This is Kibera. Most pregnant women here give birth at home This is Kibera. Most pregnant women here give birth at home. That works well except for when something unexpected happens. Complications during delivery that would have been easy to resolve in a health care facility can end up killing both the woman and the child, when the delivery happens at home. Opportunity

intervene at a decisive moment When we read the reports from the ethnography work that the students in Nairobi did, we learned that pregnant women in Kenya are supposed to come in to a health care facility for 4 standard visits during the pregnancy. Almost all women come in for a first visit, but many of them never return. Digging deeper into the statistics we came to two major insights: There are three factors that make women much less likely to return. If the pregnancy is unplanned If the woman is young (young was defined as below 25) If the woman has low education 2. The women who do come back for all of their 4 visits are highly likely to deliver in a health care facility. intervene at a decisive moment

Working from these two insights we started defining a persona for our user. ... meet prudence

Prudence.

prudence [is 16 years old, unmarried, living at home with her family, working as an assistant at a small shop, a cell phone owner, literate and can read english and swahili… and her pregnancy is UNPLANNED] Prudence is 16 and unmarried. She lives at home with her family in Kibera. She dropped out of high school and is working as an assistant at a small shop, which gave her enough money to buy her own cell phone. She does have basic education and can read english and swahili. She is pregnant, and her pregnancy is unplanned.

what is stopping prudence from coming back? We wanted to focus on the moment when Prudence leaves the clinic after her first visit, and wondered what the reason is that she is so unlikely to come back. What are the things that are preventing Prudence from coming back to that second visit? what is stopping prudence from coming back?

We looked at several things. Money is one of them We looked at several things. Money is one of them. Prudence might not have enough money to pay for the visits, or she may need to take time off work to get to the clinic, which will be a loss of income for her.

Another thing that might stand in her way is transportation Another thing that might stand in her way is transportation. Many women like Prudence live far from the clinics, and they do not own their own means of transportation. The list of tangible factors like these goes on, and in our first iteration we actually looked at ways to bridge the monetary gap. But as we learned more about Prudence we started realizing that a big part of the underlying problem was actually something different.

One discovery that really stuck with our team came up during a video conference with the students in Nairobi. We were asking about what incentives might be effective to get women into the clinic, and Dan, one of the students there, said: The women know that they need to go for the visits, but they put it out of their mind. So, the problem we realized was Prudence didn’t have the motivation to come back.

support This made us zero in on support. The choice to provide support was a very conscious one, and we made it for two main reasons: When speaking with a woman who runs a teenage pregnancy program in the bay area we learned that young women like Prudence are in a very vulnerable state and they don’t even know what questions to ask. Once a young woman understands that it’s important for her baby that she gets prenatal care she will find a way to get that care. This could be cultural and only relevant for women here, but we hypothesize that it’s actually a universal thing and also applies to Prudence and women like her. We believe that focusing on support gave us an interesting opportunity to innovate a low cost solution with potential of having great impact.

nickname (ex/ “imani”) Working with low cost and support as guidelines, we came up with this solution. When Prudence is ready to leave the hospital after her first visit, she signs up for a text messaging service. She signs up on a computer at the clinic by entering her cell phone number, her due date, and a nickname for her baby. Our system will automatically send Prudence three free text messages per week for the remainder of her pregnancy. The texts will contain information based on where she is in her pregnancy, and they will also provide directives aimed at motivating her to make healthy choices for her and her baby and supporting her to get back for her next visit. We are going to show you a text that she will get right as her next visit is approaching. cell phone due date nickname (ex/ “imani”) submit

Baby Imani now sense light and will move around Baby Imani now sense light and will move around. Count how many times you feel her move each day and tell nurse Mahu at your visit in 5 days. Arrange transport. For our prototype we wrote up messages that covered the 4th month of Prudence’s pregnancy. In order to get feedback and adapt the messages we showed them to students at the University of Nairobi, our coaches, teenage pregnancy workers, nurses and gynocolgists… (we got some really great insights on tone, phrasing, word choice, content, etc which we incorporated in the messages that we showed you today)

We hope that ultimately, these texts will support Prudence and motivate her to come back for her 2nd visit, her 3rd visit, her 4th visit, and ultimately deliver her baby, baby Imani, safely in a health facility

What we presented to you today is something small and clear… Our next step would be to roll this out and run a pilot study in order to gain more insights and information. We have gotten a lot of great feedback on this first batch of texts, but in order to get to where we want to go, we need to show these to women in Kibera, we need to refine and adapt them based on the insights of a real user population We also believe that sending information and directives might not represent the full solution… this may need to be tied to an additional hook/incentive to motivate Prudence to actually come back in… we have many ideas on what that could look like, but we believe that further development needs to happen in Kibera. To nail down this specific hook we need to be in the cultural context of where the system is supposed to be used. But the solution we presented is something we believe could be rolled out in a few weeks, with a few thousand dollars and some hard work, and that’s what we wanted to leave you with today. next steps

What we presented to you today is something small and clear… Our next step, we would roll this out first and run a pilot in order to gain more insights and information. We also realize that sending information and directives might not represent the full solution… this may need to be tied to an additional hook/incentive to motivate prudence to actually come back in… we have lots of ideas and leads about this. We believe this important next step has to happen in Kibera, to nail down this specific hook we need to be in the cultural context that will provide real insights and necessary information. But the system we presented is something we believe could be rolled out in a few weeks, with a few thousand dollars and some hard work, and that’s what we wanted to leave you with today. questions? 15

Here is an example of one of the texts Prudence will receive after she leaves… (read text) Hi Prudence. Baby Imani is learning to make a fist and needs 5 tablespoons of protein daily from beans nuts, meat, egss. Hold your belly to comfort her.