Improving antenatal care for millions of expecting mothers in Kenya

Research insights are integrated into an AI-enabled text messaging platform to promote better antenatal care-seeking in Kenya

Improving health services for expecting mothers and newborns (also called antenatal care) is a promising avenue for saving lives in settings like Kenya where the death rate for newborns is high (Imbo et al. 2021, KNBS and ICF 2023).

Researchers, supported by CEGA’s Behavioral Economics in Reproductive Health Initiative (BERI), have worked closely with Jacaranda Health, a Kenya-based maternal health nonprofit, to integrate findings from a study aimed at improving maternal health seeking behaviors into the design of their programs. Jacaranda Health partners with government agencies to sustainably improve quality of care and outcomes in public hospitals and incorporated study insights into a two-way, AI enabled text messaging program called PROMPTS, which has reached 2.5 million mothers, across 22 counties in Kenya.

The study team, led by Margaret McConnell and Jessica Cohen at the Harvard Chan School of Public Health, has set up an additional cluster randomized evaluation with Jacaranda Health to assess the PROMPTS program, in combination with a mentorship training program for frontline nurses in maternity. “We consider quality of care very important,” stressed Anneka Wickramanayake, Director of Research Design and Evaluation at Jacaranda Health. She noted that informing mothers what to expect at antenatal and postnatal care visits was key to better interactions between providers and clients and better quality of care.

PROMPTS sends expecting mothers SMS messages with gestation stage-specific information, reminders for pre and postnatal check-ups, and tips on newborn care, breastfeeding, and vaccination. An AI-enabled helpdesk reads and responds to up to 6,000 incoming questions from women daily and sparks a rapid referral chain (to a human helpdesk) if a risk is identified during the exchange.

PROMPTS was designed to be low-cost to facilitate sustainable scalability and integration within government timelines and budgets. Kenyan county governments are increasingly contributing towards the platform’s running costs, and Jacaranda Health is working with other partners – like local telecommunications companies – to achieve economies of scale as the program grows. Results from the impact evaluation of PROMPTS are forthcoming but preliminary analysis suggests a positive impact on mothers’ knowledge, health seeking behavior, and preparedness across the antenatal and postnatal periods. Working directly with the study team has helped Jacaranda Health “catalyze a really strong research partnership,” noted Wickramanayake. Jacaranda is currently broadening the scope and reach of PROMPTS, including expanding messaging content, tailoring responses, and testing alternative enrollment approaches to reach and engage the most vulnerable women.