Assess, Inform and Support
Standard Days Method® (SDM) counseling is designed to be simple and straightforward. It is based on three key elements:
Assess - helping women determine if the method is appropriate for them and their parents,
Inform - providing women with the information and tools they need to understand the instructions and us the method correctly; and
Support - helping women identify potential difficulties and how to handle them in managing the fertile days with their partners, and encouraging them to return for additional information an services as appropriate.
Key Actions for Method Provision
Determine which providers will be directly responsible for SDM counseling and how other staff will support them.
The SDM cab be offered successfully by community health workers as well as by auxiliary nurses, midwives and physicians. In clinic-based programs, midwives, nursing and auxiliary nursing personnel are usually responsible for SDM counseling while other staff provider introductory information about the method and refer clients to a trained SDM counselor. All program personnel, however, should be comfortable providing basic information about the SDM to ensure that women who are interested in the SDM have their basic questions answered and that there is a systematic mechanism for referrals. Determining how SDM services will be offered is the first step in identifying which providers should be trained in counseling on the method.
Define the counseling protocol and whether it will involve one or two counseling sessions.
Research conducted by IRH has shown that most women can learn to use the SDM correctly in one counseling session and follow-up sessions are not usually necessary. However, clients should be encouraged to return if they have questions or concerns. Nevertheless, some programs at least initially, continue to suggest two visits: an initial and follow-up visit. When deciding if scheduling a follow up visit is necessary for SDM clients, programs should follow their protocol for other client-dependent methods such as the pill and condoms.
Make counseling job aids and other SDM counseling tools available to providers.
Tools to facilitate the SDM counseling include a Screening Checklist to help providers apply the method criteria, a Provider Cue Card to show clients how to use CycleBeads, and a Job Aids Packet with additional information to provide client's should they ask. These tools are particularly useful for new SDM providers and are helpful as refresher materials for experienced SDM providers.
Ensure that providers understand the importance of screening and monitoring the cycle length of SDM users.
Following established guidelines will help select for whom the method is appropriate and screen our women with a history of frequent irregular cycles. Simple questions applied during the counseling session can identify with a high degree of accuracy the women who are likely to have most cycles in the 26-32 days range. Monitoring to ensure that a user who has 2 cycles our of the 26-32 day range (in the period of a year) does not continue to use the method should also be emphasized. Women can easily be taught to monitor their cycle length using CycleBeads to help them know if their cycles fall out of the range required for the method and seek assistance in finding another method that will work for them.
Ensure that counseling also includes strategies on how to avoid unprotected intercourse during the fertile days.
Provider's support to women in establishing a plan for discussing method use and strategies for handling the fertile days with her partner should be part of the counseling process, as it is an important first step in ensuring successful method use by the couple. Providers need to be aware of the strategies that couples use for coping with the fertile days. Many couples choose to avoid intercourse altogether on these days - and develop strategies for dealing with the fertile days, such as sleeping apart, having their children sleep with them, or working different shifts. Other couples choose to use a barrier method or alternative forms of sexual intimacy.
Consider strategies for involving men in counseling.
Providing information and counseling to men can have a positive impact on correct use and continuation of the SDM, and many programs have worked to include men in counseling. Strategies for involving men include training male counselors to counsel men directly, offering counseling in the home, and setting up specific times to talk to the man and the woman as a couple. while it is ideal to counsel men directly, it is not always easy to reach them. Other strategies for reaching men include providing written information for women to take home, group education sessions at work sites, or making information widely available in the community.
Provide clients with available take-home materials such as the CycleBeads instructions.
See a list of client materials in the Advocacy/IEC section.
Address the reluctance among providers to discuss couple relationship issues with the client.
This aspect of the counseling involves dealing with issues that are highly personal in nature and exploring them requires sensitivity and skill. Provider skills in interviewing and counseling will help in making the client comfortable in sharing information and in actively participating in the counseling process. Providers should use the Screening Checklist to ensure that the behavioral requirements for successful use of the SDM are covered during counseling.
Addressing barriers to the SDM.
Although the SDM has been successfully introduced into programs around the world, barriers to offering it have been observed in some settings. These barriers deny clients the method they seek, or they delay providing the method by causing women to return for service at another time, when that is unnecessary and cannot be scientifically justified. The Screening Checklist for assessing method eligibility can help providers screen for eligibility - namely that the woman has regular cycles between 26 and 32 days (periods that come about a month apart). The checklist, which is easy to use, suggests questions for the provider to ask so the woman's eligibility can be assessed.