Repositioning Family Planning in West Africa
Repositionnement de la Planification Familiale en Afrique de l’Ouest
Sponsored by: U.S. Agency for International Development (USAID), World Health Organization (WHO), Action for West Africa Region Project - Reproductive Health (AWARE-RH), Advance Africa, the POLICY Project
Community-based Programs: Introducing
the Standard Days Method
Lessons Learned
Candide AgbobatinkpoCaroline Blair
The Standard Days Method• Family planning method for women
with menstrual cycles between 26 and 32 days
• Identifies days 8-19 of the cycle as fertile
• Helps a couple prevent or plan pregnancy by knowing which days they should avoid unprotected intercourse
• Uses CycleBeads™ as a tool to track her cycle days, monitor cycle length, and identify her fertile period.
SDM Efficacy Study Results
• Couples used the method correctly in 97% of cycles
• Of the 478 women in the study, 43 got pregnant
•With correct use, the failure rate is 4.8
•With typical use the failure rate is 12.0
Why Offer the SDM?
Can be offered by community-based providers
Community-based mobilizers can refer to clinics
Teaching does not require clinical skills
Addresses an unmet need
Increases choice and expands coverage
Empowers women and involves men
Offers a low-cost method
240 Condoms
30 Pill Packets
8 Depo injections
.58 IUD
=
2 CYPs
1 set of CycleBeads/SDM
Adapted from USAID Office of Sustainable Development, Bureau for Africa,
Health and Family Planning Indicators Volume I, July 1999.
Type of Providers TrainedSDM O/R Study*
14%
15%
71%
51 professionals
41 paraclinical
241 CHWs
n=333* IRH Operations Research Study, Ecuador, El Salvador, Honduras, Benin, India, Philippines, 2001-2003. Data currently being analyzed.
Clinic-based v. Community-based Provider Technical Competence – The SDM
Provider Type
Training/
Supervision
Attitudes Needs
Professional/
Para clinical
Less intensive •Bias against NFP•Discomfort discussing sex
•Couple communication•Motivation
Community health workers
More intensive •Bias towards SDM•More comfort discussing sex
•Refresher training or closer individualized feedback•Emphasis on eligibility criteria•Mentoring
Source: Final Operations Research study report
Competency Improvement Over Time – By Provider Type
0102030405060708090
100
EligibilityCriteria
Use ofCycleBeads
UserInstruction
When to SeekAdvice
Clinician T1Community T1Clinical T2Community T2
Results of analysis of supervision guide in El Salvador, Honduras and India
Competency Improvement Over Time – By Provider Type
12 months after training
Results of Supervision Guide in El Salvador, Honduras and India
Volunteers(n=76)
Clinicians(n=46)
Eligibility Criteria 83% 92%
User Instructions 96% 95%
Couple Aspects 92% 91%
Total 84% 93%
Why women and men want to receive info from CHWs
Access-related factors• Time• Distance (to clinic)• Cost (transport to clinic)
Method-related factors• Non-medical• Non-hormonal• Simple (easy to use)
CHW-related factors• Feasibility• Capability (able to offer method)• Credibility (client confidence/trust in CHW)
Benin OR study 2001-2003. Data currently being analyzed.
Cumulative 6 Month Continuation Rates SDM O/R Study: 5 Programs (n=1240)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 1 2 3 4 5 6
Benin n=219
Philippines n=150
Peri-Urban India n=247
Rural India n=482
El Salvador n=142
IRH Operations Research Study, 2001-2003. Data currently being analyzed.
Results: Male Involvement SDM continuation in villages targeting male participation vs.
women focused villages
CARE India, OR Study 2001-2003 p < .05
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Months of Use
Per
cen
tage
Male focusedWomen focused
Pre Post SDM
El Salvador 45% 58%
India 49% 58%
Results: Suggested increase in Contraceptive Prevalence Ratefollowing SDM introduction into community programs
Source: 1) Project Concern International, El Salvador, 2002; 2) Project Reports: CEDPA 2004
Results: Suggested Increase in Dual Protection
Couples and Condom Use
Admission Exit
Rural India 30% 35%
Urban India 87% 98%
El Salvador 25% 34%
Philippines 22% 30%
Project reports, IRH
BCC through Community Outreach - Benin
• Health providers (clinic or community-based) were primary source of information.
• Media (flyers, poster, radio, TV) primary source for half of Beninese users.
• Family and community outreach played larger role in rural areas
Demand Generation
• The feasibility of long-term provision of the SDM depends on the ability of organizations to stimulate demand for the SDM.
Successfully Offering the SDM in Africa through CHWs and CBDsZambiaMobilizers and
Providers
BeninMobilizers and
Providers
RwandaMobilizers and
Providers
EthiopiaProviders
DRCMobilizers and
Providers
Programmatic Recommendations
• CHWs and CBDs can play a role in SDM service delivery
• Community-based workers’ competencies were similar to those of clinicians’
• CHWs/CBDs require more technical training and more intense supervision (initially) than clinicians
• Best to use an existing CHW network rather than create a parallel system
