Delivering with Dignity
Zubaida Bai was shocked to discover midwives using agricultural tools to deliver babies in her native India. Now, she’s revolutionizing the world of women’s healthcare by designing low-cost products that promote access, equality and dignity.
Interview By: Justin Harlow | Editor
Justin Harlow: Today, I’m here with the Zubaida Bai, the Founder and Chief Executive of Ayzh, a company dedicated to improving women’s health in developing countries. Zubaida was born and raised in the Indian city of Chennai. She was the first person in her family to pursue post-secondary education with her female relatives typically marrying in adolescence. She studied at Dalarna University graduating with a Master's in Engineering focusing on product development and design and received an MBA from Colorado State University here in the USA.
After her studies, Zubaida returned to India on a mission to help improve women’s health in her local community. After a couple of years developing low-resource products, she and her husband made the decision to strike out on their own and start their own initiative focused on improving women’s health. After witnessing the use of agricultural equipment during a child’s birth, Zubaida had found her calling and started Ayzh with the initial objective to provide clean birth kits to combat childbirth deaths. Since then Ayzh has gone from strength to strength, adding more women’s health products to its portfolio.
Zubaida is a TED speaker, fellow and resident. She’s also a Young Global Leader at the World Economic Forum, an Ashoka Maternal Health Champion and a UN Global Impact SDG Pioneer.
Zubaida, it’s great to have you with us today.
Zubaida Bai: Same here Justin, the pleasure’s mutual.
Justin Harlow: So, tell us a little about your life growing up in Chennai.
Zubaida Bai: Chennai is definitely home. It’s been my life’s mission to go back and build a small house in Chennai at some point in my life. I’m very proud to be employing women from in and around Chennai to do the work that I’m doing. It’s my small way of giving back to the community. It was a very conservative little society and I really enjoyed growing up Chennai, which was not too jazzy and not too modern, just the right thing that I probably needed as an introvert growing up. So, Chennai is definitely home for me and very close to my heart and a lot of our work happens around Chennai even today.
Justin Harlow: You decide to study Engineering and later Social Entrepreneurship, what was the reasoning behind those decisions?
Zubaida Bai: So, engineering was a childhood dream for me. I wanted to grow up and build cars, really fancy cars, and ride in them. I don’t do either. Somehow down the line I lost my passion for cars. Definitely after engineering I realized, as a mechanical engineer, it wasn’t the right place for me because there weren’t many women in school or in college with me. Even in the workplace, I was the only woman and I was given very mundane tasks. I wasn’t finding it interesting at all.
That’s the reason I decided to take a break and specialize in an area within engineering where I could contribute more. I chose product development and design from the perspective that I could do cars or any other products that I fancied. Once I finished my engineering, I think I realized it was time to give back to my community and I started designing and developing products with and for women in India.
Justin Harlow: As you mentioned, after your studies you returned to India. Given your studies you probably had plenty of options to choose from, why was it so important for you to return home?
Zubaida Bai: I definitely had plenty of options, even at home. I think I really wanted to get back to my parents and coming back to Chennai was close to my heart. When I returned home I was working in corporate I.T., which were not where my passions were. It definitely paid 5 to 6 times higher at that point in time, but somehow the calling was to take up product development and design in rural India. It was a way for me to give back to society.
Being a mother, I was intrigued — asking her questions about how she gave birth to babies in her house and that conversation led me to realize that she was using agricultural tools to deliver babies.
Justin Harlow: So, you worked a little in product development focused on products for low-income households, but after a while you make the decision to strike out and start something on your own. You spend 5 months researching in the field to discover ways in which you could improve women’s lives. We’ll talk about your wonderful initiative in a minute, but what types of problems did you see during that time of research?
Zubaida Bai: For me doing research was basically about going back to ground zero, because a lot of products that I was working with weren’t making it to the market or hitting the shelves. For me it was important to understand why. I also wanted to understand what the gaps in the market were before I ventured in with another product that potentially wouldn’t make it. So when I started traveling my only focus was “women-based” because that was definitely close to my heart and for my husband.
So, when we started traveling, I met with every single organization that was associated with women, be that finance, be it water, be it climate, and the only thing that emerged over and over again was the health aspect of it. Women were really concerned about their own health, the lack of access to health facilities, the lack of access to health products for themselves, their children and their families. So, health definitely emerged as the common theme throughout any conversation that I had.
Justin Harlow: You decide to focus on providing a kit to improve the safety of childbirth. What is the problem, how big is it and why did you choose that particular challenge?
Zubaida Bai: During my travels I ended up meeting a midwife, which was very serendipitous. Being a mother, I was intrigued — asking her questions about how she gave birth to babies in her house and that conversation led me to realize that she was using agricultural tools to deliver babies. Specifically, she used a sickle that was used to cut grass to cut the umbilical cord to separate the mother and the baby. That definitely was the aha moment of my life. At that point in time, it did seem hilarious, but it kind of left deep thoughts in my mind for days after. I had suffered with an infection post-childbirth and what I was seeing was clearly not right. My infection lasted a year and I had access to the best medical healthcare.
When we started research into the topic, the whole new world of maternal health dawned on us, when it hadn’t even existed in my vocabulary or dictionary at that point of time. The stark reality that was facing us was that every 2 minutes a woman dies during childbirth. Overall, 1 million mothers, about 15% of total overall deaths, died because of a lack of access to basic clean tools during childbirth. Those were the statistics that were really alarming and I really wanted to do something because it seemed like a simple solution but there was no way to get it implemented or get it out there.
Justin Harlow: Obviously I’m in the US. I have twin girls so I’ve been through the birth process, not personally, that would be a real story. Describe a typical birth in the western world, what they have access to, how much it costs and how you really had to think differently to develop something that’s relevant to lower-income countries.
Zubaida Bai: I think a typical birth in the western world costs $15,000 and above. In India, a birth can cost anywhere from $100 to $10,000 upwards, so there’s a huge range in which these facilities exist in India. In the low resource setting, we found that it was either a government setting or a low-resource poorly-stocked private hospital or a maternity home. What we actually realized was that most of these hospitals don’t have access to supplies because of supply chain issues. Plus, they didn’t realize that the equipment was needed. Also, the volume of births that happen in India is so high that making sure you prepare for one birth after another is really difficult as well.
By understanding the situation on the ground and talking to women and understanding their needs, we came to a conclusion that we had to fix the ecosystem and a complete behavior change was needed from an institutional perspective. So, when we designed the kit it was designed by keeping in mind how the mother would remember the product and talk about the product.
We also had to ensure that the healthcare institution actually used the product. We also had to ensure that even if the product was not available, that we could sustain the right behaviors. These were the things we took into consideration during the design process.
Justin Harlow: Let’s talk about the kit because I’m sure our listeners would love to know what’s in them, how you made the decision about what to include and perhaps as importantly how you decided what to omit?
Zubaida Bai: For us the Janma kits were based on WHO protocols, so there was definitely a protocol that needed to be followed at the time of childbirth. We just had to match it with products that made sense on the ground. So, we figured out component by component what was needed to reduce the risk of infection. A kit has a blood-absorbing sheet, a surgical scalpel to cut the umbilical cord, a sterile cord clamp to clamp the baby’s cord, a bar of soap, a pair of gloves and the first cloths to wipe the baby clean. I think these were the essential things that were missing during the childbirth and most infections occur during this time.
We wanted to keep it really simple. Of course, we could have added fifty more components, but we really understood the bare minimum necessary to reduce infection and we just went with that.
Justin Harlow: So, how much do these kits costs and how does that compare to the average weekly wage of your target consumers?
Zubaida Bai: So, our kit costs around three dollars. In terms of the average amount of money our consumers earn, I don’t think that would be a reference point here. I think the reference point would be how much do they spend at the time of childbirth. It’s typically anywhere between $150 and $500 and we’re talking about people living below the poverty line. Our $3 product can help reduce infection and reduce additional costs post-childbirth that include the loss of income for the mother when she’s not able to function, those costs can add up really quickly.
In fact, we just completed a study with Duke University which is called “Cost Consequence Analysis”, which helps us understand the cost impact on various stakeholders, the institutions, the mothers and the family members. The study will be published some time later this year, which will clearly show how much money is being spent and how the cost of our kits is very negligible in the larger scheme of things.
Justin Harlow: What did you learn from developing the birth-kits that surprised you, perhaps something that your education and research didn’t prepare you for?
Zubaida Bai: I think what still surprises me to this day is the fact that such a simple product is still not available. I don’t think I ever needed my engineering skills to do this. Of course it helped me to understand needs, perform cost analysis and figure out other things, but I definitely sit and wonder why such low-cost interventions don’t exist, why is there not a business around it and why can’t people have access to such life-changing products.
…being a woman and a woman of color is a big obstacle as there is not much investment available for people like us.
Justin Harlow: Let’s talk about impact. How many Janma kits have you developed? I’m sure if I asked you last week, it’s very different to this week. What’s the running total last time you got the update?
Zubaida Bai: I think we’re touching close to 400,000 kits, only with our clean-birth kits at this point.
Justin Harlow: Wow. It seems what you’ve described is a perfect example of “frugal innovation”. What does frugal innovation mean to you and how is it being reflected in your operations and products?
Zubaida Bai: I think frugal innovation, or what we call appropriate technology, is whatever is appropriate to the setting that you work in. I feel frugal innovation is basically something that is low-cost that is actually relevant to your particular setting.
Justin Harlow: One thing that I really loved when reading about your products and testimonials from women that use them is that frugal innovation often focuses exclusively on cost, however there’s a sense of style and status associated with your product as well. Tell us a little bit about how you balance cost and style and why you think that style is so important to these products.
Zubaida Bai: I think for us the focus was how could we help women aspire to buy a product that was local and also what can we do to make it more attractive to them, so our Janma comes packaged in a jute purse which is bright pink and sometimes other colors. Women are proud to own this purse and it has become an advocacy tool for us in terms of women talking about this purse and sharing their childbirth experience. There was a lot of thinking that went in to how we make our packaging biodegradable, reusable and something that women would aspire to want and most of all it serves as an advocacy tool to encourage them to discuss their childbirth experiences, just through a fancy purse.
Justin Harlow: Often frugal innovation in developing countries finds its way back into the more developed world. What lessons do you think that you’ve learned through your work in India that can be applied to Colorado where you spend a lot of your time or somewhere else in the developed world?
Zubaida Bai: Clearly the one thing that can be transferred is that healthcare doesn’t need to be so expensive. I feel the US healthcare system is flawed in so many ways. Access to people who really need it, but can’t afford it, has become difficult here in the US. I think there is a lot to learn between the two countries, in terms of access, in terms of the amount you need to spend and in terms of the kind of innovative partnerships that you need to get things going. There is a lot we can learn about reducing costs and adopting innovative technologies that can help do that.
Justin Harlow: I love the way you link together behavior and product, which is something that I don’t necessarily see in the US. I think there are also some lessons that people can learn from your work there, right?
Zubaida Bai: Definitely. I think healthcare and behavioral change go hand-in-hand. There are some very good examples of behavioral change like the hand-washing project from Unilever. It’s all about behavioral change at its most basic level and its large-scale public and social impact.
Clearly the one thing that can be transferred is that healthcare doesn’t need to be so expensive. I feel the US healthcare system is flawed in so many ways.
Justin Harlow: What’s the biggest obstacle facing your company?
Zubaida Bai: I think as we scale and grow, being a woman and a woman of color is a big obstacle as there is not much investment available for people like us. The second problem is related, most of the products we carry at Ayzh are products that people don’t want to talk about. They don’t want to engage in conversations about women and blood, it’s not their frame of reference. We don’t want to go out of our comfort zone to talk about these issues and I think that’s definitely a huge obstacle.
Another obstacle is a lack of access to capital. Companies like ours can only survive at scale or they will be small and medium enterprises. For us to be a real corporate we need large-scale investment and that can only come when people have open minds about our issue and care about the markets that we serve.
Justin Harlow: It’s interesting that you mentioned access to capital. You made the decision to set this up as a for-profit company rather than a non-profit organization, what were the reasons behind that decision?
Zubaida Bai: So, I love non-profits and they value the work that they do, but women’s wealth is often treated as a charity business and most of the products that the women are given are cheap, free or subsidized and they were not the quality that these women deserved. I believe that in healthcare, everybody deserves not only equality, but also equity.
I felt there was a need to bring that to the surface. I knew it was going to be a huge challenge. My husband and I agreed that it wasn’t going to be easy to make Ayzh a for-profit business, but that was the only way to change the mindset. We also both strongly believed that the poor are not poor in mind. They do value their health and the health of their children and that they would invest in their health and wellbeing and lo and behold we were right.
Justin Harlow: We’ve only really talked about your Janma kit so far. What other products are either currently in your portfolio, or to the extent that you are willing to share with us, are on the deck for future release?
Zubaida Bai: At this point, we have five additional products in our portfolio. Three of them are for new-born care immediately after childbirth. So, as soon as Janma is used during childbirth, these products are used to care for the baby. We have a postpartum hygiene kit, because people assume that menstrual blood and postpartum bleeding are the same, they are not, that is a specific product we have for reducing infection post-childbirth for the mother. We have a menstrual hygiene kit as well as menstrual hygiene pads that we have in the market. The kit is mostly used as an educational tool to educate young girls around the importance of the reproductive lifecycle and its hygiene. The sanitary pads are basically a menstrual hygiene product that you would use month-on-month.
Justin Harlow: That leads nicely into my last question which relates to one of the products you just described, which is your “Go with Confidence” initiative, which is looking to provide equal access to disposal menstrual pads across the world. Where did the inspiration for this initiative come from and what do you hope it will achieve?
Zubaida Bai: “Go with Confidence” is an initiative to bring equality and equity to women’s health, especially menstrual hygiene globally. We have come across a lot of women in the US who always want to help and a lot of women and young girls in India that need access to this product. This was a no-brainer and an easy way to make that marriage happen. So gowithconfidence.shop is basically a platform where you go buy your monthly supply of sanitary pads and we will donate the exact same quality and quantity of pads to a woman or girl in need in India. Around 800 million menstruate every single day and more than 50% of them don’t have access and it’s something where women can step up, contribute and bring that equality to a simple issue that can’t be ignored.
Justin Harlow: It makes sense that you had a partnership with TOMS before as it seems somewhat in line with their model, just on a different basis, right?
Zubaida Bai: Definitely. Even though we have paying customers, we have a lot of tribal areas in India where women can’t even afford the three dollars that we were talking about. The partnership with TOMS helped us reach those really tribal areas and create impact there. And, I think this is similar. Even though we have our menstrual hygiene pads that women are buying in India, there’s definitely pockets where they need this kind of donation and this model in the US will help us meet the need in those areas.
Justin Harlow: Zubaida, it really is a fantastic initiative that’s really having an incredible impact. I certainly look forward to following your organization to see what other brilliant products you develop in your mission to provide simple access to health products that quite frankly most of us take for granted. Thank you for your time today, I really appreciate it.
Zubaida Bai: Thank you so much Justin. It was fun chatting with you and hopefully a lot of people will become women’s health advocates after listening to this podcast.
