Disruption: Finding the right balance in confinement care

This article first appeared in Enterprise, The Edge Malaysia Weekly, on June 11, 2018 - June 17, 2018.

Zamzana and Hisamudin started a social enterprise

Chong believes the confinement care industry needs to be professionalised

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The post-natal care industry is ripe for disruption. It is currently fragmented and dominated by traditionalists, many of whom, while experienced, have not been certified.

The industry also faces the monumental task of bridging the digital divide between traditional confinement care “aunties” and highly educated and technologically savvy urban expectant mothers. This has created an opening for small businesses that are willing to be part of the solution by helping to transform the industry through a combination of technology, training and professionalism.

Right now, the businesses are starting with almost a blank slate because there are currently no standards to go by. Post-natal care start-ups have to establish them and promote best practices such as training caregivers (also known as confinement nannies). They run the risk of these nannies quitting, once they are properly certified, to operate on their own and earn more money.

Be that as it may, many of the businesses choose to invest in post-partum caregiver training because they believe the industry needs an overhaul, which starts with creating a more qualified workforce.

Ianie Chong, founder of 28 Days Solution Sdn Bhd, believes the industry needs to improve the quality of confinement services and professionalise the trade. “Confinement ladies are often referred to as ‘aunties’, but we are trying to brand them as post-natal caregivers. Then, mothers will have more trust in them and believe that they and their babies will be in good hands,” she says.

Chong, who founded the online confinement service search platform 28 Days in August last year, matches mothers who need post-natal care with either caregivers (RM5,000 to RM6,000 for 28 days) or confinement centres (RM5,000 to RM48,000). It also offers insurance coverage for the customer and caregiver during the confinement period.

The start-up also established 28 Days Academy, which aims to encourage women to upskill and return to the workforce, as well as to revitalise an occupation that has little appeal among the younger generation. The academy provides eight-day courses conducted by a traditional Chinese medicine (TCM) practitioner, a nutritionist, a gynaecologist, a lactation expert and a psychologist, followed by a practical stint at a confinement centre.

Chong says the age of caregivers listed on 28 Days ranges from 40 to 60, but the students at the academy are all below 50. She observes that customers tend to prefer younger confinement ladies as they have more stamina to look after the newborn.

“Usually, the older caregivers have limited strength to stay up late to care for the baby and they tire more easily. So, the mothers feel that younger caregivers are a safer choice,” says Chong.

“They also prefer someone with at least three to four years’ experience. By professionalising the occupation, it will be more appealing to the younger generation, especially those in marginalised communities, as it allows them to make a decent living even if they are not well-educated.”

Zamzana Mohd Arifin, CEO of confinement services start-up Pantang Plus (Win Quarters Sdn Bhd) and a certified post-partum doula, who refers to those she trains as “confinement therapists”, echoes this sentiment. Previously, she owned a small business that offered post-natal care house calls (with a small team of therapists). Now, she plans to grow her business by leveraging technology.

Zamzana eventually formed a partnership with Md Hisamudin Ahmad (the company’s current chief technology officer) to found Pantang Plus, an online platform that uses the sharing economy model, much like Uber. The company offers customised packages for confinement and miscarriage care (ranging from RM850 to RM8,820) and caters for customers from across the country. It has also served mothers in Singapore, Australia and the UK.

Zamzana says training and managing Pantang Plus therapists is a challenge as they have different backgrounds and mindsets. But the training programme aims to change that.

“Most therapists cannot see the business perspective of delivering the services, so the training programme ­— tailored based on certain standards derived from customer engagements — changes their outlook and attitude for the better. They are also required to wear uniforms to look more professional. When customers read the terms and conditions stipulated in the agreement, they know I mean business,” she says.

Pantang Plus therapists have been getting consistent bookings and earning up to RM5,000 a month, according to Zamzana. She says the caregivers talk about the perks of working at the start-up, which include overseas assignments, and this attracts more confinement therapists to join them.

“There is always a line of therapists waiting to be interviewed and I am very selective. We don’t have the best bunch yet, but we are slowly progressing towards that,” says Zamzana.

Pantang Plus, a social enterprise that graduated from an accelerator programme by the Malaysian Global Innovation & Creativity Centre (MaGIC), also trains unwed teenage mothers in shelter homes to become confinement therapists. Zamzana says the programme is funded by the sales of confinement packages.

“A shelter home asked if we could train its girls and we agreed. The girls are usually school dropouts and when they are discharged from the homes, they have no one to turn to. They can use these skills to earn an income, and if they are serious enough, we will recruit them,” she adds.

Tan Yunn Jin, CEO of CareDo, an online platform that sources caregivers for confinement services and elderly care, says it aims to build a solid foundation of quality caregivers through its training programmes. The start-up, which offers confinement packages (ranging from RM5,000 to RM8,000), recently redirected its focus from selling the packages to training caregivers.

“The trade is good for those in lower-income communities as it does not require formal education. But what I am concerned about is attitude,” says Tan, adding that proper training can help mould the right attitude.

Those who claim to adhere to traditional confinement practices may say they are more experienced, but there are varying confinement practices within the Chinese community, Tan points out. Although this does not mean the dos and don’ts are arbitrary, she believes that the restrictions should change with the times.

“Sometimes traditional confinement ladies use TCM to treat neo-natal jaundice, but paediatricians advise against using any medicine. This creates confusion among mothers, so we want to phase out outdated practices,” she says.

According to Tan, many modern mothers are resourceful and love doing their own research on motherhood. But when they are paired with confinement nannies who are less educated, conflicts may arise. “This is a huge problem because when there are complications with the infant, the nannies would rather cite their extensive experience [than give a logical explanation] and expect the worried mothers to trust them.”

 

Bridging the divide

In the conventional post-partum care segment, the labour pool consists of the more experienced caregivers, who have a leg-up on their younger and less experienced counterparts, regardless of their work ethics. Online platforms, however, have the ability to weed out unscrupulous caregivers and penalise unreasonable and overbearing customers.

Citing personal experience, 28 Day’s Chong (who is a mother of four) says conventionally, due to the absence of proper agreements, caregivers could get away with cancelling bookings at the last minute and leaving heavily pregnant customers in the lurch. This was before the advent of online booking platforms and Facebook business pages, when mothers would rely on word-of-mouth recommendations.

She believes that this approach lacks transparency and creates risks such as caregivers ditching their assignments and mothers paying a lower fee than what had been agreed upon. “On the platform, we use iPay88 as our payment gateway provider to secure payments on the customer’s as well as the caregiver’s side. This prevents customers from revising the fees at the end of the confinement period, which was not uncommon in the past,” she says.

The start-up managed to match its first customer with a post-natal caregiver in November last year. Within six months of its inception, 28 Days has served 30 customers. On its website, visitors can browse the profiles of confinement ladies or confinement centres. However, the demand has been heavier on the caregivers’ side, says Chong.

“Their profiles provide their photos and details such as age, language skills, experience, qualifications, contact details and the areas of confinement care they specialise in. We also allow registered customers to rate and leave reviews on the confinement ladies. We are currently in the process of gathering feedback,” she adds.

The company takes a RM300 cut from every confinement job, but the cost is borne by the customers, says Chong. She says this is a fair cut because freelance confinement ladies usually take a larger amount for each referral they make.

“When they couldn’t take a job and had to refer their friends, they would usually take a RM500 or RM600 cut for each job. We have to handle both sides of the transaction as the middlemen and our tasks cost way more than RM300. But to us, it is kind of a community service as well,” says Chong.

Confinement centres, on the other hand, are required to pay a marketing fee or be charged a commission if they want to be listed on the platform. “We ask them to furnish us with the relevant information for their profiles and usually, customers pay a visit to the centres before they decide,” says Chong.

She adds that getting the right IT team to work on the back-end development is important to ensure that the interactive website is intuitive for both customers and confinement service providers. The hard work also lies in tackling the misconception that the company is an agency and that the confinement ladies are its employees.

Unlike 28 Days, Pantang Plus has 150 confinement therapists (aged between 25 and 60) working directly with the start-up. The company had to recruit a workforce of that size after they were challenged to do so.

“During MaGIC’s accelerator programme in 2016, we could only handle four therapists at a time. But after that, we were tasked to take in 100 of them. So by word of mouth, we managed to recruit 102 therapists,” says Zamzana, adding that Pantang Plus also received a RM30,000 grant to kick off its business.

When orders started pouring in, the company needed to process the transactions quickly. It was difficult as it had to accommodate massage bookings, process quotations, confirm orders and send out therapists.

After enlisting Hisamudin, a former systems engineer who had sold his media start-up, she managed to expedite the processes. The duo were coached to focus on a certain segment and they chose the affluent and urban market.

According to Hisamudin, by tapping this particular segment, they get fewer customers but each of them is more lucrative. The company managed to grow its business from 20 bookings in 2016 (which work out to about RM43,347 in sales) to 156 bookings (RM418,540) last year. Since its debut, the company has paid out about RM280,000 to therapists.

Before the online platform was set up, there was a lot of back and forth with the customers and building trust was not difficult, says Zamzana. But now that a lot of the processes are automated, she has noticed that customers are more hesitant and apprehensive about the services it offers.

“So, I created a standard operating procedure (SOP) where we meet with customers for personalised consultation sessions so we can manage their expectations,” she says.

There is also an SOP for customers to protect the therapists. “There have been cases where they were mistreated, paid unfairly or were told to do all sorts of things beyond their job scope. The SOP lays out the conditions that govern the packages that are subscribed to. So, I take full responsibility if the customer is not satisfied or if the therapist is mistreated,” says Zamzana.

Hisamudin says the company is constantly improving the platform to automate the back-end process for both the customer and therapist. “We also plan to automate the payment gateway so we don’t have to check whether we have received payments from customers, which can be tedious,” he adds.

CareDo’s Tan made her foray into the post-natal care industry when she had difficulty securing a caregiver for her seven-month-old son when she was going through depression. At the time, she already had basic confinement knowledge as a TCM physician.

“I realised how important caregivers are and I wanted to contribute to the industry. So, I kept upgrading my skills by taking confinement care courses in China, the UK and Taiwan. Now, I have a total of seven years’ experience in the industry,” says Tan.

“In 2015, I collaborated with my alma mater — the Kuala Lumpur Academy of Traditional Chinese Medicine — to conduct a similar course here and after graduation, my students would come up to me and ask about work opportunities as it was difficult for them to secure confinement care jobs. So, I decided to create the online platform to help connect confinement ladies with mothers.”

Last year, Tan entrusted the development of the platform’s website to an IT team, following a friend’s recommendation. Unfortunately, it was not designed the way she had envisioned.

“I realise that the IT industry is not very transparent because the company that we hired outsourced the tasks to another party. The team in charge was not even familiar with the concepts of user interface design and user experience,” says Tan.

“What’s worse is when we gathered feedback from our customers, they said they tend to feel lost navigating the website. So, we had to hire a new IT team and they needed six months to get the website functioning, based on our business model.”

CareDo has trained 100 confinement ladies who are now able to secure jobs easily after graduating. The start-up imposes a processing fee of RM300 on each client.

Due to the IT hiccups as well as the lack of interest among experienced caregivers to join the platform, CareDo is focusing on producing more trained confinement ladies this year. Using a B2B model, it is collaborating with confinement centre owners to grow their businesses.

“Freelance confinement ladies are not attracted to join us as they can secure jobs more easily outside. They also hesitate to be certified with us as they are already earning a stable income,” says Tan.

“So, our business has not taken off yet. We made about RM100,000 last year and it is not enough to break even. This year, we are working with confinement centres, where we train the confinement ladies while the centres do the marketing.”

While most modern mothers in Malaysia opt for Western healthcare, they also place their trust in traditional post-natal care. Although the dietary restrictions and practices may not be backed by science, it is apparent that the demand for time-tested confinement care will not waver anytime soon.

 

Catering for pre-natal needs

Before She Pops is a subscription service founded by Zuliana Zulkiflee Abbas that curates gift boxes for pregnant women. There are three types of boxes and they address the symptoms for the three trimesters during pregnancy.

Zuliana says the first trimester gift box (RM190), which she dubs the “nausea battle kit”, targets women who go through morning sickness. “It contains organic morning wellness tea, which is meant to help with nausea, as well as a sea-band acupressure wristband, which provides a drug-free way of combatting morning sickness,” she adds.

The second trimester “Bring on the babymoon” box (RM250) is dedicated to pampering pregnant women who have hit the peak of their pre-natal journey. It contains body scrubs, a stretch-mark oil and the essential compression socks to prevent cramps during long-distance travels.

“The third trimester box (RM280) — which is called ‘Ready to pop’ — is our best-seller. It is for women who are tired of being pregnant. So, it is more of a pick-me-up kind of box,” says Zuliana.

“It has raspberry leaf tea, which is believed to be good for shortening labour time as well as the overall health of pregnant women. It also contains floral foot soak salts to reduce water retention, scented candles, essential oils and a jewellery dish — for when your jewellery won’t fit your fingers anymore.”

She adds that the boxes come with flashcards to mark pregnancy milestones as they allow mothers to document their pregnancy on social media.

Zuliana says women are realising the importance of the journey towards parenthood rather than the destination itself as it is evident that healthy pregnant women have easier pregnancies and labour. “There is a growing awareness of the importance of ensuring the well-being of pregnant mothers, and not only that of their babies,” she adds.

She says the giving of the boxes to pregnant mothers is also a great way for husbands to get involved as all of the products are 100% safe for pregnancy. “So, it eliminates the guesswork from the process of pampering their pregnant wives as we have done all of the research on what is safe to consume.”

Zuliana, who is a mother of a one-year-old, was a green building consultant when she was pregnant. The idea of Before She Pops came when she realised she wasn’t able to drive during the last few weeks of her pregnancy, but needed to get things like herbal tea.

“That was when the idea struck, that it would be good to have these things delivered to my doorstep. I spent a lot of time researching what was safe to consume during pregnancy. The pre-natal period is the last chance for pregnant women to be pampered before it is all about the baby,” she says.

Not long after Zuliana gave birth in February last year, she left her full-time job and, with the support of her husband and sister, focused on growing her start-up. She recently started selling mini versions of the second (RM100) and third (RM120) trimester boxes and is in the process of curating gift boxes for the confinement period for her “After She Pops” project.