Table 2 Final MOTIF intervention

The MOTIF final intervention comprised a series of automated voice messages to participants’ mobile phones over the three-month period following their abortion, at the time of day of their preference. Clients received the first message within one-week of receiving abortion services and then every two-weeks, with a total of six messages. The main message, recorded in the Khmer language, was as follows:

 ‘Hello, this is a voice message from a Marie Stopes counsellor. I hope you are doing fine. Contraceptive methods are an effective and safe way to prevent unplanned pregnancy. I am waiting to provide free and confidential contraceptive support to you. Press 1 if you would like me to call you back to discuss contraception. Press 2 if you are comfortable with using contraception and you do not need me to call you back this time. Press 3 if you would prefer not to receive any messages again’

Clients who pressed 1, or who did not respond to the message prompts, received a phone call from a counsellor. The phone calls aimed to support contraceptive use by addressing clients’ capability to use contraception by providing individualised information on a range of contraceptive methods, opportunity to use contraception e.g. informing clients where they could access specific methods near to their residence, and motivation by re-enforcing the benefits of contraception use. If the client requested, the counsellor would also discuss contraception with the husband or partner. Follow-up calls to clients were made during preferred times indicated by the client on her registration form. Clients were also able to call the MOTIF service at any time to request to speak with a counsellor. Clients that chose to receive the OC or injectable could opt to receive additional reminder messages appropriate to their method (e.g. to start a new packet of pills or when to receive a new injection). The sixth and final voice message provided similar information to the first five, but also reminded the client that this would be the last message they will receive.

The MOTIF intervention was delivered by trained counsellors at the MSIC head office in Phnom Penh. Voice messages were scheduled and sent using the open-source software programme ‘Verboice’, developed by InSTEDD (instedd.org). MSIC incurred the cost of outgoing communication from the provider to client, and clients incurred any costs calling into the service (the cost of a local call).