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A friendly voice over the phone
While life has otherwise been tough for the young woman, motherhood has been relatively easier with the recent birth of her daughter because she can now speak to a very special friend whenever she needs to check on something related to her health, feeding practices or immunisation; she can even find answers to "sensitive, personal issues” that she feels too shy to discuss with anyone else.
Anwari’s confidante is not an actual person but a voice that she can hear every time she accesses the mMitra app on her mobile phone. Mitra, or friend, is indeed an appropriate name for the app that provides pregnant women with pertinent advice on healthcare, both in the prenatal and postnatal stages, in the slums of Mumbai, and elsewhere. Anwari smiles shyly as she relates how she has benefited from mMitra, "Both my husband and I listen to the messages on the mobile. I can’t read that well but by regularly listening to the clips, I have learnt a lot.”
Info in local dialect
The mMitra programme, created by ARMMAN, or Advancing Reduction in Mortality and Morbidity of Mothers, Children and Neonates, a non-government organisation, is focused on reducing maternal, neonatal and child mortality and morbidity among the impoverished urban and rural communities. The initiative consists of a free mobile voice call service that provides culturally appropriate, comprehensive information, be it food and nutrition tips, timely prompts for regular doctor visits, or post child-birth care.
In a country like India, where nearly five women die every hour from complications developed during childbirth (as per World Health Organisation), such an intervention that combines technology with much-needed, relevant information has the capacity to work wonders. Quality healthcare during pregnancy and childbirth can prevent many maternal deaths, yet globally only 64 % women go in for the mandatory four antenatal care visits that are needed to spot and treat problems as well as get immunisation.
Registering for the app is very simple - a primary mobile number, be it of the expectant woman or a relative at home, and a consent signature is all that is required; no monetary subscription is involved. There are two sources through which the women can be enrolled. Firstly, through health workers posted in the antenatal/postnatal clinics of municipal hospitals and maternity homes and they register women during their first check-up visit; and secondly, through community workers of the partner NGOs, who make home visits in slum communities. For instance, in Dharavi, ARMMAN collaborates with Sant Gadge Maharaj Samajik Sanstha that works in the area of community development.
How the app works
Calls are made usually between 7 am and 9.30 am but they can be adjusted to the recipient’s preferred time. If the woman misses a call she can call back on the number, which is toll-free, and the message is repeated the next day. Altogether 145 calls (between one-and- a-half to two minutes each) are made to the registered woman - at antenatal stage, it’s twice a week and during postnatal care, once a week.
After the baby is born, the call starts with the message: 'Congrats! Now you have to look after the baby’ followed by information on breast feeding, the vaccination schedule, and so on. In the first week, calls are made once a day; from the second week and up to three months, twice a week.
From the fourth month to the child’s first birthday calls are made once a week to advise on nutrition, hygiene, etc. When the woman is expecting her second baby, the schedule is repeated. According to peer workers, also known as sakhis, or friends, on an average, there are three children per family in the slum localities.
Like Anwari, Sajida (name changed), a mother of three, has benefitted immensely from connecting with mMitra. Her husband and she were able to take an informed decision on limiting their family after they had a consultation with their local sakhi and listened in carefully to the app messages.
Sajida courageously went in for sterilisation, despite the fact that the elders in the family were not happy, as she did not want any more children. Indeed, resistance from the elders is always a possibility and even creates conflict at times, but the women are able to stick to their plans as they usually have their husband on their side. In fact, women reveal that because they keep very busy with household chores, often it’s their husband who actually reminds them of accessing the app.
Sakhis behind mMitra
Incidentally, one of the reasons behind the success of mMirtra is a committed group of sakhis, who are constantly in touch with the women.
Asha Shinde, a sakhi, says, "Initially, the community women used to be quite suspicious of our work and were reluctant to share their personal mobile numbers. Nowadays, they themselves get in touch with us.” Shinde has been associated with the programme since 2014. Other sakhis like Rohini Bhakar and Kalpana Pawar, too, have had the same experience. Their concerted efforts have resulted in the registration of 12,000 women over the last two years.
Bhakar reveals, "We had started out in a small way in 2013. Whereas women were quite hesitant to share their lives with us in the beginning, these days they voluntarily inform us if a woman in the neighbourhood is pregnant so that we can visit her. Their attitude has changed.”
The brain behind ARMMAN is Dr Aparna Hegde, obstetrician and gynaecologist, who conceptualised this intervention focused on home-based care during her work at Mumbai’s Sion Hospital, an important tertiary facility in the city. She was able to gauge the gaps in available information and support for women in the reproductive age in poor communities.
As the ARMMAN agenda asserts: 'Every eight minutes a mother dies in childbirth in India. For every maternal death in India, 20 more women suffer from lifelong health impairments that result from complications during their pregnancies. The majority of these deaths are among women in the 15-29 age group, at the prime of their reproductive lives. The most tragic aspect of these deaths is that about 90 % of them are avoidable’.
The mMira app is one way to ensure that the women always have a friendly counsel to turn to so that motherhood is healthy and happy.