There are over 200 million women around the world who do not wish to become pregnant and who are not currently using contraception. Helping women to avoid unplanned pregnancies is a best bet in development: It reduces maternal and child death and injury, helps girls stay in school longer, and results in economic growth.
Women often encounter challenges to accessing and using contraception. They may live far from a health facility or pharmacy; the cost of methods may be beyond their reach; the method they want to use may not be in stock when they arrive; or they may experience side effects that they find unacceptable. And these challenges are amplified by crises such as natural disasters or health emergencies like the COVID-19 pandemic, when we saw travel restrictions and health worker shortages negatively impact individuals’ ability to access family planning services.
FHI 360 has been working to increase access to family planning services for over 50 years. As one of the first organizations to provide family planning information to people in low- and middle-income countries via text message, we helped to show this approach has real promise. Over the past 10 years, more organizations have followed suit and more evidence has been generated — but technology continues to evolve, and research tends to lag behind.
Exploring the potential of smartphones
Now, more and more people own and use cell phones — more than half of the population in low- and middle-income countries is using mobile internet and smartphone ownership is rapidly expanding. We are exploring how we can optimize the use of these devices to connect people to family planning information and services via what many are calling digital self-care.
Current evidence suggests that older technologies like SMS and information hotlines can increase people’s knowledge about family planning. Now, FHI 360 researchers are looking toward the next generation — information and links to services provided by AI-powered chatbots, geo-located services, telehealth and online ordering — to find out whether these newer technologies can perhaps do more, helping people to find, obtain and use family planning methods.
Generating new evidence on new technologies
FHI 360’s Research for Scalable Solutions project is conducting studies in India, Rwanda and Côte d’Ivoire to better understand how digital self-care might increase family planning knowledge, access and use. In Côte d’Ivoire, we partnered with PSI on its Counseling for Choice chatbot, a digital tool which engages users on WhatsApp and Facebook in a conversation about their preferences and family planning needs and offers information. Our goal was to see if chatbots increase knowledge about family planning and reproductive health, shift norms or successfully motivate users to take up a family planning method.
The study found that most Counseling for Choice chatbot users, who were under 25, self-reported feeling more confident and capable to discuss family planning issues with partners and health care providers after interacting with the chatbot. Data also suggested that people wanted to know more about method side effects, which are key to helping people choose the right method and reducing discontinuation. This study helps us understand that chatbots may be feasible and acceptable tools for offering family planning information and it is informing how PSI and other organizations scale up these types of digital self-care interventions.
Answering the right questions at the right time
At FHI 360, we believe that generating evidence isn’t enough. Researchers must generate evidence that answers the right questions at the right time — and get solutions into the hands of the right people — to make a difference. Research can take time to undertake — and even longer to publish (up to 17 years to put into practice, according to some studies). If we limit ourselves to sharing results via peer-reviewed journals, we can miss opportunities to help others apply the results. People may waste time and resources researching questions that have already been answered, because the results weren’t yet shared.
That’s why FHI 360 researchers fast-track dissemination of our results with those who can use them, as soon as we have them, without waiting for publications. We are also teaming up with the broader digital self-care community to share the research that we all have underway so that we and others can prioritize closing evidence gaps and answering the most pressing questions — all to help women, men and young people choose when, if and how many children to have.