RT Journal Article
SR Electronic
T1 Unintended Consequences of mHealth Interactive Voice Messages Promoting Contraceptive Use After Menstrual Regulation in Bangladesh: Intimate Partner Violence Results From a Randomized Controlled Trial
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP 386
OP 403
DO 10.9745/GHSP-D-19-00015
VO 7
IS 3
A1 Reiss, Kate
A1 Andersen, Kathryn
A1 Pearson, Erin
A1 Biswas, Kamal
A1 Taleb, Fahmida
A1 Ngo, Thoai D.
A1 Hossain, Altaf
A1 Barnard, Sharmani
A1 Smith, Chris
A1 Carpenter, James
A1 Menzel, Jamie
A1 Footman, Katharine
A1 Keenan, Katherine
A1 Douthwaite, Megan
A1 Reena, Yasmin
A1 Mahmood, Hassan Rushekh
A1 Tabbassum, Tanzila
A1 Colombini, Manuela
A1 Bacchus, Loraine
A1 Church, Kathryn
YR 2019
UL http://www.ghspjournal.org/content/7/3/386.abstract
AB Automated interactive voice messages about post-menstrual regulation contraception delivered to women in Bangladesh via mobile phone were associated with increased reports of intimate partner violence. This finding highlights the importance of taking steps to minimize risk when delivering phone messages on sensitive topics and the need for assessing violence in such situations.Background:Mobile phones for health (mHealth) hold promise for delivering behavioral interventions. We evaluated the effect of automated interactive voice messages promoting contraceptive use with a focus on long-acting reversible contraceptives (LARCs) among women in Bangladesh who had undergone menstrual regulation (MR), a procedure to “regulate the menstrual cycle when menstruation is absent for a short duration.”Methods:We recruited MR clients from 41 public- and private-sector clinics immediately after MR. Eligibility criteria included having a personal mobile phone and consenting to receive messages about family planning by phone. We randomized participants remotely to an intervention group that received at least 11 voice messages about contraception over 4 months or to a control group (no messages). The primary outcome was LARC use at 4 months. Adverse events measured included experience of intimate partner violence (IPV). Researchers recruiting participants and 1 analyst were blinded to allocation groups. All analyses were intention to treat. The trial is registered with ClinicalTrials.gov (NCT02579785).Results:Between December 2015 and March 2016, 485 women were allocated to the intervention group and 484 to the control group. We completed follow-up on 389 intervention and 383 control participants. Forty-eight (12%) participants in the intervention group and 59 (15%) in the control group reported using a LARC method at 4 months (adjusted odds ratio [aOR] using multiple imputation=0.95; 95% confidence interval [CI]=0.49 to 1.83; P=.22). Reported physical IPV was higher in the intervention group: 42 (11%) intervention versus 25 (7%) control (aOR=1.97; 95% CI=1.12 to 3.46; P=.03) when measured using a closed question naming acts of violence. No violence was reported in response to an open question about effects of being in the study.Conclusions:The intervention did not increase LARC use but had an unintended consequence of increasing self-reported IPV. Researchers and health program designers should consider possible negative impacts when designing and evaluating mHealth and other reproductive health interventions. IPV must be measured using closed questions naming acts of violence.