The mHealth movement has taken hold of public health almost as fast as the exponential rise of cell phones themselves. As of early 2010, the number of cell phones in use worldwide had hit more than 4.6 billion, according to the International Telecommunication Union, a UN agency. (To add some context, the world’s population hit 7 billion in late 2011.) A recent search of PubMed, the NIH biomedical research database, yielded hundreds of articles focused on the use of cell phones to improve health or gather health information, most added in the last three years.
Labrique recalls seeing the change himself over the past decade in rural Bangladesh. When he started work 11 years ago on the JiVitA project, a study designed to understand the effects of supplementing pregnant women’s diets with vitamin A, Labrique remembers the abysmal communication among members of the research team scattered throughout the rural countryside dotted with green rice paddies. The people were quick to offer a place to sit and a betel nut to chew, but were stunningly isolated.
“We couldn’t make a phone call to the next town,” Labrique says. The only reliable way to pass information among team members was to pay messengers to carry written memos by bus, so getting a simple answer to a question could be an all-day affair. “I joke when I lecture about this that we were seriously contemplating carrier pigeons,” he adds.
By 2004, the first cell phones started making their way through the area. With just a single tower nearby, it still wasn’t a useful way for Labrique and his colleagues to connect—it worked better as a landmark. His research team counseled visitors driving to their site to travel north until they saw that cell phone tower, then take a left to reach the field site.
But in a few short years, the landscape changed. As 30 new cell phone towers popped up around the JiVitA site, more and more of his local colleagues began using cell phones themselves—not just senior managers in the study, who could easily afford what started out as a luxury item, but, eventually, grassroots-level field workers as well.
“In the span of two years, these field workers—who usually have no more than an eighth-grade education—went from having no phones whatsoever, to almost every single one carrying a personal phone,” Labrique says.
Eventually, he and his colleagues started noticing that cell phones were infiltrating the narratives they were collecting from women and their families to describe obstetric crises and maternal or infant deaths. When they crunched the numbers, they found that about half the women in their study who’d experienced an obstetrical crisis had used a mobile phone to try to turn their situation around—by calling a provider, arranging transportation to a clinic, getting financial aid to pay providers or seeking out medical advice.
With access to cell phones skyrocketing in the area, either through direct ownership or access to a village phone, Labrique and his colleagues decided to start up a mobile phone–based labor and birth notification system. In a recent study, led by International Health Professor Parul Christian, when pregnant women went into labor, they or their families called or sent text messages to a central number. This action dispatched nurse-midwife teams to the women’s homes, where 90 percent of births take place in rural Bangladesh. Results showed that about 89 percent of these births—which would normally have taken place without any medical care—were attended by highly skilled health care workers with the new system.
Alain Labrique shows off a trove of low-cost technological treasures that support research from Kenya to Bangladesh.
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