Evaluating a Low-Literacy SMS Intervention for Postpartum Family Planning Knowledge and Intention in Rural Mali: A Cluster Study

Postpartum family planning is essential for maternal and child health. In rural Mali, low literacy and limited access to information constrain service uptake. Scalable communication strategies for low-literacy populations are required. This study evaluated the effectiveness of a low-literacy, tailored SMS intervention for improving postpartum family planning knowledge and intention among women in rural Mali. A cluster intervention study was conducted. Rural health centres were randomised to intervention or control clusters. Postpartum women in intervention clusters received a three-month series of pictogram-supported SMS messages on postpartum family planning; control clusters received standard care. Knowledge and intention were measured using interviewer-administered questionnaires at baseline and post-intervention. Data were analysed with mixed-effects models to account for clustering. The intervention group showed a statistically significant increase in comprehensive postpartum family planning knowledge compared to controls. The proportion of women with high knowledge scores rose from 22% to 58% in the intervention group, compared to an increase from 25% to 31% in the control group. Intention to use a modern contraceptive method within the next year was also significantly higher in the intervention group post-intervention. A low-literacy tailored SMS intervention effectively improved postpartum family planning knowledge and intention in rural Mali. This approach represents a scalable tool for health education in comparable low-resource settings. Low-literacy SMS messaging should be integrated into routine postnatal care services in rural Mali. Further research should assess the intervention’s impact on actual contraceptive uptake and long-term continuation, and explore its integration with other maternal health platforms. postpartum family planning, mHealth, SMS intervention, health literacy, Mali, rural health This study provides evidence for a practical, scalable mHealth strategy to address the critical knowledge gap in postpartum family planning among low-literacy populations in rural Africa.