Family Planning via mobile phones: Proof-of-concept testing in India


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  • 6 in 10 people around the world now have a cell phone subscription. Two-thirds of the world’s 4.1 billion cell phone users live in developing countries! SMS represents a way to transmit timely, personalized health messages directly to a person’s cell phone. India topped 350 million cell phone users in 2008! Both urban and rural use is driving growth. (more information below) Jan 26, 2009 (Arab News - McClatchy-Tribune Information Services via COMTEX) -- VOD | Quote | Chart | News | PowerRating -- India has emerged as the fastest growing telecom market in the world, attracting not just global service providers like Britian-based Vodafone but also big handset manufacturers like Finland's Nokia that not too long ago was reluctant to make an entry because of low volumes. For a country that stood at the bottom of the pyramid in terms of telecom penetration a decade ago, 2008 was a watershed when India's subscriber base topped 350 million users to make its network the second largest in the world after China , displacing the US. Going by the recent data compiled by industry watchdog Telecom Regulatory Authority of India (TRAI), the growth is being powered with equal fervor by rural areas, once regarded as low-end, low-volume markets with modest purchasing power.
  • Other projects utilize SMS technology to provide health-related information directly to users (e.g., One World’s Mobile4Good in Kenya, SIMpill ® Medication Adherence System in South Africa and Bostwana). No current application guides family planning method-use. The Standard Days Method is uniquely appropriate for this intervention. The woman will only have to provide the date her menstrual period starts (each cycle), after which she can be advised of her fertility status on a daily basis via text messaging. Additional messages support correct use of the Standard Days Method, monitor her cycle lengths to identify whether they are in the 26-32 day range, and offer information on other family planning options and reproductive health issues, with an emphasis on the importance of healthy timing and spacing of pregnancies. As the project develops, women and men will be able to access, via SMS, answers to their questions about the Standard Days Method and other frequently-asked questions about reproductive health issues.
  • CycleTel is an mHealth solution that will pioneer supplying a modern family planning method directly to a user’s mobile phone. No other application exists that offers a modern family planning method directly to a user’s handset.
  • The Standard Days Method identifies days 8 – 19 of the menstrual cycle as the fertile days, when there is a significant probability of pregnancy. On all the other days of the cycle, pregnancy is most unlikely. The method works best for women who have cycles between 26 and 32 days long. Therefore, to use the Standard Days Method to prevent pregnancy, couples avoid unprotected sex from day 8 through day 19 of each cycle. On all the other cycle days, they can have unprotected sex. To plan pregnancy, the Standard Days Method can help a couple identify the days to have sex. While this is not sufficient for all couples, it can be an important first step. The Standard Days Method is used with CycleBeads TM , a color-coded string of beads to help a woman Track her cycle days Know when she is fertile Monitor her cycle length Many people also find that CycleBeads are an important factor in gaining the man’s support to use the method. It is very visual – he can literally see when the woman is on a fertile day.
  • Key questions to have answered before investing large technology development costs: Does the need and demand exist for the mHealth service? Is it a local solution for a local problem?
  • Uttar Pradesh is the yellow state
  • “ Had a need for family planning” means they wanted to avoid a pregnancy but were using either no method, a traditional method, or condoms inconsistently
  • For testing in another country, can mention Philippines and Rwanda, but try to be vague! We don’t want to mention countries where we don’t have current government support to do the testing. Software development: IRH is partnering with Voxiva, Inc. as the technology provider for CycleTel. Since 2001, Voxiva has delivered mobile information solutions for real-time data collection, analysis, patient interaction and support via their unique, award-winning technology platform. Voxiva, Inc. ( is a privately held, socially responsible technology company, with headquarters in the District of Columbia and offices in Lima, Peru, and Delhi, India. Voxiva’s mission is to provide practical, innovative and scalable ICT solutions to improve the health, safety and well-being of people in the developing world. Voxiva is a leading worldwide provider of mobile-centric information and communication technology (ICT) solutions for public and private sector development agencies. Voxiva solutions let governments and other partners collect and analyze real-time data from the field, and communicate and interact with their staff and patients more effectively. Voxiva solutions leverage the world's four billion mobile phones as well as fixed-line phones, PCs, smart phones, the web, and other technologies for a much broader reach than Internet-only solutions. The application has the potential to operate at scale, across multiple countries and in different languages. The application can handle a high volume of users and messages (initially 500 users, with the potential of reaching millions based on demand). Voxiva’s system is able to send as many as 200 SMS messages per second and has proven ability to support expanding messaging and data needs as projects scale.  Data collection occurs in real time and is stored in one central database, accessible to researchers and project managers at any time from any PC connected to the internet. IRH and Voxiva are in discussion with community groups and messaging services, SMS aggregators, and cell phone service providers. Negotiate competitive pricing on in- and out-bound messages with local aggregators and telcos.
  • Refer to next slide for scale up considerations
  • IRH has significant experience with multi-country scale-up of the Standard Days Method (using CycleBeads) in public and private non-profit health and community development systems, utilizing the World Health Organization’s ExpandNet model. This experience translates to scale up of CycleTel and there are various aspects that need to be considered. Moving forward, the focus on collaborative implementation, engagement of local partners, monitoring and evaluation, and information sharing will be integral to scale-up.   To ensure acceptance of the application and its sustainability within the target markets, IRH and Voxiva will engage other partners (cell phone companies, aggregators, social marketing companies) and user communities whose members may be interested in the CycleTel service. When the system becomes available, the CycleTel number will be integrated into existing materials (billboards, brochures, etc.) that are already distributed throughout the target countries. Share information on project status with local stakeholders and international audiences to enhance potential for sustainability and scale-up.
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