By Judy Meehan, CEO, National Healthy Mothers, Healthy Babies Coalition

Tragically, in the U.S. approximately 28,000 babies die before their first birthday, despite a volume of science around behaviors that improve a baby’s chances for a healthy birth and opportunity to thrive. Text4baby was developed to deliver evidence-based health information to the women who need it most: the 1.5 million women on Medicaid who give birth each year. While many of these women may lack access to the Internet and other sources of health information, the vast majority of them do have a cell phone, and a reported 80 percent of Medicaid beneficiaries are active texters.

Since its launch in February 2010, text4baby has enrolled over 157,000 users and delivered over 12 million evidence-based tips to help them keep themselves and their babies healthy. That’s a great start but it’s not enough. Thanks to the grassroots efforts of more than 500 text4baby partners across the country, we are on track to achieve our goal of bringing the service to 1 million moms by the end of 2012 and delivering over 100 million timely and relevant health messages.

Developed in collaboration with the Centers for Disease Control and Prevention (CDC), Health Resources and Services, Administration (HRSA), American Academy of Pediatrics (AAP), and other experts, text4baby messages cover topics like immunization, nutrition, smoking cessation, safe sleep, and the importance of early prenatal care. The content also connects women to services such as health insurance, childcare, and toll-free “quitlines” for assistance in becoming smoke- and drug-free. Text4baby has also delivered urgent infant product alerts at the request of the Food and Drug Administration and outbreak and immunization alerts at the request of CDC.  Just last month, text4baby moms saw: “Breaking news! The American Academy of Pediatrics announced new car seat guidelines. Kids should now ride in rear facing-car safety seats until AGE 2.”

We know that women like the service (over 96 percent say they would refer a friend). Preliminary data analysis indicates that text4baby is reaching the target audience: for example, analysis of enrollment data in Virginia showed that text4baby utilization is highest in zip codes with lower income levels and higher incidence rates of low birthweight babies.

However, we also want to understand if and how text4baby is improving knowledge and changing behavior. There are currently six formal evaluations underway to examine text4baby’s impact. The largest study, funded by the Department of Health and Human Services (HHS) and conducted by Mathematica Policy Research, is a mixed mode study and includes a mobile survey of text4baby users, focus groups, a community survey, electronic health record review, and interviews with key partners. This study will assess utilization of recommended care during prenatal and postpartum periods (considering things such as prenatal visits, postpartum visit, well-child visits, dental visits, and immunization); adherence to recommended health practices (such as breastfeeding and infant sleep position); and adoption of healthy behaviors (such as smoking cessation, healthy eating and exercise). Additional studies are being conducted by Emory University, the National Latino Research Center, AmeriChoice/UnitedHealth and the Department of Defense Military Health System in partnership with George Washington University. These studies are assessing similar outcomes around knowledge and self-reported behavior change among text4baby users, as well as exploring the perceived value of a text-based educational tool for pregnant women and new moms.

When the National Healthy Mothers, Healthy Babies Coalition (HMHB), Johnson & Johnson, Grey Healthcare Group (A WPP Company), Voxiva, CTIA – The Wireless Foundation, the nation’s wireless carriers, and the U.S. government came together to launch text4baby, we established four clear objectives:

• Demonstrate the potential of mobile health technology to address a critical national health priority: maternal and child health.
• Demonstrate the potential of mobile health technology to reach underserved populations with critical health information.
• Develop a base of evidence on the efficacy of mobile health interventions.
• Catalyze new models for public-private partnerships in the area of mobile health.

At launch, text4baby was intended to be a pilot project in Virginia but enthusiasm for the program spread quickly. Organizations across the country saw that text4baby filled a critical void and signed on to promote the service to the women they reach. Text4baby partners include:

• 30 State Health Departments
• 65 City & County Health Departments
• 72 Health Plans
• American Academy of Pediatrics
• American Public Health Association
• American College of Nurse Midwives
• Association of Women’s Health, Obstetrics, and Neonatal Nurses
• Association of Maternal and Child Health Programs
• Hospital Corporation of America
• March of Dimes
• National Association of County and City Health Officials
• National Business Group on Health
• National Council of La Raza
• National Healthy Start Association
• National WIC Association
• MTV

In addition to the 500+ official Outreach Partners, local text4baby coalitions have sprung up in states and counties across the country to promote enrollment. In Martinsville, VA, partners raised funds to put up text4baby billboards. In New York City, they send out text4baby fliers with every birth certificate.  In San Diego, the coalition enlisted a local DJ to become the text4baby spokesperson. While HMHB supports these local efforts with promotional materials, text4baby enrollment is largely the result of a volunteer grass roots movement of partners developing their own strategies and tools.

Looking back at our objectives, we believe that: (1) we are demonstrating the potential of mobile health technology to address a critical national health priority; (2) we are demonstrating the potential of mobile health technology to reach underserved populations with critical health information, and (3) we have catalyzed a new model for public-private partnerships in the area of mobile health. As the six evaluations are completed over the next 12-24 months, we fully expect to establish the evidence on the efficacy of mobile health interventions.

Even before the formal study results are in, we know that delivering over 12 million important evidence-based health tips to 157,000 individuals (and, by the end of next year, 100 million messages to 1 million moms) is an important national service. It is something that the hundreds of text4baby partners can be very proud of having accomplished together.