Add option of fertility awareness-based methods
How much do you know about natural methods of family planning? While such options may be exactly what some women are seeking, many providers don't learn about them during their medical training.1
Get ready for that scenario to change. Experts at the Washington, DC-based Georgetown University's Institute for Reproductive Health have just published a review of two fertility awareness-based (FAB) methods and are presenting information at upcoming national family planning conferences.1
"Ideally, a provider should be aware of the pros and cons of all available types of family planning so that she or he is able help a patient chose the method that is best for her needs," says Victoria Jennings, PhD, institute director and professor of obstetrics and gynecology at Georgetown University. "An important component in helping a patient choose an appropriate contraceptive method is to consider her preferences as well as medical eligibility criteria."
While some FAB methods, such as the Ovulation Method and Symptothermal Method require patients to attend several instruction sessions, two more recent methods, the Standard Days Method (SDM) and the TwoDay Method (TDM), can be taught in one brief session, says Jennings.1
Newly published research indicates that while there is no clear profile of clients for whom the SDM (and TDM) would be inappropriate, it is important for providers to help couples overcome potential difficulties by focusing on male involvement,2 says Jennings.
Research supported by the Office of Population Affairs is ongoing in collaboration with Planned Parenthood of San Diego/Riverside County to look at SDM, says Jennings. The investigation is focusing on how inclusion of the SDM in the agency's program affects the 1) the ability of service providers to incorporate a "couple-focused" perspective into their counseling; 2) the ability of women to gain their partners' support for family planning use; and 3) the involvement of men in family planning decision making, says Jennings.
Take a closer look
Fertility awareness-based methods rely on a woman's observations of the fertile and infertile phases of her menstrual cycle. Women who choose a FAB method avoid unprotected intercourse on fertile days by abstaining or using a barrier method to prevent pregnancy.1
Success with a FAB method depends on three things: the method's accuracy in identifying the fertile days, the woman's ability to follow the method instructions to determine when she is fertile, and the couple's ability to avoid unprotected intercourse on the woman's fertile days.3
Consistency is key
The Standard Days Method is appropriate for women whose menstrual cycles are usually between 26 and 32 days long.1 A two-year clinical trial evaluated the effectiveness of the method for 478 women in Bolivia, Peru, and the Philippines, all of whom were of childbearing age with menstrual cycles between 26 and 32 days long.3 The study followed the women over 13 cycles. A life table analysis of the data indicates a cumulative probability of pregnancy of 4.75% over 13 cycles of correct use of the method, and an 11.96% probability of pregnancy under typical use.
To use the method, a woman must count the days of her menstrual cycle, starting with the day her menstrual bleeding begins. The first day of bleeding is Day 1, and during Days 1 through 7, the woman can have unprotected intercourse. On Days 8-19, the woman should be counseled to use a barrier method or avoid intercourse if she does not want to become pregnant. From Day 20 until the end of the cycle, the woman can resume unprotected intercourse.4
One way to help women use SDM successfully is to introduce use of CycleBeads. The beads, a string of 32 color-coded beads, help a woman keep track of her cycle days, know which days she can get pregnant, and monitor her cycle lengths to be sure they are between 26 and 32 days.1
CycleBeads can be combined well with condoms, says Anita Nelson, MD, professor in the obstetrics and gynecology department at the University of California in Los Angeles (UCLA) and medical director of the women's health care programs at Harbor-UCLA Medical Center in Torrance. Women often use condoms when they think they are at risk, says Nelson; the CycleBeads could identify those days for women more accurately, she notes.
Studies in several countries are looking at factors associated with correct use and continuation of the Standard Days Method, reports Jennings. She says issues include whether women who buy CycleBeads from commercial outlets can use the method as well as women who receive instruction from a provider; whether community educators can provide the same quality service as clinical providers or trained counselors; and how various strategies to help women build the skills to communicate about method use with their partners affect correct use and continuation.
Ask two questions
The Two-Day Method is a simple observation method based on the presence or absence of cervical secretions. To use the method, a woman asks herself two questions every day of her cycle:
- Do I have secretions today?
- Did I have secretions yesterday?
If the woman had secretions of any type either "today" or "yesterday," she should consider herself fertile.4
Researchers conducted an efficacy trial of the method, which was designed as a prospective, nonrandomized, multicenter study. A total of 450 women ages 18-39 were followed for up to 13 cycles of method use. The first-year pregnancy rate was 3.5 pregnancies per 100 women/years with correct use of the method (pregnancies and cycles with no intercourse on identified fertile days), 6.3 with use of a backup method on the fertile days, and 13.7 including all cycles and all pregnancies in the analysis.5
References
- Jennings VH, Landy HJ. Explaining ovulation awareness-based family planning methods. Cont Obstet Gynecol July 2006; accessed at: www.contemporaryobgyn.net/obgyn/article/articleDetail.jsp?id=353172.
- Sinai I, Lundgren R, Arevalo M, et al. Fertility awareness-based methods of family planning: Predictors of correct use. Int Fam Plan Perspect 2006; 32:94-100.
- Arevalo M, Jennings V, Sinai I. Efficacy of a new method of family planning: The Standard Days Method. Contraception 2002; 65:333-338.
- Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology: 18th revised edition. New York City: Ardent Media; 2004.
- Arevalo M, Jennings V, Nikula M, et al. Efficacy of the new TwoDay Method of family planning. Fertil Steril 2004; 82:885-892.
Resources
Materials for training and service provision in the Standard Days Method and TwoDay Method are available from the Institute for Reproductive Health's web site, www.irh.org. Click on "Implementing SDM" to review the most recent edition of the publication, Standard Days Method Implementation Guidelines for Program Personnel, which is designed to assist program managers to integrate the method into their services. Support materials include screening and follow-up checklists, a reference guide for counseling patients, informational videos, a training video, a provider training manual, and patient brochures. Contact the institute at: 4301 Connecticut Ave. N.W., Suite 310, Washington, DC 20008. Telephone: (202) 687-1392.
To order CycleBeads, visit the manufacturer's web site, www.cyclebeads.com. Pricing varies by order size. For more information about ordering CycleBeads, send an e-mail to [email protected] or write to: Cycle Technologies, 5505 Connecticut Ave. N.W., No. 237, Washington, DC 20015.
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