The Amazing Reason Mothers in India are Giving their Babies Wearable Medical Records

This blog post was originally posted on Upworthy.com as part of a project with Girls’ Globe, Upworthy and Johnson & Johnson.

When Ruchit Nagar’s parents moved to Houston, Texas, in the late 1980s, they had no idea their son would grow up to save children’s lives in their home country of India.

Then again, it wasn’t exactly a total surprise, though, as their son had been interested in global health from a young age. Nagar had loved biology in high school, so he volunteered in American hospitals to learn more about the healthcare system. Later, he went on global health mission trips to Honduras and Ecuador, where he spent time working in a research laboratory at a government-run hospital.

But it was while he was in college, studying at the Yale Center for Engineering Innovation and Design, that he learned a startling truth. 1.5 million children die from vaccine-preventable diseases every year and an estimated 9.5 million infants worldwide still don’t have routine immunization services. Despite how critical these vaccines are, this “vaccination gap” still exists.

Nagar quickly realized that it wasn’t just an issue of access, either. Poor record keeping was making the problem much worse.

An agricultural community in Udaipur, India. Photo credit: Wikimedia Commons/TeshTesh

Maintaining immunization data in developing countries is a difficult task. Healthcare workers usually collect and store the information manually in paper log books, which means searching through all that data by hand. Couple that with how often families lose their medical documents and you can see what obstacles providers are up against.

That’s why, after Nagar’s professors asked the question: “What can you do to address the world’s vaccination gap?”, he and a group of other students came up with a business plan that could help address the vaccination gap, while helping healthcare workers too.

This led them to launch a nonprofit called Khushi Baby to help monitor the health care of mothers and children in India.

Khushi Baby (which translates to “Happy Baby” in Hindi) created a culturally-symbolic necklace that also happens to contain their full medical history.It’s a digital, battery-free, waterproof data storage device. In other words, it allows people to literally wear their medical records.

In order to access those medical files, healthcare workers in rural villages just need to scan the necklace with the help of the smartphone Khushi Baby app.

Photo credit: Khushi Baby

So, in a way, this invention is like a child’s medical passport, as well as a visual reminder for mothers to get their babies vaccinated on time.

The team hopes that when mothers and their babies wear their Khushi Baby pendant in the village, it might also start a conversation among mothers who may not be attending health camps regularly. And since Khushi Baby services include voice call reminders in the local dialect, the team is also hopeful that more mothers will plan checkups and vaccinations ahead of time.

Hopefully, this easy-to-use technology will help bridge the healthcare gap that exists between developing nations and the rest of the world.

“I have a reason to get out of bed every morning because I truly believe that what we are doing has the potential to make a difference to improve maternal and child healthcare for those who may otherwise be forgotten,” says Ruchit.

Digitizing vaccination data makes treating patients much easier, and, since the technology is relatively low-cost, it’s accessible even in low-income areas.

But Khushi Baby is about more than access to vaccines. It’s also about giving health workers the data they need to improve their treatment programs.

The technology empowers healthcare providers by allowing them to make better decisions faster. The app’s checkup summary page helps them consolidate patient info from busy health camps, which then helps them make appropriate recommendations and offer the right kind of care.

The Khushi Baby team at work developing technology. Photo credit: Khushi Baby

“Many of our early interactions with mothers and frontline nurses in rural Udaipur [India] showed us that there was an opportunity to do things better,” says Nagar.

Monitoring data is crucial in helping countries prioritize and tailor vaccination strategies for each region. The app also comes in handy for medically-focused nonprofits because it helps them monitor the impact of their work, ensuring the success of their immunization programs.

Of course, for the Khushi Baby app to work, people have to actually use it. That’s why Nagar chose to make it a necklace.

He tapped into a cultural norm in India to get locals interested in wearing his smart device. The black thread around the necklace is traditionally worn across India to ward off buri nazar, or evil eye. It’s said to bring good health and fortune.

“By observing that children were wearing jewelry in rural Udaipur, we realized that we could slot our technology into something that was already culturally-symbolic and accepted by the communities. In doing so, it made our wearable less likely to be lost or forgotten,” he explains.

A woman in India wearing the Khushi Baby necklace. Photo credit: Khushi Baby.

So far, the Khushi Baby app is operating in over 350 villages and tracking the health of over 15,000 mothers and their babies.

And they’re not stopping there.

Khushi Baby aims to scale its impact to over 1000+ villages with a team of over 250 health workers. They hope to track the health of over 80,000 beneficiaries in the future.

Photo credit: Khushi Baby

“Closing the vaccination gap will require national and multinational resources and efforts,” says Nagar. “Our goal is to track the health of the entire district of Udaipur by 2020 and lay down the blueprint for other districts across India (and elsewhere) to replicate and scale-up.”

It’s no surprise Khushi Baby was named as one of the finalists of the GenH Challenge, which acknowledges and awards innovative solutions to worldwide health issues.

Khushi baby is on the verge of transforming lives for the better in areas that desperately need the help.

It all started with a simple but powerful idea — that everyone, no matter where they are in the world, deserves the chance to thrive. Thanks to innovators like Nagar, that possibility is closer than ever.

And with technology like this leading the way, we might someday live in a world where no mother or child is left behind.

Preeti Shakya co-authored this post with Maisha Z. Johnson.

Burn the Dowry, Spare the Bride

India – a country of contrasts – shows you a myriad of colours. It is home to many highly educated and intelligent people, as well as to many who are illiterate, poor, hungry and troubled. India boasts the beautiful Himalayas, deep blue seas, green forests and glistening rivers, but also acres of slums and dry and parched lands.

The country is also famous for its big, fat Indian weddings – a major and thriving industry. But in India, the dowry system is an ever-present menace which frequently changes shape to adapt to society. Increasingly, dowry is being masked by more socially acceptable norms, such as gift-giving.

A car for your daughter to travel in.

A house for your daughter to live comfortably in.

Gold jewellery to give her security in the future.

These lines by a groom’s family mask dowry demands as gifts. How difficult would it be to understand that this was extortion? The bride’s family had no intention of giving such ‘gifts’ to their daughter. But now they have been made to make them!

The girl’s family may find it easy to turn a blind eye, and to tell themselves that they are simply gifting their daughter. Who else did they earn money for all their life? Their daughter needs to get married after all! It is the most important identity for a woman. She may be well educated, earning enough to feed an entire family, raising the bar at her workplace, but if she’s unmarried she is viewed by many as incomplete.

For some, it ends on the wedding day. The groom and his family’s ego have been appeased. The newlyweds go on to live a happy life. But for some others, the demands continue. The first festival, the first child, the naming ceremony, the first house that the new couple build, and at every other occasion – the bride’s family must gift again. Sweets, clothes, gold, cash – the list is endless. If the parents are unable to provide, the woman is often packed off back to her mother’s house, not to return till the demands are met. Some are physically and emotionally abused; beaten, starved and even burnt.

India has had a long battle against dowry – an unsuccessful one. Legislations have been made and amended. But the practice seems to be growing. It has spared no economic or social group. The battle lines must now be altered. What can be done when law has not eradicated the problem? Why not focus on the one link that can be our biggest asset? The bride’s parents!

This is a call to parents of every girl child in every country where the dowry system is flourishing. Why should we not say no? It starts with the birth of our daughters. Let us give them a good education, a good upbringing, a happy and safe environment at home and combine all this with a good dose of self confidence and self esteem. Let us say no to any potential groom and his family who talk about marriage like a business transaction. Let us stand strong and firm so our daughters learn from us to say no.

Let us teach them that life throws us many challenges. That we are all supposed to enjoy the journey of life – marriage is never the final destination. It is one part of our journey. Let us give our daughters the confidence to walk out of a marriage where they are being abused and harassed for dowry, knowing that it is not the end of the world. Let there be no more burned brides, hanged brides, poisoned brides or strangulated brides.

Maybe the power has been with us all along. It is time to exercise it. To show the world that every single woman’s life matters. Let us bring forth a change, and let us start at home.

Babies are Born. Then they Breastfeed!

The baby let out a wild cry the moment it came out. We felt triumphant. After a four week period of intensive supervision, the mother had finally delivered a healthy baby. I was a resident doctor in obstetrics and had stayed up for several long nights, struggling to help this woman to complete her nine months – complications constantly threatening to sabotage our plans. But now there was relief and joy as it had all turned out ok.

Or so I thought.

The next day, I found the new mother anxious. Desperately, she said: “I am unable to breastfeed. I don’t know what to do.” I tried giving her some tips but immediately realised I was as unable to get this baby to breastfeed as she was. Giving out a few customary instructions I moved ahead, knowing I had hardly made any difference to her anxiety.

The following day, the baby was in the Intensive Care Unit, having convulsed due to low sugars. I knew that meant potential for future intellectual disability. I glanced through the glass windows of the ICU and saw the mother standing besides the incubator. I had a sick feeling which I could neither deny nor escape; I had failed her. We had all failed her. Our moment of triumph was now no more. We had poured in all our collective efforts pre-delivery to bring forth a ‘healthy’ baby, but had ignored her post-delivery struggle with breastfeeding. We all assumed that it just happens naturally; every mother just knows how to do it. But this is far from true. They all need personal support and guidance.

I was suddenly acutely aware of my deficient skill set. As resident doctors, there had been more important things to update ourselves on; the newest infertility treatments and best ways to deliver high risk pregnancies. Breastfeeding was not something we were told to consider actively in our rounds or spend hours training ourselves in. Our singular focus as obstetricians had become to help deliver a ‘healthy live baby’ and as neonatologists, to ace resuscitation protocols when babies weren’t breathing at birth and then get busy with the incubators. With doctors’ alternative priorities and nurses’ preoccupation with injections and clerical work, whose job was it to look at breastfeeding?

The void in lactation support was glaring. I was restless. How can we make breastfeeding a breeze for mothers; a joyful journey of bonding and nourishment rather than a nightmare? That’s when our lactation consultant asked me to try ‘Breastcrawl’, a term I had never heard before.

Apparently, just like newborns of all animals, our babies have an innate capability to seek out the breast and feed; if left undisturbed and ‘skin-to-skin’ with the mother for the first crucial hour after birth. This is called ‘early initiation’ through Breastcrawl. I felt stunned by the potential behind this beautiful miracle of nature. It seemed to have all the answers for a successful start and continuation of breastfeeding! I attempted it in our labour room and sure enough, the baby crawled up from the mother’s abdomen to the breast, latched on its own and smoothly drank its first precious drops. Its reflexes were the only coach it needed. What a perfect start it was!

Breastcrawl has deep implications on health of newborns. As I started following up these ‘Breastcrawled’ babies in the wards, I saw that even the first time mothers breastfed with the confidence of a woman who had just had her third child! Science supports the impact of this technique way beyond just nutrition – sensory-neural development, immune priming, bonding, temperature control and more.

Photo credit: Dr Taru Jindal
Every mother and newborn deserve this experience. But in our hurry to complete paper work and protocols, we had been thoughtlessly separating the mother and baby in those critical first moments and preventing this beautiful miracle from manifesting itself. Our support had been inconsistent and ill-timed. We were either getting in the way of mothers when we needed to step aside or we were simply too far away for help when mothers were desperately seeking us.

The experience with breastfeeding in my residency taught me how ‘lactationally illiterate’ I was. I learnt that supporting mothers in breastfeeding is as critical as doing a perfect caesarean surgery. Ensuring a ‘live birth’ was indeed just the first step.

As WABA keeps reminding us so rightly, babies are born, what do they do next? They breastfeed!

 

It’s Time to Recognize Women Farmers in India

Farmer. I don’t know about you, but when I hear that word, I think of a man.

Or, at least I used to think of a man. Before I went to India, that is. In India, 80% of all rural female workers are in agriculture but due to traditional gender roles they are rarely recognized as farmers. This is no news, but because of severe climate change and male work migration to cities women farmers are now more visible than ever, which creates an urgent need for them actually to be recognized as such.

So, the feminization of farming does not mean that women suddenly start taking part in agriculture work, but rather that they become visible within the agricultural sector. It means that many women across India are now taking care of both their households and their farms, while their husbands move to the cities in order to find another income to make ends meet. It means that women work for 3300 hours, while men work 1860 hours in a crop season. It means that there is an urgent need for women farmers to be recognized in order to be able to maintain a sustainable way of living.

There are a lot of initiatives in India aimed at the empowerment of small farmers. However, they are often formed to fit the average male farmer, which means that they fail to address the specific needs of women farmers. Taking care of the household and the children result in women having less time and opportunity to, for example, take part in farming training and travel to the market to sell their produce. Furthermore, if women are not recognized as farmers in the first place, they will still be overlooked when new projects for farmers’ empowerment are initiated.

Women play a vital role in food production, not only in India, but around the world. However, due to patriarchal structures they do not have equal access to land ownership. In India, 80% of all rural female workers are in agriculture, but only 9.4% own land. We know that if women could improve their economic and social status it generates more productive farms and decreases child malnutrition. If women were to be given equal access to productive resources, they could yield 20-30 % more.

Farmer. I don’t know about you, but when I hear that word I now think of strong women.

In addition to tending to their farms, they are also looking after their children, cooking, cleaning and fetching water and firewood. These women have been discriminated for ages and their skills and knowledge have not been recognized simply because they are women. It has to change. If women farmers are not recognized, if they do not have access to productive resources, if they do not have access to proper education, who will feed the next generation?

The feminization of farming has been going on for decades, and it will most likely continue. Women farmers are the future and there is an urgent need to recognize them as such. Not only in India, but everywhere.

India, Thank You for Re-energizing Me!

In front of me stands a woman in a blue saree. She is sharing her experiences as a female farmer in rural Tamil Nadu, India. We have gathered under a couple of trees to shield ourselves from the broiling sun and while we are talking, the cows standing in the yard are dipping their whole heads while drinking water from a bucket, trying to cool down in the summer heat.

As the woman in the blue saree tells me how old she was when she got married, I can only stare at her in disbelief. Of course I knew that child marriage exists in India, but this is the first time I’ve actually met a woman who got married when she was only thirteen years old. Although it has been prohibited in India since 2006, child marriage is still practiced regularly and India has the highest number of child brides in the world. According to Girls Not Brides, in 2016, 47% of all girls under 18 years old were already married. As I try to regain my composure and wrap my head around the fact that this woman was married when she was only thirteen, she just smiles and carries on talking.

The women I have met during my four months in India are some of the strongest women I have ever come across. Can you imagine being married at thirteen and having three children at the age of eighteen? For me, it is an unimaginable scenario – showing just how privileged I am to have the possibility to choose for myself what my (love)life will look like. However, for many women in India, choice is an impossibility. Furthermore, to speak about sex and reproductive health is still taboo and many girls do not know how their bodies actually work.

My time in India has made me realize, even more than before, how lucky I am to have grown up in a country where sex and reproductive health are relatively easy topics to bring up (even though improvements could still be made). It has also made me more convinced than ever before of how important the feminist struggle has been, and will continue to be for many years to come. It has reminded me that, as a feminist, I need to be responsive and listen in order to be able to choose my battles, without trying to impose my beliefs on others.

Intersectional feminism has taught me to be aware of my privilege, to listen and to understand that there are many different feminist struggles going on side by side. It has also taught me to realize when it is my place to speak and when it is not.

There are already a lot of initiatives in India working towards the abolition of child marriage (and other institutional inequalities), and sometimes the best thing to do is to show support and solidarity. As the world becomes ever more globalized and intertwined this will be important to remember as we go forward with the feminist movement. Because we must go forward!

Being in India has thought me a lot of things but most of all it has made me angrier than I ever was before. How can it be that I get to choose how to live my life when so many women and girls around the world can not choose how to live theirs? Of course, imperialism, colonialism, racism and capitalism can answer that question and explain why the world is so unfair. However, a theoretical answer is not enough. Action is needed. And it is needed now.

So, India, you mesmerizing, colorful, but oh-so-patriarchal country, thank you for all you taught me and all you made me realize about the world. But most of all, India, thank you for re-energizing me!

Raising Awareness of Menstruation and Sustainability in India

During a visit to Auroville, India a couple of days ago I was happy to have the opportunity to chat briefly with Eco Femme co-founder Kathy Walkling in between customers at their busy stall at the market. I had already heard about Eco Femme before I came to India and I was exited to meet the people behind it in real life. I wanted to get to know more about their important work on raising awareness of menstrual hygiene and sustainability among rural women in the state of Tamil Nadu.

Eco Femme was founded in 2010 and in collaboration with the Auroville Village Action Group – an NGO working for womens’ empowerment in rural Tamil Nadu – they started to design and produce eco-friendly, washable cloth pads for sale worldwide. The cloth pads are stitched by women in self-help groups who have been trained in advanced tailoring. The women run their own collective tailoring unit and Eco Femme, whose monthly production order alone provides a full time livelihood to 7 women, is just one of their customers.

The cloth pads are not only helping women to make a living for themselves, but they also contribute to a more sustainable planet. The pads can often be used for more than three years, which is a real investment for the environment and especially so in India, where waste management is really poor.

Cloth pads are nothing new to the Indian women who have been using them for centuries. However, due to lack of information about hygenic practicies, many women and girls in rural Tamil Nadu still have unanswered questions about their bodies and menstruation. Therefore Eco Femme initiated the “Pad for Pad” education programme which sets out to inform and educate adolescent girls on menstruation and hygiene so that they can make informed choices about their own bodies. For every pad sold outside of India a donation is made to the programme which enables Eco Femme to offer menstural health education and washable cloth pads to adolescent girls in India.

During my conversation with Kathy we were interrupted several times by women and girls who were curious about the pads, and at one point, two men approached the stall. This is, unfortunately, a rare sight, Kathy told me. She, (like most of us, I guess) wishes there were more men engaging in women’s rights. However, a lot of effort is needed to make changes just among women. The pads are generally positively received although there are women who initially are sceptical, especially on whether the pads are hygenic and if they are safe to use without any leakage. Furthermore, Eco Femme has to compete with the high volume of commercials on disposable menstural products which claim to be hygenic and safe to use. However, Kathy stresses, a lot of women experience discomfort, such as allergic reactions to synthetic ingredients, while using disposible menstrual products and would actually benefit from switching to reusable ones.

Another obstacle which has to be overcome is the lack of basic facilities for women to be able to change and wash the pads properly. Therefore, the pads are always distributed to NGOs, who are advised to carry out basic studies on access to water and proper toilets before starting any projects. This reminded me of the importance of a holistic perspective when working with development projects.

Overall, Kathy told me, we all have to really recognize the importance of working with girls because they are our future. Certainly, here in India girls are very marginalized and face many obstacles. It is also important not only to educate girls but to educate all levels of society in order for things to change. We need to acknowledge the importance of organization and solidarity throughout the world.

So, if you would like to act in solidarity with women and girls in India and at the same time contribute to a more eco-friendly planet, go ahead and visit the Eco Femme website to learn more about how to engage!

Cover photo credit: Eco Femme