BACKGROUND:
Over
50% of pregnancies in the United States are unintended, meaning that the
pregnancy is mistimed, unplanned, or unwanted. Unintended pregnancy increases
health risks for mother and child, leads to high economic costs for society,
and increases social disparities. Mobile phone ownership is rapidly increasing,
providing opportunities to reach at-risk populations with reproductive health
information and tailored unintended pregnancy prevention interventions through
mobile phone apps. However, apps that offer support for unintended pregnancy
prevention remain unevaluated.
OBJECTIVE:
To
identify, describe, and evaluate mobile phone apps that purport to help users
prevent unintended pregnancy.
METHODS:
We
conducted an extensive search of the Apple iTunes and Android Google Play
stores for apps that explicitly included or advertised pregnancy prevention or
decision-making support in the context of fertility information/tracking, birth
control reminders, contraceptive information, pregnancy decision-making, abortion
information or counseling, sexual communication/negotiation, and pregnancy
tests. We excluded apps that targeted medical professionals or that cost more
than US $1.99. Eligible apps were downloaded and categorized by primary
purpose. Data extraction was performed on a minimum of 143 attributes in 3
domains: (1) pregnancy prevention best practices, (2) contraceptive methods and
clinical services, and (3) user interface. Apps were assigned points for their
inclusion of features overall and for pregnancy prevention best practices and
contraceptive information.
RESULTS:
Our
search identified 6805 app descriptions in iTunes and Google Play. Of these,
218 unique apps met inclusion criteria and were included in the review. Apps
were grouped into 9 categories: fertility trackers (n=72), centers and
resources (n=38), birth control reminders (n=35), general sexual and
reproductive health (SRH) information (n=17), SRH information targeted
specifically to young adults (YA) (n=16), contraceptive information (n=15), service
or condom locators (n=12), pregnancy tests (n=10), and games (n=3). Twelve apps
scored at least 50 points (out of 94) for overall number of features and at
least 15 points (out of 21) for contraceptive information and pregnancy
prevention best practices. Overall, 41% of apps did not mention any modern
contraceptive methods and 23% mentioned only 1 method. Of apps that did mention
a modern contraceptive method, fewer than 50% of these apps provided
information on how to use it. YA SRH apps had the highest percentage of
pregnancy prevention best practices in each app. Demographic and interface
evaluation found that most apps (72%) did not target any race and only 10%
explicitly targeted youth. Communication interface features were present in
fewer than 50% of apps.
CONCLUSIONS:
This
review identified several useful, evidence-based apps that support the
prevention of unintended pregnancy. However, most apps miss opportunities to
provide users with valuable information, interactive decision aids, and evidence-based
interventions for unintended pregnancy prevention. Further, some apps in this
space may increase the likelihood of unintended pregnancy due to the low
effectiveness of the contraceptive methods promoted.
Below: Primary purposes of 218 apps that support unintended pregnancy prevention
Below: Pregnancy Prevention Best Practices Found in Apps
Below: Percentage of mobile phone apps containing information about types of contraceptive methods, their effectiveness, and use
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