Telemedicine contraceptive counselling through WhatsApp in South African abortion care: a mixed-methods acceptability study

While telemedicine contraceptive counselling may enhance access and uptake, particularly in low-resource settings, the evidence for its acceptability as an alternative to in-person counselling remains limited. We therefore assessed the acceptability of PlanUrFam, a comprehensive WhatsApp-based contraceptive counselling tool, among women seeking abortion care in South Africa. We conducted a mixed-methods pilot study at two public health clinics. Women seeking abortion care (<i>n</i> = 31) used PlanUrFam for contraceptive counselling and were followed-up at two weeks (<i>n</i> = 28). The primary outcome was a composite measure acceptability, informed by the Theoretical Framework of Acceptability (TFA). The secondary outcome was choice of long-acting reversible contraception (LARC) and preference for future counselling. In-depth interviews with a nested subgroup (<i>n</i> = 8) explored experiences of the tool using the TFA and content analysis. There was high acceptability (89%, <i>n</i> = 25/28) across framework domains. Qualitative results confirmed that PlanUrFam was acceptable, easy to use, understand and reduced judgement experienced in in-person care. Comprehensive information increased perceived confidence and agency in contraceptive decision-making. After using PlanUrFam, most participants chose LARC methods (64%, <i>n</i> = 18/28), chose a different contraceptive than previously used (96%, <i>n</i> = 27/28), and preferred either PlanUrFam alone (54%) or in combination with in-person counselling (36%) for future contraceptive care. This pilot demonstrates high acceptability of PlanUrFam in abortion care and supported informed decision-making and choice of LARC. The effectiveness of PlanUrFam or similar interventions compared to standard care should be explored in randomised controlled trials measuring method initiation, continuation, recurrent pregnancy and abortion. This study finds that a new WhatsApp chatbot for low-data settings, offering interactive decision aid and medical eligibility screening for contraceptive choice, has high acceptability across all measured domains and may result in reduced perceived stigma and increased informed decision-making.