A Cross-sectional Survey of MomConnect Adoption and Barriers to Use Among Primigravid Women in the Rural Eastern Cape, 2013

Mobile health (mHealth) initiatives are deployed in low-resource settings to improve maternal health. MomConnect, a national SMS-based platform in South Africa, provides stage-based information to pregnant women and new mothers. Its adoption and utility among first-time mothers in remote rural areas, a key target group, are not well documented. This study aimed to assess the adoption rate of the MomConnect platform among primigravid women in the rural Eastern Cape and to identify the primary barriers to its registration and sustained use. A cross-sectional survey was conducted across six primary healthcare clinics. A structured questionnaire was administered via face-to-face interviews to a consecutive sample of primigravid women attending antenatal care. Data were analysed descriptively and thematically for open-ended responses. Among 422 participants, 38% were registered with MomConnect. The predominant barrier to registration was lack of awareness of the service (reported by 61% of non-users). Among registered users, common barriers to use included inconsistent mobile network coverage (52%), lack of airtime (48%), and messages perceived as too generic or ill-timed (31%). MomConnect adoption among first-time mothers in this rural setting was low. Key barriers were foundational, relating to service awareness and basic mobile infrastructure, rather than solely to the platform's content. Strengthened on-site promotion and registration support at antenatal clinics is required. Programme implementers should advocate for improved mobile network coverage and explore zero-rated access to mitigate airtime constraints. Message content should be reviewed for contextual relevance. mHealth, maternal health, SMS, digital health, rural health, South Africa, antenatal care This study provides empirical evidence on the low uptake and key implementation barriers to a national mHealth platform among a vulnerable rural population, highlighting critical gaps in service awareness and digital infrastructure.