This spring, the World Health Organization (WHO) launched its first-ever guidelines on healthcare for mothers and infants in the weeks after birth. These brand-new guidelines reveal how much the norm has been to send mom and baby home with little more than best wishes. Yet, serious conditions – ranging from postpartum depression to preeclampsia – can present themselves in the days and weeks following childbirth. And, of course, every new parent could use some advice on breastfeeding and sleep.
Nadia Diamond-Smith, PhD, studies ways to improve care for women in India and Nepal that extends from family planning through postpartum care. She and her co-PI Alison El Ayadi, ScD, recently received an NIH R01 grant for a project to improve postpartum outcomes for new mothers in the Indian states of Punjab, Haryana and Maharashtra. This project builds on a development grant and an ongoing partnership with the Postgraduate Institute of Medical Education and Research and the Indraprastha Institute of Information Technology, Delhi.
The intervention, called MeSSSage connects postpartum women through digital support groups, including an app and interactive voice content, WhatsApp groups, and a weekly group call, guided by community health workers. In many parts of India, women have limited access to care for both sociological and geographical reasons. These women are often the lowest-status members of their husband’s family’s household, so their needs are not always met. They may also live far from the nearest clinic.
“Women need a lot of postpartum support for things that are important, such as breastfeeding,” Diamond-Smith said.
The project was devised before the pandemic, but access to care became even more restricted in the intervening years, thus making mobile health approaches like this one all the more necessary.
Diamond-Smith said the initial idea was to use the phone for the weekly group calls, but realizing that most people have smartphones, the research team conducted the pilot using Zoom groups. The first few meetings were slow going – the women were strangers and didn’t dive right into intimate conversations. But they warmed up.
“During the first few groups, I think our partners were thinking ‘This is never going to happen.’ People weren’t engaging,” Diamond-Smith said. “But with time they did, and now reading women’s feedback, they liked it. They felt like they’d found support.”
As the team prepares to launch the broader study, they covering more geographical terrain and expanding the content of their intervention. The trial would provide information on the impact of this intervention breast feeding, postpartum family planning and maternal mental health and host 26 support group sessions. The group leaders will refer women to in-person care as needed.
Diamond-Smith’s view of the technology – informed by her father Kirk Smith’s work in India to reduce indoor air pollution from cookstoves – is that people want something better than what they have, not just a tiny, incremental step. This is what led the team to offer rural women, some with limited literacy, an app and video calls, rather than just phone calls. If the content is fun to interact with in some way, it will have more impact.
The study will focus not just on whether the intervention works but also how it works and if providing postpartum support digitally is cost effective.