Informed Choice: One Text Message at a Time

By Callie Simon, Pathfinder International, and Sandra Jordan, USAID

Today, more Mozambicans are using mobile phones than ever before. What if we could use these phones to share accurate, clear information about sexual health contraceptives with youth? Could we deliver this information in a creative way that fosters reflection and dialogue, ensuring young people have full and informed choice? Yes. Here’s proof.

Between October 2013 and June 2014, more than 2,000 youth (1,146 women and 859 men, all between the ages of 15 and 24) enrolled in the pilot phase of Pathfinder International’s mCenas! project, funded by USAID, and implemented in Maputo and Inhambane provinces. They made more than 17,000 requests for information about their sexual and reproductive health.

The mCenas! project understands that for young people in Mozambique, making an informed choice requires innovation not only in getting services and family planning commodities into clinics, but also in how family planning programs communicate and reach out to their clients.

Family Planning 2020’s Rights and Empowerment Principles for Family Planning lays out a definition of Informed Choice that highlights both elements:

Informed Choice:   Individuals have the ability to access accurate, clear and readily understood information about a variety of contraceptive methods and their use. To exercise full, free and informed decision-making, individuals can choose among a full range of safe, effective and available contraceptive methods (barrier, short-acting, long-acting reversible, permanent and emergency contraception).

Before launching the project, Pathfinder conducted 15 small group sessions with youth. They asked them to draw on their experiences to answer, what stops young people like you from using contraception? Here’s what they found: a lack of accurate information is a major obstacle for everyone, and young parents face very different barriers than youth who have not had children. They had to make sure both groups received texts and stories with information relevant to them.

Access to accurate, clear and readily understood information: In addition to sending youth text messages with information about contraceptives (i.e., “Implants are small sticks placed by health provider under the skin of the woman’s arm. Can be removed when a woman wants.”), the project texted them highly engaging stories about fictional characters dealing with sex and reproduction. In 24 installments—three times a week for three months—youth received text messages about “Ema,” whose boyfriend wouldn’t wear a condom. With each text message, the character’s story unfolds—Ema learns she’s not pregnant, and her older sister tells her the truth about contraception. Then she visits a youth-friendly clinic.

To make sure information was easily understood, Pathfinder found a local scriptwriter who has experience with young people and local youth texting slang. Then they tested the stories with the youth themselves to make sure the messages spoke to them—LOLs, emoticons, and all.

Day or night, youth could access a menu to request information on a host of topics that matter to them, from “Am I ready for sex” to “masturbation” to “sexual pleasure.” But they could also reply to texts to learn more. Remember when Ema got her IUD? At that point in the story, youth received a second message— “Want to learn more about IUDs? Just reply ‘1’,” and information was instantaneously sent to their phones.

Text messages alone cannot meet the complex needs of youth. So, Pathfinder fully integrated mCenas! into one of the organization’s existing health projects—the USAID-funded Extended Service Delivery/Family Planning Initiative—to ensure youth had equitable access to lifesaving contraceptive information, services, and supplies. If they wanted to talk to real people, they could turn to the 325 providers and 336 peer educators Pathfinder trained in collaboration with the Ministry of Health and local partners.