Maternal mortality in low-income urban Pakistan remains high due to a complex interplay of medical, social, and informational barriers. Women often lacked basic knowledge about prenatal care, held misconceptions about practices such as ultrasounds or supplements, and relied heavily on advice from mothers-in-law or traditional midwives. Even when modern medical services were available, women faced restricted mobility, gendered household dynamics, and overburdened health systems where physicians had little time to educate patients. These challenges meant that simple health information was not reaching those most in need, and mobile health interventions risked being undermined by literacy limitations, family interference, and social norms that constrained women’s autonomy 

The study followed a three-phase, mixed-methods design: 

1. In Phase 1, we conducted qualitative fieldwork including 18 interviews with medical staff and 93 interviews with pregnant mothers, along with observations in a major public hospital, to understand knowledge gaps and sociocultural barriers. 

2. In Phase 2, we designed an SMS and robocall (voice)-based system for information delivery and implemented a randomized controlled trial with 180 pregnant mothers, divided into four groups: control, SMS, voice, and combined SMS+voice. Participants received approximately 110 tailored messages during pregnancy, and outcomes were measured with baseline and follow-up knowledge tests plus visit tallies. 

3. In Phase 3, the team conducted follow-up phone interviews to explore family dynamics and long-term perceptions. This combination of qualitative and quantitative methods ensured both rigorous impact evaluation and a nuanced understanding of the contextual factors shaping maternal health.