Maa- Maternal Health Awareness

Maa, is a maternal health awareness system for pregnant women in which SMS text messages and recorded voice messages were sent to them on mobile phones regarding antenatal care. The results were fruitful and it was found out that that mothers exhibited dramatic, statistically significant, gains in knowledge about pre-natal care.

The Challenge

Globally 830 women die per day among which 99% from developing countries. Pakistan is among top 3 in south Asian countries with 30,000 maternal deaths annually. In Pakistan 1 in every 13 woman dies due to maternal complications. Maternal mortality is higher in women living in rural areas and among poorer communities. One theme which occurred repeatedly was a general lack of information or misinformation about health and pregnancy related healthcare among low-income mothers in Pakistan. Some of the miss-conceptions are following. They were unaware of the value of routine checkups during pregnancy; iron supplements; pre-natal supplements; ultrasound appointments; high-risk indicators; or even the value of hospital births. Another prominent theme was the reliance on advice from people without proper medical training, including traditional midwives (“daai”) and relatives, particularly mothers-in-law.

Our Solution

Based on our interviews, pregnant mothers’ lack of good information seemed to be a prominent issue that an ICT intervention could target. Thus, we decided to design a mobile information system that focused on providing short, simple messages during pregnancy via SMS text messages, automated voice calls, or both. A total of 180 pregnant mothers participated in the trial, with 45 mothers registered in each of four groups: (1) a control group, (2) an SMS group, (3) a voice message group, and (4) a group that received both SMS and voice messages. Following recommendations resulting from the amplification theory of technology, the system was designed to have a clear association with the hospital. The first task in designing the information system was to decide on the sources of content. The content had to be appropriate for Urdu-speaking expecting mothers from low-income settings. Because our source book did not contain material in bits of information suitable for text messaging or voice recording, we first finalized a list of themes in consultation with the doctors. The topics included: reminders of follow-up visit, adherence to iron and calcium supplements, tests to be performed during pregnancy, healthy diet and healthy lifestyle, high risk indications, baby movements, delivery preparations, newborn care and birth spacing. A total of 110 different messages were prepared that cover all the necessary information required during pregnancy. Reminders about follow-up visits and medicine intake are also sent as messages to the expecting mothers. For the follow-up visits, reminder messages are sent one day before the visit day. Three times a week, informational messages are delivered to expecting mothers on the basis of their gestational age, customized to the week and the month they are in. The technical implementation of the system has two parts: SMS message delivery and automated voice calls. The impact on knowledge of pregnancy showed dramatic gains among all three modes of messaging. Overall, our evaluation showed that all three types of messaging had a large effect on mothers’ knowledge about pregnancy that was statistically significant with very small p values. In addition, the two groups receiving text messages had a slight tendency toward increased follow-up visits, though not with statistical significance.