Fertility Awareness Based Methods and Gender


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  • Promote gender equality and empower women Improve maternal health Women’s ability to control their fertility is a cornerstone of gender equity ICPD places responsibility for family planning equally on men and women, emphasizing the importance of educating men as a means of achieving gender equity
  • The SDM provides a standard definition of days 8-19 as fertile – during these days couples must abstain from vaginal intercourse or use a condom. The method works best for women with cycles between 26-32 days. Most SDM users rely on a color-coded string of beads to track their fertile days and to facilitate partner communication about when to have sex.
  • The Standard Days Method is used with CycleBeads TM , a color-coded string of beads to help a woman Track her cycle days Know when she is fertile Monitor her cycle length Many people also find that CycleBeads are an important factor in gaining the man’s support to use the method. It is very visual – he can literally see when the woman is on a fertile day.
  • She asks herself two questions: Did I notice any secretions today? Did I notice any secretions yesterday? If she noticed any secretions today OR yesterday, she is potentially fertile today and should not have unprotected sex today. They need to use a condom, or abstain, or whatever….. If she did not notice any secretions today nor yesterday (two consecutive dry days), her probability of becoming pregnant today is very low, so she can have unprotected sex today.
  • What is the effect of FAM use on gender equity, women’s power and sexual expression?
  • SJT: Would be useful to know the 7 countries
  • Results from efficacy trials and introduction studies show that men participate in SDM use in a number of ways which you can see listed on this slide. SJT: Couples were asked to keep a log to find out how they managed the white day as a couple – comes from introduction studies
  • From DHS data in 27 countries Accordingly, we looked at coital frequency from the SDM efficacy trials. Results show that SDM users have intercourse as frequently as other method users, although almost all intercourse takes place on days 1-7 or on or after day 20 of the cycle. Great, we thought. SDM users are having sex just as often as other method users, so they must be equally satisfied. But then we started to look at the data coming in from SDM users, and saw that frequency of intercourse was not always the most salient issue for couples who chose the SDM. Comments such as, “We don’t have any problem, it’s not like sex is an every day thing”, were common. Moreover, as we moved out of clinical trials into introduction of the SDM on a wider scale, couples were counseled to avoid unprotected intercourse during the fertile period in whatever way worked best for them. From 40-60% of users around the world opted for condom use during the fertile period – thus increasing the opportunity for intercourse.
  • Increase from 5.27 to 5.81 SJT: So they became more comfortable with the method and starting having more sex? SJT: More intercourse during non-fertile days…
  • So we decided to deconstruct this assumption and look at dimensions of sexual satisfaction based on data emerging from our introduction studies. As a result, we developed a framework consisting of four parameters which represent the intersection between well-being and sexual pleasure with emotional and physical dimensions. SJT: Looking at well being and sexual pleasure and then looking at physical and emotional connections
  • SJT: so not really dramatic changes then?
  • SJT:
  • Women were able to understand the menstrual cycle and how the method worked to prevent pregnancy, as opposed to other elements of Western medicine. Men were able to plan their family without the assistance of a doctor. Active involvement with the method resulted in better understanding of their wives.
  • Fertility Awareness Based Methods and Gender

    1. 1. Kampala, Uganda ________ 16 November 2009________ Fertility Awareness Based Methods and Gender Irit Sinai and Sujata Bijou Presenter: Sarah J. Terlouw
    2. 2. Background <ul><li>Gender equity critical to achieving MDGs </li></ul><ul><li>Inclusion of fertility awareness methods (FAM) has the potential to help FP programs address gender equity in FP services </li></ul><ul><li>National access to simple, newer natural methods may be achieved in 3-5 countries by 2010 </li></ul>
    3. 3. The Standard Days Method ® <ul><li>Helps couples prevent pregnancy by knowing which days they should avoid unprotected intercourse </li></ul><ul><li>Identifies days 8-19 of the cycle as fertile </li></ul><ul><li>Works best for women with menstrual cycles from 26 to 32 days </li></ul>
    4. 4. CycleBeads ® <ul><li>The SDM is used with CycleBeads, a color-coded string of beads to help a woman: </li></ul><ul><ul><li>Track her cycle days </li></ul></ul><ul><ul><li>Know when she is fertile </li></ul></ul><ul><ul><li>Monitor her cycle length </li></ul></ul><ul><ul><li>Involve her partner </li></ul></ul>
    5. 5. TwoDay Method ® Did I note any secretions today? Did I note any secretions yesterday? YES YES NO NO I can get pregnant today. I can get pregnant today. Pregnancy is not likely today.
    6. 6. Study questions <ul><li>Can men use FAM? </li></ul><ul><li>How does FAM use influence the couple relationship? </li></ul><ul><li>How does FAM use affect women’s empowerment? </li></ul>
    7. 7. Data collection <ul><li>Introduction studies: </li></ul><ul><li>Quarterly interviews </li></ul><ul><ul><li>1600 male and female SDM users </li></ul></ul><ul><ul><li>822 female TDM users </li></ul></ul><ul><ul><li>Focus groups & in-depth interviews: </li></ul></ul><ul><ul><li>current and discontinued female and male users </li></ul></ul><ul><li>Efficacy trials: </li></ul><ul><li>Standard Days Method: Peru, Bolivia, Philippines </li></ul><ul><li>TwoDay Method: Peru, Philippines, Guatemala </li></ul>
    8. 8. SDM and TDM introduction studies <ul><li>16 service delivery settings in 7 countries in Asia, Latin America and Africa </li></ul><ul><li>Reproductive health programs, FP agencies and community development NGOs </li></ul>
    9. 9. CAN MEN USE FAM?
    10. 10. n=4025 cycles n=3928 cycles Percentage of cycles with reported intercourse Arevalo 2004, Arevalo 2002
    11. 11. Strategies of SDM users for managing the fertile days SDM introduction studies, interviews with users
    12. 12. Men participate in SDM use by… <ul><li>Using a condom or abstaining during fertile days </li></ul><ul><li>Following wife’s instructions </li></ul><ul><li>Keeping track of fertile days </li></ul><ul><li>Purchasing CycleBeads and condoms </li></ul>SDM introduction studies, interviews with users
    13. 13. Women’s opinion of the SDM SDM introduction studies, interviews with users
    15. 15. Comparison of mean coital frequency (FAM data from efficacy trials) *Stover et al, 2001 **Sinai, Arevalo, 2005 All sexually active women 5.5 per cycle* Coitus-dependent methods 4.9 per cycle* SDM users 5.5 per cycle** TDM users 5.6 per cycle**
    16. 16. 0 Days with intercourse per cycle Mean coital frequency by cycle (SDM and TDM use) **Sinai, Arevalo, 2005
    17. 17. Couples comment on the influence of FAM use on their relationship <ul><li>Many report no differences. Among those who do: </li></ul><ul><li>Some mention dissatisfaction with fertile days </li></ul><ul><li>Most report enhanced feelings of control, love, mutual respect and physical well being </li></ul><ul><li>Some comment on heightened eroticism related to timing of sex and non-coital practices </li></ul>SDM introduction studies, interviews with users
    18. 18. Effect of SDM on the couple relationship (India) <ul><li>92% of rural users in India report that SDM use had a positive influence on their relationship citing… </li></ul><ul><ul><li>increased partner communication </li></ul></ul><ul><ul><li>Improved ability to negotiate sex </li></ul></ul><ul><ul><li>increased affection/understanding </li></ul></ul><ul><ul><li>improved sexual relations due to confidence in fertile days </li></ul></ul><ul><li>8% cite a negative influence </li></ul><ul><ul><li>Husband angry/uncomfortable </li></ul></ul>SDM introduction studies, India CARE, 2008
    19. 19. Dimensions of Sexual Satisfaction Framework Based on in-depth interviews with male/female SDM users in El Salvador, Honduras, Philippines Physical Emotional Well-being <ul><li>Side effects </li></ul><ul><li>Menstrual changes </li></ul><ul><li>Love </li></ul><ul><li>Respect/appreciation </li></ul><ul><li>Harmony </li></ul><ul><li>Locus of control </li></ul><ul><li>Moral congruence </li></ul>Sexual Pleasure <ul><li>Opportunity/scarcity </li></ul><ul><li>Enhanced desire </li></ul><ul><li>Sensation </li></ul><ul><li>Erotic touching </li></ul><ul><li>Libido </li></ul><ul><li>Relaxation </li></ul><ul><li>Respite </li></ul>
    20. 20. Effect of TwoDay Method use on the couple relationship TDM introduction study, Peru (2007)
    21. 21. In their words… Influence on their relationship “ The SDM has helped us to come closer, understand each other’s needs. Unlike earlier, we now discuss intimate things with each other and this has added pleasure to our otherwise monotonous sex life.” -male SDM user, India “ I feel good that my husband now understands how my body works. He pays attention to my suggestions and respects my wishes. For the first time he asks me if we can have intercourse. I am happy that he cares about me.” -female SDM user, India
    22. 22. In men’s words… Influence on sexual pleasure <ul><li>“ I think that abstinence contributes to enjoying sex more, because we have greater desire.” -Honduras </li></ul><ul><li>“ How can I explain it..when one sleeps apart and you have to make an appointment, things get good.” -El Salvador </li></ul><ul><li>“ It seems like two months have gone by and we never move beyond these white beads.” </li></ul><ul><li>-Philippines </li></ul>SDM introduction studies, interviews with users
    23. 23. In women’s words… Influence on sexual pleasure <ul><li>“ We get to the moment in which we begin to caress each other, even the genitals, and we get to the point when the man as well as the woman feels good. How do you say it? When we finish. But there is not sex.” </li></ul><ul><li>-Honduras </li></ul><ul><li>“ Unlike when I used pills, I always had a headache. You can have sex every day but you wouldn’t like it because you felt dry. My husband noticed that. When I used the SDM, it seemed natural, like we were newlyweds again.” -Philippines </li></ul>SDM introduction studies, interviews with users
    25. 25. Comparison of scores on gender equity index pre/post SDM use (Guatemalan women) Velasquez, 2007 Score=1-5, 5 most equitable
    26. 26. Comparison of scores on right-to-refuse sex index (Indian women) Score=1-5, 5 most equitable Mode, 2007 Endline household survey, Ranchi
    27. 27. Women gained confidence and felt empowered by knowledge of menstrual cycle <ul><li>“ Knowledge of safe and unsafe period has been liberating.” - El Salvador </li></ul><ul><li>“ Now we know about our bodies and how to protect ourselves during the unsafe days. Because of the necklace we know how our period comes.” - Benin </li></ul>SDM introduction studies, interviews with users
    28. 28. KEY FINDINGS
    29. 29. <ul><li>Men are interested in FAM </li></ul><ul><li>Most men are able to use FAM correctly </li></ul><ul><li>Many couples report enhanced sexual pleasure and strengthened partner relationships </li></ul>
    30. 30. Program Implications <ul><li>Introducing FAM contributes to efforts to improve gender equality because their use contributes to couple communication and negotiation. </li></ul><ul><li>As FAM are scaled up and efforts to engage men and promote couple dialogue, FP programs could have a greater impact on gender equity. </li></ul>
    31. 31. WWW.IRH.ORG