Transforming Maternal and Infant Health in Mumbai, One Phone Call at a Time
April 14, 2015 | 3380 views
Ahead of the 2015 Skoll World Forum, SkollWorldForum.org and Johnson & Johnson teamed up for this special series on cities and health. We asked social entrepreneurs and partners about the innovative solutions, treatments and technologies that are being developed or deployed to address health challenges in urban settings. What gaps need to be addressed? Who are you collaborating with? What is your vision for the future? And what can we learn from 15 years of working towards the Millennium Development Goals, that might be applied to the UN's new Sustainable Development Goals?
It was a particularly busy night during my third year of residency in obstetrics and gynecology at Sion Hospital, a major referral hospital in Mumbai. Asha arrived in labor, pale, bleeding profusely and gasping. She had placenta previa, a life-threatening complication of pregnancy. We fought through the night to save her and her baby’s life, but we failed.
Asha’s story always stays with me. Not just because she suffered a very tragic death, but because we could have prevented it. Asha had attended the hospital’s antenatal clinic during the third month of her pregnancy. But she never returned for antenatal care, because we failed her.
Due to the long queue of patients waiting to be attended to, we could do no more than quickly examine her and ask her to come back for her next visit. We did not counsel her about the danger signs of pregnancy, the potential complications and the need to come back for regular antenatal and infancy care.
This was not an isolated case. A woman dies in childbirth every ten minutes in India. More than 300,000 infants died on the day of their birth in 2011.
While the situation in rural India is grim, urban India does not offer much respite. This is due to a web of interrelated problems – poverty, the illegal nature of slums, inequitable distribution of resources, lack of community support, management problems in the government health system, and poor primary healthcare services and referral systems. As a result, urban slum populations are some of the most underserved in India, and their health indicators compare unfavorably with both rural and national averages.
Another reason for these woeful statistics is lack of access to basic education – on health promotion, disease prevention, birth preparedness, and complications during pregnancy and infancy. Without this information, mothers can’t adopt behaviors that help to ensure good heath for themselves and their children.
However, providing information alone is not enough. To be effective, it must be timed and targeted to reach the right people at the right time. A dramatic increase in mobile phone penetration – from five million subscribers in 2001 to nearly a billion today – provides an opportunity to reach women directly with information that is culturally sensitive, specific to the month of pregnancy or infancy, and reinforced by repetition.
Mobile phones provide the opportunity for a healthier and happier outcome for women like Vaishali, who had a stillbirth in her first pregnancy. She did not have access to information then on how to take optimal care of herself, despite attending all four required antenatal hospital appointments.
She is pregnant again, with her second child. However, this time around, she is confident of her and her child’s health. She has enrolled herself into the mMitra program, an initiative of ARMMAN and Mobile Alliance for Maternal Action, through which she receives voice calls providing her with preventive care information twice a week in her chosen timeslot and language. Mitra means friend in Hindi.
The calls are about a minute and half long, delivered in a warm sisterly voice. If she misses a call, the service will keep trying to reach her. She can inform the call centre when she delivers, so that she can start receiving infancy messages. She can also inform the centre of other change in her health status, so that she gets the information that is most useful for her. Vaishali is confident that she will be able to care for baby through infancy, as the calls will continue until her child is one year old.
The mMitra service currently reaches 67,000 new and expectant mothers like Vaishali throughout Mumbai, and the number of women using the service increases daily. Enrolment is done at antenatal clinics in almost all government hospitals, and also in the slums through partner NGOs. Our goal is to reach 200,000 women by the end of 2015 and 400,000 women by 2016, in Mumbai and other cities.
Personally it is a matter of great satisfaction for me that at Sion Hospital, where I saw many women like Asha during my residency, women now have mMitra guiding them through pregnancy and infancy. mMitra is true to its name. It is a friend to new and expectant underprivileged mothers, providing them with the information that is their basic human right.
Mobile Alliance for Maternal Action is a partnership between USAID, Johnson & Johnson, the UN Foundation and BabyCenter.