Developing a contextualized mHealth integrated system for tracking and reporting obstetric violence incidences in Tanzania

Obstetric violence, characterized by abuse during pregnancy, childbirth, and after childbirth, is a critical obstacle to maternal health globally especially in low-resource settings. Studies have found that many women have reported experiencing violence. The actual prevalence of obstetric violence is likely underestimated due to cultural norms that often discourage women from speaking out about their negative experiences encountered during pregnancy and childbirth. This study presents the development of a contextualized mobile health (m-Health) system, designed to monitor and report incidences of obstetric violence in the Central Zone of Tanzania. The first phase involved a qualitative study that examined context-specific components of obstetric violence among postnatal mothers, healthcare providers, and key community informants. The components identified from this qualitative study were used to develop the contextualized mHealth system. The contextualized system was designed using the Laravel framework, a robust Model-View-Controller (MVC) PHP framework designed for web application development. MySQL was selected as the relational database management system for data storage. Java was used to implement specific features, while XML was utilized for designing user interface layouts. During the pilot testing, 25 pregnant women and seven health care providers were randomly selected and followed for four weeks in one of the health care facility in Dodoma city. The sampling frame were pregnant women attending the Antenatal visits with the gestation age between 34 and 36 weeks. Overall, the system successfully captured 17 incidents of obstetric violence during pilot testing phase and sent 128 messages within a four-week period. A notable pattern was lack of supportive care and treatment 6 (35.4%), verbal violence 5(29.5%), lack of autonomy 2(11.8%), stigma and discrimination 1(5.9%), psychological and emotional violence 1(5.9%), Sexual violence 1(5.9%) and lack of privacy 1(5.9%). On the other hand, the system was also able to capture five self-reflection messages from the healthcare providers. Feedback on system functionalities was also received, and improvements were made. The m-Health system has the potential to empower women and healthcare providers, offering an easily accessible reporting system. By incorporating local languages, and the use of regional technology infrastructure, this mHealth solution can be a significant step towards reducing obstetric violence.