womensHealthAndTheNewBottomBillionThe Millennium Development Goals (MDGs) have galvanized stakeholders around the globe to improve the health and well-being of the world's poorest people by 2015. While progress has been made, more than 1000 women per day still perish in childbirth, and more than 2.5 million babies are stillborn each year. Searching for solutions to meet the MDG targets has mobilized governments, the private sector and non-governmental organizations alike to form public-private partnerships to address some of the toughest global health challenges.

The Mobile Alliance for Maternal Action (MAMA), a collaboration with USAID, Johnson & Johnson and supporting partners, mHealth Alliance, the United Nations Foundation, and BabyCenter, launched in May 2011. This unique partnership leverages the respective strengths of a wide range of partners to bring vital health information to new and expecting mothers via their mobile phones, empowering them to make healthy decisions for themselves and their babies

When today's mothers were children, the mobile phone as we know it now, barely existed. Now, there are more than five billion mobile phone subscribers in the world. This small device is showing real promise as a tool to transmit and exchange information to improve the health of mothers and children around the world.

For Grace, a woman living in a village outside Dar es Salaam, the last day of her pregnancy was the worst and most dangerous day of her life. Her painful labor stretched on for endless hours and without the help of anyone trained in even the most basic obstetric skills, Grace's ordeal ended with her unborn baby dead inside her. Some people would later tell Grace that she was fortunate to have survived this heartbreaking ordeal, but she is not so sure.

The World Health Organization (WHO) estimates that every day a thousand women die from preventable causes related to pregnancy, mostly in the world's poorest countries. And sadly, nearly 2.6 million babies are stillborn, never taking their first breath of life. While there are no simple solutions for safer pregnancies and births, mobile phones are showing promise for improving maternal and newborn health and survival. Access to simple health information via mobile phones can offer women around the world hope of safer pregnancies and of a healthy, happy start for their babies.

A generation ago, when today's new mothers were children, the mobile phone as we know it now barely existed. Today, its ubiquity is unmatched by any single modern device. Mobile access to information is empowering people in every level of society in nearly every country, providing real-time data about everything from weather to crop prices to financial transactions. And with more than five billion subscribers worldwide, the power of the mobile phone as a game-changer in global health is just being realized.

Doctors are performing surgeries in remote areas while receiving guidance via text message from experts in nearby cities or in other parts of the world. Epidemiologists are able to track disease outbreaks via information transmitted wirelessly to mobile phones. And while we know that there are no simple answers in addressing major global health challenges, mobile phones are showing promise as a means to advance the Millennium Development Goals and to improve maternal and child health.

Even in the United States, mobile health messaging services are making a difference for at-risk mothers. Since February 2010, more than 250,000 women have signed up for a free service called text4baby. The women, many of whom live in lower-income households and are not part of a formal health care system or support network, have collectively received more than 24 million text messages informing them of available prenatal care services in their communities, details about their babies' stage of development, and reasons to seek better nutrition and quit smoking. In October, text4baby published its first research study that demonstrates positive behavior change in expecting moms using the service. The results are encouraging: 75% of text4baby users reported that text messages informed them of a warning sign, which they went on to discuss with a doctor. Sixty-three percent reported that text4baby helped them remember an appointment or immunization their child needed.

What has made the model effective are networks of public health partners and healthcare providers across all 50 states who help ensure that women are aware of the service, free to users and available in English and Spanish. Partner organizations from academia and government provide sound, science-based information to women who can benefit from it most. Joining the National Healthy Mothers, Healthy Babies Coalition as founding partners are Johnson & Johnson, CTIA-The Wireless Foundation, the White House Office of Science and Technology Policy, the U.S. Department of Health and Human services, and the American Academy of Pediatrics. The service will soon be available to expectant and new mothers in Russia with the support of the founding partners Health and Development Foundation, the Russian Ministry of Health, the Kulakov Center, USAID, and Johnson & Johnson.

Relevant, real-time health information is especially in demand in countries where maternal and child mortality is high and the ratio of health workers to patients shrinks daily. To meet this need, USAID, Johnson & Johnson, and supporting partners, mHealth Alliance, the United Nations Foundation, and BabyCenter, launched the Mobile Alliance

for Maternal Action (MAMA) in May, 2011. By tapping into the collective experience of existing mobile messaging models, MAMA is engaging a diverse, innovative global community to bring culturally-customized, scientifically-sound health information to women in a discreet, portable manner. Over the next three years, MAMA will create and strengthen programs in three countries–Bangladesh, India and South Africa–and enhance global capability of new and existing mobile health information programs for moms in those countries and beyond.

MAMA's first shareable resource was announced in December when BabyCenter, a member of the Johnson & Johnson family of companies, launched adaptable mobile health messages for programs that use mobile phones to reach new and expectant mothers. These messages are adaptable, stage-based and available in written and audio formats and include vital health information and reminders that can be translated and modified to address specific needs in a way that is culturally sensitive and relevant.

The great availability and discreet nature of mobile phones is already proving transformational for women all across sub-Saharan Africa. In a part of the world that is home to 90% of all pregnant women with HIV, women must often travel great distances to reach a health clinic for basic maternal care. Widespread stigma and discrimination in the

community often prevent women from getting tested for the virus or from returning to the clinic for treatment.

mothers2mothers, a Johnson & Johnson partner organization that employs HIV-positive mothers to mentor expectant and new moms to prevent transmission of HIV to their babies has noticed that mobile phones offer a clever work-around to these common barriers. In one pilot, women who received text messages about missed medication and counseling were more likely to return for these critical health services. In another study, phone calls to remind new mothers to have their babies tested for HIV increased the likelihood that the newborns would be brought in for follow up care. Mobile communications are the tipping point, offering the privacy, urgency, and access to ensure that those who need care can receive it.

Our planet's burgeoning population of seven billion has stretched existing health systems to the breaking point. One billion people will never see a doctor in their lifetime. But more than one billion women in low- and middle-income countries already own a mobile phone. Used wisely, it's a technology that can help transform pregnancy from a risky undertaking into a safe and joyful experience. By harnessing the power of mobile technology for health, we can deliver critical health information to even the most remote areas of the

globe to ensure that young mothers-to-be, like Grace, have the possibility of improved health outcomes for themselves and their families.