Annually, India hosts 2.7 crore pregnancies and contributes to 20% of the world’s total number of births. However, we struggle to deliver healthy childhood for our large population of infants.
Despite significant increases in the government allocation for addressing mother and child nutrition (The Integrated Child Development Services allocation tripled from 2007-08 to 2013-14), improvements in children’s health lag the targets set by the Five-year plans as well as the National Population Policy. We have missed our targets for 100 Maternal Mortality Rate (MMR) and Infant Mortality Rate (100 and 30 respectively) by 2010 as well as our under-five mortality targets for the Millennium Development Goals (MDG). Children born in India bear a very high morbidity burden:
We have missed our targets for 100 Maternal Mortality Rate (MMR) and Infant Mortality Rate (100 and 30 respectively) by 2010 as well as our under-five mortality targets for the Millennium Development Goals (MDG). Children born in India bear a very high morbidity burden:
- 21.5% of newborns in the country have LBW (Low Birth Weight) and an estimated 5 lakh children die before the age of five from diarrhea.
- Child malnutrition across India was expected to be at 40% in 2015, well short of the MDG target of 28.6%.
- The evidence clearly indicates that the burden of poor children’s health is distributed across rural and urban communities. 32.7% of urban children under five years of age are underweight and 39.6% are stunted. Childhood mortality indicators among urban poor are higher compared to the urban averages: 72.7 vs 51.9 for the under-5 mortality, 54.6 vs 41.7 for the Infant Mortality Ratio, and 36.8 vs 28.7 for the Neonatal Mortality rate.
Impact of Malnourishment on Life Cycle and Economy
Childhood malnutrition is one of the most common causes of infant suffering. The long-term consequences of chronic malnutrition are far-reaching since the adverse impact in the first 24 months of life by itself is largely irreversible.
The impact of under-nutrition on the girl child has serious inter-generational effects. A stunted young girl is likely to grow to be a stunted adolescent girl and subsequently a stunted woman with increased chances that her children will be born undernourished.
The adverse effects of malnutrition are therefore not limited to children but can have serious implications throughout the life cycle, eventually resulting in adversely affecting the health, education, productivity as well as the economy of the state.
In urban India, 51% of women (15 to 49 years) and 17.7% of men (15 to 49 years) are reported to be anaemic across all states and socio-economic groups.
Physical development and proper nutrition of children are essential for the positive development of cities as they form the future workforce stimulating economic growth. We clearly have to do much more to ensure safer births but also healthier childhoods for our young ones.
Part of the challenge is India’s low healthcare worker ratios. The government deploys over 1.8 million Aanganwadi workers across India and has invested significantly in nearly tripling Aanganwadi centres number from 0.54 million in 2002 to 1.4 million in 2014.
The beneficiaries in the same period have increased from 370,000 to over a million. However, adequate and appropriate training and capacity building of workers at these centres remains an ongoing challenge. Most pregnant women and new mothers in underserved populations do not access much needed health interventions that impact maternal and child health indicators. Anemia rates remain very high, predisposing infants and children to a poor growth trajectory in infancy and childhood.
Urban Migration and State of the Urban Poor
Another challenge is the increasing rate of urbanization in India over the last three decades. The proportion of India’s urban population has increased from 19% in 1971 to 32% in 2011.
Migrants typically have access to more economic opportunities, but not comparable healthcare services. Many mothers and infants in these populations access health and nutrition from multiple sources.
Communication about the importance and sources of nutrition remains sub-optimal due to multiple touch points for these conversations. Cultural norms (many women chose to travel back to their villages for deliveries) also limit the opportunity to create sustained engagement with local healthcare workers.
The Internet and Mobile Access Trends
The telecom revolution in India over the last decade juxtaposes with the health infrastructure and urbanization challenges. Mobile penetration and access has leapfrogged fixed telephony lag. With nearly a billion wireless subscribers, mobile phones are ubiquitous in India, even across the rural landscape.
However, there remains a gender divide in the ownership of mobile phones, with females in India owning only 250 million mobiles. Most women mobile ownership is seen in urban centres (even amongst the poor), in the 14-38 years age group and amongst literate and higher income groups.
Despite these gaps, women ownership of mobile phones has been increasing consistently over the last decade. Anecdotal feedback suggests a proportional rise in the mobile ownership of rural women as well.
Although, a recent GSMA report highlights the gender gap in ownership of mobile phones, particularly in South Asian countries. Indian women lag significantly in ownership as well as usage of mobile phones. This creates some limitations but also opportunities in engaging with women and their families to induce behavior change communication.
The Role of Technology in Delivering Better Healthcare for Children and Mothers
Technology can help accelerate the improvements we need to deliver for healthier childhoods. Broadly, all interventions are directed at improving health seeking behaviors of the consumers (mothers and children) and boosting the ability of the health providers to deliver better (and more targeted) interventions.
Changing behaviors of mothers and young children is vital in these efforts. We know that educating mothers about breast-feeding, nutrition practices, diarrhea management, and regular immunizations can lead to significantly improved health outcomes. Much of this education has been done in the past using health workers or mass media communication tools.
These tools have limitations – the former created huge demands on the time of the Front-line Health Worker (FLHW) and required substantial training to standardize content and delivery. The latter tend to be diffusely targeted.
They are also expensive to scale and are largely push interventions. Most importantly, behavior change does not happen when it’s convenient to push out educational tools but when the target consumer is most ready to receive, absorb and act upon that information.
Mobile based technologies offer the most compelling interface to create widespread behavior change. They provide highly personalized and sustained messaging to the target consumers, allow interactivity, and can be on-demand—all of which are key to influencing behavior change.Technology can help accelerate the improvements we need to deliver for healthier childhoods.Click To Tweet
Several mobile based programs around the world (Aponjon in Bangladesh and mMitra in India) are demonstrating an increase in the uptake of health services when consumers were targeted and educated with specific health information.
Mobile technologies have also boosted the ability of the health workers to provide interventions. Monitoring target populations — pregnant women, new mothers, and sick children is vital to ensure that health workers can intervene in the highest risk cases to prevent morbidity and mortality.
Several mobile-based tools like the Commcare platform have been deployed in dozens of programs that educate and empower health workers to monitor and provide appropriate interventions to target mothers and children. These tools reduce the cost and time of trainings (and retrainings), are scalable and allow health workers to intervene with targeted populations in highly precise ways.
There are millions of Indian children in underserved communities across that suffer from malnutrition and diseases. Mobile technologies offer exciting and viable opportunities to give these children the healthy lives and upbringing they deserve.
Dr. Aakash Ganju is a healthcare consultant and entrepreneur, focused on increasing transparency, access, and convenience to health providers and consumers. He is the CEO of Mirai Health and lives in Mumbai, India.
Forgotten Voices: Save the Children 2015