SynthesisBMC public health2026
Assessing the impact of SMS-based interventions in promoting family planning uptake and modern contraceptive utilization in sub-Saharan Africa: a systematic review and meta-analysis.
Synthesis in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundModern contraceptive use in Sub-Saharan Africa remains low. Limited access to accurate and culturally-appropriate reproductive health information continues to hinder family planning uptake, affecting reproductive health outcomes. With a large percentage of the region's population owning a mobile phone, Short Messaging Service (SMS) interventions are a promising solution to improve outcomes. This review assessed the impact of SMS-based interventions on enhancing modern contraceptive uptake in the region and identified key barriers and facilitators.
methodsFollowing the PRISMA guidelines, we searched PubMed, Cochrane Library, and Google Scholar for relevant peer-reviewed studies. Eligible studies were peer-reviewed interventional studies published between January 2010 and December 2024. Data extraction was conducted by independent reviewers, and pooled odds ratios were calculated using the random-effects model in R 4.4.3. Study quality was assessed using Cochrane Risk of Bias tools and Joanna Briggs Institute checklists. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Thematic synthesis was used for qualitative data.
resultsSixteen studies (n = 16,849) across seven countries were included, including 10 randomized controlled trials, four quasi-experimental studies, and two pilot studies. SMS content included clinic reminders, educational content, and service accessibility information. From the meta-analysis, SMS interventions significantly improved contraceptive uptake (OR: 1.41, 95% CI: 1.26-1.57). Greater effectiveness was observed for longer durations (OR: 1.91 vs. 1.37; p < 0.0001), two-way messaging (OR: 1.76 vs. 1.39; p = 0.04), and personalized content (OR: 1.78 vs. 1.38; p = 0.03). No significant variation was found across sub-regions or population groups. There was no improvement in modern contraceptive knowledge. Key facilitators included confidentiality, simple language, and postpartum care integration, while barriers included spousal resistance, phone access limitations, literacy challenges, and fears of side effects.
conclusionSMS-based interventions are promising at improving modern contraceptive uptake, and should be scaled further to maximize impact. Future interventions should address key barriers while leveraging facilitators to maximize success.
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