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Reach for Your Pocket: Nicaraguans Turn to their Phones for Reproductive Health

Access to the Internet is something often taken for granted in the Western world. For many of us it’s a handy way to share our thoughts and lives over social media, or to keep in touch with friends, or to look up the latest sports scores. For many people in the developing world the Internet promises much more, if only they had access to it. In this installment of Digital Diversity, Chloe Lew, a Peace Corps Volunteer in Nicaragua, shares details of a project which bypasses the need for the Internet and focuses on girls’ empowerment and teen pregnancy prevention through widely accessible text messaging.

Digital-DiversityDigital Diversity is a series of blog posts from kiwanja.net featuring the many ways mobile phones and other appropriate technologies are being used throughout the world to improve, enrich, and empower billions of lives. This article was curated by Gabrielle Lepore, our Media and Research Assistant.

By Chloe Lew

Yesterday I googled “safer sex.”

You’ve possibly done it too. Most people have. Perhaps you wanted to double check something that your friends were talking about or maybe you were simply curious about an aspect of your own health and didn’t want to navigate a face-to-face discussion.

While sex permeates many aspects of our lives, including health, relationships, self-esteem and gender dynamics, it is still a sensitive and often uncomfortable subject. For topics such as sex, the Internet is particularly useful. One of its unappreciated beauties is that you don’t need to endure the discomfort of an in-person conversation. Instead, you can investigate your concerns and questions in private. After all, your search engine can’t judge you.

But how do you get the answers you need when you don’t have Internet access?

In January 2012 I moved to Nicaragua to serve as a reproductive health educator with Peace Corps. During my training a fellow volunteer suggested that one of our roles as volunteers was to serve as Google for our communities. At first I found this idea slightly condescending – I don’t have all of the answers. But then I understood his point. In more-developed countries people are used to finding answers to intimate questions independently. However, in a country like Nicaragua, where only 10.6% of the population have Internet access most people do not have the luxury of finding immediate answers to more embarrassing inquiries in an anonymous manner.

In smaller communities the reality is that the public health system is not easily accessible. This is due to a number of barriers, including geography, socioeconomics and culture.  Additionally, generations of cultural beliefs have led to the perpetuation of false information. Getting correct answers to sensitive questions generally requires a face-to-face conversation, and in small communities this usually involves friends, family, or both – even in the medical center. Anonymity is rare and pena, meaning embarrassment, shame, or shyness, is abundant.

Pena is particularly extreme in Nicaragua where machismo, or macho culture, is rampant. Machismo helps to propagate the perception that a woman who inquires about her sexual reproductive health (SRH) or asks for condoms is promiscuous or unchaste. As such, pena, along with other barriers, is one of the greatest impediments to the dissemination of and access to scientifically correct SRH information, and the consequences are quite evident.

Nicaragua has the highest teen pregnancy rate in Central America. Approximately 1 out of 4 adolescent girls will become pregnant before they reach the age of 19. Another frightful statistic is that nearly 48% of women who are married or in a union are affected by gender-based violence, which, according to World Health Organization, is 57 times higher than what is considered an epidemic (Nicaraguan Dispatch, 17 Oct. 2012).  Although historically Nicaragua has had the lowest rate of HIV infections in Central America, the annual incidence of registered cases of HIV has tripled in the past six years.

Like everyone, Nicaraguans have questions about their SRH and want to make informed decisions. While Google is not an accessible or familiar resource to those living without the Internet, Peace Corps volunteers have identified a different tool that can help Nicaraguans bypass the “pena barrier” that needs no cultural adoption – the cell phone.

 

Coverage
A young boy gets cell phone service out in the mountainous municipality of Rancho Grande, Matagalpa, Nicaragua. Photo: ChatSalud

 

Cell phones are one of the most ubiquitous and transformative agents of social change ever. The reality is that, in Nicaragua, more people have access to cell phones than to indoor plumbing or electricity. According to the International Telecommunications Union, in 2011 82% of the Nicaraguan population had a cell phone, with coverage in 151 out of the 153 municipalities – and these numbers have only been increasing. Nicaraguans rich and poor, from city centers and rural mountains, with and without access to running water, all have cell phones and use them daily.

If people can text “amor” to 3766 to discover who the love of their life will be, why can’t we also harness the power of cell phones to disseminate vital SRH information and resources to those who need and want it most? After months of discussing various strategies for using cell phones to deliver health messages, Peace Corps volunteers and their Nicaraguan colleagues settled on a platform: ChatSalud.

ChatSalud, an SMS-based sexual and reproductive health hotline, is the first of its kind in Nicaragua. The goal is to empower Nicaraguans to lead healthier, safer, and more productive lives by providing correct SRH information and connecting them to local resources in a free, confidential, reliable, and accessible manner, directly to their cell phones.

 

The Peace Corps members of the ChatSalud team from left to right: Talia Langman (Peace Corps Volunteer 2012-2014), Danny Murphy (2007-2010), Jessica Bixby (2012-2014), Lauren Spigel (2011-2013), Gabe Goffman (2011 -2013), Nishant Kishore (2011-2014) and Chloe Lew (2012-2014) . Photo: ChatSalud
The Peace Corps members of the ChatSalud team from left to right: Talia Langman (Peace Corps Volunteer 2012-2014), Danny Murphy (2007-2010), Jessica Bixby (2012-2014), Hannah Grow (2012-2014), Lauren Spigel (2011-2013), Gabe Goffman (2011 -2013), Nishant Kishore (2011-2014) and Chloe Lew (2012-2014) . Photo: ChatSalud

 

Using FrontlineSMS, a free, open-source software, we have been able to leverage its auto-response function to create a platform that will deliver culturally sensitive and contextually correct information on five central themes – reproductive health, safer sex, HIV/AIDS, STIs and domestic violence. The system is entirely demand-driven and interactive, with users able to select which theme to explore and from there select the information he or she wants to receive.

For example, a 16-year-old girl living in a rural community thinks she is ready to have sex with her boyfriend for the first time.  She is too scared to ask her parents for advice and is uncomfortable broaching the subject with the doctor at the health center since he also lives in her community. She decides to text ChatSalud for information on safer sex and condom negotiation. She begins by texting “info” to ChatSalud and automatically receives a text in response that contains a menu of informational categories. The menu says “Text 1 for HIV”, “2 for STIs”, “3 for safer sex” and so on. She texts “3” and educates herself about how to protect her health and avoid an unwanted pregnancy. After receiving the interactive automated messages, she feels more confident about negotiating condom use with her boyfriend and about protecting herself from an unhealthy relationship.

From teenage girls approaching their first sexual relationships to men wanting more information on STIs after noticing a potential symptom, to women concerned about the cycle of violence who are looking for domestic violence resources in their communities, ChatSalud is a resource for all Nicaraguans.

Since its inception, ChatSalud has grown substantially both in scope and in support. The project has received tremendous interest from the public and private sectors in Nicaragua. Almost entirely funded by local in-kind contributions, the project is low-cost and will be free to Nicaraguan users. The Nicaraguan Red Cross serves as the main project partner with Peace Corps, keeping the focus on sustainability and cultural application. With chapters in every department across Nicaragua, the Red Cross will be particularly vital in the promotion and marketing of the hotline.

 

At the World Bank sponsored Central America Domestic Violence Hackathon, Nishant Kishore, Lauren Spigel, Gabe Goffman and Chloe Lew pose with our Nicaraguan IT-counterparts, who worked 48 hours without sleep on the ChatSalud project (Photo: ChatSalud)
At the World Bank sponsored Central America Domestic Violence Hackathon, Nishant Kishore, Lauren Spigel, Gabe Goffman and Chloe Lew pose with our Nicaraguan IT-counterparts, who worked 48 hours without sleep on the ChatSalud project (Photo: ChatSalud)

 

However, much of the success depends on the strength and relevance of the content. The World Bank in Nicaragua has connected the ChatSalud team to NGOs and local actors across the country to develop the content and organisational structure, and to ensure the program’s longevity. In addition, a local technology company is working to strengthen the back-end functionality and to provide the user with a seamless experience. We are extremely grateful for the advice and dedication from all of our project partners who are committed to ChatSalud, a service developed by Nicaraguans for Nicaraguans.

ChatSalud is still in development. The Peace Corps and Nicaraguan partners are currently finalizing content, system and evaluation tools, but hope to begin the first phase of the project in the coming months. Stay tuned for more updates as we perfect and launch the service. For more information, please email us at chatsalud@gmail.com or follow us on Twitter.

Chloe Chloe Lew is a current Peace Corps Volunteer in Nicaragua and ChatSalud´s public relations advisor. She has been living and working in a small community in Nueva Segovia since 2012. There, her service has been largely focused on girls empowerment and teen pregnancy prevention. Prior to joining Peace Corps she worked in Program Innovation and Policy at the Elizabeth Glaser Pediatric AIDS Foundation. She holds a Bachelor of Arts in International Affairs and Anthropology from George Washington University. Lauren Spigel and Nishant Kishore – both co-founders of ChatSalud – helped with the editing of this article.

Digital Diversity is produced by Ken Banks, innovator, mentor, anthropologist, National Geographic Emerging Explorer and Founder of kiwanja.net, FrontlineSMS and Means of Exchange. He shares exciting stories in “Digital Diversity” about how mobile phones and appropriate technologies are being used throughout the world to improve, enrich, and empower billions of lives. You can follow him on Twitter @kiwanja

Comments

  1. Richard Richards
    Nicaragua
    July 18, 2013, 12:08 pm

    Impressive! What an awesome use of this ubiquitous technology and a creative delivery method using channels of communication that otherwise would be used for only social purposes. Congratulations to the Team! Richard.