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A systematic review of randomised controlled trials of the effects of digital health interventions on postpartum contraception use
  1. Yik Yan Sze1,2,
  2. Sima Berendes1,
  3. Sophie Russel3,
  4. Laura Bellam3,
  5. Chris Smith4,5,
  6. Sharon Cameron6,7,
  7. Caroline J Free1,8
  1. 1 Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 Faculty of Medicine, University of Hong Kong Faculty of Medicine, Hong Kong
  3. 3 Medical Student, Manchester University, North Manchester, Indiana, USA
  4. 4 School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
  5. 5 Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
  6. 6 Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
  7. 7 University of Edinburgh Division of Health Sciences, Edinburgh, UK
  8. 8 Clinical Trials Unit, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Yik Yan Sze, Li Ka Shing Faculty of Medicine, University of Hong Kong, 21 Sassoon Road, Pok Fu Lam, Hong Kong; angelayysze{at}


Background Digital health interventions (DHI) have been used to enhance the uptake of postpartum contraception and reduce unmet contraception needs. We conducted a systematic review of the effectiveness of DHI on postpartum contraceptive use and repeated pregnancy.

Method We searched MEDLINE, Embase, Global Health, CINAHL and Cochrane CENTRAL (January 1990–July 2020). Randomised controlled trials (RCTs) of DHI promoting contraception among pregnant or postpartum women were included. Two researchers screened articles and extracted data. We assessed the risk of bias, certainty of evidence (CoE) and conducted meta-analyses following Cochrane guidance.

Results Twelve trials with 5527 women were included. Interventions were delivered by video (four trials), mobile phone counselling (three trials), short message services (SMS) (four trials) and computer (one trial). During pregnancy or the postpartum period, mobile phone counselling had an uncertain effect on the use of postpartum contraception (risk ratio (RR) 1.37, 95% CI 0.82 to 2.29, very low CoE); video-based education may moderately improve contraception use (RR 1.48, 95% CI 1.01 to 2.17, low CoE); while SMS education probably modestly increased contraception use (RR 1.12, 95% CI 1.01 to 1.23, moderate CoE). Mobile phone counselling probably increased long-acting reversible contraception (LARC) use (RR 4.23, 95% CI 3.01 to 5.93, moderate CoE). Both mobile phone counselling (RR 0.27, 95% CI 0.01 to 5.77, very low CoE) and videos (RR 1.25, 95% CI 0.24 to 6.53, very low CoE) had uncertain effects on repeated pregnancy.

Conclusions During pregnancy or in the postpartum period, videos may moderately increase postpartum contraception use and SMS probably modestly increase postpartum contraception use. The effects of DHI on repeated pregnancy are uncertain. Further well-conducted RCTs of DHI would strengthen the evidence of effects on contraception use and pregnancy.

  • contraception behavior
  • Counseling
  • family planning services
  • long-acting reversible contraception
  • Randomized Controlled Trial
  • Reproductive Health

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  • Contributors YYS and CJF conceived the idea for the project. YYS designed the study with input from CJF. YYS, SB, SR and LB screened abstracts and papers for inclusion. YYS, SB, SR and LB extracted data. YYS and SB analysed the data. YYS, SR and LB carried out the GRADE assessments with input from CJF. All authors contributed to interpreting the data, critical review of drafts, have approved the final version and accept accountability for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.