OMOMI leads a mothers’ outreach effort at the Useh Primary Health Center in Benin City, Nigeria. (Photo courtesy of OMOMI)
It was close to 11 p.m. one night in April 2021 when Aishat Shoyoye’s water broke. With her husband’s arms wrapped around her waist and seated on the back of a commercial motorcycle, Shoyoye was rushed to a teaching hospital a few kilometers away from her home in Epe, a town on the north side of the Lekki Lagoon of Lagos, Nigeria.
On the ride, she rehearsed the breathing lesson she had received from Agnes, Nigeria’s first artificial intelligence (AI) multilingual midwife, shortly before going into labor.
“In pidgin English, Aunty Agnes told me to breathe with my mouth open during labor and inhale deeply through my nose and out through my mouth, if I couldn’t get to the hospital on time,” Shoyoye recalls. Soon after the call ended, she got a follow-up text message from the AI midwife reminding her to breathe slowly during labor.
Wanting to assist low-income women in Nigeria throughout their pregnancy, health technology expert Abisola Oladapo had the idea for Agnes in 2016. The AI system offers customized solutions to pregnant people through their phones, with specialized programming for assisted-pregnancy tracking, perinatal education, and extended-lifestyle assistance to underserved pregnant women and infants.
Oladapo, a mother of two, had the idea for Agnes after almost losing her second child in birth nearly six years ago. Her experience inspired her to think of scalable solutions to transform the future pregnancy care so that no woman would lose her life or suffer a miscarriage or stillbirth.
Studies show that not having access to maternal health-care services poses significant problems to women in developing countries like Nigeria. With nearly 1,000 maternal deaths out of 100,000 deliveries per year, Nigeria has the fourth-highest maternal mortality rate in the world. In sub-Saharan Africa, 1.1 million neonatal deaths — more than 45 percent of the global 2.4 million deaths—occur every year. Nigeria’s neonatal death rate is 38 per 1,000 live births, and the number rises to 132 deaths per 1,000 live births for children under the age of 5. These numbers translate to 1 Nigerian woman dying in childbirth every 10 minutes, and 1 in 8 Nigerian children never reach the age of 5, according to the 2018 Nigeria Demographic and Health Survey.
The causes associated with these mortality rates include lack of access to a medical facility and to skilled pregnancy care. They are also linked to obstetric hemorrhage, eclampsia, sepsis, and complications from unsafe abortions.
Agnes is just one of several low-tech initiatives, including OMOMI and Babymigo, established in recent years that address the underlying contributors to maternal and neonatal mortality rates in Nigeria. These initiatives operate via apps and other digital platforms to facilitate easy, free to low-cost access to educational and medical resources and engagement with other expectant and new parents. If they succeed in scaling, they can help mothers and newborns well beyond Nigeria in the future.
The Virtual Midwife
Early in the iteration process, Oladapo knew that education was critical to maternal-health outcomes, but she had yet to devise a strategy for using technology to reach pregnant people at scale. A solution crystallized during the COVID-19 lockdowns in 2020, when she and health-technology expert Michelle Ijomah, who serves as chief product officer for Agnes, and Noel Abotti, a fintech professional and Agnes COO, led prenatal education sessions with expectant mothers around Ibeju-Lekki and Ikorodu in Lagos.
During these sessions, they figured out that language posed a significant barrier to education. “And we also realized that many of the women don’t have access to the internet,” Oladapo says. “Some may have smartphones, but they can’t afford to always have it online and for data to be spent, and a majority of them use the feature phones that don’t have access to the internet.” The team determined that smartphones were not necessary to providing pregnant people with the information and resources that they needed, and that they could reach a broader population by devising programming obtainable through any working phone.
Agnes delivers weekly prenatal information to pregnant people through both preprogrammed text messages and voice notes recorded by midwives that are customized specifically to a person’s stage of pregnancy. The midwifery team follows up with a phone call after birth to ask the new parents about their health and the baby’s health and if they are experiencing any difficulty with their post-birth guidelines. Pregnant people and new parents can also call a 24/7 toll-free teleconsultation line for additional support from Agnes’ midwifery team. Information is available in several local Nigerian languages —including pidgin English, Ibo, Hausa, and Yoruba—to help overcome language barriers.
Mbelu Ogochukwu, a midwife for Agnes, explains that the app gives women the knowledge to help them build confidence and trust in giving birth at the hospital, as well as providing resources for finding local, cost-friendly medical care. “We see women giving birth at home because [most of them] do not have the money to afford to go to the hospital,” she notes, as most of these women live below the international poverty line of $1.90 per person a day. “As a result, they rely on traditional birth attendants. Agnes helps them to know that they can access the hospital where the doctor gets to know them and know how they are doing [in their pregnancy]. It reduces the influx of women in traditional birthing homes and reduces the rate of mortality.”
The Agnes app has additional features, including daily health tips that are delivered as either prerecorded phone calls or text messages, as well as reminders for expectant parents to take medications and prenatal vitamins to ensure a healthy pregnancy. It also has a vaccination-reminder feature, which sends prompts to new parents to alert them of the necessary vaccinations for their babies through 15 months of age.
Corporate grants financed Agnes’ launch, and local governments, NGOs, and health organizations have made it possible for the app’s services to be free or low cost for users. The Lagos State Government, for instance, has provided financing to cover prenatal calls, access to the toll-free service, health updates, and two monthly home-care visits from a specialist for each woman registered with Agnes.
Agnes has reached 1,300 pregnant women across 60 communities in Lagos and Ogun State—both located in southwestern Nigeria—since its launch in 2020. According to the team’s internal survey of its users, 79 percent of women who use Agnes have chosen to have their babies in health centers with medically trained attendants. These women are four times more likely than the national average to survive pregnancy in Nigeria, and the survival rate of their babies is 33 percent higher than the national average.
Vital Information
Five years prior to Agnes’ launch, in 2015, OMOMI—meaning “My Child” in Yoruba—was created by Charles Akhimien and Emmanuel Owobu, medical doctors and founders of the digital health company a href="https://mobicure.biz/" target="_blank">MOBicure. OMOMI’s defining feature is that it provides real-time access to doctors so that people can receive immediate maternal and child health care and information.
App users can select from one of three subscription options when consulting with OMOMI’s doctors: 50 cents per session, $1.50 per week, or $5 per month. Support for operational costs and some of the free services offered to moms is provided by the United States African Development Foundation (USADF), the US State Department via the US Consulate in Lagos, the Private Sector Health Alliance of Nigeria, and the biopharmaceutical company Merck.
The parenting platform Babymigo was founded three years later, in 2018, by product management expert Adeloye Olanrewaju and physiotherapist Kemi Olawoye. It quickly became one of Nigeria’s largest parenting communities, with more than 250,000 members. Babymigo was selected as part of the first class of Google’s Launchpad Accelerator program for African startups in 2018, and its current funders include Facebook, the US Department of State, and Google, in addition to private investors. Babymigo offers prenatal and postnatal resources to new and expectant parents, concierge services connecting them to medical experts, and a social platform for parents to crowdsource information and to ask other parents questions about pregnancy, infant care, and childcare. It charges a general access fee of $7 for a virtual consultation with a gynecologist or pediatrician.
Both Olanrewaju and Olawoye had personal experiences that motivated them to create Babymigo. Olanrewaju’s aunt lost her baby due to complications in childbirth, which, he believes, could have been avoided had she had the proper health care and correct pregnancy health information. For Olawoye, she first noticed the lack of prenatal and maternal health information in 2016, when she led antenatal classes at a Lagos hospital’s physiotherapy department. The expectant mothers, she recounts, were reluctant to attend the classes “because they didn’t believe in it culturally.”
Physiotherapist Kemi Olawoye cofounded Babymigo in 2018 to offer expectant and new parents better health information. (Photo courtesy of BABYMIGO)
Olawoye explains that cultural myths result in several misconceptions and fears about pregnancy and childbirth—especially about undergoing a cesarean section (CS).
“We asked a few women to share their CS story, and one thing that resonated in all of them was fear,” Olawoye says. “One of our moms told us that she had to pray and fast when the doctor told her that she was going to have a CS,” and because of this religious belief, “she even had more complications because of her lack of intake of food.”
OMOMI and Babymigo offer similar services, particularly when it comes to providing accurate information and education to combat such entrenched myths. Both apps allow expectant and nursing mothers to receive answers to pressing medical needs within minutes through virtual consultations—what OMOMI calls its “chat-a-doc” feature. And both platforms provide free maternal-health services to pregnant women via SMS text messaging, app, and web portal.
OMOMI’s specialized features include a maternal calculator that helps pregnant moms determine their stage of pregnancy and due date, and an immunization tracker to chart their baby’s future vaccination dates. Funding from the USADF and the US Consulate in Nigeria, in partnership with three major telecommunications operators in Nigeria (MTN, Airtel, and 9mobile), has covered the SMS service charges for personalized health information since 2015. OMOMI also partnered with the Mobile Alliance for Maternal Action (MAMA), a free maternal-health SMS-text-messaging service that was offered to pregnant women at different pregnancy stages.
A feature that distinguishes Babymigo from OMOMI is its vast network of more than 7,000 local service providers. Babymigo’s network has a far greater reach in support and more rapid response time than OMOMI’s three medical doctors are capable of; they only provide answers to moms and make recommendations on the Mother’s Community and chat-a-doc features.
Among Babymigo’s service providers are gynecologists, lactation consultants, and pediatricians. The app also has what it refers to as a maternity hospital arm, which includes a list of registered hospitals that are searchable by geographic proximity. Women can search for in vitro fertilization (IVF) and fertility clinics on the app, too. Additionally, Babymigo has a feature designed for parents to research and read reviews and recommendations of more than 5,000 day care and Montessori centers across major states and cities in Nigeria.
Mothers Know Best
Both OMOMI and Babymigo offer community forums for expectant and new parents to engage with each other as well as with doctors. On these forums, they can ask questions and share personal stories about pregnancy and parenting experiences.
The value of these forums for mothers stems from the common belief that motherhood is a critical life-changing period both for the individual parent and for the community. It is considered to be a bonding experience where experienced mothers share their knowledge about motherhood with expectant or new moms. These forums are modernizing the culture of motherhood by expanding mothers’ communities beyond their mothers, mothers-in-law, and close female relations to thousands of other women, who share their experiences on motherhood, childbirth, childcare, and even marriage and relationships, in vibrant online communities.
Nancy Akpobari, a mother of two, has been a member of OMOMI’s Mother’s Community forum for more than a year. She uses the forum whenever she’s unable to go to the hospital, because it offers real-time responses and advice from other mothers and doctors.
“The Mother’s Community is such an interesting forum,” she says, “because the moment you put up a question, you find other moms who have had similar problems to yours, and you get quick answers from them.”
Initially, OMOMI created its community for mothers only. However, about two years after its launch, OMOMI’s founders observed the limitations and setbacks of this decision. A significant one was that these mothers had no access to medical advice from trained medical experts. The second problem was that instead of getting a well-channeled conversation that provided clear and direct solutions, “you’d see a lot of people giving different and often contradictory responses,” which caused confusion for mothers, Onyedikachi Nwizu, MOBicure’s former head of operations, recalls. As a solution, OMOMI created the chat-a-doc feature to enable their users to have access to medical doctors and medical treatment, including prescription drugs.
Muhammed Usman, who started using the OMOMI app a year ago, accessed the chat-a-doc feature after suffering a miscarriage at home. A doctor quickly responded to her message, and they discussed next steps, including setting up a private consultation. “I was advised to see a doctor for a scan and medication, and I was okay after then,” says Usman, who had a successful pregnancy a year later.
Redefining antenatal and maternal health care by leveraging technology is the most promising way to transform Nigeria’s health-care system.
For Babymigo, Olawoye says, “the goal was to have a community where parenting and motherhood journeys are made easy. We realized that parenting is one of the toughest journeys that we don’t talk enough about, and motherhood takes a lot, so establishing a community was very important for us.”
At Babymigo’s forum, women can ask questions and receive instant responses from a community of mothers, and they can directly communicate with various medical experts, including pediatricians, gynecologists, and nutrition experts. They can also find and connect with various local services around them.
One mother on the platform, for example, posted a question about her baby’s refusal to drink breast milk and asked for recommendations on how to breastfeed and which formula to use as a supplement.
Chizi Enebua, a participant on the forum, responded immediately, advising her to make sure her baby latched well when breastfeeding and make sure to empty one breast before giving the second one. She also advised the mother to ensure that her baby breastfed for at least six months before introducing complementary feeding.
Scaling and Challenges
For companies like Agnes, OMOMI, and Babymigo, redefining the future of antenatal and maternal health care in Nigeria by leveraging technology is the most promising way to transform the country’s entire health-care system.
In Nigeria, approximately 95 percent of the country’s population lacks health insurance. Fewer than 5 percent of its citizens employed in the formal sector are covered by the National Health Insurance Scheme (NHIS), and even fewer—3 percent—employed in the informal sector are covered by voluntary private health insurance.
The fragile health-care infrastructure is one that adds more challenges to initiatives aiming to improve health outcomes, especially as they attempt to assist pregnant women with medical care. The health-care system is poorly funded, and mass emigration of skilled medical practitioners affects the quality of health care in Nigeria.
Nigeria has 4 doctors per 10,000 patients and roughly 16 nurses and midwives per 10,000 patients—significantly less than the World Health Organization’s recommendations of 1 doctor per 600 patients and the critical threshold of 23 doctors, nurses, and midwives per 10,000 patients.
Because of the country’s impoverished health-care system, the three teams of founders all have hopes of scaling their companies and their respective platforms’ accessibility, first by expanding the number of languages, and then by scaling their efforts beyond Nigeria. Agnes, for example, has initiated a plan to go global and has rebranded its name to incorporate this vision. According to its LinkedIn profile, Agnes Global is now headquartered in Clerkenwell, England.
Persistent funding challenges, however, have slowed progress. OMOMI even had to discontinue their SMS service in 2017—it had become too expensive to maintain as their user base expanded. “We couldn’t just keep running on grants,” Owobu says. “We had to be sustainable to find a way to generate revenue, else the business will die. The mothers would not gain—nobody would gain from it—and staff would have to be laid off,” he adds.
Owobu and his team also recently remodeled and rebranded the chat-a-doc feature as “ask-a-doc.” And, because it was cheaper than the SMS feature, they could offer it for free to its users. Melody Eghelen, OMOMI’s head of products, says the change was primarily made as a point of clarification for OMOMI users, who would often mistakenly go to the Mother’s Community forum to seek an answer from a medical doctor. She adds that a website version was created expressly for users who did not have smartphones or who were unable to download the app on their smartphones.
In March 2022, the team at Babymigo improved their service offerings with Babymigo 2.0, a more user-friendly, human-centered design platform with more than 50 community groups designated by topic and interest, a question-and-answer forum, and in-person and virtual doctor consultations. Babymigo 2.0 also offers a Mamacare Pregnancy Plan insurance plan, which allows Babymigo users to have access to top maternity and childcare hospitals for childbirth and related services at a heavily discounted rate.
Olawoye says that this new platform will enable Babymigo to continue to have a “positive influence on maternal and child health indices in the country by giving individuals access to the right information and resources.”
Babymigo has reached more than 200,000 users. The app has been downloaded 30,000 times, and its mobile-friendly website has 90,000 registered users—most from Nigeria, with the rest from sub-Saharan Africa. The team also plans to expand to other African countries, including Kenya and Ghana in the near future. Yet their primary client base remains the Nigerian market, and they are currently conducting a focus group with mothers about existing and potential new features. Babymigo’s founders say they will commence implementation of their findings this year.
While these innovations provide low-tech solutions to help new moms, users still have to grapple with hiccups from network glitches associated with phone apps and telecommunications services. As of January 2021, Nigeria had more than 200 million active mobile lines, according to the Nigerian Communications Commission (NCC), but broadband subscriptions totaled just over 78 million in February 2022. Consequently, solutions such as OMOMI and Babymigo that require internet service remain inaccessible to many mothers who may benefit from the prenatal, antenatal, and motherhood information on these apps. However, for services that can be delivered via SMS and short codes, like those provided by Agnes, the potential reach could be greater.
Despite these limitations, improving Nigeria’s poor maternal and newborn outcomes requires determined and collective efforts. The founders of these three companies are working with a common goal—to ensure safe births and build a continent where expectant, pregnant, and nursing mothers can connect with their peers and experts from their homes.
Read more stories by Valentine Benjamin.