Promoting Family Planning During COVID-19
A farmer in Vidisha, Madhya Pradesh, India, had little interest or knowledge of family planning. That is until he started using askNivi, a sexual and reproductive health (SRH) chatbot on WhatsApp. “I started using condoms after reading information on askNivi,” he told our team, “It gave me all the correct information. It changed my point of view.”
In Madhya Pradesh — a rural state in central India with a population of over 75 million people — there is a high unmet need for family planning methods. A 2019 study by Surgo Ventures on SRH in Madhya Pradesh found that 44% of women are not using modern contraceptives but 94% women wanted to space or limit their pregnancies. The study also showed that most family planning decisions are made privately and couples are often unaware of all available SRH choices or they have other concerns, such as possible side effects, that stop them from using a family planning method.
This past year, the new realities imposed by COVID-19 — social distancing, limited health access, financial constraints — have deepened the need for family planning. Many couples in Madhya Pradesh who want to space or limit their family size, don’t have the means to act because COVID-19 has restricted their access to critical SRH information and services.
So what can be done to help people find the knowledge they need? Can chatbots, like askNivi, bridge the gap by providing family planning information and links to services at people’s fingertips, even in rural India?
Surgo Ventures, the Clinton Health Access Initiative, and Nivi partnered to answer this question. Using askNivi, a first-of-its-kind digital health intervention, we hoped to reach the growing number of men and women who have smartphones in Madhya Pradesh.
With the health system overstretched — even before the additional burden of COVID-19 — people need tools that empower them to take charge of their own health by providing health information and services where they want, when they want, and how they want.
With askNivi, individuals can discreetly and freely find customized SRH information, guidance, and advice, and access health services without going to the doctor’s office. Moreover, askNivi refers users to nearby public and private clinics to access family planning services.
But just because it sounds like the ideal solution doesn’t mean that people will want to use it.
So, we set out to test the feasibility and usability of askNivi over the course of a 6-month pilot across 4 districts in Madhya Pradesh. The results to date are encouraging.
Here is what we have learned during the first 4 months of our pilot:
1. Offline and online marketing channels can reach different groups of people
We tested both online and offline strategies to encourage people to use askNivi. We found that both kinds of channels had unique value, pointing to the importance of a combined approach to reach the most people.
Online advertising provided a faster and simpler way to reach and engage a large number of people. Facebook ads were more successful in engaging people compared to Google ads, with an average 4% click through rate — higher than the 1% industry average — and a 3% conversion rate. This cost of onboarding people was high, at $2, due to narrow geographical and gender targeting, but with proper optimization, this could go down significantly.
In contrast, offline channels — including providing collateral at pharmacies and posters at high-footfall outlets — reached smaller numbers of people, but more specific groups. This type of outreach was over 16 times more successful in the rural areas than in the urban areas of Madhya Pradesh. Unlike online channels, which engaged far more young people, offline channels engaged people in older age categories.
2. Messages that evoke curiosity and address broader health/life goals are more appealing
Using a creative mix of online and offline channels, we undertook an iterative process to test and improve our health messaging. We began outreach with general messages designed to raise awareness of askNivi. Then we ran more targeted campaigns to encourage people to seek specific SRH information. We focused on messages that played to couples’ curiosity about new and modern family planning methods and keeping up with the times, judgment-free access to reliable and trusted sources of information, and leading a ‘Khushal’ or ‘happy life’ by taking control of one’s future with modern contraception, which performed the best.
3. Balanced, customized information builds trust and empowers people to act
“A lot of my misunderstandings and doubts have been cleared by the askNivi chatbot, and I’ve learned about other family planning methods. Having this knowledge gives you some confidence. If you are aware, then you can help a person who is not educated or who cannot ask or consult anyone when needed.”
— Woman living in MP
Many people we have spoken to during the pilot phase felt that the information provided by askNivi was balanced and presented them with choices for family planning, in contrast to their conversations with service providers who often provide specific options. Users also appreciated the convenience of askNivi, which unlike Google or YouTube, provides information all in one place both on the types of family planning methods available and where they can get contraceptives.
People are also using askNivi in different ways: over 53% of users have had conversations about various family planning topics, while nearly 18% of those onboarded have received referrals to public health facilities — significantly higher than the industry standard of 6% for other similar health services.
4. Men want to be part of the conversation
“I am hesitant to ask someone about sensitive topics, but I can use askNivi to ask questions to get answers. Moreover, it is fully private, only me and my mobile.”
— Man living in MP
In Madhya Pradesh, men are often the key decision-makers when it comes to family planning, yet existing programs have found it challenging to engage men. Early results from our pilot indicate that askNivi is different, with men making up 74% of users to date. Men have found that the privacy, ease of use, and convenience of askNivi allows them to seek answers to family planning questions and concerns both for themselves and their partners, without having to go to the health system, which they are less likely to do.
5. Adaptability is key
Unlike traditional offline interventions that require a lot of pre-planning and time-consuming monitoring and evaluation, askNivi collects real-time data from user interactions to provide quick, actionable insights that can directly inform program decision-making. With these regular insights on user behavior and actions — such as seeing how users engage over the course of individual conversations — we have been able to rapidly adapt our marketing strategy over the last four months.
These five early learnings demonstrate the viability of this unique digital intervention. askNivi offers a promising glimpse at the positive impact private sector innovations — chatbots and smartphones in particular — can have in addressing knowledge-intention-action gaps within public health programs. In the last two months of our pilot, we plan to use re-engagement messages — nudges — to help sustain the interest of the people we’ve onboarded and encourage them to use the public health system to access contraceptives.
We hope to continue overcoming barriers to family planning, one conversation at a time.
This work was made possible by everyone at Surgo Ventures, the Clinton Health Access Initiative, and Nivi including (in alphabetical order): Ankit Anand, Ben Bellows, Nitin Beri, Dr. Amit Bhanot, Sofia Braunstein, Abigail Faylor, Megha Khandelwal, Diana Klatt, Santosh Kumar, Mokshada Jain, Anne Nyanchoka, Nidhi Sen, Prakhar Srivastava.