Contraception Family Planning Use and Attitudes

Assessing the effect of introducing a new method into family planning programs in India, Peru, and Rwanda

Lundgren R, Sinai I, Jha P, Mukabatsinda M, Sacieta L, León FR

Published September 2012 Reproductive Health
DOI 10.1186/1742-4755-9-17 PMID 22938378 PMC PMC3490951

RRM Academy Synopsis

Standard Days Method attracted women new to family planning in India

The Standard Days Method attracted women new to family planning in study regions of India, Peru, and Rwanda: more than 8 out of 10 new users in India had used no method before. The two-year quasi-experimental study surveyed over 3400 women at endline. Awareness in intervention areas reached 9 out of 10 women in Rwanda.

Key Findings

  • Share of women aware of the Standard Days Method at endline: 59.2% in India (endline-1), 63.2% in Peru, 90.3% in Rwanda. Fewer men than women were aware in every country.
  • Among new users, over 85% in India had used no method before. Over 90% in Rwanda and 57% in Peru had used none in the prior two months.
  • By quarter 6, the method made up 12% of new temporary-method users in India and 13% in Peru. In Rwanda it made up 4% of new users.
  • In India's intervention area, modern contraceptive prevalence rose from 47.8% to 50.8%, a statistically significant increase. The control area showed a small increase that was not statistically significant.
  • In Peru, contraceptive prevalence rose significantly in both control and intervention areas. The authors state that prevalence did not decrease as a result of introducing the method.

Interpretation

This quasi-experimental study tracked awareness, acceptance, and contraceptive use among married women and men in parts of India, Peru, and Rwanda. Researchers picked the control and intervention sites together with each country's government. In Peru, use rose in both areas. The authors note they cannot credit the Standard Days Method alone for that rise. The findings support larger studies of community-based rollout of the method in more regions.

RRM Context

Fertility awareness-based methods teach a couple to identify the fertile window and work with the cycle. The Standard Days Method treats cycle days 8 through 19 as that window. The authors cite an earlier efficacy study reporting 4.8 pregnancies per 100 women years for correct use, and 12.0 for typical use. In 14 pilot studies, users learned it in a single visit.

Abstract

Background

Introducing a new method into family planning programs requires careful attention to ensure it meets an actual need and has a positive effect on program goals. The Standard Days Method® is a fertility awareness-based method of family planning that is being introduced into family planning programs in countries around the world. It is different from other methods offered by programs, and may bring new couples into family planning, and increase contraceptive prevalence. The study assesses the effect on contraceptive use and prevalence of Introducing Standard Days Method into existing family planning services in whole regions of India, Peru, and Rwanda.

Methods

In collaboration with the Ministry of Health, health providers were given a contraceptive update on all methods, then trained in counseling on Standard Days Method. Efforts were made to promote demand in the context of informed choice. Routine monthly service statistics in control and intervention areas were used to assess the effect of Standard Days Method introduction at the clinic level; baseline and endline household-based surveys were undertaken to obtain results at the community level (n > 3400 women at endline).

Results

Demand for the method is evident in countries with different levels of contraceptive prevalence. The method attracts couples new to family planning, and introducing it into services may increase overall contraceptive prevalence.

Conclusions

Introducing Standard Days Method into existing family planning has the potential of benefiting men and women in diverse settings and populations. This study illustrates the critical role of evidence in scaling up a health innovation.

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Contraception › Family Planning Use and Attitudes › Method Use and Prevalence · Fertility Awareness › Effectiveness › Comparative Effectiveness
Rebecka Lundgren, Irit Sinai, Priya Jha, Marie Mukabatsinda, Luisa Sacieta, Federico R León
R Lundgren, I Sinai, P Jha, M Mukabatsinda, L Sacieta, F León
PMID 22938378 22938378 DOI 10.1186/1742-4755-9-17 10.1186/1742-4755-9-17 Lundgren et al. 2012, Lundgren 2012