Impact of Digital Health Interventions on Access, Quality, and Outcomes of Antenatal and Postpartum Care: A Systematic Review

Siska Ilannur Lubis; Desmawati Desmawati

doi:10.37430/jen.v9i2.362

Impact of Digital Health Interventions on Access, Quality, and Outcomes of Antenatal and Postpartum Care: A Systematic Review

Siska Ilannur Lubis, Desmawati Desmawati

Abstract

Digital health technologies are increasingly adopted to enhance access, quality, and outcomes of antenatal and postpartum care, particularly in low- and middle-income countries (LMICs), yet empirical evidence on their effectiveness and implementation challenges remains heterogeneous. This systematic review aimed to evaluate the impact of digital health interventions on service utilization, quality of care, and clinical outcomes across the antenatal and postpartum continuum, while identifying multilevel implementation challenges. A systematic search of PubMed, Scopus, and Taylor & Francis (2021–2025) identified 19 eligible studies assessing digital health applications, including e-registries, clinical decision support systems (CDSS), telehealth, SMS/audio messaging, and community-based mHealth tools. Data were synthesized narratively across three domains: access and utilization, quality and user experience, and maternal–neonatal outcomes. The findings show that digital interventions consistently improved ANC attendance, timeliness, screening completeness, adherence to clinical guidelines, and communication quality between clients and providers. However, improvements in hard outcomes such as maternal or neonatal morbidity and mortality remained modest or non-significant. Key challenges were identified at multiple levels, including gender norms and device control at the household level; workload and infrastructure gaps at the facility level; data fragmentation and financing sustainability at the system level; and the need for co-design and behavior-theory-based development at the intervention level. Overall, digital health functions as an enabler that strengthens access and quality of antenatal and postpartum care, but measurable reductions in maternal–neonatal complications require integration with system strengthening, improved service coverage, and broader socio-cultural interventions.

Keywords

digital health; pregnancy; antenatal care; postnatal care; quality of care

Full Text:

PDF

References

S. M. Haddad et al., “Building a digital tool for the adoption of the World Health Organization’s antenatal care recommendations: Methodological intersection of evidence, clinical logic, and digital technology,” J. Med. Internet Res., vol. 22, no. 10, pp. 1–14, 2020.

M. Bonet, M. Barreix, S. Gupta, T. Tamrat, Ö. Tunçalp, and A. Portela, “Efforts to implement WHO recommendations on antenatal, intrapartum and postnatal care,” Bull. World Health Organ., vol. 103, no. 9, pp. 518-518A, 2025.

B. F. Endehabtu, B. Tilahun, K. A. Gelaye, and S. A. Mengiste, “Mapping the Role of Digital Health Interventions to Enhance Effective Coverage of Antenatal Care: A Scoping Review,” J. Multidiscip. Healthc., vol. 17, no. January, pp. 71–82, 2024.

H. Mohamed, A. Ismail, R. Sutan, R. A. Rahman, and K. Juval, “A scoping review of digital technologies in antenatal care: recent progress and applications of digital technologies,” BMC Pregnancy Childbirth, vol. 25, no. 1, 2025.

A. Chandrasekar et al., “mHealth interventions for postpartum family planning in LMICs: A realist review,” PLOS Glob. Public Health, vol. 4, no. 7 July 2024.

J. Wang et al., “Association of Digital Health Interventions With Maternal and Neonatal Outcomes: Systematic Review and Meta-Analysis,” J. Med. Internet Res., vol. 27, 2025.

T. Thepha, G. Carr, D. Marais, J. Kuasri, K. Klangphaow, and J. Tangpukdee, “The effectiveness of digital health versus standard care on exclusive breastfeeding duration among postpartum mothers in LMIC: Systematic review and meta-analysis,” Digit. Heal., vol. 10, 2024.

C. Kachimanga et al., “Impact of Mobile Health (mHealth) Use by Community Health Workers on the Utilization of Maternity Care in Rural Malawi: A Time Series Analysis,” Int. J. Women's. Health, vol. 17, no. January, pp. 245–257, 2025.

B. Bogale et al., “The effect of a digital targeted client communication intervention on pregnant women's worries and satisfaction with antenatal care in Palestine: A cluster randomized controlled trial,” PLoS One, vol. 16, no. 4, April, pp. 1–13, 2021.

M. Venkateswaran et al., “A digital health registry with clinical decision support for improving quality of antenatal care in Palestine (eRegQual): a pragmatic, cluster-randomised, controlled, superiority trial,” Lancet Digit. Heal., vol. 4, no. 2, pp. e126-e136, 2022.

K. Thirugnanasundralingam et al., “Effect of telehealth-integrated antenatal care on pregnancy outcomes in Australia: an interrupted time-series analysis,” Lancet Digit. Heal., vol. 5, no 11, pp. e798-e811, 2023.

A. M. El Ayadi et al., “Effectiveness of Kushal Maa, a group-based mhealth interactive education and social support intervention for maternal and neonatal health outcomes: Study protocol for a multisite randomised controlled trial in India,” BMJ Open, vol. 15, no. 6, pp. 1–13, 2025.

G. Bulcha, H. G. Abdissa, J. Noll, D. A. Sori, and Z. B. Koricha, “Effectiveness of a Mobile Phone Messaging–Based Message Framing Intervention for Improving Maternal Health Service Uptake and Newborn Care Practice in Rural Jimma Zone, Ethiopia: Protocol for a Cluster Randomized Controlled Trial,” JMIR Res. Protoc., vol. 13, pp. 1–11, 2024.

E. C. Atukunda et al., “mhealth-based health promotion intervention to improve use of maternity care services among women in rural southwestern Uganda: Iterative development study,” JMIR Form. Res., vol. 5, no. 11, pp. 1–14, 2021.

A. Choudhury and M. Choudhury, “Mobile for Mothers mHealth Intervention to Augment Maternal Health Awareness and Behavior of Pregnant Women in Tribal Societies: Randomized Quasi-Controlled Study,” JMIR mHealth uHealth, vol. 10, no. 9, pp. 1–11, 2022.

R. S. Pendse et al., “Access to and Use of Mobile Phone by Postpartum, Married Women in Punjab, India: Secondary Analysis of mHealth Intervention Pilot Data,” JMIR Form. Res., vol. 6, no. 5, pp. 1–8, 2022.

S. van Pelt et al., “Pregnant women’s perceptions of antenatal care and utilisation of digital health tools in Magu District, Tanzania: a qualitative study,” Sex. Reprod. Heal. Matters, vol. 31, no. 1, 2023.

N. Dinh et al., “Implementation Outcomes Assessment of a Digital Clinical Support Tool for Intrapartum Care in Rural Kenya: Observational Analysis,” JMIR Form. Res., vol. 6, no. 6, 2022.

A. Coulibaly and S. Kouanda, “Effects of the Pregnancy and Newborn Diagnostic Assessment (PANDA) App on Antenatal Care Quality in Burkina Faso: Protocol for a Cluster Randomized Controlled Trial,” JMIR Res. Protoc., vol. 12, 2023.

Z. U. Haq, A. Naeem, D. Zaeem, M. Sohail, and N. ul A. Pervaiz, “Development of a Digital Platform to Promote Mother and Child Health in Underserved Areas of a Lower-Middle-Income Country: Mixed Methods Formative Study,” JMIRx Med, vol. 5, pp. e48213 e48213, 2024.

L. A. Silva, B. M. B. Gil, F. P. Robledo, I. M. Pires, V. R. Q. Leithardt, and A. M. F. da Rocha, “Integrating AI and Telemedicine in Maternal-Infant Care: An Innovative Approach for Personalized Healthcare,” Procedia Comput. Sci., vol. 241, no. 2019, pp. 600–605, 2024.

E. C. Atukunda et al., “Evaluating the Feasibility, Acceptability, and Preliminary Efficacy of SupportMoms-Uganda, an mHealth-Based Patient-Centered Social Support Intervention to Improve the Use of Maternity Services Among Pregnant Women in Rural Southwestern Uganda: Randomized,” JMIR Form. Res., vol. 7, pp. 1–18, 2023.

K. W. Cheung, T. S. T. Au, J. K. O. Wai, and M. T. Y. Seto, “Perceptions and Challenges of Telehealth Obstetric Clinics Among Pregnant Women in Hong Kong: Cross-Sectional Questionnaire Study,” J. Med. Internet Res., vol. 25, no. 1, pp. 1–15, 2023.

B. Kim, J. Y. Moon, J. Y. Shin, H. R. Jeon, S. Y. Oh, and S. Y. Kim, “Effect of smartphone app-based health care intervention for health management of high-risk mothers: a study protocol for a randomized controlled trial,” Trials, vol. 23, no. 1, pp. 1–12, 2022.

Y. Chen et al., “Effect of the mHealth-supported Healthy Future programme delivered by community health workers on maternal and child health in rural China: Study protocol for a cluster randomised controlled trial,” BMJ Open, vol. 13, no. 1, 2023.

DOI: https://doi.org/10.37430/jen.v9i2.362