Male Involvement with the Standard Days Method: A Review of Research
By: Avina Duong, DO
Director’s Note: As we celebrate National Marriage Week, we are featuring a summary of research published in World Health & Population titled, “Engaging Men in Family Planning Services Delivery: Experiences Introducing the Standard Days Method in Four Countries.”  Dr. Avina Duong, a former FACTS elective participant, summarized research exploring the role of men in family planning decision making. Investigating the use of the Standard Days Method (SDM) in four countries, the study discusses benefits of providing counseling in fertility and family planning methods to male partners. The study also explores outcomes of various education approaches, including specific effects of male counseling offered by other males.
Prior to the 1994 International Conference on Population and Development (ICPD) in Cairo, females were responsible for family planning decision making. The ICPD ignited a movement encouraging men to participate in family planning to achieve better reproductive health goals. Subsequent strategies to involve men in family planning included male and couple education and counseling, increasing male healthcare professionals, catering to male work schedules, and gender sensitivity training. In a review of studies on couples and family planning, interventions that involved both males and females were more effective compared to those aimed solely at women. This included improved outcomes in contraceptive use, pregnancy, and pregnancy avoidance. A study in 2007 also found that providing reproductive health counseling to couples resulted in more positive attitudes, gender equity, and better partner communication.
“In a review of studies on couples and family planning, interventions that involved both males and females were more effective compared to those aimed solely at women. This included improved outcomes in contraceptive use, pregnancy, and pregnancy avoidance.”
During that time, new contraceptive and family planning methods were being developed. In 2003, the Standard Days Method was introduced to 30 countries, and it was used regularly in 16 countries. The Standard Days Method, a modern method developed by Georgetown University’s Institute for Reproductive Health (IRH), uses color-coded beads to monitor cycle length as well as fertile and “safe” days in women with 26-32-day cycles. Unprotected intercourse is avoided from days 8 to 19. The SDM helps women identify their fertile days and offers an opportunity to involve men in family planning.
The study by Lundgren and colleagues followed four SDM projects in four countries from 2001 to 2006 that utilized various methods to include male partners in family planning.
- In El Salvador, the IRH collaborated with Project Concern International (PCI) to train male staff and volunteers of a water and sanitation program through health education, emphasizing the relationship between fertility and natural resources. The male workers received two home visits by PCI volunteers. In the first visit, they discussed health resources and benefits of family planning for couples. The second visit provided content regarding fertility, the menstrual cycle, and family planning methods. To evaluate the effectiveness of this project, baseline and end surveys were analyzed.
- Family planning in Uttar Pradesh, India through CARE India was tested through research comparing information provided to female residents by female volunteers versus males providing counseling to both female and male residents. Both groups received home visits to review the use of SDM beads and provide counseling.
- In the Philippines, SDM was introduced to farmers and agrarian reform beneficiaries through the Kaanib Foundation. Male involvement was tested through two groups: one counseled by couples, the other counseled by men.
- The Guatemalan Highlands developed a project which used posters, radio, and TV interviews given by men to target men. The projects emphasized supporting a wife’s family planning methods, helping her identify fertile days, and abstaining from intercourse on fertile days.
Analysis of the survey data from El Salvador revealed that male participants demonstrated a higher knowledge of male fertility and contraceptive methods compared to non-participants. Health promoters also described increased acceptability of family planning discussions and increased male engagement in conversation. In terms of SDM use, females who were counseled with their partner had fewer pregnancies than those whose husbands were not present.
Interviews conducted in India revealed that men claimed to have better understanding of SDM methods because it was explained by a male. The volunteers also had improved attitudes regarding family planning. Compared to the female-provider group, twice as many males who were counseled by male providers recommended SDM; they felt they were more comfortable discussing sexual issues. The experimental group had higher rates of long-term use and continuation, and lower rates of incorrect use and pregnancy.
“Compared to the female-provider group, twice as many males who were counseled by male providers recommended the Standard Days Method; they felt they were more comfortable discussing sexual issues.”
In the Philippines, SDM knowledge at the end of the study from the group counseled solely by males was not significantly different from the group counseled by couples. In both groups, over 90% of users were able to explain the method. Furthermore, positive changes in attitudes and communication from males were found in both groups.
SDM user statistics and interviews following the research in Guatemala suggested male counseling had increased male engagement in family planning.
The article by Lundgren et al reviewed the positive effects of males providing counseling in fertility, knowledge of family planning and contraceptive methods, attitudes and communication. The studies were completed in four countries and could suggest this assessment is a good representation globally. However, variabilities in demographics, population, and analysis methods lead to more questions and point to the need for further research.
Male engagement can be measured in other ways aside from males being counseled by other males. For example, engagement can be assessed through populations that receive indirect education of family planning methods. Research can determine if there is a change in male engagement in developed or developing countries. Differences in cultural norms and gender roles may affect the outcomes. Perhaps a pressing question is how male engagement differs when the male partner is present with the female at family planning sessions compared to a verbal summary from the woman.
“A pressing question is how male engagement differs when the male partner is present with the female at family planning sessions compared to a verbal summary from the woman.”
This review observed results from a variety of methods like surveys and interviews. Consistent use of one data method will help emphasize the positive results of these studies. For example, use of standardized testing can better gauge an increase in knowledge. Surveys from the female partner can provide a more objective view of improved attitudes and communication.
 Lundgren R, Cachan J, Jennings V. Engaging Men in Family Planning Services Delivery: Experiences Introducing the Standard Days Method in Four Countries. World Health & Population. 2012;14:44-51.
ABOUT THE AUTHOR
Avina Duong, DO
Avina Duong, DO is a family medicine resident at HCA Oak Hill Hospital in Brooksville, FL. She recently graduated from the Philadelphia College of Osteopathic Medicine in Suwanee, GA. She completed an undergraduate degree in health sciences at the University of South Florida. Dr. Duong has a special interest in women’s health and lifestyle medicine. She enrolled in the FACTS elective as a fourth-year medical student to learn more about natural family planning methods to give her patients the tools they need to understand their reproductive health and feel more empowered to make medical decisions.