How to pronounce "nimble"

[SHAPE YOUR FUTURE]

Anita died in my presence while giving birth to life.

She bled to death and lost her child.

The irony was that she had access to care.

In the first trimester of pregnancy,

she had visited the antenatal clinic of the hospital in Mumbai

where I was doing residency.

But over four hours of waiting in the hot, sweaty,

dingy, overcrowded clinic

just to get a minute with me,

a harried, overworked resident doctor,

meant that she never came back,

only to die in labor months later.

I was wracked with guilt.

If only I had counseled her about the danger signs,

why she needed to access regular care.

Would she and her child have survived?

She did not die due to a terminal condition.

She died because of underlying anemia,

an easily treatable, preventable condition.

I saw these stories daily.

Systemic, preventable problems resulting in mothers and children dying

in the most unjust of circumstances.

In the next one hour,

three women will die while giving birth somewhere in India.

Two children under age five die every minute in India.

I am a practicing urogynecologist,

but very early in my medical training,

I realized that hospital-based solutions were not enough.

And given the sheer scale of India's problems,

any solution that made a difference had to be scalable,

accessible to the last woman and child directly in their homes,

and yet cost-effective and resource-light.

And then the mobile phone came to India

and within a few years everyone had a mobile phone.

There are currently more mobile phones in India than toilets.

The idea then struck me.

Why not use a simple technological tool like a mobile phone,

which is available in almost every Indian household

to bridge the yawning systemic gaps in health care?

Maybe we could have simply called Anita weekly

with critical lifesaving information.

On the other hand,

maybe we could have provided mobile-phone-based training

to the health worker who could have diagnosed Anita's anemia

in the community itself.

Thus was born my NGO ARMMAN.

Our programs, mMitra and Kilkari,

are free, weekly voice call services.

They provide preventive information directly to women

through pregnancy and infancy

in their chosen time slot and language.

There are multiple tries for every message,

a missed-call system,

and mMitra also has a call center.

If only Anita had received this service.

In the second month of pregnancy itself,

it would have told her about the need to take an iron pill daily

from the third month of pregnancy.

When the third month arrived,

it would have sent her a reminder

and counseled her on how to take the iron pills.

For example, the need to avoid tea, coffee to improve the absorption of iron

and stress on why it is so necessary to prevent anemia.

Two weeks later,

it would have spoken about how to tackle the adverse effects of iron pills,

like constipation.

If she had any query,

she could have reached out to our call center staff.

These are simple voice calls.

As a typical doctor,

I expected them to just inform

and hopefully lead to better health behaviors.

However, the one unexpected transformational benefit

that has completely blown my mind is this:

Information is empowerment.

Armed with this information,

women like Anita are upending patriarchal family dynamics,

challenging entrenched mores

and demanding care.

Karnam, the wife of a deeply conservative preacher,

convinced her husband to adopt family planning

because mMitra told her

that spacing between pregnancies is necessary.

And the change is intergenerational.

Punita, form a deeply conservative family,

sent her daughter to an English medium school.

In addition to the big pictured messages,

the most underprivileged of women want to know

when their child will understand color,

how to ensure psychosocial stimulation of the child,

when their child will develop fingers in their womb and so on.

Like any woman would.

Our services respect that.

Over 20 million women in over 16 states in India

have enrolled for these services since 2014.

This is testament to how easily scalable and replicable these solutions are

anywhere in the world.

Similarly, our mHealth-based refresher training program

for government frontline health workers called Mobile Academy

has trained over 130,000 health workers in 13 states in India.

Both Kilkari and Mobile Academy, in collaboration with the government,

will extend through the country in the next three to five years.

Our goal is to be able to reach

over 15 million women and their children every year,

and that would mean

over half of the mothers and children born every year

have the information they need.

And this massive scale is only possible

because so many of our partners,

be it NGOs, hospitals and the government,

recognize the value of this approach

and provided the scaffold on which we grew.

Our quest in the next five years is to adopt multimedia approaches,

and given the massive amounts of data we have,

use the power of AI and predictive analytics

to better serve our mothers and children.

And our tech platform and the networks we build are nimble.

When COVID-19 struck,

lockdown was announced overnight.

Among the worst affected were the underprivileged women and children

in the slums of Mumbai and Delhi,

which were declared as containment zones.

However, pregnancy and infancy can't wait for a lockdown.

When there's an emergency like bleeding, care is needed immediately.

And we were right there and ready.

We repurposed our tech platform within a matter of days.

We created a virtual clinic for antenatal pediatric care

manned by qualified doctors.

Our call-center staff arranged logistic support, like ambulances.

We also sent COVID-specific information covering pregnancy and infancy

to over 300,000 pregnant women and mothers through voice calls.

But why should you care about our mothers and children?

The pandemic has made us confront this most implacable of truths.

A robust primary health care system is an absolute pillar

of a functioning and efficient society.

Improvement in maternal and child health

leads to horizontal development of health systems

and improved primary health care.

A village that can look after its mothers and children well

can look after all other conditions by ripple effect.

And pregnancy is not a disease.

Childhood is not an ailment.

Dying due to natural life event is not acceptable,

and we know why our mothers and children die.

Yet we invest so little in preventing their deaths.

There can be no global progress

until all our mothers and children do well.

I implore you to add your voices to ours.

To amplify this message loud and clear.

That maternal and child health is a human right.

Thank you.