Fighting maternal deaths; 160 characters at a time
Every day, 830 women worldwide die from preventable causes related to pregnancy and childbirth. Almost all (99%) die in developing countries, usually in remote areas with limited access to pre and postnatal information and care.
In rural and low income settlements in Kenya, SMS is bridging this gap. Health providers like Jacaranda Health are using the Echo Platform to engage expectant women via SMS before and after childbirth in order to provide vital stage-based information and drive behaviour change.
Jacaranda is a social enterprise dedicated to transforming maternal healthcare and making pregnancy and childbirth safer in East Africa. To achieve this mission, Jacaranda has been leveraging the ubiquity of mobile phones since 2015 and is now using the Echo platform to help four county governments across Kenya extend their reach.
Why Echo?
SMS self registration
Using the Echo platform, Jacaranda has enabled expectant women and new moms to register themselves for for free, personalized SMS services. Women seeking services at public facilities are directed to posters that instruct them to send a free SMS with a keyword to the toll-free short code linked to Jacaranda’s Echo platform account (E.g. send “MAMA” to 12345).
Once the keyword is sent, the Echo platform instantly captures the sender’s phone number and creates a contact profile for her. The keyword SMS also triggers a short SMS survey to collect information on the mother’s SMS language preference (English or Kiswahili) as well as how far she is in her pregnancy. Each woman’s preferences and key dates are stored in custom fields, allowing for automated, personalized follow-ups tailored to the mother’s trimester.
In the months following registration, the expectant mother receives a series of key health information messages with reminders about prenatal care, newborn care, danger signs to watch for, and reminders on family planning after birth. This content was developed by Jacaranda with help from Kenyan women, nurses, and doctors, to make sure the most relevant information is getting sent.
Scheduled SMS reminders and tips
The Echo platform’s scheduling feature allows organizations like Jacaranda to set up messages, surveys, and other communications that send automatically based on the unique data of individual recipients.
Based on the due date that each woman provides when registering with Jacaranda’s shortcode, Echo delivers fully automated, stage-based messaging through the course of her pregnancy.
These messages serve both to provide women with vital information about caring for themselves and their baby and to drive behaviour change — motivating women to attend regular, recommended prenatal and postnatal clinic visits that can make the difference between life and death.
Women in rural and low income areas face a variety of barriers that hinder them from attending clinic appointments, including poverty, distance, lack of information, and cultural practices. Echo SMS enables organisations to send informative tips on pre and postnatal care and reminders to women on the importance of clinic visits.
Through Randomized Control Trials, Jacaranda Health has found that these frequent SMS reminders have improved uptake of antenatal and postnatal care. Amongst women who did not receive the SMS reminders, fewer than half returned for followup appointment, compared with 70% return rates amongst those who received SMS reminders . Engaging the husbands postpartum over a series of SMS reminders also increased family planning uptake.
What about expectant mothers who can’t make it to the clinic? How can SMS be used to reach them?
Expectant mothers in remote areas often miss clinical appointments because of the high financial and opportunity costs of travel. Jacaranda’s research shows that in low income countries nearly 45 percent of pregnant women do not attend all four antenatal appointments recommended by the World Health Organization.
Missing these appointments prevents women from asking questions to medical professionals. However, the Echo platform now enables women to ask questions via free SMS and Jacaranda to provide answers remotely and automatically, empowering women with free information even when they miss appointments.
Jacaranda receives dozens of daily SMS questions from women with unique concerns and responds to all in consultation with staff nurses. These SMS responses are not meant to replace prenatal and postnatal clinic visits, but rather to encourage expectant mothers into healthier pregnancies, resulting in fewer maternal mortalities.
What’s Next?
By engaging women through SMS at key touch points, Jacaranda Health is positive it can improve maternal outcomes by targeting critical behaviours related to antenatal and postnatal care.
In the coming months, Jacaranda Health plans to expand its SMS program to thousands more women across the country; build out content related to breastfeeding support; and analyze the effect of the messages on health outcomes. With the support of the Echo Mobile platform, women will increasingly get information tailored to their needs and link to health providers nearby.
SMS may not be the magic bullet to zero maternal deaths, but it empowers expectant women with information that could save their and their babies’ lives. Smartphone penetration may be well increasing but the feature phone remains dominant in Africa and the relevance of SMS to support stage-based behaviour change initiatives is applicable across sectors.
Outside of the health sector, for example, Precision Agriculture for Development (PAD), on behalf of the Kenyan Ministry of Agriculture, is using the Echo platform to empower farmers to fight the Fall Army Worm with SMS info on how to identify and counter the pest.
If knowledge is power, information liberating and education the premise of progress, the ubiquitous mobile phone and the uniformity of SMS on every mobile phone makes it an ideal channel of communication to empower communities.
Want to learn more about the Echo platform? Email us on info@echomobile.org.
