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Evidence summaries

Interventions to Improve Contraception Use

Mobile phone-based interventions appear to improve the use of contraception.Level of evidence: "B"

A Cochrane review [Abstract] 3 included 23 studies with a total of 12 793 subjects. 11 studies were conducted in high-income and 12 were in low-income settings. 13 studies used unidirectional text messaging-based interventions, 6 studies used interactive text messaging, 4 used voice message-based interventions and 2 used mobile-phone apps to improve contraception use. Mobile phone-based interventions increased contraception use compared to the controls, however there was little or no difference in rates of unintended pregnancy (table T2).

The certainty of the evidence is downgraded by heterogeneity.

Mobile phone-based interventions compared to usual care for contraception use

OutcomeRelative effect (95% CI)Risk with usual careRisk with intensive counseling (95% CI)of participants (studies)
Contraception useOR 1.30(1.06 to 1.60)515 per 1000580 per 1000(529 to 629)8972(16)
PregnancyOR 0.82(0.48 to 1.38)21 per 100018 per 1000(10 to 29)2947(8)

A Cochrane review [Abstract] 1 included 10 studies with a total of 6 242 subjects. The included trials investigated interventions in women using a variety of different shorter-term hormonal contraceptive methods. Intensified counselling improved continuation of hormonal contraceptive methods compared with usual care (table T1). There were no difference in discontinuation in 12 months. Women in the daily text-message group were more likely than the standard-care group to continue use (OR 1.33, 95% CI 1.03 to 1.73; 2 trials, n=933, I²=69%).

Intensive counseling compared to usual care

OutcomeRelative effect (95% CI)Risk with usual careRisk with intensive counseling (95% CI)of participants (studies)
Continuation of hormonal contraceptive methodOR 1.28 (1.07 to 1.54)392 per 1 000452 per 1 000 (408 to 498)2624 (6)
Rate of discontinuation due to menstrual disturbancesOR 0.20 (0.11 to 0.37)320 per 1 00086 per 1 000 (49 to 148)350 (1)
Rate of discontinuation due to all other adverse eventsOR 0.73 (0.36 to 1.47)549 per 1 000470 per 1 000 (304 to 641)350 (1)
PregnancyOR 1.24 (0.98 to 1.57)18 per 10021 per 100 (18 to 25)1985 (3)

A Cochrane review [Abstract] 2 included 53 studies with a total of 105 368 adolescents. 18 studies randomized individuals, 32 randomized clusters (schools 20, classrooms 6, communities/neighbourhoods 6), and 3 studies were mixed. The length of follow up varied from 3 months 7 years. Combination of educational, skill building and contraception promotion lowered significantly the rate of unintended pregnancy among adolescents (RR 0.66, 95% CI 0.50 to 0.87; 4 individual RCTs, n=1905).

Educational interventions increased reported condom use at last sex in adolescents compared to controls (RR 1.18, 95% CI 1.06 to 1.32; 2 studies, n=1431). However, it is not clear if the educational interventions had any effect on unintended pregnancy as this was not reported. For adolescents who received contraceptive-promoting interventions, there was little or no difference in the risk of unintended first pregnancy compared to controls (RR 1.01, 95% CI 0.81 to 1.26; 2 studies, n=3 440 participants).The use of hormonal contraceptives was significantly higher in adolescents in the intervention group (RR 2.22, 95% CI 1.07 to 4.62; 2 studies, n=3 091).

    References

    • Mack N, Crawford TJ, Guise JM et al. Strategies to improve adherence and continuation of shorter-term hormonal methods of contraception. Cochrane Database Syst Rev 2019;(4):CD004317. [PubMed]
    • Oringanje C, Meremikwu MM, Eko H et al. Interventions for preventing unintended pregnancies among adolescents. Cochrane Database Syst Rev 2016;2(2):CD005215. [PubMed]
    • Perinpanathan T, Maiya S, van Velthoven MHH et al. Mobile phone-based interventions for improving contraception use. Cochrane Database Syst Rev 2023;7(7):CD011159. [PubMed]

Primary/Secondary Keywords