Effectiveness of WhatsApp-based education on improving access to maternal health: A systematic review

Abstract

Background

Access to timely and reliable maternal health information is a critical determinant of maternal and neonatal outcomes. Mobile health interventions, particularly WhatsApp, are increasingly used to overcome geographic, financial, and sociocultural barriers. However, evidence on their effectiveness in antenatal care (ANC) remains scattered.

Objectives

To synthesize evidence on the effectiveness of WhatsApp-based educational interventions in improving knowledge, behaviors, psychological well-being, clinical outcomes, and service uptake among pregnant women.

Data sources

Six databases (PubMed, Medline, SCOPUS, Web of Science, Cochrane Library, and Google Scholar) and reference lists were searched up to March 2025.

Study eligibility criteria

Eligible studies were randomized controlled trials (RCTs) or quasi-experimental designs evaluating WhatsApp-based interventions in pregnant women, compared with routine ANC or other educational modalities.

Study appraisal and synthesis methods

Screening and data extraction were performed independently by two reviewers using Rayyan. Given heterogeneity in interventions and outcomes, findings were synthesized narratively.

Results

Of 4374 records identified, 21 studies (12 RCTs, 9 quasi-experimental) were included. Most studies (76%) enrolled ≤50 participants per WhatsApp arm and were conducted in upper-middle and high-income countries. WhatsApp-based interventions improved maternal knowledge (e.g., anemia prevention, breastfeeding), health behaviors (self-care, smoking cessation, and dietary practices), psychological outcomes (reduced anxiety, depression, tokophobia and improved maternal–fetal attachment), clinical outcomes (hemoglobin, blood pressure and glycemic control), and ANC attendance and satisfaction. However, WhatsApp was less effective than motivational interviewing, phone calls, or face-to-face education in some domains.

Limitations

Heterogeneity in interventions and outcome measures precluded meta-analysis. Most studies were small, for a short term, and concentrated in higher-income settings.

Conclusions

WhatsApp-based education is a feasible, low-cost adjunct to routine ANC that can improve knowledge, health behaviors, psychological well-being and satisfaction. Future research should prioritize large-scale, multicenter RCTs in low-resource settings, with standardized outcome measures and long-term follow-up, to establish effectiveness and scalability.

Keywords

WhatsApp pregnancy maternal health health communication digital health antenatal care

Introduction

Access to quality information during pregnancy remains a critical determinant of maternal and neonatal health.¹ Timely, accurate, and reliable information enables women to adopt healthy behaviors, supports informed decision-making, empowers them to recognize early warning signs, and thereby reduces the risk of preventable complications and contributes to psychological well-being during pregnancy.² Despite the availability of accurate and reliable pregnancy-related information, the knowledge and behavior of women during their pregnancy remain suboptimal, particularly in resource limited settings, highlighting a persistent geographic, financial, and sociocultural barriers to accurate health information.¹ Overcoming these barriers requires innovative, scalable, cost-effective, and culturally adapted approaches that bring reliable information closer to women and empower them to engage in healthy pregnancy practices.

The rapid global proliferation of mobile technology presents an unprecedented opportunity to mitigate these barriers. Mobile health (mHealth), defined as the use of mobile technologies to support health practices and services, has increasingly emerged as a promising tool to address barriers in maternal health, particularly in low- and middle-income countries (LMICs).^3,4 Several systematic reviews have shown that mHealth interventions, such as SMS reminders, voice calls, and mobile applications, can increase ANC attendance, improve maternal knowledge, and enhance adherence to recommended practices.^3,5 However, implementation of conventional SMS-based and health-specific mobile app approaches are generally limited by high costs, restricted character length, and one-directional communication. In contrast, social media platforms such as WhatsApp may offer advantages over SMS and dedicated mobile applications by enabling low-cost and interactive multimedia communication; however, their effectiveness remains context dependent and may be limited in settings where smartphone access, data affordability, and digital literacy are constrained.⁶

WhatsApp has become one of the most frequently used mobile applications worldwide,⁷ offering opportunities to deliver tailored health education. Its widespread availability and low-cost accessibility make it an effective tool for reaching women, even in resource-limited settings. The platform allows for real-time, two-way communication between healthcare providers and pregnant women, fostering interactive learning, trust, and timely clarification of concerns. It also supports multiple formats (text, audio, images, and videos) making health information more engaging, adaptable to varying literacy levels, and culturally appropriate. Furthermore, WhatsApp facilitates group discussions, enabling peer-to-peer support and shared experiences, which can enhance motivation and adherence to healthy practices during pregnancy.⁸

Although a growing number of studies have assessed the effectiveness of WhatsApp-based educational programs on improving maternal health, the evidence is scattered across diverse education delivery models, outcomes, populations, and settings. A comprehensive synthesis is therefore needed to guide policy and practice. This review therefore aimed to assess the effectiveness of WhatsApp-based education provided on pregnancy related outcome.

Methods

The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42023404056.⁹ This work, whose main objective was to assess the effectiveness of WhatsApp-based education on improving access to maternal health, was carried out in accordance with the methodological framework Cochrane¹⁰ and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.¹¹

Search strategy

Six main databases (SCOPUS, Web of Science, PubMed, Medline, Cochrane Library, and Google Scholar) were assessed for a comprehensive search of relevant articles. Additional manual searches were performed (Google Scholar and online based on the references of some relevant articles). Considering the large number of targeted outcomes, the search focused only on WhatsApp and pregnancy. The PubMed search strategy was as follows: (“WhatsApp” OR “social media messaging”) AND (“pregnancy” OR “pregnant women” OR “antenatal care”). Searches were conducted from database inception to March 31, 2025, with no date restrictions.

Articles review and screening

The article review and screening process was conducted systematically using Rayyan, a web-based software designed to facilitate the screening and selection of studies for systematic reviews.¹² The process involved three main steps: de-duplication, title and abstract screening, and full-text screening. Two independent researchers performed the screening to ensure objectivity and minimize bias. The researchers were blinded to each other's decisions during the initial screening phases to prevent influence on individual judgments.

First, duplicate articles were identified and removed using Rayyan's deduplication feature. Next, the two researchers independently screened the titles and abstracts of the remaining records against the predefined inclusion and exclusion criteria. Articles that clearly did not meet the eligibility criteria were excluded at this stage. The full texts of the remaining articles were then retrieved and independently assessed by the two researchers for eligibility, with the inclusion and exclusion criteria rigorously applied.

After the full-text screening, the researchers were unblinded, and all discrepancies in their decisions were reviewed and discussed. Consensus was reached through discussion, and any unresolved disagreements were adjudicated by a third independent reviewer. The detailed flow of the screening process, including the number of studies excluded at each stage and the reasons for exclusion, is presented in the PRISMA flow diagram shown in Figure 1.

Figure 1.

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram.

Inclusion and exclusion criteria

The inclusion and exclusion criteria are listed in Table 1.

Table 1.

Inclusion and exclusion criteria for a systematic review assessing the effectiveness of WhatsApp-based intervention on improving access to antenatal care.

Elements	Inclusion criteria	Exclusion criteria
Population	Pregnant women regardless of their pregnancy age and health condition	All other populations as care providers, community workers
Intervention	WhatsApp-based intervention	WhatsApp used for participant's enrollment, study follow-up or reporting, WhatsApp Chatbot
Control	All (standard antenatal care or any other intervention)
Outcome	All pregnancy-related outcomes (knowledge and attitudes, behavioral change, psychological outcomes, clinical/physiological outcomes, health service uptake and satisfaction)	Outcomes not directly related to maternal health, including studies focusing solely on provider outcomes, health system efficiency metrics, app usability without health outcomes, or neonatal outcomes without maternal measures
Study type	Trials and quasi-experimental studies (with at least two arms)	Other research types, study protocols, reviews, conference abstracts, editorials, commentaries, letters to the editor, essays, book chapters and books
language	English	Language other than English

Data extraction

A standardized data extraction form was developed on Excel, a priori and pilot-tested on a subset of studies to refine the process. The form captured key data elements, including study characteristics, participant characteristics, interventions and comparators descriptions, outcomes, main results, and other relevant information.

Study characteristics included author(s), year of publication, country of origin, study design, and setting. Participant characteristics included age, pregnancy age, specific medical conditions, etc. Intervention and comparator descriptions included the number of study arms, type, frequency, duration, and mode of delivery of the intervention. Results included key findings related to the outcomes of interest, along with effect measures such as risk ratios, odds ratios, or mean differences, accompanied by confidence intervals or p-values. Outcomes were categorized into five domains: knowledge and attitudes, behavioral change, psychological outcomes (anxiety, depression, stress, fear of childbirth, self-efficacy, maternal-fetal attachment), clinical/physiological outcomes (hemoglobin levels, blood pressure, glycemic indicators, and carbon monoxide levels among smokers) and health service uptake and satisfaction.

Two independent researchers performed the data extraction to minimize errors and ensure reliability. Any discrepancies between the researchers were resolved through discussion, and unresolved disagreements were adjudicated by a third reviewer.

Data analysis

A descriptive synthesis approach was used to analyze the included studies. Characteristics of articles included, such as publication year, study locations, Pregnancy age at enrolment, study design, number of arms, and pregnancy age at enrollment were systematically captured and presented. Qualitative data, such as intervention and control features and reported outcomes, were analyzed to highlight key findings on effectiveness. Given the diversity in study methodologies, types of WhatsApp interventions employed, and outcome measures, results were synthesized carefully to ensure meaningful interpretations.

Results

Literature search results

The literature search identified a total of 4374 records from various databases and registers. After the removal of 842 duplicate records, 3532 records remained for title and abstract screening. Following this initial screening, 3229 records were excluded based on their non-relevance to the research questions and inclusion criteria. A total of 303 full-text articles were retrieved and assessed for eligibility. After applying the inclusion and exclusion criteria more rigorously, 284 articles were excluded for reasons such as irrelevant outcome, study design, and WhatsApp not been the tool to administer the intervention. Additionally, two studies were identified through backward and forward citation searching. In total, 21 studies met the eligibility criteria and were included in the final review as presented on the PRISMA flow diagram (Figure 1).

Characteristics of the included studies

Publication years of the 21 studies included in this systematic review ranged from 2020 to 2025 as presented in Figure 2. The studies were conducted across various regions, most being in Middle East and North Africa^13–22 and East Asia and Pacific.^15,23–25 No study was conducted in sub-Saharan Africa. Seventeen studies were conducted in upper-middle and high-income countries.^13–20^,22–30 Most of the studies had not more than 50 women in the WhatsApp arm as presented in Table 2.

Figure 2.

Publication years of articles included in the systematic review assessing the effectiveness of WhatsApp-based interventions on improving access to antenatal care.

Table 2.

Characteristics of studies included in the systematic review assessing the effectiveness of WhatsApp-based interventions on improving access to antenatal care.

Description	Frequency	Percentages
Countries
Iran ^{13,16,17,19,20,22}	7	33%
Indonesia ^23–25^,30	4	19%
India ^31–33	3	14%
Malaysia ^27,34	2	10%
Saudi Arabia ^14,15	2	10%
Turkey ²⁶	1	5%
Brazil ²⁹	1	5%
Egypt ²¹	1	5%
Region
Middle East and North Africa ^13–22	10	48%
East Asia and Pacific ^23–25^,27,30,34	6	29%
South Asia ^31–33	3	14%
Europe and Central Asia ²⁶	1	5%
Latin America and Caribbean ²⁹	1	5%
Income group
High income ^14,15	2	10%
Upper middle income ^13,16–20^{,22–27,29,30}	15	71%
Lower middle income ^21,31–33	4	19%
Number of participants in the WhatsApp arm
≤50 ^{13,15,17,19–22}^{,23,25,26,29,30–33}	16	76%
50–100 ^{14,16,18,27,34}	5	24%
Pregnancy age at enrolment
1^st trimester ^14,20,32	3	14%
2^nd trimester ^{13,15,17–19}^,34	6	29%
3^rd trimester ^22,27	1	5%
All the 3 trimesters ³³	2	10%
Not reported ^{16,21,23–26}^,29–31	9	43%
Special condition of participants at enrolment
Anemia ^14,34	2	10%
Adolescent ¹³	1	5%
Gestational diabetes mellitus ²⁹	1	5%
Moderate to severe tokophobia ²¹	1	5%
Prehypertension ²⁰	1	5%
Overweight and obese pregnant women with diabetes ²²	1	5%
Psychological distress ¹⁷	1	5%
Tobacco use ²⁶	1	5%
None ^{15,16,18,19,23–25}^,31–33	12	57%
Study design
Randomized control trial ^15–18^{,21,22,27,29,30,32,33,34}	12	57%
Quasi-experimental ^{13,14,19,20,23–26}^,31	9	43%
Number of arms
2 ^14–18^{,20–26,29,30,31}	18	86%
3 ^13,19,32	3	14%
Control group
Routine ANC ^{13,14,16,19,21–23}^{,24–26,30,34}	14	67%
Education through leaflets ^20,29,31	3	14%
Education in semi-attendance (face to face, then online) ¹⁷	1	5%
Education on another topic ¹⁸	1	5%
Intervention through Snapchat ¹⁵	1	5%
Motivational Interviewing ³³	1	5%
WhatsApp intervention used as intervention or control
Intervention ^{13,14,16,18–22}^{,25–27,29,30–34}	19	90%
Control ^15,17	2	10%

Design of the intervention and control

Out of the 21 studies included in the review, 12 were randomized controlled trials (RCT),^15–18^{,21,22,27,29,30–33,34} and 9 were quasi-experimental studies.^{13,14,19,20,23–26}^,31 Eighteen studies used a two-arm design,^14–18^{,20–26,29,30,31} and 3 studies used three-arm design.^13,19,32 The most common comparator was routine ANC.^{13,14,16,19,21,23–26}^,30,34 WhatsApp was predominantly used as the main intervention,^{13,14,16,18–22}^{,25–27,29,30–34} while two studies used WhatsApp as a control arm.^15,17 The total number of participants included in the study varied from 36 (31) to 196 (14) and 16/21 (76%) had not more than 50 women in the WhatsApp groups^{13,15,17,19–23}^{,25,26,29,30–33} as presented in Table 2.

Intervention initiation varied across studies, most commonly beginning in the second trimester when reported; however, trimester of initiation was not consistently documented. As presented on Table 3 frequency of the sharing intervention content through WhatsApp varied by studies, with the most frequent being daily.^24,30 The duration of the interventions also varied across studies, going up to 12 weeks.¹⁸ The format of the content delivered to the participants trough WhatsApp also varied across the studies and was including text messages,^{20,22,26,30,31} short videos,^25,34 images,¹⁹ voice messages,¹⁶ and other formats such as pdf documents, posters, PowerPoint,.^15,20,24,32 Nine studies reported giving opportunity to peer-to-peer communication and support.^16–24^,27

Table 3.

Summary of findings of the systematic review assessing the effectiveness of WhatsApp-based education on improving access to maternal health care.

Author/Year	Country	Study design	Sample size (per arm)	Intervention	Peer-to-peer support	Comparator	Outcome domain	Format of education	Frequency of delivery	Main findings
Wahidah and Greiny, 2020 ³¹	Indonesia	Quasi-experimental (posttest-only)	IG = 18, CG = 18	WhatsApp breastfeeding group	No	Routine care	Behavioral change (Breastfeeding practice)	WhatsApp group text messages	NR	Improved breastfeeding behavior in first week postpartum (p < 0.05).
Balmumcu and Ünsal Atan, 2021 ²⁶	Turkey	Quasi-experimental design reported	IG = 25, CG = 25	WhatsApp text messages + motivational counseling (TTM-based)	-	Routine ANC	Behavioral change (Smoking cessation)	WhatsApp text messages aligned with stages of change	3 times/week	60% in intervention vs 36% in control ceased smoking; reduced nicotine dependence and CO levels.
Ardiyanti et al., 2021 ²³	Indonesia	Quasi-experimental (pretest-posttest, non-equivalent groups)	IG = 31, CG = 31	WhatsApp group health promotion	Yes	Routine care	Health service uptake (ANC attendance)	WhatsApp group messages and scheduled promotion	Scheduled sessions	Higher ANC visits in intervention (p = 0.018).
Pilus et al., 2022 ²⁷	Malaysia	Cluster randomized controlled trial	IG = 86, CG = 86	Face-to-face + WhatsApp breastfeeding self-efficacy module (SeBF)	Yes	Routine care	Knowledge and behavioral change (Breastfeeding self-efficacy, knowledge, attitude)	WhatsApp group plus in-person sessions	NR	↑Self-efficacy, ↑knowledge, no effect on attitude.
Rahman et al., 2022 ³⁴	Malaysia	Cluster randomized controlled trial	IG = 60, CG = 60	“MyPinkMom” WhatsApp anemia program (HBM-based)	No	Routine counseling	Knowledge, behavior, clinical outcome (hemoglobin)	WhatsApp-delivered infographic videos	6 sessions	↑Hb, ↑knowledge, ↑IFA adherence, ↓tannin intake.
Khayat et al., 2022 ¹³	Iran	Quasi-experimental (3 arms)	WhatsApp = 40, Face-to-face = 40, Control = 40	WhatsApp telemedicine education	No	Face-to-face education; Control	Self-care (nutrition, hygiene, smoking, physical activity)	WhatsApp group messages	5 sessions	WhatsApp and face-to-face improved most domains; face-to-face superior for physical activity.
Elsharkawy et al., 2022 ¹⁴	Saudi Arabia	Randomized controlled trial	IG = 98, CG = 98	Health Information Package + WhatsApp follow-up	No	Routine care	Knowledge, compliance, hemoglobin	WhatsApp reminders plus counseling	NR	↑Knowledge, ↑food selection, ↑compliance, ↑Hb levels.
Husna et al., 2022 ²⁵	Indonesia	True experimental (posttest-only control design)	IG = 20, CG = 20	WhatsApp video-based counseling on childbirth	No	Routine care	Knowledge and attitudes (childbirth)	WhatsApp video messages	One-time	↑Knowledge and attitudes during COVID-19.
Arifah et al., 2023 ³⁰	Indonesia	Randomized controlled trial	IG = 22, CG = 22	Daily WhatsApp anemia prevention messages (7 weeks)	-	Routine care	Knowledge, behavior (IFA adherence), diet	WhatsApp daily text messages	Daily for 7 weeks	↑IFA adherence, ↑knowledge, no effect on diet.
Abasi et al., 2023 ¹⁶	Iran	Randomized controlled trial	IG = 50 couples, CG = 50 couples	WhatsApp couples’ training on maternal–fetal attachment	Yes	Routine care	Maternal–fetal attachment	WhatsApp group sessions	Weekly for 4	↑Maternal–fetal attachment score (p < 0.001).
Aboalshamat et al., 2023 ¹⁵	Saudi Arabia	Randomized controlled trial	SG = 34 (Snapchat), CG = 34 (WhatsApp)	Social media oral health education (Snapchat) vs WhatsApp	No	Routine care	Health knowledge (oral health)	Multimedia messages via Snapchat or WhatsApp	NR	Both groups ↑knowledge short-term, no difference between apps.
Fatemi et al., 2023 ¹⁷	Iran	Randomized controlled trial (2 arms)	VSIT=48, Semi-attendance SIT=48	Virtual stress inoculation training (WhatsApp-assisted)	Yes	Semi-attendance SIT	Psychological (anxiety, depression, stress)	WhatsApp live/virtual sessions	Weekly × 6	Both ↓distress; semi-attendance superior for anxiety/depression.
Bashirian et al., 2023 ¹⁸	Iran	Randomized controlled trial	IG = 54, CG = 51	WhatsApp oral health education (HPM-based)	Yes	Routine care	Behavioral change (oral health behaviors, HPM constructs)	WhatsApp structured sessions	Daily for 12 weeks	↑Brushing time and HPM constructs, no change in brushing frequency.
Persis et al., 2023 ³²	India	Randomized controlled trial (3 arms)	App = 50, WhatsApp = 50, Control = 50	WhatsApp pregnancy self-care education	No	Routine care	Self-care KAP and satisfaction	WhatsApp group education	NR	WhatsApp and app ↑self-care KAP; satisfaction highest with WhatsApp.
Askari et al., 2023 ¹⁹	Iran	Quasi-experimental (3 arms)	WhatsApp = 50, Phone call = 50, Control = 50	WhatsApp telehealth sessions in addition to standard ANC	Yes	Phone call education; Routine care	Self-care, self-efficacy, satisfaction, ANC visits	WhatsApp virtual sessions	4 sessions	WhatsApp ↑self-care and satisfaction; phone calls had higher self-care scores.
Budiarti et al., 2024 ²⁴	Indonesia	Quasi-experimental	IG = 20, CG = 20	WhatsApp-based ANC group model	Yes	Routine care	Childbirth readiness	WhatsApp ANC group sessions	Daily over 2 weeks	↑Childbirth readiness.
Amitha et al., 2024 ³³	India	Randomized controlled trial	WhatsApp = 42, MI = 42	WhatsApp oral health education	No	Motivational interviewing (face-to-face)	Oral health knowledge, attitude, behaviors	WhatsApp group education	NR	MI superior to WhatsApp in knowledge, oral hygiene, behaviors.
Moghaddam et al., 2024 ²⁰	Iran	Quasi-experimental	IG = 31, CG = 30	WhatsApp-based TPB program on salt reduction for prehypertension	Yes	Routine care	Nutrition behavior and blood pressure	WhatsApp text education	3 sessions	↑Perceived control, ↓SBP/DBP.
Valença et al., 2025 ²⁹	Brazil	Randomized controlled trial	IG = 47, CG = 34	WhatsApp reminders supplementing outpatient nutrition guidance (GDM)	No	Standard outpatient nutrition guidance	Glycemic control and dietary intake	WhatsApp reminders	Weekly for 4–8 weeks	Improved glycemic control; ↑lipid intake.
Abdelaziz et al., 2025 ²¹	Egypt	Randomized controlled trial	IG = 48, CG = 48	WhatsApp-delivered Internet-based CBT for tokophobia	Yes	Routine ANC	Psychological (fear of childbirth, self-efficacy)	WhatsApp CBT modules	Weekly × 6	↓Tokophobia, ↑self-efficacy.
Salarkarimi et al., 2024 ²²	Iran	Randomized controlled trial	IG = 40, CG = 40	WhatsApp self-care education for overweight/obese pregnant women with diabetes	Yes	Routine care	Self-care, lifestyle, blood glucose	WhatsApp text + group support	NR	↓Postprandial glucose, ↑self-care and lifestyle scores.

Abbreviations: ANC = antenatal care; CBT = cognitive behavioral therapy; CG = control group; GDM = gestational diabetes mellitus; Hb = hemoglobin; HBM = health belief model; HPM = health promotion model; IFA = iron and folic acid; IG = intervention group; KAP = knowledge, attitudes, and practices; MI = motivational interviewing; SeBF = self-efficacy in breastfeeding module; SIT = stress inoculation training; TPB = theory of planned behavior; TTM = transtheoretical model (stages of change); VSIT = virtual stress inoculation training; NR = not reported; CO = carbon monoxide (biomarker of smoking exposure); SBP = systolic blood pressure; DBP = diastolic blood pressure.

Targeted domains and outcomes

As presented on Table 4, targeted outcomes were classified into five main domains: knowledge and attitudes,^{14,15,25,27,30–34} behavioral change^{18,27,31–33}^{,13,19,22,24,32} psychological outcomes,^16,17,19,21 clinical/physiological outcomes,^{14,20,22,26,29,30,34} and health service uptake and satisfaction.^19,23,32

Table 4.

Domains and specific outcomes targeted by studies assessing the effectiveness of WhatsApp-based education on improving access to maternal health.

Outcome domain	Specific outcome
Knowledge and Attitudes	• Knowledge of anemia prevention ^14,30,34
	• Knowledge and attitudes toward breastfeeding, childbirth, and oral health ^15,25,27,33
	• Attitudes toward self-care and pregnancy practices ³²
Behavioral change	• Breastfeeding practices (initiation, exclusivity, self-efficacy) ^27,31,32
	• Smoking cessation (quit rates, nicotine dependence, CO levels) ^13,26
	• Oral health behaviors (brushing time, hygiene practices) ^18,33
	• Self-care practices (nutrition, hygiene, routine ANC self-care, physical activity) ^13,19,22,32
	• Childbirth readiness behaviors ²⁴
Psychological outcomes	• Anxiety, depression, and stress reduction ¹⁷
	• Maternal–fetal attachment ¹⁶
	• Fear of childbirth (tokophobia) ²¹
	• Self-efficacy (general and pregnancy-specific) ^19,21
Clinical/physiological outcomes	• Hemoglobin levels (anemia prevention) ^14,30,34
	• Blood pressure (SBP, DBP – hypertension prevention) ²⁰
	• Glycemic control (FBS, 2HPP, OGTT – diabetes management) ^22,29
	• Nicotine dependency and CO levels ²⁶
Health service uptake and satisfaction	• ANC attendance (frequency of antenatal visits) ^19,23
Health service uptake and satisfaction	• Patient satisfaction with ANC and telehealth interventions ^19,32

Abbreviations: ANC = antenatal care; CO = carbon monoxide (biomarker of smoking exposure); SBP = systolic blood pressure; DBP = diastolic blood pressure; FBS = fasting blood sugar; 2HPP = 2-hour postprandial blood glucose; OGTT = oral glucose tolerance test.

Effectiveness of WhatsApp-based interventions

Pregnancy related knowledge and attitudes

Ten studies assessed the effectiveness of a WhatsApp-based intervention on maternal knowledge. While one study focused on general pregnancy-related knowledge, nine focused on a specific topic such as breastfeeding, prevention of anemia, and oral health.

Husna et al.²⁵ conducting a study aiming to determine the effect of WhatsApp video-based counseling on childbirth on the knowledge and attitudes of third trimester pregnant women during the Covid-19 period found that their intervention improve overall knowledge and attitude of pregnant women.

Pilus et al.²⁷ in a cluster randomized controlled field trial conducted in Malaysia found that WhatsApp-based educational program significantly increased the breastfeeding knowledge of pregnant mothers.

Increasing anemia prevention awareness was also targeted by WhatsApp-based interventions. All three studies focused on that outcome presented an improvement in pregnant women's knowledge about anemia and anemia prevention measures.^14,28,30

Among the two studies that assessed the effectiveness of WhatsApp-based educational program on the change in knowledge on oral health, Aboalshamat et al.¹⁵ used Snapchat groups as the comparator while Amitha et al.³³ used motivational interviewing as a comparator. The findings of the two studies showed that WhatsApp educational programs were less effective in increasing the knowledge on oral health of pregnant women. In addition, Amitha et al.³³ observed that pregnant women exposed to the motivational interviewing program exhibited a significantly better oral hygiene status and significantly improved their oral health behaviors. The finding of the randomized controlled trial conducted by Bashirian et al.¹⁸ evaluating the impact of an educational program through WhatsApp on the oral health prevention behavior of pregnant women, using pregnant women receiving routine ANC only as the control arm, reported significant differences between the intervention and control groups regarding perceived benefits, perceived barriers, positive affect, negative affect, commitment to the action plan, and tooth brushing time. However, no significant difference was observed regarding the tooth brushing frequency after the intervention.

Behavioral change

Wahidah and Greiny³¹ and Pilus et al.²⁷ examined the effect of WhatsApp-based education on breastfeeding practice. Wahidah and Greiny³¹ reported that WhatsApp-based education improved breastfeeding behavior of mothers in the first week after birth while Pilus et al.²⁷ demonstrated that WhatsApp-based education significantly increased the breastfeeding self-efficacy and did not significantly improve the breastfeeding attitude 8 weeks after delivery.

Two research investigated the effect of WhatsApp-based education on smoking habits and nicotine use. The first one conducted by Khayat et al.,¹³ compared the effect of face-to-face training, telemedicine program through WhatsApp, and routine care on the smoking and narcotics use. They found that there was no significant difference in face-to-face and telemedicine training in improving the scores of smoking and narcotics use. However, face-to-face training and telemedicine training led to a significant reduction in smoking habits and narcotics use compared to the routine ANC group. The other study, conducted by Balmumcu et al.²⁶ showed that the intervention was effective in reducing nicotine dependency and carbon monoxide levels of pregnant women and was effective at helping pregnant mothers quit smoking.

In regard with anemia prevention behaviors, studies conducted by Rahman et al.²⁸ and Elsharkawy et al.¹⁴ demonstrated that WhatsApp-based educational program significantly increased compliance with iron and folic acid supplementation, food selection ability, and dietary iron and vitamin C intake, and also significantly decreased the dietary tannin intake. Although Arifah et al.³⁰ demonstrated that daily educational messaging increased folic acid tablet consumption in pregnant women, they also reported no significant difference in the anemia prevention diet between the intervention and control groups.

A study caried out by Khayat et al.¹³ showed a significant improvement in nutritional performance among pregnant women who received WhatsApp-based education compared to the control group while there was no significant difference compared to women who received face-to-face education. Moghaddam et al.²⁰ also demonstrated a positive effect of WhatsApp-based intervention on nutrition. Their study showed an increase in perceived behavioral control scores regarding food and salt consumption in the intervention group compared to the control group. Furthermore, Valença et al.²⁹ in their study on women with gestational diabetes mellitus found that nutritional guidance through WhatsApp significantly increased glycemic control and lipid intake. However, they observed no changes in calories, macronutrients and fiber uptake.

Among the four studies assessing pregnancy selfcare, one compared the WhatsApp-based education group with the control (routine ANC) group²² while three others in addition to the control group added another intervention group: face-to-face training group,¹³ mobile app group,³² and phone call group.¹⁹ In the four studies, WhatsApp-based educational program improved pregnancy selfcare compared to the control group. No significant difference was found between WhatsApp-based education and face-to-face training¹³ or mobile app group³² as pregnancy self-care and personal hygiene were concerned. On the other hand, Askari et al. reported a high pregnancy self-care score in the phone call group compared to the WhatsApp group.

Khayat et al.¹³ compared the effectiveness of face-to-face training, WhatsApp-base education and routine ANC only on physical activity on adolescent pregnant women. They found that face-to-face training caused better improvement in the scores of sports and physical activity as compared to WhatsApp-based education group, and when compared to routine ANC, WhatsApp-based education group led to a significant improvement in scores of sports and physical activity.

Psychological outcomes

Studies conducted by Budiarti et al.²⁴ and Abdelaziz et al.²¹ demonstrated that educating pregnant women through the WhatsApp platform reduced the fear of childbirth and increased the readiness of delivery in pregnant women. In addition, Abdelaziz et al.²¹ demonstrated that the education program through WhatsApp also increased maternal self-efficacy.

Comparing the WhatsApp-based stress inoculation training and a semi-attendance stress inoculation training, Fatemi et al.¹⁷ reported that both WhatsApp-based and semi-attendance interventions effectively reduced anxiety, depression, psychological distress, pregnancy-specific stress, and general perceived stress. However, semi-attendance was more effective on reducing anxiety, depression, and psychological distress compared to the WhatsApp-based intervention on the one hand, and on the other hand there was no significant difference between the two interventions as pregnancy-specific stress and general stress were concerned.

The result of the randomized controlled trial conducted by Abasi et al.¹⁶ showed that couples’ online training through the WhatsApp platform on maternal–fetal attachment had a positive effect on the maternal–fetal attachment score.

Clinical/physiological outcomes

In the study conducted with the objective to explore the effect of an educational intervention through WhatsApp, based on the Theory of Planned Behavior on the amount of salt consumed by prehypertensive pregnant women, Moghaddam et al.²⁰ observed that the mean score of systolic blood pressure and diastolic blood pressure decreased significantly in the intervention group. Salarkarimi et al.²² in their randomized controlled trial that assessed the impact of WhatsApp-based self-care education on self-care behaviors and lifestyle in overweight and obese pregnant women with diabetes reported that the intervention group had significantly lower one-hour and two-hour postprandial blood glucose levels compared to the control group.

Moreover, Rahman et al.²⁸ reported that a theory-based intervention program through WhatsApp targeting pregnant women with anemia was effective to increase significantly the hemoglobin level six weeks after the intervention compared to the control group.

Health service uptake and satisfaction

Two studies examined the effect of a WhatsApp based intervention on antenatal care attendance. Ardiyanti et al.²³ found that the group that received the intervention had a higher rate of antenatal visit compared to the control group. Askari et al.¹⁹ assessed the impact of telehealth on antenatal services uptake in the context of COVID-19 where the reduction of the number of face-to-face visits were recommended. They reported no significant difference in the number of face-to-face visits at the hospital between pregnant women receiving education through WhatsApp and those who received education through phone calls. When comparing the WhatsApp arm and the control arm (pregnant women receiving standard care), they found that WhatsApp-based intervention significantly reduced the number of face-to-face visits at the hospital.

Two studies explored the effectiveness of a WhatsApp-based education on women’s satisfaction with antenatal care. Persis et al. (34) and Askari et al. (19) reported significantly high satisfaction among pregnant women who received education through WhatsApp compared to those who received routine antenatal care only.

Discussion

Principal findings

This systematic review synthesized findings from 21 studies published between 2020 and 2025, conducted across Middle East and North Africa, East Asia and Pacific, South Asia, Europe and Central Asia. and Latin America and the Caribbean region. Included studies were conducted in high- and middle-income countries with relatively small sample sizes.

Overall, WhatsApp-based education combined with routine antenatal care demonstrated mixed effectiveness across outcome domains. Compared with routine antenatal care alone, several studies reported improvements in maternal knowledge, particularly in relation to breastfeeding, anemia prevention, and selected aspects of pregnancy self-care. Positive effects were also observed for certain health behaviors, including adherence to iron and folic acid supplementation, smoking cessation, and selected dietary practices. In addition, WhatsApp-based interventions were associated with improvements in psychological outcomes such as reduced fear of childbirth, anxiety, and depressive symptoms, as well as enhanced maternal–fetal attachment and higher satisfaction with antenatal care services in some settings.

However, these effects were not consistent across all domains or studies. In several trials, WhatsApp-based education coupled to routine antenatal care showed limited or no advantage over routine care for specific behaviors, including dietary modification for anemia prevention, breastfeeding attitudes, brushing frequency, and physical activity. Furthermore, when directly compared with more intensive or personalized approaches, such as face-to-face education, motivational interviewing, semi-attendance programs, or structured phone-based counseling, WhatsApp interventions were often comparable but not superior, and in some cases less effective.

Comparison with existing literature

The findings of this review are consistent with previous systematic reviews of mHealth interventions in maternal and neonatal health. Recent reviews, such Ameyaw et al.²⁷ and Ogundaini et al.,²⁵ reported that mHealth interventions were effective in pregnancy more specifically in the areas like: ANC attendance, maternal anxiety and depression, diabetes in pregnancy, gestational weight management, maternal healthcare use, behavioral modification toward smoking cessation, and controlling substance use during pregnancy. Our review extends this evidence by focusing on WhatsApp, which differs fundamentally from other mHealth platforms such as SMS in its affordability, interactive capacity, and ability to transmit multimedia content.⁷ These features make WhatsApp interventions more engaging, and context sensitive compared to traditional text messaging, potentially leading to greater behavioral impact.

We noted that mHealth interventions for maternal health care are disproportionately concentrated in high-income countries. This is in line with the findings of the systematic review conducted by Ameyaw et al. reporting that mHealth interventions for maternal health care are skewed toward high-income countries.²⁵ This reflects structural inequities in research and health system priorities, where most interventions are designed and tested in well-resourced settings with strong technological infrastructure. In contrast, implementation in low- and middle-income countries remains limited, even though these regions experience the highest maternal and child mortality rates³⁵ and face significant gaps in accessing timely and reliable health information.³⁶ This contrast highlights an urgent need to prioritize the implementation of innovative, context-appropriate digital health strategies in low-income settings. Scalable and low-cost platforms such as WhatsApp could play a transformative role in bridging information gaps, promoting self-care, and supporting continuity of antenatal care where health services are scarce. Strengthening research in low-resource settings and aligning mHealth interventions with national maternal health priorities will be critical to reducing preventable maternal and newborn deaths and ensuring equitable access to high-quality care.

Other limitations to the scalability of mHealth in resource-limited settings include digital illiteracy, poor network infrastructure, and sociocultural resistance. For example, Sondaal et al. reported that network coverage limitations and electricity shortages were significant obstacles in sub-Saharan Africa when testing mobile and WhatsApp-based maternal health programs.³⁷ Sociocultural factors further limit uptake, with Manji et al. noting that gender norms restricting women's phone access, stigma, and confidentiality concerns discouraged participation in WhatsApp-based maternal health groups.⁸ To overcome these barriers, interventions should be co-designed with local communities, include digital literacy training, leverage low-bandwidth features, and incorporate clear data protection protocols. Hybrid models that combine WhatsApp with in-person support may enhance trust, acceptability, and overall effectiveness, ensuring such tools can be sustainably scaled in low-resource settings.

Most WhatsApp-based mHealth interventions included in this review enrolled relatively small numbers of participants, with several studies involving not more than 50 women in the WhatsApp arm. This has been reported previously in mHealth systematic reviews such as the one carried out by Eaton et al.³⁸ While these trials provided valuable feasibility insights, they lacked sufficient statistical power, limiting the robustness and generalizability of their findings. Larger, multicenter randomized controlled trials are needed to generate stronger evidence and establish the true effectiveness of WhatsApp interventions in improving maternal and newborn health outcomes across diverse contexts. Beyond sample size, scaling up WhatsApp interventions presents practical challenges, including difficulties in following up participants, ensuring confidentiality in group settings, and moderating discussions as numbers grow. These issues can compromise both data security and the fidelity of intervention delivery. Innovative approaches such as integrating artificial intelligence like chatbots^39,40 may help overcome these barriers by automating routine messaging, personalizing content delivery, supporting secure data management, and improving monitoring of participant engagement. When combined with trained facilitators and clear governance protocols, such hybrid models could make WhatsApp-based interventions more scalable, sustainable, and impactful in maternal health care.

Findings from this review suggest that interventions involving direct patient-provider contact often yield stronger effects than those delivered through digital platforms such as WhatsApp. For example, motivational interviewing has been shown to improve oral health outcomes more effectively than digital education alone,⁴¹ and face-to-face interventions appear to produce greater improvements in physical activity compared with technology-based approaches.⁴² These observations align with the World Health Organization's position that digital health interventions should serve as supportive tools integrated within health systems rather than as stand-alone replacements.⁴³ In practice, this highlights the importance of combining WhatsApp-based education with direct provider contact, ensuring that digital interventions reinforce rather than substitute the interpersonal components of antenatal care. Such hybrid approaches may maximize engagement, improve behavioral outcomes, and safeguard the quality of maternal health services.

Strengths and limitations

A major strength of this review lies in its rigorous design, including comprehensive database searching, independent screening, and adherence to PRISMA guidelines. By including both randomized controlled trials and quasi-experimental studies, the review provides a broad and balanced synthesis. However, limitations include heterogeneity across intervention designs, outcomes, and comparators, which precluded meta-analysis. Many studies were small scale and for a short term, limiting generalizability. Furthermore, the predominance of studies from upper- middle and high-income countries raises questions about applicability in lower-middle and low-income settings with different health system structures and digital use patterns.

Implications for practice and policy

Our findings suggest that WhatsApp should be considered as a supportive adjunct to routine antenatal care. Its integration into ANC programs should be context specific, accompanied by safeguards for equity, privacy, and clinical escalation, and evaluated through rigorous implementation research.

Future research

Future studies should include large-scale randomized controlled trials with standardized outcome measures, allowing for meta-analysis and clearer conclusions. Research should also assess cost-effectiveness, long-term sustainability, and the equity impact of WhatsApp-based interventions, particularly for vulnerable populations. Incorporating behavioral theory, such as the Behavior Change Wheel,⁴⁴ may further optimize intervention design and delivery.

Conclusions

This review provides one of the first comprehensive synthesis of WhatsApp-based educational interventions effectiveness. Evidence shows that WhatsApp can be used to improve maternal knowledge, ANC attendance, health behaviors, physiological outcomes, and satisfaction with care, although comparative effectiveness remains mixed. WhatsApp holds promise as a complementary tool in ANC delivery, but further high-quality research is required to establish its role in improving maternal and neonatal outcomes across diverse contexts.

Supplemental Material

sj-docx-1-dhj-10.1177_20552076261428152 - Supplemental material for Effectiveness of WhatsApp-based education on improving access to maternal health: A systematic review

Supplemental material, sj-docx-1-dhj-10.1177_20552076261428152 for Effectiveness of WhatsApp-based education on improving access to maternal health: A systematic review by Fabrice Djouma Nembot, Blake Nkemngu Afutendem, Collins Buh Nkum, Dora Ateudjieu, Deborah Kakapen, Zacheus Ebongo Nanje, Roger Ndzana, Francis Duhamel Nang Nang1 and Jerome Ateudjieu in DIGITAL HEALTH

Footnotes

ORCID iDs

Fabrice Djouma Nembot

Blake Nkemngu Afutendem

Collins Buh Nkum

Deborah Kakapen

Roger Ndzana

Francis Duhamel Nang Nang1

Jerome Ateudjieu

Author contributions

Conceptualization: DNF, JA. Methodology: DNF, JA, BKA. Screening of abstracts and full-text, data extraction: BKA, DK. Resolved discrepancies: DNF. Data synthesis: DNF, BKA. Writing original draft: DNF, BKA. Review and editing: JA, DA, ZEN, FDNN. All authors have read and approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability

Data generated or analyzed during this review are included in this article. Full database search strings, screening logs, and the data-extraction codebook are available on request. The review protocol is registered with PROSPERO (CRD42023404056).

Supplemental material

Supplemental material for this article is available online.

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