Harnessing the Power of a Text Message to Save Lives
How USAID is improving access to health services with digital technology for mothers in Kenya
In Kenya, the maternal mortality rate is almost 2.5 times higher than the average maternal mortality rate worldwide. Gaps in the quality of intrapartum care and delays in care seeking contribute to a significant number of maternal deaths in Kenya.
Pregnant women who do not recognize critical danger signs during pregnancy or the postpartum period, such as heavy bleeding, may not reach care in a timely manner, or turn to traditional community healers, family members, or neighbors who might not be equipped to deal with clinical emergencies. Without clinically-accurate information on pregnancy, labor, delivery, and postpartum care, many women seek care when it is already too late — or not at all.
In Kenya, for example, less than 60% of women attend the World Health Organization (WHO)-recommended number of antenatal visits during pregnancy due to health systems that are difficult to navigate or previous experience with poor quality care.
To improve health outcomes for mothers and babies in Kenya, USAID partnered with Jacaranda Health, a Nairobi-based public health organization, to support the implementation of its digital health platform, Promoting Mums Through Pregnancy & Postpartum Through SMS, or PROMPTS, in two of Nairobi’s low-income residential areas, Mathare in northeast Nairobi and Kawangware in western Nairobi.
The PROMPTS platform uses text messages to communicate directly with expectant and new mothers throughout their pregnancy journeys, designed to improve care-seeking behavior at key moments during and after pregnancy.
Women can enroll in PROMPTS through their local health facility at no cost, with support from a health provider. The platform sends mothers ‘nudge’-based information encouraging them to practice optimal health behaviors based on the stage of pregnancy — like sleeping on one side to improve blood flow and oxygen to the baby — and reminders to attend antenatal check-ups. Expectant and new mothers can also ask questions at any time in either English or Swahili, or a mix of the two.
Mothers often ask general questions like, “Can I eat avocados during pregnancy?” which are answered directly through the PROMPTS platform. Artificial intelligence is used to categorize mothers’ questions and flag clinically urgent questions like, “I’m bleeding, what should I do?” for a help desk agent for follow-up and referral. Within one hour, a help desk agent (who is a trained clinical provider) calls the mother at risk directly and refers her to the appropriate level of care with affordable emergency transportation.
The use of artificial intelligence means PROMPTS is able to field up to 4,000 questions a day from mothers, and can respond to urgent cases in minutes.
Mothers can continue to use the platform after delivery to receive reminders to attend check-ups for themselves and their infants, encouragement to practice exclusive breastfeeding for up to six months, and information on infant vaccinations. After receiving care, women are also given the opportunity to provide feedback through the PROMPTS platform on the quality and timeliness of the care they received.
Women throughout Kenya have found this program to be critically important and lifesaving for themselves and their newborns.
One mother said, “I lost two pregnancies before I came across PROMPTS. I signed up for the SMS service in a hospital near me. I’ve since learned through the messages that bleeding during pregnancy is a danger sign…. I know where and when to look for support now.”
Another mother, Josephine Mucoro, was in the later stages of pregnancy when she received a text message from PROMPTS with a tip for monitoring pregnancy danger signs, explaining that pain in the upper abdomen during pregnancy is a critical sign to seek health care.
“One Thursday, I started feeling this pain. I thought it’d pass, but it persisted,” she explained.
Remembering the text message she received from PROMPTS, she decided to visit a nearby clinic. She was referred to a hospital in Chwele after finding that her blood pressure was too high.
High blood pressure during pregnancy can be especially dangerous for mothers and babies. At the hospital, she found that her baby wasn’t moving, and she had an emergency cesarean section that saved her and her baby’s life.
“I’m so grateful to Jacaranda for sending these messages,” said Josephine. “Because of PROMPTS, I was able to recognize the pain I was feeling was not normal and I went to find care at the hospital. I don’t know what might have happened to me and the baby otherwise.”
To date, with support from USAID and other partners, PROMPTS has reached more than 1.25 million women across Kenya, with health providers enrolling mothers to the platform in over 1,000 of the country’s public hospitals. Among a sample of all mothers enrolled in the PROMPTS platform, 27% of women were more likely to attend all recommended antenatal care visits, and 85% of mothers who were told to seek further care by the clinical helpdesk followed through at a hospital.
Through the support of USAID and Jacaranda Health, pregnant women and new mothers in Kenya are better equipped to support healthy pregnancies and achieve improved health outcomes for themselves and their children.
About the Author
Stephanie Mork is a Communications Analyst in USAID’s Bureau for Global Health.
