This post is one in a series of five that explores the themes generated by a panel of global experts — who discussed the need for, barriers to, and the way forward for maternal and newborn health integration — at Putting Mothers and Babies First: Benefits Across a Lifetime, an event at The Forum at Harvard T.H. Chan School of Public Health on February 26th, 2015.
When the idea of MAMA was in its infancy it was always about maternal, newborn and child health (MNCH), because we knew that they go hand in hand. If a woman’s pregnancy isn’t healthy then chances are her baby, and ultimately her growing child, won’t be either. That’s why we worked with BabyCenter and other MNCH experts to create a set of core health messages that adhere to global best practices, designing them to be sent two to three times a week to cover a woman’s pregnancy all the way through her child’s third year of life.
We prioritize the geographic areas we go into based on two main factors: existing MNCH needs and current mobile penetration. Once location is decided, we work with local partners to help customize the core MAMA message set for local language and cultural context. This allows us to integrate key drivers for maternal and infant mortality for the specific area and address factors like myths around child birth and other relevant customs in a way that will best resonate with the women we serve.
From the beginning, MAMA provides a continuum of information that expecting and new mothers need to know to keep themselves and their babies healthy, all timed and targeted for exactly where the woman is in her pregnancy or her child is in his or her development. Our messages talk about saving for transportation costs to the clinic for check-ups and birth, having a trained birth attendant if a clinic birth isn’t a possibility, nutrition information for mom and baby, and cognitive development as the child gets older. So even in the absence of a functioning health system, a woman can make the best decisions for herself and her child.
As we dig into a new geographic area, MAMA learns as much as it can about what impacts maternal, newborn and child health so we can be as proactive and responsive as possible. For example, in South Africa where the rate of HIV and AIDS are much higher than other countries where we work, we developed a complement of messages around preventing HIV transmission from mother to child. When a woman signs up for the MAMA messages, we don’t ask about her HIV status, but rather give her the opportunity to opt in to HIV related content. In Bangladesh where husbands and mothers-in-law have a huge impact on the care of mothers and babies, we developed messages addressed specifically to them. We also make content available as voice messages given the high rate of illiteracy there.
Through our work we’ve come to understand the importance of designing programs that are focused and appropriate for the mother and do our best not to make any assumptions. For example, a lot of people assume that everyone has a phone and has access to the internet, but that’s not always true. We must know who the woman is, in what context she lives and the realities of her world if we are going to truly be able to have an impact on her and her baby’s health.
In getting our four country programs off the ground – Bangladesh, South Africa, India and Nigeria – we’ve overcome a lot of challenges. From creating the right tech platforms to engaging the right global and local partners, we’ve learned valuable lessons that have helped us reach more than 2 million women and families with health information that is changing key health behaviors, including adherence to recommended pre- and postnatal care visits, exclusive breastfeeding and recommended vaccinations.
Now that we have proven that we can scale and have impact, our biggest challenge is securing flexible funding that will allow us to iterate as we go along. This work doesn’t happen overnight and each context is different, two factors that don’t always fit with a funding partner’s specific requirements. As a public/private partnership that harnesses the strengths and resources across the NGO, government, technology and corporate sectors, our solutions work best when they can adapt to a changing environment and be empowered to make decisions based on new information, just like the mothers and babies we are here to help.
Photo: Sharon learned about the MAMA program during one of her routine check-ups at the Wits Reproductive Health Clinic in South Africa and began receiving the MAMA messages when she was several months pregnant with her second child. After a very difficult first pregnancy that left Sharon hospitalized and afraid for her survival, the information she received twice a week was a huge help to her and her husband, Frank. Sharon and Frank credit MAMA with helping them understand everything from what foods to eat for a healthy pregnancy, when she should seek help from a trained health worker to how best to treat an eye infection her baby caught. They also helped Frank understand what he could do to make things easier for Sharon and now he helps more with cooking, cleaning and other household duties. Having moved from her homeland, Malawi, to Johannesburg, South Africa, Sharon says the MAMA messages are like a second mother who’s always there to support her. Copyright 2015. Photograph courtesy Mobile Alliance for Maternal Action, photo by Karin Schermbrucker.
This post originally appeared on the blog for MAMA.