Over the last few years, there has been an explosion in the use of mobile technology in healthcare, and maternal health is no exception. At the beginning of this month, The Guardian wrote an article about the use of WhatsApp and SMS being used to save the lives of babies (although the title should have mentioned that it is being used to save the lives of mothers), highlighting the Kenyan maternity provider Jacaranda Health in particular. Jacaranda Health uses WhatsApp and SMS to remind mothers of their antenatal appointments, alert mothers on danger signs, and uses WhatsApp to create support groups for mothers that cannot attend in person. This type of intervention has resulted in better knowledge, meaning mothers will go to a health center if they recognize danger signs. Jacaranda are now looking to create a chat service to better meet the needs of women in order to escalate emergencies quicker.
Jacaranda Health is one example of many companies using mobile technology to improve maternal health. The World Bank has stated that mobile applications can lower costs, improve quality of healthcare and shift behavior to strengthen prevention. There is also the benefit of empowerment as mobile technology is more patient centered and gives patients health information in their hands. However, mobile technologies can also lead to inequities when the mobile phone owner is not necessarily the one that needs the help. This is particularly the case for mobile technologies aimed at women. Motech, a maternal, newborn and child platform launched by the Grameen Foundation with the support of the Bill and Melinda Gates Foundation in India and Ghana, showed that women themselves didn’t tend to own a phone and had to rely on their husband’s or neighbor’s phone. This created difficulties in accessing the health information and it gave men the chance to filter messages. Women also said that their partners didn’t like women operating the phone without their permission. With some mobile health programs, there is a charge for the messages, and so women felt that because their husbands didn’t understand why they needed mobile healthcare, they were not willing to pay for the messages. Gendered access to technology will need significant consideration in the scaling up of mobile technology.
The use of mobile health however is not only of benefit to developing regions of the world. Right now, the US healthcare system is currently failing pregnant and postpartum women. A recent article in STAT explained how women are dying in the US due to ‘broader failures of social support’ - not seeking timely care, not following medication plans, have poor family support, and are victims of all sorts of abuse. The potential benefits of mobile health are huge here, and can be a source of support for women that have been missed by the health system. This is only going to be more important as rural OB centers shut down. There are companies in the US that are using mobile technology to improve obstetric care such as Babyscripts in Washington DC, who are also realizing the importance of extending the platform into the postpartum period. Mobile technology can be of use here – it can be a platform where women are heard, women are monitored, and women are supported.
The BiliDx is a novel system for diagnosing jaundice. The device uniquely meets the Target Product Profile (TPP) developed as part of the NEST 360 initiative in that it allows blood-based testing at the bedside. This initiative is part of an emerging global consensus in the Every Newborn Action Plan that countries need functional WHO level-2 inpatient units to care for "small and sick newborns."
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.