Reaching Women, new Mothers, and Male Partners in Benin with Health Information through an SMS and IVR Platform

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An SMS and Interactive Voice Response (IVR) service for supporting pregnant women, their partners, and parents of infants under one year to access information on general health, child development, positive health care seeking behavior at the household level.

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An SMS and Interactive Voice Response (IVR) service for supporting pregnant women, their partners, and parents of infants under one year to access information on general health, child development, positive health care seeking behavior at the household level.

Introduction

Pregnant women and new mothers in low resource settings often lack access to vital information about pregnancy, preparation for birth, early child development, and best practices when caring for their newborn. Not only can this lead to a perpetuation of harmful practices, but also missed opportunities in positive care-seeking behaviors and linkages with the health system.

Digital health interventions can bridge the health information gap which can lead to improved healthy behaviors at the household levels, drive demand for care, and boost service utilization and link families with appropriate facility-level care, thereby contributing to improved maternal and neonatal health outcomes. [1] Messaging services that provide pregnant women with access to information and include reminders to seek care have proven effective in increasing antenatal care seeking behavior.

About Benin IVR Project

Pregnant women and new mothers in low resource settings often lack access to vital information about pregnancy, preparation for birth, early child development, and best practices when caring for their newborn. Not only can this lead to a perpetuation of harmful practices, but also missed opportunities in positive care-seeking behaviors and linkages with the health system.

Digital health interventions can bridge the health information gap which can lead to improved healthy behaviors at the household levels, drive demand for care, and boost service utilization and link families with appropriate facility-level care, thereby contributing to improved maternal and neonatal health outcomes. [1] Messaging services that provide pregnant women with access to information and include reminders to seek care have proven effective in increasing antenatal care seeking behavior.

Evaluation and Results

Piloting of the IVR platform took place from Jan – March 2021 with 515 end users in Adjohoun, Benin. The core aim of the pilot was to assess acceptability of the developed messages and distribution method (e.g. frequency, timing of messages, IVR vs. SMS platform), as well as to refine and fine tune the content and the distribution modes. 346 users were included in pilot M&E (78% women, 22% men). The pilot evaluation included three components:
– A rapid-evaluation quantitative survey,
– User data from Viamo, and
– Qualitative data including FGDs and interviews with pregnant women, new mothers, and their partners. Demographic information for participants showed that age was evenly distributed evenly, a relatively low education among women with moderate degree of education for male partners, and a high simple phone ownership for women with much lower access to smartphones: (< 25% of women; > 50% of men). Figure 1

All female users and a large number of male partners found message “very useful” and easy to understand.
Content reported to be most useful by pregnant women and their partners were appointment reminders and danger signs, while most useful content for parents of young children was reported as breastfeeding and child development. All female users and a large number of male partners found message “very useful” and easy to understand.
Content reported to be most useful by pregnant women and their partners were appointment reminders and danger signs, while most useful content for parents of young children was reported as breastfeeding and child development.

Recipients reported they felt well informed and better able to identify danger signs, and that the language used in the messages is appropriate and the messages are well translated without difficulties in understanding.

84% say they shared the information with others (family, friends, other parents). To this end, one respondent (the husband of pregnant woman who told a story of counseling his friend to seek care for his pregnant wife who was bleeding) said, “We are now able to recognize danger signs such as bleeding in pregnant women.”

Additionally, a common theme in focus groups among women was that the messages enabled them to respect exclusive breastfeeding and proper maternal nutrition, despite pressure from family/ older women to take up harmful practices, and that sharing messages with them helped encourage whole household behavior change. There was also a self-reported increase in: adherence to immunization schedules, prenatal consultations, better diet (consumption of fruits, vegetables, meat, etc), hygiene, sleeping under impregnated mosquito nets, and strengthened communication between partners. Figure 2

Figure 3 Data from tech partner Viamo confirms that recipients found it easy to access the messages and appreciated them. Of 1210 people contacted who had originally shown interest, 43% were actually enrolled which is quite high compared to the Viamo-reported average of of around 10%. A very low drop- out rate (4.6%) was also recorded across gender, and on average, the recipients listened to all the messages received. Figure 4 The Benin SMS/IVR platform has now been scaled to a total of 2000 (300 from pilot plus 1700 scale) users throughout 2021. As of October 2021, and endline evaluation with control group comparison is underway. While the pilot M&E focused on acceptability and gathering data to better the platform, the endline will seek to document changes in knowledge, attitudes, and practices as well as changes in health seeking behavior.

Lessons Learned

– We confirmed that innovation should not be done just for innovation’s sake; it is about designing for the end users. While there was money in our project budget to create a “higher tech” solution, design research showed that the preferred platform at the current moment (due to literacy and phone ownership barriers) was SMS/IVR.
– We initially had not planned to enroll male partners, but when there was an interest, we did not want to leave them out. This shows an opportunity for male involvement, and in fact findings from pilot data suggested that users of both genders felt that communication had increased between themselves and their partners.
– Partnering with local entities was critical to ensure acceptability of the platform, both in terms of local tech organizations for design aspects and local community-based organizations for sensitization about and enrollment in the platform.
– French was a barrier for initial enrollment, which needed to be changed to local languages during scale period.

Conclusion

Initial results show the SMS/IVR platform to be easy to access and understand, appreciated by end users, and have a positive effect on healthy behaviors at home and care-seeking behaviors as well as communication about maternal and child health amongst families.

The next steps for the platform will be focused on branding (naming and packaging the platform for replication), as well as formal documentation of results, best practices, and challenges for the digital health knowledge base. A brief and journal article are expected in 2022. Maternity Foundation hopes to continue the platform in Benin, and work with Plan Bornefonden and other interested partners to replicate in other countries, with contextualization to each country’s cultural considerations, key health issues, and priorities.

References

1. Feroz, A., Perveen, S. and Aftab, W., 2017. Role of mHealth applications for improving antenatal and postnatal care in low- and middle-income countries: a systematic review. BMC Health Services Research, 17(1).