1. Promising Innovations to Improve PAFP Women Deliver 2013 MOTIF: MObile Technology for Improved Family Planning Mobile phone-based support for PAFP in Cambodia Presenter: Chris Smith, MOTIF Lead Investigator, MSIC Contributors: Thoai Ngo, Judy Gold, Uk Vanak, Ly Sokhey, Caroline Free

2. Promising Innovations to Improve PAFP Women Deliver 2013 Challenge: low uptake of PAFP and repeat abortion Abortion 44 million/year, 50% unsafe, 47K maternal deaths (Sedgh 2011) Low uptake of PAFP No method 32%, condom 24%, pill 20%, injectable 11%, IUD 5%, implant 5% (MSIC data 2011) Repeat abortion 25% repeat abortion within 5 years (CDHS 2010) 4% return to the same MSIC clinic within 1 year (MSIC data 2012) Repeat abortion  negative health outcomes (Curtis 2010) PAFP interventions are important to reduce repeat abortion

3. Promising Innovations to Improve PAFP Women Deliver 2013 What are the opportunities for mHealth? Of the world’s estimated 7 billion, 6 billion have access to mobile phones In Cambodia Mobile Phone access: ->80% of MSIC clients provided a mobile number -As over 50% of clients (many from rural areas) don’t return to the clinic post-abortion, opportunity to maintain contact

4. Promising Innovations to Improve PAFP Women Deliver 2013 Hypothesis: adding mobile support to the continuum of PA care can increase PAFP Opportunities o Information o Reminders o Support (e.g. SE’s) Opportunities o Build on success in PAFP counseling o Wide range of methods available Beyond the Facility At the Facility Level

5. Promising Innovations to Improve PAFP Women Deliver 2013 MOTIF programme intervention MSI Innovation Fund October 2012 – December 2013 Develop, implement and evaluate a mobile phone-based intervention to support PAFP in Cambodia Piloted in 4 MSIC clinics

6. Promising Innovations to Improve PAFP Women Deliver 2013 Formative research to understand the local context Interviews/focus groups: Difficult to make PAFP choices at the time of abortion Concerns about side-effects, want to complete abortion first, need to discuss with husband Limited literacy, simple phones, prefer to talk Women prefer voice message to SMS

7. Promising Innovations to Improve PAFP Women Deliver 2013 Overview of intervention developed Provider Client Service provided for 3 months after which client continue to receive standard care VM every 2 weeks Pill/appointment reminders Client can call in +/- follow up phone call MOTIF: Mobile Technology for Improved Family Planning

8. Promising Innovations to Improve PAFP Women Deliver 2013 Voice message as conduit for additional support “Hello, this is a voice message from a Marie Stopes counsellor. I hope you are doing fine. Contraceptive methods are an effective and safe way to prevent unplanned pregnancy. I am waiting to provide free and confidential contraceptive support to you”. Press 1 if you would like me to call you back to discuss contraception. Press 2 if you are comfortable with using contraception and you do not need me to call you back this time. Press 3 if you would prefer not to receive any messages again”

9. Promising Innovations to Improve PAFP Women Deliver 2013 Mixing medical services with technology http://instedd.org/blog/marie-stopes-verboice-will-mobile-phones-improve- contraceptive-use-in-cambodia/

10. Promising Innovations to Improve PAFP Women Deliver 2013 Randomised controlled trial overview

11. Promising Innovations to Improve PAFP Women Deliver 2013 Preliminary Results (using intervention data) PAFP (pill, injection, IUD, implant) increase from 33-56% Uptake new methods, support SE’s for existing users (continuation and safe method switching) Post-abortion support (medical/emotional) 12% cancel 4% cannot contact

12. Promising Innovations to Improve PAFP Women Deliver 2013 Next steps Optimise registration process − Client sign up Increase automation − Automatically schedule VMs and redial Improve content & delivery − Add SMS option / APP? − Adjust number of VMs Offer service in different settings − Private clinics/MOH Financial sustainability − Fee for service? − Revenue sharing/sponsorship − eVouchers

13. Promising Innovations to Improve PAFP Women Deliver 2013 Thank you! If you are interested to learn more about this project, or in funding the next phase, please get in touch: chris.smith@mariestopes.org.khchris.smith@mariestopes.org.kh Contributors: Thoai Ngo, Judy Gold, Uk Vannak, Ly Sokhey, Caroline Free MSI Cambodia, Innovation and Best Practice & Research Monitoring and Evaluation team MSI

14. Promising Innovations to Improve PAFP Women Deliver 2013 SIM card switching Phone sharing Competition with commercial spam Timing of VMs Clients busy Reaching out to youth/students/EWs Challenges

15. Promising Innovations to Improve PAFP Women Deliver 2013 Response to VM: first 100 clients

16. Promising Innovations to Improve PAFP Women Deliver 2013 Appendix: Conceptual framework

17. Promising Innovations to Improve PAFP Women Deliver 2013 Different categories of clients? Urban youth, literate, confidentiality important? Rural, limited literacy, married, disclosed to others re abortion? Voice SMS / App?