1. 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

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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

9. 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 weeks postpartum

10. 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

11. 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.

12. 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

13. Thanks!
Acknowledgements: Shalini Subbiah, Faith Muigai, Nick Pearson, Jacaranda Health Staff, Brigham and Women’s Hospital Contact info: WhatsApp: