Research / Weiss Fund Supported ResearchFeb 27, 2017

Impact of a Text-Messaging Program on Adolescent Reproductive Health: A Cluster–Randomized Trial in Ghana

Jessica Cohen, Günther Fink, Slawa Rokicki, Joshua A. Salomon
American Journal of Public Health

More than 13 million adolescent girls give birth each year, and greater than 95% of these births occur in low- and middle-income countries (LMICs).1 Adolescent pregnancies are associated with an increased risk of unsafe abortion,2 low birth weight and preterm delivery,3 birth complications,4 child stunting,5 and early school exit and social stigmatization for adolescent mothers.6 Despite the large number of risk factors associated with adolescent pregnancies, reproductive health knowledge and the adoption of modern contraception remain low in many developing countries.7,8 In many countries in sub-Saharan Africa, more than 50% of unmarried, sexually active 15- to 19-year-old adolescents have an unmet need for modern contraception.2,9

Over the past 10 years, mobile phone access has skyrocketed in LMICs, from 22 subscriptions per 100 people in 2005 to 90 in 2014.10 Text-messaging programs offer a promising new platform to improve sexual and reproductive health, in particular among adolescents, by providing information in a private and confidential way. The past decade has seen a rapid rise in text-messaging programs that aim to improve health11–13; however, systematic reviews have consistently found a dearth of high-quality peer-reviewed studies examining outcomes of these programs in LMICs.14–17 Despite a large number of recent projects leveraging mobile technology among adolescent populations in LMICs, none of these employs a randomized trial design to provide evidence of effectiveness.18–23

To examine the potential of text-messaging sexual-education programs to improve adolescent reproductive health, we conducted a randomized controlled trial in Ghana, investigating the effectiveness of both 1-way and 2-way text-messaging programs on knowledge and sexual behavior. Ghana provides an ideal setting for this study both because of the high rates of cell phone access (115 mobile phone subscriptions per 100 people in 2014)10 and because of the large gaps in adolescents’ reproductive health knowledge.