Here are some suggestions for how to engage this couple in discussing how to handle the fertile days:
- Ask open-ended questions to start a dialogue, such as "How do you think you'll manage to avoid unprotected sex on the fertile days?"
- Normalize that discussing this can feel awkward but is important for the method to work. Say something like "A lot of couples find talking about this private, but it's a key part of using this method successfully."
- Suggest they come up with a code word or signal to remind each other when the fertile days start. For example, "maybe you could agree one of you will say 'CycleBeads' to remind the other."
- Role play
LAW: THE SUM TOTAL OF RULES AND REGULATIONS BY WHICH THE SOCIETY IS GOVERNED
ETHICS: Ethics is the systematic study of What a persons conduct ought to be with regard to him or herself, other human beings and the environment, it is the justification of what is right or good and the study of what a person’s life and relationship ought to be, not necessarily what they are.
The document discusses adolescent pregnancy, unwed mothers, causes and risks. It defines adolescent pregnancy as affecting girls aged 19 or younger. Rates have declined due to increased condom use. Younger teens aged 12-14 are more at risk of unplanned sex. Unwed mothers face social stigma and economic hardship without family support. Preventive measures include education, easy access to contraceptives, and banning prostitution. Nurses can educate youth and advocate for the rights of unwed mothers.
This presentation gives you a basic overview to the psychological changes in a pregnant lady during the trimesters, at the end there are a couple of useful links for further reading about the topic.
This document discusses the emotional and physical changes that occur during pregnancy for both mothers and fathers. It covers the three trimesters of pregnancy and common feelings in each stage like anxiety, depression, and concern over weight gain or the baby's sex. Fetal development from embryo to fetus is outlined week by week. The importance of emotional support from family as well as understanding the psychological changes of pregnancy for better coping is also emphasized.
Preconception care involves providing health interventions to women and couples before conception to improve health and reduce risk factors. It aims to secure optimal health for both parents to improve chances of conception and reduce risks of complications. Key components of preconception care include screening for nutritional deficiencies, genetic conditions, infections like HIV, and risk behaviors like tobacco use. It also involves health promotion, counseling, and treating existing conditions to help ensure women and their partners are healthy when they conceive.
The document discusses the psychological changes that occur during pregnancy and the influences on a woman's attitude toward her pregnancy. It outlines that a woman's perspective is shaped by her environment growing up, family messages about pregnancy, and the culture and society she lives in. Specifically, it explores how social influences like views of pregnancy as an illness or empowering experience, and cultural influences such as traditions and taboos, can impact outlook. Family influences like a woman's experience of being wanted or blamed for hardships also mold psychological readiness for motherhood.
Physiological and psychological changes during pregnancyHI HI
The document discusses various physiological changes that occur during pregnancy across multiple body systems. It describes changes in the endocrine, reproductive, cardiovascular, respiratory, gastrointestinal, renal, integumentary, and skeletal systems. Major hormonal changes driven by the placenta cause physical adaptations in many organs to support the developing fetus. Organs like the uterus, breasts, and cardiovascular system undergo significant changes to accommodate pregnancy.
LAW: THE SUM TOTAL OF RULES AND REGULATIONS BY WHICH THE SOCIETY IS GOVERNED
ETHICS: Ethics is the systematic study of What a persons conduct ought to be with regard to him or herself, other human beings and the environment, it is the justification of what is right or good and the study of what a person’s life and relationship ought to be, not necessarily what they are.
The document discusses adolescent pregnancy, unwed mothers, causes and risks. It defines adolescent pregnancy as affecting girls aged 19 or younger. Rates have declined due to increased condom use. Younger teens aged 12-14 are more at risk of unplanned sex. Unwed mothers face social stigma and economic hardship without family support. Preventive measures include education, easy access to contraceptives, and banning prostitution. Nurses can educate youth and advocate for the rights of unwed mothers.
This presentation gives you a basic overview to the psychological changes in a pregnant lady during the trimesters, at the end there are a couple of useful links for further reading about the topic.
This document discusses the emotional and physical changes that occur during pregnancy for both mothers and fathers. It covers the three trimesters of pregnancy and common feelings in each stage like anxiety, depression, and concern over weight gain or the baby's sex. Fetal development from embryo to fetus is outlined week by week. The importance of emotional support from family as well as understanding the psychological changes of pregnancy for better coping is also emphasized.
Preconception care involves providing health interventions to women and couples before conception to improve health and reduce risk factors. It aims to secure optimal health for both parents to improve chances of conception and reduce risks of complications. Key components of preconception care include screening for nutritional deficiencies, genetic conditions, infections like HIV, and risk behaviors like tobacco use. It also involves health promotion, counseling, and treating existing conditions to help ensure women and their partners are healthy when they conceive.
The document discusses the psychological changes that occur during pregnancy and the influences on a woman's attitude toward her pregnancy. It outlines that a woman's perspective is shaped by her environment growing up, family messages about pregnancy, and the culture and society she lives in. Specifically, it explores how social influences like views of pregnancy as an illness or empowering experience, and cultural influences such as traditions and taboos, can impact outlook. Family influences like a woman's experience of being wanted or blamed for hardships also mold psychological readiness for motherhood.
Physiological and psychological changes during pregnancyHI HI
The document discusses various physiological changes that occur during pregnancy across multiple body systems. It describes changes in the endocrine, reproductive, cardiovascular, respiratory, gastrointestinal, renal, integumentary, and skeletal systems. Major hormonal changes driven by the placenta cause physical adaptations in many organs to support the developing fetus. Organs like the uterus, breasts, and cardiovascular system undergo significant changes to accommodate pregnancy.
The document discusses various psychological changes and disorders that can occur during the postpartum period. It describes common changes like adjustment to new roles, postpartum blues, cultural influences on attachment. It also discusses postpartum disorders like depression, anxiety, stress reactions and trauma from delivery, postpartum OCD, PTSD and psychosis. Nursing interventions are focused on early detection and referral for treatment of any psychological issues and supporting positive parenting behaviors.
Menopause typically occurs between ages 49-52 as the ovaries gradually slow production of eggs and reproductive hormones, causing menstrual periods to stop. It may be induced by surgery or occur prematurely under age 40. Symptoms include hot flashes, mood changes, and increased risk of osteoporosis and heart disease due to hormonal changes. Hormone replacement therapy can help treat symptoms but also carries risks if used long term. Maintaining a healthy lifestyle through diet, exercise, avoiding smoking and limiting alcohol can also help manage menopausal effects.
The document discusses the Safe Motherhood Initiative, which aims to reduce deaths and illnesses among women and infants in developing countries by improving access to family planning services, maternal healthcare, and education. It was launched in 1987 with the goal of cutting maternal deaths in half by 2000. The initiative promotes primary healthcare, antenatal care, clean and safe delivery services, essential newborn care, and postnatal services. It also aims to monitor health services and conduct research to generate best practices. The document outlines support for Safe Motherhood initiatives through events in India to raise awareness of maternal health issues.
Post-partum intrauterine devices (IUDs) provide safe, effective long-term contraception without interfering with breastfeeding. The document discusses the types and mechanisms of IUDs and the benefits of post-partum insertion. Post-partum IUD insertion can occur immediately after vaginal or cesarean delivery while the uterus is still enlarged, making it easier than non-pregnant insertion. Providers must obtain informed consent and provide counseling and follow-up to clients choosing this method.
Family planning provides methods to help couples decide the number and timing of children through contraception. Common methods include barrier methods like condoms and diaphragms, hormonal methods like oral contraceptive pills, and long-acting reversible methods like IUDs. Family planning has benefits like improving health outcomes, empowering individuals, and slowing population growth when used correctly. Counseling helps educate eligible couples on the various contraceptive options, their effectiveness, side effects, and proper usage.
Psychological changes during pregnancy are influenced by various social, cultural and family factors. A woman's attitudes towards her pregnancy are shaped by the environment she was raised in, messages from her family, and the society and culture she lives in. Initial reactions to pregnancy can include a wide range of emotions from surprise to fear. As the pregnancy progresses, most women reach an acceptance. Cultural beliefs and societal views of pregnancy and childbirth have changed over time and continue to influence expectations. Family background also impacts how positive or negative one views pregnancy and motherhood.
Normal labor is defined as the process by which the fetus, placenta, cord, and membranes are expelled from the uterus through contractions of the uterine musculature. Several factors can contribute to the onset of labor, including uterine distension, fetal and placental hormones like estrogen and prostaglandins, and nervous stimulation. In the weeks leading up to labor, women may experience lightening, bloody show, and cervical changes. True labor is characterized by painful contractions over the uterine fundus that become stronger and more frequent, resulting in cervical effacement and dilation. The progress of labor depends on contractions of the uterine musculature, the passenger (fetus), passage (maternal pelvis), and maternal mental
This document discusses the psychological adaptations that occur during pregnancy. It covers three trimesters of pregnancy and the common experiences women face, including ambivalence, introversion, acceptance of pregnancy, role assumption, self-image changes, establishing a relationship with the fetus, and preparation for birth. It also discusses cultural influences on pregnancy experiences, such as dietary practices, activity levels, and birth preparations that are specific to different cultures. Understanding these psychological and cultural aspects can help both mothers and their partners during this transition to parenthood.
Postpartum care involves monitoring for common medical complications like headaches, hemorrhoids, varicose veins, and vulvar edema. It also addresses mental health issues such as postpartum blues, depression, and psychosis. Counseling is provided on breastfeeding, sexuality, and contraception. The routine postpartum visit at 4-6 weeks involves patient education, maternal monitoring, laboratory tests, breastfeeding support, perineal care, and prevention of complications like venous thrombosis.
This document discusses abortion and post-abortion care. It defines abortion and classifies the different types. It also discusses the magnitude of abortion globally and in Africa and Ethiopia. It then covers spontaneous abortion, including risk factors and potential causes. It discusses the clinical features and diagnosis of abortion. It defines post-abortion care and its five key elements. It notes that unsafe abortion is a major cause of maternal mortality worldwide and in East Africa.
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the use of a partograph to monitor labor. It begins by explaining the importance of monitoring during labor to detect problems early. It then describes the components of the partograph including patient identification, fetal condition, labor progress, and maternal condition. The document outlines how to use the partograph to assess cervical dilation, descent of the fetal head, contractions and other metrics against alert and action lines to monitor labor progress and make decisions about interventions or transfers.
Congenital malformations of the female genital tract can occur due to abnormalities during embryonic development. Uterine malformations in particular result from abnormal development of the Mullerian ducts. The most common types are caused by incomplete fusion of the ducts during embryogenesis. Uterine anomalies are often associated with vaginal maldevelopment and may cause issues like infertility, miscarriage, or obstructed labor. Diagnosis involves imaging tests like ultrasound, MRI, or hysteroscopy. Treatment depends on the type of abnormality but may involve surgical procedures to enable pregnancy or reduce risks.
This document provides an overview of various methods of contraception, including hormonal methods, intrauterine devices, barrier methods, natural methods, and sterilization. For hormonal methods, it discusses oral contraceptive pills, the contraceptive patch, progestin-only pills, and injectable contraception. For intrauterine devices, it describes copper and hormonal IUDs. Barrier methods discussed include diaphragms and condoms. Natural methods outlined are fertility awareness and lactational amenorrhea. The document concludes with a brief section on surgical sterilization.
The document provides guidance on family planning counselling for women after childbirth or abortion. It discusses the role of the family planning counsellor in supporting women and their partners in choosing a method that meets their needs. The counsellor should assess the situation, discuss various method options based on effectiveness, side effects and other factors, check eligibility, and provide instructions for correct use. The guidance emphasizes facilitating shared decision-making and tailoring advice to individual needs and circumstances.
RMC is an approach centered on the individual, based on principles of ethics and respect for human rights, and promotes practices that recognize women’s preferences and women’s and newborns’ needs.
This document discusses various contraceptive methods including hormonal contraception, intrauterine devices, barrier methods, natural family planning, and sterilization. It provides details on the mechanisms of different hormonal methods like combined oral contraceptives, progestin-only pills, patches, injections, and vaginal rings. Benefits and risks of long-acting reversible contraceptives like implants and intrauterine devices are also outlined. Emergency contraception and natural family planning methods are briefly described. Contraindications and effectiveness of various contraceptive options are covered.
The document outlines international standards and codes of ethics for midwifery practice. It discusses establishing a midwifery-specific regulatory authority to effectively regulate midwives and support autonomous midwifery practice. It also covers protecting the title of midwife, governance structures for regulatory authorities, and the importance of national regulation and collaboration between regulatory bodies.
Please find the power point on Hyperemesis gravidarum and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
1) The document discusses the clinical features, differential diagnosis, and investigations of menopause. It describes various symptoms that can occur during perimenopause and menopause such as hot flashes, sleep issues, mood changes, and changes to the skin, hair, cardiovascular and genitourinary systems.
2) Differential diagnoses are provided for different symptoms. Investigations like hormonal tests and imaging can help determine if symptoms are due to menopause or other potential medical conditions.
3) Natural menopause is diagnosed if a woman over age 40 has 12 months of amenorrhea accompanied by menopausal symptoms and elevated FSH levels on two separate occasions.
Teenage pregnancy is defined as girls aged 13-19 becoming pregnant. Half of the world's population is under 25. Each year, 14 million children are born to young women aged 15-19 worldwide. Causes of teenage pregnancy include early marriage, lack of sex education, peer pressure, poverty, and family issues. Impacts include negative psychosocial and medical effects on both the teenage mother and her child, such as higher risks of medical complications, living in poverty, and continuing the cycle of teenage pregnancy. Prevention strategies include sex education, promoting abstinence, use of contraceptives, and prevention programs.
Langkah-langkah memperbaiki sistem manajemen perusahaan meliputi meninjau bisnis proses, struktur organisasi, sarana dan prasarana, serta kefektifan sistem dan komitmen manajemen agar sistem manajemen dapat berjalan dengan efektif dan meningkatkan kinerja perusahaan.
The document discusses various psychological changes and disorders that can occur during the postpartum period. It describes common changes like adjustment to new roles, postpartum blues, cultural influences on attachment. It also discusses postpartum disorders like depression, anxiety, stress reactions and trauma from delivery, postpartum OCD, PTSD and psychosis. Nursing interventions are focused on early detection and referral for treatment of any psychological issues and supporting positive parenting behaviors.
Menopause typically occurs between ages 49-52 as the ovaries gradually slow production of eggs and reproductive hormones, causing menstrual periods to stop. It may be induced by surgery or occur prematurely under age 40. Symptoms include hot flashes, mood changes, and increased risk of osteoporosis and heart disease due to hormonal changes. Hormone replacement therapy can help treat symptoms but also carries risks if used long term. Maintaining a healthy lifestyle through diet, exercise, avoiding smoking and limiting alcohol can also help manage menopausal effects.
The document discusses the Safe Motherhood Initiative, which aims to reduce deaths and illnesses among women and infants in developing countries by improving access to family planning services, maternal healthcare, and education. It was launched in 1987 with the goal of cutting maternal deaths in half by 2000. The initiative promotes primary healthcare, antenatal care, clean and safe delivery services, essential newborn care, and postnatal services. It also aims to monitor health services and conduct research to generate best practices. The document outlines support for Safe Motherhood initiatives through events in India to raise awareness of maternal health issues.
Post-partum intrauterine devices (IUDs) provide safe, effective long-term contraception without interfering with breastfeeding. The document discusses the types and mechanisms of IUDs and the benefits of post-partum insertion. Post-partum IUD insertion can occur immediately after vaginal or cesarean delivery while the uterus is still enlarged, making it easier than non-pregnant insertion. Providers must obtain informed consent and provide counseling and follow-up to clients choosing this method.
Family planning provides methods to help couples decide the number and timing of children through contraception. Common methods include barrier methods like condoms and diaphragms, hormonal methods like oral contraceptive pills, and long-acting reversible methods like IUDs. Family planning has benefits like improving health outcomes, empowering individuals, and slowing population growth when used correctly. Counseling helps educate eligible couples on the various contraceptive options, their effectiveness, side effects, and proper usage.
Psychological changes during pregnancy are influenced by various social, cultural and family factors. A woman's attitudes towards her pregnancy are shaped by the environment she was raised in, messages from her family, and the society and culture she lives in. Initial reactions to pregnancy can include a wide range of emotions from surprise to fear. As the pregnancy progresses, most women reach an acceptance. Cultural beliefs and societal views of pregnancy and childbirth have changed over time and continue to influence expectations. Family background also impacts how positive or negative one views pregnancy and motherhood.
Normal labor is defined as the process by which the fetus, placenta, cord, and membranes are expelled from the uterus through contractions of the uterine musculature. Several factors can contribute to the onset of labor, including uterine distension, fetal and placental hormones like estrogen and prostaglandins, and nervous stimulation. In the weeks leading up to labor, women may experience lightening, bloody show, and cervical changes. True labor is characterized by painful contractions over the uterine fundus that become stronger and more frequent, resulting in cervical effacement and dilation. The progress of labor depends on contractions of the uterine musculature, the passenger (fetus), passage (maternal pelvis), and maternal mental
This document discusses the psychological adaptations that occur during pregnancy. It covers three trimesters of pregnancy and the common experiences women face, including ambivalence, introversion, acceptance of pregnancy, role assumption, self-image changes, establishing a relationship with the fetus, and preparation for birth. It also discusses cultural influences on pregnancy experiences, such as dietary practices, activity levels, and birth preparations that are specific to different cultures. Understanding these psychological and cultural aspects can help both mothers and their partners during this transition to parenthood.
Postpartum care involves monitoring for common medical complications like headaches, hemorrhoids, varicose veins, and vulvar edema. It also addresses mental health issues such as postpartum blues, depression, and psychosis. Counseling is provided on breastfeeding, sexuality, and contraception. The routine postpartum visit at 4-6 weeks involves patient education, maternal monitoring, laboratory tests, breastfeeding support, perineal care, and prevention of complications like venous thrombosis.
This document discusses abortion and post-abortion care. It defines abortion and classifies the different types. It also discusses the magnitude of abortion globally and in Africa and Ethiopia. It then covers spontaneous abortion, including risk factors and potential causes. It discusses the clinical features and diagnosis of abortion. It defines post-abortion care and its five key elements. It notes that unsafe abortion is a major cause of maternal mortality worldwide and in East Africa.
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the use of a partograph to monitor labor. It begins by explaining the importance of monitoring during labor to detect problems early. It then describes the components of the partograph including patient identification, fetal condition, labor progress, and maternal condition. The document outlines how to use the partograph to assess cervical dilation, descent of the fetal head, contractions and other metrics against alert and action lines to monitor labor progress and make decisions about interventions or transfers.
Congenital malformations of the female genital tract can occur due to abnormalities during embryonic development. Uterine malformations in particular result from abnormal development of the Mullerian ducts. The most common types are caused by incomplete fusion of the ducts during embryogenesis. Uterine anomalies are often associated with vaginal maldevelopment and may cause issues like infertility, miscarriage, or obstructed labor. Diagnosis involves imaging tests like ultrasound, MRI, or hysteroscopy. Treatment depends on the type of abnormality but may involve surgical procedures to enable pregnancy or reduce risks.
This document provides an overview of various methods of contraception, including hormonal methods, intrauterine devices, barrier methods, natural methods, and sterilization. For hormonal methods, it discusses oral contraceptive pills, the contraceptive patch, progestin-only pills, and injectable contraception. For intrauterine devices, it describes copper and hormonal IUDs. Barrier methods discussed include diaphragms and condoms. Natural methods outlined are fertility awareness and lactational amenorrhea. The document concludes with a brief section on surgical sterilization.
The document provides guidance on family planning counselling for women after childbirth or abortion. It discusses the role of the family planning counsellor in supporting women and their partners in choosing a method that meets their needs. The counsellor should assess the situation, discuss various method options based on effectiveness, side effects and other factors, check eligibility, and provide instructions for correct use. The guidance emphasizes facilitating shared decision-making and tailoring advice to individual needs and circumstances.
RMC is an approach centered on the individual, based on principles of ethics and respect for human rights, and promotes practices that recognize women’s preferences and women’s and newborns’ needs.
This document discusses various contraceptive methods including hormonal contraception, intrauterine devices, barrier methods, natural family planning, and sterilization. It provides details on the mechanisms of different hormonal methods like combined oral contraceptives, progestin-only pills, patches, injections, and vaginal rings. Benefits and risks of long-acting reversible contraceptives like implants and intrauterine devices are also outlined. Emergency contraception and natural family planning methods are briefly described. Contraindications and effectiveness of various contraceptive options are covered.
The document outlines international standards and codes of ethics for midwifery practice. It discusses establishing a midwifery-specific regulatory authority to effectively regulate midwives and support autonomous midwifery practice. It also covers protecting the title of midwife, governance structures for regulatory authorities, and the importance of national regulation and collaboration between regulatory bodies.
Please find the power point on Hyperemesis gravidarum and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
1) The document discusses the clinical features, differential diagnosis, and investigations of menopause. It describes various symptoms that can occur during perimenopause and menopause such as hot flashes, sleep issues, mood changes, and changes to the skin, hair, cardiovascular and genitourinary systems.
2) Differential diagnoses are provided for different symptoms. Investigations like hormonal tests and imaging can help determine if symptoms are due to menopause or other potential medical conditions.
3) Natural menopause is diagnosed if a woman over age 40 has 12 months of amenorrhea accompanied by menopausal symptoms and elevated FSH levels on two separate occasions.
Teenage pregnancy is defined as girls aged 13-19 becoming pregnant. Half of the world's population is under 25. Each year, 14 million children are born to young women aged 15-19 worldwide. Causes of teenage pregnancy include early marriage, lack of sex education, peer pressure, poverty, and family issues. Impacts include negative psychosocial and medical effects on both the teenage mother and her child, such as higher risks of medical complications, living in poverty, and continuing the cycle of teenage pregnancy. Prevention strategies include sex education, promoting abstinence, use of contraceptives, and prevention programs.
Langkah-langkah memperbaiki sistem manajemen perusahaan meliputi meninjau bisnis proses, struktur organisasi, sarana dan prasarana, serta kefektifan sistem dan komitmen manajemen agar sistem manajemen dapat berjalan dengan efektif dan meningkatkan kinerja perusahaan.
Leadership involves influencing and guiding people, as opposed to just managing tasks and processes. There are different types of leaders, including those who lead by position, personality, moral example, or power. Leaders focus on inspiring and motivating people, while managers focus more on planning, organizing, directing, and controlling work. Effective new leaders must quickly learn, establish relationships, and focus on priorities while balancing flexibility. They should create a vision, build political support for change, and secure early wins to create momentum for further transformation.
The document discusses bringing new family planning methods, specifically the Lactational Amenorrhea Method (LAM) and Standard Days Method (SDM), to more people. It provides an overview of these natural family planning methods, research on their effectiveness and typical use, and examples of how various countries and programs have successfully integrated and scaled up the methods. Key points discussed include how LAM and SDM can increase contraceptive choice, expand access to family planning, and attract new users while not negatively impacting other method use.
The document discusses various aspects of leadership including definitions of leadership, management, and managerial skills. It contrasts the differences between leadership and management, and between leaders and managers. It also outlines important attributes, qualities, and skills required for effective leadership such as intelligence, accountability, bravery, delegation skills, and the ability to analyze problems and avoid disputes. The document emphasizes that developing a great team requires leaders to inspire a shared dream, foster positive attitudes, build relationships, and encourage excellence among team members.
This document discusses the roles and responsibilities of strategic leaders. It outlines that leaders establish vision, develop and implement strategies, allocate resources, shape culture, and project the organization's image. The document then examines specific roles leaders play in implementing strategies, fostering a strategy-supportive culture, keeping the organization responsive to change, exercising ethics leadership, and making corrective adjustments. Throughout, it emphasizes the importance of leaders inspiring others to achieve goals and adapt to changing conditions.
The document discusses the 5-E model of instruction for teaching science. The 5-E model includes 5 phases - Engage, Explore, Explain, Elaborate, and Evaluate. The Engage phase introduces a topic to spark curiosity. The Explore phase allows students to experiment. The Explain phase guides students to understand concepts. The Elaborate phase has students apply concepts to new situations. The Evaluate phase assesses student learning throughout the process. The 5-E model is based on an inquiry approach and is designed to help students develop scientific understanding.
The menstrual cycle involves changes in the ovaries and uterus across approximately 28 days. In the ovaries, a follicle grows and matures, culminating in ovulation around day 14 when the mature egg is released. After ovulation, the ruptured follicle transforms into the corpus luteum which secretes progesterone and estrogen to prepare the uterus in case of fertilization. If fertilization does not occur, progesterone and estrogen levels drop and the endometrial lining is shed through menstruation, starting a new cycle.
The document discusses human resource planning, including its objectives, forecasting workforce needs, factors that influence demand, and challenges. It covers techniques for forecasting future demand like expert forecasts and trend projections. The supply of human resources depends on internal factors like staffing audits and succession planning, and external factors like labor market analysis. Effective HR planning requires determining standards, analyzing current resources, succession planning, forecasting future supply, considering organizational culture, and choosing forecasting techniques.
*Adapun isi Paket SOP PERUSAHAAN ini, meliputi:
1. SOP untuk Departemen Purchasing.
2. SOP untuk Departemen Humas.
3. SOP untuk Departemen Marketing
4. SOP untuk Departemen Umum-Transport
5. SOP untuk Departemen Umum-Maintenance
6. SOP untuk Departemen Umum-Satpam
7. SOP untuk Departemen Akunting
8. SOP untuk Departemen Food & Beverages
9. SOP untuk Departemen Information Technology and Security
*Selain itu, Nantinya disertakan juga bonus tambahan berupa:
1. Materi-materi SOP
2. Contoh Job Description
3. Alat bantu kata kerja aktif untuk Jobdesc
4. Kebijakan HRD
5. KPI Catalogue
6. Tabel Penuntun Penilaian Karyawan
The document discusses family planning and provides information on various topics related to it. It defines family planning as controlling the number and timing of children through contraception or sterilization. It discusses modern family planning methods like birth control, assisted reproductive technology, and family planning programs. It also covers adoption, maternal health risks, contraceptive options like IUDs and implants, and the importance of family planning for health, economic, and social reasons.
An invisible citizen wakes up feeling overwhelmed by their lack of stable employment and housing situation. They interact with relatives they live with but feel excluded from society. In the afternoon, they go to the job center seeking opportunities but feel frustrated by the lack of support. They internalize their situation and feel insecure. In the evening, they spend time alone feeling disconnected from their neighborhood due to their work situation.
ITFT_Device management in Operating SystemSneh Prabha
This document discusses different approaches to device management in computer systems, including direct I/O, interrupt-driven I/O, memory mapped I/O, and direct memory access (DMA). It describes how each approach handles coordination between software and hardware to complete I/O operations and optimize CPU usage. The key aspects covered are device drivers, buffering techniques, and the design of interfaces between applications, drivers, and device controllers.
The document discusses various teaching-learning strategies including microteaching, team teaching, experimental learning, programmed instructions, and simulation teaching. Microteaching involves teaching short lessons to small groups of students with a focus on developing specific teaching skills. It follows a cycle of planning, teaching, receiving feedback, and re-teaching. Team teaching involves two or more teachers jointly teaching the same class. Experimental learning involves learning through direct experiences. Programmed instructions break down lessons into small steps with immediate feedback. Simulation teaching approximates real-life situations to allow students to practice applying concepts.
The Standard Days Method (SDM) is a natural family planning method that is effective and easy to use. It involves abstaining from unprotected sex on days 8-19 of a woman's menstrual cycle, which are considered the fertile days. Studies have shown the SDM to be over 95% effective with correct use. It uses colored beads called CycleBeads to help women track their cycle. The SDM has potential to expand contraceptive use since it is low-cost, requires little training to use, and involves men in family planning. While it may not be suitable for all women, it provides an entry point to contraceptive methods for many.
This document provides information on various contraceptive methods including hormonal methods like oral contraceptives, implants, injections, and IUDs. Barrier methods such as condoms, diaphragms, and spermicides are also discussed. Permanent sterilization procedures for both males and females are covered. Other methods based on fertility awareness through monitoring things like basal body temperature and cervical mucus are explained. Abstinence is presented as the only 100% effective method of birth control.
The Standard Days Method (SDM) is a contraceptive method that identifies a fixed fertile window in a woman's menstrual cycle based on analysis of 7,500 cycles. It is over 95% effective with correct use and 88% effective with typical use. The SDM uses CycleBeads to help women track their cycle and know when to abstain from sex or use condoms to avoid pregnancy. It has been recognized by the WHO and USAID as an evidence-based family planning method. Studies in multiple countries show that the SDM encourages male involvement by requiring abstinence or condom use during the fertile window. Introduction of the SDM has also been shown to improve condom use and counseling for other family planning clients.
This document discusses the Standard Days Method of natural family planning which uses CycleBeads. It provides an overview of how the method works and identifies the fertile window using colored beads. It also outlines how to counsel clients on the method, including screening to ensure appropriate cycles and teaching how to use the beads. Support for correct and consistent use is emphasized, including discussing the method with partners and monitoring cycle length.
The Standard Days Method (SDM) is a natural family planning method that identifies the fixed fertile window in a woman's menstrual cycle. Users of the method avoid unprotected sex from days 8-19 of the cycle to prevent pregnancy. Studies show the SDM to be over 95% effective with correct use. The SDM expands family planning options and has been recognized by the WHO as a best practice. It appeals to new family planning users and helps address unmet need due to its ease of use and lack of side effects.
The Standard Days Method (SDM) is a natural family planning method that identifies the fixed fertile window in a woman's menstrual cycle. Users of the method avoid unprotected sex from days 8-19 of the cycle to prevent pregnancy. Studies show the SDM to be over 95% effective with correct use. The SDM expands family planning options and has been recognized by the WHO as a best practice. It appeals to new family planning users and helps address unmet need due to its ease of use and lack of side effects.
The Standard Days Method (SDM) is a natural family planning method that relies on avoiding unprotected intercourse between days 8-19 of a woman's menstrual cycle. SDM was developed through analysis of over 7,500 menstrual cycles and determines the most fertile days are days 8-19. To use SDM, a woman tracks her cycle length and avoids unprotected sex from days 8-19. With perfect use, SDM is 95% effective at preventing pregnancy, but with typical use is only 88% effective. SDM provides a low-cost option but requires cycle regularity and abstinence during fertile periods.
A guide to family planning for community health workers and their clientsPaul Mark Pilar
This document provides guidance for community health workers and their clients on family planning methods. It aims to help clients choose the method that best suits their needs and to provide health workers with the information required for effective counseling. The tool compares different family planning methods and covers topics such as choosing a method, method instructions, special health situations, frequently asked questions, and counseling checklists.
Contraception allows individuals and couples to plan their families and prevent unintended pregnancies. 1.1 billion women worldwide have a need for family planning, with 842 million using contraception and 270 million having an unmet need. Modern contraceptive methods like implants, IUDs and sterilization are highly effective at preventing pregnancy, while traditional methods have higher typical use failure rates. Increasing access to and use of effective family planning can help reduce maternal and infant mortality as well as unsafe abortions globally.
- Family planning, also known as contraception, involves limiting family size and preventing unwanted pregnancy. There are about 1.2 billion women of reproductive age worldwide.
- In Nigeria, the total fertility rate is high at 5.7, leading to high population growth and a doubling of the population every 22 years if trends continue. However, contraceptive use is low, with only 14.6% using any method and 9.7% using modern methods.
- Family planning methods include natural methods like fertility awareness and lactational amenorrhea, as well as hormonal methods like oral contraceptives, implants, injections, patches, rings, and IUDs. Barrier methods and permanent sterilization procedures
Contraception 2015 O.C.P, Dr. Sharda Jain, Dr. Jyoti Bhaskar, Dr. Jyoti Bhask...Lifecare Centre
This document provides information about contraceptive trends and methods in India. It discusses:
- Unwanted pregnancies and large family sizes are still issues in India
- Contraceptive usage in India has tripled from 1970 but unmet need remains high
- Most common methods are female sterilization and condoms, while effective reversible methods are underutilized
- Oral contraceptive pills are one effective option but myths and misconceptions about side effects still exist
This document summarizes various contraceptive methods. It discusses periodic abstinence methods like coitus interruptus and lactational amenorrhea. It also describes mechanical barriers like condoms, diaphragms and caps. The document outlines several hormonal contraceptives including implants, injectables, pills and patches. It provides details on effectiveness, advantages and disadvantages of each method. The ideal characteristics of contraception are also stated in the beginning.
contraception-171119180501.pdf in gynaecologyschhataria
This document discusses various contraceptive methods, including barrier methods like condoms and diaphragms, hormonal methods like pills and implants, IUDs, and permanent or terminal methods like sterilization. It notes that contraception aims to prevent unwanted pregnancies by regulating conception. Ideal contraceptives should be safe, effective, acceptable, reversible, inexpensive, long-lasting, and require little medical supervision. The document also reviews India's family planning program and initiatives to increase access to contraception.
This document provides information about various contraceptive methods. It discusses the need for contraception to avoid unwanted pregnancies and regulate timing and spacing of pregnancies. It describes ideal characteristics of contraceptives and categorizes main methods as barrier methods, IUDs, hormonal methods, emergency contraception, and terminal/permanent methods. Specific contraceptive options are explained including condoms, diaphragms, spermicides, IUDs, pills, implants, injections, sterilization procedures. Effectiveness, side effects, and service providers for different methods are also summarized.
This document discusses various contraceptive methods including barrier methods like condoms and diaphragms, intrauterine devices (IUDs), hormonal methods like pills and implants, and terminal methods like sterilization. It provides details on the different types of each method, how they work, effectiveness, side effects, and appropriate use. The document also discusses India's family planning program, initiatives to increase access and uptake of contraception, and service providers for different methods.
This document provides information about various contraceptive methods. It discusses the need for contraception to avoid unwanted pregnancies and regulate timing and spacing of pregnancies. It describes ideal characteristics of contraceptives and categorizes common methods as either spacing methods (reversible) or terminal methods (permanent). The main spacing methods discussed are barrier methods (condoms, diaphragms, spermicides), IUDs, hormonal methods, and emergency contraception. Terminal methods discussed are male and female sterilization. Unmet need for contraception in India and initiatives by the Indian government to increase access and awareness of contraceptive options are also summarized.
This document provides information about various contraceptive methods. It discusses the need for contraception to avoid unwanted pregnancies and regulate timing and spacing of pregnancies. It describes ideal characteristics of contraceptives and categorizes common methods as either spacing methods (reversible) or terminal methods (permanent). The main spacing methods discussed are barrier methods (condoms, diaphragms, spermicides), IUDs, hormonal methods, and emergency contraception. Terminal methods discussed are male and female sterilization. Unmet need for contraception in India and initiatives by the Indian government to increase access to family planning services are also summarized.
This document provides an overview of various contraception methods. It discusses periodic abstinence methods like coitus interruptus and lactational amenorrhea. Mechanical barriers like condoms and diaphragms are covered. Hormonal contraceptives such as implants, injections, pills and IUDs are summarized. The effectiveness, advantages and disadvantages of each method are highlighted. Intrauterine devices, sterilization procedures, and emergency contraception are also summarized. The document aims to inform about the different types of contraception, their characteristics and appropriate usage.
Similar to SDM Training Workshop: Bringing New People to Family Planning (20)
This PPT was created for Rwanda, and is meant for Implementing Organizations at the community level to use during an orientation of the EOI3 approach for all levels of stakeholders.
This document discusses strategies for involving men in family planning programs in order to promote gender equity and responsible fatherhood. It recommends training healthcare providers to counsel men and couples, introducing family planning methods like the Standard Days Method that engage men, and reaching out to men through their existing social networks and community groups. Evaluation of programs found they improved couple communication, increased modern contraceptive use, and led to men having more positive attitudes toward supporting their partner's family planning choices. The document concludes that working with men through their own networks and expanding family planning options for men can help achieve the goals of supportive male partners and engaged fathers.
The document summarizes research conducted on CycleTel, an SMS-based fertility awareness mobile health service in India. It discusses:
1. Three phases of formative research - focus groups, cognitive interviews, and manual testing of CycleTel - which found high satisfaction, ease of use, and willingness to pay.
2. Automated testing of CycleTel with over 700 women, which also found high satisfaction and ease of use but less interest in long-term use.
3. How the research results informed a business analysis to identify target markets, develop a go-to-market strategy, and identify scenarios to achieve sustainability of CycleTel in India within 5 years through partnerships and initial investment.
Systematic screening was implemented in rural health clinics to improve preventative care delivery. Staff were trained to screen patients for various health issues using a checklist and provide additional services if needed. Shadowing patients found that screening often identified additional needed services but these were not always provided due to time constraints. Interviews found that screening facilitated difficult conversations but implementation challenges included maintaining staff motivation over time. Further analysis will assess the effectiveness, feasibility and value of systematic screening to determine if a revised approach should be tested and scaled up to help reduce health disparities in underserved populations in the US.
“Condoms are not a family planning Method”: Why efforts to prevent HIV have failed to comprehensively address adolescent sexual and reproductive health
This document outlines a capacity building strategy for a project to revitalize family planning services through Christian Health Associations in Africa. The strategy includes 5 components: 1) Establishing a supply chain to ensure community health workers have access to family planning commodities. 2) Training community health workers and supervisors on family planning service provision. 3) Developing reporting mechanisms for community health workers to report activities. 4) Creating a supportive environment through sensitizing religious leaders. 5) Providing ongoing supervision and support to community health workers. The goal is to strengthen the capacity of Christian Health Associations to improve access to family planning information and services.
This document summarizes a study on maximizing collaboration between faith-based organizations and secular groups on family planning and maternal health. The study found that family planning aligns with both Christian and Muslim values when framed around health, responsibility, and family well-being. However, challenges to collaboration include mistrust, philosophical differences, and lack of capacity among faith groups. Moving forward, the document recommends continued dialogue, capacity building, strategic messaging, and taking time to build trust between partners.
This document discusses monitoring and evaluating the scale-up of the Standard Days Method (SDM) family planning program in multiple countries. It provides background on a 5-year study of SDM scale-up using the ExpandNet/WHO model. The document outlines the importance of monitoring and evaluation to guide the scale-up process and assess outcomes. It presents the SDM scale-up logic model and operational framework. Metrics for monitoring benchmarks and indicators are proposed, along with data sources and tools for collection. Initial monitoring results are reported for some countries. Challenges of scaling up SDM integration across health systems and service coverage are also examined.
This document describes a proposed project to address unmet need for family planning in Mali by leveraging social networks. The project would use a 5-year, $5.75 million implementation science approach guided by the ExpandNet model to design, test, and potentially expand interventions targeting key social influencers. The goal is to better understand social factors influencing fertility preferences and contraceptive use, and to activate social networks to reduce barriers and strengthen support for smaller, healthier families. Research questions focus on how social groups impact reproductive decisions and how addressing these social determinants through couple-focused and other network-based interventions could increase modern contraceptive use.
The document summarizes the development and deployment of CycleTel, a mobile health application in India that sends SMS alerts to women about their fertile days using the Standard Days Method. It describes how formative research including focus groups and user testing was conducted during the proof-of-concept phase to design messages and the service appropriately. This established demand and helped refine the product before significant resources were invested. The document outlines various partners needed for full deployment and sustainable scale-up, and emphasizes that the deployment process is more complex than anticipated requiring careful planning, communication with partners, and leveraging open source resources and literature on new product development.
This document summarizes data on natural family planning (NFP) use in the United States and other countries. It finds that 15-20% of women in developing countries have ever used the rhythm method, though current use is only 3-5%. Specific NFP methods like the Standard Days Method have very low ever and current use rates below 1% in the countries surveyed. In the United States, 19.4% of women have ever used the rhythm method by calendar, but only 0.5% currently use it. Periodic abstinence by natural family planning methods have an ever use rate of 4.6% but only 0.1% current use. The document recommends designing surveys that better capture use of specific N
The annual meeting of the Inter-agency Working Group on Reproductive Health in Crises discussed the use of fertility awareness based family planning (FAM) methods in areas affected by conflict and civil unrest, using examples from Haiti and the Democratic Republic of Congo (DRC). IRH has experience implementing FAM methods like the standard days method and lactational amenorrhea method in these settings due to their advantages of requiring few or no commodities and short counseling sessions. In Haiti and DRC, IRH training led to hundreds of new FAM accepters and research found couples continuing use for years. FAM methods are well-suited for crisis settings.
IRH brought together organizations in Guatemala to develop radio programs about gender, sexual rights, and family planning. The programs aim to increase awareness of family planning benefits and methods. They will air in Spanish and several Mayan languages on radio stations that reach over 5 million listeners across 14 departments. The 10-week program will feature vignettes on family planning, the menstrual cycle, male participation, and sexual/reproductive rights. It partners with health organizations to create and disseminate accurate content to encourage informed family planning decisions.
The document summarizes the Millennium Development Goals (MDGs), which were established in 2000 to address global poverty, hunger, disease, and lack of access to clean water. It provides an overview of the 8 goals and related targets to be achieved by 2015. Progress made so far is discussed for each goal, such as reducing extreme poverty and hunger, achieving universal primary education, and improving maternal health. Challenges that remain are also noted, such as providing employment, eliminating hunger, and reducing maternal mortality and improving sanitation.
This document discusses using private sector approaches and information communication technologies (ICT) to scale up family planning programs in India. It proposes partnering with private medical providers and manufacturers to distribute contraceptives. It also describes developing a mobile phone-based fertility awareness app called CycleTel and conducting pilot tests of it in India. Preliminary results found interest among users and a willingness to pay for the service. Next steps include further pilot testing, software development, and scaling up programs within India and other countries.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
SDM Training Workshop: Bringing New People to Family Planning
1. Bringing New People to Family Planning: The
Broader Impact of Fertility Awareness Methods
1
2. Workshop Objectives
• Review basic information about the Standard
Days Method (SDM) and Lactational
Amenorrhea Method (LAM), two simple
fertility awareness methods.
• Understand what is involved in the counseling
in SDM and LAM and practice of using simple
tools for providing these methods.
• Learn about newest guidelines and training
resources available for SDM and LAM
2
4. Fertility Awareness Methods
• Modern FAMs are effective options for
many women who want to space
pregnancies without using a hormonal
method.
• FAMs offer an opportunity to involve the
partner in optimal birth spacing and timing.
• They have no side effects and are
economical.
4
5. How FAM work
• Identify “fertile window” (days intercourse can
result in pregnancy) of the menstrual cycle
• Use one or more “indicators” to identify
beginning and end of fertile window. FAM
method users:
− monitor indicators to identify fertile
window
− avoid unprotected intercourse (use barrier
methods or abstain) on fertile days
5
6. Why develop new FAM?
• Very low use of current FAM methods.
• Very poor understanding of fertility in the general
population.
• Significant unmet need for family planning.
• Most health providers do not have time to counsel
their patients/clients in FAM.
• Many women/couples who express interest in a FAM
do not actually use them
• FAM can contribute to efforts to reduce the gap
between contraceptive commodity needs and donor
capacity. 6
7. Context for FAM
FAM in the context of:
• Healthy Timing and
Spacing of
Pregnancies (HTSP)
• Informed choice in
family planning
7
8. What is HTSP?
Is it different from birth spacing?
• Previous birth spacing
recommendations refer
to when to give birth.
• HTSP is about
pregnancy spacing:
when to become
pregnant – rather
than when to give
birth. 8
9. What are the advantages of waiting two years
after having a baby to become pregnant again?
Increases likelihood of healthy outcomes
for the baby and the mother
Reduces neonatal, infant and child
mortality
Reduces maternal mortality
Improves nutritional status of children
Addresses unmet need for contraception
among postpartum women
Benefits family economically
9
9
10. Healthy Timing & Spacing of Pregnancies
• After a live birth couples should use an
effective family planning method of
their choice, continuously for at least 2
years before trying to become
pregnant again.
• The SDM can offer women and couples
at least 95% protection from
pregnancy when the method is used
correctly.
10
11. Method Characteristics
Standard Days Method with CycleBeads
Method Eligibility Women with cycles between 26 and 32
Criteria (who can use days long
the method) Couples who can avoid unprotected sex on days 8 to19
Exceptions (who Women in postpartum or breastfeeding must have had at least 4 periods
cannot use) about a month apart.
Women who recently used a hormonal method must have 3 periods
about a month apart after stopping hormonal.
Effectiveness 95% with correct use
88% with typical use
Pregnancies for every 100 woman-years
How it works The woman considers herself fertile on days 8 to19 of the menstrual the
cycle. She and her partner use condoms or abstain on those days to
prevent pregnancy.
Key Research and • Multi-site prospective study
Findings • Services provided in existing programs
• Clients followed monthly for 13 cycles
• Couples used the method correctly in 97% of cycles
• 478 women in the study, 43 got pregnant
• With correct use, the failure rate is 4.8
• With typical use the failure rate is 12.0
12. Contraceptive Failure of User-Directed Methods
*Percentage of women who
Correct Use Typical Use
became pregnant 1st year of use
OCs .3 8
Condom 2 15
***Standard Days Method 5 12
Diaphragm 6 16
Spermicides 18 29
No Method 85 85
*Adapted from Contraceptive Technology, 18th edition, 2004
***Source: Arévalo et al. Contraception, 2002
13. Comparing effectiveness of FP methods
Source: Family
Planning: A Global
Handbook for Providers
2007, WHO
15. What is the Standard Days
Method
• Identifies days 8-19 of the cycle as
fertile
• Is appropriate for women with menstrual
cycles between 26 and 32 days long
• Helps a couple avoid unplanned pregnancy
by knowing which days they should not
have unprotected sex
• Helps a couple plan pregnancy by knowing
which days they should have sex
15
16. CycleBeads
The SDM is used with CycleBeads®, a
color-coded string of beads to help a
woman:
• Track her cycle days
• Know when she is fertile
• Monitor her cycle length
16
17. SDM Offered Worldwide
Albania Guinea Rwanda
Angola Haiti Senegal
Armenia Honduras Tajikistan
Azerbaijan India Tanzania
Bangladesh Kenya Timor Este
Benin Malawi Turkey
Bolivia Mali Uganda
Burkina Faso Mauritius Ukraine
Burundi Mozambique United States
DR Congo Nicaragua Zambia
Ecuador Nigeria
El Salvador Pakistan
Ethiopia Peru
Ghana Philippines
Guatemala Romania
17
18. Determining the Fertile Window
Ovulation
5 days (sperm life) 12 to 24 hours
(ovum life)
Day 8 Day 19
18
19. Group Work: How Effective Is the
Standard Days Method?
• How effective do you think SDM is?
• What do you think may be some
benefits of a natural method like the
SDM?
• What some of the constraints or
challenges of the SDM?
19
20. Efficacy Study of the SDM
• Multi-site prospective study
• Services provided in existing programs
• Clients were followed monthly for 13 cycles
• Couples used the method correctly in 97%
of cycles
• 478 women in the study, 43 got pregnant
• With correct use, the failure rate is 4.8
• With typical use the failure rate is 12.0
Source: Arevalo, M. et al. 2002. Contraception 65:333-338. 20
21. Contraceptive Failure of
User-Directed Methods
% of women who became pregnant during 1st year of use
Correct Use Typical Use
OCs .3 8
Condom 2 15
Standard Days Method 5 12
Diaphragm 6 16
Spermicides 18 29
No Method
85 85
Source: Hatcher, R.A. et al. 2004. Contraceptive Technology. New York: Ardent Media, Inc. 21
22. What Have We Learned About Offering
SDM to Clients?
22
23. SDM User Profile
Six Countries1 U.S.2
Mean Age 29 27
Mean Parity 2.8 .4
Previous use of:
Nothing/ineffective method
52% 0%
Condom (inconsistent) 38% 87%
Pills/injection 33% 96%
IUD 10% 2%
1
Interviews with users in 6 countries 23
2
Survey of internet purchasers
24. Reasons for Choosing the SDM
Six Countries1 U.S.2
Doesn’t affect health 70% 80%
No side effects 20% 30%
Economical 30% 5%
Easy to learn/use 10% 45%
1
Interviews with users in 6 countries 24
2
Survey of internet purchasers
25. How Couples Manage the Fertile Days
Abstain Condom
Rural India 70% 30%
Urban India 13% 87%
Philippines 70% 30%
U.S. 15% 85%
Rwanda 67% 20%**
**Rwanda 13% used withdrawal.
25
Source: Project reports and U.S. Survey
26. Counseling Time at GoJ Clinics
Comparison of SDM, Sterilization, and Pill
SDM Pill Sterilization
(n=59) (n=59) (n=59)
Interpersonal 78% 78% 83%
relations
Information 64% 58% 44%
exchange
Session length 17 min. 13 min. 15 min.
Source: Simulated clients, endline Jharkhand, India 26
27. Reasons for Choosing the SDM
Six Countries1 U.S.2
Doesn’t affect health 70% 80%
No side effects 20% 30%
Economical 30% 5%
Easy to learn/use 10% 45%
1
Interviews with users in 6 countries; 2 Survey of internet purchasers 27
28. Group Work: SDM Attributes
Who might be interested in using SDM?
• Someone who has never used a FP method
• Woman who doesn’t desire hormonal method or
devices
• Adolescent woman
• Woman who has little to no access to a health care
facility
• Couple who uses condoms to delay pregnancy
• Breastfeeding woman with regular menses
28
29. Lessons Learned
• Providers’ attitudes toward the SDM improve with
training and experience.
• The SDM can be offered by different kinds of
providers.
• The SDM can be taught in clinic and community
settings.
• Involving men increases method satisfaction and
continuation.
• Women can learn to use the SDM during a 20-minute
session.
• Offering the SDM helps programs reach new clients.
• Many couples use condoms on fertile days.
29
31. How is the SDM offered to Clients?
• Screening
• Teaching
• Support couple’s use
• When to return
31
32. Screening
Who Can Use the SDM?
Women with cycles 26 to 32 days long
(women who have their monthly periods are within this range)
Couples who can avoid unprotected sex
on days 8 to19
SDM does not protect
against STIs or HIV
32
33. Screening to See if the SDM is
Appropriate for the Woman
Is her cycle within the 26 and 32-day range?
Simple questions to assess cycle length and
regularity.
Do you get your periods about once a month?
Do you get your periods when you expect them?
When did your last period start?
Most women have a general idea of when their
periods will come.
Women who know when their last period
started can use the SDM right away.
Women who do not know can begin the SDM
when their next period starts. 33
34. Criteria for Starting the SDM
Date of the last period known Start immediately
Date of last period unknown Start on first day of next period
Wait 90 days after injection and to have
Contraceptive Injection
two periods about a month apart
Wait until last 3 periods are about a
Pill, patch, implant, IUD month apart (after stopping the hormonal
method)
Postpartum/breastfeeding Wait until she has 4 periods and the two
most recent are about a month apart
34
35. Group work: Case studies for
cycle length and regularity
• In pairs, spend 5 minutes resolving the
case study assigned to your team.
• Use the case studies handout and
answer sheet.
• Be prepared to share your response to
the cases
35
36. Key Points - Screening
• Ask simple questions to know if client has her
monthly periods regularly.
• Determine if client and partner will be able to
manage 12 fertile days.
• Women who recently had a baby or are
breastfeeding must wait to have regular cycles
before using SDM.
• Ask when last period started to determine if
client can start using SDM now or must wait
for next period to start. 36
37. Teaching - How to use the SDM
• Teach client how to use the SDM Provider Cue Card
with CycleBeads
• Confirm client knows how to use
the method and when to return to
the provider
• Check client knows how to use a
condom
• Both, the CycleBeads instructional
insert and the provider cue card
include essential information to
help women use the method.
CycleBeads Insert37
38. Teaching-Monitoring Cycle Length
• Periods must always come
between darker brown
bead and last bead.
• If period comes early
(before darker brown
bead) or late (does not
start the day after the
last bead) more than
once in a year, switch to
another method.
Source: Package Instructions 38
39. Group Work:
Teaching Cycle Beads
• In pairs, spend 5 minutes taking turns explaining each
other how to use CycleBeads. Use the beads and the
package instructions to explain key points.
• In your group, discuss the following questions:
− How to help women remember to move the ring every day?
− How can a woman know if her periods are coming on time so
CycleBeads continue to work for her?
− How would you help a women know what to do if she’s not sure if
she moved the ring on any given day?
• Be prepared to discuss in the larger group your
experience
− How did you feel teaching how to use CycleBeads?
− Did you have any challenges?
− Did you use the Cue Card or the insert? Was it helpful? 39
40. Key Points - Teaching
• Explain CycleBeads represent the cycle and each bead is
a day in the cycle.
• Red is the first day of bleeding. Brown means no
pregnancy. White means fertile days when pregnancy is
very likely. Use condoms or abstain on white bead days.
• How to use:
40
41. Supporting the Couple
During counseling, a service
provider should:
•Set the stage
•Encourage women to discuss SDM
use with their partners
•Engage client in a discussion on
how she/partner will handle the
fertile days
BE SURE SHE •Identify possible challenges and
LEAVES WITH A solutions
PLAN! •Role play talking with her partner
•Offer to talk with her partner
41
42. Involving Men- Issues to Consider
• SDM is a couple method. If men understand
it, couples are more likely to use it
correctly.
• Special efforts should be made to involve
men.
• Counseling men is ideal, but men can also be
taught about the method through: posters,
flyers, radio, TV and community networks.
42
43. Group Work:
Video Case Studies
• In small groups, discuss the short video
case you just saw.
• Use the discussion points in your
handout and be prepared to share your
conclusions in the larger group.
• Spend no more than 10 min. discussing.
43
44. Group Work – How to discussing the fertile
days with a partner?
• How would you engage this
couple in discussing how to
handle their fertile days?
• How would you feel if this
couple used the SDM?
• If they decide to start
using SDM, would you
schedule a follow-up visit?
Why or why not?
44
45. When to contact the provider
• If couple has sex on a white bead day
• If couple has difficulty managing fertile days
• If her period starts before the dark brown
bead (cycle shorter than 26 days)
• If her period has not started by the day
after moving ring to the last brown bead
(cycle longer than 32 days)
• If her period has not returned and thinks she
might be pregnant
• If she wants to use another method 45
47. What have we learned?
• Mary wants to use SDM. What will you ask her
in order to know if she can use it?
• Abena is going home with CycleBeads. What will
you tell her about checking her monthly
bleeding is on time to use the SDM.
• How can you tell if a client has cycles of the
right length to use SDM
• Jane had a baby 7 months ago that stills
breastfeeds. Can she use SDM?
• Nana wants to know what the beads are for.
What would you tell her about the beads and
the colors? 47
48. What have we learned? (cont.)
• Lucy and Abebe have used condoms sometimes but
Abebe now refuses to use them. How will you help
Lucy decide if SDM is appropriate for her.
• Claire is concerned she might forget to move the
ring. What can she do if she is forgets one day.
• Adai and Chidi had sex on a white bead day. What
can they do? Can they continue to use SDM?
• Mina started her period before reaching the dark
brown bead. This happened in November last year
and again this month (April). Can she still use
SDM?
48
49. Why Offer SDM
Increases choice
Expands coverage
Addresses unmet need
Empowers women
Involves men
Offers low-cost method
49
50. Guidance Documents
IPPF Medical Bulletin – 2000, 2003
IRH Reference Guide – 2002
WHO Medical Eligibility Criteria – 2002, 2004
WHO Selected Practice Recommendations – 2004
Contraceptive Technology – 2004, 2007
USAID Global Health Technical Briefs – 2004
Pocket Guide to Managing Contraception – 2004
Pop Report (New Contraceptive Methods) – 2005
WHO FP Decision-Making Tool – 2005
WHO Global Handbook for Family Planning – 2008
Pop Council Balanced Counseling Strategy – 2006
Ministries of Health norms and policies 2003 – 2010
50
51. K4Health-SDM Toolkit
Reference Materials
Links to scientific
Training Materials
articles
Technical Briefs Trainers’ Manual
SDM Service Participant Handbook
Protocol Training Video
Sample Norms Online Training
Frequently Asked
Questions www.irh.org
http://archive.k4health.org/toolkits/sdm51
52. Common Misconceptions about SDM
• “Natural methods don’t work”
• “Is this a modern method? “
• “Is there demand for this method?”
• “Natural methods take too much time in
counseling”
• “Men don’t collaborate, women have no power to
decide when to have sex”
• “If we offer this method clients will start
switching from more effective methods”
• “Illiterate women cannot use this method”
52
53. Myth: “Women will not have the power to
decide when to have sex.”
Fact: FAM are best suited for couples that
can communicate about sex
53
54. Myth:“If we offer this method, clients
using modern methods will switch.”
Fact: FAM integration has no negative
effects on FP use and method mix 54
55. Myth:“SDM counseling would take too
much time, just like other natural
methods.”
Fact: SDM is easy to teach in about
the same amount of time as other
methods 55
56. Myth: "It would be hard
for illiterate women to
use SDM.”
Fact: SDM appeals to women
from a range of socio-
economic backgrounds
Fact: Low literacy or
illiterate women can learn Myth: "More educated
how to use SDM correctly women would not be
56
interested in using SDM.”
Editor's Notes
Welcome to this two-hour workshop on Fertility Awareness Methods of family planning.
By the end of this training, you will be able to: Explain how the Standard Days Method and CycleBeads work Summarize the scientific basis and efficacy of the method Explain how to provide the method the method Describe how and why the programs include this method
HTSP After a live birth: Couples can use an effective family planning method of their choice, continuously for at least 2 years before trying to become pregnant again The FAM can offer women and couples over 95% protection from pregnancy when the method is used correctly INFORMED CHOICE Offering FAM helps programs reach new clients FAM helps expand options for women who want to use a natural method. Simple FAM are feasible to integrate in a variety of programs FAM are effective when use correctly.
[For countries where “3 to 5 saves lives” has been promoted, facilitator may need to explain that waiting 2 years to become pregnant again results in births no closer than 57 months apart (2 years plus 9 months.)] Couples who wait at least two years after having a baby before becoming pregnant again: Are more likely to have a healthy outcome for their baby – Babies born more than 3 years after their sibling are generally healthier. Also, a baby is more likely to be healthy and have better nutritional status (breastfeeding) if its mother doesn’t have another baby for at least 3 years. The mother will be healthier – There are fewer complications for women who waited two years to become pregnant after their previous birth Reduces neonatal, infant and child mortality. – Few deaths among newborns, infants and children born more than 3 years after their sibling Improves nutritional status of children – Both babies benefit from breastfeeding more than infants born too close together Addresses unmet need for contraception among postpartum women – Most women do not want to become pregnant within two years of their previous birth Economic benefits to family – Fewer births reduce economic demand on families Postpartum contraception reduces the numbers of women becoming pregnant, and therefore at risk of dying from pregnancy-related complications. Pregnancy intervals of less than six months (15-month birth intervals) are associated with 150% increased risk of maternal death. These intervals are also associated with 70% elevated risk of third trimester bleeding, 70% increase of premature rupture of membranes, 30% increase of anemia, and 30% increased risk of postpartum endometritis in the next pregnancy. Fewer newborns, infants and children die if they have been conceived at least 2 years after their sibling was born (World Health Organization. 2006. Report of a Technical Consultation on Birth Spacing: 13-15 June 2005. Geneva) Source : Conde-Agudelo and Belizan 2000 More than 100 million women in less developed countries would prefer to avoid pregnancy, but are not using any form of FP. These women are considered to have an "unmet need" for FP . (Ross and Winfrey 2002) The message is to wait two years to become pregnant, not to wait two years to give birth to another baby
It is important to put this information about efficacy in the context of other user-directed methods. Of 100 women using no method of family planning for 1 year, 85 will become pregnant. Those who use spermicides, a diaphragm, or condoms correctly, every time they have sex, 18, 6, and 2, respectively will become pregnant during the first year of use. OCs, used correctly, are more effective, with less than 1 woman getting pregnant with correct use. Clearly, the SDM is as or more effective with correct and typical use than other user-directed methods.
The Standard Days Method identifies days 8 – 19 of the menstrual cycle as the fertile days, when there is a significant probability of pregnancy. On all the other days of the cycle, pregnancy is most unlikely. The method works best for women who have cycles between 26 and 32 days long. Therefore, to use the Standard Days Method to prevent pregnancy, couples avoid unprotected sex from day 8 through day 19 of each cycle. On all the other cycle days, they can have unprotected sex. To plan pregnancy, the Standard Days Method can help a couple identify the days to have sex. While this is not sufficient for all couples, it can be an important first step.
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.
Here are some of the places around the world where the SDM has been introduced.
Suggested script: You may be wondering how cycle days 8 through 19 were selected as the fertile window for the Standard Days Method. Researchers applied various formulae to over 7500 cycles in an existing data set from the World Health Organization, and looked at probability:... the probability of pregnancy on different days around ovulation (from up to 5 days before ovulation…until 24 hours after ovulation taking into consideration the viability of sperm and ovum during this time), and they also looked at the probability of ovulation on different days of the cycle (usually occurring close to the middle of the cycle, give or take a day or two.) As a result they determined that for cycles between 26 to 32 days, a fertile window of cycle days 8 through 19 (shown here in green in the lower graph) provided maximum coverage for efficacy while minimizing the number of days for avoiding unprotected intercourse.
Ask participants about what they’ve heard of the Standard Days Method. Ask what they think is the effectiveness of the method and any concerns they may have. Often providers have concern about the efficacy of natural methods of family planning and it is important to address those concerns with evidence on the method. To be prepared to discuss information and evidence, the facilitator can rely on: The SDM Technical Brief found at: www.irh.org/SDM_Implementation/pdfs/SDM Technical%20Brief%20SPA.pdf The SDM Fact Sheet 20 Most Frequently Asked Questions on the SDM
Suggested script: An international multi-center study was conducted. The Standard Days Method was provided to clients of public and private sector family planning programs. Health personnel were trained to offer the Standard Days Method to their clients. Clients who were interested in using the method were screened according to specific criteria. They were taught how to use the method. They were followed every month for a little over one year, to collect data about their menstrual regularity, their use of the method, their satisfaction with the method, whether they had gotten pregnant, etc. Results of the efficacy trial were published in Contraception. References: Arevalo M, Jennings V, Sinai I. Efficacy of a new method of family planning: the Standard Days Method. Contraception . 2002;65:333-338.
It is important to put this information about efficacy in the context of other user-directed methods. Of 100 women using no method of family planning for 1 year, 85 will become pregnant. Those who use spermicides, a diaphragm, or condoms correctly, every time they have sex, 18, 6, and 2, respectively will become pregnant during the first year of use. OCs, used correctly, are more effective, with less than 1 woman getting pregnant with correct use. Clearly, the SDM is as or more effective with correct and typical use than other user-directed methods.
Results from operations research and introduction studies tell us about a variety of profiles for women using this method. Some interesting differences between the U.S. and other countries in terms of previous contraceptive use. The countries included here are Ecuador, El Salvador, Honduras, Benin, India, and the Philippines. Whereas about half of women in other countries had never used any method and about 1/3 had ever used condoms, pills, and injections, in the U.S., all women had contraceptive experience. 87% had used condoms and 96% hormonal methods. It appears that in the U.S., some women who have used other methods may be looking for a different kind of method.
In studies conducted in several countries, - six countries plus the U.S. - we find that the overwhelming reason why women choose the SDM is that it doesn’t affect their health and has no side effects. We know that most contraceptives do not have negative health effects for the vast majority of women. Indeed, there is good evidence that some methods actually have health benefits. And we know that most side effects are transitory and manageable. Nonetheless, these are many women who want something natural .
Couples in different settings and with different experiences and backgrounds will use different approaches to managing their fertile days. While there are a range of options, the 2 most frequently reported are abstaining from sex or using a condom. Many couples abstain sometimes and use a condom other times. Here we can see what couples report in 4 quite different settings.
Intervention clinics only
In studies conducted in several countries, - six countries plus the U.S. – it was found that the overwhelming reason why women choose the SDM is that it doesn’t affect their health and has no side effects. We know that most contraceptives do not have negative health effects for the vast majority of women. Indeed, there is good evidence that some methods actually have health benefits. And we know that most side effects are transitory and manageable. Nonetheless, these are many women who want something natural .
Instructions for facilitator: The purpose of this activity is to ensure that participants understand how the characteristics of the SDM might affect a client’s choice of or eligibility for this method. Ask participants for reasons why women might prefer or avoid this method. Then, click the mouse to reveal the next example. Move through each case quickly and mention the following points. Many women who have never used a method before or who distrust some methods might find SDM attractive because she can control it and does not require taking anything. If she meets the SDM criteria, starting with this method might help her transition to other methods in the future as she starts to trust the concept of spacing with an effective approach. █ Similarly, SDM might appeal to women who are not interested in hormonal methods for any reason. SDM can help young women learn about their menstrual cycles and keep track of when their period starts. They need counseling on consistently using condoms to prevent pregnancy and ITS, including HIV. It is important that information on the SDM as a method of birth control is explained in the context of other existing methods that are also appropriate for young women. █ A woman who uses the SDM with CycleBeads does not need to return to a clinic for resupplies, except to obtain condoms if she chooses to use a barrier method during the fertile days. █ Couples who use condoms sometimes are excellent candidates for the SDM if the woman has regular cycles. Couples who may not want to use condoms all the time can limit their use during the fertile window. █ Once a woman who is breastfeeding has four periods that are about a month apart, she can consider using the SDM. █ Note to facilitator: Distribute the handout: SDM Fact Sheet . Some providers might have biases against providing the SDM to adolescents because they believe their cycles are not regular. However, once a young woman’s cycles become regular, there is no reason younger clients cannot use it with appropriate counseling.
About half of women in other countries had never used any method and about 1/3 had ever used condoms, pills, and injections, in the U.S., all women had contraceptive experience. 87% had used condoms and 96% hormonal methods. In studies conducted in several countries, - six countries plus the U.S. - we find that the overwhelming reason why women choose the SDM is that it doesn’t affect their health and has no side effects. We know that most contraceptives do not have negative health effects for the vast majority of women. Indeed, there is good evidence that some methods actually have health benefits. And we know that most side effects are transitory and manageable. Nonetheless, these are many women who want something natural . Couples in different settings and with different experiences and backgrounds will use different approaches to managing their fertile days. While there are a range of options, the 2 most frequently reported are abstaining from sex or using a condom. Many couples abstain sometimes and use a condom other times. Here we can see what couples report in 4 quite different settings.
Facilitators will deliver a demonstration of a counseling session in which the SDM is being offered. Take 15 min to role play as a counselor with another facilitator (or a volunteer participant) as a client. Use the provider job aid and the CycleBeads packet instructions when demonstrating the screening, teaching and supporting couple use aspects of the SDM counseling. Below are more detailed notes to guide you; feel free to use/adapt as needed. Read the demonstration case study that you will role play as an SDM counselor or provider. Practice the demonstration case study and adapt the script as necessary. Become proficient in the use of the SDM provider job aids and familiar with all aspects covered during an SDM counseling session. Assign a volunteer participant the role of client in advance. Give the volunteer a description of the client's profile and ask her to play this role. Explain that this activity will begin with a demonstration followed by a general discussion in which the whole group will analyze the components of an SDM counseling session. Ask the participants to observe the demonstration and to write down any questions or comments so that they can share them when the demonstration is completed. Indicate that during this activity you as a counselor will be using the provider job aid and the instructions for CycleBeads. Before you start demonstrating the counseling session, set the stage for the case. Indicate the following: • The client has arrived at the center; she has been greeted and asked the reason for her visit. Her biographical information has been taken and her clinical history has been filled out, if applicable. She has also been given general information about all available contraceptive methods. In this case, she has decided that she would like to use the SDM. • The demonstration of the SDM counseling starts here. 4. Start the demonstration of the counseling session by screening to see if the method is suitable for the client, continue by informing the client how to use it, and conclude by exploring aspects of couple communication and offering support to the client in using the method with her partner. Throughout, make use of the respective provider job aids, making them visible to the participants. 5. After completing the demonstration, open the group discussion by asking participants to describe what they have just seen in the demonstration. Lead a group discussion to identify and analyze each component of the counseling session that you have just demonstrated using the “Components of the SDM Counseling” flipchart paper. If necessary, relate the SDM counseling to the counseling model of the participants’ service delivery programs (for example, the GATHER model). 6. Go over each of the three components of the SDM counseling (Screen, Teach, Support Couple Use) using the flipchart or PowerPoint slide and referring participants to the job aid and feedback checklist. Ask them which of the points in the checklist were addressed and if any was left out. Let participants know they will have an opportunity to role play the counseling and use the feedback checklist to assess each other.
Follow the notes to the facilitator in the previous slide. The objective of this activity is to give a general overview of counseling in the SDM. Each of the three components—screen, teach, and support—will be explored in depth by the end of the workshop. This session is the first opportunity participants have to become familiar with the job aids. If necessary, discuss with participants how the SDM counseling fits within the general process of family planning service delivery in their programs. Stress that this is not an additional task but one more method to offer within their existing services. Analyze the similarities and differences between SDM counseling and counseling in other methods.
Note: Brainstorm before showing these bullets The World Health Organization, in its publication “Medical Eligibility for Contraceptive Use”, states that the SDM, like other fertility awareness-based methods, poses no adverse risk to women who choose to use it. But the SDM is intended for women who meet certain criteria: What are they? The majority of her cycles should be between 26 and 32 days. If a woman does not know the approximate length of her menstrual cycles, this can be determined by a few simple questions. If she has more than 1 cycle outside this range during a year, she should be encouraged to use another method. She and her partner should be able to use the method together. The collaboration of the man is extremely important for the successful use of the method. He needs to understand and accept that on days 8-19 of each cycle, they will need to use a condom or not have intercourse. If the man (or the woman) cannot avoid unprotected intercourse during the fertile days, they should be encouraged to use another method. She should not be at risk of sexually transmitted infections. If either member of the couple is exposed to the risk of sexually transmitted infections, the Standard Days Method, as well as most other methods of family planning, will not protect against these infections. Condoms are the only method that provides protection from these infections.
It is important to assess whether the method is appropriate for the individual woman, primarily if most of her cycles are between 26 and 32 days long. To calculate the length of the cycle prospectively, count the days from the first day of her period until the day before the next period is expected to start. Studies in several countries have found that most women have a general idea of: When their last period came When their next period will come Whether it usually comes when they expect it Simple questions to assess cycle length and regularity have been well tested. Women who typically have cycles between 26 and 32 days long and know the day their last period started can begin to use the SDM right away. Those who are not sure about the day of their last period can use the method when they start their next period.
Now, to summarize, when can a woman start using the SDM: For women using no method, a barrier method, or a non-hormonal IUD – if they know the date they started their last period, they can begin using the method immediately. They simply count on the calendar to see which day of their cycle they are on and put the ring on the corresponding bead. Women who are not sure of the date they started their last period, are using the pill, implant or patch, have had a miscarriage or abortion, or have used EC can start on the first day of their next period. Breastfeeding and other postpartum women and those who have been using the 3-month injectable need to wait until their cycles become regular again and their most recent two periods are about a month apart. If a woman is unable to start the SDM right away, she can use CycleBeads to track her cycle length while using a back-up method
After participants complete the activity of problem solving with case studies, answer any questions they may have and close this topic of counseling with key “take-home” messages related to screening.
After screening for cycle length any possible special circumstances, the next step is to explain the client how to use the methods and how the beads work. Asking clients to explain back is a good way to determine whether the instructions are clear and clarify them as needed. Remind clients that the instructions for use also are included in the insert that accompanies the beads. A cue card to use during the teaching is available to help the provider remember the key points to cover.
Note to facilitator: Both the video animation of how CycleBeads work and the script for a demonstration mention how a woman can continue to monitor that her periods come on time. However, emphasis on this aspect is critical to ensure the method is appropriate for her in the future. While a woman’s cycle may be within the correct range to use the Standard Days Method, it is possible that over time her cycles may change. Thus, she needs to continue to know that her periods should always come between the dark brown bead and the last brown bead ( show that section of the necklace ). To the extent possible avoid language about “needing to have cycles within 26 to 32-day range”. Rather, show on the necklace when she must get her periods to know they’re coming on time and be able to have this method work for her. Explain that: • If you start your period before you put the ring on the DARK BROWN bead, it means it has come too soon to use the method. • If you have not started your period by the day after you put the ring on the last BROWN bead, it means your period is too late to use this method. • Contact your provider if you have more than on cycle out of range.
March 2009 Combined Oral Contraceptives – Family Planning Training Resource Package Note to facilitator: Ask participants to share any strategies that they have developed or their clients have used to establish a daily routine in order to remember to move the ring on her CycleBeads and thus know if: (1) she’s on fertile or infertile day; and (2) if her cycles continue to be on the 26 to 32-day range required for the SDM. Possible strategies may be to move the ring at the same time every day, moving the ring at the time she wakes-up or as she gets ready for her first daily activity or, pairing moving the ring with another daily activity such as washing up before bed. Ask participants to describe how they would counsel a client who comes to the clinic after having unprotected sex on a white-bead day.
After participants complete the activity of practicing teaching a client how CycleBeads work, summarize the key messages related to teaching the mechanics of how the beads work on a daily basis to know if the woman is on fertile or infertile day.
Providing counseling in the SDM involves teaching the client how to use CycleBeads to help her know on which days she can get pregnant and days pregnancy is unlikely. It also involves checking for client’s understanding and confirmation that she knows how to use CycleBeads and how to avoid getting pregnant if she so desires. Finally, counseling involves helping the client use the method with her partner, i.e. helping her identify any potential issues that may prevent them from using the method effectively and exploring options for dealing with those issues.
Screening for behavioral criterion – Couple’s ability to handle fertile days Note to the trainer : The following vignettes are designed to support training in the SDM and are part of a 45-minute video featuring a full counseling session (approx 20”) and other cases (approx 2 to 4 minutes each) where providers counsel clients who experience different special circumstances. Introduce each episode before playing it. This will help viewers know what to look for as the action transpires. Ask them to pay close attention to each episode since there will be questions after viewing each one Show vignettes and stop the video prior to counselor’s recommendations to client Ask Px that while watching the video, think about how they would help the couple manage the fertile days (video ends before this discussion takes place) Divide Px into 2 to 3 groups to reflect and discuss on vignette. Ask Px to answer discussion questions. After each episode, ask the questions listed in the handout or develop your own. When the episode is over, help the audience summarize the main points before moving on. Make sure the participants have no additional questions before ending the discussion. Discussion Questions for Participants Maggie & John’s Case – Recent use of Emergency Contraception What are ways in which you could engage this couple in discussing how to handle their fertile days? What questions would you ask Maggie and John to help them figure out how they will handle the fertile days? How would you feel about this couple using the SDM If they decide to start using the method, would you schedule a follow-up visit? Why or why not? Linda’s case – A Woman with Couple Communication Issues How would you feel asking these kinds of question to a client in a similar situation? Is there something else you would do as a counselor? Tracy’s case – A Woman at Risk of a STI Please talk over this situation and continue with the counseling. Be prepared to share specifics with other participants on how you handled Tracy’s case.
Note: Ask participants to turn to the person next to them. The one who was the provider before is now the client, and vice versa. Ask the provider to engage the client in a discussion about how she and her partner will handle the fertile days. After about 5 minutes stop the activity and ask how they felt. What questions did the provider ask? How did he/she feel asking them? How did the client respond? How did she feel talking about this? Anything else? Other issues
Any time we consider adding a new method to our program, we need to think seriously about what we expect to gain by offering this particular method. In the case of the SDM, it is very likely that providers don’t have any experience with it or even with any similar methods, so they may be very skeptical. Current clients may be adequately served by existing methods, and most clients – and potential clients – don’t know about the method. What are some reasons why we might want to offer the SDM? (Note: Ask audience/trainees this question before clicking on answers. Be prepared to address issues of provider bias.)
You have heard about how the SDM underlying science, research, program experiences and how it is offered to clients. You have seen what’s included in a training of service providers at the facility level and seen the methodology and practiced it. As master trainers, you’re probably thinking what other tools exist to help you adapt and use other resources in your respective programs and organizations. We would like to show you what other materials exist for clients, providers, programs, for addressing policy makers, but most importantly, for training different levels of providers. There is a large collection of materials both, generic and tailored by programs in different countries. All these are available in the CD included in your packet plus our website at www.irh.org. Some of those materials include: - online SDM training for providers - provider job aids - reference guide for counseling clients - informational SDM video - counselor training video - provider training manual - pamphlets, brochures, etc. As programs in the field continue to refine and adapt these resources, we collect them and disseminate them to a variety of audiences. As we close this workshop, w e hope we can stay in touch to share your experiences in training and for us to continue sharing new resources and information. In addition to including you in periodic updates, we are working on setting-up an online community on the ibp-initiative's knowledge gateway and our IEC Program Officer Susana Mendoza will contact you in a few weeks to invite you to join. In the meantime, please access our website for more information and here is Susana’s card in case you’d like to contact her directly.
Here are common issues that you will hear about FAM in general and the SDM in particular, and the arguments and evidence you have available to deal with them.
Fact : SDM is best suited for couples that can communicate about sex SDM is unlikely to succeed with couples whose relationship is characterized by gender inequity and gender-based violence For correct SDM use, it is important: That both the woman and man agree about whether or not they want a pregnancy That both understand how SDM works FP counselors encourage couples to decide how to manage the fertile days beforehand
Research shows that SDM brings new users to family planning In fact, in the state of Jharkhand, India, 87% of new SDM users are new to family planning
Comparison of SDM, sterilization, and pill counseling at government clinics (Jharkhand, India) - Session length” SDM 17 ; Pill 13 min.; Sterilization 15 min - Information exchange: SDM 64%; Pill 58%; Sterilization 44% (Simulated clients)
It is entirely possible for low literacy and illiterate women to use this method. There is no need for them to be able to read in order to use it. CycleBeads serve as a helpful visual tool for women, regardless of whether or not they are literate IRH has developed low-literacy inserts to support method use SDM is offered in over thirty countries worldwide, including the United States, in both the public and private sectors Women worldwide choose SDM because: It is natural and free of health side effects It teaches them about their fertility and helps them monitor their cycle lengths CycleBeads help women negotiate & discuss sex with their partners