By Namuunda Mutombo, Associate Research Scientist, APHRC
Half of Mozambique’s population which is aged below 25 years, is characterized by early marriage and childbearing. Mozambique’s youth have limited knowledge, skills, and services to protect themselves from unintended and early pregnancy, HIV, and other sexually transmitted infections. Misconceptions that impede contraceptive use are common. Women and girls often lack the autonomy to make independent decisions about using contraceptives. Structural barriers such as long distances to health facilities and commodity stock-outs are also a reality for many. The majority of young women living in Mozambique do not use modern contraceptives.
As the proportion of young people in Mozambique has grown over the past decade, so has their use of mobile phones. Mobile phone subscriptions in the country surged from 152,652 in 2001 to 12,401,290 in 2013. The use of mobile phones – particularly SMS – is a growing mechanism for delivering health education messages. However, there is a gap in evidence linking SMS to sexual and reproductive health (SRH) outcomes in a low-income context such as Mozambique.
To fill this evidence gap, the USAID-funded Evidence to Action (E2A) project assessed the use of a comprehensive text message program for youth, called mCenas!. mCenas! was implemented by Pathfinder International, with assistance from Dimagi, Inc. The implementation was carried out in Mozambique’s Matola district, Maputo province and Inhambane City district, Inhambane province, from September 2013 to June 2014. mCenas! was an activity of the Extending Service Delivery/Family Planning Initiative project funded by USAID.
mCenas! targeted youth aged between 15 and 24 in an interactive two-way SMS system that engaged them with narrative and informational messages to increase their knowledge about contraceptive methods, dispel common myths around contraception, and address common barriers youth face regarding use of contraception. Using open-ended and closed-ended survey questions based on mCenas! messages participants received, E2A elicited information from 50 youth in Mozambique regarding whether delivering information on contraception via SMS is acceptable to youth in Mozambique and could lead to improvement in their contraceptive knowledge, attitudes, and self-efficacy. Data were collected through face-to-face interviews.
Results of the assessment show that mCenas! had some significant contribution towards youth’s contraceptive knowledge, attitudes, and self-efficacy. For example, while 74% of females with children and 60% of females without children had medium-high knowledge of three or more methods at baseline, 87% and 74% percent did respectively, at endline. Regarding attitudes, youth were better informed about contraception and its effects following exposure to the SMS interventions. For instance, during the mCenas! intervention, there were significant declines in the percentages of youth who hold the view that use of a contraceptive method will make it difficult to have children after stopping use, and significant increases in the percentage of youth that agreed it was okay for a young married/unmarried woman to use other contraceptive methods besides condoms. However, the self-efficacy of youth regarding use of contraception did not improve especially among females.
At both baseline and endline stages, self-efficacy was high for males and extremely low for females. While there was no task for which less than seven of ten male youth expressed confidence in their ability to perform/accomplish, there was not a single task in which up to one of ten female youth expressed confidence in their ability to perform/accomplish. While the SMS interventions could be said to have moderately enhanced the confidence of male youth to perform some tasks, the same cannot be said of female youth: the SMS intervention appears to have had no effect on their confidence to perform contraception-related tasks.
From the Mozambican experience, it is evident that mHealth messaging through mobile phones is a useful tool in reaching out to young people and even other populations that may not have access to mainstream sources of information on SRH. However, even though this intervention demonstrated significant change on youth’s knowledge and attitudes for both males and females, there are some glaring gaps in self-efficacy between males and females. The general low level of self-efficacy among females could, however, not be explained by this study but could be deciphered as a pointer to some gender orientations around SRH issues in Mozambique. It is, therefore, important to ensure that any such future interventions are also tailored to provide messages that empower women and girls to make independent decisions regarding their SRH.