From Passive Recipients to Custodians: Mothers Transforming Maternal Health in India & beyond

The Social Innovation

Magnitude of the Problem, and its Root Causes

High maternal and infant mortality rates persist in low-resource settings. In India, the Maternal Mortality Rate (MMR) is 167/100,000 live births, and the Infant Mortality Rate (IMR) is 34/1,000. Rural and urban poverty-stricken populations, especially migrants and marginalized groups, face systemic barriers to accessing health information and services.

During their participation in the Globalizer co-created by Ashoka and Philips Foundation in 2018, the ZMQ team highlighted the following key factors contributing to the magnitude of the problem:  

• Lack of accessible, culturally relevant health information for women (especially illiterate/semi-literate)
• Overburdened and under-resourced Community Health Worker (CHW) networks; insufficient last-mile connectivity
• Social exclusion and mistrust of health systems among marginalized groups (e.g., migrants, transgender people)
• Gender inequity and lack of dignified livelihood opportunities for women

Based on their systems change analysis, ZMQ made it a mission to transform the role of pregnant women and new mothers from passive recipients of care to proactive demand-generators for it and, ultimately, to custodians of their own health in the maternal and child healthcare systems in India and beyond.

"Every Globalizer is a great learning. If I get an opportunity to participate in the Globalizer, it is not to just to go to the Summit and meet other Fellows—it is to reflect through the strategy process and learn about what all is possible. We look at other Fellows, see their models, and realize: my model is based on something, but when I see how someone else does it, I learn from them."   

Strategy to Catalyze a Network of Changemakers towards the Targeted Mission

The strategy includes driving widespread adoption of the tools and technology through cross-sector stakeholder engagement where mothers are the custodians of health.

Some of the tactics they deployed towards the mission as a part of the strategy include:

1) Collaborating with Multi-Sector Partners for Involving Mothers as Custodians

In 2012, ZMQ launched the MIRA Channel—a mobile phone–based maternal and child health platform designed for rural women—aimed at shifting pregnant women and new mothers from passive recipients of services to active drivers of care and informed stewards of their own health.

MIRA Channel is a mobile-based integrated health platform reducing maternal and child mortality through last-mile, cost-effective solutions.

The work starts with teams conducting house-to-house visits to identify pregnant women and children for immunization. The platform:

• Digitally registers and tracks pregnant women, children (0–5 years), and adolescent girls.
• Provides customized weekly health information and behavior-change stories.
• Monitors pregnancies, identifies high-risk cases and connects women to ANC, TT, IFA, ultrasounds and other services.
• Equips health workers with decision-support tools, live-data dashboards and house-to-house engagement to strengthen service delivery.

MIRA helps strengthen the health systems by training health workers, supporting mothers to adopt proactive health-seeking practices and detecting high risk pregnancies on time.

ZMQ has co-created multi-sector partnerships for government adoption of MIRA which required aligning stakeholders around a shared vision and national priorities. 

For the adoption and scaling up of any effective healthcare system, government involvement is crucial. With this in mind ZMQ collaborates with public, private, civil society, and researchers early through structured dialogue to build ownership and define clear roles. This engagement generated strong evidence and unified messaging to influence policy windows and decision-makers. ZMQ has developed a sustainable model where, on the one hand, government provides infrastructure and policy support along with access to their system and CHWs and, on the other, international donors, the private sector and Corporate Social Responsibility partners contribute with resources and funding.  

The collaborative approach has enabled ZMQ to scale MIRA in different states in India and to Uganda and Afghanistan, with pilots carried out in Rwanda and Haiti as well. Through this multi-stakeholder approach to amplify government adoption, MIRA has reached over 5,200,000 beneficiaries and 7,700 CHWs. This extended reach substantially improved MMR and IMR in the areas of interventions. See more here.

The lasting uptake and expansion of this effective healthcare information and diagnostics tool requires more than technology and frontline workers—it demands a network of committed partners. 

2) Involving and Training Transgender People as Health Intermediaries in Poverty Stricken Urban Areas to Influence Communities (especially Mothers) to Immunize Children

Recognizing that traditional health outreach often misses the most marginalized, ZMQ also works with hyper-local solutions like their SAKHEE program which provide direct benefit to the communities as is the case of poverty-stricken urban areas in Thane, Maharashtra.

SAKHEE trains transgender individuals as Intermediary Health Workers, leveraging their informal community networks and technology to identify zero-dose and low-immunized children, build trust, and improve access to vaccination.

SAKHEE has reached over 390,000 population, identified 1,511 zero-doe and low-immunized children and successfully converted 73% refusal cases. This tactic has not only improved health outcomes but has also provided dignified livelihoods for transgender individuals, challenging social stigma and creating new models of inclusion.  

3) Involving and Training Women from Vulnerable Communities to Improve Nutrition and Livelihoods

Along with providing healthcare support, ZMQ recognizes undernutrition and economic inequality in India continue to weaken women’s health, especially in tribal and rural areas. Limited nutrition and healthcare reduce their strength and productivity, restricting access to education and entrepreneurship. These restrictions trap families in cycles of poverty and intergenerational malnutrition.

ZMQ’s Hatching Hope India initiative empowers women in vulnerable tribal communities of Mayurbhanj, Odisha, by promoting backyard poultry farming to improve household nutrition and create sustainable livelihood opportunities. The program combines digital and non-digital tools for training and capacity building of women entrepreneurs with strong community mobilization, robust on-ground implementation, and real-time monitoring through a live dashboard.

The program has reached 330,802 households (1,654,010 people), trained 120,000 girls on nutrition, 80,000 women on poultry farming and created over 120 rural women entrepreneurs and substantially improved the nutrition level of the communities.
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Over the years, across these tactics and more, ZMQ has delivered 230+ behaviour-change projects and 65+ system-change solutions, reaching over 275 million people worldwide. Through a South-South collaboration model, ZMQ scales proven innovations across Low- and Middle-Income Countries including Uganda, Rwanda, Afghanistan and DR Congo with offices in Kampala and Montreal, supporting its growing global impact.

Moving forward, ZMQ aims to focus on tackling the impact of climate change on health, livelihoods, and gender equity through its multi-dimensional approach, ZMQ is reaching underserved communities and advancing holistic development in line with India's vision of Viksit Bharat to achieve zero poverty through inclusive development and financial empowerment of marginalized communities by 2047.