Having knowledge of obstetric danger signs and embracing good birth preparedness practices could enhance maternal and newborn health outcomes. For example, a woman, working with her family, can choose her preferred birth location; choose her preferred birth attendant and make advance arrangements with that provider; make advance arrangements for transport to the skilled care site; obtain basic safe birth supplies; and save or arrange alternative funds for costs of skilled and emergency care.
However, in many Ugandan households, especially in rural areas, it is taboo to make these preparations. As a result, by the time of delivery, many are stuck in a reactive mode, which has sometimes led to death of either the mother or newborn, and sometimes both.
Through the use of communications and media advocacy, the intervention study is tackling social and cultural issues that affect maternal and newborn health negatively. We are using village-level dialogues (once every three months) and radio talk shows (monthly) as well as spot messages (daily). The dialogues and talk shows offer a platform for discussing these issues and rally community suggestions and participation in addressing them. This community involvement promotes ownership and sustainability of behavioral changes. The dialogues are also expected to provide peer influence in favour of healthy maternal and newborn practices. And as convenors of the dialogues, village health teams (VHTs) have shared vital knowledge that is slowly changing the negative attitudes towards birth preparedness.
During the dialogues, women and men shared sad memories of maternal and newborn illness and death, underlining the grim reality of the situation. They also discussed good and bad practices and made commitments to abandon negative practices and therefore improve maternal and newborn health.
"I resolve to stop putting cow dung and other dangerous things on the cord of newborns. After today's talk I realise why my baby's cord took that long to heal. I urge fellow women to join a new me," said Ms Nabirye at a dialogue in Kamuli to thunderous applause from fellow women.
Monitoring data shows that, while only 17 per cent of sampled women who had just given birth treated cords with nothing but the appropriate saline water in mid-2013, that percentage had shot to 56% in mid-2014.
Mr Francis Kedi, a CHW in Pallisa says he has observed that more families are now appreciating delivery under skilled care, a view backed by monitoring data. In mid-2013, deliveries in health facilities in the three districts stood at 66%. As of May 2014, that
number had jumped to 84 per cent.
As at the end of August 2014, a total of 73,429 persons had attended the meetings. And if one of the goals of dialogue is to find common ground and find better solutions, then this is starting to manifest itself in the context of maternal and newborn health in the districts of Kamuli, Pallisa and Kibuku.
By Kakaire Ayub Kirunda, FHS Uganda Policy Influence and Research Uptake Officer
[Editor's note: This article is the first in a series of updates from the FHS Uganda team that were also compiled in their recent Showcase.]