Interventions to reduce unmet need for contraception: A systematic review

Background: Interventions aimed at reducing the prevalence of unmet needs for contraception have been implemented globally. However, the results across studies remain inconsistent, with significant differences observed among various types of interventions.Objectives: This systematic review aims to evaluate interventions designed to reduce the unmet need for contraception among women of reproductive age.Methods: The review follows the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature searches were conducted across multiple databases, including Scopus, Web of Science, ProQuest, Medline, Embase, CINAHL, Wiley Online Library, and JSTOR. The search utilized keywords such as mobile health, telemedicine, smartphone applications, videoconferencing, telephone consultations, education, counseling, family planning services, contraception, and fertility rate, combined with Boolean operators "AND" and "OR." Inclusion criteria comprised English-language studies, randomized controlled trials (RCTs) or quasi-experimental designs, full-text availability, and publication dates ranging from 2000 to 2023. Exclusion criteria were retracted articles, case reports, letters, editorials, personal opinions, meeting abstracts, reviews, meta-analyses, and book chapters. Study quality was assessed using the GRADE approach, while the risk of bias was evaluated with the RoB2 tool by two independent reviewers. Data extraction was conducted independently by the authors and validated with external reviewers. A qualitative synthesis method employing narrative and textual approaches was used to summarize, analyze, and assess the evidence.Results: The initial search yielded 899 publications; after a rigorous selection process, 25 studies met the eligibility criteria. The interventions identified in the reviewed studies included video-based health education, mobile phone consultations, direct contraceptive counseling, condom use practice sessions, text message reminders, community meetings, street theater performances, wall paintings, interpersonal counseling, electronic monitoring devices, Facebook campaigns, pamphlets/brochures, educational books, flip charts, training workshops, intrauterine device (IUD) insertion services, and the Yam Daabo intervention package. Among these, SMS/text message interventions were the most frequently studied; however, their effectiveness showed no significant difference compared to control groups.Conclusion: The evidence suggests that a range of interventions have demonstrated effectiveness in reducing unmet need for contraception, either directly or indirectly. However, further research is needed to identify the most effective strategies and optimize their implementation.