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 Text4baby, the largest ever national mobile infant health initiative to date was launched in February. Endorsed by the White House Office of Science and Technology Policy, the educational program of the National Healthy Mothers, Healthy Babies Coalition (HMHB) is designed to promote maternal and child health.
Elizabeth "Betty" Jordan, DNSc, RNC, assistant professor in the department of community and public health, noted that the Text4baby program demonstrates the ability to use a national mobile health technology to reach underserved women with critical healthcare information.
Today, there are 85,000 women signed up for the Text4baby program around the country. And this past June, Text4baby was officially launched in Baltimore through the B'more for Healthy Babies initiative brought forth by the Baltimore City Health Department and The Family League of Baltimore City.
In 2007, Baltimore's infant mortality rate was 11.3 percent - one of the reasons the city adopted the Text4baby program.
"We're hoping to improve birth outcomes in general in Baltimore by educating women through these text messages for healthy pregnancies with messages telling them to get into prenatal care, eat well, and avoid drugs and alcohol, among other messages" said Ellen Ray, MS, CNM, an instructor in the department of community and public health.
How Text4baby Works
Women can sign up for the service by texting BABY (or BEBE for Spanish) to 511411. They become registered after they provide their zip code and due date. Once registered, women receive three messages per week based on the gestational age or how far along they are in their pregnancy.
When new mothers inform the service that they have given birth, they will receive newborn messages. Text4baby is free up until the baby's first year of birth. It can also be ended at any time by texting STOP.
Throughout the woman's pregnancy, the text messages are customized toward their baby's development, mentioned Jordan.
"The text messages are tailored to the gestational age in pregnancy as well as the newborn age. For example, if you are in the third trimester and you are just about due, the service will give you messages preparing you for labor," she said. "It's key information being delivered right at the time that you have the baby."
The type of information provided to mothers was chosen to give babies the best possible start in life.
Women can expect messages about healthcare access, emphasizing the need for prenatal care and the importance of keeping an appointment; nutrition, stressing the significance of eating breakfast in the morning and healthy eating; and drugs or alcohol, underscoring the importance of not using those substances and providing information about smoking cessation. Other topics include safe sleep, immunizations for the newborn and car seat safety.
"We really have selected what we believe are the most important messages and are sending them consistently at the time when mothers might be thinking about those things," said Jordan.
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Using Mobile Technology
Text4baby relies on mobile communication - not the Internet - to get their messages to subscribers. And there's a good reason for that. The vulnerable or underserved women Text4baby is targeting are more likely to use a cell phone than the Internet, explained Jordan.
When comparing cell phone use versus Internet use among certain income brackets, education levels, and different races and ethnicity, one begins to understand why the service used mobile technology.
Statistics show 63 percent of women who fall into the "less than $30,000 income" level have a cell phone versus only 53 percent who use the Internet. (That Internet use is less than 1 hour a day.) Of those women who are high school-educated, 59 percent have cell phone use versus 44 percent of women who do not have a high school degree.
"This information is going directly on this person's cell phone," said Ray. "So it's more of a personal approach than giving someone a book to read or a pamphlet. Women have this information on their cell phone and they could go back time and time again to look at the information, as opposed to seeing it once on, say, a commercial."
This one-way service (women currentlly can't text a question in and get an answer back) also provides women with phone numbers to call if they need help or require more information on a certain subject.
"It won't just say, 'Stop smoking,'" for example, Ray explained, "It will provide women with a resource for doing so."
The Future of Text4baby
Jordan notes that many people have asked her if she knows for sure that the program is working.
"We don't know," she confessed. "But we have an ongoing evaluation at several levels. We are planning a national trial that will evaluate the service."
Researchers will be looking at whether or not women take action after receiving a message.
"Just because we send you a message to eat breakfast, do you do something about it because of that message?" Jordan asked rhetorically.
On a smaller scale, information is being collected and the program is being evaluated within where it has been implemented. Jordan and Ray are currently looking obtaining feedback in Baltimore to see if women like this program, if Text4baby is sending the right type of messages, if the service is sending the correct amount of messages, etc.
Ray noted that she is setting up a project at Franklin Square Hospital that will focus on women who have not yet registered for prenatal care. These women will be given information about Text4baby, and then if they do register for prenatal care, they will be asked if one of the messages from Text4baby encouraged them to get into care.
"I think whenever you launch a program you also have to think, 'Well, how do you know it works?' Ellen and I have been actively involved in evaluation of the program," concluded Jordan.
Beth Puliti is a frequent contributor to ADVANCE.
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