Does Mobile Phone Ownership Predict Better Utilization of Maternal and Newborn Health Services? -A Cross-Sectional Study in Timor-Leste

Abstract

Background: Increasingly popular mobile health (mHealth) programs have been proposed to promote better utilization of maternal, newborn and child health services. However, women who lack access to a mobile phone are often left out of programs and research. In this study, we aimed to explore whether household mobile phone ownership is an independent predictor of utilization of maternal and newborn health services in Timor-Leste. Methods: 581 women aged 15-49 years with a child under the age of two years from the districts of Manufahi and Ainaro in Timor-Leste participated in the study from March to April 2012. Participants were interviewed via a structured survey of knowledge, practices, and coverage of maternal and child health, with added questions related to ownership and utilization of mobile phones. Mobile phone ownership was the exposure variable, and five composite variables were at least four antenatal care visits, skilled birth attendance, health facility delivery, postnatal checkup, and neonatal checkup. Logistic regression models were applied to assess for associations. Results: 364 (67%) women reported having at least one mobile phone in the family. The results of bivariate analysis showed that women who had a mobile phone were more likely to utilize maternal and newborn health services. The results of multivariate logistic regression demonstrated a significant association between mobile phone ownership and an increased rate of four antenatal visits [adjusted Odds Ratio (aOR): 1.60; 95% CI: 1.01-2.55; P=0.046], but not for skilled birth attendance, health facility delivery, and postnatal care or neonatal care within 2 days after delivery. Conclusion: Women with a mobile phone were more likely to utilize maternal and newborn health services than women without a mobile phone. Mobile phone ownership in this population is highly associated with socioeconomic status. It is an independent predictor only for completing four antenatal care visits but not for other positive maternal health behaviors. Researchers in mHealth programs need to consider the population with limited or no access to a mobile phone.