“We look towards India as a development innovation hub,” he added. In Delhi this week, health practitioners, researchers and policy makers discussed how the Standard Days Method for family planning fulfils an unmet need, especially in resource poor settings.
The SDM is a simple fertility awareness-based method of family planning based on a woman`s menstrual cycle. Appropriate for women who usually have menstrual cycles between 26 and 32 days long, SDM identifies days eight through 19 as the fertile days. To prevent pregnancy, the couple avoids unprotected sex on the fertile days. A woman can use CycleBeads, a colour-coded string of beads, to help track the days of her menstrual cycle and see which days she is most likely to get pregnant. Studies show that SDM is 95% effective in preventing pregnancy with correct use.
Developed by the Institute for Reproductive Health, Georgetown University, Washington, in 2001, the SDM has found many takers across the world. Over the last decade it has been used in over 30 countries such as Rwanda, Mali, Guatemala, DRC. In India, it has been used in Jharkhand as part of the public health programme, and in Uttar Pradesh the CycleBeads has been made available to women in pilot projects in Lucknow and Kanpur under the brand name Ritumala by HLFPPT.
“It is easy to teach, use and learn. It can be offered equally well by medical providers and community-level providers. It teaches women about their fertility, has no side effects, and is natural,” said Priya Jha, IRH India.
An unmet need
Victoria Jennings, Director and Principal Investigator of the IRH, explains how the low-cost low-technology method fulfils an unmet need.
“Despite millions of dollars being spent on contraceptive services there is a gap in needs met. SDM does not have any side effects, it can be used where there is cultural opposition to contraception,” she says. With over 85% users not using any other family planning method mainly because of concerns about side effects, this becomes the gateway to talk about methods available while adding to the basket of choices people have. In addition, it helps women understand their fertility, engages men, improves couple communication, and is cost effective.
Jennings said SDM had been used in Guatemala, which has a high indigenous population and rural population, and a Catholic majority. It has been effective in DRC Congo where contraceptive use is low, infrastructure is poor, and there is high infant and maternal mortality. In India, the SDM is being used in Jharkhand over the last six years. The State has low literacy, high tribal population, high infant and maternal mortality. “The important thing is how to be strategic and integrate it into existing systems,” Jennings said.
Reaching remote areas
According to Dr Manish Ranjan, NRHM Mission Director, Government of Jharkhand, the Fertility Awareness based Methods programme has reached remote areas of the State. It has helped community empowerment, he said. The pilot initiative done in three blocks of Ranchi district was scaled up to 12 districts.
Awareness of SDM is high – almost 50%. Three out of four SDM users said they managed fertile days with condom use. The community-based approach and engaging Sahiyyas – community health workers – has been vital for achieving health goals, Dr Ranjan said. “These methods support the strategy of task shifting from clinical providers to community-based workers, it also shows the importance of capacity building and training of community workers, role of IEC activities,” he said.
Life and death
Priya Jha, IRH India, said to Citizen News Service – CNS that quality assurance is pivotal to scale up, as is repeated training of community workers and follow up with beneficiaries. “We are now looking at expanding in other States with low contraceptive use and high fertility rate,” she said.
According to WHO, every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. It is the leading cause of death for teenage girls in the developing world. Melinda Gates, whose Gates Foundation is one of the world’s leading donors to expand access to contraception for women in some of the poorest countries of the world, says, ‘access to contraceptives can often be the difference between life and death’.
No wonder then that making family planning methods accessible to women across the world is a high priority. The more choices, the better. – Citizen News Service
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