In rural Ethiopia, pregnant women and new mothers now learn about nutrition, breastfeeding and other health topics through their mobile phone. Mobile health (mHealth) services also provide an effective means of getting the fathers-to-be more involved in safe pregnancy and childbirth.
Despite significant progress made in the last decade to advance the health of women and children, Ethiopia still has one of the highest maternal mortality rates in the world. A major factor behind this tragic statistic is the fact that too few women seek maternal health services during pregnancy or delivery. According to Ethiopia's 2016 Demographic and Health Survey, only 26% of women gave birth with a skilled birth attendant and 87% of newborns did not receive a postnatal check within the first two days of birth.
For more than a decade, Maternity Foundation has worked on-the-ground in Ethiopia through community groups, livelihood programs, and traditional radio broadcasts to increase access to information about healthy behaviors during pregnancy and childbirth.
As the world becomes more connected through new tools and technologies, organizations must look toward enhanced opportunities to increase access to this critical knowledge and services. And with over five billion people now having access to a mobile phone, there is a clear opportunity to transform the delivery of health services and information around the globe – this is known has mHealth.
Building upon lessons learned from the Wired Mothers project which sought to leverage Short Message Service (SMS) systems to increase access to antenatal care (ANC) and skilled attendance at delivery, Maternity Foundation began investigating how similar technologies could be applied to reduce maternal mortality in West Wollega region, a rural part of Ethiopia facing challenges with access to quality maternal health care.
Enter LUCY – a free and anonymous SMS system for pregnant and lactating women which delivers critical healthcare messages in line with Ethiopia’s national clinical guidelines and international recommendations.
Named after "the grandmother of humanity", the Ethiopian early human fossil Lucy, the SMS service message package starts from week 5 in pregnancy to week 4 post-partum. Consenting mothers are registered into the mobile system with their approximate due date or baby’s birth date. She then receives 2-3 weekly messages – voice or text – tailored to her and her baby’s health needs.
The LUCY system covers a range of topics on healthy behavior including nutrition and reminders to attend ANC visits. At week 27 of pregnancy, for example, a woman receives a message saying: "Drink milk and eat cabbage to get plenty of calcium. Calcium helps your baby's bones and teeth grow strong."
In May-June 2017 a localized Oromiffa language version of LUCY was rolled out in nine districts (covering 650.000 people) in West Wollega. More than 400 key stakeholders including health extension workers, midwives, and health centre personnel were trained to enroll women into the system. In the following six months, 1500 women were enrolled with the objective of increasing the percentages of women who complete ante-natal care visits and deliver with a skilled birth attendant.
Recent follow up interviews were conducted with 15 women and two health workers. In interviews, Maternity Foundation found improved knowledge and health behavior amongst them.
"We see direct results", explains Washumw Garuma, a health extension worker in the Jarso district of Ethiopia. "For example, a woman received a message about iron, and then she called her health worker to know where she could get iron. Another woman called on a danger sign of vaginal bleeding and they referred her to the health center."
Many women do not own their own mobile phones and therefore use their husbands phones to receive messages. This leads to increased male involvement in pregnancy and childbirth says health extension worker Kapabush Tegefa: "We have seen a lot of changes. Men are taking better care of their wives, especially making sure that they rest, so that the husband will fetch water, buy clothes to them and keep cleanliness. They also make sure the women get a balanced diet by adding fruits and vegetables. Sometimes they also ask us about the meaning of the messages."
The results from West Wollega are encouraging and scaleable with the right investments.
mHealth technologies like Lucy and the Safe Delivery App – Maternity Foundation’s other mHealth plaform which trains skilled birth attendants throughout Ethiopia on how to handle complications in childbirth – demonstrate the power of innovations to drive improved health outcomes for girls and women around the world.