Aparna Hegde: The life-saving tech helping mothers make healthy decisions | TED Fellows

24,683 views

2021-06-23 ・ TED


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Aparna Hegde: The life-saving tech helping mothers make healthy decisions | TED Fellows

24,683 views ・ 2021-06-23

TED


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00:14
[SHAPE YOUR FUTURE]
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Anita died in my presence while giving birth to life.
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She bled to death and lost her child.
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The irony was that she had access to care.
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In the first trimester of pregnancy,
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she had visited the antenatal clinic of the hospital in Mumbai
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where I was doing residency.
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But over four hours of waiting in the hot, sweaty,
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dingy, overcrowded clinic
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just to get a minute with me,
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a harried, overworked resident doctor,
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meant that she never came back,
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only to die in labor months later.
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I was wracked with guilt.
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If only I had counseled her about the danger signs,
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why she needed to access regular care.
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Would she and her child have survived?
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She did not die due to a terminal condition.
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She died because of underlying anemia,
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an easily treatable, preventable condition.
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I saw these stories daily.
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Systemic, preventable problems resulting in mothers and children dying
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in the most unjust of circumstances.
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In the next one hour,
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three women will die while giving birth somewhere in India.
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Two children under age five die every minute in India.
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I am a practicing urogynecologist,
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but very early in my medical training,
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I realized that hospital-based solutions were not enough.
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And given the sheer scale of India's problems,
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any solution that made a difference had to be scalable,
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accessible to the last woman and child directly in their homes,
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and yet cost-effective and resource-light.
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And then the mobile phone came to India
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and within a few years everyone had a mobile phone.
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There are currently more mobile phones in India than toilets.
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The idea then struck me.
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Why not use a simple technological tool like a mobile phone,
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which is available in almost every Indian household
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to bridge the yawning systemic gaps in health care?
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Maybe we could have simply called Anita weekly
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with critical lifesaving information.
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On the other hand,
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maybe we could have provided mobile-phone-based training
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to the health worker who could have diagnosed Anita's anemia
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in the community itself.
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Thus was born my NGO ARMMAN.
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Our programs, mMitra and Kilkari,
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are free, weekly voice call services.
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They provide preventive information directly to women
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through pregnancy and infancy
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in their chosen time slot and language.
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There are multiple tries for every message,
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a missed-call system,
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and mMitra also has a call center.
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If only Anita had received this service.
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In the second month of pregnancy itself,
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it would have told her about the need to take an iron pill daily
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from the third month of pregnancy.
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When the third month arrived,
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it would have sent her a reminder
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and counseled her on how to take the iron pills.
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For example, the need to avoid tea, coffee to improve the absorption of iron
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and stress on why it is so necessary to prevent anemia.
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Two weeks later,
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it would have spoken about how to tackle the adverse effects of iron pills,
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like constipation.
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If she had any query,
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she could have reached out to our call center staff.
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These are simple voice calls.
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As a typical doctor,
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I expected them to just inform
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and hopefully lead to better health behaviors.
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However, the one unexpected transformational benefit
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that has completely blown my mind is this:
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Information is empowerment.
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Armed with this information,
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women like Anita are upending patriarchal family dynamics,
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challenging entrenched mores
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and demanding care.
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Karnam, the wife of a deeply conservative preacher,
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convinced her husband to adopt family planning
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because mMitra told her
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that spacing between pregnancies is necessary.
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And the change is intergenerational.
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Punita, form a deeply conservative family,
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sent her daughter to an English medium school.
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In addition to the big pictured messages,
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the most underprivileged of women want to know
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when their child will understand color,
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how to ensure psychosocial stimulation of the child,
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when their child will develop fingers in their womb and so on.
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Like any woman would.
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Our services respect that.
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Over 20 million women in over 16 states in India
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have enrolled for these services since 2014.
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This is testament to how easily scalable and replicable these solutions are
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anywhere in the world.
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Similarly, our mHealth-based refresher training program
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for government frontline health workers called Mobile Academy
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has trained over 130,000 health workers in 13 states in India.
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Both Kilkari and Mobile Academy, in collaboration with the government,
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will extend through the country in the next three to five years.
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Our goal is to be able to reach
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over 15 million women and their children every year,
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and that would mean
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over half of the mothers and children born every year
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have the information they need.
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And this massive scale is only possible
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because so many of our partners,
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be it NGOs, hospitals and the government,
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recognize the value of this approach
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and provided the scaffold on which we grew.
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Our quest in the next five years is to adopt multimedia approaches,
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and given the massive amounts of data we have,
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use the power of AI and predictive analytics
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to better serve our mothers and children.
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And our tech platform and the networks we build are nimble.
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When COVID-19 struck,
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lockdown was announced overnight.
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Among the worst affected were the underprivileged women and children
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in the slums of Mumbai and Delhi,
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which were declared as containment zones.
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However, pregnancy and infancy can't wait for a lockdown.
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When there's an emergency like bleeding, care is needed immediately.
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And we were right there and ready.
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We repurposed our tech platform within a matter of days.
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We created a virtual clinic for antenatal pediatric care
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manned by qualified doctors.
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Our call-center staff arranged logistic support, like ambulances.
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We also sent COVID-specific information covering pregnancy and infancy
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to over 300,000 pregnant women and mothers through voice calls.
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But why should you care about our mothers and children?
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The pandemic has made us confront this most implacable of truths.
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A robust primary health care system is an absolute pillar
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of a functioning and efficient society.
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Improvement in maternal and child health
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leads to horizontal development of health systems
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and improved primary health care.
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A village that can look after its mothers and children well
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can look after all other conditions by ripple effect.
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And pregnancy is not a disease.
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Childhood is not an ailment.
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Dying due to natural life event is not acceptable,
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and we know why our mothers and children die.
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Yet we invest so little in preventing their deaths.
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There can be no global progress
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until all our mothers and children do well.
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I implore you to add your voices to ours.
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To amplify this message loud and clear.
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That maternal and child health is a human right.
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Thank you.
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