Culturally appropriate family planning methods: Counseling Somali refugee women about CycleBeads

Introduction: Minnesota has the largest concentration of Somali refugees in the U.S. Due to historically high fertility rates but decreasing infant mortality rates upon resettlement, family planning has become a critical issue. Focus groups conducted in 2004 revealed that many women do not use modern contraceptive methods due to cultural and religious values about their acceptability. Natural contraceptive methods, however, are widely accepted.

Materials and Methods: A female Somali community health worker (CHW) was trained in the Standard Days Method (SDM), a natural contraceptive method that uses a color-coded necklace—CycleBeads—to teach couples when a woman is fertile. The CHW conducted in-home, individual counseling sessions about SDM with Somali women. CycleBeads were distributed to eligible women. After three months, the CHW conducted follow-up visits to track usage. The project collaborated with Georgetown University Institute for Reproductive Health to develop a Somali instructional insert and educational video about CycleBeads for use during counseling sessions.

Results: Forty-three counseling sessions were conducted over 9 months. 100% of women were eligible for SDM and began using CycleBeads. Of 23 women contacted during follow-up, 83% planned to continue using CycleBeads. Those discontinuing use did so because their partners no longer lived with them, not because they disliked the method or found it difficult to use. Only one woman became pregnant.

Conclusion: Quality counseling and a same-gender, Somali CHW resulted in high acceptance, continuation, efficacy, and cultural acceptability of SDM. This project may be replicable in other populations where modern methods are not widely accepted.