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Can health information through mobile phones close the divide in health behaviours among the marginalised? An equity analysis of Kilkari in Madhya Pradesh, India
  1. Diwakar Mohan1,
  2. Kerry Scott1,
  3. Neha Shah1,
  4. Jean Juste Harrisson Bashingwa2,
  5. Arpita Chakraborty3,
  6. Osama Ummer4,
  7. Anna Godfrey5,
  8. Priyanka Dutt3,
  9. Sara Chamberlain3,
  10. Amnesty Elizabeth LeFevre1,6
  1. 1Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, Observatory, Western Cape, South Africa
  3. 3BBC Media Action, New Delhi, Delhi, India
  4. 4Oxford Policy Management, New Delhi, Delhi, India
  5. 5Research and Policy, BBC Action Media, London, UK
  6. 6School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
  1. Correspondence to Dr Diwakar Mohan; dr.dmohan79{at}


Kilkari is one of the largest maternal mobile messaging programmes in the world. It makes weekly prerecorded calls to new and expectant mothers and their families from the fourth month of pregnancy until 1-year post partum. The programme delivers reproductive, maternal, neonatal and child health information directly to subscribers’ phones. However, little is known about the reach of Kilkari among different subgroups in the population, or the differentiated benefits of the programme among these subgroups. In this analysis, we assess differentials in eligibility, enrolment, reach, exposure and impact across well-known proxies of socioeconomic position—that is, education, caste and wealth. Data are drawn from a randomised controlled trial (RCT) in Madhya Pradesh, India, including call data records from Kilkari subscribers in the RCT intervention arm, and the National Family Health Survey-4, 2015. The analysis identifies that disparities in household phone ownership and women’s access to phones create inequities in the population eligible to receive Kilkari, and that among enrolled Kilkari subscribers, marginalised caste groups and those without education are under-represented. An analysis of who is left behind by such interventions and how to reach those groups through alternative communication channels and platforms should be undertaken at the intervention design phase to set reasonable expectations of impact. Results suggest that exposure to Kilkari has improved levels of some health behaviours across marginalised groups but has not completely closed pre-existing gaps in indicators such as wealth and education.

  • Epidemiology
  • Maternal health
  • Public Health

Data availability statement

The RCT data are available upon request from Diwakar Mohan (corresponding author) and Amnesty LeFevre (the study PI). NFHS-4 data is available for download from the Demographic and Health Surveys website (

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

The RCT data are available upon request from Diwakar Mohan (corresponding author) and Amnesty LeFevre (the study PI). NFHS-4 data is available for download from the Demographic and Health Surveys website (

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  • Handling editor Seye Abimbola

  • Twitter @jbashingwa, @priydee

  • Contributors DM: conceptualised the study, wrote the first draft of the manuscript, and analysed the data. KS, SC, AG, PD, OU and AC: provided feedback and helped to write sections of the paper. JJHB and NS: supported the data analysis and provided feedback on the manuscript drafts. AEL: PI for study, conceptualised the study, inputted on the analysis, and helped to write the manuscript.

  • Funding This study was funded by Bill and Melinda Gates Foundation.

  • Competing interests All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare that the research reported was funded by the Bill and Melinda Gates Foundation. AG, SC and PD are employed by BBC Media Action; one of the entities supporting program implementation. The authors do not have other relationships and are not engaged in activities that could appear to have influenced the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.