FAM Project: Expanding the method mix in Mali  
A CycleBeads demonstration at a trainer-of-trainers seminar in Bamako, Mali.
Mali is a focus country of the Institute for Reproductive Health’s (IRH) Fertility Awareness-Based Methods (FAM) Project, a U.S. Agency for International Development (USAID) funded initiative. The purpose of the FAM Project is to facilitate and document the scale up of FAM services in select focus countries, and to continue supporting increased access to and use of FAM worldwide.
IRH has partnered with the Mali Ministry of Health (MOH) and other organizations to integrate the Standard Days Method® (SDM) and the Lactational Amenorrhea Method (LAM) into the country’s family planning program method mix. SDM was introduced through the Malian health system in four regions where other USAID health partners were working. Through these partnerships, IRH was able to able to introduce LAM in 210 health centers in Koulikoro province as well as train trainers and providers in both methods. IRH worked with partners to integrate the SDM and LAM into other aspects of service delivery such as behavior change communication, norms, training curricula, management and supervision, and the procurement and distribution systems.
Recent FAM Project accomplishments in Mali
Although SDM is still a relatively new family planning method in Mali, IRH has made strong steps forward in expanding SDM knowledge and use. These steps include creating a supportive environment, training public and private sector partners, building widespread awareness of the method, and strengthening management and logistics systems.  This has been accomplished by:
  • Incorporating the SDM into national reproductive health norms and procedures
  • Integrated SDM into the national IEC strategy
  • Integrating CycleBeads® into forecasting, logistics and distribution systems
  • Raising awareness of SDM and LAM through on-going sensitization campaigns
  • Developing partnerships with the MOH, USAID family planning cooperating agencies and local NGOs
  • Training national and regional MOH trainers and supervisors in the SDM
  • Training providers in the public and NGO sectors in SDM and LAM in eight regions
  • Introducing LAM in nine districts in Koulikoro
  • Training over 5000 community-based distributors to inform women about the SDM in their communities
  • Advocating for the inclusion of the SDM and LAM in pre-service curriculum
The FAM Project: Expanding access to family planning in Mali
Currently, IRH is partnering with the MOH and select NGO partners to scale up SDM and LAM and strengthen its family planning program to reach all regions of Mali. The scaling up process is guided by the World Health Organization’s ExpandNet model for scaling up reproductive health innovations.
The FAM Project addresses unmet need for family planning in Mali
Family planning choices and utilization rates in Mali are limited, with the 2006 DHS reporting the most popular methods being the pill (2.6%) and injectables (2.2%).  Only 6.2% of the population report using a modern method with the total fertility rate resting at more than 7.34 children born/woman (CIA 2008 statistics). 
The government of Mali recognizes the importance of offering new family planning methods to better meet the needs of its people, but, like so many countries, has limited financial and human resources to respond to the needs.  IRH has worked closely with the MOH since 2003 to provide additional resources, training and supervision support to ensure the method mix is expanded beyond the pill and injectable, and that overall contraceptive use increases.  
Following the research-to-practice-to-scale model in Mali
IRH has conducted several research studies to examine the feasibility and success of scaling up in Mali.  In April 2009, IRH began working with the Malian research organization CAREF to conduct household surveys, facility assessments, CHW focus groups, and stakeholder interviews in several regions in Mali focusing on urban, semi-rural, and rural areas. 
IRH is also partnering with Population Services International (PSI) to conduct a small scale project with accompanying research on the use of boutiques to expand use and knowledge of the SDM.  This activity will examine the impact of distributing CycleBeads® to boutique owners with some basic IEC materials in an effort to promote the use of SDM.  The results of this study will aid IRH in possibly expanding access to the SDM through community based distribution in Mali. 
Building partnerships to expand choice
IRH has engaged many partners in their work with SDM and LAM.  Since 2003, IRH has worked hand in hand with the MOH’s reproductive health department to ensure integration of the SDM and LAM into norms and policies.  More recently IRH has also reached out to the Ministry’s nutrition department to develop public health messages about LAM and integrate LAM into nutritional programming.  IRH has also increased communication with the youth division of the MOH in efforts to address family planning issues among this important and often neglected population. 
IRH maintains and is building upon several other partnerships with local and international NGOs to integrate LAM and SDM into their reproductive health programs. IRH has had a particularly close relationship with CARE’s Keneye Ciwara Project and Abt Associates ATN and ATN+ projects.  Additionally, IRH has and/or continues to partner with Population Services International, Association to Support the Development of Population ActivitiesSave the ChildrenGroupe Pivot Sante PopulationConstella FuturesNational Technical Assistance ProgramCapacity Project/IntraHealthDeliver Project/John Snow, and others. 
Contact the FAM Project in Mali or IRH Headquarters
For more information on IRH’s programs in Mali, contact:
IRH/Mali Technical Coordinator, Sékou Traoré at
IRH Program Officer for Africa, Sarah Terlouw at st379@georgetown.ed