Testing a proof of concept model for group couples counseling in family planning in Northern Uganda.

INTRODUCTION: The post-conflict Acholi sub-region of Uganda is undergoing a period of transition that is influencing access, acceptability and use of family planning (FP). Low FP use and high unmet need for FP in Uganda's northern region provides a unique opportunity to test a community-based group counseling approach to reduce unintended pregnancies among young couples. We share findings from a proof of concept testing model in delivering fertility awareness methods (FAM) to groups of couples by trained non-health community youth agents. METHODS: The group counseling model was developed for couples interested in two FAM-standard days method (SDM) and TwoDay Method-within rural communities in Northern Uganda. WALAN was tested in a three-month proof of concept phase, employing 24 direct observations of group counseling sessions; quantitative interviews with 9 couples using either SDM or TwoDay Method; 2 focus group discussions with youth facilitators, and; 9 key informant interviews with providers and leaders. RESULTS: The proof of concept results suggest model feasibility and acceptability among participating communities. Couples learned how to use FAM correctly. All 9 interviewed female users reported 100% correct knowledge of method use. Couples also reported high levels of satisfaction for both methods. SDM and TwoDay Method participants reported comfort and satisfaction in learning about FAM in small groups with other couples. CONCLUSION: The proof of concept phase confirmed intervention feasibility, albeit with some model adjustments. The results were used to inform the pilot intervention, launched in April 2016 within 15 other villages in the same region.

Assessing the Competency and Acceptability of Community Health Worker Provision of Standard Days Method® in Family Planning Services in Gisagara District, Rwanda.

This study assesses the competency and acceptability of community-based provision of Standard Days Method® (SDM) to first-time users in Rwanda. The national strategy equips community health workers (CHWs) to resupply pills, injectables and condoms to existing clients. With the aim of expanding access, SDM provision to first-time users was added to the method mix in Gisagara district and assessed with a 12 month prospective, mixed methods study. Thirty percent of SDM clients had never used a method of family planning and 58 percent had not been using a method for at least three months. Eighty-seven percent of CHWs correctly screened clients to use SDM and 92 percent accurately explained how to use CycleBeads to prevent pregnancy. After being counseled by the CHWs, 89 percent of clients reported knowledge of all key steps required in using SDM to prevent pregnancy. Nearly all SDM clients (99 percent) believed that CHWs were able to counsel them adequately. These results suggest that CHWs were able to offer SDM as part of their family planning responsibilities, and the study adds to the evidence on the role of CHWs in expanding contraceptive access and choice.

Engaging men in family planning services delivery: experiences introducing the Standard Days Method® in four countries.

Family planning is often regarded as the woman's responsibility, but there is growing recognition of the need to involve men in family planning programs. Since 2001, the fertility-awareness-based Standard Days Method® (SDM) has been introduced in more than 30 countries, providing a natural, effective birth control option. SDM requires the cooperation of the male partner, and its introduction created an opportunity to test innovative strategies to engage couples in family planning. Such strategies included couple counselling, outreach activities that encouraged men to participate in family planning and integration of family planning into traditionally male programs. Due to the SDM's intrinsic characteristics as a couple method, SDM providers are sensitized to the importance of exploring other critical sexual and reproductive health topics, including intimate partner violence, HIV, sexuality and partner communication. This paper presents several case studies describing how men were engaged in SDM introduction activities in four countries.

A Bridge for postpartum women to Standard Days Method®: I. Developing the Bridge.

BACKGROUND: A new fertility-awareness-based Bridge was developed for postpartum women starting with their first postpartum menses and until they are eligible to use the Standard Days Method®. This article describes the development of the Bridge and theoretical efficacy. STUDY DESIGN: Analysis of a preexisting data set collected in 1986-1990 was performed. Seventy-three breastfeeding women in Australia, Britain and Canada were followed starting 42 days postpartum until they had at least two potentially fertile cycles. We used these data to calculate the theoretical probability of pregnancy from intercourse on different days of the cycle relative to ovulation for postpartum women following the instructions of the Bridge. RESULTS: The fertility-awareness-based family-planning Bridge is theoretically effective for postpartum women until they reestablish cycle regularity and can start using the Standard Days Method. CONCLUSION: The Bridge can potentially be effective for postpartum women until they are eligible to use the Standard Days Method. Results from an efficacy study of the Bridge are described in a companion article.

A Bridge for postpartum women to Standard Days Method®: II. Efficacy study.

BACKGROUND: In a companion article, we described the development of a new fertility-awareness-based Bridge for postpartum women starting with their first postpartum menses and until they are eligible to use the Standard Days Method®. This article presents the results of an efficacy trial to test the Bridge. STUDY DESIGN: This was a prospective, nonrandomized, multicenter study following 157 women for up to 9 months. Participants were aged 18-39 years, had menstruated at least once since their baby was born, and wished to avoid or delay pregnancy using a fertility-awareness-based approach. Acceptability and correct use were examined. Life table pregnancy rates were calculated to assess method effectiveness. RESULTS: The typical-use failure rate is 11.2 for 6 months of Bridge use. CONCLUSION: The Bridge can offer significant protection from pregnancy for postpartum women who prefer using a fertility-awareness-based approach to avoiding pregnancy but are not yet eligible to use the Standard Days Method. Counseling should emphasize the importance of following the Bridge guidelines for it to be effective.