Objectives. To assess the effect of 2-way short message service (SMS) with a nurse on postpartum contraceptive use among individual women and couples.

Methods. From 2016 to 2017, we conducted a randomized controlled trial at 2 public hospitals in western Kenya. We assigned eligible pregnant women to receive 2-way SMS with a nurse or no SMS, with the option to include male partners. We delivered automated family planning–focused SMS messages weekly until 6 months postpartum. Women and men receiving SMS could interact with nurses via SMS. In intention-to-treat analysis, we compared highly effective contraceptive (HEC) use at 6 months postpartum between groups using the χ2 test. We used Poisson regression in adjusted analysis.

Results. We randomized 260 women to 2-way SMS or control, and we enrolled 103 male partners. At 6 months postpartum, 69.9% women receiving SMS reported HEC use, compared with 57.4% in control (relative risk = 1.22; 95% confidence interval [CI] = 1.01, 1.47; P = .04). In analysis adjusted for baseline demographic differences, the adjusted relative risk for HEC use in the SMS group was 1.26 (95% CI = 1.04, 1.52; P = .02).

Conclusions. Two-way SMS with a nurse, including optional male participation, increased postpartum contraceptive use.

Trial Registration. ClinicalTrials.gov; identifier: NCT02781714.


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Elizabeth K. Harrington, MD, MPH, Alison L. Drake, PhD, MPH, Daniel Matemo, MPH, Keshet Ronen, PhD, MPH, Alfred O. Osoti, MBChB, MMed, MPH, Grace John-Stewart, MD, PhD, John Kinuthia, MBChB, MMed, MPH, and Jennifer A. Unger, MD, MPHElizabeth K. Harrington and Jennifer A. Unger are with the Department of Obstetrics & Gynecology, University of Washington, Seattle. Alison L. Drake, Keshet Ronen, Grace John-Stewart, and Jennifer A. Unger are with the Department of Global Health, University of Washington, Seattle. Grace John-Stewart is also with the Departments of Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle. Alfred O. Osoti is with the University of Nairobi, Nairobi, Kenya. Daniel Matemo and John Kinuthia are with the Kenyatta National Hospital, Nairobi, Kenya. “An mHealth SMS intervention on Postpartum Contraceptive Use Among Women and Couples in Kenya: A Randomized Controlled Trial”, American Journal of Public Health 109, no. 6 (June 1, 2019): pp. 934-941.


PMID: 31067089