Mobile and networked technology

Can mobile phones save the lives of mothers and their children?

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.

Rede Jovem: Mapping neighborhoods with mobile phones

Catalina Gomez, Rio de Janeiro Community Manager

Until very recently, only the better-off neighborhoods in Rio were able to explore local cultural life and entertainment options online. Today, however, it's possible to get updated and geo-referenced information about the region's history and cultural life, as well as where to shop and eat in some of the city's poorest neighborhoods — such Complexo da Mare, Complexo do Alemão, Santa Marta, Pavão Pavozinho, and Cidade de Deus. All this is possible thanks to an initiative called Wikimapa, created in 2009 by Rede Jovem, an organization that has been working for more than 12 years to promote social inclusion among low-income adolescents though the use of technology.

Wikimapa aims to enable young people from Rio's low-income areas to map interesting sites and relevant activities in their neighborhood and promote greater knowledge and understanding of its culture and history. The project first developed a wiki system that can be accessed through a desktop or mobile web browser. Next, a mobile application was developed using GPS to allow users to contribute to the detailed mapping of areas in their own communities, down to the street level. Then the project was implemented in each of the five communities mentioned above.

In order to implement the project, Rede Jovem works with about 10 adolescents from each neighborhood, who act as community mobilizers. These youth are given mobile phones as their main working tool. They all receive a small "grant" for four hours of service a day during their free time from school. These mobilizers are the ones who tell their friends about the initiative, and help map the sites using the Wikimapa technology. In addition, these mobilizers engage more people to serve as "Wiki reporters" — contributing bloggers who report on cultural and sporting events in the community, and also on the history of streets and iconic areas of their communities. Thus far, more than 2,000 people have downloaded the application to their phones; there are about 2,000 registered contributors; and more than 5,000 points within the five communities have been geo-referenced — the Complexo do Alemão alone has more than 1,500 geo-referenced points.

According to Patricia Azevedo, Strategic Coordinator of Rede Jovem, the Wikimapa initiative has served to engage youngsters with the cultural activities offered by local NGOs and community groups. It has also helped to promote a positive identity among neighborhood residents who, up to now, didn't know much about the interesting histories of their communities or what resources are available about them. Outside of the communities themselves, the project is helping to generate a positive understanding of the many great things taking place in low-income neighborhoods that few people knew about before. Mayanara de Farias Xavier, a 21-year-old Wiki reporter from the Complexo do Alemão, reports that her greatest aim as a Wikimapa reporter is to "show that the community has many options and positive things going on besides the violence that is associated with the place."

Now that Wikimapa is present in five communities, Rede Jovem has plans to consolidate its work in these areas and expand the number of users and contributors. This is all done through the community mobilization and engagement carried out by their young local contributors. Rede Jovem is also in the process of expanding its work to other communities like Rocinha, Mangueira, and some other neighborhoods in Rio's metropolitan area, especially within the Baixada Fluminense. It is clear that the project is scaling up rapidly: for example, it will begin to implement activities in São Paulo, which will create interesting opportunities for exchange between these two cities.

According to Azevedo, additional future challenges include updating the application to Android telephones, as well as finding additional co-sponsors of the initiative, which up to now has counted VIVO telephone company as its main supporter and provider of mobile phones.

We invite you to check the web site, download the application, and discover what is going on in Rio's neighborhoods, especially those that are less well known and explored....