JMIR Publications

ABSTRACT

Background:

Researchers and activists have expressed concerns over the unavailability and non-use of reversible modern contraceptive methods in India since decades. New attempts to increase access, availability and acceptance of reversible contraceptives, instead of sole reliance on female sterilization, need to be developed. mHealth initiatives may offer one way to serve the underprivileged populations in countries like India, with challenges in sexual and reproductive health (SRH).

Objective:

To examine the outcome of a mHealth intervention in enhancing knowledge and practice of reversible contraceptives in rural western India.

Methods:

We implemented a non-randomized controlled trial (before-and-after study in an intervention area and control area) in the Indian state of Maharashtra. The intervention in this case was a mobile-based SRH helpline provided by a non-governmental organization (NGO). Baseline and follow-up surveys were carried out in two government run primary health centre (PHC) areas one each in the intervention and control area and 405 respondents were surveyed in the two rounds respectively. Interview-based structured questionnaire that suits 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 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% confidence interval is reported here. This exponent corresponds to the odds. Calls received in the intervention were recorded and their topics analysed.

Results:

The current use of reversible contraception (18% increase in intervention area versus 2% increase in control area; 95% CI) has seen changes. The proportion of respondents who had heard of contraception method from an NGO rose in the intervention area by 23%, while 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.