skip to main content
10.1145/3136560.3136573acmotherconferencesArticle/Chapter ViewAbstractPublication PagesictdConference Proceedingsconference-collections
research-article

Maternal Complications: Nuances in Mobile Interventions for Maternal Health in Urban Pakistan

Published: 16 November 2017 Publication History

Abstract

We present a three-phase exploration of mobile messaging to address the high rate of maternal mortality in low-income, urban Pakistan, with a focus on identifying deviations from previously published findings about mobile interventions in developing-world health.
Phase 1 was a qualitative study of healthcare staff and pregnant mothers. It found that while the deeper medical challenges of maternal mortality were beyond the reach of ICT interventions, many of the problems could be partially addressed through a mobile-phone system that issued health-related information and reminders. In Phase 2, we ran a randomized controlled trial of 180 pregnant mothers split into four arms based on the mode by which the messages were sent -- (1) no messages (control), (2) SMS text messages, (3) recorded voice messages, and (4) a combination of SMS and voice messages. Consistent with prior research, we found that mothers receiving messages exhibited dramatic gains in knowledge about pre-natal care, though whether the messages increased follow-up hospital visits was not clear.
Phase 3 involved follow-up phone interviews with the participants of the Phase 2 evaluation. Complex family dynamics involving husbands and mothers-in-law mediate the impact of mobile information interventions, with both positive and negative effects.

References

[1]
Wikipedia, "Maternal death," Wikipedia, {Online}. Available: https://en.wikipedia.org/wiki/Maternal_death.
[2]
WHO, "Maternal Mortality," WHO, November 2015. {Online}. Available: http://www.who.int/mediacentre/factsheets/fs348/en/.
[3]
Y. P. Khan, S. Z. Bhutta, S. Munim and Z. A. Bhutta, "Maternal health and survival in Pakistan: issues and options," J Obstet Gynaecol Can, vol. 31, pp. 920--929, 2009.
[4]
U. Nations, "Sustainable Development Goals," 2015. {Online}. Available: https://sustainabledevelopment.un.org/?menu=1300.
[5]
A. Bashir, M. Aleem and M. Mustansar, "A 5-year study of maternal mortality in Faisalabad City Pakistan," International Journal of Gynecology \& Obstetrics, vol. 50, pp. S93--S96, 1995.
[6]
R. Rahim, T. Shafqat and N. R. Faiz, "An analysis of direct causes of maternal mortality," Journal of Postgraduate Medical Institute (Peshawar-Pakistan), vol. 20, 2011.
[7]
Z. Batool, "Socio-cultural factors affecting anemia and its effects on mother child health in the rural areas of district Faisalabad, Punjab, Pakistan," Faisalabad, Pakistan, 2010.
[8]
G. Mahmud, F. Zaman, S. Jafarey, R. Khan, R. Sohail and S. Fatima, "Achieving millennium development goals 4 and 5 in Pakistan," BJOG: An International Journal of Obstetrics \& Gynaecology, vol. 118, pp. 69--77, 2011.
[9]
N. Lalji, A. M. Thaver and A. Kamal, "Maternal neonate and child health (MNCH) research in Pakistan: trend and transition," J Pak Med Assoc, vol. 60, pp. 401--403.
[10]
P. N. Mechael, "The case for mHealth in developing countries," innovations, vol. 4, pp. 103--118, 2009.
[11]
R. Lester and S. Karanja, "Mobile phones: exceptional tools for HIV/AIDS, health, and crisis management," The Lancet infectious diseases, vol. 8, pp. 738--739, 2008.
[12]
T. Tamrat and S. Kachnowski, "Special delivery: an analysis of mHealth in maternal and newborn health programs and their outcomes around the world," Maternal and child health journal, vol. 2012, pp. 1092--1101, 16.
[13]
J. L. Watterson, J. Walsh and I. Madeka, "Using mHealth to improve usage of antenatal care, postnatal care, and immunization: A systematic review of the literature," BioMed research international, vol. 2015, 2015.
[14]
"Liga Inan," {Online}. Available: http://www.ligainan.org/.
[15]
M. R. Khorshid, P. Afshari and P. Abedi, "The effect of SMS messaging on the compliance with iron supplementation among pregnant women in Iran: a randomized controlled trial," Journal of telemedicine and telecare, 2014.
[16]
D. A. Hanauer, K. Wentzell, N. Laffel and L. M. Laffel, "Computerized Automated Reminder Diabetes System (CARDS): e-mail and SMS cell phone text messaging reminders to support diabetes management," Diabetes technology \& therapeutics, vol. 11, pp. 99--106, 2009.
[17]
N. Pai, P. Supe, S. Kore, Y. Nandanwar, A. Hegde, E. Cutrell and W. Thies, "Using automated voice calls to improve adherence to iron supplements during pregnancy: a pilot study," in Proceedings of the Sixth International Conference on Information and Communication Technologies and Development: Full Papers-Volume 1, 2013.
[18]
B. MacLeod, J. Phillips, A. E. Stone, A. Walji and J. K. Awoonor-Williams, "The architecture of a software system for supporting community-based primary health care with mobile technology: the Mobile Technology for Community Health (MoTeCH) initiative in Ghana," Online Journal of Public Health Informatics, vol. 4, 2012.
[19]
"MAMA: Mobile Alliance for Maternal Action," {Online}. Available: http://www.mobilemamaalliance.org/.
[20]
"Gifted Mom," {Online}. Available: http://www.giftedmom.org/.
[21]
"Medic Mobile," {Online}. Available: http://medicmobile.org/.
[22]
T. Fedha, "Impact of mobile telephone on maternal health service care: a case of Njoro division," Open Journal of Preventive Medicine, vol. 2014, 2014.
[23]
S. Lund, B. B. Nielsen, M. Hemed, I. M. Boas, A. Said, K. Said and M. H. a. R. V. Makungu, "Mobile phones improve antenatal care attendance in Zanzibar: a cluster randomized controlled tria," BMC pregnancy and childbirth, vol. 14, p. 29, 2014.
[24]
J. Sherwani, N. Ali, S. Mirza, A. Fatma, Y. Memon, M. Karim, R. Tongia and R. Rosenfeld, "Healthline: Speech-based access to health information by low-literate users," in Information and Communication Technologies and Development, 2007. ICTD 2007. International Conference on, 2007.
[25]
B. DeRenzi, N. Lesh, T. Parikh, C. Sims, W. Maokla, M. Chemba, Y. Hamisi, M. Mitchell and G. Borriello, "E-IMCI: Improving pediatric health care in low-income countries," in Proceedings of the SIGCHI conference on human factors in computing systems, 2008.
[26]
S. Grisedale, M. Graves and A. Grunsteidl, "Designing a graphical user interface for healthcare workers in rural India," in Proceedings of the ACM SIGCHI Conference on Human factors in computing systems, 1997.
[27]
D. Ramachandran, J. Canny, P. D. Das and E. Cutrell, "Mobile-izing health workers in rural India," in Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, 2010.
[28]
D. Ramachandran, V. Goswami and J. Canny, "Research and reality: using mobile messages to promote maternal health in rural India," in Proceedings of the 4th ACM/IEEE International Conference on Information and Communication Technologies and Development, 2010.
[29]
H. Underwood, S. Sterling and J. K. Bennett, "The design and implementation of the PartoPen maternal health monitoring system," in Proceedings of the 3rd ACM Symposium on Computing for Development, 2013.
[30]
W. Brunette, W. Gerard, M. A. Hicks, A. Hope, M. Ishimitsu, P. Prasad, R. E. Anderson, G. Borriello, B. E. Kolko and R. Nathan, "Portable antenatal ultrasound platform for village midwives," in Proceedings of the First ACM Symposium on Computing for Development, 2010.
[31]
"UNdata | country profile | Pakistan," Department of Economic and Social Affairs, United Nations, {Online}. Available: http://data.un.org/CountryProfile.aspx?crName=PAKISTAN. {Accessed 17 11 2015}.
[32]
"The World Bank - Country Data: Pakistan," The World Bank Group, {Online}. Available: http://data.worldbank.org/country/pakistan. {Accessed 17 11 2015}.
[33]
"Pica: Causes, Common Cravings and Risks During Pregnancy," American Pregnancy Association, {Online}. Available: http://americanpregnancy.org/pregnancy-health/unusual-cravings-pica/.
[34]
"Health Care in Pakistan," {Online}. Available: https://en.wikipedia.org/wiki/Health_care_in_Pakistan.
[35]
K. Toyama, Geek Heresy: Rescuing Social Change from the Cult of Technology, 2015.
[36]
World Health Organization, "Provisions of Effective Antenatal Care, Standards for Maternal and Neonatal Care," Department for Making Pregnancy Safer, WHO, 2006.
[37]
N. Sambasivan, E. Cutrell, K. Toyama and B. Nardi, "Intermediated technology use in developing communities," in ACM, 2010.
[38]
I. Medhi, S. R. Menon, E. Cutrell and K. Toyama, "Beyond strict illiteracy: abstracted learning among low-literate users," in Proceedings of the 4th ACM/IEEE International Conference on Information and Communication Technologies and Development, 2010.
[39]
J. Blumenstock and N. Eagle, "Mobile divides: gender, socioeconomic status, and mobile phone use in Rwanda," in Proceedings of the 4th ACM/IEEE International Conference on Information and Communication Technologies and Development, 2010.
[40]
A. Zainudeen, T. Iqbal and R. Samarajiva, "Who's got the phone? Gender and the use of the telephone at the bottom of the pyramid," New Media \& Society, 2010.
[41]
J. Tacchi, K. R. Kitner and K. Crawford, "Meaningful mobility: Gender, development and mobile phones," Feminist Media Studies, vol. 12, pp. 528--537, 2012.
[42]
M. R. Rifat, J. Chen and K. Toyama, "Money, God, and SMS: Explorations in Supporting Social Action Through a Bangladeshi Mosque," in Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems, 2017.

Cited By

View all
  • (2024)Experiences from Running a Participatory Media Platform for Women and Led by Women in Rural North IndiaProceedings of the ACM on Human-Computer Interaction10.1145/36536858:CSCW1(1-23)Online publication date: 26-Apr-2024
  • (2023)Unsettling Care Infrastructures: From the Individual to the Structural in a Digital Maternal and Child Health InterventionProceedings of the 2023 CHI Conference on Human Factors in Computing Systems10.1145/3544548.3581553(1-16)Online publication date: 19-Apr-2023
  • (2023)An Intersectional Look at Use of and Satisfaction with Digital Mental Health Platforms: A Survey of Perinatal Black WomenProceedings of the 2023 CHI Conference on Human Factors in Computing Systems10.1145/3544548.3581475(1-20)Online publication date: 19-Apr-2023
  • Show More Cited By

Index Terms

  1. Maternal Complications: Nuances in Mobile Interventions for Maternal Health in Urban Pakistan

      Recommendations

      Comments

      Information & Contributors

      Information

      Published In

      cover image ACM Other conferences
      ICTD '17: Proceedings of the Ninth International Conference on Information and Communication Technologies and Development
      November 2017
      333 pages
      ISBN:9781450352772
      DOI:10.1145/3136560
      • Conference Chair:
      • Umar Saif
      Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than ACM must be honored. Abstracting with credit is permitted. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request permissions from [email protected]

      Publisher

      Association for Computing Machinery

      New York, NY, United States

      Publication History

      Published: 16 November 2017

      Permissions

      Request permissions for this article.

      Check for updates

      Author Tags

      1. Expecting Mothers
      2. Maternal Health
      3. Mobile intervention
      4. Pakistan
      5. interactive voice response
      6. mHealth
      7. pregnancy
      8. randomized controlled trial

      Qualifiers

      • Research-article
      • Research
      • Refereed limited

      Conference

      ICTD '17

      Acceptance Rates

      Overall Acceptance Rate 22 of 116 submissions, 19%

      Contributors

      Other Metrics

      Bibliometrics & Citations

      Bibliometrics

      Article Metrics

      • Downloads (Last 12 months)36
      • Downloads (Last 6 weeks)2
      Reflects downloads up to 20 Feb 2025

      Other Metrics

      Citations

      Cited By

      View all
      • (2024)Experiences from Running a Participatory Media Platform for Women and Led by Women in Rural North IndiaProceedings of the ACM on Human-Computer Interaction10.1145/36536858:CSCW1(1-23)Online publication date: 26-Apr-2024
      • (2023)Unsettling Care Infrastructures: From the Individual to the Structural in a Digital Maternal and Child Health InterventionProceedings of the 2023 CHI Conference on Human Factors in Computing Systems10.1145/3544548.3581553(1-16)Online publication date: 19-Apr-2023
      • (2023)An Intersectional Look at Use of and Satisfaction with Digital Mental Health Platforms: A Survey of Perinatal Black WomenProceedings of the 2023 CHI Conference on Human Factors in Computing Systems10.1145/3544548.3581475(1-20)Online publication date: 19-Apr-2023
      • (2023)FemTech and Taboo Topics: Raaji as a Tool for Educating Women in PakistanFemTech10.1007/978-981-99-5605-0_9(185-210)Online publication date: 24-Dec-2023
      • (2022)Commissioning Development: Grantmaking, Community Voices, and their Implications for ICTDProceedings of the 2022 International Conference on Information and Communication Technologies and Development10.1145/3572334.3572402(1-18)Online publication date: 27-Jun-2022
      • (2022)Design Implications to Support Integrative Medicine in Pregnancy CareProceedings of the ACM on Human-Computer Interaction10.1145/35555406:CSCW2(1-32)Online publication date: 11-Nov-2022
      • (2022)A Descriptive Analysis of Cohesion within Virtual and Physical Small Groups of Mothers in Bandwidth-Constrained Communities in Cape Town.Proceedings of the 5th ACM SIGCAS/SIGCHI Conference on Computing and Sustainable Societies10.1145/3530190.3534793(152-164)Online publication date: 29-Jun-2022
      • (2022)“Should I visit the clinic”: Analyzing WhatsApp-mediated Online Health Support for Expectant and New Mothers in Rural IndiaProceedings of the 2022 CHI Conference on Human Factors in Computing Systems10.1145/3491102.3517575(1-20)Online publication date: 29-Apr-2022
      • (2022)Embodied Negotiations, Practices and Experiences Interacting with Pregnancy Care Infrastructures in South IndiaProceedings of the 2022 CHI Conference on Human Factors in Computing Systems10.1145/3491102.3501950(1-21)Online publication date: 29-Apr-2022
      • (2021)Living with Uncertainty and Stigma: Self-Experimentation and Support-Seeking around Polycystic Ovary SyndromeProceedings of the 2021 CHI Conference on Human Factors in Computing Systems10.1145/3411764.3445706(1-18)Online publication date: 6-May-2021
      • Show More Cited By

      View Options

      Login options

      View options

      PDF

      View or Download as a PDF file.

      PDF

      eReader

      View online with eReader.

      eReader

      Figures

      Tables

      Media

      Share

      Share

      Share this Publication link

      Share on social media