An mHealth SMS intervention on Postpartum Contraceptive Use Among Women and Couples in Kenya: A Randomized Controlled Trial

Abstract

Objectives. To assess the effect of 2-way short message service (SMS) with a nurse on postpartum contraceptive use among individual women and couples. Methods. From 2016 to 2017, we conducted a randomized controlled trial at 2 public hospitals in western Kenya. We assigned eligible pregnant women to receive 2-way SMS with a nurse or no SMS, with the option to include male partners. We delivered automated family planning-focused SMS messages weekly until 6 months postpartum. Women and men receiving SMS could interact with nurses via SMS. In intention-to-treat analysis, we compared highly effective contraceptive (HEC) use at 6 months postpartum between groups using the χ2 test. We used Poisson regression in adjusted analysis. Results. We randomized 260 women to 2-way SMS or control, and we enrolled 103 male partners. At 6 months postpartum, 69.9% women receiving SMS reported HEC use, compared with 57.4% in control (relative risk = 1.22; 95% confidence interval [CI] = 1.01, 1.47; P = .04). In analysis adjusted for baseline demographic differences, the adjusted relative risk for HEC use in the SMS group was 1.26 (95% CI = 1.04, 1.52; P = .02). Conclusions. Two-way SMS with a nurse, including optional male participation, increased postpartum contraceptive use. Trial Registration. ClinicalTrials.gov; identifier: NCT02781714.

Figures

FIGURE 1—

CONSORT Flow Diagram for the Mobile WACh XY Randomized Controlled Trial: Kenya, 2016–2017 Note. SMS = short message service. aReasons for ineligibility (participants could choose more than 1 reason, so percentages do not add up to 100%): gestational age less than 28 weeks: 155 (46%); no daily access to mobile phone: 95 (28%); no Safaricom SIM: 40 (12%); does not know phone number: 15 (4%); unwilling to receive SMS: 4 (1%); receiving antenatal care elsewhere: 60 (18%); other research study: 31(9%); HIV positive: 4 (1%); younger than 14 years: 2 (0.5%). bThirty-one of 51 wanted to consult a spouse or return for enrolment at another time; some of these participants may have been rescreened and enrolled in the study. cTwo participants who were included in the analysis stopped the SMS intervention upon their request.

FIGURE 2—

Probability of Family Planning (FP) Initiation Over Time Since Delivery: Kenya, 2016–2017 Note. SMS = short message service.