Keep it simple: the more choices, the better

[Cross-posted from the original article by Sumita Thapar, Citizen News Service, 17 July 2013]

Family planning is a key strategy for child survival, said Michael Stern, USAID India, in Delhi this week. “We look towards India as a development innovation hub,” he added. In Delhi this week, health practitioners, researchers and policy makers discussed how the Standard Days Method (SDM) for family planning fulfils an unmet need, specially in resource poor settings. The SDM is a simple fertility awareness-based method of family planning based on a woman`s menstrual cycle. Appropriate for women who usually have menstrual cycles between 26 and 32 days long, SDM identifies days 8 through 19 as the fertile days. To prevent pregnancy, the couple avoids unprotected sex on the fertile days.

A woman can use CycleBeads, a colour-coded string of beads, to help track the days of her menstrual cycle and see which days she is most likely to get pregnant. Studies show that SDM is 95% effective in preventing pregnancy with correct use.

Developed by the Institute for Reproductive Health (IRH), Georgetown University, Washington, in 2001, the SDM has found many takers across the world. Over the last decade it has been used in over 30 countries such as Rwanda, Mali, Guatemala, DRC. In India, it has been used in Jharkhand as part of the public health programme, and in Uttar Pradesh the CycleBeads has been made available to women in pilot projects in Lucknow and Kanpur under the brand name Ritumala by HLFPPT. Says Priya Jha, IRH India: “It is easy to teach, use and learn. It can be offered equally well by medical providers and community-level providers. It teaches women about their fertility, has no side effects, and is natural.”

Victoria Jennings, Director and Principal Investigator of the IRH, explains how the low-cost low-technology method fulfils an unmet need. “Despite millions of dollars being spent on contraceptive services there is a gap in needs met. SDM does not have any side effects, it can be used where there is cultural opposition to contraception,” she says. With over 85% users not using any other family planning method mainly because of concerns about side effects, this becomes the gateway to talk about methods available while adding to the basket of choices people have. In addition, it helps women understand their fertility, engages men, improves couple communication, and is cost effective.

Jennings said SDM has been used in Guatemala, which has a high indigenous population and rural population, and a Catholic majority. It has been effective in DRC Congo where contraceptive use is low, infrastructure is poor, and there is high infant and maternal mortality. In India, the SDM is being used in Jharkhand over the last six years. The State has low literacy, high tribal population, high infant and maternal mortality. “The important thing is how to be strategic and integrate it into existing systems,” Jennings said.

According to Dr Manish Ranjan, NRHM Mission Director, Govt of Jharkhand, the Fertility Awareness based Methods programme has reached remote areas of the State. It has helped community empowerment, he said. The pilot initiative done in 3 blocks of Ranchi district was scaled up to 12 districts. Today, Jharkhand has over one lakh SDM users. Awareness of SDM is high – almost 50%. Three out of four SDM users said they managed fertile days with condom use. The community-based approach and engaging Sahiyyas – community health workers – has been vital for achieving health goals, Dr Ranjan said. “These methods support the strategy of task shifting from clinical providers to community-based workers, it also shows the importance of capacity building and training of community workers, role of IEC activities,” he said.

Priya Jha, IRH India, agrees that quality assurance is pivotal to scale up, as is repeated training of community workers and follow up with beneficiaries. “We are now looking at expanding in other States with low contraceptive use and high fertility rate,” she said.

In Kanpur, Uttar Pradesh, the Cycle Bead has been made available through social marketing by HLFPPT. Priced at Rs 35 and sold under the brand name Ritumala, the project began in 10 slums and ran from November 2010 till June 2013. There were about 4,000 users. Sharad Agarwal, CEO HLFPPT said, “This intervention became the beginning for the community worker to talk about a range of issues such as menstrual hygiene, pregnancy card etc.”

Shovon Chowdhury, Streetlife Advertising, who created a digital campaign for the product says the media is excellent when the target is primarily young people. With penetration of smartphones, numbers of people accessing the Internet on the phone has grown manifold. Since SDM is a knowledge-based method, it can be promoted and even be used via digital media, Chowdhury said. Downloadable version, online version are some ways of increasing access to CycleBeads. With the Indian telecom market being the second largest in the world, innovations are also on to see if the SDM can be offered via phone.

According to WHO, every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. It is the leading cause of death for teenage girls in the developing world. Melinda Gates, whose Gates Foundation is one of the world’s leading donors to expand access to contraception for women in some of the poorest countries of the world, says, ‘access to contraceptives can often be the difference between life and death’.

No wonder then that making family planning methods accessible to women across the world is a high priority. The more choices, the better.