The Institute for Reproductive Health, Georgetown University

This report is based on a study conducted to research the potential of socially-marketing the Standard Days Method (SDM) in three countries. SDM is a relatively new method of natural family planning that helps couples to recognise when they are most fertile. Most women who use this method use special colour-coded beads called CycleBeads to help keep track of where they are in their cycles. The study, conducted in Ecuador, Benin, and the Democratic Republic of the Congo (DRC), sought to assess the feasibility of providing the SDM through social marketing programmes in different contexts, and evaluate the impact of mass media campaigns on knowledge, sales and distribution, and quality of information provided by pharmacists. In each country a social marketing campaign was conducted to raise awareness of the SDM and the benefits of CycleBeads. The study found that the social marketing campaign succeeded in raising awareness of the SDM in all three countries, but was most successful in countries in which television augmented information provided by clinics and other sources.

According to the study, the mass media campaign increased knowledge of the SDM in all three countries, with substantial increases observed in the endline survey compared to the baseline in Ecuador (from 5% to 30%) and Benin (35% to 64%). Television was the major source of information about the SDM in Ecuador, while in Benin it was both television and clinic personnel. In DRC, where television was not used, the clinic was the major source of information. In both Benin and Ecuador, more than a quarter of the SDM clients were new family planning users. Very few were using family planning in the months preceding SDM use.

Sales of CycleBeads by pharmacies and clinics were also influenced by the campaigns in all three countries, and increased awareness was accompanied by a dramatic rise in CycleBeads sales. In Ecuador, clinics sold more CycleBeads; but pharmacy sales increased substantially as a result of the campaign, and they remained high following the campaign while clinic sales returned to their pre-campaign level. Benin had the highest sale of CycleBeads among the three countries, and clinic sales continue to increase at the end of the campaign, while pharmacy sales started to drop.

In all three countries, women preferred to obtain the SDM at the clinic, though an increased number of women cited the pharmacy in the endline survey. In addition, the simulated client visits and follow-up of SDM users demonstrated that socially marketing the SDM through pharmacies is a feasible and successful strategy. A major concern that women voiced, however, was that pharmacists do not have time to properly instruct women on the method. Even though pharmacists gave less information about the SDM, results from the users follow-up showed no difference in client ability to use the method correctly.

The report suggests that more research is needed on the most appropriate training strategies and service delivery protocol for pharmacies to achieve optimal information exchange within the constraints of the pharmacy setting. It also states that the results of the study could lead to considering the following larger issues in these and other countries, such as how to:

• foster commitment to the SDM among the Ministry of Health, non-governmental organisations, and participating clinics and commercial retailers, i.e. development of a cost-recovery programme to support sustained provision of CycleBeads;
• identify and put into practice strategies for successful community education/mobilisation regarding the SDM i.e. counseling and distribution of the SDM by community agents from the private and public sector; and
• explore the potential for eventual expansion of social marketing of the SDM.

Population and Health InfoShare website on March 30 2009.