CycleTel™ was an SMS-based mobile health (mHealth) product, and the first family planning method available directly to a woman via SMS in India. CycleTel was developed to transform how family planning is accessed and used by women.

 

 

Our motivation

We believe no woman should be without family planning options. Yet unmet need for family planning burdens over 225 million women worldwide and is estimated to grow 40% by 2050. In India, nearly 36 million women aged 20-34 want to avoid a pregnancy but don’t have an effective, affordable, and accessible method.

The proliferation of mobile phones offers unprecedented opportunities to change this. With well over six billion mobile subscriptions worldwide, mobile phones can reach women once deemed unreachable. Our solution capitalized on the growing technological landscape in India from 2013-2017.

How it worked

CycleTel was based on the scientifically-tested, knowledge-based Standard Days Method® (SDM) of family planning, a fertility awareness method proven to address unmet need. SDM identifies the fixed set of days in each menstrual cycle when a woman can get pregnant, known as her fertile window. To use SDM, a woman tracks her cycle and uses a barrier method or abstains from sex on her fertile days to avoid pregnancy.

CycleTel automated this process, alerting women of their unsafe (fertile) days each month via SMS, indicating when unprotected sex should be avoided to prevent unwanted pregnancies. To enroll, women answered three screening questions to determine eligibility for the method and enter their upcoming period dates to initiate the service. To continue receiving personalized alerts based on their own cycle, they entered their period start date monthly. CycleTel was available in English and Hinglish.

The target population for CycleTel included women aged 18–34 in urban and peri-urban areas of India, where there is a high unmet need for birth spacing as well as high mobile phone usage. But anyone with a need for family planning who is eligible to use SDM could use CycleTel.

Developing CycleTel

CycleTel was designed with and for our users. We worked with over 800 women in India to test, provide feedback, and help build the CycleTel system.With support from USAID’s Development Innovation Ventures (DIV) and the UN Foundation’s mHealth Catalytic Grant Mechanism, we worked with a private sector partner in India to test a market-based business model and scale up the service nationwide. IRH began developing CycleTel in 2010 through multiple phases of testing.

Proof-of-concept Testing (2010)

IRH completed three phases of proof-of-concept testing in Lucknow and Delhi, India.

Phase 1: Focus Group Discussions: Seven focus group discussions—four with women, two with men, and one with couples, with approximately 54 participants total— yielded valuable findings about the potential interest in CycleTel and feedback on the service’s features.

Phase 2: Cognitive Interviews: The cognitive interviews were structured to verify message comprehension and finalize the message content.        

Phase 3: Manual Testing: The final phase tested CycleTel with actual users to refine the service. Participants were very satisfied with the method. They felt that it improved their communication with their partner and would have liked to continue using it if the service was available.

Interviews with women who tested CycleTel showed that:

  • Users liked CycleTel as a family planning method for its ease of use, convenience, and lack of side effects.
  • The majority felt it was easy to communicate with their partners about the unsafe days; about 70% of users showed their husbands CycleTel messages.
  • 92% were very satisfied with CycleTel as a method to prevent pregnancy.
  • 100% would recommend the service to others.
  • 35% of participants called the helpline. Helpline calls decreased after one cycle of use.
  • 86% said they would be willing to pay on average Rs. 33 per month for the CycleTel service. (Sending one SMS in India costs less than Rs1.)

Positive proof-of-concept results validated an investment in technology development for CycleTel.

Read the report

 

Automated pilot testing (2011)

The study recruited 715 women to use CycleTel as a family planning method for two menstrual cycles in order to:

  • ensure that the automated technology functioned properly with a higher volume of users
  • evaluate user experiences with the service
  • integrate user feedback
  • test the feasibility of integrating the service with a fully-functioning family planning helpline
  • develop processes to handle real-time data analysis and system monitoring

Overall, the automated testing was successful in (1) validating that the technology generally worked as expected, (2) integrating a helpline into the service, and (3) determining processes for monitoring the service.

Read the report

 

The Market Validation Testing (2013)

In the final stage of testing, IRH marketed the CycleTel service and tracked leads and conversions for 7,500 potential customers. The study used a “high-touch” field engagement model along with follow up and engagement through customer call center.

Read the report

Implementing CycleTel

CycleTel aimed to expand the benefits of SDM to women in India in a way that realizes both the operational economies of scale and ultimate sustainability through revenue-generation models. The project objective was to introduce and roll-out CycleTel to women in India by implementing and assessing go-to-market strategies, establishing the foundations of a sustainable operating model, and acquiring 100,000-150,000 users from July 2014 to June 2017.

The 5-year goal for the CycleTel initiative was to serve over 1,000,000 women in India, while increasing family planning use and reducing unmet need for different market segments. Working backwards in ambition and timeline, this project intended to accomplish the next immediate steps towards that goal.

In 2014, IRH identified and established a partnership with HCL Services Ltd. (HCL), the firm that oversaw, managed, and implemented the Nokia Life information platform application in India. The Nokia Life platform, re-branded as the Life Tools application in 2015, was available on selected Nokia handsets and provided information on agriculture, health, and education to over 50 million users across India. Through the HCL partnership, CycleTel was integrated as an opt-in app on the Life Tools platform. Although the Life Tools platform was based on standard SMS, messages were sent in a proprietary format and were thus found in a separate inbox on user phones. This partnership brought several benefits. By integrating the service into a well-known, trusted brand, CycleTel was able to gain more legitimacy not available to a new, independent service. In addition, Life Tools provided access to an extensive database of potential users who had previously accessed health information through a mobile phone.

However, in September 2015, a mere 3 months into this project, coinciding with the launch and user acquisition phase, HCL shut down their services leading to an early shift in project reach and abilities to access and acquire users to build a base and ensure financial sustainability of CycleTel. Early project diversions led to innovation in exploring small and large-scale efforts to acquire and retain users to reach project goals.

In our implementation, we made efforts to reach users through outreach campaigns, mass media marketing, digital marketing, public relations and coverage and NGO distribution and outreach through a multiple-ended SMS service. Throughout implementation of CycleTel, financial sustainability strategies were employed working with private and public sector entities to explore options for market integration. Our distribution partners included Child Survival India (CSI), Prerana and Hindustan Latex Family Planning Promotion Trust (HLFPPT). The Indian Society of Health Professionals (ISHP) is our research partner, and Boring Brands and PR Mantra act as our marketing and social outreach partners.

Learn more about CycleTel in the final project report.

Despite numerous challenges, implementing CycleTel as an mHealth product primed for market integration has brought about many generalizable learnings for the community concerning selecting and monitoring strategic partnerships and anticipating technological advancements. The ability to be innovative, flexible in implementation, and willing to make quick course corrections is critical. After three years of implementing CycleTel, the team has learned that exclusively SMS-based mHealth innovations are past their prime. As the technological landscape evolves, mHealth projects need to be beyond the curve of innovation and creativity in order to not begin behind.

The CycleTel Team

CycleTel was conceptualized and developed by Georgetown University’s Institute for Reproductive Health (IRH). IRH addresses global reproductive health and family planning issues through a research-to-practice-to-scale agenda.

Our global team were and still are passionate about improving the lives of women and girls though improved family planning options. In the CycleTel project, our team consisted of entrepreneurs, researchers, technologists and family planning experts in India and Washington, DC.

Throughout the years, CycleTel was supported by USAID through the FAM and FACT projects, as well as through the UN Foundation’s mHealth Catalytic Grant Mechanism.and USAID’s Development Innovation Ventures (DIV) mechanism.

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