Fertility Awareness Methods Dominick Shattuck

Institute for Reproductive Health Georgetown University VARIABLE FERTILITY DURING THE MENSTRUAL CYCLE

PROBABILITY OF PREGNANCY FROM INTERCOURSE • A woman has a ON DAYS RELATIVE TO OVULATION number of fertile days 35% during her menstrual 30% cycle. 25% • The fertile time is based 20% on 15% OVULATION OVULATION – timing of ovulation 10% – lifespan of sperm 5%

0% -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2

[Source: Wilcox et al. 1998]

WAYS TO IDENTIFY FERTILE DAYS

Calculation Approach Symptoms Approach

. Woman knows beforehand . Woman identifies fertile days in when her fertile days will be “real time”, based on one or (based on data, individual or more symptoms (indicators of population-based) fertility) . She keeps track of days to know when she is on those fertile days

What day am I on today? What do I feel or observe today?

3 STANDARD DAYS METHOD

FAILURE RATE

Perfect: 95%

Typical: 88%

STANDARD DAYS METHOD

• Appropriate for women with Ovulation most cycles 26-32 days long

• Identifies days 8-19 as fertile 5 days (sperm life) 12 to 24 hours (ovum life)

DAY 8 DAY 19 If you have not started 1. On the day you start your period, your period by the day move the ring to the RED bead. you put the ring on the last brown bead, your cycle is 2. Every morning move the longer than 32 days. ring to the next bead. Contact Provider.

3.On BROWN bead days If you start your period you can have intercourse before you put the ring on with very low chance of a the darker brown bead, pregnancy. your cycle is shorter than 26 days. Contact Provider.

4. On WHITE bead days When you start your next you can get pregnant. period, move the ring Avoid unprotected directly to the red bead intercourse to prevent a and start again. pregnancy.

Standard Days Method with CycleBeads TWODAY METHOD

YES Did I note any I can get secretions pregnant today? today. FAILURE RATE NO Perfect: 96%

YES Typical: 86% Did I note any I can get secretions pregnant yesterday? today.

NO

Pregnancy is not likely today. [Source: “Efficacy of a new method of family planning: the TwoDay Method” Fertility and Sterility, 2004] How does TwoDay Method work?

. It uses cervical secretions as an indicator of fertility. . The woman checks daily for the presence or absence of secretions (of any type). . If she notes secretions TODAY or YESTERDAY, she is considered to be fertile TODAY. To prevent pregnancy, abstain TODAY. Recording Secretions Lactational Amenorrhea Method

• LAM is a family planning method based on the physiological infertility experienced by breastfeeding women

• A “gateway” to help women transition to another modern FAILURE RATE method Perfect: 99.5%

Typical: 98%

NERVE IMPULSES IN THE BRAIN AFFECT HORMONES

NIPPLE STIMULATION

SUPPRESSION OF OVULATION

LAM Mechanism of Action Institute for Reproductive Health, Georgetown University 1 2 3

Period has not Baby is less than six returned Breastfeeding only months old Transition COMMON MISCONCEPTIONS ABOUT FAM

FAM doesn’t There’s no SDM is just really work— demand for the why would we methods rhythm offer it? like these. method.

Do you want LAM is the people to stop same as using other breastfeeding. methods? FAM IS MODERN AND EFFECTIVE NEW! ARTICLE Failure Rate of Family Planning Methods % of women who became pregnant during 1st year of use

Correct Use Typical Use Implant .05 .05 IUD .6 .8 Injectable .2 6 OCs .3 9 Condom 2 18 Standard Days Method 5 12** TwoDay Method 4 14* Diaphragm 6 16 No Method 85 85

6 month pregnancy rate Correct use Typical Use LAM 1.0 2.0

Adapted from Contraceptive Technology, 20th edition, 2011 |*Source: Arévalo et al. Fertility & Sterility, October 2004 |**Source: Arévalo et al. Contraception, 2002 FAM IS ACCEPTABLE AND BRINGS NEW USERS TO FP FAM addresses women's concerns about family planning and helps fill a critical gap in family planning programs.

REASONS FOR CHOOSING SIX SDM COUNTRIES

DOESN’T AFFECT HEALTH 70%

NO SIDE EFFECTS 20%

ECONOMICAL 30%

EASY TO LEARN/USE 10%

[Source: Interviews with Users in 6 Countries] ATTRACTS FIRST-TIME USERS: PREVIOUS METHOD USE BY SDM CLIENTS

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% India Peru Rwanda

LAM Injection Condom Pill Nonuser/ Trad. User FAM: GUIDING PRINCIPLES

WOMEN’S EQUITABLE QUALITY EMPOWERMENT ACCESS • Ensuring provider • FAM offered within • Underserved competency framework of informed geographic areas • Providing clients practical choice • Low-literacy tools to support method • Emphasis on couple materials use communication and • Non-traditional • Ensuring stock of shared decision-making service delivery CycleBeads, condoms • Fertility-awareness and channels • Implementing quality body literacy as assurance strategies to empowerment monitor provider competency, informed choice, correct use of method COMMUNITY-BASED SOLUTIONS

CHWs Social Marketing Group Learning

CHWs can offer FAM CycleBeads sales • Group counseling for couples alongside other FP through pharmacies, • Non-health volunteer methods to expand kiosks, boutiques community provider choices available at the (facilitator) community • Community-wide sensitization on family planning • Health service linkages TECHNOLOGY SOLUTIONS

CycleBeads™ app Dot 2day app StandardDaysMethod.org KnowYourBod.org DotTheApp.com k4health.org/toolkits

irh.org