Using mHealth to Support Postabortion Contraceptive Use: Results From a Feasibility Study in Urban Bangladesh

Abstract

BackgroundAs access to mobile technology improves in low- and middle-income countries, it becomes easier to provide information about sensitive issues, such as contraception and abortion. In Bangladesh, 97% of the population has access to a mobile signal, and the equity gap is closing in mobile phone ownership. Bangladesh has a high pregnancy termination rate and improving effective use of contraception after abortion is essential to reducing subsequent unwanted pregnancies.ObjectiveThis study examines the feasibility and acceptability of implementing a short message service (SMS) text message-based mHealth intervention to support postabortion contraceptive use among abortion clients in Bangladesh, including women’s interest in the intervention, intervention preferences, and privacy concerns.MethodsThis feasibility study was conducted in four urban, high abortion caseload facilities. Women enrolled in the study were randomized into an intervention (n=60) or control group (n=60) using block randomization. Women completed a baseline interview on the day of their abortion procedure and a follow-up interview 4 months later (retention rate: 89.1%, 107/120). Women in the intervention group received text message reminders to use their selected postabortion contraceptive methods and reminders to contact the facility if they had problems or concerns with their method. Women who did not select a method received weekly messages that they could visit the clinic if they would like to start a method. Women in the control group did not receive any messages.ResultsAlmost all women in the feasibility study reported using their mobile phones at least once per day (98.3%, 118/120) and 77.5% (93/120) used their phones for text messaging. In the intervention group, 87% (48/55) of women were using modern contraception at the 4-month follow-up, whereas 90% (47/52) were using contraception in the control group (P=.61). The intervention was not effective in increasing modern contraceptive use at follow-up, but 93% (51/55) of women reported at follow-up that the text reminders helped them use their method correctly and 76% (42/55) said they would sign up for this service again. Approximately half of the participants (53%, 29/55) said that someone they did not want to know about the text message reminders found out, mostly their husbands or children.ConclusionsIn this small-scale feasibility study, text reminders did not increase postabortion contraceptive use. Despite the ineffectiveness of the text reminder intervention, implementation of a mHealth intervention among abortion clients in urban Bangladesh was feasible in that women were interested in receiving follow-up messages after their abortion and mobile phone use was common. Text messages may not be the best modality for a mHealth intervention due to relatively low baseline SMS text message use and privacy concerns.

Developing mHealth Messages to Promote Postmenstrual Regulation Contraceptive Use in Bangladesh: Participatory Interview Study

“…Reminders were seen as particularly useful for those women using short-term methods, as they knew that forgetting to use the method would have an impact on its effectiveness. In 2013, a pilot study tested the feasibility of using a simple, one-way SMS to send contraceptive reminders to menstrual regulation clients in Bangladesh, of which 93% (51/55) of women reported that the SMS helped them use their method correctly [ 25 ].…”

“…Voice messages may be preferential in terms of effort expectancy and ease of use for the women; however, information shared in an automated call has to be received at when it is delivered, rather than when the individual is ready as is the case with SMS or pull-type interventions such as call centers. The desire to have a number to call for information was expressed in similar studies in Bangladesh [ 25 , 30 ]. Women receiving mobile phone messages about reproductive health could be given the option of connecting to the call center.…”

Effectiveness of mHealth Interventions for Improving Contraceptive Use in Low- and Middle-Income Countries: A Systematic Review

“…17 Several interventions have been implemented to assess whether mHealth technologies could be used to help reduce unmet contraceptive needs in LMICs by attempting to increase the uptake of modern contraceptive methods. [18][19][20][21][22][23][24][25] Three published reviews [26][27][28] explored the effectiveness of mHealth interventions for different contraceptive outcomes. Smith et al 28 assessed the effect of interventions delivered via mobile phone for improving contraceptive use in 5 randomized controlled trials (RCTs) conducted in the United States, Cambodia, and Israel.…”

Developments in Privacy and Data Ownership in Mobile Health Technologies, 2016-2019

“…Still other authors noted this dichotomy within their reported results with some participants expressing significant privacy concerns and others stating it to not be an issue [146,147]. While some users expressed such concerns related to collection of highly sensitive-data, such as that related to behavioral health, reproductive health, or HIV status [135,[148][149][150][151], other users who provided such data still reported little unease related to their privacy [139,142,[152][153][154]].…”

“…User concern with privacy of personal data collected by mobile health apps is widely variable. In some studies, data privacy and security was cited as of primary concern or importance [74,134,138], while in others, users expressed very little concern [125,[139][140][141][142][143][144][145]. Still other authors noted this dichotomy within their reported results with some participants expressing significant privacy concerns and others stating it to not be an issue [146,147].…”