Developing and evaluating a chatbot to support maternal health care

Abstract

The ability to provide trustworthy maternal health information using phone-based chatbots can have a significant impact, particularly in low-resource settings where users have low health literacy and limited access to care. However, deploying such systems is technically challenging: user queries are short, underspecified, and code-mixed across languages, answers require regional context-specific grounding, and partial or missing symptom context makes safe routing decisions difficult. We present a chatbot for maternal health in India developed through a partnership between academic researchers, a health tech company, a public health nonprofit, and a hospital. The system combines (1) stage-aware triage, routing high-risk queries to expert templates, (2) hybrid retrieval over curated maternal/newborn guidelines, and (3) evidence-conditioned generation from an LLM. Our core contribution is an evaluation workflow for high-stakes deployment under limited expert supervision. Targeting both component-level and end-to-end testing, we introduce: (i) a labeled triage benchmark (N=150) achieving 86.7% emergency recall, explicitly reporting the missed-emergency vs. over-escalation trade-off; (ii) a synthetic multi-evidence retrieval benchmark (N=100) with chunk-level evidence labels; (iii) LLM-as-judge comparison on real queries (N=781) using clinician-codesigned criteria; and (iv) expert validation. Our findings show that trustworthy medical assistants in multilingual, noisy settings require defense-in-depth design paired with multi-method evaluation, rather than any single model and evaluation method choice.