There are currently 1.8 billion young people between the age of 10 and 24, and the youth population is growing fastest in developing countries. The majority of these young people are faced with a myriad of challenges, including weak health systems with limited access to sexual and reproductive health resources. Hear from Pathfinder International, a global health organization, on how mobile technology can be used to effectively reach these individuals with important sexual and reproductive health information and services. Pathfinder has experience using mobile technology to support health programs in eight countries, including SMS projects in Ethiopia and Mozambique that are designed to support youth with timely, accurate, and impartial sexual and reproductive health information.

1. Using mHealth to Reach Youth
with Contraceptive Information:
Mozambique and Ethiopia
Marion McNabb, MPH, DrPH
Senior Technical Advisor, mHealth

2. • mCenas!: Pathfinder Mozambique
• m4Youth: Pathfinder Ethiopia
• Lessons learned using SMS to deliver
sexual health information and link to
services
Presentation Outline

3. mHealth Alliance | 3
7 Billion
People
6 Billion
Mobile Phone
Users
1 Billion
Mobile Phone Users
Limited Access to Healthcare

5. Mozambique
• Population: 25 million
• Urban population: 32%
• Rural population: 68%
• Population under age 24: 65%
• USAID-Funded Essential Service
Delivery/Family Planning Initiative
Project; Technology Partner Dimagi, Inc.
• Sub-Project Goal:
• Youth have greater access to
contraception, reproductive health,
and HIV services through youth-
friendly health centers
• In 2014, 69.7 mobile subscriptions per
100 inhabitants

6. 1. Story using barriers and
facilitators identified by
youth
2. Informational messages
on contraceptive
methods
3. Interactive frequently
asked questions menu
on range sexual health
and reproductive health
topics
mCenas! (Mobile Scenes)

7. • The Pathways to Change game was
used with youth to gather information
about barriers and facilitators of
contraceptive use and to generate
initial story ideas
• 2 stories developed for parenting and
non-parenting youth
• 8 weeks, 3 chapters per week
• First person narrative style chosen
• Texting slang/abbreviations essential
• Service was free for youth
Content Development

8. • September 2013 - February 2014
• 2,005 young people enrolled in mCenas!
Enrollment
46%
54%
15-17 years 18-24 years
67%
33%
No Children
Have Children
43%
57%
Men Women

9. Menu Messages Number of Requests (N=10,451)
Am I ready for sex? 14.1% (1,474)
Masturbation 9.1% (955)
Sexual pleasure 8.9% (931)
Can I be pregnant? 8.7% (907)
Can I have an STI or HIV? 8.4% (882)
Am I ready to have a child? 8.4% (880)
Menstruation 7.8% (813)
Sex and violence 6.6% (689)
Personal hygiene 6.5% (679)
Post-abortion care 5.7% (594)
Circumcision 5.4% (561)
Sex post-partum 5.3% (557)
HIV and pregnancy 5.1% (529)

10. Contraceptive Method Number of Requests (N=6,887)
Injectables 18.7% (1,288)
IUD 12.7% (875)
Implants 12.0% (826)
Pill 11.2% (770)
Male condoms 10.9% (754)
Amenorrhea by lactation 9.9% (679)
Emergency contraception 9.4% (645)
Female condoms 8.8% (609)
Where to go for FP 6.4% (441)

11. • Client exit interviews with youth, review of SMS
logs for interaction data
• 895 youth interviewed at baseline
• 504 youth interviewed at end line
– Results presented focus on end line respondents
– Majority aged 20-24 (about 60% of all males and
females) and had never been married but had had
sex
Research Design

12. Contraceptive Knowledge
74.4
59.9
33.5 30.9
86.6
73.9
53.4
57.7
0
10
20
30
40
50
60
70
80
90
100
Females
w/children
Females w/o
children
Males w/
chidlren
Males w/o
children
Percentage.medium-high
knowledge,3ormoremethods
Baseline
Endline

13. • Statistically significant increase in ever and current
use for COC and emergency contraception methods
– Only among females with children
• Statistically significant increase in intention to use (or
partner to use) a method among:
– Females without children who reported not using a method
– Males without children who reported to be already using a
method (condoms included in methods already used)
Contraceptive Use

14. Ethiopia
• Population: 94 million
• Urban population: 19%
• Rural population: 81%
• Population 15-24 years: 20%
• USAID-Funded Integrated Family
Health Program (IFHP); Technology
RapidSMS; 2008 - 2015
• Project Goal:
• Focus on Adolescent Sexual and
Reproductive Health,
strengthen university based
SRH services and peer
education
• In 2014, 31.6 mobile subscriptions
per 100 inhabitants

15. m4Youth Overview
• Target 20,000 students
• Short code allowed
youth to use service for
free (project covered
SMS costs)
• Promoted through peer
educators, billboards,
posters, and fliers

16. • Implemented April 2014 – June 2015
• Over 11,000 SMS information requests
• 33% more students took condoms from the University
Youth Friendly Service clinic compared to the previous
year
• 26 GBV cases were reported to the gender office
during the project period, compared to none during the
same period the previous year
m4Youth Results

17. Menu Requests (April 2014- May 2015)
783 872
1249
1579
2324
4050
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Where to find
YFS
Unsafe
Abortion
Healthy and
Abusive
Relationship
STI/HIV Contraception Sexuality and
FAQs

18. % of responses on SRH
knowledge and practices
15.7
67.3
77.8
40.3
56.3
16.2
62.7
72.4
42.4
50.4
0 10 20 30 40 50 60 70 80 90
Misconceptions about
Contraceptives
Knowledge on EC
Knows where to find a condom
Currently has a sexual partner
Used condom during last sex
Baseline Endline

19. • SMS is an acceptable and feasible method to deliver sensitive
and confidential SRH information for African youth
• Interventions resulted in increased contraceptive knowledge,
comfort and intention to use methods
• Integrating SMS interventions within larger service delivery
projects is critical to ensure supply for demand created
• Narratives designed for an by youth and interactivity essential
• Scaled SMS projects can become costly; business models and
market research on willingness to pay
• Both experiences suggest youth might be willing to pay for the
service
Lesson Learned

20. Marion McNabb, MPH, DrPH
Senior Technical Advisor, mHealth
Pathfinder International
mmcnabb@pathfinder.org
marionmcnabb23@gmail.com
Twitter: @PathfinderInt and
@23me2