Mother’s helper? Text messages deliver health advice to South African women

JOHANNESBURG, South Africa – I walked into the Esselen clinic in Hillbrow, Johannesburg on a recent morning to find around 40 women and their newborn babies crowded together on rows of wooden chairs. They were waiting for a health worker to call them into another room where a chorus of cries could be heard — the sound of babies being stuck with vaccination needles.

Some of the women had arrived at the health clinic as early as 6:30 in the morning, standing in line outside in the winter cold, aiming to be the first to enter when the doors opened at 8 a.m. Those women lucky enough to get in sat patiently for hours, rocking their babies and playing with their cell phones.

Mandla Goshwa, a 24-year-old health worker, interrupted their chatter in the noisy space as he stood at the front of the room and told the women about a free health text messaging service called the Mobile Alliance for Maternal Action (MAMA). Mothers who elect to subscribe to the service, he said, receive text messages twice a week that deliver advice on how to care for their child. If the women are pregnant, they receive tips on prenatal care. 

Goshwa spoke in both English and Zulu, and has been coming to this clinic every day for two months since he began working with Wits Reproductive Health & HIV Institute (WRHI), an academic research institute that is collaborating with several clinics in the area to provide the SMS messages. WRHI is part of the global public-private partnership behind the MAMA program, which is the brainchild behind it all.

Relebogile Motlhabi, a 25-year-old new mother, has been receiving the text message for months. She signed up when she was pregnant, and her son is now seven weeks old. She says she already knew much of the information she receives in the texts, but has picked up new tips as well.

“I didn’t know that when you are pregnant you should still be using a condom with your partner,” she told me. “You must continue using a condom when you’re pregnant to prevent the child from getting any kinds of infections while giving birth.” 

Hillbrow is a densely populated, low-income residential neighborhood. Just a decade ago, because of high levels of crime, this area of was considered a no-go zone, sometimes even by police. While its conditions have improved significantly, some of the apartment complexes still house people in squalor conditions with as many as 12 families living in a two-bedroom apartment, said Jesse Coleman, program manager for mHealth at WRHI. Many of the area inhabitants are from neighboring countries — migrants who came to South Africa to look for work. This means that for many women, support networks for pregnancy and child rearing are back home, in other African nations.

Many of the women I met at the clinic were, like Motlhabi, in their twenties. Some were domestic workers, others students. Many of the women came from Zimbabwe; for some, their lives placed on hold for when they can save enough money to head back home. About 88 percent of those who register for the MAMA program live in a household that makes less than $460 per month. Goshwa’s job is to inform the women about the project and sign them up for the service.

“Most of the women are interested in signing up for the service. We see very few that aren’t,” he told me. 

The text messages provide the women advice on health topics such as nutrition and HIV transmission to newborns, and relay the importance of talking and singing to their babies. A text geared for a woman early on in her pregnancy reads: “Your baby is just the size of your thumb. Keep her safe by not smoking or drinking alcohol, as they can make her weaker and less healthy.” Another for HIV-positive women: “You can help stop your baby getting HIV. Go to all clinic check ups, take the right medicines, and feed breastmilk ONLY for the first 6 months.” 

Many of the women at the clinic have heard Goshwa’s speech before. He has already signed up over 90 percent of the pregnant women at Esselen. Health workers like Goshwa keep coming back to scoop up women he might have missed in previous visits, or newly pregnant mothers that are on one of their first antenatal visits to the clinic. 

Getting pregnant women into Esselen as early as possible in their pregnancy is a priority so that the clinic can begin testing for HIV. The earlier in a pregnancy the clinic is able to identify an HIV-positive woman, the easier it is to take steps to reduce the likelihood that the child will contract the disease. About 40 percent of the women at Esselen who sign up for the service opt to receive messaging on HIV. Not all of these women are HIV positive, some just are interested having the information, either for their own knowledge or to share with friends. 

With dozens of women waiting in lines for their antenatal and postnatal visits, it was easy for me to see how the health workers can’t provide each woman with extensive or individualized health information. The MAMA program aims to fill this gap in health care and hopes the messages will reduce maternal and child mortality in the nation — a goal this country has made little progress with over the years. 

And it seems to be reaching the women at Esselen. I spoke with Mthandazo Ntini, another new and young mother, and later watched as she pulled out her phone and flipped through her messages — including a text from MAMA.

“I didn’t know anything about babies…I’m the last born,” she told me. The texts "have been helpful." 

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