TwoDay Method: A Quick Start Approach

Women requesting a family planning method expect to get it there and then. Asking them to return when they menstruate is a medical barrier that can result in unwanted pregnancies. The literature demonstrates that a quick start approach to providing oral contraceptives and IUDs – where women receive the method of their choice regardless of timing in the cycle -- is feasible, acceptable, and does not reduce method effectiveness. We describe a study to test a similar approach to providing the TwoDay Method, a new fertility awareness-based method of family planning, based on the daily identification of the presence or absence of cervical secretions. The current protocol requires that users be counseled and initiate method use during the first week of their menstrual cycle, before the onset of secretions.

A study in Peru assessed a quick start approach to providing the TwoDay Method. Participants received counseling when they requested the method, regardless of time in the cycle. The study tested whether users who receive counseling later in the cycle could use the method successfully, and assessed the acceptability of this approach to providers. Simulated client visits show that providers adapted to the new protocol easily. Some 200 users were followed quarterly for seven months of method use. Preliminary analysis suggests that the time in the cycle in which users are provided the method (counseled in method use) does not influence correct use. We conclude that a quick start approach to providing the TwoDay method is a feasible option.