Prenatal Care Through SMS

Posted by CorinneRamey on Sep 22, 2009

In India, especially in rural areas, men are often in charge of the family mobile phone.  But Subhi Quaraishi, CEO of ZMQ Software Systems, thinks that phones are a great way to reach women as well.

"The goal of our program is to use technology to empower women," said Quaraishi, of ZMQ's new pilot program.

ZMQ is currently running a program to provide women with information on prenatal care via SMS. The messages, which are all in Hindi, contain information on vaccinations, exercise, diet, medication, and how to deal with emergencies that arrive during pregnancy. This is the only program of its kind in India, although other programs -- like a Grameen Bank sponsored program in Ghana -- also use SMS to give advice on prenatal care.

So far 18,000 women have participated in the program.  Each woman receives a message every couple of days, said Quaraishi. For example, transliterations of two of the messages read: "Diet -- 7th week. You may feel nausea.  Drink lemon water to avoid it" and "Test -- 20th week. Get second ultrasound if you haven't done it." Currently, the women enroll through a hospital, but in the future ZMQ plans to get a short code and allow women to enroll directly through SMS.

The program started because of the need for more prenatal care in India, Quaraishi said. About 72 percent of women receive prenatal care at least once, and 37 percent receive prenatal care at least four times, according to UN data. Forty-seven percent of women have a skilled attendant, like a nurse or midwife, at the birth of the child.

Currently, the program is funded by ZMQ, which puts about 12 percent of its profits towards corporate social responsibility, said Quaraishi, who founded the company with his twin brother, Hilmi. Currently, ZMQ is using a third-party SMS Gateway, Reliance, but eventually plans to send the messages directly to cut down cost. In the future, developing more health content and consulting with health experts will cost more than sending SMS or software development, Quaraishi said.

In the past, ZMQ has also designed educational programs like environmental games and games about sexual health.

Quaraishi said that he thinks that providing women with education and information is important for Indian development. "The most important reason of making the program is because women form the basis of development," he said. "They are the mothers and wives, and take care of homes. Whatever you do with technology with men will not be as efffective unless you do it with women."

Because most men in India are in charge of the mobile phone for their family, Quaraishi said, the program offers an incentive for men to show the text messages to their wives. For each message that the man opens, he receives one minute of free call time. "If he's opened the message and read the message, the chances that he's shared the message are high," said Quaraishi. "He's concerned about his child." Because receiving a text message is free in India, there is no fee for the user. In the future, ZMQ may charge users one rupee, or $.02 U.S. dollars, to subscribe to the service. Although users can only receive advice, and not ask questions, the service does connect women to other local health resources.

ZMQ has yet to do any testing to measure the effectiveness of the service, although they plan to survey users in the future. Anecdotaly, the program has been well received, Quaraishi said. "We've gotten good feedback from a lot of women," he said. "They say they understand better how to handle pregnancy, what kind of food is good to eat, and how often they need to go to a doctor."

But changing the culture the prenatal care in India isn't easy. "The most challenging part of the program was designing the messages in a language that people could understand," said Quaraishi. They had to translate medical terminology into SMS-sized advice that was easy to comprehend, he said.

Other challenges may include making sure that women, and not only their husbands, actually view the messages and ensuring the messages reach populations that need them most. Because currently the program only targets women who go to hospitals, the program likely excludes those without the ability to receive medical help, and certainly those without access to mobile phones.

By early next year, ZMQ plans to be launch the program in almost 1900 hospitals and hopes to have 100,000 women using the service. As the program expands to different regions, the content of the messages could be customized, said Quaraishi. "We want to target specific regions and design for their food habits, like if the people are vegetarian," he said. They also would like to expand to Latin America and Africa in the future, and to send users images of fetuses at different stages of development, Quaraishi said.

Photo: Hilmi Quaraishi, project director of social initiatives at ZMQ. Photo credit to ZMQ.

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