The FAM Project: Expanding access to family planning in India
In India, Georgetown University's Institute for Reproductive Health (IRH) is collaborating with a wide range of partners to increase access to family planning and expand family planning options. Specifically, IRH is helping local organizations to integrate two modern, effective fertility awareness-based methods (FAM)—the Standard Days Method® (SDM) and the Lactational Amenorrhea Method (LAM)—into their services and programs. The FAM Project's activities in India reflect IRH's goal to make these options available throughout the world.
Women in Jharkhand find that using CycleBeads is an easy way to practice SDM.
Currently, IRH is providing technical assistance to the Government of Jharkhand in its effort scale up SDM and LAM and strengthen its family planning program statewide. The scaling up process is informed by the World Health Organization's ExpandNet model for scale up of reproductive health innovations. IRH is also working with a variety of organizations in other states to integrate these methods into their programs, including NGO members of the State Innovations in Family Planning Services Agency (SIFPSA) in Uttar Pradesh.
The success of the SDM and LAM at the state level fuels the advocacy activities of IRH and its partners for the Government of India's inclusion of these methods in the national family planning program. In addition, IRH and its partners are exploring innovative community health worker training strategies, social marketing initiatives, and direct-to-consumer strategies to further expand and diversify access to this method.
FAM Project accomplishments in India
- Jharkhand Ministry of Health to Scale Up SDM and LAM, November 2008, The latest issue of the USAID/India newsletter highlights the commitment of the Government of Jharkhand Ministry of Health and Family Welfare to scale up the Standard Days Method and LAM in the state.
- HLL Lifecare Limited, a Government of India enterprise, has become a licensed manufacturer of CycleBeads in India.
The FAM Project addresses unmet need for family planning in India
Family planning choices in India are limited, with a predominant focus on permanent methods. According to the National Family Health Survey (NFHS-3, 2005-2006), about 38% of married women of reproductive age use a permanent method, while only 11% report using a modern spacing method such as condoms, the pill, or the IUD. The most commonly used spacing methods are condoms and the rhythm method, which are often not used consistently or correctly.
Consequently, the Government of India has recognized the need for additional family planning methods. In its Reproductive and Child Health (RCH-II) plan, the GOI put an emphasis on expanding birth spacing options, listing SDM and LAM among methods to expand choice, and developing effective strategies to address unmet need for such methods, especially among hard-to-reach populations.
Following the research-to-practice model in India
IRH started working in India in 2001, with the objective of determining the feasibility and acceptability of offering the SDM through community-based reproductive health programs. Pilot studies conducted with partners in rural Uttar Pradesh and urban Delhi showed that the SDM appealed to women who were not currently using a family planning method and that SDM introduction contributed to an overall increase in contraceptive prevalence rates in the study areas, indicating a strong potential for SDM to address unmet need in India through community programs.
The pilot study results fueled interest in the SDM, as a variety of non-governmental organizations in Kerala, Maharashtra, Bihar, and Uttar Pradesh began to integrate SDM into their programs.
Additional research activities were conducted, including a large-scale integration study implemented in collaboration with the Government of Jharkhand in eastern India and other partners. This study demonstrated the feasibility of incorporating SDM into government programs and confirmed the results of the pilot studies: that the SDM is an attractive method to women who want to space births, that the method brings new users to family planning, and that community health workers can effectively offer the method and are in fact essential for expanding access.
Building partnerships to expand choice
Since the SDM has been offered in India, it has attracted interest at the national level, including the Government of India, UNFPA, the Catholic Bishops' Conference of India, the Family Planning Association of India, and professional organizations such as the Federation of Obstetrics and Gynecology Societies of India (FOGSI) and the Indian Medical Association (IMA). HLL Lifecare Limited, a Government of India enterprise, has become a licensed manufacturer of CycleBeads in India.
Other IRH partners have included CEDPA, CARE, CASP/PLAN, URMUL, PREM, KGVK, World Vision, Futures Group, Population Services International, Population Council, Abt Associates, Pathfinder, Uttar Pradesh Voluntary Health Association, and many more.