Over the counter provision of a fertility awareness-based method: Can pharmacy clients use it correctly? Claudia Velasquez, MPH; Trinity Zan, BA; Josephat Avocet, MD; and Dido Bolekela, MA Many couples risk unplanned pregnancy due to inaccessible or poor quality services. Programs and policy makers are challenged to provide a greater variety of services to an increasing number of users with fewer resources. Expanding the range of family planning options provided through pharmacies can address unmet need. 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. Conclusions Women who obtained the SDM from a pharmacy were more educated and more likely to have used a method prior to the SDM than clinic users. Women who obtained the SDM in pharmacies as well as clinics used the method correctly and were very satisfied with the method. A study comparing pharmacy and clinic clients conducted in Benin provided information on SDM use and acceptability. Research Questions How does the profile of women who obtain the SDM from clinics compare to the profile of those who purchase the method from pharmacies? Is there a difference in correct use between pharmacy and clinic SDM users? Are women who obtain the SDM in pharmacies as satisfied with the method as those who obtain the method in clinics? Study Background Methods A total of 79 pharmacy and 219 clinic SDM users were admitted into the study and followed for six months. This cohort of new SDM users was interviewed during home visits conducted after months 1, 3, and 6 of method use. Follow-up data from the pharmacy SDM users was compared to data from the clinic users. Benin Sites: Cotonou, Parakou, and Djougou 4 clinics and 24 pharmacies Organizations participating in study: PSI Pharmacy Network PSI Network Clinics Ministry of Health (MOH) ABPF (IPPF affiliate) OSV-Jordan (NGO) HOMEL (MOH Hospital) SDM Training for Clinic Providers and Pharmacists Results Training: One day SDM training workshop for clinic based providers, pharmacists and pharmacy dependents. Learning Objectives:  Basics of the method  Eligibility Criteria  User instructions  Couple Communication  Follow-up Job Aides  SDM 5 point service protocol for pharmacists and their dependents  SDM counseling manual and eligibility criteria checklist  CycleBeads insert Study Sample ClinicPharmacy Received the method Admitted into study21979 Pregnancies214 Lost-to-follow-up200 Discontinuations (stopped using SDM or no longer eligible to continue in study) 3329 Completed study (still using SDM when study ended) Note: Both clinics and pharmacies offered the SDM. Many clients received the method but not all wanted to or were eligible to participate in the study. Profile of Clinic and Pharmacy Users Clinic n=219 Pharmacy n=79 Age (SD) 29.4 (7.74) 29.9 (6.24) Educational level None Primary Secondary Technical University* % % Parity (SD) 2.05 (1.95) 1.97 (1.46) Previous contraceptive use**67.1%84.8% Conceptive use 2 months prior to SDM86.1%82.3% *Significant difference (p≤0.05); **Significant difference (p≤0.05) Introduction Clinic and pharmacy SDM users were on average 29 years old, had 2 children, and the majority had used a method two months prior to starting the SDM. However, pharmacy users were more educated and had higher previous use of a family planning method than clinic SDM users. Can women use the method correctly? Comparison of indicators of correct use measured after three cycles show there is no significant difference between clinic and pharmacy users. How satisfied are SDM users? Satisfaction, measured by the desire to continue using the SDM after cycle 4, was very high among both women and men. No significant difference was found between clinic and pharmacy users. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Clinic (n=157) Pharmacy (n=55) Black ring on correct bead Avoided unprotected sex on white bead days 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Clinic (n=177) Pharmacy (n=42) Wife wants to continue SDM use Husband wants to continue SDM use Recommendations Access to the SDM should be expanded through pharmacies.