Impact of short messaging service interventions on contraceptive uptake and family planning utilization in sub-Saharan Africa: a systematic review and meta-analysis
1
1 College of Medicine, University of Ibadan, Ibadan, Nigeria
2
2 Digital Health Africa, Lagos, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Modern contraceptive use in Sub-Saharan Africa remains low at 22%, compared to 58.7% globally. Limited access to accurate and culturally-appropriate reproductive health information continues to hinder family planning uptake, negatively affecting reproductive health outcomes. With over 75% of the region's population owning mobile phones, Short Messaging Service (SMS) interventions are a promising solution to improve outcomes. This review assessed the impact of SMS-based interventions on enhancing modern contraceptive uptake in the region and identified key barriers and facilitators.
METHODS:
Following the PRISMA guidelines, we searched PubMed, Cochrane Library, Embase, and Google Scholar for relevant peer-reviewed studies. Eligible studies were peer-reviewed interventional studies published between January 2010 and December 2024. Data extraction was conducted by independent reviewers, and pooled odds ratios were calculated using the random-effects model in R 4.4.3. Study quality was assessed using Cochrane Risk of Bias tools and Joanna Briggs Institute checklists. Thematic synthesis was used for qualitative data.
RESULTS:
Seventeen studies (n=16458) across seven countries were included, including 10 randomized controlled trials, four quasi-experimental studies, two pilot studies, and one qualitative study. SMS content included clinic reminders, educational content, and service accessibility information. From the meta-analysis, SMS interventions significantly improved contraceptive uptake (OR: 1.41, 95% CI: 1.26–1.57). Greater effectiveness was observed for longer durations (OR: 1.91 vs. 1.37; p < 0.0001), two-way messaging (OR: 1.76 vs. 1.39; p = 0.04), and personalized content (OR: 1.78 vs. 1.38; p = 0.03). No significant variation was found across sub-regions or population groups. Key facilitators included confidentiality, simple language, and postpartum care integration, while barriers included spousal resistance, phone access limitations, literacy challenges, and fears of side effects.
CONCLUSIONS:
SMS-based interventions are effective at improving contraceptive uptake in Sub-Saharan Africa. Future interventions should address key barriers such as spousal resistance and misperceptions while leveraging facilitators to maximize success.
Modern contraceptive use in Sub-Saharan Africa remains low at 22%, compared to 58.7% globally. Limited access to accurate and culturally-appropriate reproductive health information continues to hinder family planning uptake, negatively affecting reproductive health outcomes. With over 75% of the region's population owning mobile phones, Short Messaging Service (SMS) interventions are a promising solution to improve outcomes. This review assessed the impact of SMS-based interventions on enhancing modern contraceptive uptake in the region and identified key barriers and facilitators.
METHODS:
Following the PRISMA guidelines, we searched PubMed, Cochrane Library, Embase, and Google Scholar for relevant peer-reviewed studies. Eligible studies were peer-reviewed interventional studies published between January 2010 and December 2024. Data extraction was conducted by independent reviewers, and pooled odds ratios were calculated using the random-effects model in R 4.4.3. Study quality was assessed using Cochrane Risk of Bias tools and Joanna Briggs Institute checklists. Thematic synthesis was used for qualitative data.
RESULTS:
Seventeen studies (n=16458) across seven countries were included, including 10 randomized controlled trials, four quasi-experimental studies, two pilot studies, and one qualitative study. SMS content included clinic reminders, educational content, and service accessibility information. From the meta-analysis, SMS interventions significantly improved contraceptive uptake (OR: 1.41, 95% CI: 1.26–1.57). Greater effectiveness was observed for longer durations (OR: 1.91 vs. 1.37; p < 0.0001), two-way messaging (OR: 1.76 vs. 1.39; p = 0.04), and personalized content (OR: 1.78 vs. 1.38; p = 0.03). No significant variation was found across sub-regions or population groups. Key facilitators included confidentiality, simple language, and postpartum care integration, while barriers included spousal resistance, phone access limitations, literacy challenges, and fears of side effects.
CONCLUSIONS:
SMS-based interventions are effective at improving contraceptive uptake in Sub-Saharan Africa. Future interventions should address key barriers such as spousal resistance and misperceptions while leveraging facilitators to maximize success.
| eISSN: | 2654-1459 |
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