As low- and middle-income countries transition from paper to digital systems, family planning programs can benefit from unprecedented opportunities to improve services. Investments in digital health tools have expanded exponentially, but information on what works—and what does not— remains limited and scattered. As investments have increased, digital applications and data fragmentation have proliferated, but stakeholders are moving towards more coordinated efforts to scale digital health solutions, support countries’ digital health infrastructure, and share evidence-based learnings.
This Digital Health Compendium enables users to explore case studies across a range of digital health technologies used to enhance family planning programs mainly in sub-Saharan Africa, but also in other regions of the world. Digital health applications in family planning programs can be broadly classified as those affecting demand generation, service delivery, supply chain management, and the policy and enabling environment. In many low- and middle-income countries, digital health innovations were adopted earlier in other health sectors, including HIV/AIDS, maternal and child health, and noncommunicable disease prevention and response. As a result, much of the impact evidence is likewise restricted to those sectors. To advance greater adoption of digital technology in family planning programs, more data and information on the challenges, opportunities, scalability, and results are needed. This compendium aims to consolidate emerging information and data on applications of digital technology in family planning programs to inform adoption and scale-up of successful approaches.
All of the case studies were submitted by the implementing organizations and include a description of the digital health intervention, program context, and, if available, important findings and lessons learned through rigorous evaluations or program data. The compendium facilitates a quick search for case studies based on the target user for digital health intervention, building block for the digital health enabling environment, family planning program classification, and country location. The case studies give policy and program decisionmakers insights on real-world applications of digital health, promising practices, challenges, and other lessons that can be applied to current and future programs.
Cycle Technologies, Inc.
The information below appeared in the original case study.
Cycle Technologies developed and manages the applications
The Institute for Reproductive Health at Georgetown University provided consulting support
Founder & President
Services and Applications
This case study was originally published in the mHealth Compendium Volume 1, developed by the African Strategies for Health project, implemented by Management Sciences for Health with support from the U.S. Agency for International Development (USAID). Updates to the original case study, submitted by the implementing organization in March 2021, appear in the final section of this case study.
iCycleBeads smartphone applications enable women to use the Standard Days Method® (SDM) of family planning through their iPhone or Android devices. The SDM is a fertility awareness-based family planning method that was developed by Georgetown University’s Institute for Reproductive Health (IRH). The method identifies which days during a woman’s menstrual cycle she is most likely to become pregnant if she has cycles within a certain range. The SDM has been proven more than 95 percent effective. iCycleBeads iPhone and Android apps were developed by Cycle Technologies under license.
Cycle Technologies launched the iCycleBeads iPhone app in December 2010 and the iCycleBeads Android app in July 2011. Currently, the smartphone apps are available to anyone with an iPhone or Android device. They are available in iTunes and the Android Marketplace for one time purchase at $2.99. They are available in English and Spanish. Other languages can be made available.
Cycle Technologies is exploring opportunities to make iCycleBeads smartphone apps more readily available to users worldwide, and in particular, throughout the developing world.
iCycleBeads Smartphone apps are available to anyone with an iPhone, iPod Touch, iPad, or Android device. The iCycleBeads Smartphone Apps use a CycleBeads visual, as well as a calendar, to help a woman track her cycles and know which day pregnancy is likely.
To use the iCycleBeads smartphone apps, a user enters the date that her period starts. The app will calculate which days during her upcoming cycle she is potentially fertile or not based on her cycle start date and the methodology of the SDM. Color-coded visuals help a user readily identify her fertile days, non-fertile days, and when her next cycle is likely to start. A user will also receive pop-up alerts on her phone for key days such as when her fertile days are about to start, when they are ending, when she can expect her next period to begin, and to remind her to enter her next period start date. The apps immediately notify a user if she has a cycle that is outside the 26-32 day recommended range for effective use of the SDM.
Since the launch in 2010, the apps have been downloaded by approximately 8,000 users (as of October 2012). A majority of users are in the U.S., U.K., Canada, Australia, and other English speaking countries. However, users from all regions and more than 75 countries have downloaded the apps.
iCycleBeads smartphone apps have yet to be introduced in low-resource settings, although a handful of users in developing countries are already using the apps. Given the rapidly expanding use of smartphones in many countries, there is significant potential for impact.
iCycleBeads smartphone apps can have a significant impact in areas where smartphones, and in particular iPhones and Android devices, are being used. These apps are attractive to women and programs because they enable a woman to use a family planning method that has no side effects, is easy to use, and requires only a one-time, low-cost purchase by the end-user. There are issues related to specific country contexts that may need to be examined more closely in determining the potential impact in a given area.
The app is now called CycleBeads ™ Smartphone Apps. The CycleBeads app has been studied in a range of settings and used by hundreds of thousands of women since its launch in 2011. The app has been tested by third-party researchers in addition to ongoing monitoring by Cycle Technologies. Direct marketing of the app to users has also been tested, to understand the potential impact and the ability of this type of intervention to reach women with unmet contraceptive needs.
The CycleBeads app was evaluated by researchers at the Institute for Reproductive Health at Georgetown University between 2015 and 2018. The study collected quantitative and qualitative data from CycleBeads app users in Kenya at three time points between May and September 2015. All CycleBeads app users in Kenya aged 18 or older who downloaded the app during the distribution period were eligible. Each received a pop-up notification in the app within two weeks of downloading it, asking if they would like to participate in the study. Interested users provided their phone number through the app in response to the notification, and were called by researchers to schedule an interview. Overall, 185 CycleBeads app users were enrolled in the study.
The baseline structured interview included questions on how users learned about the Standard Days Method and the app (distribution channel), how they intended to use the app (e.g. to track cycles or to plan or prevent pregnancy), their experience downloading the app, and their initial understanding of the app and how to use it after less than two weeks of use, as well as their previous family planning use. Participants were contacted again at midline and endline for additional structured interviews related to ongoing understanding and correct use of the app and the method and satisfaction with the app. They were also asked whether they had discussed the method or the app with their current partner.
In-depth interviews collected qualitative data through conversations of approximately one hour. Three interview guides (baseline, midline/endline, and discontinued users) were designed to supplement the structured quantitative interviews and elicit in-depth insights into how users had heard about the CycleBeads app and had decided to use it, as well as how they used both the Standard Days Method and the app, communicated with their partners, and managed fertile days.
Findings show the app increased users’ awareness of family planning, addressed unmet contraceptive needs, and could be made available directly to users in a cost-efficient manner.
With no differences in knowledge and correct use of the app by distribution channel, it appears that the CycleBeads app can be distributed easily and inexpensively through digital marketing campaigns to women in need of a natural way to prevent pregnancy. More than 2,115 of the CycleBeads app downloads in Kenya were attributable to Facebook advertising, at a low cost of US$0.47 per download. Through digital marketing, the CycleBeads app has the potential to reach women outside of the health system directly on their smartphone.
The app was studied in Ghana, Kenya, India, Egypt, Jordan, Senegal, and Nigeria.
Haile, Liya T., et al., “Market-Testing a Smartphone Application for Family Planning: Assessing Potential of the CycleBeads App in Seven Countries Through Digital Monitoring,” mHealth, July 23, 2018,
Victoria Shelus et al., “Preventing Pregnancy in Kenya Through Distribution and Use of the CycleBeads Mobile Application,” International Perspectives on Sexual and Reproductive Health 43, no. 3 (2017): 131-41, https://doi.org/10.1363/43e4617.