Aparna Hegde The lifesaving tech helping mothers make healthy decisions TED Fellows
[SHAPE YOUR FUTURE]
Anita died in my presence
while giving birth to life.
She bled to death and lost her child.
The irony was that she had access to care.
In the first trimester of pregnancy,
she had visited the antenatal clinic
of the hospital in Mumbai
where I was doing residency.
But over four hours of waiting
in the hot, sweaty,
dingy, overcrowded clinic
just to get a minute with me,
a harried, overworked resident doctor,
meant that she never came back,
only to die in labor months later.
I was wracked with guilt.
If only I had counseled her
about the danger signs,
why she needed to access regular care.
Would she and her child have survived?
She did not die
due to a terminal condition.
She died because of underlying anemia,
an easily treatable,
preventable condition.
I saw these stories daily.
Systemic, preventable problems
resulting in mothers and children dying
in the most unjust of circumstances.
In the next one hour,
three women will die
while giving birth somewhere in India.
Two children under age five
die every minute in India.
I am a practicing urogynecologist,
but very early in my medical training,
I realized that hospital-based
solutions were not enough.
And given the sheer scale
of India’s problems,
any solution that made a difference
had to be scalable,
accessible to the last woman
and child directly in their homes,
and yet cost-effective and resource-light.
And then the mobile phone came to India
and within a few years
everyone had a mobile phone.
There are currently more mobile phones
in India than toilets.
The idea then struck me.
Why not use a simple technological tool
like a mobile phone,
which is available in almost
every Indian household
to bridge the yawning
systemic gaps in health care?
Maybe we could have simply
called Anita weekly
with critical lifesaving information.
On the other hand,
maybe we could have provided
mobile-phone-based training
to the health worker who could have
diagnosed Anita’s anemia
in the community itself.
Thus was born my NGO ARMMAN.
Our programs, mMitra and Kilkari,
are free, weekly voice call services.
They provide preventive
information directly to women
through pregnancy and infancy
in their chosen time slot and language.
There are multiple tries
for every message,
a missed-call system,
and mMitra also has a call center.
If only Anita had received this service.
In the second month of pregnancy itself,
it would have told her about the need
to take an iron pill daily
from the third month of pregnancy.
When the third month arrived,
it would have sent her a reminder
and counseled her
on how to take the iron pills.
For example, the need to avoid tea, coffee
to improve the absorption of iron
and stress on why it is so necessary
to prevent anemia.
Two weeks later,
it would have spoken about how to tackle
the adverse effects of iron pills,
like constipation.
If she had any query,
she could have reached out
to our call center staff.
These are simple voice calls.
As a typical doctor,
I expected them to just inform
and hopefully lead to better
health behaviors.
However, the one unexpected
transformational benefit
that has completely blown my mind is this:
Information is empowerment.
Armed with this information,
women like Anita are upending
patriarchal family dynamics,
challenging entrenched mores
and demanding care.
Karnam, the wife of a deeply
conservative preacher,
convinced her husband
to adopt family planning
because mMitra told her
that spacing between
pregnancies is necessary.
And the change is intergenerational.
Punita, form a deeply conservative family,
sent her daughter
to an English medium school.
In addition to the big pictured messages,
the most underprivileged
of women want to know
when their child will understand color,
how to ensure psychosocial
stimulation of the child,
when their child will develop fingers
in their womb and so on.
Like any woman would.
Our services respect that.
Over 20 million women
in over 16 states in India
have enrolled for these
services since 2014.
This is testament to how easily scalable
and replicable these solutions are
anywhere in the world.
Similarly, our mHealth-based
refresher training program
for government frontline health workers
called Mobile Academy
has trained over 130,000
health workers in 13 states in India.
Both Kilkari and Mobile Academy,
in collaboration with the government,
will extend through the country
in the next three to five years.
Our goal is to be able to reach
over 15 million women
and their children every year,
and that would mean
over half of the mothers
and children born every year
have the information they need.
And this massive scale is only possible
because so many of our partners,
be it NGOs, hospitals and the government,
recognize the value of this approach
and provided the scaffold
on which we grew.
Our quest in the next five years
is to adopt multimedia approaches,
and given the massive amounts
of data we have,
use the power of AI
and predictive analytics
to better serve our mothers and children.
And our tech platform
and the networks we build are nimble.
When COVID-19 struck,
lockdown was announced overnight.
Among the worst affected were
the underprivileged women and children
in the slums of Mumbai and Delhi,
which were declared as containment zones.
However, pregnancy and infancy
can’t wait for a lockdown.
When there’s an emergency like bleeding,
care is needed immediately.
And we were right there and ready.
We repurposed our tech platform
within a matter of days.
We created a virtual clinic
for antenatal pediatric care
manned by qualified doctors.
Our call-center staff arranged
logistic support, like ambulances.
We also sent COVID-specific information
covering pregnancy and infancy
to over 300,000 pregnant women
and mothers through voice calls.
But why should you care
about our mothers and children?
The pandemic has made us confront
this most implacable of truths.
A robust primary health care system
is an absolute pillar
of a functioning and efficient society.
Improvement in maternal and child health
leads to horizontal development
of health systems
and improved primary health care.
A village that can look after
its mothers and children well
can look after all other
conditions by ripple effect.
And pregnancy is not a disease.
Childhood is not an ailment.
Dying due to natural life event
is not acceptable,
and we know why
our mothers and children die.
Yet we invest so little
in preventing their deaths.
There can be no global progress
until all our mothers
and children do well.
I implore you to add your voices to ours.
To amplify this message loud and clear.
That maternal and child health
is a human right.
Thank you.