With literacy statistics still far from perfect across the country, and unavailability of highly qualified gynecologists in rural and peri-urban areas, many expectant mothers are likely to have little or no access to key healthcare information needed for a safe pregnancy.
While conventional wisdom remains helpful, it cannot be relied upon to substitute for scientifically verified information about food to be eaten or avoided and the type of nutritional supplements required, or about the right time to get an ultrasound examination and visit a doctor for prenatal check-ups.
In its 2018 report, the United Nations Children’s Fund (UNICEF) stated that chances of survival of babies born in Pakistan were the lowest in the world, with one in every 22 newborns likely to die. Complications after childbirth like the postpartum hemorrhage (PPH) contribute to the death of 178 out of every 100,000 women in Pakistan every year.
Many of these deaths can be prevented if timely information is provided to families with expectant mothers. With this objective in mind, researchers at the Information Technology University (ITU) have developed a telephone-based helpline that departs from existing information services like the Punjab Healthline (0800-99000) in targeting husbands and mothers-in-law of expectant mothers.
Field interviews conducted by Sacha Ahmad, the project lead, and her six-member team suggested that there was little demand for information about maternity care amongst men. “It was not only that men didn’t know what was going on with their wives’ pregnancy or how it was progressing, but they were also completely uninterested in finding out about it. Yeh tou aurato ka kaam hai (This concerns women, not me) was the response we used to get. Some men even used to get slightly offended and asked us to talk to their mothers or wives instead,” Ahmad recalls.
However, she and her team proceeded with the plan, knowing that in the patriarchal context in which they were operating, it was men and their mothers who controlled household finances. “Convincing them to get involved in pregnancy-related care is going to be crucial to efforts targeted at improving maternal and infant mortality statistics,” she says.
Ahmad says that she had first explored the idea of such a helpline during the International Development Design Summit (IDDS) Lahore held in 2016. After working on the project at the summit, most of the team members moved on to other projects but Ahmad decided to continue and see it come to fruition. Moving from the Lahore University of Management Sciences (LUMS) to ITU, she started looking for funding and support for the project in the hope that it might eventually lead to a better outcome for everyone.
With the help of the UNICEF Innovation Fund and the mentorship of Dr. Agha Ali Raza, an assistant professor at ITU, she and her new research team set about building the helpline. At the time, she remembers, the team received a lot of criticism about their ‘impractical’ solution. “We were told that informational hotlines have a high failure rate,” she says.
When the team launched its interactive voice response (IVR) service called Super Abbu, their biggest challenge was to not only convince people to try out the service but also to make sure that they remained engaged long enough to absorb some useful information about infant and maternal health. “We thought that if we are able to bring people to this point, then we would consider our project to be a success,” says Dr. Raza.
To use the hotline, anyone can place a call at 0423-890-0800. The call gets rejected at no cost to the caller. Then the IVR calls you back and presents you with options: i) ask ‘Dr. Saba’, a fictional female persona, a question; ii) listen to recorded maternal health advice from parents and experiences relating to pregnancy; and iii) submit feedback.
The highlight of the hotline is the ‘Q&A with Dr. Saba’, where users are able to record questions that get forwarded by content moderators to a panel of 20 volunteer doctors from Lahore’s Ghurki Trust Teaching Hospital, Services Hospital and Lady Wellington Hospital through a smartphone app. The doctors answer the questions in the form of audio or written text and send them back to the administrator, the answer is recorded by a voice artist and then a call goes out to the person who asked the question and they are able to listen to the answer.
During the two months since its launch, the hotline has received 39,487 calls from 21,568 unique users. “To our surprise, 87 percent of users who recorded questions were men and only 13 percent were women,” says Dr. Raza, “Most of the feedback we received was also positive, with only 11 percent being negative.”
“We found out that people are really interested in this concept of telemedicine. The main benefit has been that all the relevant information is available on a hotline that ordinary people can access while sitting at home,” notes Dr. Raza.
“We got feedback from our users saying that they feel respected because ‘Dr. Saba’ is taking out time to listen to their medical ailments,” adds Ahmad. “They also feel like they are given importance, which you may not always get at public hospitals.”
“The doctors have very clear instructions to not only answer the questions that they have but to also give four to five extra pieces of information related to the question. That’s our opportunity to increase the callers’ knowledge around maternal and neonatal health issues,” she says.
Through the project, the team also ended up learning about many myths prevalent in Pakistani society. For example, a question came to them asking whether boys should be breast fed more as compared to girls. The team plans on conveying correct information related to these myths to women health workers employed across the country with provincial governments so that they can educate families accordingly.
“Maternal and child health is an important issue in Pakistan and we want to work towards improving it,” says Dr. Umar Saif, the ITU vice chancellor. “We are currently in talks to make Super Abbu a part of the Punjab Health Line where it will soon be available as one of the menu options.”