WAWARED Getting Connected using Mobile Technologies for Better Maternal and Child Health in Peru Randomized Controlled Trial

Background: Pregnancy-related complications continue to be unacceptable high, especially in low resource countries. Antenatal care (ANC) could be an effective intervention. However, still most pregnant women in the developing world go to only one-or less than the recommended ANC visits during their whole pregnancy, so there is a need of strategies to improve ANC attendance. Digital technologies represent an innovative approach to increase ANC attendance. Within the project WAWARED: “Getting connected for a better maternal and child health”, we included a randomized controlled trial (RCT) to evaluate the impact of the introduction of individually tailored SMS messages to pregnant women in Peru. The objective of this paper is to present the results of the WAWARED RCT and examine the effects of SMS messages in ANC visits, behavioral outcomes, maternal and neonatal outcomes. Methods: The WAWARED system sent automatic SMS messages according to gestational age and any specific pathology registered in the Electronic Medical Records (EMR). ANC appointment reminders were sent, and additional educational messages were also sent to the intervention group until the end of the pregnancy. 651 participants were randomized to the intervention group and the control group respectively. Findings: Pregnant women who received SMS messages were 6% more likely to attend more than 6 ANC visits and 25% more likely to attend the visits on time. This effect was modified by education, since all the effect was seen in women with secondary or higher education. Interpretation: SMS sent to pregnant women had a significant effect in increasing the number of ANC visits and these effects were more evident in women with more education, but it was also possible that the introduction of the EMR helped to improve the number of ANC in both control and intervention groups.