After four months of pregnancy, Farida Khatun, 22, does not know she should see a medically-trained professional for periodic check-ups — or that she can receive an SMS reminder to do so as part of a new Bangladeshi health initiative.
Khatun, who lives in Rahimapur, a remote village of northern Rangpur district, worries about giving birth, after witnessing another woman’s profuse bleeding lead to a hospital stay. “Yes, I would take the service if someone gives me details,” she told Khabar South Asia about the SMS reminders.
Under the government’s Aponjon (dear one) initiative, expectant mothers can receive weekly SMS messages with medical reminders and advice. The texts carry a Tk 2 ($.03) fee. Voicemails are sent to those who cannot read.
A pregnant woman can register simply by sending an SMS with the date of her last menstrual period, said Abul Kalam Azad, additional Director General (Planning) of Health Services.
“The system will reply to her automatically with the expected date of delivering. She also gets advice from time to time,” he said. The service continues until the baby’s first birthday.
So far, more than 24,000 pregnant Bangladeshi women have subscribed to the service since it was officially launched in December 2012. The project reaches 23 districts, and aims to reach a total of 30 by year’s end, Project Co-ordinator Rizwana Rashid Auni said.
Word is being spread through radio and television ads, as well as field staff of partner organisations who go door-to-door, counseling expectant mothers about the service.
“It’s only Tk 2 per message, but they will get all vital info, even related to the diet,” she said.
Dhaka-based D.Net, the private organisation implementing the Aponjon service, hopes to make it sustainable by increasing subscribers. But poverty remains a challenge. Among current subscribers, 20% cannot afford to pay the tiny per-text fee. Their subscriptions are being underwritten by the government and non-governmental organisations.
According to the Bangladesh Telecommunications Regulatory Commission, two out of three Bangladeshis use SMS messaging. For health officials, that phenomenon has created an opportunity to deliver medical advice to people who might not otherwise receive it.
“There is evidence that better communications – particularly availability of mobile phones – can reduce maternal mortality,” Azad told Khabar.
High risk factors
The Health Services Department designed Aponjon to specifically address high maternal and infant mortality rates in rural areas where pregnant women either do not use or do not have access to professional health care.
The service was launched because lack of pre-natal checkups is linked to maternal mortality, Director General of Health Services Khandaker Md Shefayetulla told Khabar. “It will at least make them aware,” he said.
According to the Bangladesh Maternal Mortality Survey 2011, more than 75% of Bangladeshi women deliver their babies at home — and 30% of those mothers die from post-delivery haemorrhaging due to incomplete placenta removal.
Dhaka Medical College Hospital gynecologist Salma Akhter told Khabar, “There are thousands of women who have no knowledge about how to plan their births, whether they should deliver at facilities or not.”