TwoDay Method® is a new option being integrated into family planning services worldwide. TwoDay Method services are being provided in the United States, Guatemala, Peru, the Democratic Republic of the Congo, Rwanda, and Uganda. Women using TwoDay Method to prevent pregnancy rely on observation of cervical secretions to indicate fertility.
TwoDay Method services appeal to women who want to use a hormone-free method regardless of cycle length. TwoDay Method was developed for women interested in a natural approach that relies on their body’s signs and symptoms of fertility.
A woman using TwoDay Method checks for cervical secretions at least twice a day. If she notices secretions of any type, color, or consistency either “today” or “yesterday,” she considers herself fertile. A woman can use a simple card to help her keep track of the days she has secretions.
Secretions are a reliable indicator of fertility. When a woman has cervical secretions, she is potentially fertile and can become pregnant from unprotected intercourse. An efficacy trial found TwoDay Method was more than 96% effective in preventing pregnancy with correct use. That means that out of 100 women using the method for one year, fewer than four of them would get pregnant if they used TwoDay Method correctly. With typical use, it is more than 86% effective. These efficacy rates are similar to those of other user-directed methods.
How does the Two Day Method work?
- A woman checks for secretions at least twice daily as soon as her menstrual bleeding stops. Secretions are anything that the woman perceives as coming from her vagina, except menstrual bleeding.
- A woman may feel moisture at the opening of her vagina or see secretions on toilet paper, her underpants, or her fingers.
- Secretions generally start a few days after her period stops. Once secretions start they continue for several days in a row followed by days without secretions.
- If she does not notice secretions today AND yesterday (two consecutive days without secretions), pregnancy is unlikely today.
- If she notices secretions either today OR yesterday, pregnancy is likely today. She must avoid unprotected sex today to avoid pregnancy.
Useful facts | Secretions have several key functions:
- Secretions make it possible for sperm to live up to five days in a woman’s body. Without secretions, the acidic environment of the vagina will cause the sperm to deteriorate quickly.
- When cervical secretions are very fluid (more watery, around the day of ovulation), they serve as a medium for the sperm to navigate into the uterus. This fluidity allows the secretions to flow down the vaginal walls making them easily noticeable for the woman at the opening of her vagina or vulva.
- When secretions have little water content (on the infertile days), they form a sticky plug at the opening of the cervix, which is impenetrable by sperm. With less water content, secretions do not flow down and are not noticeable to the woman.
TwoDay Method achievements
TwoDay Method Services: Quick start approach
Requiring that women wait until the onset of menses before they initiate a family planning method is a medical barrier that could result in unintended pregnancies. Hence, a quick-start approach to TwoDay Method service delivery was tested. 167 women in Peru were counseled in TwoDay Method use (regardless of cycle day) and followed for up to seven months. No significant differences were observed in correct use, continuation rates, and acceptability of the method between women who were counseled at different points in the cycle. These findings suggest that women can be taught and successfully learn to use the method at any time in their menstrual cycle.
Community-based TwoDay Method Services
Since the TwoDay Method is an easy-to-use, knowledge-based family planning method, it is well suited for provision at the community level. A study in the Democratic Republic of Congo (DRC) and Guatemala explored how to further simplify the way this method is used by clients when the service is offered at the community level. Results show community-based programs can successfully engage their community workers to offer the TwoDay Method through their existing activity platforms, even if they are not experienced in health or family planning service provision. Despite efforts to move away from text-based tracking tools, results showed women still prefer daily, paper-based approaches. Even when counseling was conducted with women only, the TwoDay Method still engaged men as participatory partners in family planning. This study also found that participants improved their knowledge of healthy and unhealthy secretions and increased their understanding of the fertile window.
Implications of some traditional practices for TwoDay Method use
Female genital cutting and other traditional vaginal practices are still highly prevalent in parts of Africa and elsewhere. Health consequences and side effects of these practices may influence the presence and appearance of cervical secretions, which may affect the efficacy and acceptability of the TwoDay Method. Yet many of the countries where these practices are prevalent also have low contraceptive use, high rates of unmet need for family planning, and resource constraints at individual and country levels that result in limited access and availability of contraceptive commodities and may, therefore, benefit from TwoDay Method service introduction. The protocol for offering the method includes an explanation of normal patterns of the presence or absence of secretions, and may need to be modified to include the possible effects of these traditional practices on method use. Given the potential challenges and possibilities of offering TwoDay Method services in areas where women have been subjected to female genital cutting and other traditional vaginal practices, studies to explore the feasibility and acceptability of the method in these areas should also explore the possible impact on the effective use of the TwoDay Method, and carefully document the cultural, sexual, and gender-related influences of these practices as they relate to TwoDay Method use.