use and that they would recommend it to others. The reasons men and women give for their positive attitudes towards the SDM include that it is natural, has no side effects, and is effective, affordable and easy to use.

Reasons for Choosing the SDM

Six Countries1
Doesn’t affect health
No side effects
Easy to learn and use
1 Interviews with users in 6 countries, IRH
2 Survey of internet purchasers

The results of research worldwide also show that women and men are able to successfully manage the woman’s fertile period—either through abstinence or using other means of protection. Women and men have also reported that the SDM has helped them to improve couple communication—and women are empowered by having better knowledge and information about their bodies and reproductive health. Research shows that women who complete one year of SDM use are very likely to continue using the method. In a multi-year use study conducted by the Institute for Reproductive Health, 66% of SDM users were still using the method two years later.

SDM increases male participation in family planning

While program planners and providers often are concerned about the acceptability of the SDM for men, research shows that men generally are satisfied with the method. In the clinical trial of the SDM, only 2% of women dropped out of the study because their partners did not want to use the method. And in many instances men actually increased their participation in family planning. Results of the SDM introduction studies, which followed some 1,600 users in nine countries for up to 13 cycles, showed that most men participated in method use by helping to keep track of the fertile days and by abstaining or using condoms during these days.

SDM attracts clients who are not interested in other methods

While the SDM is used by a range of clients with different backgrounds, research shows that the method is very attractive for clients who never before have used any family planning method. For example, research in Benin and Rwanda showed that 80% and 96% of SDM users, respectively, were first time users of family planning.

SDM has no side effects and does not affect the woman’s health

The SDM is an appropriate alternative for women seeking a family planning method that does not cause side effects. Although the SDM also attracts many clients with no previous family planning experience, some SDM users are women who have discontinued other methods because their concerns about side effects and other health issues. When men and women were asked about their reason for using the SDM, the majority stated that they chose it because it has no effect on their health. In Burkina Faso, for example, with the introduction of the SDM, 89% of women reported choosing the SDM because it had no effect on their health.

Copyright 2006 Institute for Reproductive Health