1. Kate Lairmore
May 13, 2015
mHealth for Family Planning

2. Outline
! Background
! Unmet need & family planning programs
! What is mHealth?
! Aim
! Methods
! Results
! Key considerations for development &
implementation
! Conclusions

3. Global Unmet Need for Family
Planning (a very brief overview)
! 225 million married women have an unmet need for
contraception (+ unmarried women)
" Unwanted pregnancies, unsafe abortions, poorer maternal
and reproductive health outcomes, higher maternal mortality
" Highest unmet need typically found in low-income countries,
many of them in Africa
! Access to contraceptives on the global stage:
" Overpopulation, women’s rights, international development
" Ability to control one’s fertility now considered a basic
human right

4. Overall FP Program Structure
Funders:)
Government,*
donors*
Community)
level)Programs:)
Clinics,*service*
providers*
Target)
Popula7on:)
Adults,*
adolescents,*
etc*
Family)Planning)
Outcomes)

5. What is mHealth?
! Mobile Health is the use of mobile and wireless
technologies to support the achievement of health
objectives.
" Can include SMS, IVR, audio, and/or videos, presented on…
" Mobile phones, tablets, or PDAs
! Including, but not limited to…
1.
Client education and BCC
7. Provider-to-provider communication
2. Sensors and point-of-care diagnostics
8. Provider work planning & scheduling
3. Registries and vital events tracking
9. Provider training and education
4. Data collection and reporting
10. Human resource management
5. Electronic health records
11. Supply chain management
6. Electronic decision support
12. Financial transactions & incentives

6. Client Education & Behavior Change
Communication (BCC)
! mHealth strategies focused on the client
" Interacting directly with the intended beneficiary
! Aims to improve people’s knowledge, modify their
attitudes, and change their behavior
" Ex. Encouraging medication adherence or use of health
services

7. My Aim
! Evaluate the potential of mHealth for client
education and BCC in family planning programs
! Focus areas/inclusion criteria:
" Technology: user-owned mobile phones
" Health domain: contraception and sexual and reproductive
health
" Users:
" Women (and men) with an unmet need for family planning
" Specific target population for family planning programs

8. Target Audience of mHealth FP Tools

9. Methods
! Compared unmet need to mobile phone coverage
! Assembled an inventory of mHealth interventions
! Three types of searches:
" Structured search of PubMed and Web of Science for mHealth
and family planning terms
" Online project repositories
" Project & paper recommendations
! Exclusions:
" General health interventions including FP
" MCH… +FP

10. Results
1. Examining unmet need levels and mobile
phone coverage indicates real potential for
mHealth tools to be beneficial in most
countries

12. Results, cont.
2. mHealth tools and strategies for client
education and BCC have been implemented to
increase uptake and awareness of contraceptive
methods and services
! Developed an inventory of tools and projects, then
narrowed it to a table of illustrative examples

13. Illustrative Examples
! Includes information on implementing organizations,
locations, technology, available evidence, and
current status
! Developed a set of six illustrative examples:
" Hotline: Ligne Verte
" SMS-based: Mobile for Reproductive Health (m4RH)
" Voice recordings: Mobile Technology for Improved Family
Planning (MOTIF)
" Warmline (text-based hotline): BrdsNBz
" Text and voice tree: SMS and IVR to Improve Family
Planning Services
" Smartphone app: NaturalCyles

15. Ex. Mobile for Reproductive Health
(m4RH), by FHI 360
! Goal: Improve knowledge and use of long and short
acting family planning methods
! Strategy: Automated SMS tree
" Users text in to the m4RH system, receive menu to navigate
" Question/answer design
" Includes searchable database of FPSPs
! Target users: Men & Women of reproductive age
! Location: Kenya & Tanzania
! Evaluation evidence:
" Effectiveness of providing info via text
" Especially effective for younger audience

16. Six Key Implementation Considerations
1. mHealth is NOT a stand-alone intervention.
" Must be paired with accessible services
" Partnerships and collaboration are essential
" May include: IT firms, regional FP programs, organizations with
similar mHealth experience, governments, local phone services
2. Formative Research is essential when developing mHealth
interventions.
" Cultural reasons: social norms, accurate translation, effectiveness of
messaging
" Communication reasons: build on established communications norms and
pathways
3. Choose the right technology.
" Apps
" SMS and/or voice

17. Six Key Implementation Considerations,
cont.
4. Promotion matters.
5. Content matters.
" Positive, supportive messaging to empower users
" If significant stigma or partner opposition exists, consider
complementary community-wide approach
6. Don’t reinvent the wheel.
" Highly collaborative field with many online resources
" Databases
" Toolkits
" Guides
" Online classes

18. Conclusions
! mHealth strategies are already at work around the
world, and the evidence base is growing…
! …but technology and partnerships are growing
faster, and should be the focus area for developing
new tools and strategies.
! mHealth has great potential to increase awareness
and uptake of modern contraceptive methods by:
" Providing medically accurate health information
" Linking individuals to care
" Reducing stigma & social barriers

19. Acknowledgments
Many, many thanks to:
Dr. Amy Tsui
Dr. Scott Radloff
Jamie Haines
James Bontempo and Heidi Good-Boncana, JHU-CCP
The PopFam staff and faculty
And my PopFamily –
you are PopFabulous.

20. References
1. Darroch JS, G. Ball, H. Contraceptive Technologies: Responding to Women's Needs. New YOrk: Guttmacher Institute;
2011.
2. Singh SD, JE. Ashford, LS. Adding It Up: The Costs and Benefits of Investing in Sexual and Reproductive Health - 2014.
New York: Guttmacher Institute;2014.
3. Corker J. “Ligne Verte” Toll-Free Hotline: Using Cell Phones to Increase Access to Family Planning Information in the
Democratic Republic of Congo. Cases in Public Health Communication & Marketing. 2010;4:23-37.
4. m4RH: Mobile 4 Reproductive Health (booklet). In: 360 F, ed2011.
5. L'Engle KL, Vahdat HL, Ndakidemi E, Lasway C, Zan T. Evaluating feasibility, reach and potential impact of a text
message family planning information service in Tanzania. Contraception. 2013;87(2):251-256.
6. Vahdat HL, L'Engle KL, Plourde KF, Magaria L, Olawo A. There are some questions you may not ask in a clinic:
providing contraception information to young people in Kenya using SMS. Int J Gynaecol Obstet. 2013;123 Suppl 1:e2-6.
7. Smith C, Vannak U, Sokhey L, et al. MObile Technology for Improved Family Planning Services (MOTIF): study protocol
for a randomised controlled trial. Trials. 2013;14:427.
8. Phillips KR. BrdsNBz: a text-messaging forum for improving the sexual health of adolescents in North Carolina. N C
Med J. 2010;71(4):368-371.
9. McQueen SK, S. Palmer, N. Morgan, G. Bitrus, S. Okoko, L. mHealth Compendium, Edition One. Arlington, VA.:
Management Science for Health; November 30 2012.
10. NaturalCycles, the fertility monitor. 2014;
https://itunes.apple.com/us/app/naturalcycles/id765535549?ls=1&mt=8. Accessed May 8, 2015.
11. Berglund Scherwitzl E, Linden Hirschberg A, Scherwitzl R. Identification and prediction of the fertile window using
NaturalCycles. Eur J Contracept Reprod Health Care. 2015:1-6.