Mazanick - SMS messaging for education and support of women

pregnant woman      message

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Our story starts with Prudence. Prudence is a 16 year old girl who is unmarried, lives at home with her family, works at a small shop and has enough money for a very basic cell phone. Prudence went to a nearby health clinic and has just found out that she is pregnant. Her pregnancy is unplanned. For our Designing Liberation Technologies project, we decided to focus on trying to find a way to leverage simple mobile technology to help young women in Kibera with unplanned pregnancies have a better chance to deliver in a safe medical facility. This was a big issue to try to tackle, but we decided to try to use this class to incubate potential solutions.

As we began our initial research, we learned that
in many cases, easily preventable complications in pregnancy can have catastrophic outcomes for women and children during delivery. This risk is much more acute when a woman gives birth at home. In our research, we also discovered that while most women come in for an initial visit to the health clinic (like Prudence), many do not come back after this first visit. There are several factors which make it much more likely that a woman will not come back after that first visit: 1. If the pregnancy is unplanned 2. If the woman is young and 3. If she has a lower level of education. However, if a woman is able to come for the four standard prenatal visits that are typical in Kibera, she is significantly more likely to end up giving birth in a safe health facility.

Equipped with this knowledge, we decided to try to intervene when a woman like Prudence comes in for that first visit, to see if we could find a way to help her come back for her second, third and fourth visit, and ultimately give birth in a safe health facility. As we began to think about potential solutions, we considered the spectrum of things that might prevent Prudence from getting back to the facility. She needs money, transportation, resources; many of the things she needs are very tangible. However, for our project, we wanted to try to get to the root of what might be stopping her. We discovered that one of the principle things that was preventing Prudence was something a little less tangible, and that was motivation.

Armed with this insight, we made the conscious decision to try to intervene and provide something very simple for Prudence: support. We decided to try to provide support for Prudence because during that moment she is leaving the health facility after her first visit, she is vulnerable. She needs to be validated and she needs information about what to do next, so that she can be empowered to come back. We were also interested in providing support for Prudence because we thought that the category of support would allow us room to really innovate, to potentially make a big impact with limited resources.

With all of this information in hand, we came up with a solution. When Prudence is ready to leave the hospital after her first visit, she will sign up with our system. On a simple computer interface, Prudence will register for our system by entering just three pieces of information: her name, her cell phone number, and a nickname for her baby. After signing up, Prudence will receive three free text messages per week which provide her with important information based on where she is in her pregnancy and directives aimed at motivating her to get back to the health facility for her next prenatal visits.

An example of one of these texts is the following:

Baby Imani can now sense light and will move around. Count how many times you feel her move each day and tell nurse Mahu at your next visit in 5 days. Arrange transport.

For our prototype we crafted messages that would cover the fourth month of Prudence's pregnancy. We showed our texts to students at the University of Nairobi, our coaches and medical professionals in the Bay Area. Based on the insights and feedback they provided, we adapted the tone, content and phrasing of the messages to best serve Prudence.  We hope that ultimately these texts will support Prudence and motivate her to come back for all of her prenatal visits and ultimately give birth in a safe health facility.

We have gotten a lot of great feedback on our prototype, but in order to push this project to the next phase, we need to go to Kibera.  We need to show our texts to women like Prudence, and adapt them based on insights we get from our real users. This is an essential next step because we are dealing with content that is delicate and nuanced, and ultimately, our final solution must be based on deep empathy and a much richer understanding of our user. We are excited to move our project to this next phase, and believe that we can roll out a simple, actionable prototype over a short period of time with just a few thousand dollars.

Additional Reading on Pregnancies in Kenyan Slums

We referenced findings from a series of studies published in 2009-2010 to inform some of the decisions we made about our personal and her needs.

In 2006, the World Bank and the African Population and Health Research Center carried out a household survey that was part of a multi-faceted Maternal Health Study. Overall, 2482 women aged 15–49 were identified as having had a pregnancy outcome in 2004 or 2005. A series of studies were conducted investigating the state of Emergency Obstetrics Services, Delivery Care Satisfaction and Mothers' Autonomy for pregnant women living in slums outside Nairobi. Out of the 2482 women surveyed, 183 women out-migrated or died, 373 were not interviewed because they had had a miscarriage, were not found at home, or refused, giving a response rate of 84% (1926/2299). Of the women interviewed, 1266 women gave birth in a health facility (66%)

See additional readings:

Sample Texts and Text Translations into Sheng and Swahili