Tackling the Tragedy of Maternal and Child Deaths
 in India

How a programme offering pregnancy-related information via mobile phones and home-based care by specially trained local women helped to address preventable maternal and infant mortality in India's Maharashtra state.

Two months into her second pregnancy, housewife Chaitali Umesh Shinde learnt there was excessive amniotic fluid surrounding her unborn baby. The fluid protects the foetus from knocks and helps its lungs to develop properly, but too much of it sometimes indicates a problem with the baby's development. To help, Mrs. Shinde was given medication by a doctor in her village of Baswantwadi in India's western Maharashtra state.

She was told it was a common complication of pregnancy, but after suffering a miscarriage when she first became pregnant at the age of 18, she was nervous.

Everything seemed fine until a month before her due date. The same doctor informed her she now had dangerously little amniotic fluid. "Maybe I didn't take the right dosage," she recalled thinking. She was given more drugs. About 30 days later, she gave birth to a stillborn.

"Worrisome and scary"

Last year, India accounted for 23% of all stillbirths globally - more than any other country.

Experts say this is because of a lack of proper obstetrics care on offer in many parts of the world's second most populous nation. They add this is also responsible for India having a quarter of the globe's neonatal (children under 28 days of age) deaths and 15% of maternal deaths.

Prime Minister Narendra Modi last year described the situation as "worrisome and scary."

The majority of these deaths are preventable. Often they occur in swathes of India where road connectivity is poor, health facilities are far and few between and qualified doctors and nurses refuse to work, leading to rampant quackery.

This is the case in much of
rural Maharashtra, where a
programme was launched
in 2013 by iPartner India
and two partnering NGOs,
ARMMAN and Swayam
Shikshan Prayog (SSP).

Its aim: to help ensure 
pregnancy doesn't mean 
death for mother or child.

Although Maharashtra's infant and maternal mortality rates are lower than the national average, half of its women are anaemic - a common trigger for pregnancy-related complications.

Meanwhile, health risks are presented by recurring droughts in the region. And, like elsewhere in the country, gender prejudice continues, meaning women in Maharashtra often leave school early and are unable to read or write.

"Difference between life and death"

As a result, many people lack vital basic information about pregnancy. That's why the project, funded by the U.K. government's Department for International Development, involved sending time-appropriate information for free to pregnant women via mobile phones.

Throughout their pregnancies and until their babies turned one, the women received 128 short audio messages produced in consultation with doctors on topics like iron deficiency, breastfeeding, family planning and child immunisations.

"Knowing these things can be the difference between life and death," said Dr. Aparna Hegde, who founded ARMMAN (short for Advancing Reduction in Mortality and Morbidity of Mothers, Children And Neonates) after witnessing the systemic problems faced by underprivileged pregnant women and children while working as a resident doctor at a government-run hospital in Mumbai.

The expectant mothers enrolled on the programme were also shown animation clips on pregnancy-related matters by specially trained local women known as Arogya Sakhis, or health friends, who also offered home-based diagnostic care and treatment.

Equipped with a basic medical kit, the Arogya Sakhis, among other things, were trained to test blood sugar levels to detect diabetes and regularly monitor body weight among pregnant women because very fast and extreme weight gain can be a sign of pre-eclampsia.

"In India, villages are cut off from services like health centres and there's financial barriers of commuting to them. That's why we felt it was important to provide home care," Dr. Hegde said.

In total, 1,000 women and their babies scattered across 250 villages in the districts of Osmanabad, Solapur and Washim benefited. This included Mrs. Shinde.

Still determined to have a child after two failed pregnancies, in July 2014, six months after giving birth to a stillborn, she was expecting again.

Nine months later, after receiving pregnancy-related mobile messages and regular visits by an Arogya Sakhi, she gave birth to a healthy baby boy. Weighing 2.8 kilograms, she named him Samarth.

"I did not know about many things during my first two pregnancies," Mrs. Shinde, now 23, said. "But that has changed."

According to results of a random cluster trial carried out as part of the three-year-long project which ended in December 2015, the programme's goals were largely achieved.

"Roaring success"

The study found that women who just received information from the audio and animation service - known as mMitra - were far more likely to seek treatment for hypertension, a prominent cause of maternal deaths, than those who did not.

It also found among mothers who benefited from mMitra as well as home-based care from one of the 250 Arogya Sakhis, cases of diarrhoea among their babies reduced by about half. Diarrhoea is a major global child killer.

Dr. Sandhya Joshi, research director at ARMMAN, said the findings indicate the project had been a "roaring success" and echo those of a study published in February on a similar programme in eastern India.

Often the audio messages were sent to mobile phones belonging to family members including husbands, who would then share them with their pregnant wives. Prema Gopalan, who founded SSP, which has been working in Maharashtra for over 20 years, said this brought about "an increased sense of awareness and responsibility among husbands as caregivers."

She added: "This is a progressive change" and another important impact of the programme.

Meanwhile, because many of the Arogya Sakhis continue to provide their services, now for a fee to the wider community, local primary health care systems have been bolstered.

The project has created a cadre of empowered women who contribute to their family's income, according to iPartner India's programme director, Sumitra Mishra. "We are very proud that it has been a hugely successful project."

How you can help

Our goal is to expand the programme so mothers and children in other parts of India, particularly where maternal and infant mortality rates are among the worst in the country, can benefit and lead longer and healthier lives.

We are seeking to raise funds to train more local women to become Arogya Sakhis and equip them with medical equipment to enable them to offer home-based care. Funding is also needed to translate existing voice messages and animations offering health advice into more regional Indian languages.

To get in touch or for more information about the project, click here.