Using Social Networks to Improve Maternal and Newborn Health Suha Patel, MD Jacaranda Health Brigham and Women’s Hospital MPH Candidate, Harvard T. H. Chan School of Public Health I’m going to review how we are utilizing in-person group-based care, and testing innovative group-based mobile support for clients in peri-urban Nairobi

Problems Globally, women… Experience high stress during pregnancy and the postpartum period Suffer poor outcomes from preventable health conditions Are not empowered to take care of their own health demand high quality care Perception of quality can be very different depending on who you ask.

New WHO ANC guidelines (2016) A “Positive pregnancy experience” Addresses: promotion of healthy behavior awareness of self-care in pregnancy and postnatal include social support during and after pregnancy

Group-based Care Improves Health Increases: Knowledge and self-care Social support satisfaction with care postpartum contraceptive use Decreases: stress preterm birth rates postpartum depression http://www.flickr.com/photos/hdptcar/2529980825/in/photostream/

Innovation hub in maternal and newborn health service delivery Social enterprise delivering low-cost, high quality reproductive health services in Kenya Innovation hub in maternal and newborn health service delivery Public sector collaborations SMS for automated health reminders Postnatal care seeking 70% as compared to 48% in Kenya within the first 4 weeks

Jacaranda Group ANC JH Group ANC (n=12) JH overall Kenya Average ANC visits 5.5 2.5 -- conversion from ANC to delivery to Jacaranda 83% 42% Postpartum contraceptive use 92% (75% LARC use) 40% 24% Client feedback: Would attend group care for their next pregnancy and would recommend it to a friend All rated group ANC care as “best” or 5/5 Group ANC was: “the best care I got” Requested to know more about taking care of their infants 5 groups, 2 completed groups (N=12) – have attended their postnatal session and completed a survey

ANC Groups utilized WhatsApp The first group started using whatsapp. Still exchange advice and text each other as new moms over a year after their deliveries.

Client survey results 150 women presenting for ANC at Jacaranda 100% use WhatsApp 98% were interested in joining mobile support groups in pregnancy 60% of Kenyans have smartphones Half of the population is on WhatsApp 40% of patients presenting to our public facility collaborator where we were enrolling women in SMS message streams also had smart phones

Feasibility Study of mobile-based support groups for women presenting for ANC care at Jacaranda Health 50 women <30 weeks, use WhatsApp Group administrator is a clinical coordinator 5 groups of 10 within 2 months by EDD Followed until 10-12 weeks postpartum

Feasibility Study of mobile-based support groups for women presenting for ANC care at Jacaranda Health Acceptability Postpartum survey, in-depth interviews, focus groups, plans for continuation or discontinuation of the WhatsApp group postpartum Demand Interest to use, actual use, positive or negative effects on organization Implementation Upon completion of the study, evaluate if Jacaranda Health leadership adopts the program as a sustainable service for clients Practicality Positive or negative effects on participants, cost analysis Limited efficacy Effects on outcomes: antenatal and postnatal attendance, facility-based delivery at Jacaranda, postnatal contraceptive uptake, facility-based newborn maternal care-seeking by 9 weeks postpartum

Prototype Design Promote healthy behavior, self-care, and social support in in the reproductive years Features: Join or create a support group based on health interests. Find pregnancy groups based on EDD. Subscribe to reproductive health message streams Subscribe to receiving messages from participating health facilities Ask health specialists general questions.

Next steps Leverage lessons learned from the feasibility study Build a functional, secure platform for women and girls that promotes: Healthy behavior Self care Social support Demand for high quality health services Ideally starting pre-conception Market size (Kenya) – 1.5 million pregnancies per year, 60% have access to smart phones, so 1 million moms with potential access Market size (US) – 3.9 million pregnancies per year, 80% have smart phones, 3 million moms with potential access

Thanks! Acknowledgements: Shalini Subbiah, Faith Muigai, Nick Pearson, Jacaranda Health Staff, Brigham and Women’s Hospital Contact info: suha.patel@gmail.com WhatsApp: +1-919-395-8841