Myths and misinformation: an analysis of text messages sent to a sexual and reproductive health Q&A service in Nigeria

posted in: Africa, Newsletter, Nigeria | 0

Ann K Blanc, Kimberly Glazer, Uju Ofomata-Aderemi, Fadekemi Akinfaderin-Agarau

Studies in Family Planning 2016;47(1):39–53

MyQuestion is a platform that allows young people to ask SRH questions via text message. Trained counselors provide responses using a database of answers to frequently asked questions or customized replies. We analyze the content of more than 300,000 text messages received by the service since 2007 to address three questions: which health topics are most frequently submitted; what kinds of questions are asked about these topics; and what language is used to convey the questions? We found a substantial unmet need for basic SRH information, with users’ questions communicated in ways that convey considerable confusion, misinformation, and urgency. The analysis can be used to improve similar Q&A services and to improve the provision of SRH services for young people more generally.

Among the almost 50 million young people aged 10–24 in Nigeria more than one in three 18-year-old women has already had a child or is pregnant. Approximately 1.6 million Nigerian women aged 15–24, more than three quarters of whom are married, are estimated to have an unmet need for contraception. Less than 8% of married women in this age group are using contraception, compared to 63% of sexually active unmarried women. The country is characterized by large variations in adolescent sexual and reproductive health…

The potential contribution of mobile phone-based platforms for reaching young people with sexual and reproductive health information and services is not yet well understood. Some innovative applications have been tested in recent years in sub-Saharan Africa and elsewhere, and the World Health Organization is pilot testing the Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO), an on-demand system that allows young people to request and receive SRH information through an SMS platform, with future plans to evaluate its impact. In this article, we describe one such application underway in Nigeria…

Approximately 12,000–15,000 questions are received on the platform each month, with the majority received via text. [Questions about pregnancy were the 5th most frequent.] The average response time for questions received via text is 2–3 hours, although telecommunication network problems occasionally cause delays… When highly sensitive questions are asked (e.g. from a person who says she has had an unsafe abortion), the user is sent a short message asking her to call the hotline immediately for more detailed counseling…

…Many users ask about products for pregnancy prevention or termination. Texts cite “the pill to prevent pregnancy” or mention specific products by name. Data frequently show requests for information on “which pill” or the “correct pill” and where to get it. Numerous submissions ask whether it is possible to prevent pregnancy after sexual intercourse and seek pills to “remove pregnancy” either immediately or in the early weeks or months after having unprotected sex (“Plz want is d name of d pill …to kill d sperm ejaculated in my vagina so as not to get pregnant?”)…

…There is a desire for information on abortion procedures and access to the “drugs for abortion.” Texts include references to both medical and surgical abortion (“What is the name(s) of the pill a pregenate woman will take when she does not want the child”; “What is the name of the medicine for abortion?”; “what is the full meaning of D&C when doing an abortion”; “what is d&c use for abortion”), but indicate substantial ignorance and misconceptions about certain methods and how they can be obtained (“How many types of abortion do we have?”; “Is flushing out sperm immediately after sex abortion?”; “Is there a particular drug 4 abortion”). The importance of privacy in a context where abortion is highly stigmatized is evident (“What are the drugs use in abortion? pls reply no matter how embarrassing the question may be”; “Pls a friend of mine is pregnant and she does not want anybody to know she wants an abortion what should she do”; “How can one abort an unwanted pregnancy without going to a hospital ”)…