Forget Me Not: Promoting the Utilization of Antenatal Care Services by Providing Reminder Text Messages and Transportation Fare

Abstract

Background: Global infant mortality rates remain extremely high. This is especially the case in developing countries, such as Kenya, where antenatal care (ANC) is greatly lacking and rarely sought out by women. The World Health Organization recommends that women attend a minimum of four antenatal visits during their pregnancy, but this is often unrealized due to circumstantial factors, such as limited access to health care facilities, cost of transportation, or lack of access to information about the importance of ANC utilization throughout pregnancy. The psychology of scarcity suggests that, in the context of poverty, individuals may suffer from mental and money scarcity that reduces an individual’s cognitive capacity because poverty-related concerns and stressors consume an individual’s mental resources and hinder them from attending to important matters, such as ANC visits. Objective: This study addresses mental and money scarcity by determining whether providing poor pregnant women with cash payments for transportation fare or sending reminder text messages about meeting ANC requirements could (1) increase ANC utilization and (2) improve maternal and neonatal outcomes. Methods: A randomized control trial was conducted with pregnant mothers upon their first antenatal visit at Mbagathi Hospital in Nairobi, Kenya. Participants were randomly assigned to one of four conditions: control, reminder text message only, reminder text message and transportation fare, or transportation fare only. Reminders and transportation fare were sent at four distinct time points during the pregnancy. Upon delivery, data was collected on the number of ANC visits attended, birth outcome, birth weight, and location of delivery. Results: There were no significant differences in the number of ANC visits that mothers attended across all treatment conditions (mean number of visits = 4.52, p = 0.91). There were no significant differences in the birth weights of the children across all treatment conditions (mean birth weight = 3.18 kg, p = 0.30). All live birth deliveries occurred within a health institution. Conclusion: There may need to be a shift in the goal of ANC utilization in urban health settings in the developing world towards that of the developed world. Limitations and suggestions for future work are also discussed.