Posted by Rob Knies

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India has one of the highest maternal mortality rates in the world. The nation also has a staggeringly high child mortality rate—about 46 of every thousand births result in death.

It doesn’t have to be that way. Anemia during pregnancy plays a major contributory role in such cases—87 percent of pregnant Indians are anemic, and anemia is connected to 40 percent of the maternal deaths. The most common cause for anemia is a lack of healthy iron levels in the mother’s diet, but even though that shortcoming can be abated via iron supplements and many governmental hospitals freely distribute iron tablets, Indian women rarely complete the course of medication.

Bill Thies and his collaborators at Microsoft Research India, the nonprofit Armman, and Sion Hospital are determined to change things, as he will make clear Dec. 4 during the fourth annual mHealth Summit, being held Dec. 3-5 in National Harbor, Md., just outside Washington, D.C.

“We’re trying to address this problem with a series of timely voice-call reminders and motivational messages,” Thies says, “delivered in a medium that pregnant women easily can understand and from a person they trust, recorded in the voice of their personal doctor.

“We hope that, in response to these messages, women will increase their consumption of iron supplements and that this leads to a healthier pregnancy and delivery—and a healthier child.”

Thies’ efforts, part of Microsoft Research India’s Technology for Emerging Markets (TEM) explorations, is outlined in Automatic Voice Calls to Improve Adherence to Iron Supplementation During Pregnancy: A Pilot Study in Urban India.

The project aimed to assess the potential for automated voice calls to improve pregnant women’s dedication to taking iron supplements, with a focus on low-income, urban Indians with a low level of literacy. Previous research demonstrated that text reminders can improve the use of such medications, but the text approach doesn’t meet the needs of the target population.

The TEM team conducted a small-scale, controlled trial involving 87 women randomly assigned to control and treatment groups. Participants had an average of eight years of education and a household income of $1,500 per year.

Members of both groups received initial counseling and a free, one-month supply of iron supplements. In addition, the treatment group got automated phone calls sent to their mobile phones three times per week. Each message lasted for just 30 seconds, was customized to the individual’s stage of pregnancy, and was delivered by the doctor the participant met during the initial counseling.

Results showed that the treatment group did achieve a higher level of adherence to the iron supplements than did the control group, though, because of a limited sample size, the results were not statistically significant. The conclusion was that automated voice calls could hold promise for combating anemia in low-income pregnant women. Plans are under way to replicate the study on a larger scale.

While the project aims specifically at helping pregnant women avoid illness, there are larger research goals at stake.

“We are witnessing a global transformation whereby many of those living in extreme poverty are also gaining access to technology, in the forms of mobile phones,” Thies says. “Our research agenda is to see how this newfound access can be leveraged to address key challenges in health, education, and socioeconomic development.

“Our inspiration is to discover simple interventions that have a large impact on end users and then to disseminate and replicate those solutions in partnership with nongovernmental organizations, governments, and other stakeholders in order to have a large-scale impact.”

The pursuit continues, with the goals of expanding and improving the proposed service by encompassing more patients, by recording enhanced messages, and by improving access to medication.

“We are in conversations with several partners regarding scaling up this solution,” Thies concludes. “There is excitement from both nonprofit and government offices in providing informational voice messages to pregnant women across whole states in India.”