Standard Days Method® & CycleBeads® A Simple Fertility Awareness-Based Approach to Family Planning

1. Delivering Family Planning at the Community Level throughMuslim, Christian & Voodoo NetworksExperience from Burkina Faso and BeninBernard K. BalibunoProgram Officer – Institute for Reproductive Health/Georgetown UniversityPresented at CCIH 2008 Annual Conference: Community Health and Wholeness, May 2008

2. Standard Days Method® & CycleBeads®A Simple Fertility Awareness-BasedApproach to Family Planning

3. What is the Standard Days Method? The SDM is a fertility awareness-based method that… • Identifies days 8-19 of the cycle as fertile • Is appropriate for women with menstrual cycles between 26 and 32 days long • Helps a couple avoid unplanned pregnancy by knowing which days they should abstain • Helps a couple plan pregnancy by knowing which days they should have intercourse • Is used with CycleBeads®

4. Easy to integrate into existing programs. Can be provided by non-clinically trained staff. Information based. Does not require special equipment, facilities, costly commodities. Consistent with religious beliefs. The SDM is a good option for Faith-Based Organizations

5. How to use Standard Days Method Every morning move the rubber ring to the next bead. Always move the ring in the direction of the arrow.   THERED BEAD is day 1 of cycle. On the first day of your period, move the rubber ring onto the red bead.  WHITE BEAD DAYS are days when you CAN get pregnant. Each bead represents a day of your menstrual cycle Mark a calendar to help remember. Use a condom or do NOT have sex on these days to prevent pregnancy.  BROWN BEAD DAYSare days when pregnancy is unlikely. You can have sex on these days. No condom needed. When your next period starts, move the ring to the red bead again. Skip over any remaining beads. Are you ready to choose this method?

6. Burkina Faso (Koudougou – 75 km west of Ouagadougo) Catechists Registered perish members Volunteers “model” Catholic couples Trained for 4 years in ministering to hard-to-reach communities Strategy: Door-to-door provision of basic health services Church meeting and reference from neighbors Weekly social counseling talks on the Parish radio (Notre Dame Radio and Noctino Bisanga radio) Marriage counseling classes Partners: Commission Diocésaine de la Pastorale Familiale (CDPF) - 23 parishes JHPEIGO Innovative ways to address unmet needs of FP: Catechists, Burkina Faso

7. Benin(Malanville - Bénin's northern region) Voodoo Networks: Followers believe in supreme God and spirits who link human with divine (60% of Beninese) Voodoo priests are respected community members, taken seriously by flowers Strategy: Involved Voodoo priests in selection of Community Health Workers (CHW) Developed champions among respected Voodoo priests Presented at association meetings Partners: OSV/Jordan Innovative ways to address unmet needs of FP:Voodoo Networks, Benin

8. Benin (Cotonou) Muslim leaders: Muslim leaders and the MOH to address teachings of Islam regarding family planning (not opposed to birth spacing) Strategy: Religious leaders made presentations on Islam and birth spacing based on Koran and teachings of Islam Involved in selecting community health workers Encouraged male involvement Partners: OSV/Jordan Innovative ways to address unmet needs of FP:Muslim leaders, Benin

9. “When the values of public health and religion converge, the most vulnerable and hardest to reach, are more likely to gain access to much-needed health services. The case for involving religions groups in sexual and reproductive health and rights is almost self-evident. Through their influence on individuals, cultures, and policies, religions play a critical role in shaping people’s and governments’ attitude toward reproduction and sexuality. Whatever one may think about religion personally, its importance is undeniable …” Monsignor Basile Tapsoba of Koudougou, Burkina Faso Why Catechist, Muslim, and Voodoo?

10. Much of the rural health care in Benin and Burkina Faso is run by FBOs. Many of these groups are better financed than government supported services. FBOs are integral part of the communities they serve. FBOs’ credibility in the community provides a safe and comfortable entrée to family planning to those who might not normally seek such services from other sources. FBOs personnel are often well trained, highly skilled and sensitive to community needs. Why Catechist, Muslim, and Voodoo?

11. By reaching into rural communities and isolated neighborhoods, community-based distribution programs can serve unmet needs for contraception. CHW programs take SDM and other services to people where they live, rather than requiring people to visit clinics for services. Why Community Distribution?

12. CHW strategy also can effectively address: Religious concerns Social barriers Misinformation that can limit the acceptability Why Community Distribution?

13. Trained priests and catechists (mostly couples) to educate community members about birth spacing and provide SDM to couples who chose it. Kept records about number of couples contacted, number choosing SDM over a period of 18 months, and their previous use of family planning. Interviewed sample of leaders, conducted focus groups to assess their understanding of SDM, their communication strategies, and their overall experience in counseling couples on the method. Applied tool to assess provider skill. Design and evaluation methods (focus on Catechists)

14. Trained 12 master trainers Trained 170 Catechist couples providers from the Communaute Chretien de Base (a lowers level Catholic association of neighbors) and the commute de service communauteurs (a pool of church social workers). In 18 months, more than 5,000 families were visited. CDPF registered more than 2,000 SDM users. Activities and results

15. Catechists and Church social workers had positive experiences with SDM (96% planned to continue offering it). Catechists had high levels of understanding of SDM and demonstrated adequate counseling skills, based on their responses to the assessment tool. 90% of SDM users had not used family planning previously. Results

16. Knowledge of SDM spread primarily by Catechists talking to clients and clients telling their neighbors . Sensitization activities carried out in 12 villages. Catechists used CDPF local radio station, Notre Dame of Koudougou province, to promote SDM. CDPF organized plays and included SDM messages in other church activities. IRH and JHPIEGO conducted advocacy activities and met with numerous officials, including MOH, Archbishop of Ouagadougou, and other community leaders to encourage them to endorse and give high priority to family planning. Building awareness of and support for SDM

17. Catechists’ attitudes toward the SDM improve with training and experience. FBO leaders and CHWs can offer a critical point of entry to FP, especially in rural areas with low contraceptive prevalence where people are unlikely to seek services from other sources. FBOs are trusted source of information and can create a bridge to segments of the community that may be hard to reach through formal program channels. When residents of a community actively participate in making decisions about family planning, people gain a better understanding of the health and economic benefits of FP. Lessons Learned…

18. Community involvement is crucial for strategic planning. CHW agent selection should be guided by community opinion rather than by predetermined criteria. CHW agent deployment should use traditional social or economic networks as a convenient basis for reaching village groups. CHW agent training should be based on competence and be incremental and practical. CHW agent supervision should be supportive rather than directive. Lesson Learned…

19. Sustainability (they are there for generations) Lesson Learned…

20. Thank you!