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

Elizabeth Harrington | 2017

Advisor: Grace C. John-Stewart

Research Area(s): Global Health, Maternal & Child Health



To evaluate the effect of a two-way SMS intervention on postpartum contraceptive use among individual women and couple dyads.


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.


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.


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.