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Kampala, Uganda ________ 16 November 2009________ Fertility Awareness Based Methods and Gender Irit Sinai and Sujata Bijou Presenter: Sarah J. Terlouw
Background  ,[object Object],[object Object],[object Object]
The Standard Days Method ® ,[object Object],[object Object],[object Object]
CycleBeads ® ,[object Object],[object Object],[object Object],[object Object],[object Object]
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.
Study questions ,[object Object],[object Object],[object Object]
Data collection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SDM and TDM introduction studies  ,[object Object],[object Object]
CAN MEN USE FAM?
n=4025 cycles n=3928 cycles Percentage of cycles with reported intercourse Arevalo 2004, Arevalo 2002
Strategies of SDM users for managing the fertile days SDM introduction studies, interviews with users
Men participate in SDM use by… ,[object Object],[object Object],[object Object],[object Object],SDM introduction studies, interviews with users
Women’s opinion of the SDM SDM introduction studies, interviews with users
HOW DOES FAM USE INFLUENCE THE COUPLE RELATIONSHIP?
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**
0 Days with intercourse per cycle Mean coital frequency by cycle (SDM and TDM use) **Sinai, Arevalo, 2005
Couples comment on the influence of FAM use on their relationship  ,[object Object],[object Object],[object Object],[object Object],SDM introduction studies, interviews with users
Effect of SDM on the couple relationship (India)  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],SDM introduction studies, India  CARE, 2008
Dimensions of Sexual Satisfaction Framework Based on in-depth interviews with male/female SDM users in  El Salvador, Honduras, Philippines Physical Emotional Well-being ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sexual   Pleasure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Effect of TwoDay Method use on the couple relationship  TDM introduction study, Peru (2007)
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
In men’s words… Influence on sexual pleasure ,[object Object],[object Object],[object Object],[object Object],SDM introduction studies, interviews with users
In women’s words… Influence on sexual pleasure ,[object Object],[object Object],[object Object],SDM introduction studies, interviews with users
HOW DOES FAM USE AFFECT WOMEN’S EMPOWERMENT?
Comparison of scores on  gender equity index pre/post SDM use (Guatemalan women)  Velasquez, 2007 Score=1-5, 5 most equitable
Comparison of scores on right-to-refuse sex index (Indian women) Score=1-5, 5 most equitable Mode, 2007 Endline household survey, Ranchi
Women gained confidence and felt empowered by knowledge of menstrual cycle ,[object Object],[object Object],SDM introduction studies, interviews with users
KEY FINDINGS
[object Object],[object Object],[object Object]
Program Implications ,[object Object],[object Object]
WWW.IRH.ORG

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Fertility Awareness Based Methods and Gender

  • 1. Kampala, Uganda ________ 16 November 2009________ Fertility Awareness Based Methods and Gender Irit Sinai and Sujata Bijou Presenter: Sarah J. Terlouw
  • 2.
  • 3.
  • 4.
  • 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.
  • 7.
  • 8.
  • 9. CAN MEN USE FAM?
  • 10. n=4025 cycles n=3928 cycles Percentage of cycles with reported intercourse Arevalo 2004, Arevalo 2002
  • 11. Strategies of SDM users for managing the fertile days SDM introduction studies, interviews with users
  • 12.
  • 13. Women’s opinion of the SDM SDM introduction studies, interviews with users
  • 14. HOW DOES FAM USE INFLUENCE THE COUPLE RELATIONSHIP?
  • 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. 0 Days with intercourse per cycle Mean coital frequency by cycle (SDM and TDM use) **Sinai, Arevalo, 2005
  • 17.
  • 18.
  • 19.
  • 20. Effect of TwoDay Method use on the couple relationship TDM introduction study, Peru (2007)
  • 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.
  • 23.
  • 24. HOW DOES FAM USE AFFECT WOMEN’S EMPOWERMENT?
  • 25. Comparison of scores on gender equity index pre/post SDM use (Guatemalan women) Velasquez, 2007 Score=1-5, 5 most equitable
  • 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.
  • 29.
  • 30.

Editor's Notes

  1. 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
  2. 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.
  3. 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.
  4. 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.
  5. What is the effect of FAM use on gender equity, women’s power and sexual expression?
  6. SJT: Would be useful to know the 7 countries
  7. 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
  8. 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.
  9. 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…
  10. 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
  11. SJT: so not really dramatic changes then?
  12. SJT:
  13. 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.