| “It was 1 am and a busy on call night. Suddenly I was called to the emergency room to examine Aruna, a 25 year old primipara with undiagnosed gestational diabetes whose baby had developed macrosmia. She had been transferred from a rural hospital in Thane district in Maharashtra with her baby’s head delivered but the body stuck inside due to shoulder dystocia. I will never forget the first sight of her: a beautiful frail young woman with the head of a beautiful bonny baby sticking out of her vagina. She was sinking due to a ruptured uterus due to the baby stuck in it for more than four hours. When an emergency explorative surgery was performed, the baby’s neck was too jammed for us to be able to deliver it through the incision. So we had to behead the baby on the operating table. Since we could not hand over a beheaded baby to the relatives, I had to sew the baby’s head to the rest of the body. Aruna died three days later.
The sight of the bonny beheaded baby will forever haunt me. The memory of sewing the baby’s head onto its body still gives me nightmares. Aruna’s death will forever stay with me. Not just because she died a most horrible death, but also because it was so easily preventable……
She had gone for her first antenatal visit in the first trimester. But she had not been counseled about the remaining visits and the danger signals. She had never been informed of the potential complications. If only she had been………”.
- A personal experience of Dr Aparna Hegde, during her first post as a resident doctor in Mumbai.
India ranks first among the countries that account for 2/3rd of the maternal and under-5 mortality in the world. Lack of access to preventive care information is a major cause. The rhetoric of urban bias in development and better conditions in urban vis-à-vis rural has masked the real picture of urban poor.
1 Urban slums populations rank among the poorest and most under-served groups in terms of health.
2 The infant mortality rate for urban infants with low standard of living index is 76.1 and the neonatal mortality rate is 48.8 per thousand, which is higher than the national average. All indicators of delivery and postnatal care were consistently poorer in slum areas when compared to non-slum areas in most Indian cities in NFHS-3.
India has over 900million mobile phone subscribers. Almost 63.5% of households have mobiles in the slums of India.
mMitra leverages this unique opportunity of using mobile technology to reach out to pregnant women and mothers of infants with relevant information. The information is appropriately timed to the stage of pregnancy or age of child and targeted to influence adoption of the health seeking behaviours among pregnant women and mothers of infants. mMitra is a friend and companion that guides the woman and the family through pregnancy and childhood.
The voice calls
The voice messages have been developed by BabyCenter that were validated by Federation of Obstetrics and Gynecological Society of India (FOGSI) experts. These messages were dubbed in Hindi and Marathi before pre testing it with women in the community.
A total of 145 individualized voice messages of 60 – 90 seconds are being sent directly to the mobile phones of each enrolled woman, based on the stage if her pregnancy or age of the infant, with the following frequency:
Registration into the service:
Enrolment will be done in the slums directly through community partners and in the government hospitals where mMitra is being offered as a part of their antenatal care.
Unique features of the service:
Thus, mMitra can improve interaction between women and the health care system and increase demand for
skilled birth assistance and other skilled obstetric and neonatal interventions known to reduce maternal and child mortality. It can do this far better than current alternatives such as text messaging (which is not suitable for illiterate women) and radio and TV messages (which have lower penetration than mobile phones).
Technology for mMitra has been built by the Inscripts Pvt. Ltd. pro bono.
- 5000 women attending the antenatal clinic of Sion hospital, Mumbai will now give mMitra as a part of their antenatal care (funded by Glenmark Foundation).
- MAMA (a global alliance of Johnson and Johnson, UN Foundation, USAID, mhealth alliance and BabyCenter) will fund ARMMAN to reach across to one million urban poor women in Mumbai and other cities. DASRA will help ARMMAN build the capacity needed to implement the project.