Evaluation of an mHealth SMS dialogue strategy to meet women’s and couples’ postpartum contraceptive needs in Kenya (Mobile WACh XY): A randomized controlled trial

Abstract

Objective: To evaluate the effect of a two-way SMS intervention on postpartum contraceptive use among individual women and couple dyads. Methods: Mobile WACh XY was an unblinded randomized controlled trial conducted in two public county hospitals in western Kenya. Pregnant, HIV-negative women at least 14 years of age with estimated gestational age ≥28 weeks who had access to a mobile phone, were able to read and respond to SMS, and intended to remain in the area until trial completion were included. Women were randomly assigned (1:1) to receive two-way SMS or control (no SMS). Prior to randomization, partnered women had the option to refer male partners; if referred, study staff approached men for enrollment. Family planning (FP)-focused SMS messages were delivered weekly from enrollment to 6 months postpartum, and the SMS platform enabled SMS dialogue with a nurse. Follow up visits occurred at 6 and 14 weeks and 6 months postpartum. The primary outcome, self-reported highly effective contraceptive (HEC) use at 6 months postpartum, was compared between groups by the 2 test, and Poisson regression with robust standard errors was used in adjusted analysis. Results: We enrolled 260 women (130 to each group), and 254 women were included in the analysis. Median maternal age was 23 (IQR 20-26.5), and 198 women (76.2%) were partnered, of whom 153 referred male partners for trial inclusion. Of these, 103 men were enrolled. At 6 months postpartum, 69.9% women who received two-way SMS were using HEC, compared with 57.4% in the control group. In an analysis adjusted for baseline differences in education, parity, and desire for future children, the adjusted risk ratio for HEC use was 1.26, 95% CI 1.04-1.52, p=0.02. Conclusions: This two-way SMS intervention focused on FP education and counseling led to increased HEC use at 6 months postpartum among women and couples in Kenya.