The founders of JioVio Healthcare, a startup based in India, couldn’t believe what they were seeing. The smart bracelet they’d designed to remotely track the health of pregnant women in India was sending back some truly frightening data from the country’s rural regions.   

“One woman walked 85,000 steps a day,” said Senthil Kumar, JioVio’s cofounder. “Another woman’s heart rate was over one hundred bpm. We became paranoid seeing them jogging and running around.”

The JioVio team, based in Madurai, one of the largest cities in the southern state of Tamil Nadu, had chosen a color for the bracelet it thought would be popular: gold. India has long been one of the world’s biggest importers of gold, where it’s used to signal social status, celebrate childbirth, and as an heirloom. 

The product, called Allowear, records a wearer’s heart rate, sleep cycle, and caloric output, and it was a hit with women in India’s cities. But in the country’s rural areas, it proved to be even more popular with men, who took the bracelets from their wives and wore them instead. The region’s men wanted to show off the bracelets and thought they’d be wasted on women working at home or in the fields. 

“A few women tried to cover up for their husbands,” Kumar said. “But their neighbours gave us the true story. They saw the men wearing shiny devices strutting down the streets.”

JioVio’s product was designed to address a persistent public-health problem. Though the global maternal mortality rate fell by 38 percent between 2000 and 2017, in India’s rural regions, maternal health is still at near-crisis levels. Because many health departments are short-staffed and workers are overextended, rural women are nearly three times more likely to die from complications during pregnancy or childbirth than those in more wealthy, urban areas.  Many of these women are also still wary of the modern health-care system, and childbirth often happens at home, with neighbors filling in as midwives. Women who suffer miscarriages can be stigmatized, and government-appointed health-care workers have been known to make up data.

The idea was that the bracelet would monitor the vitals of pregnant women and send this data to government health workers so they could make regular visits to high-risk mothers. JioVio’s theory was that collecting some data on maternal vitals was better than having no data at all.

So when it came time to redesign their bracelet, JioVio designers looked to the local culture of the Adivasi, the collective name for tribal people in India. In the interior villages of Wayanad, Adivasi women often wear bracelets made of rudraksha seeds, a spiritual symbol in Hinduism used to mark devotion to Lord Shiva. Taking these rudraksha bracelets as inspiration, Kumar and his team decided to redesign the next iteration of Allowear as unassuming prayer beads. 

The switch worked — in one village in Wayanad, where infant mortality rates remain stubbornly high, the team began receiving more reliable data, and ultimately saw a 38 percent increase in the average weight of newborns. 

JioVio even succeeded in getting data from the Adivasis, one of the most marginalized groups in India’s rigid social hierarchy, who often work as daily wage laborers, farmers, or as brickmakers. The Adivasis have endured centuries of discrimination and disenfranchisement, which has bred both a deep mistrust of outsiders and a reliance on their own form of traditional medicine.

The lesson, for Kumar and his team, was that “technology alone doesn’t solve problems.” JioVio’s engineers needed to get out into the world. “We have made an organizational decision that every engineer who builds products must have basic interaction with their target customers,” Kumar said. “We ensure they visit the place and shadow field-workers to understand how the solutions they build are being used by the customer.” 

Still, the Allowear devices offer only a partial solution to India’s rural maternal-health crisis, even after the culturally sensitive redesign; the bracelet is meant to work with Allotricorder, a more powerful device used for full neonatal checkups. Though the bracelets, if worn, should prevent health-care workers from fudging data, some four out of 10 devices are discarded simply because they’re not water-resistant, according to Dhinesh Pandian, a JioVio cofounder. Sometimes, the women take the device off and simply forget to put it back on, he added. 

Companies have long tried to tackle the problem of maternal health through software, but JioVio is among a handful of small startups that are taking a more integrated approach, using mobile technology like World Health Organization-approved birth kits, and low-cost medical equipment like portable ultrasounds. JioVio believes its smart bracelet is unique, though, and the product has been piloted across nearly 100 villages in the rural areas of Kerala, Maharashtra, Karnataka, and Tamil Nadu.

Kumar believes his best chance to scale his product, which operates on a subscription model, is to bake it into India’s government health-care apparatus. The device, he estimates, could be used to treat more than two million women living in India’s Western Ghats mountain range.  

“NGOs have stepped in and are helping us,” he says. “However, until the government takes this up as a policy it cannot have the scale or a long term impact.”