Behavioral Nudge Approaches to Address Systemic Gaps in the Postnatal Continuum

Low uptake of postnatal care and family planning (FP) are significant factors to poor health outcomes for mothers and babies in Kenya. To address this, we develop innovations that improve the quality of care that we test in our own maternity clinics and replicate in public hospitals. One innovation that showed strong evidence in early iterations is a Postpartum Checklist delivered via phone call, which created dramatic results in health-seeking behavior: an increase in maternal care-seeking by 40% and in FP use by 90%. The goal is to test a cheaper and more scalable version: a web-based questionnaire sent via SMS post-delivery, which will trigger automated referral to seek facility-care and phone calls if certain danger signs are triggered. We will first conduct a feasibility screen in our own clinics, then rollout in a larger sample in a partner public facility. We aim to demonstrate that this tool can improve return rates for care at two weeks postpartum by 25%, and postpartum family planning at 10 weeks by 20%. We demonstrate Integrated Innovation: 1) Scientific/technological - it uses mHealth and research-based M&E to prove strong early results; 2) Social - it takes advantage of the popularity of mobile phone usage in Kenyan culture, as well as the role of government as political determinant of health and an essential partner for scaling; and 3) Business - it achieves financial sustainability through extreme affordability for low-income women in Kenya.