The 'mHealth' revolution

A promising new way to expand access to abortion care in the world’s poorest countries

by Margie Snider

Summer 2013

Simple text messages like this one—“Hello! Today is the day that you must take the 4 pills you were given at the clinic”— are emerging as an important new tool in the global fight to prevent deaths and injuries caused by unsafe abortion.

With cell phones and other mobile devices now accessible to millions of people in the world’s poorest countries, Ipas and other reproductive health advocates are launching “mobile health” projects to connect women to vital information, care and support.

In South Africa, for example, Ipas is partnering with a technology-based solutions company to send free, informational SMS text messages to women who have chosen to have a medical abortion (an abortion with pills) and want to receive support and follow-up information. Upon starting the medical abortion at a health facility, women receive a series of text messages reminding them when to take the next dose of pills, explaining symptoms, and prompting them to get follow-up care if needed.

The project also promotes access to a broad range of easy-to-understand sexual and reproductive health information through a mobile website which has received nearly 500,000 hits since its launch in March 2012. The Mxit “mobi-site” offers a free instant messaging application that runs on multiple mobile and computing platforms accessible throughout South Africa. As of January 2012, the company had 50 million total subscribers, making it the largest mobile social network in Africa and one that is extremely popular with young South Africans. The Ipas-supported component on the mobi-site discussing abortion has ranked first in hits each and every month since its launch, indicating a demand for this information.

These efforts look to be a promising way to expand awareness that abortion is legal in South Africa and that safe services, including medical abortion, are available. As Ipas South Africa Community Access and Program Coordinator Buyile Buthelezi says, “It puts correct information in women’s hands to allow them to act in the interests of their own choices.”

Women who have signed up for the text messages say the information has been helpful and welcome. “Felt someone was holding my hand through the whole process,” said one, while another reported, “I’m now ready for family planning method with the help of the SMSs.”

Ipas has mobile health projects in development in several other countries, including Mexico, Nigeria, Kenya and Bangladesh, and will be stepping up investment in mobile health in the coming months. “Mobile devices are a low-cost, effective way to reach women, health-care workers, community-based organizations and others involved in the delivery of abortion care,” says mobile health expert Chris Kelley. “They can break down some of the barriers that prevent women from getting care, whether it’s being a long distance from the nearest health facility or lacking information about the availability of safe services.”

The how and why

mHealthThe rise of mobile health—or “mHealth” as it’s often called—stems from the vast expansion of mobile phone technology. There are now about six billion mobile-cellular subscriptions worldwide, according to a 2012 World Bank/International Telecommunications Union report. The fastest growth is in developing countries, where hundreds of millions of subscriptions are added each year, and where the need for safe abortion care is most urgent.

The story of Medic Mobile, a nonprofit organization Ipas is partnering with in Mexico, is a prime example of the ‘how’ and ‘why’ of mobile health. While in rural Malawi in 2007, Stanford University student Josh Nesbit saw people walking 60 miles or more to get health care. He also noticed that his cell phone reception was stronger in Malawi than it usually was in California. Surely, he thought, there has to be a way to connect people to health care using cheap cell phones.

Nesbit is a co-founder of Medic Mobile, which uses cell phones and other low-cost mobile technologies to connect and improve health systems in developing nations. Medic Mobile now has programs in 18 countries and is working with Ipas on a project being developed in Mexico.

In a recent interview, Nesbit said mobile health is a particularly effective way to reach young people: “We design the programs based on their challenges and preferences. Many teenagers, for instance, will feel much more comfortable getting information from a mobile phone, rather than spending half a day waiting in a clinic.”

For all the positive aspects of mobile health, there are concerns as well. For instance, is a woman’s health and safety at risk if text messages about contraceptive methods are found on her cell phone? Confidentiality is a legitimate concern. To work around this, most mHealth program texts are not automatically sent; the user has to request them, which allows the user to view the information in private and then delete it.

Another significant issue is the “gender gap” in mobile phone ownership. While there is no doubt that mobile phones are empowering women and girls in developing countries by giving them direct access to information and services, there is a gender gap that needs to be addressed. As former Secretary of State Hillary Clinton noted in a speech last year, some 300 million women in the developing world do not have access to cell phones—and one reason is the belief by some that cell phones give women “too much” freedom.

Despite these kinds of challenges, however, mHealth is growing explosively. The World Health Organization, among others, says mobile health has the potential to “revolutionize” health care, particularly for those who are poor and live in remote areas.

In the fight to improve access to reproductive health care and prevent the 47,000 deaths each year from unsafe abortion, the mHealth revolution is good news. As Medic Mobile’s Josh Nesbit said, “Technology is a tool, not a solution. It becomes a solution when someone uses it to achieve a better health outcome.”

From paper to database

mHealthMobile health extends well beyond programs centered on getting information to and from clients via text messages or mobile websites. It includes using mobile technology for such purposes as providing support and training for health-care workers, monitoring inventory levels of medical supplies and collecting data more efficiently.

In Kenya, the Ipas Africa Alliance has launched a pilot program using mobile phone technology to collect and transmit data on abortion services provided at Ipas-supported health sites. The mobile application, which operates on smartphones, captures data that previously would have been entered by hand into paper logbooks. It stands to greatly speed up the collection and transfer of data that will be used to monitor and evaluate abortion service delivery, with the goal of improving care for Kenyan women. Only a few months into the pilot, Senior Research and Evaluation Associate Erick Yegon says facility staffers seem motivated to enter data by the simplicity of the program.