Healthy moms, healthy babies: Mobile technology and data systems save lives and improve outcomes for refugees and migrants
Globally, newborns and mothers continue to die in large numbers, mostly from preventable or treatable causes. Every day, about 6,500 newborn babies die in their first 30 days (UNICEF). In the decade ending in 2030, 48 million children under the age of 5 are projected to die; of these, half will be newborns (UNICEF). Among women worldwide, one dies every two minutes during pregnancy or childbirth (UNICEF); 99% of these deaths take place in developing countries (CDC).
The conditions in which people are born, live, learn, work and age — the social determinants of health — are strongly correlated to both complications and fatalities resulting from pregnancies and birth. Women experiencing vulnerabilities, such as refugee and migrant women, are at the greatest risk because they lack sufficient income, social protection, nutritious food, clean water, housing and safe surroundings. These women are more likely to delay their decision to seek care, experience challenges to reach health services and, when they do, have limited access to quality care. As a result, they suffer disproportionately from infectious diseases, bleeding, high blood pressure, infections and other complications during pregnancy and childbirth.
Better data and information systems, which are inclusive, reliable and responsive to local populations, can identify areas of concern and inform policies, planning and action to help improve health outcomes for all.
- Mobile phone interventions, when designed and implemented to meet the needs of women and girls, are cost-effective tools to provide personalized, low-cost support whenever and wherever they are needed.
- Counselling on family planning, coupled with mobile technologies, can improve the uptake of sexual and reproductive health interventions among postpartum women, yielding better family planning and health outcomes for mothers and babies.
- Digital technologies can address challenges within health systems and improve the coverage and quality of prenatal care, postnatal care, and family planning services and practices.
- Gamification, or the use of mobile games and interactive tools, can increase opportunities to educate expectant and new mothers, spouses, obstetricians and midwives, particularly when participation includes incentives specific to the context.
- Digital health and data can help improve human rights, promote participation in maternal health (including by spouses), provide disaggregated data for better program decision-making and, when well designed, protect privacy and ensure accountability.
Research to action: Knowledge that transforms lives and yields results
IDRC-funded researchers are offering hope to refugee and migrant populations through projects that use transformative data and information systems for better sexual and reproductive health (SRH) outcomes. Their work is ensuring these populations are visible and their needs are met. Ultimately, the researchers are developing solutions that save lives and show great promise to be scaled up to similar settings.
Research projects funded by IDRC demonstrate that digital health solutions, designed and tested by local innovators and health practitioners, can improve the delivery of quality SRH services. For example, mobile technologies can empower women by providing customized information that enables them to make decisions about their SRH needs. This can help overcome challenges that lead to delays in seeking care, reaching care and receiving quality care when needed.
As with any resource, digital technologies reflect the contexts in which they are designed and implemented. Ensuring positive outcomes relies on inclusive and localized design, which focuses on populations most in need, responds to policy and legal environments, and safeguards users. Localized and inclusive mobile technologies, combined with data to inform evidence-based decision-making, are showing promise in supporting groups experiencing multiple vulnerabilities, such as refugees, migrants and displaced populations.
Examples of recent IDRC-supported projects include:
- Mobile health (mHealth) applications (apps) to improve family planning and maternal and newborn health
- Reproductive health registry to support healthcare planning and service delivery
- Data collection to measure neonatal deaths and guide prevention programs
Gamifying maternal health: Creative solutions to save lives
The ongoing refugee crisis in the Middle East and North Africa (MENA) places the healthcare system in a precarious situation. Infrastructure is outdated and there are not enough skilled health workers. As a result, refugee women and girls are often not receiving the access to care they need and, when they do, the care provided is frequently sub-optimal.
Antenatal care: In countries such as Lebanon, which hosts a large proportion of refugees and is experiencing severe health system challenges, the needs of pregnant mothers and newborns from disadvantaged host populations are chronically unmet. One project aims to address that gap for pregnant mothers. It uses:
- Digital health interventions, including weekly educational mobile messages targeted to mothers and spouses to enhance the uptake of antenatal care services among disadvantaged and refugee pregnant women.
- Gamification that leverages algorithms introducing incentives to upskill health workers with limited time for professional development.
- Artificial intelligence (AI) to optimize capacity strengthening outcomes by ensuring that questions for each user are based on machine learning from past performance and behaviours.
Postpartum family planning: A second project working across Jordan and Lebanon uses mHealth to support family planning during the postpartum period. The project team evaluated the effectiveness of integrating digital technologies with enhanced counselling on family planning methods among postpartum married women.
Researchers developed a mobile app in co-design workshops with women and healthcare professionals. The app dispels harmful stereotypes and provides targeted information in Arabic on contraceptive methods, how to use them, side effects and where to find services. It also sends regular messages to encourage the continued and correct use of contraception. The user interface includes information on child feeding and growth, immunization, and other maternal and child health issues.
A culturally sensitive, evidence-based training guide on effective counselling was developed and used to train midwives to deliver counselling about contraceptive use. After four months, nearly 97% of women in the counselling and mHealth group were using family planning methods.
From paper to screen: Creating an electronic registry to support refugee mothers
In the Mafraq Governorate of Jordan, another project is implementing and testing a harmonized reproductive health registry (hRHR) at more than 20 health centres as part of an initiative to digitize Jordan’s paper-based health records. The area has the second largest population of Syrian refugees and features the largest refugee camp in Jordan. The harmonized system strengthens continuity of care for women and newborns from pregnancy to childbirth and postnatal visits.
In addition to strengthening reproductive heath outcomes, the team addressed broader social determinants of health that can shape the trajectory of women throughout the healthcare system. The project highlights include:
- Engaging the community: Discussions were held in the community around SRH, gender and gender equity, and the importance of engaging men in SRH services.
- Training: Healthcare providers and teachers received training in gender-based violence and SRH. Once trained, they are certified to offer SRH counselling at health facilities and schools.
- Providing personalized care: Through the hRHR, healthcare providers can access personalized care information during antenatal visits, labour, delivery and postnatal visits.
- Introducing sustainable interventions: The harmonized system provides greater access to and use of reproductive health data to support program planning, policy development and decision-making at every level of the health system.
The project is contributing to better quality and timeliness of reproductive health data to inform health planning and decision-making. It is also strengthening health systems through greater integration and interoperability among different health facilities and a stronger referral system. There are plans to scale up the hRHR effort to other parts of the country.
Every life counts: Collecting data on deaths to guide programs and service delivery
The death of an unborn baby remains a taboo topic in many cultures. In Jordan, doctors do not track these deaths. The Jordan Stillbirths and Neonatal Deaths Surveillance System (JSANDS) aims to address the gap. JSANDS identifies mortality rates and complications among Syrian refugees through a secure online data entry system that collects, organizes, analyzes and disseminates data to measure the burden of neonatal mortality. The data is used to guide programs to prevent and control perinatal and neonatal deaths.
Important results from the project to date include:
- Insights from evidence: The data highlighted the disproportionate burden of poor perinatal outcomes among displaced Syrian families affected by chronic stress, insecurity and trauma.
- Informing change: UNHCR is adapting JSANDS forms and processes for surveillance of maternal and neonatal mortality in Syrian refugee camps.
- Scaling and integration: UNICEF, USAID and the Jordanian Ministry of Health are looking to integrate JSANDS within the national health system.
- Healthcare improvements: The data are spurring inter-professional discussions around how to improve care. The information is also empowering female nurses to discuss the causes and contributors to perinatal and neonatal death with doctors and other professionals.
- Changes in discourse and attitudes: Training and discussions with healthcare providers included gender-responsive approaches to address gender norms in prenatal care. After the training, nurses reported that doctors assigned value to their knowledge and perspectives.
While the system currently tracks stillbirths and neonatal deaths, researchers are planning to scale it up to include maternal mortality and causes and link it to other systems. Lessons and insights from this project are informing the national scaling of JSANDS in Jordan and its adaptation to other settings, including to improve the surveillance of maternal and neonatal outcomes in Syrian refugee camps within the region.
Healthier mothers and babies on the horizon
Significant gains have been made globally on reducing maternal and infant mortality, but there is much more work to be done. Pockets of unmet need are growing at a distressing pace among populations experiencing vulnerabilities across the MENA region. Better data and digital health technologies offer great potential to serve underserved populations, including refugee women and girls, to ensure healthier pregnancies and healthier babies. These transformative projects highlight important lessons and good practices, each showing promise for upscaling mHealth and data systems to more countries and regions in need of support for better maternal and child health outcomes.