Objective To evaluate the effects of a mobile phone-based intervention on postnatal maternal health behavior and maternal and infant health in a middle-income country. Methods A prospective evaluation enrolled consecutive postpartum women at two public hospitals in Quito, Ecuador, between June and August 2012. Inclusion criteria were live birth, no neonatal intensive care admission, and Spanish speaking. Intervention and control groups were assigned via random number generation. The intervention included a telephone-delivered educational session and phone/text access to a nurse for 30 days after delivery. Maternal and infant health indicators were recorded at delivery and 3 months after delivery via chart review and written/telephone-administered survey. Results Overall, 102 women were assigned to the intervention group and 76 to the control group. At 3 months, intervention participants were more likely to attend the infant’s postnatal check-up (P = 0.022) and to breastfeed exclusively (P = 0.005), and less likely to feed formula (P = 0.016). They used more effective forms of contraception (more implants P = 0.023; fewer condoms P = 0.036) and reported fewer infant illnesses (P = 0.010). There were no differences in maternal acute illness or check-up attendance. Conclusion Mobile phone-based postnatal patient education is a promising strategy for improving breastfeeding, contraceptive use, and infant health in low-resource settings; different strategies are needed to influence post-partum maternal health behavior.

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