The effects of text reminders on the utilization of family planning services: Evidence from a randomized controlled trial in urban Mozambique

Abstract

Introduction: Reduction of unmet need for contraception is associated with enhanced health outcomes. We conducted a randomized controlled trial in urban and peri-urban Mozambique to analyze the effects of text message reminders encouraging utilization of clinic-based family planning services within a sample of women who received clinic referrals from community health workers. Methods: This trial was conducted within a sample of women served by one organization (Population Services International) implementing the Integrated Family Planning Program (IFPP), in which community health workers provide information and clinic referrals to women who report interest in contraception. The evaluation enrolled 5,370 women between January 20 and December 18, 2020 who received a referral, reported access to a mobile phone, and provided written consent. Women were randomly assigned to a treatment group that received a series of eight text message reminders over a month encouraging them to follow up with a clinic visit, or to a control group receiving status quo follow-up. An intention-to-treat analysis was conducted using administrative data to analyze the effect of reminders on the probability of a clinic visit and contraceptive uptake following counseling. The final analysis includes 3,623 women enrolled; 1,747 women were lost to follow-up. Results: Women assigned to receive the text reminders are weakly more likely to visit a clinic (risk difference 2.3 percentage points, 95% CI: -0.003—0.048, p=0.081), and to receive a contraceptive method at a clinic (2.2 percentage points, 95% CI: -0.004—0.048, p=0.091), relative to a base rate of 48.0% and 46.9%, respectively. The effect on clinic visits is larger and statistically significant in the prespecified subsample of women enrolled prior to the COVID-19 related state of emergency (3.2 percentage points, 95% CI: 0.001—0.063, p=0.042). Conclusion: Evidence from this trial suggests that text message reminders may be a promising nudge that increases the probability that women received contraception.