Effect of mHealth on Postpartum Family Planning and Its Associated Factors Among Women in South Ethiopia: A Cluster-Randomized Controlled Trial

Introduction: Postpartum family planning (PPFP) is a critical strategy for improving maternal and child health by preventing unintended pregnancies and optimizing birth spacing. However, PPFP uptake remains suboptimal in Ethiopia, where sociocultural barriers, limited health information, and inadequate counseling impede progress. Mobile health (mHealth) interventions have shown promise in overcoming these challenges by delivering targeted health information directly to individuals. This study aimed to evaluate the effect of an mHealth intervention on uptake and the intention to use PPFP among postpartum women in South Ethiopia. Methods: We conducted a cluster-randomized controlled trial in randomly selected health facilities in South Ethiopia. Pregnant women from primary hospitals and health centers were selected from registers and family folders. Data were collected using face-to-face and mobile interviews and analyzed using a generalized linear mixed model (GLMM) to account for the clustering. Results: The mHealth intervention significantly increased PPFP uptake (OR = 2.89, 95% CI: 1.55-5.37) and the intention to use PPFP (AOR = 2.05, 95% CI: 1.24-3.46) compared to standard care. The predicted probability of using PPFP was 85% in the intervention group. Women who discussed family planning with their partners (AOR = 2.10, 95% CI: 1.30-3.35) had a higher probability of using PPFP, and those exposed to media (AOR = 1.58, 95% CI: 1.07-2.32) had an increased likelihood of planning to use PPFP. Conversely, limited autonomy in decision-making and delays in postnatal care attendance were associated with reduced uptake and intention to use PPFP. Conclusions: The mHealth intervention improved uptake of PPFP and increased intention to use PPFP among postpartum women in South Ethiopia. PPFP uptake was higher in the intervention group (85%) than in the control group (68%). Partner involvement, decision-making autonomy, and media exposure emerged as significant facilitators of PPFP adoption. Scaling up mHealth interventions could address unmet family planning needs, but integration with broader strategies that address sociocultural barriers and enhanced counseling is essential. Interventions must be contextually tailored and grounded in behavioral theory (HBM, TPB, and TAM) to maximize effectiveness. Future research should examine the long-term sustainability and adaptability of mHealth approaches across diverse contexts.