Transcript SDM

Standard Days
Method (SDM)
Session II:
Who Can and Cannot
Use SDM
Session II, Slide 1
Medical Eligibility
What are medical
eligibility criteria?
Define the conditions
related to temporary
methods of family
planning.
Define the conditions
related to fertility
awareness methods
Session II, Slide 2
Conditions Relating to Fertility
Awareness Methods
WHO Category
Conditions
A= Accept
Vaginal discharge
Diseases that elevate body temperature
C= Caution
Age: post menarche or perimenopause
Taking drugs that affect cycle regularity*
D=Delay
Breastfeeding< 6 weeks postpartum
Breastfeeding > 6 weeks postpartum
Postpartum not breastfeeding
Postabortion
*Delay until drug’s effect has been determined, then use caution
Source: Family Planning A Global Handbook for Providers 2011
Session I, Slide 3
Who Should Delay or Use Caution
in Beginning SDM
Circumstances that can affect cycle length and
regularity are recent pregnancy or recent use of a
hormonal method of contraception
Postpartum/breastfeeding
Wait for 4 consecutive periods
Start after 2 most recent periods are
about a month apart
3-month Injection, pill, patch,
implant, IUD
Wait 90 days after last injection
Start after 3 most recent periods are
about a month apart
If cycles before pregnancy were 26 to
Emergency Contraceptive
32 days long
Pills, miscarriage or abortion
Start on first day of next period
Session I, Slide 4
When is SDM Most Successful?
SDM is most successful at preventing pregnancy
when:
• Women have regular menstrual cycles (26 to 32
days long)
• Couples are motivated to avoid intercourse or
use condoms during fertile days
**SDM does not protect against STIs or
HIV/AIDS. Use condoms (for men and women)
every time you have sex, to help protect
yourself from these diseases.
Session I, Slide 5
Screening to See if SDM is
Appropriate for the Woman
 Is her cycle between 26 and 32 days long?
 Ask simple questions to assess cycle
length and regularity:
• Does your her period come about once
a month?
• Does it usually come when you expect
it?
• When was the first day of your last
period?
Session I, Slide 6
Is SDM Appropriate for the Couple?
Can they use condoms or avoid sex on
days 8 through19 of the cycle?
Session I, Slide 7
Using SDM with Partner’s Support
It is important to:
• Approach clients to inquire about the couple’s
relationship in a careful and sensitive way.
• Engage your client in talking about sexuality and
her couple relationship?
• Inquire about possible domestic violence or
alcohol/drug use that can affect correct SDM
use?
• Discuss condom use
during the fertile days.
Session I, Slide 8
When to Start SDM
User knows the first day of her
last period.
User does not remember the first
day of her last period
Postpartum or breastfeeding.
3-month injection user.
Hormonal method user (the pill, 1month injection, or implant)
Had a miscarriage or abortion in
the past month OR used
emergency contraception.
Start today
Start the first day of the next
period
Wait until you have had 4 periods
since baby was born. Start after
last two periods have been about
a month apart
Wait until 90-day protection ends,
and last three periods have been
about a month apart
After discontinuing method, start
SDM if her last three periods have
been about a month apart
Start on the first day of her next
Session I, Slide 9
period
Case Study 1
SDM Eligibility Criteria – Cycle Regularity
Case 1 - Fatima
Date last menstrual period: April 8
Date of visit to clinic: April 14
Your client has regular periods that
come each month, when she
expects them. She and her
husband are both interested in a
natural method. She is not
breastfeeding and has never used a
hormonal method of family
planning.
• Can she use
Standard Days
Method? Yes
• If suitable, when
could she start using
it?
Immediately.
• What are some
recommendations to
offer this client?
Monitor cycle length over
time, discuss with partner.
Place ring on correct bead.
Session I, Slide 10
Case Study 2
SDM Eligibility Criteria – Cycle Regularity
Case 2 - Sarah
Date last menstrual period: Does
not remember; beginning of month
Date of visit to clinic: May 20
Your client and her partner are
interested in SDM because it is
natural and there are no side
effects. She does not know the
exact date of her last period but her
periods come around the same time
each month. She has not been
using a method and has been
married only a few months.
• Can she use
Standard Days
Method? Yes
.
• If suitable, when
could she start using
it?
Wait until next period starts
• What are some
recommendations to
offer this client?
Use
condoms or abstain until she
starts SDM. Discuss with partner
method use. If she had sex this
month, she may already be
pregnant.
Session I, Slide 11
Case Study 3
SDM Eligibility Criteria – Cycle Regularity
• Can she use
Standard Days
Yes.
Method?
Case 3 - Emma
Date last menstrual period: May 12 • If suitable, when
could she start
Date of visit to clinic: May 28
using it? Immediately.
Emma breastfeeds her 15-month old
• What are some
son. She started getting her periods
recommendations to
offer this client?
regularly about eight months ago. Her
husband travels often, at least twice a
with partner
month and for several days at a time. Discuss
method use. If she had sex
Sometimes they abstain and other
this month, she may already
times they use withdrawal. They both be pregnant..
have decided to use a natural method.
Session I, Slide 12