In 2009, with funding from the U.S. Agency for International Development (USAID), PROGRESS began developing the Mobile for Reproductive Health (m4RH) project, which has generated a set of text messages on family planning methods that users can access via their mobile phones. Based on its experiences with this text message system, PROGRESS also created Inside m4RH: A Collection of Resources to provide online tools and guidance for planning, designing, promoting and evaluating m4RH and related programs.

The low-cost m4RH approach to reaching contraceptive users was deployed in Kenya and Tanzania as part of a research study aimed at determining the feasibility of providing family planning information via text message, the reach of this communication channel, and the suggested impact on family planning use. FHI 360's PROGRESS project is now working to adapt the program for young people in Rwanda and to scale up the program in both Kenya and Tanzania. You can view an interactive demonstration of the text message system here (Adobe Flash Player required). We welcome any feedback you have on the system.

Formative research results for m4RH

Before implementing the PROGRESS m4RH approach in Kenya and Tanzania, FHI 360 found that an mHealth service providing family planning information could be successful. Results from in-depth interviews in Nairobi and Dar es Salaam showed that texting is prevalent, that users would welcome and trust messages on family planning options via text, and that they would share such messages with their partners and friends. View the full formative research findings here.

Message Content Development

The m4RH messages were developed using evidence-based content, including the World Health Organization's handbook Family Planning: A Global Handbook for Providers. They were crafted specifically for short message service (SMS) or text message use. Each message was designed and tested to ensure user comprehension within the 160 character limit. The m4RH service provides information on long- and short-acting family planning methods including implants, intrauterine devices, permanent methods, injectables, oral contraceptive pills, emergency contraception, condoms and natural methods including the Lactational Amenorrhea Method (LAM). The messages address side effects, method effectiveness, duration of use and ability to return to fertility. The service also lists local clinics in a database that is searchable by province (Kenya) or ward (Tanzania).

In Tanzania, additional messages to promote contraceptive continuation are currently under development. Development of these messages is following the same systematic process used for developing the main family planning messages. In Rwanda, FHI 360 is developing and testing new message content for young people based on evidence-based youth sexual and reproductive health curricula. New messages will include information about puberty, sex and pregnancy, HIV and sexually transmitted infections.

Implementation and evaluation of m4RH service — Kenya and Tanzania

The m4RH approach has been operational in Kenya and Tanzania since 2010. Many organizations have been involved in its development, deployment and promotion. These organizations include Text to Change, Sliced Bread Design, Marie Stopes International, Family Health Options of Kenya, PSI, Pathfinder, FHI 360 ROADS Project, GIZ, ISHI Project, Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the Department of Reproductive Health of the Ministry of Public Health and Sanitation in Kenya, and the Ministry of Health and Social Welfare in Tanzania.

A user in Kenya can access the m4RH system from any mobile phone in the country by texting "m4RH" to the short code "4127." Similarly, the system can be accessed (in Swahili) in Tanzania by texting "m4RH" to the short code "15014."

To date, the m4RH program has reached more than 70,000 users in Kenya and Tanzania. Preliminary results suggest that m4RH is reaching four key populations: women, men, youth and community health workers. Electronic data collection reveals that users have accessed more than 475,000 messages through September 2012.

Phone interviews with m4RH users indicate that:

• Users are learning new information about the full range of contraceptive methods, thereby increasing their family planning knowledge, as a result of using m4RH.
• Many users are changing their behavior after viewing m4RH messages (self-reported).
• Users of m4RH are sharing messages with others.
• The m4RH approach seems to promote communication among couples.
• Users appreciate the novel, simple and objective presentation of information about family planning provided on mobile phones.

Complete findings from the pilot study of m4RH in Kenya and Tanzania are summarized in this research brief.

Adaptation of m4RH for Young People — Rwanda

The Rwanda Ministry of Health, with technical assistance from FHI 360, is adapting the m4RH program for young people in Rwanda in an effort to improve young people's access to sexual and reproductive health information. Over the next year, the Rwanda Ministry of Health together with FHI 360 will adapt m4RH as a standardized and automated mobile phone information service that will provide sexual and reproductive health information to young people ages 10–24 in Rwanda. The information provided by m4RH will be expanded to include information about five content areas: puberty, sex and pregnancy, pregnancy prevention (information about contraceptives), HIV and sexually transmitted infections. The m4RH platform in Rwanda also will include a database of youth-friendly services and stories that model positive sexual and reproductive health behaviors among young people. Health content will be tailored and field tested to ensure that the messages and delivery format are clear, relevant and engaging to young people.

Next Steps

Kenya: An mHealth Task Force was formed within the Division of Reproductive Health of the Ministry of Public Health and Sanitation in order to coordinate in-country mHealth activities and to help identify a plan to sustain m4RH after PROGRESS funding ends. FHI 360's staff members in Kenya are involved in this task force and the efforts to identify opportunities to hand m4RH over to other communications or service delivery partners. A brief describing efforts to expand m4RH in Kenya is available.

Tanzania: During the m4RH pilot project, the Tanzania Capacity and Communication Project (TCCP), operated by Johns Hopkins University (JHU), incorporated m4RH into its family planning campaign called "Jiamini!" ("be confident"). The m4RH approach was included in Jiamini! radio and TV spots with a national reach, leading to a dramatic increase in the use of m4RH. As a result of this successful partnership, JHU-TCCP is interested in incorporating m4RH into its current programming. A brief describing efforts to expand m4RH in Tanzania is available.

Rwanda: At the conclusion of the m4RH adaptation in Rwanda, a tailored ready-to-launch version of m4RH for young people in Rwanda, as well as recommendations for program launch related to technological deployment and partnerships, will be available. Once the program is developed, the Rwanda Ministry of Health will lead the implementation process in collaboration with key partners. A brief describing efforts to expand m4RH in Rwanda is available.

PHOTOS: (top) Courtesy of Photoshare; (bottom) Courtesy of World Bank.

PROGRESS (Program Research for Strengthening Services) was a five-year project awarded to FHI 360 by the U.S. Agency for International Development (USAID) in June 2008. The project sought to improve access to family planning among underserved populations by providing global technical leadership and working in selected countries.