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WIRED MOTHERSIncreasing skilled delivery attendance to reduce maternal and neonatalmorbidity and mortalityEvery year, approximately 270,000 women die duringpregnancy. Moreover, the risk in Sub-Saharan Africa ismuch larger, 50 times greater than indeveloped countries. Seven million childrenalso die before reaching the age of five, agrowing proportion of these (43%) occurs ator around the time of birth. Therefore,antenatal care (ANC), skilled deliveryattendance and access to emergency obstetriccare are essential in improving maternal,neonatal and child health. In Zanzibar, 99% ofpregnant women attend an ANC visit at leastonce, yet only 51% of births are attended by ahealth professional and more than half do notreceive any postnatal care.Wired Mothers is an mHealth project that seeksinnovative ways to ensure access to ANC andskilled attendance at delivery and to examine thebeneficial impact mobile phones can have on maternaland neonatal morbidity and mortality. In 2009/2010, theUniversity of Copenhagen, in collaboration withZanzibar’s Ministry of Health and Social Welfare and theDanida Health Sector Programme Support, conducted astudy to compare differences in service delivery andhealth outcomes between women receiving the WiredMothers mobile phone intervention and those receivingstandard care.Implementation date: March 2009 to March 2010About Wired MothersThe Wired Mothers mobile phone intervention wasdesigned with the aim of linking pregnant women totheir primary health care provider throughout theirpregnancy, childbirth and post-partum period. Wiredmothers, or mama mitandao, received appointmentreminders and educational information via SMS andwere provided with mobile phone vouchers to enablethem to call a primary care provider to discuss anyacute or non-acute issues. Additionally, mobile phoneswere used by health facility workers, ambulance drivers,and referral hospital employees to strengthencommunication between different levels of the healthsystem.The intervention involved all three levels of the healthsystem.Evaluation and ResultsThe Wired Mothers intervention was evaluated in acluster randomized controlled trial. The study involved2,550 pregnant women (1,311 interventions and 1,239controls) receiving care from 24 primary health carefacilities in six districts in Zanzibar. Within each district,two facilities were randomized for intervention and twofor no intervention (standard care). To ensure mobilephone access, the pregnant women in the interventiongroup received a phone credit voucher.The intervention significantly increased the proportionof women receiving four ANC visits during pregnancy asrecommended by WHO and there was a trend towardsmore women receiving preventive health services, morewomen continuing to attend ANC late in pregnancy andmore women with antepartum complications who wereidentified and referred.The majority of intervention women stated that theappointment reminders influenced their health seekingbehavior and felt that the educational messages helpedthem in various areas, including learning about dangersigns in pregnancy and feeling that the health systemcared for them.Results also showed that the mobile phone interventionwas associated with an increase in skilled deliveryattendance. 60% of the women in the intervention18 mHEALTH COMPENDIUM | VOLUME 3