Ownership and use of mobile phone and utilization of maternal health services in India

Abstract

Despite decades of maternal and child health programming, neonatal disorders, undernutrition, and iron deficiency, feature in the top ten causes of premature death or disability in India. With the increasing use of mobile phones, mobile health (mHealth) programs have been implemented to promote MCH services. As no study has examined the role of Indian women's ownership/access to mobile phones on their healthcare utilization, we assess whether ownership and use of mobile phones are associated with the utilization of antenatal care (ANC) and institutional delivery services in India. We analyzed data from a nationally representative household survey from India. Our analytic sample was 12047 women with data on mobile phone ownership. Mobile phone ownership and use (access to internet, texting facility) were the exposure variables. The outcome variables were having at least four ANC visits(ideal) and an institutional delivery. Survey-adjusted logistic regression models adjusted for women's autonomy, socioeconomic indicators, and access to mass media were fit. The unadjusted odds of having an ideal ANC were higher (OR = 1.5; CI = 1.35-1.62) among those who owned a mobile phone versus not. After adjustment for all covariates, mobile phone ownership was not associated with both outcomes. Women with access to the internet had higher odds (OR = 9.24; CI = 6.51-13.2.)of reporting an institutional delivery and of receiving an ideal ANC(OR = 2.99;CI=2.40-3.73). In the fully adjusted model, access to the internet was positively associated with having an institutional delivery (OR = 2.85; CI = 2.82-1.31) whereas ideal ANC was not(OR = 1.7;p=0.07). mHealth interventions targeting women in India, especially the rural, low-income subgroup, are unlikely to be effective unless simultaneous efforts are made to increase access to, and autonomy in, mobile phone use. The need to partner with social scientists during intervention design/implementation as well as other policy-relevant implications are discussed.