For FABMs to Be Most Effective, Women Need Proper Education
By: Mariana Rodriguez Duran
Editor’s Note: Though there are many types of fertility awareness-based methods (FABMs) to use when looking to achieve or avoid pregnancy, it is important that women and couples are properly educated and instructed on how to use each method. As part of the FACTS elective, Mariana Rodriguez Duran summarized a 2018 study published in the International Journal of Nursing Sciences that showed how nurses in India played a vital role in helping women successfully avoid unplanned pregnancies using the Standard Days Method.
Introduction
While unintended pregnancies in countries with accessible medical care have declined, unintended pregnancies continue to be prevalent globally [1]. Since these may have a significant impact on the health and socioeconomic well-being of women, children and families, it is important that people have appropriate, accessible, and accurate forms of family planning for avoiding and achieving pregnancy. With proper education, fertility awareness-based methods (FABMs) have been found to be highly effective for couples trying to avoid pregnancy, even in developing countries [2]. In the interest of reducing maternal and child mortality rates and addressing socio-economic challenges in developing countries, it is important to assess the impact of efforts aimed to increase education about these methods.
Researchers Jyothi Ramesh and Ramesh Chandrababu studied the Standard Days Method, a form of family planning colloquially known as “the necklace method,” in reference to the CycleBeads tool used that women may wear around their neck [1]. This FABM involves women moving a rubber band along a circle of beads with 3 different colors, which correlate to the changes in a woman’s fertility.
The Standard Days Method, originally developed at the Institute for Reproductive Health at Georgetown University, is one of the simpler methods to use for women who have a regular menstrual cycle between 26 and 32 days because it has a standard fertile window, from day 8 to 19, and a simple tool, the CycleBeads necklace, women can use to track their cycle [3]. In their study, the researchers assessed the effectiveness of teaching the Standard Days Method in a community of reproductive age women in rural India.
“The Standard Days Method is one of the simpler methods to use for women who have a regular menstrual cycle between 26 and 32 days.”
Methodology
In order to be included in the study, women from the rural communities of Bangalore, Karnataka, India had to be between the ages of 19 and 45, have a menstrual cycle between 26 and 32 days, and could not be using other methods of family planning. In total, 120 reproductive age women were given a brief pre-questionnaire that assessed their knowledge on general family planning and the Standard Days Method.
Following the questionnaire, the participants were instructed by nurses, who used checklists to educate the women on the Standard Days Method. Subsequently, there was a discussion and demonstration using CycleBeads to clarify any information about the method. One week after the educational intervention, the participants were given a post-test to assess their level of knowledge and practice of the Standard Days Method, then categorized as adequate, moderate, or inadequate.
Results
Of the 120 women who participated in the study, most were 19 to 25 years old, had delivered at least one child previously, completed secondary education, were housewives, were Hindu, and had a low income compared to India’s national average.
All of the participants had inadequate knowledge and poor practice of the Standard Days Method, according to the pre-questionnaire and practice checklist assessments. However, the post test revealed that the majority of participants had an adequate level of knowledge (81%) and good practice (64%). There was also a positive correlation between the level of knowledge and practice of the Standard Days Method. Analysis revealed that educational intervention had a statistically significant effect. No association was found between any of the demographic variables and the level of knowledge and practice.
Discussion
This study in rural India demonstrates the important role trained community health professionals play in educating women about the Standard Days Method, one of the modern FABMs that can be used to guide their family planning decisions. These methods empower women by increasing their understanding of the menstrual cycle and enabling them to track their fertility to avoid or achieve pregnancy in a cost-effective manner.
“This study demonstrates the important role trained community health professionals play in educating women about … modern FABMs.”
Prior to this study, it was not well known whether a community-based intervention on the Standard Days Method would provide women in rural areas, who were primarily of low-income and had limited education, with adequate knowledge to practice the method. The study indicates, however, that an educational intervention is effective at increasing their knowledge and use of the method.
The overall effectiveness of the educational intervention can be attributed to the ease of use of the method. The user only has to know the day of the onset of menses, move the rubber band one bead at a time each day, and understand the coloring of the beads in relation to the woman’s potential fertility and the couple’s goals of achieving or avoiding pregnancy. With an effectiveness of 95% with perfect use and 88% with typical use, the Standard Days Method is a good option for women with regular cycles [3].
It is important to note that the Standard Days Method is not suitable for women with menstrual cycles less than 26 days or greater than 32 days. However, other methods, such as the Billings Ovulation Method or the sympto-thermal method (STM), can be taught to women who have a menstrual cycle outside of 26 to 32 days [4],[5]. These alternate methods also provide high-effectiveness rates for avoiding and achieving pregnancy and remain cost effective, although they do require multiple educational interventions.
Studies have been conducted on the efficacy of educating women on the Billings Ovulation Method in diverse populations [4].However, studies done in larger and more diverse populations are important to continue demonstrating general applicability of the FABMs. Similarly, additional long-term studies of the Standard Days Method can further evaluate the effectiveness of an educational intervention and assess the relationship between usage duration and unintended pregnancy rates.
[1] Ramesh J, Chandrababu R. Community-based educational intervention on Necklace Method as a natural family planning amongst reproductive age group women in India. Int J Nurs Sci. 2018;5(1): 29-32. doi:10.1016/j.ijnss.2017.12.009
[2] Duane M, Stanford JB, Porucznik CA, Vigil P. Fertility Awareness-Based Methods for Women’s Health and Family Planning. Front Med (Lausanne). 2022;9:858977. Published 2022 May 24. doi:10.3389/fmed.2022.858977
[3] Arévalo M, Jennings V, Sinai I. Efficacy of a new method of family planning: the Standard Days Method. Contraception. 2002;(65): 333–338. doi:10.1016/S0010-7824(02)00288-3
[4] Bhargava H, Bhatia JC, Ramachandran L, Rohatgi P, Sinha A. Field trial of billings ovulation method of natural family planning. Contraception. 1996;53(2):69-74. doi:10.1016/0010-7824(95)00269-3
[5] Frank-Herrmann P, Heil J, Gnoth C, et al. The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple’s sexual behaviour during the fertile time: a prospective longitudinal study. Hum Reprod. 2007;22(5):1310-1319. doi:10.1093/humrep/dem003
ABOUT THE AUTHOR
Mariana Rodriguez Duran
Mariana Rodriguez Duran is a fourth-year medical student at Emory University in Atlanta, Georgia. She participated in the FABM elective through FACTS during her third-year of medical school and is a FACTS Ambassador. Throughout her education and career, she looks forward to helping educate patients, physicians, residents, and medical students on FABMs.
