The Surprising Tech Saving Pregnant Women’s Lives In Sub-Saharan Africa

Dr Farouk Jega remembers his training at a major Nigerian maternity hospital. “On the backs of trucks, women arrived in absolute crisis, having suffered extreme complications giving birth alone at home. Others had it even worse. Weak and bleeding, they travelled for hours on rickshaws, pulled by mules and camels, to reach a doctor who could save their lives.” Every day, over 800 women die from complications during pregnancy or childbirth. Most of these deaths occur in developing countries. While the maternal mortality rate has dropped in recent years – globally, mothers are 42% less likely to die from complications during pregnancy than in 1995 - there are parts of the world where the figures remain obstinately high, like in Nigeria which alone accounts for around 14% of the world’s maternal deaths every year. Angered by seeing mothers needlessly die in labour, Dr Jega joined Pathfinder International, an international development organisation spearheading the use of mobile phone technology to save women’s lives in countries where being pregnant stands a high risk of killing them. In the developing world, somewhere between 80 and 90% of people have access to a mobile phone. Pathfinder is using that knowledge to better look after pregnant women, and challenge the misconceptions over what is a normal birth. “People are ignorant, they’ll say voodoo is to blame for women bleeding or sepsis,” said Dr Jega of some of the challenges in Nigeria. Here, 150 community health workers and midwives have been trained to use an app called Commcare, which allows them to track the health of their mums-to-be and tailor health services to them. Texts are sent to women telling them when their next appointment is, and the health worker can see if they attended and what happened.

The data is collected centrally, so that if they do encounter complications, the healthcare facility has the right information to treat them. Through this technology, birth plans for over 42,000 mothers have been written. Because monitoring is haphazard, there would be little chance otherwise of a hospital or clinic in an emergency situation knowing what a mother’s pregnancy had been like. But the chance of a woman turning up at a clinic to give birth is pretty minimal. In Nigeria, there is a strong preference for giving birth at home, partly because of costs of healthcare and the distances that often need to be travelled, but also because that’s the tradition, and it’s proving hard to change. Nearly a third of women give birth at home, with no skilled birth attendant on hand.

It’s vital that women stay connected to their health worker during pregnancy, so any potential complications are monitored. If a woman bled heavily during a previous birth, a routine drug can be made available to take during labour to prevent postpartum haemorrhage, a key cause of maternal death. It’s hoped more women, if armed with knowledge that their labour may be complicated, will eventually access clinics to give birth. Plans are underway for an emergency transport and payment system for pregnant women and women who've recently given birth. If there are any danger signs, she or someone around her can call a free phone number. The system dispatches a taxi or ambulance to take her to the nearest hospital, or if there are some weeks left of the pregnancy, to a clinic where they can be looked after. The driver is paid through a mobile money app, which is an incentive, as they know the money is safely theirs.

The aim of all these mobile technology initiatives is to arm mothers with information and access to better healthcare. Soon to be rolled out across Nigeria by a partnership that includes Pathfinder, is another messaging service run by the Mobile Alliance for Maternal Action (MAMA), already being used in Bangladesh, India and South Africa. MAMA’s service sends pregnant women texts and voicemails telling them what sort of changes they should be experiencing according to what month of pregnancy they’re in, advice on nutrition and on how to look after their baby up to the age of one. “When you’re pregnant, every woman needs a mother around so you can ask what you don't know,” says Sharon Makumba, a mother of two who felt she didn’t have anyone to talk to for advice, since like so many women in South Africa, she had no mother of her own. She believes that it was being signed up to MAMA that made her second pregnancy so much safer than her first, which ended in serious complications. As mothers often don’t have decision-making powers over their own births, influencing the people who do is important. “We’ve heard that husbands and mother-in-laws have changed their attitudes because of the information received, like not making the mother collect water. These are big cultural shifts,” said Kirsten Gagnaire, MAMA’s Executive Director.

It changed things around the house for Makumba: “I would show the messages to my husband and saw a change that I never expected. I’d find he had prepared the food already, and that he had cleaned, I was so impressed.” The key to the success of initiatives like this partly lies in the willingness of national governments to raise the standard of maternal care. In Nigeria, horror stories abound even in private hospitals. This was brought into sharp focus late last year when a well-known dancer and choreographer called Kemi Omotoyinbo, died in childbirth after her husband was unable to raise the deposit needed for an emergency caesarean. One of his aims, said Dr Jega, was for clinics to be better held to account for the care they provide. They send mothers information on what to expect from their health visits, and have designed an online questionnaire for mothers to fill in, on their phones, after they’ve attended an appointment. In South Africa, the government has adopted MAMA’s service and rolled it out nationally, despite concerns over costs, since not all mobile providers wanted to offer discounted rates on texts. "It was difficult to make the argument to government officials that they should invest in sending messages rather than purchase a vaccine or a stethoscope," Kirsten said.

A sustained attack on the high rates of maternal and infant mortality also needs to come from a long-term commitment by the international development community. Kirsten told me that MAMA’s funding from key donors USAID and Johnson & Johnson wasn’t to be extended from next year as they pursued “different priorities”. The programmes are safe where MAMA already operates, but they wouldn't be expanding to new countries or able to lobby for new funding. She and most of her central staff, with all their knowledge, were out of a job.

Despite Kirsten’s funders’ believing hers was a successful pilot and wanting to move on to the next, she feels there is a lot more that needs to be done. “There is such a huge lack of information, from mothers, from mother-in-laws, from other women in the community. All the issues still persist.” In Nigeria, Dr Jega agrees that MAMA’s messaging service is vital. “Despite interventions, we’ve seen little preference to giving birth at home. This gives them women information about what is normal. Excessive bleeding after birth isn’t normal and convulsions during birth aren’t normal. The mobile messaging tells them what is normal.”