Home Mobile Phones and Maternal Health in Bangladesh: A qualitative needs analysis

By Murali Shanmugavelan

There are now 5.04 billion mobile phone subscriptions in the world and the majority of new customers are in developing countries. Many organizations have started to develop projects which use mobile phones to improve people’s lives. However, these are often being developed with limited analysis of the needs of the groups being targeted. 

This article looks at a project in Bangladesh which involved MCS director, Murali Shanmugavelan. It involved undertaking a qualitative needs assessment to identify potential roles for mobile phones to increase women’s access to information on maternal and child health related issues. The project developed a methodology which can be used to conduct needs analysis of other mobile for development projects. 

Why mobile phones and Maternal Health

The review by the UN Millennium Campaign which assessed the progress of MDGs1 indicated that policies, strategies and systems are in support of the Millennium Development Goals (MDGs) in many countries but that alone does not guarantee the delivery of services at the local levels. The outcome September 2010 UN report on the Millennium MDGs2 noted the general progress but it was “...deeply concerned about the alarming global levels of maternal and child mortality”.

To reduce maternal and child mortality the report emphasised the need to ensure health workers have the right capacity, to strengthen infrastructure, to remove financial, social and cultural barriers to access, to hold power holders to account for credible results, and to mobilise political leadership and communities. The UN Global Strategy document for Women’s and Children’s Health also specifically mentions3 that the global community must maximise the impact of new innovations in technologies such as mobile phones by developing cost-effective and evidence-based applications to improve women and child health.

In other words, a strategy to successfully reduce maternal and child mortality requires the innovative use of communication tools and processes. Communication plays a crucial role in helping citizens participate in debates and decisions, monitor local progress, hold governments to account and articulate their needs so the policy making process can truly respond to those needs and concerns4.

The opportunity and the gap
The flexibility and relatively easy accessibility of mobile phones means that applications are being developed both by large agencies and technology companies and small scale enthusiasts and local community initiatives5.  However, the most profound shifts in this sector are coming not from aid agencies, the development world or media development organisations but from commercial development of communications on a global level6.

There are many projects in developing countries using mobile phones and mobile phone applications7. However, many of these interventions are applications-driven (with a ‘build it and they will come’ approach) and are often without proper needs analysis and impact measurements8.

The Study
D.Net and Panos London conducted a qualitative needs analysis that seeks to identify new ways of appropriately using mobile phones to increase women’s access to information related to maternal and child health issues.  The research study was designed to map the maternal health needs and relevant communication opportunities of rural women. A research methodology was also developed that can be used to conduct needs analysis for other mobile for development projects.

168 women were interviewed from three upazillahs (subdistricts) Shaghata, Bagerhat and Purbodhola. These women represented the lowest social and economic conditions from the respective locations.


A range of research tools were identified and developed to map existing health barriers (challenges) and to identify potential communication opportunities (solutions). These included focus group discussions, open-ended questions for local leaders, a semi-structured questionnaire, a case history check list and a medical check-up to validate health problems. An algorithm was used to collate systematic qualitative data in a questionnaire format. This helped to analyze complex behaviour needs in order to arrive at solutions.

The research focused on understanding:

  1. How often women access health care services (demand side).
  2. How health professionals and health care workers provided health care support to these women (supply side).
  3. How women, health professionals and outreach workers use existing communication channels to access general and health care services.


Key Findings
The study found that9:

  • Many of the women did not consult with doctors or health care workers even when they suffered from a health problem. Cultural factors were cited as key barriers.
  • Women said they would take impersonal services as delivery through mobile phones seriously only if recommended by existing trusted and credible people from the family, community, health care workers etc.
  • 76.83% of women respondents said they could not fix prior appointments with doctors because they did not have phone numbers to call local hospitals. Women also received poor quality of health services because they were not aware of their legal rights and entitlements.
  • Overall 81.55% of families of the respondents have mobile phone availability but only 39.88% of women respondents have access to mobile phones.
  • 90.07% of respondents were positive about voice messages. Only 31.37% women respondents said they were happy to receive text messages.
  • 31.55% of women respondents said their mobile phones had neither camera nor the internet.
  • All women respondents were positive about potential use of mobile phones. 82.14% of women respondents said they would use phones for remote consultation

These findings indicate that:

  • The use of mobile phones for development is inextricably linked with personal, social and cultural factors in users’ lives. For example, it found that the reason for women’s low level of consultation with doctors and health care workers is largely triggered by social and cultural barriers and not by lack of communication channels.
  • Mobile phones may be the new mass media tool in rural Bangladesh and enable everyone to connect with each other but traditional networks are still the most trusted information sources, according to the study. However these information sources are not in competition with mobile phones, and mobile phone based services should still be developed to complement existing sources and ensure diversity of communications channels.
  • Explosion in the use of mobile phones continues in rural Bangladesh but there is a distinctive gender gap and this calls for gender-friendly regulatory arrangements such as female-specific airtime tariffs, gender-friendly information services and support to improve capacities (technical and handset affordability) of women’s use of mobile phones.
  • National level mobile phone based dissemination services that push information to millions of people may not require a rigorous needs analysis. However mobile phone based services for customised groups (e.g. support to disabled groups) require in-depth needs analysis to situate the target group’s and gate keepers’ social, economic and political profile in the existing development and communication landscape.

 


 

  1. Citizens Monitoring of Millennium development goals: UN Millennium campaign
  2. United Nations General Assemble: Sixty-fifth session, 2010
  3. Ibid: p.10
  4. Pagliani, P. 2007, ‘The MDGs as a Communication Tool for Development’, United Nations Development Programme, Oslo Governance Centre, Norway
  5. See http://mobileactive.org/directory and http://mobiles.tacticaltech.org/taxonomy/term/4 for directories of examples
  6. Verclas,K .& Mechael,P. 2008, A Mobile voice :The use of mobile phones in Citizen media , USAID
  7. Some examples are provided on the Mobile Active site: http://mobileactive.org/directory
  8. Panos London 2009: Mapping mobile phones for social change – scoping survey; The Information Society Programme
  9. See the “Mobile Phones for Millennium Development Goals: Qualitative needs analysis to overcome communication barriers to improve maternal health” report for the detailed findings

 

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