Over the counter provision of a fertility-awareness based method: Can pharmacy clients use it correctly?

Many couples risk unplanned pregnancy due to inaccessible or poor quality services. Program managers and policy makers now recognize the need to provide a greater variety of services to an increasing number of users with reduced resources. Efforts to address unmet need must expand access to family planning options, Many couples rely on pharmacies as their main source of health care. Successful over-the-counter provision of oral contraceptives has been documented in several settings. No similar information exists on the feasibility of providing the Standard Days Method (SDM) and its accompanying visual tool, CycleBeads®, in pharmacies or on the ability of clients to use it correctly. A study comparing pharmacy and clinic clients conducted in the Democratic Republic of the Congo and Benin provides information on SDM use. These clients purchased CycleBeads from pharmacies supported by Population Services International (PSI) and public and private clinics. A total 162 pharmacy and 420 clinic clients were admitted into the study and followed quarterly for six months. Results suggest that in both countries it is equally feasible to offer the SDM via pharmacies and clinics; clients found the method simple to learn and use; most couples decided to use a combination of abstinence and barrier method on fertile days; and most users were satisfied with the method and found that it improved the couple's relationship. Recommendations for program managers wanting to expand access to family planning through pharmacy networks will be discussed, as well as implications for national policies regarding family planning service delivery.