This fall, through to May 11th 2019, the Gates Foundation’s Discovery Center is presenting ‘Design with the 90%’, an exhibition featuring design projects that address challenges faced by marginalized communities around the world. The exhibition features innovative, low-cost design responses to the needs of underserved communities. 26 projects were chosen, ranging from interventions that help people access clean water to educating children. Out of all of these amazing innovations, there is one, that we at Maternova are particularly excited about and proud to be connected to – an innovation called ‘Heart strings’ developed by Mother Health International.

Heart Strings is the plural for a Heart String, which is a color-coded bracelet allowing birth attendants who cannot read or write to monitor the fetal heart rate in pregnant women. Whilst birth attendants are listening to the fetal heart rate, a bead is pressed each time they hear a beat. After fifteen seconds, the bracelet is looked at by the attendant, whereby the color pattern determined by the heart beats will guide the attendant in assessing whether the heart rate is normal or not. For example, if the attendant is in the white section, the fetal heart rate is too slow, whilst green represents normal, and red is too high. The fetal heart rate is an indicator for fetal distress, and therefore can guide decisions during labour and delivery. The bracelet gives illiterate attendants some knowledge and ability to risk stratify mothers, a fundamental concept in obstetric care.

The best part of Heart Strings is that it can be used now and by any birth attendant. Every day thousands of mothers and their fetuses die due to complications in labor and delivery. One response to ensure safer deliveries is to send attendants to school to become qualified midwives. Although in the long term there will be workforce gains, women need care today. Their fetuses need monitoring today. When taking into account today’s need, we cannot wait for nurse midwives to finish school.  We have to make use of the birth attendants that are present, and have to try and provide them with the equipment and knowledge to make births safer.  Birth attendants, who are trusted by their communities, can now have some way of determining which mothers will require extra care and/or should be transferred somewhere safer. The fetal heart rate is one of the first things to change when the fetus is distressed, and so Heart Strings can allow attendants to make vital decisions at an earlier stage, potentially saving many lives.

Heart Strings’ birthplace is in Uganda. There, strings cost approximately $1 to make. Mother Health International has made sure that Heart Strings, as a tool, integrates into everyday maternal healthcare. The counting method is based on Ugandan methods of counting the days of the moon, a method that will be accepted by traditional midwives. The bracelet can also be carried/worn, anytime and anywhere. It is not expensive to scale up and no other complex technology is required. Preserving traditional practices is important in Uganda. Heart Strings, therefore, integrates easily.

For more information about Health Strings, visit the Gates Foundation’s Discovery center, or Mother Health International, or contact us at Maternova. We are selling bracelets to small and large organizations globally, and are eager to get these new interventions to the communities and individuals that need it the most.


By Shreya Patel

Photo credit: US Army Africa

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