The call came at 1am. Dr Aparna Hegde rushed to the emergency room. She will never forget what she saw: “A beautiful, frail young woman with the head of a dead baby sticking out of her”.
Aruna , 25, had just about made it to Sion Hospital in the heart of Mumbai for her first delivery after a journey of 30km from a hospital on the city outskirts. Undiagnosed gestational diabetes meant her baby’s body was too large to come out. Three days after that harrowing Friday night of 1996, when Hegde — then a resident doctor — found herself using a needle and twine to join the infant’s body back with its head, Aruna passed away.
“Not only did she die a horrible death, it was preventable,” says Hegde. Aruna was not told about the danger signs and potential complications from gestational diabetes during her first visit to the gynaecologist. She wasn’t told to follow up with regular check-ups either. “If only she had been...” Hegde trails off. That unfinished thought birthed an NGO in 2008.
In a country where an Aruna dies every 20 minutes, ARMMAN (Advancing Reduction In Mortality And Morbidity Of Mothers, Children And Neonates) has been working to ensure pregnant women and mothers seek timely healthcare, and health workers are equipped to provide quality services through timely voice calls and video messaging services.
“Information is empowerment,” says Hegde. “Lack of access to information is the biggest reason for maternal and child mortality in India.” Her 16-year-old NGO now boasts nearly 4 lakh frontline workers across 21 states who have reached more than 5.2 crore women and their children. “The goal is to reach 7 crore women and their children and train 8.5 lakh health workers by 2030,” says the Stanford alumnus.
While a recent UN report says India’s share of global maternal deaths has dropped from 26% in 1990 to 8% in 2020 — a positive fall attributed to women increasingly opting to go to the hospital for delivery — Hegde says it’s not enough.
“In the next one hour, three women will die while giving birth. For every woman who dies, 20 more suffer debilitating morbidity. Two children below five years die every minute. Thirty per cent of children under five are malnourished and 35.5% are stunted. These are not just physical problems, but sociocultural phenomena rooted in gender discrimination,” says the urogynaecologist. While the focus on hospital deliveries has cut down deaths, Hegde says lack of awareness and access to primary maternity care, and lack of training among health workers, leads to systemic deficiencies.
“The experience of antenatal (pre-birth) care in a govt hospital can be very apathetic in urban India,” says Hegde. “In rural India, ASHA workers don’t get an incentive for counselling. They can’t visit homes more than once a month. So, you can’t counsel mothers-to-be when required. Also, since the primary care system does not work very well, you would have women whose cases can be managed by level-two hospitals getting sent to a tertiary hospital, leading to overcrowding.”
Hegde chanced upon the solution in a village in mid2000s Karnataka where she spotted an affirming sight: a villager using a cellphone to tell her employer that she would be late to work.
ARMMAN’s free mobile voice call service, mMitra, was born. It sends targeted preventive care information twice a week to the enrolled women throughout pregnancy and infancy in their chosen language and time. The alerts continue till the child is a year old. And it pays attention to the details as well. For example, while mothers-to-be are told about the importance of taking iron pills in the second month of pregnancy to tackle anaemia, it also advises them on how to take these pills. “Avoid coffee after taking the pill as it reduces the absorption of iron,” warns the voice. Two weeks later, women are also told how to tackle the adverse effects of iron pills. “Women loved it,” recalls Hegde.
Mumbai-based Sonia Gawde received a call from mMitra when she was seven months pregnant with her second child. “Your baby should be kicking by now,” the voice said in Marathi. She felt nothing. Gawde approached her doctor and learned that her foetus had died in the womb. Gawde soon became a ‘sakhi’, a trained community health worker, to enrol women directly in the early stages of pregnancy, at mMitra. She has had a healthy boy since. mMitra’s success would lead to the Union ministry of health and family welfare tying up with ARMMAN for the implementation of a similar mobilebased maternal messaging programme by the govt, called Kilkari, expanding the NGO’s reach. “Kilkari motivated me to become a health worker,” 25-year-old Chhattisgarh-based Puja Verma told ARMMAN’s team recently.
After listening to the calls all through her pregnancy, when this new mother from Raipur district applied to become a frontline health worker, her familiarity with maternal and child health made an impression on the village selection committee. “One aspect I really like about Kilkari is that it focuses on the health and recovery of the mother, too, post-childbirth,” says Sabita Maliful from Odisha’s Nabarangpur district. Mother of a six month-old, Sabita says the calls have guided her on breastfeeding, immunisation, and nutrition after delivery. “Even my husband started listening to the calls,” says Sabita.
“It took me five years to get the first rupee into ARMMAN. I knocked on hundreds of doors. At that point, there was no CSR and the idea of using tech for medical care was alien. Now, of course, post-Covid, it (virtual medical care) seems so obvious, right?” laughs Hedge. “The most underprivileged women want to know when their child will be able to tell colour, when their child will develop fingers in their womb and so on.
Armed with information, women are upending patriarchal family dynamics, challenging entrenched mores, and demanding care.” In Assam, which has India’s highest maternal mortality rate, ASHA worker Lacky Rani is discussing issues like family planning and open defecation with new mothers. “Most women need help in these areas,” says Rani, who attributes her newfound confidence on such uneasy subjects to Dr Anita, a voice on Mobile Academy, a mobile-based govt audio service implemented by ARMMAN.
“The glaring absence of comprehensive guidelines for the management of high-risk pregnancies means that health workers remain largely unaware of when and how to refer women to higher centres for treatment, what counselling to give, and what they need to do when a pregnant woman is referred back from a higher centre,” says Hegde.
Of the 35 “evidence-based guidelines for management of high-risk conditions” prescribed by ARMMAN as part of its programme to train auxiliary nurse midwives (ANMs), medical officers, and specialist doctors in Telangana and Andhra Pradesh, many have recently been drafted into govt policy by the two states.
“With the vast geographical, social, and cultural diversity in India, the interventions have to break the barriers of socio-cultural-politico-economic norms and address existing inequities in society to enhance the decision-making powers for women when it comes to their health,” says Hegde, adding that ARMMAN is now looking to harness AI and predictive analytics to understand the reasons for low listenership and dropouts, and set aside funds to retain them. “We are now focusing on both husband and wife,” says Hegde.
(Know about any such inspiring story? Share it with us at changebeginshere@timesofindia.com)
Aruna , 25, had just about made it to Sion Hospital in the heart of Mumbai for her first delivery after a journey of 30km from a hospital on the city outskirts. Undiagnosed gestational diabetes meant her baby’s body was too large to come out. Three days after that harrowing Friday night of 1996, when Hegde — then a resident doctor — found herself using a needle and twine to join the infant’s body back with its head, Aruna passed away.
“Not only did she die a horrible death, it was preventable,” says Hegde. Aruna was not told about the danger signs and potential complications from gestational diabetes during her first visit to the gynaecologist. She wasn’t told to follow up with regular check-ups either. “If only she had been...” Hegde trails off. That unfinished thought birthed an NGO in 2008.
In a country where an Aruna dies every 20 minutes, ARMMAN (Advancing Reduction In Mortality And Morbidity Of Mothers, Children And Neonates) has been working to ensure pregnant women and mothers seek timely healthcare, and health workers are equipped to provide quality services through timely voice calls and video messaging services.
“Information is empowerment,” says Hegde. “Lack of access to information is the biggest reason for maternal and child mortality in India.” Her 16-year-old NGO now boasts nearly 4 lakh frontline workers across 21 states who have reached more than 5.2 crore women and their children. “The goal is to reach 7 crore women and their children and train 8.5 lakh health workers by 2030,” says the Stanford alumnus.
While a recent UN report says India’s share of global maternal deaths has dropped from 26% in 1990 to 8% in 2020 — a positive fall attributed to women increasingly opting to go to the hospital for delivery — Hegde says it’s not enough.
“In the next one hour, three women will die while giving birth. For every woman who dies, 20 more suffer debilitating morbidity. Two children below five years die every minute. Thirty per cent of children under five are malnourished and 35.5% are stunted. These are not just physical problems, but sociocultural phenomena rooted in gender discrimination,” says the urogynaecologist. While the focus on hospital deliveries has cut down deaths, Hegde says lack of awareness and access to primary maternity care, and lack of training among health workers, leads to systemic deficiencies.
“The experience of antenatal (pre-birth) care in a govt hospital can be very apathetic in urban India,” says Hegde. “In rural India, ASHA workers don’t get an incentive for counselling. They can’t visit homes more than once a month. So, you can’t counsel mothers-to-be when required. Also, since the primary care system does not work very well, you would have women whose cases can be managed by level-two hospitals getting sent to a tertiary hospital, leading to overcrowding.”
Hegde chanced upon the solution in a village in mid2000s Karnataka where she spotted an affirming sight: a villager using a cellphone to tell her employer that she would be late to work.
ARMMAN’s free mobile voice call service, mMitra, was born. It sends targeted preventive care information twice a week to the enrolled women throughout pregnancy and infancy in their chosen language and time. The alerts continue till the child is a year old. And it pays attention to the details as well. For example, while mothers-to-be are told about the importance of taking iron pills in the second month of pregnancy to tackle anaemia, it also advises them on how to take these pills. “Avoid coffee after taking the pill as it reduces the absorption of iron,” warns the voice. Two weeks later, women are also told how to tackle the adverse effects of iron pills. “Women loved it,” recalls Hegde.
Mumbai-based Sonia Gawde received a call from mMitra when she was seven months pregnant with her second child. “Your baby should be kicking by now,” the voice said in Marathi. She felt nothing. Gawde approached her doctor and learned that her foetus had died in the womb. Gawde soon became a ‘sakhi’, a trained community health worker, to enrol women directly in the early stages of pregnancy, at mMitra. She has had a healthy boy since. mMitra’s success would lead to the Union ministry of health and family welfare tying up with ARMMAN for the implementation of a similar mobilebased maternal messaging programme by the govt, called Kilkari, expanding the NGO’s reach. “Kilkari motivated me to become a health worker,” 25-year-old Chhattisgarh-based Puja Verma told ARMMAN’s team recently.
After listening to the calls all through her pregnancy, when this new mother from Raipur district applied to become a frontline health worker, her familiarity with maternal and child health made an impression on the village selection committee. “One aspect I really like about Kilkari is that it focuses on the health and recovery of the mother, too, post-childbirth,” says Sabita Maliful from Odisha’s Nabarangpur district. Mother of a six month-old, Sabita says the calls have guided her on breastfeeding, immunisation, and nutrition after delivery. “Even my husband started listening to the calls,” says Sabita.
“It took me five years to get the first rupee into ARMMAN. I knocked on hundreds of doors. At that point, there was no CSR and the idea of using tech for medical care was alien. Now, of course, post-Covid, it (virtual medical care) seems so obvious, right?” laughs Hedge. “The most underprivileged women want to know when their child will be able to tell colour, when their child will develop fingers in their womb and so on.
Armed with information, women are upending patriarchal family dynamics, challenging entrenched mores, and demanding care.” In Assam, which has India’s highest maternal mortality rate, ASHA worker Lacky Rani is discussing issues like family planning and open defecation with new mothers. “Most women need help in these areas,” says Rani, who attributes her newfound confidence on such uneasy subjects to Dr Anita, a voice on Mobile Academy, a mobile-based govt audio service implemented by ARMMAN.
“The glaring absence of comprehensive guidelines for the management of high-risk pregnancies means that health workers remain largely unaware of when and how to refer women to higher centres for treatment, what counselling to give, and what they need to do when a pregnant woman is referred back from a higher centre,” says Hegde.
Of the 35 “evidence-based guidelines for management of high-risk conditions” prescribed by ARMMAN as part of its programme to train auxiliary nurse midwives (ANMs), medical officers, and specialist doctors in Telangana and Andhra Pradesh, many have recently been drafted into govt policy by the two states.
“With the vast geographical, social, and cultural diversity in India, the interventions have to break the barriers of socio-cultural-politico-economic norms and address existing inequities in society to enhance the decision-making powers for women when it comes to their health,” says Hegde, adding that ARMMAN is now looking to harness AI and predictive analytics to understand the reasons for low listenership and dropouts, and set aside funds to retain them. “We are now focusing on both husband and wife,” says Hegde.
(Know about any such inspiring story? Share it with us at changebeginshere@timesofindia.com)
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