Includes bibliographical references / Problem Statement: The use of mobile technology in health (mHealth) has been ascribed as transformative power in the health systems of the developing countries, especially for improving healthcare delivery in rural areas. However, the full potential of mHealth has not been realised and there is a dearth of evidence on effectiveness and impact. This has limited informed policy-making, affecting the buy-in from investors and policy makers, and limiting adoption and scaling up of mHealth interventions that could benefit rural communities. Purpose of the research: The main objective of this study was to examine how mHealth interventions contribute to maternal health outcomes in a developing country context, at a micro level. The specific aims were to examine how mHealth outcomes for maternal health consumers in rural communities are produced and how variations in outcomes can be explained. Design/methodology/approach: The study adopted a critical realism approach, and drew on Capability Approach as a theoretical lens, with the aim to explain how and why mHealth interventions work in maternal health, for whom, and in what circumstances; by analysing patterns between context, mechanisms and outcomes. Data for this research was obtained through semi-structured interviews with users of mHealth in maternal healthcare in Malawi, and various project stakeholders. Project documents were also used as secondary data. Findings: mHealth interventions may affect maternal health outcomes and service delivery through multiple mechanisms. Three different types of mechanisms were found to produce mHealth outcomes for women in maternal health. These were: Technology adoption mechanisms that led to the uptake and adoption of mHealth services in maternal health; agential mechanisms that facilitated agency of consumers in achieving health goals; and health system mechanisms for realisation of desired health outcomes. A myriad of personal, sociocultural, and environmental factors either activated or inhibited the mechanisms, resulting invaried outcomes for the women. Originality/contribution: mHealth as a complement to existing maternal health services can lead to improvement in consumer behaviour and experiences, and even clinical outcomes. This research has highlighted a pathway through which mHealth outcomes are produced for consumers in maternal health. This process starts from mHealth acceptance and adoption as a technology by the consumers; to women acting as agents of their own health by utilising the opportunities generated by mHealth; and finally health system efficiencies for provision of adequate care to the women. This understanding of how mHealth works in maternal health can improve design and operations of such interventions for effectiveness that may lead to the realisation of its full potential.