Maternal mortality and deaths of children under age five remain high across much of the low-income world. Although well-funded global health efforts have halved the rate of these deaths worldwide, many countries still have high mortality rates (e.g., Pakistan), while others have experienced backslides (e.g., South Africa). Disturbingly, the United States has seen increases in maternal mortality, so the problem is not simply about availability of funding. Gaps in culture and education mean that public messaging designed by slow-moving committees of college-educated health specialists are unconvincing for low-literate communities and unresponsive to volatile, locally generated health myths. 

Low-literacy communities have rich oral traditions instead of text-based ones. In rural South Africa, community-produced street theater is widespread. Pakistan has street theater too, but maternal folk wisdom tends to be privately transmitted from mothers to daughters. In inner-city America, large families share information through tightly knit social networks. Potential digital channels differ as well. In South Africa, low-cost smartphones are increasingly common, even in poorer townships, but the cost of mobile internet is high. In Pakistan, women tend to be limited to “dumb” phones which they borrow from their husbands. In Detroit, Facebook and other social media dominate, with intense intra-family sharing.

Culturally credible video/audio recordings that are used by local organizations and distributed using customized digital technologies are the objective. In each site — Detroit, Cape Town, Lahore, and surrounding rural areas — researchers will conduct ethnographic design, community-based content development, participatory technology design and deployment, and pilot evaluations. Oral traditions provide credibility with local communities; public health input ensures medical validity; and digital channels offer quick, adaptive communication with potential to scale.