Carlin Carr, Mumbai Community Manager
High maternal and infant mortality rates continue to burden the developing world. Although international organizations have called for an increased focus on maternal health, more than 500,000 women in developing nations die during pregnancy or childbirth annually. In Asia, one out of every 43 women will die of maternal-related causes, compared to one in 2,500 in the United States. The fifth Millennium Development Goal (MDG) aims to reduce the maternal mortality ratio (MMR) by one-third in the next four years; however, India’s efforts — and those of many developing nations — lag woefully behind.
According to PLoS Medicine, between 1990 and 2005, global maternal deaths decreased by only 1 percent per annum instead of the 5 percent needed to reach MDG 5. Training programs and technology to dramatically reduce these numbers are widely available, though appropriate funding, infrastructure and resources for maternal health have been lacking in countries that need it the most. India, for example, has seen tremendous economic growth over the last decade, although government spending on healthcare — less than 2 percent of GDP (China spent 5.8 percent in 2002) — has not kept pace.
An article in the Mint newspaper, “Mobiles can save India’s poor women,” says that mobile phones have great potential to help improve the state of women in India. “Women in India suffer from pervasive inequality and have distinct health, education, and economic needs not being addressed by current institutions and media,” says the article, quoting a research report:
- Mobile phones represent the largest opportunity to address these needs, with 225 million women owning phones and the female VAS (value-added services) market worth $1 billion and growing.
Leveraging the ubiquitous mobile
Mobile phones are everywhere in India, from the most rural villages to the deepest trenches of vast slum areas. The phones are relatively affordable (often under $50 for the initial purchase), and, according to a study conducted by the Indian Institute of Management (IIM), are an investment with a good payoff, both socially and economically. The survey found that mobile phone users in nearly 100 slums in Ahmedabad, Calcutta and Delhi spend a significant amount of their wages on communication, and nearly 57 percent of respondents said they top-up their talk time at least once a week. The ability to communicate better with employers on work location and times saves money in travel, and the phones help in networking for employment, as well.
The issue, however, is that while many slum dwellers have found that they have better communication with their mobile phones, they are often not aware of its other uses, according to an article in the Hindu entitled “More poor people own mobile phones, but productive use still a far cry.” “While there has been a marked rise in mobile phone use by BoP persons in rural and urban India, Bangladesh, Pakistan, Sri Lanka, Indonesia and Thailand, unfortunately, the device’s use is primarily restricted to making or receiving calls or SMSs. In some cases, it is also used as a substitute for radio or as a torch.”
Lessons may be learned from looking toward South Africa, where mobile phone penetration is at 95 percent, and innovative initiatives have begun to leverage this vast user base. In fact, more people use their phones than listen to the radio or watch TV, making the cell phone the most comprehensive and scalable means for disseminating information. More organizations have begun to think creatively about how to incorporate the technology into their work. For example, the Praekelt Foundation, which focuses on preventing HIV/AIDS, added a short message about HIV to the country’s standard “Please Call Me” message, which all mobile users can send for free when they run out of talk time. “Almost forty million of these messages are sent daily,” says an article in the Huffington Post. However, following the addition of the HIV message, “1.5 billion messages were sent out in six languages, resulting in 1.5 million calls to the national HIV hotline.” The success of the seemingly simple program has sparked new ideas for harnessing mobile technology in solving some of the world’s most pressing issues.
MAMA
A new three-year initiative, Mobile Alliance for Maternal Action (MAMA), provides expecting and new mothers access to vital and often life-saving information using mobile phones. Another advantage of the mobile is that information can be passed along by voice as well as in text messages — especially helpful given that 35 percent of women in India are still illiterate. The $10 million program — a joint initiative of the U.S. Agency for International Development (USAID), Johnson & Johnson, the United Nations Foundation and BabyCenter, in collaboration with the mHealth Alliance — has launched in South Africa and Bangladesh, and is expected to launch soon in India.
“We incorporate insights and delightful details alongside health messages, sending mothers week by week messages that tell her how her baby is growing, developing the emotional connection,” according to the MAMA Alliance. “Once you gain a mother’s trust, she is much more likely to act on the vital health messages she is receiving.”
MAMA’s Global Director Kirsten Gagnaire was in Delhi in July 2012 to lay the groundwork for expansion into India. In a blog post she wrote during her visit, she explained the challenges that lay ahead:
- India is a large and diverse place. Made up of 28 states and 18 official languages, the cultural beliefs and norms surrounding women, pregnancy, birth and child rearing are endless. For MAMA to succeed here, it is vital that we work to overlay the best practices for developing maternal messaging services with strong local partners and an understanding of the world in which the “mamas” we are trying to serve live each and every day in this vibrant, complex and beautiful country.
Subscribers to the service register by indicating the expected due date or birthday of their recently born child and receive weekly health messages and reminders during the pregnancy and up to the child’s first birthday. Messages include everything from proper nutrition, breastfeeding, vaccinations and referrals to local health resources.
“No single approach is the silver bullet for improving global maternal health,” writes Linda Murray in the Huffington Post, acknowledging the need to meet vast cultural differences, especially related to birthing practices and infant care. However, messages developed for expecting mothers can be easily tweaked or translated into local languages to meet the target community’s specific needs.
Don’t stop at the messages
Mobile phones are providing much-needed information to the poor, especially in the case of expecting mothers who are at risk. While the information is essential, the maternal and child mortality rate will decrease only if the overburdened public health system is also fixed. After all, where will these messages refer women if not to the public hospitals and birthing centers? The systems around these women need to be strengthened through more government investment in the health care sector and a dedication to women’s health and equality. Only with this holistic approach will mobile health messages have the potential to save the lives of millions, and empower women to bring new life into the world in the safest ways for both mother and baby.
Bilbao, Spain
On the slopes of Mathare Valley in the eastern part of Nairobi, a couple of miles from the city center, lies “Mathare slum,” the oldest shantytown in Kenya.
After independence, Mathare’s population grew substantially and residents began to attempt to improve their surroundings by establishing their own schools, community organizations, and Nairobi City Council (NCC)-provided services. Nevertheless, according to Muungano Trust, these actions went largely ignored, and the only service the NCC provided was forced structure demolitions.
As is still the case today, most of these people neither owned nor squatted the shacks they lived in, but were required instead to pay rent to structure owners who had no clear title to the land themselves.
Following the 2009 government census that tallied the population of Mathare at 80,309 — a number which Muungano Trust argues should be closer to 188,000 — a small group of researchers began to assemble photographs taken of Mathare Valley residents over the decades.
In a recent interview, Torres explained that the project started as a research tool to understand the Mathare way of life and the relationship that residents have to its land and structures.
According to Torres, the MFPA is also intended to provide a permanent archive for slum dwellers: “People lose pictures in slums due to fires, flooding, and demolitions, but they do everything they can to preserve them — these are vulnerable artifacts that need to be preserved for continuity.”
The MFPA documents the story of Mathare — which, as mentioned above, is intrinsically tied to the surrounding land. “What we wanted to prove in this particular case,” Torres tells us, “is that relocation is not a viable alternative for slum upgrading in Mathare because slum-dwellers here have historical ties to this land. We have pictures that show a mother with a baby in 1967, and then, years later, that baby grown up with children of his own. This kind of stuff proves continuity and is an anti-eviction tool, something specific that can be used as proof in a legal claim.”
“I don’t know how this will be linked to future slum-upgrading or improving initiatives,” Torres concludes. “However, how slum dwellers are related historically to a piece of land is a global problem, so whether we can use it here as an effective advocacy tool will then prove if it can be replicated elsewhere.”
En otras palabras, este término quiere decir que el ser humano es un ente con un organismo complejo y con una mentalidad enredada que construye su vida con base en valores, conciencia, ética, motivaciones, deseos, personalidad, entre varios ingredientes. Estas variables se forjan en sociedad a través de la familia, amistades, comunidad, municipio, nación, grupos sociales, entre otros.