Here in the U.S. pregnant women focus, sometimes obsessively, on diet, nutrition and prenatal vitamins -- and debate about use of epidurals or C-section rates. But in the developing world, getting just the most basic information to pregnant women and new mothers has been a monumental task, and that lack of information contributes to high mortality rates.
Every day about 800 women in the developing world die during pregnancy or childbirth and more than 3 million newborns die of preventable illnesses every year, Kristen Gagnaire told me recently. She was in San Francisco spreading the word about MAMA, the Mobile Alliance for Maternal Action. Gagnaire is MAMA's global director and a firm believer in the power of education to make a difference. She's working to get information out to help save lives via a surprisingly simple platform: the mobile phone.
MAMA is a global public-private partnership launched two years ago by former Secretary of State Hillary Clinton. USAID, Johnson & Johnson and the U.N. Foundation are all involved. And so is San Francisco's BabyCenter (a division of Johnson & Johnson) where we met, along with Colleen Hancock, BabyCenter's global chief operating officer. On its website BabyCenter says one its main areas is to provide "expert advice" about pregnancy, childbirth, babies, toddlers and more. It is a trusted source for women in the U.S. and other western countries.
The idea was to adapt the BabyCenter model for cultures in the developing world and send out text messages to give women "critical health information about how to take care of themselves, how to give care to their babies and when and how to seek help" from trained health care providers, Gagnaire said.
"The fetus develops in the same way in a mother, whether she's in Zambia or she's in California or she's in the UK," added Hancock. According to MAMA's website, the messages are developed around evidence-based key health behaviors and interventions that can improve health outcomes.
Gagnaire said that across the developing world about 1 billion women have access to mobile phones -- either their own or phones they share. Deploying text messages can have a "major impact," Gagnaire said, which they are in the process of measuring. They also provide the messages by voicemail for people who may not be able to read.
Bangladesh was one of the first countries to participate in the program, called Aponjon locally. In this short video, a mother describes how much she has learned.
In the video, the young mother said she signed up for the service when she had her second child. She said there's so much she hadn't known with her first child, including the fact that breast milk was all the food her baby would need for the first six months.
The program also pays attention to local culture. In Bangladesh, when a woman marries, she and her husband usually live with his mother. The mother-in-law is a powerful figure in the family unit, so there is a set of messages just for mothers-in-law. Gagnaire told the story of a new mother whose mother-in-law said that breast-feeding was not sufficient for the baby. Often women are told to feed their babies honey. "(The mother) showed her mother-in-law the message that talked about exclusive breast-feeding," Gagnaire said, "and then the mother-in-law said, 'OK, you can keep breast-feeding.'"
One text message focuses on care of the newborn baby's umbilical cord. Here's a sample text message: "A cord infection can make your baby very ill. Sponge the cord with clean water and leave it uncovered to dry. It needs nothing else." It turns out that many mothers mistakenly believe they should put oil on the cord but that can lead to infection. Gagnaire said many newborn deaths are the result of these kinds of easily avoided infections.
"If we can prevent those either because a mother understands that she shouldn't put oil" on the umbilical cord or another message tells her the signs of infection and how critical immediate care is, "then those infections can be eliminated rather quickly. If they go uncared for, the baby will die," Gagnaire said.
But the most powerful text message, she said, is the one that tells new mothers to make eye contact with their babies. BabyCenter's Hancock pointed out that "in many cultures people don't make eye contact for a variety of reasons, not the least of which is that [the baby] might die."
More than 100,000 women have signed up for the program in Bangladesh -- and another 200,000 people in 35 countries from Afghanistan to Zambia are enrolled through local partner programs. Growth has been "exponential," Gagnaire said, and they ultimately hope to reach 20 million women.