Keeping pace with the technological advancements, ARMMAN has sharpened its focus on innovation, using Artificial Intelligence (AI) and the WhatsApp platform to enhance the effectiveness of our interventions. Amrita Mahale, Director, Product & Innovation, ARMMAN, shares her experiences of meeting women while trying to understand the role mobile phones play in helping navigate the socio-economic environment that they live in.
Stories from the field
Tabassum*, 21, was five months pregnant when we visited her home in a village on the outskirts of Ranchi. We met with Tabassum to understand her experience of using the Kilkari service on WhatsApp as a pilot participant. Tabassum got pregnant for the first time within months of getting married. Superstitions around revealing the pregnancy early made her family pressure her to not register her pregnancy or discuss it with the Accredited Social Health Activist (ASHA**) worker, or even see a doctor. In the third month, she suffered a miscarriage which left her shattered, but a month later, she was pregnant again. This time, she insisted on informing the ASHA and getting her pregnancy registered, and making sure that she did not miss a single antenatal check-up. She also subscribed to the Kilkari*** service on WhatsApp, so that she could get timely information about how to look after herself better during pregnancy. Encouraged by the Kilkari messages, she made changes to her diet, including replacing junk foods with healthy fruits. In her fourth month, a health complication forced her to return to her parents’ home for a few weeks so she could get ample rest. Her husband damaged his phone just before she left, and she was forced to hand over her smartphone to him. While she did not have the power in the household to insist on keeping her own phone with her, she had the presence of mind – and sense of agency – to insist that her husband forward the Kilkari messages to her aunt’s phone so she would continue to receive the preventive care information that she had come to trust and enjoy.
Living just a few kilometres away from Tabassum, Swati*, 30, enrolled for the Kilkari WhatsApp service in the early months of her fifth pregnancy. Married at the age of 13 years, Swati has two teenage daughters and a younger son. She has owned a smartphone for the past couple of years, but admitted that it was primarily used by her eldest daughter for schoolwork. Her daughter had tried to teach her how to use WhatsApp, but without much success. “I am too old to learn new things now. My brain can’t take the load,” she said. As someone who cares deeply about personal agency and has often reflected on the importance of a growth mindset, I was pained by her words.
Crucial role of a health worker
Swati’s story, however, has a slim silver lining.
It was her ASHA who convinced her to sign up for the Kilkari service on WhatsApp, inspite of Swati’s insistence that having gone through multiple pregnancies, the messages will not provide her any new information. She saw the first few videos half-heartedly, but realised soon that there were gaps in her knowledge for which the videos were helpful. Her daughter responded to the first quiz on WhatsApp; Swati eagerly answered the remaining questions. A video on the importance of rest and exercise even gave her the confidence to tell her family that she would put her chores aside to rest for an hour or two in the afternoon. I would like to believe that this confidence will spill over to other parts of her life.
Smartphones are bringing a quiet revolution to the lives of women like Tabassum and Swati. A smartphone can be a gateway to better educational opportunities and greater financial empowerment, and a source of critical health information, especially on sensitive topics around sexual and reproductive health. As we see with Tabassum and Swati, access to secure, trustworthy and easy to understand health information can improve women’s sense of agency and self-efficacy and improve their decision-making capacity about their own health.
In 2016, the UN Human Right Council General Assembly declared that access to the Internet is an essential human right. However, several factors impede women’s access to smartphones, including gatekeeping from family members, restrictive societal norms, fear of online harm and harassment, and the lack of digital education avenues. The latest National Family Health Survey (NFHS-5) found that only one in three women in India (33%) have ever used the internet, compared to more than half (57%) of men. This gender-based digital divide is even more pronounced in rural India, where only 25% of women have accessed the internet compared to 49% men.
In many ways, it is our frontline health workers who are leading the digital revolution in health for women. Sadhana*, 39, has been an ASHA since the year 2007. As a 15-year-old, she lost her mother to breast cancer, and was forced to drop out of school after matriculation. The late diagnosis and poor care that her mother received influenced her decision to become a health worker when the ASHA programme was launched in Jharkhand. When she first got a smartphone, she limited her usage to job-related activities and the occasional YouTube videos. Her relationship with her smartphone changed when a block trainer instructed ASHAs on how to use ‘Search’ to get answers to queries from their beneficiaries. Immediately, she began to dig into the treasure trove of health information on the internet, starting with questions about the disease that had scourged her family for decades (a few years ago, her father was diagnosed with oral cancer too). In recent months, she has become aware of multiple cases of cancer in her community, which has strengthened her resolve to learn more about the early signs of different cancers so that she can help her community to seek timely care. Her search history, which she graciously shared with us, was testament to her curiosity and dedication. When we asked Sadhana what motivates her to continue to learn, she said it was important for her to keep getting better at her job. ‘When I do my job well, I help my gaanv-samaaj (village and society) move forward.’
It is ASHAs like Sadhana, and countless pregnant women like Tabassum and Swati, who motivate us to keep improving our mHealth programmes like Kilkari and Mobile Academy. In a world where most emerging technologies are built largely by men, for men, and even tested on men, we want to make sure that the voice of our users shapes the design and development of our products at every step. From making our gender-transformative content available in multiple languages to ensuring that an illiterate user can navigate our products using visual cues alone, our iterative, human-centred and evidence-based innovation process puts women at the centre. Like Sadhana, we too believe that when women do well, society moves forward.
*Names changed to protect privacy
**An Accredited Social Health Activist (ASHA) is a community health worker employed by the Ministry of Health and Family Welfare (MoHFW) as a part of India’s National Rural Health Mission (NRHM)
*** The largest mobile-based maternal messaging programme in the world, implemented by ARMMAN in partnership with Ministry of Health and Family Welfare (MoHFW), Government of India
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