The document discusses the Text4baby program, which sends free text messages to pregnant women and mothers of young children with health information. It began in 2010 and has grown significantly, with over 400,000 enrollees. The program was created through a public-private partnership and develops messages with input from health experts. Research shows Text4baby improves health knowledge, helps users remember appointments, and facilitates interactions with healthcare providers.

1. Harnessing the Power of
Mobile for Maternal &
Child Health: The
Text4baby Program

2. The Need

3. Maternal & Child Health in the U.S.
 The United States has one of the
highest infant mortality rates in the
industrialized world.
 Each year in the United States:
 500,000 (1 in 8) babies are born
prematurely.
 28,000 die before their first
birthday.
 Many factors contribute to these
negative outcomes including:
 Lack of access to healthcare
 Negative health behaviors
 Poverty
 Research supports that increasing
knowledge around health can help
people stay healthier.
3

4. Maternal & Child Health in the U.S.
Distribution of prenatal care adequacy categories: US, 2002
In the United States,
11.3% of live births were
to women receiving
inadequate care.
4

5. Maternal & Child Health in the U.S.
Percentage of women aged 18--49 years pregnant during October 2010--January 2011 (N = 1,457) who
received influenza vaccination before, during, or after pregnancy, by month of delivery or expected
month of delivery --- United States, Internet panel survey, April 2011
In 2010-2011,
only 49% of
pregnant women
had received
influenza
vaccination: 32%
during pregnancy
and 17% before
pregnancy or after
delivery.
5

6. Maternal & Child Health in the U.S.
Each year in the United States, more than 4,500 infants die suddenly of no
immediately, obvious cause. Half of these deaths are due to Sudden Infant Death
Syndrome (SIDS), the leading of all deaths among infants aged 1–12 months.
6

7. Why go mobile?
 82% of adults age 18 and older
in the U.S. have cell phones.
 81% of adult women in the U.S.
have cell phones.
 72% of adults with cell phones
send and receive text messages.
 Adults who text typically send
and receive a median of 10 texts
a day.
Source: Amanda Lenhart. Cell Phones and American Adults.
Washington, DC:
Pew Research Center; 2010
7

8. Texting by Insurance Type
Texting by Insurance Type
Source: PricewaterhouseCoopers HRI Consumer Survey, 2010
8

9. Innovation in MCH

10. What is Text4baby?
 An educational program of the National
Healthy Mothers, Healthy Babies
Coalition (HMHB).
 A free texting service that provides
pregnant women and moms with babies
under age one with timed health and
safety information to help them care for
their health and give their babies the
best possible start in life.
 The largest national mobile health
initiative to date with over 400,000
enrollees since launch.

11. National Partnership
National Partnership

12. Mobile Provider Partners
Participating mobile providers have agreed to deliver
text4baby to their subscribers at no charge.
12

13. How Text4baby
How Text4baby Works Works
User registration via
text or website:
Text BABY/BEBE to
511411
User gives zip and
due date/DOB
If pregnant, user gets a
starter-pack of 6 key
messages (over 2wks)
User gets free tips
3x/week
Ends if user texts STOP
or on the baby’s 1st
b-day

14. Text4baby Content

15. Content Development & Review Process
Message feedback from •Institute for Health and Recovery •Organization of Teratology
organizations, including (but not •Just in Time Parenting Information Specialists
limited to)*: •Kansas Dept of Health & Environment •Prevent Child Abuse Arizona Expert input from:
•Arizona Dept of Health Services •Lamaze International •Safe Kids USA •Alliance for Hispanic Health
•Association of Poison Control Centers •Massachusetts Breastfeeding •The AOA Foundation •American Academy of Pediatrics
•Berkeley University Coalition •The National Campaign to Prevent •American Academy of Pediatric
•California Dept of Social Services •National Center for Hearing Teen & Unwanted Pregnancy Dentistry
•Carolina Breastfeeding Institute Assessment and Management •Utah County WIC •American College of Nurse-Midwives
•Cincinnati Children's Hospital •National WIC Association •Virginia Dept of Health •American College of Obstetricians and
•Fairview Hospital (Cleveland) •Nevada Dept of Health •Washington State Dept of Health Gynecologists
•First Candle •New York State Dept of Health •DC Breastfeeding Coalition
•National Domestic Violence Hotline
•Florida Dept of Health •Ohio Dept of Health •West Virginia Hospital Association
•Postpartum Support International
•Georgia Dept of Community Health •Oral Health Kansas •Wisconsin Childhood Lead Poisoning
•Text4baby Breastfeeding Council
•Healthy Fathering Collaborative •Oregon Dept of Human Services Prevention Program
Literature
Review
Priority Content Expert Audience Ongoing
Topics Development Review Testing Revision
Federal Government
U.S. Department of Health and Human Services:
Audience Testing • Centers for Medicare and Medicaid Services
• Centers for Disease Control and Prevention
• Health Resources and Services Administration, Maternal and Child Health
Bureau
• Emory University Rollins School of • HHS Office on Women’s Health
Public Health •National Institutes of Health
• Hablamos Juntos U.S. Consumer Product Safety Commission
U.S. Department of Agriculture, Food and Nutrition Service
U.S. Department of Defense Military Health System
U.S. Department of Transportation

16. Messages on Critical Issues
 Smoking Cessation
 Breast Feeding
 Health Care Access
 Diabetes
 Nutrition
 Oral Health
 Immunization
 Prenatal Care
 Disabilities
 Family Planning
 HIV/AIDS Prevention
 Violence Prevention
 Physical Activity
 Safety & Injury Prevention
 Mental Health
 Substance Abuse Prevention
 Developmental Milestones
 Labor & Delivery
 Car Seat Safety
 Safe Sleep
 Exercise

17. Sample Messages
Sample Messages
Premature babies need extra Diabetes can happen for the A seat belt protects you &
help with breastfeeding. Even 1st time in pregnancy. You your baby. Shoulder belt goes
if your baby can’t breastfeed may be tested at 24-28 between your breasts & lap
at first, she can still be fed weeks. If you have it, you & strap goes under your belly
your pumped milk. your Dr. will make a plan to (not on or above). Wear it
Back control it. every time.
Back Back
Keep your baby away from Keeping your baby’s mouth
tobacco smoke. It can Time for baby’s 2-month
checkup! Time for him to get clean is important even before
damage baby’s heart, lungs she has teeth! Wipe her gums
& brain and increase baby’s vaccines to protect him from
serious diseases. And time each day with a wet washcloth
chances of getting colds or use a soft baby toothbrush.
and ear infections. for you to share how your
Back
Back baby’s doing!
Back

18. Delivery of Time-Sensitive Messages
 Tylenol recall, May 2010
 Pertussis outbreak CA (CDC), July 2010
 Similac formula recall, September 2010
 Sleep positioners warning (FDA), October 2010
 New car safety seat guidelines (AAP), March 2011
 Deadly hot cars (Safe Kids), July 2011
 Benzocaine warning (FDA), August 2011
 Window falls prevention (AAP & CDC), September
2011
 Warning about crib bumpers (AAP & CDC), October
2011
 Carbon monoxide poisoning (CT & MA) in response to
power outages, November 2011
 Warning about button batteries (Safe Kids),
December 2011
 CMS enrollment (CMS), February 2012
 Medicine safety (CDC), March 2012
 Pertussis - 7 states (CDC), April 2012

19. The Public-Private Partnership

20. More than 800 Promotional Partners
Federal Agencies State & Local Health & 97 Health Plans
Medicaid Agencies
representing all 50 states, DC,
& US territories
64 National Health Orgs 125 Hospital Networks
Media

21. Spreading
About the Service the Word
Promotional activities have included:
 Mass emails to colleagues & consumers
 Printed promotional materials in health clinics/exam & waiting
rooms & hospital discharge packets
 Medicaid/health plan member enrollment letters/mailings
 E-newsletter or print newsletter blurbs
 Word-of-mouth at conferences & community events (“baby
showers”)
 Promotion through home visiting programs
 Earned and paid public service advertising on TV, radio,
buses, billboards, etc.
 Text4baby info recorded on phone “hold” messages
 Media events
 Outreach to elected officials

23. American College of Obstetricians
and Gynecologists
 Co-branded fact sheet for OB/GYNs.
 Information on patient (at right) and
members-only web pages
 Congressional Leadership
Conference session (Feb 2012).
 Media release (at right; Feb 2012).
 ACOG News article (Spring 2012).
 National Women’s Health Week
blast email to 37,500 members (May
2012).
 Co-sponsorship of Congressional
Briefing (May 2012).
 Materials included in flu season
mailing to 35,000 members (Fall
2012)

24. AAP Promotion Academy of Pediatrics Promotion
American
 Blurbs in SmartBrief, AAP News, &
Healthy Child Care America newsletters
 President’s letter to 40,000 pediatricians
citing evaluation results & encouraging
promotion (Jan 2012)
 Co-branded Bright Futures/AAP tear-pads
mailed to members & in t4b store
 Dedicated page on AAP site for
pediatricians to view messages
(http://www2.aap.org/text4baby/)

25. Association of Women’s Health, Obstetric
and Neonatal Nurses
 Cover article in Journal of
Nursing for Women’s Health
spring 2011 (at left)
 Promotion through Healthy
Mom&Baby consumer
magazine
 Text4baby info on website

26. Congressional Support
Congressional Support
Congresswoman Lois Capps (D-CA):
 Held a Congressional Briefing in 2010
 Distributed a press release expressing her support
 Sent a letter to members of the House of Representatives encouraging her
colleagues to host text4baby events in their
local districts.
 Attended events in California to launch the text4baby campaign
Congressman Trey Gowdy (R-SC):
 Strong advocate of program
 Working with the South Carolina Department of Health and the Environment
to spread word about text4baby to constituents
Senator Tom Carper (D-DE):
 Hosted a Congressional Briefing in May 2012
 Encourages organizations in Delaware to promote text4baby
 “Text4baby works by providing patients with the information they need to
have a safe, healthy pregnancy in an inexpensive, easy to use format that is
delivered regularly to their cell phone. This simple tool can help ensure
healthier pregnancies and reduce health care costs that stem from a lack of
access to important information about prenatal health.”

27. Text4baby in the News

28. Earned Media Coverage
Text4baby in the Media

29. Text4babyText4baby in the Media: NYT
in the New York Times
February 7, 2011, 9:15 pm Mothers-to-Be Are Getting the Message
By DAVID BORNSTEIN
We’re used to hearing about public initiatives that get mired in politics or
entangled in bureaucracy, but we rarely hear about programs that exceed
expectations. So here’s one: last week marked the one-year anniversary of a
program called text4baby, a service that sends free text messages to women
who are pregnant or whose babies are less than a year old, providing them with
information, and reminders, to improve their health and the health of their
babies.
The service, made available through a broad partnership of community health
organizations, wireless carriers, businesses, health care providers and
government health agencies, is catching on like wildfire: to date, about 135,000
women have signed up – and organizers have set a new goal of reaching one
million users by the end of 2012 (there are four million births each year in the
U.S.) What are they doing right?

30. Text4baby in the Media: Time
Text4babyMagazine Magazine
in Time
“With cell-phone companies comping the
text charges, text4baby is the first free,
large-scale foray into mobile health
education in the U.S. States are creating
text4baby coalitions and encouraging
nurses to talk up the program. Word is also
going out through local health departments
and TV channels like Telemundo and MTV.”
- May 2010

31. Text4baby
Text4baby on MTV on MTV
I didn’t know I was supposed to be cleaning
out her mouth already…And they sent me
messages about trying to find daycare. They
also reminded me about her two-month
doctor appointment. I had completely
forgotten about it. For me, since I’m new at
this and really don’t know, it’s helpful.”

32. HHS Innovates Award
Text4baby Wins Prestigious Award

33. Making a Difference

34. Using DataTracking Enrollment
to Drive Enrollment
text4baby Enrollment by Zip Code
Virginia Feb-Aug 2010
Six text4baby billboards
went up in Martinsville

35. Tracking Enrollment
North Carolina
PSAs
launch
7/26/11
Number of
Radio
New PSAs
Unique
Users
Date (January 1, 2011 through August 11, 2011)
Text4baby data allows for a real-time understanding of
effective promotional strategies. In 2011, partners in North
Carolina ran TV PSAs that increased state enrollment by
400% over one week.

36. Program Impact
 95% of text4baby survey respondents say they would refer it to a friend (n=24,093)
 Text4baby is improving adherence to appointments and immunizations: 67.0% reported
that text4baby helped them remember an appointment or immunization that they or their
child needed.*
 Alliance of Chicago Community Health Services (network of FQHCs) found the
percentage of missed appointments was lower among text4baby enrollees (N=917)
compared to non-enrollees (N=1,647) when comparing the two patient populations at one
point in time (11% vs. 17% missed appointments, respectively). Although these findings
are not statistically significant, and were not the result of rigorous research methods, the
trend is in a very positive direction and will continue to be monitored.
 Users are increasing health knowledge: 73.4% reported that a text4baby message
informed them of medical warning signs they did not know.*
 The Service is facilitating interaction with health providers: 63.5% reported talking to their
doctor about a topic that they read on a text4baby message.*
 Improving access to health services: 39.2% reported they called a service or phone
number they received from a text4baby message.*
 Underinsured participants are improving their access to health services and health
information services as a result of text4baby messages :46.5% reported that they called a
service or phone number they received from a text4baby message.*
*Study by National Latino Research Center at California State University, San Marcos and the University of California,
San Diego Department of Obstetrics and Gynecology of 342 text4baby users in San Diego

37. External Evaluations
 Alliance Healthcare Foundation – National Latino Research Center:
Phone survey with t4b users in San Diego, CA – Phase 1 & Phase 2
completed
 CareFirst BlueCross BlueShield – George Washington University:
Pre/post survey exploring behavior and knowledge change for
women in Fairfax County, Virginia - completed, awaiting
dissemination
 Beaumont Foundation – Emory University: Pre/post survey
exploring behavior and knowledge change for WIC recipients in
Atlanta, GA- completed, awaiting dissemination
 DOD TATRC - Madigan Army Medical Center/George Washington
University: Randomized control trial exploring behavior and
knowledge change with pregnant women seeking care in Takoma,
WA – recruitment ongoing
 HHS – Mathematica Policy Research: Behavior and knowledge
change in users in 4 communities

38. Join the Movement

39. Action Steps
Become a Friend or Outreach Partner of Text4baby:
 No cost to your organization.
 Access to text4baby logo and Adobe InDesign art files for
customization.
 Access to zip code-level data to track enrollment.
 Promotion in Text4baby Tuesday, a weekly e-mail alert
providing program updates.
 Technical assistance through HMHB.
 Recognition on the text4baby website & in select
communications.
 Opportunity to be connected with your peers.
 Sign up here: http://my.text4baby.org/page/s/partner

40. Action Steps
Tell all pregnant women and moms with infants < 1
about text4baby. Make sure to say:
 This service is free to you – your wireless company is
waiving the fees. Even if you don’t have a texting plan,
you can get these messages.
 I feel good about this content. It comes from a
trustworthy source.
 Sign up by texting the word BABY to the number
511411.
 You will get messages until baby’s 1st birthday but you
can stop any time; just reply with STOP.

41. Action Steps
Tear-off pads (4 designs)
Spread the word:
 Send a mass email with information
about text4baby (standard language at
www.text4baby.org)
 Include text4baby info in your
organization’s print or electronic
newsletter.
 Order free printed materials to hand
out to consumers – place a stash next
to your check-in/out counters, waiting
rooms, exam rooms, and the like. Visit  Flyers (4 designs)
http://tinyurl.com/t4bstore to order.

42. Action Steps
Go digital:
 Post on Facebook and Twitter about the
program. Sample post: Free #text4baby service
sends helpful pregnancy & baby tips to your cell
phone. Text BABY to 511411.
http://www.text4baby.org
 Add our traceable web button to your webpage.
Download it at
http://text4baby.org/index.php/partner-
resources/2-uncategorised/186

43. Action Steps
Stop the presses:
 Host a media event in your community and invite
broadcast, print, and digital outlets to attend.
 Call local media you already partner with and tell
them about text4baby. Use health observances like
Infant Mortality Awareness Month (September)
when you pitch.
 Share the TV and radio PSAs with local stations in
your area. Preview and share them at:
 TV PSAs: http://www.tvaccessreports.com/text4baby/
 Radio PSAs:
http://www.plowsharegroup.com/media_downloads/text4baby.p
hp

44. Action Steps
Connect with others in your area:
 Over 800 organizations are already
partnering with text4baby. Learn
who’s involved in your area so you
can team up at
http://text4baby.org/index.php/partn
ers

45. Thank you!
Questions? Contact info@text4baby.org or
visit
www.text4baby.org for more information