Mobile Helpline and Reversible Contraception: Lessons From a Controlled Before-and-After Study in Rural India

Abstract

Background Researchers and activists have expressed concerns over the lack of availability and nonuse of reversible, modern, contraceptive methods in India for decades. New attempts to increase access, availability, and acceptance of reversible contraceptives need to be developed, instead of relying solely on female sterilization. Mobile health (mHealth) initiatives may offer one way to serve underprivileged populations who face challenges in sexual and reproductive health (SRH) in countries such as India. Objective This study aimed to examine the outcome of an mHealth intervention for enhancing knowledge of, and practices related to, reversible contraceptives in rural Western India. Methods We implemented a nonrandomized controlled trial (before-and-after study in an intervention area and a control area) in the Indian state of Maharashtra. The intervention in this case was a mobile-based SRH helpline provided by a nongovernmental organization (NGO). Baseline and follow-up surveys were carried out in two government-run primary health center areas, one each in the intervention and control area, and 405 respondents were surveyed in the two rounds. An interview-based structured questionnaire suitable for a low-literacy environment was used to collect data. The effect of the intervention was estimated using logistic regression, adjusted for gender, by calculating robust standard errors to take into account the clustering of individuals by the area (intervention or control). In each regression model, the effect of intervention was estimated by including a term for interaction between the intervention area and the period before and after the intervention. The exponent of the regression coefficient of the interaction term corresponding to the period after the intervention, along with the 95% CI, is reported here. The odds ratio for the control village multiplied by this exponent gives the odds ratio for the intervention village. Calls received in the intervention were recorded and their topics analyzed. Results The current use of reversible contraception (18% increase in intervention area vs 2% increase in control area; 95% CI) has seen changes. The proportion of respondents who had heard of contraception methods from an NGO rose in the intervention area by 23% whereas it decreased in the control area by 1% (95% CI). However, the general level of awareness of reversible contraception, shown by the first contraceptive method that came to respondents’ mind, did not improve. Demand for wider SRH information beyond contraception was high. Men and adolescents, in addition to married women, made use of the helpline. Conclusions A mobile helpline that one can confidentially approach at a time most convenient to the client can help provide necessary information and support to those who need reversible contraception or other sexual health information. Services that integrate mHealth in a context-sensitive way to other face-to-face health care services add value to SRH services in rural India.

Nothing so practical as theory: a rapid review of the use of behaviour change theory in family planning interventions involving men and boys

“…We identified several examples of interventions and programmes that detailed a novel theory of change, developed in tailored way for a specific intervention. One example of this was applied by Kulathinal and colleagues [ 49 ]. This intervention drew on a theory of change developed through desk-based research that identified three key issues in contraceptive uptake: a lack of information, gender bias, and unavailability or inaccessibility of contraceptives.…”

Using e-vouchers to promote use of a family planning call center: A comparative interruptive time series analysis

“…Taking advantage of the rapid increase in phone access, family planning programs in several countries have started to use call centers to increase access to quality sexual and reproductive health information (Antillon et al, 2022; Corker, 2010; Kulathinal et al, 2019). In Nigeria, DKT’s Honey&Banana call center provides confidential family planning information and counseling, free of charge.…”

“…Research on smoking cessation hotlines has consistently shown that offering incentives, such as free nicotine patches or gum, substantially increases call volumes to these quitlines (An, Schillo, Kavanaugh, Luxenberg, et al, 2006; An, Schillo, Kavanaugh, Lachter, et al, 2006; Anderson, Kirby, Tong, Kohatsu, & Zhu, 2018; Bauer, Carlin-Menter, Celestino, Hyland, & Cummings, 2006; Cummings et al, 2006; Hood-Medland et al, 2018; Momin et al, 2014; Tong et al, 2023; Vijayaraghavan et al, 2018). Although several organizations operate family planning call centers (Antillon, Webbe, & Husken, 2022; Corker, 2010; Kulathinal, Joseph, & Saavala, 2019; Yagnik et al, 2015), to the best of our knowledge, there are no studies that examine whether e-vouchers can be effective for increasing use of such family planning hotlines.…”

Effect of smartphone-based education on knowledge and self-care of reproductive health in married students

“…The study by Kulathinal et al . [ 27 ] showed that the use of reversible contraceptive methods (18% increase in the intervention area versus 2% increase in the control area) increased using mobile application. The results of this study are consistent with the present research on general self-care.…”