What is the Standard Days Method?

The Standard Days Method® (SDM) is a simple method of family planning that was developed and tested by Georgetown University’s Institute for Reproductive Health (IRH) in 2001. IRH developed a computer model, based on data from the World Health Organization and determined that women who usually have menstrual cycles between 26 and 32 days long (periods that come a month apart) are most likely to be fertile – or able to get pregnant – on days 8 through 19 (also called fertile days) of their cycles. The probability of pregnancy on other days of the cycle is very low. Therefore, the SDM identifies a fixed set of days in each menstrual cycle as the days when a woman can get pregnant if she has unprotected intercourse. If the woman does not want to get pregnant, she and her partner avoid unprotected intercourse on the fertile days of her cycle.

The SDM is used with CycleBeads®, the visual tool that helps a woman determine her fertile days (when she is most likely to get pregnant). IRH tested the SDM in a clinical trial with almost 500 women in three countries – Bolivia, Peru and the Philippines. Women were able to use the method correctly, and when they used it correctly, the SDM was more than 95% effective. That is, out of 100 women using the method for 1 year, fewer than five became pregnant. The total pregnancy rate (correct plus incorrect use) was slightly less than 12 pregnancies per 100 women per year. This is similar to the effectiveness of some other user-dependent methods.

Is the SDM considered a “modern” method of family planning?

Yes. It meets the criteria of modern methods because it

• is based on woman’s reproductive physiology
• was developed following the scientific model and utilizing tools of modern science, including mathematics and computer modeling.
• was field-tested following the rules and methodology used to test other modern family planning methods.

It is not necessary for a method to involve drugs or surgical procedures to be a modern method. The SDM should be differentiated from traditional practices, such as the rhythm (or calendar) method or other rules for periodic abstinence, which are based on popular beliefs, and/or medical assumptions, and have never been properly tested.

How effective is the SDM?

In an efficacy study conducted by the IRH, the SDM was found to be more than 95% effective. That means that, out of 100 women using the method for 1 year, fewer than five of them would get pregnant if they used the SDM correctly. However, the study also found that women who do not keep careful track of their cycle days or have unprotected intercourse on the fertile days of her cycles are much more likely to get pregnant. When we added pregnancies occurring with correct use and with incorrect use of the method, the total was approximately 12 pregnancies for every 100 women/year of method use. Further studies in several countries showed effectiveness rates in the same range. The effectiveness of the SDM is similar to that of some other user-dependent methods.

Source: World Health Organization’s Family Planning Global Handbook for Providers

How does efficacy of the SDM compare to that of other methods?

The SDM is at least as effective as many other methods of family planning, including barrier methods. It is 88% effective with typical use and 95% effective with correct use.

How is the SDM different from the rhythm (or calendar) method?

It is very different. The rhythm (or calendar) method requires having exact information about the last six or more menstrual cycles and making arithmetical calculations – adding and subtracting – every month to figure out which days in the current cycle a woman is likely to get pregnant. The rhythm method has never actually been tested in a well-designed efficacy study. The SDM is simple – it does not involve any calculations, and it is the same every cycle. It has also been tested in a well-designed efficacy trial, with good results.

Who can use the SDM?

The SDM works well for women who usually have menstrual cycles between 26 and 32 days long. Between 50-60% of women have cycles between 26 and 32 days long. However, women who have cycles shorter than 26 days or longer than 32 days are not good candidates for this method. Also, couples who can use a condom or avoid unprotected intercourse on fertile days can successfully use this method. According to studies conducted by IRH, SDM users have been women as young as 18 and as old at 47, with the average age ranging from 28-32 years.

How do I use SDM correctly?

To use SDM correctly, it is very important to use it with the CycleBeads. CycleBeads have been found to be an easy-to-use tool for helping women keep track of their cycles and know which days are fertile and which are not, as well as to monitor cycle length. However, a woman using CycleBeads would also need to be sure that her cycles usually are between 26 and 32 days so that the fertile window is accurate for her.

How does CycleBeads work?

CycleBeads is a visual tool that helps a woman use the SDM to keep track of the days of her cycle and know when she is likely to get pregnant if she has unprotected intercourse. CycleBeads is a string of color-coded beads, with each bead representing a day of a woman’s menstrual cycle. They have a black rubber ring that the woman moves over one bead each day, in the direction of the arrow. When the woman starts her period, she puts the ring on the first red bead and marks that date on the calendar. She continues moving the ring one bead each day of her cycle. When the ring is on a brown bead, her she is on a day in her cycle when she can have intercourse with very low likelihood of getting pregnant. When she is in on a day represented by the white beads, she may be fertile and could get pregnant if she has unprotected intercourse.

Where can we get CycleBeads in India?

IRH is the developer of the SDM and the tool CycleBeads. IRH, however, does not sell CycleBeads. The organization that manufactures CycleBeads in India is HLL Lifecare Limited, a Government of India Undertaking based out of Trivandrum, Kerala. IRH is not involved in pricing, marketing or distribution of CycleBeads, managed by HLL Lifecare as the licensed manufacturer in India. You can purchase them by contacting HLL Lifecare Limited at vgpillai@lifecarehll.com and/or on 0471-2358151. If you need any additional information, you can also contact us at info@irh.in

Are CycleBeads available in pharmacies?

CycleBeads are currently not available in pharmacies. The licensed Indian manufacturer of CycleBeads is HLL LifeCare Limited and CycleBeads can be procured from them. However, for a sample set of CycleBeads and information related to SDM, you can write to info@irh.in or call us at +91-1146113415.

Why is it important that the partner be willing to use the SDM and understand how it works?

First, it is important that both the woman and her husband agree about whether or not they want a pregnancy. It is also critical that both understand how the SDM works so they can decide how to deal with the days when she can potentially get pregnant. For best results, it is important that both understand that she is likely to get pregnant if they have unprotected sex during her fertile days. It is also critical that they decide beforehand how they will manage the fertile days– they may decide to use a condom or abstain from sex during this time. In the efficacy study, only about 2% of women dropped out of the study because their husbands did not want to use the method. What we found was that, once men understand the method, they are very supportive. Other studies show similar results. CycleBeads can help women and men talk about the method. And even if they don’t talk about it, CycleBeads are very visual – the man can see when the woman is fertile, and he understands what they need to do to avoid pregnancy.

What are the essential steps to integrating SDM into programs?

Programs need to follow a systematic approach when integrating the SDM, as they would when introducing any new method of family planning. To ensure that SDM is integrated and made a regular part of the service delivery system, a program must:

• create a supportive environment to facilitate integration and sustainability of SDM within existing services;
• train providers on how to screen and counsel clients;
• include SDM in the on-going supervision and monitoring and evaluation system;
• raise awareness within the community about the availability of SDM; and
• ensure that CycleBeads are available where services are offered

What is the value added when integrating SDM into programs?

SDM is an addition to the method mix that provides a simple, easy and natural option to couples who are interested in preventing unplanned pregnancy. Offering SDM in programs:

• attracts new family planning users and reduce unmet need, as shown by study results published in the March 2008 issue of Contraception.
• improves access to family planning methods by enabling programs to reach women through a variety of service delivery approaches. Physicians, nurses, auxiliary nurses, and community volunteers can offer the SDM in both the public and private sectors and at the community level.
• empowers women. Women who learn and use the SDM have increased knowledge of their bodies and their menstrual cycles, increased self-confidence, and greater levels of communication with their partners.
• involves men, because the couple has to decide together how to manage the fertile days. Offering the SDM encourages and offers programs an opportunity to make serious efforts to reach men with family planning information and services and to incorporate gender issues into family planning counseling.

Can the SDM be provided at the community level?

Yes. IRH has developed simple tools and training material that enable community-based workers to provide the SDM to their clients. This is happening successfully in India, Democratic Republic of Congo, Mali and several other countries. The SDM has been successfully introduced into the family planning and reproductive health programs in India. The health service providers here are trained to screen and counsel couples about the method. Proper screening is critical for effective use of the SDM and to establish method eligibility.

Can illiterate women use the SDM?

It is entirely possible for illiterate women to use this method. There is no need for them to be able to read in order to use it. In fact, that is one of the reasons the CycleBeads are so helpful. CycleBeads provide a visual aid for women, regardless of whether or not they are literate. Other findings have shown that CycleBeads are an effective communication tool and have helped women talk about family planning with their husbands. Results also reveal that men are very interested in SDM and to participate in method use in a number of ways: using condoms or abstaining during fertile days; supporting women’s use of method by keeping track of her fertile days; or moving the black ring forward each day. With her husband’s support and counseling from health service providers, even women with no formal education can successfully use the method.

What percentage of family planning users can be expected to choose the SDM?

Program experience shows that in well-run programs, demand has tended to plateau at 5-15% of all new family planning clients choosing the SDM. Demand for the SDM tends to be higher in countries/sites with lower contraceptive prevalence.

What if women switch from more effective methods to SDM?

What we are seeing in programs that are already offering and providing the SDM to their regular clientele is that most women who choose the SDM were either completely new to family planning (had never before used a method), were practicing periodic abstinence (based on vague and almost always incorrect information), were inconsistent users of a modern method, or had discontinued their previous method because of side effects or other personal reasons. Very few new SDM users report recent use of another family planning method. However, it is important for women to have the option to switch to the SDM is they want to do so. Also the efficacy of the SDM is similar to that of some other user-dependent methods.