9:00am, Monday morning. As I start down the red dirt path to my office, eyes to the ground in my daily effort to keep my feet dust-free, the twinkling of women’s laughter drifts through the banana trees to my ears. What day is it? In my new life as a Global Health Corps Fellow, some days the gravity of this transition takes over my sense of time. Is today the day? As the realization hits me, I abandon my careful trek and tear off wildly towards the sound. I turn right at the sweet potato garden, hang a left at the papaya tree, scurry down the trail between the maize fields, and with a flourishing swipe of the matooke fronds in my path I happen upon the most beautiful sight: sixty women, bedecked in their brightest kitenge, patiently awaiting the opening of the S.O.U.L. Foundation Antenatal Education Center.
Today is not just any other Monday in sleepy Kyabirwa, my new home along the Nile; it is the official opening of S.O.U.L. Foundation’s Maternal Health Network, a project of love that has gestated, grown, and been laboriously delivered into being. The idea of building a program to address rural maternal health problems in this region was originally conceived around a table between S.O.U.L. and leaders of the community a year ago, and has been tended to with collaborative care ever since. As I walk into the S.O.U.L. schoolyard this morning, wading through the women’s excited hugs and morning greetings, the love and hard work of everyone who molded the intentional foundations of this program is abundantly evident.
In the past five years, substantial progress has been made across the world to meet the Millennium Development Goals; and while significant strides have been taken towards improved global health and education, progress is far from sufficient in regards to global maternal and infant mortality rates. The Sustainable Development Goals as a result demand a more exacting requirement of the global community, to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030.
Here in Uganda, 360 women die per 100,000 live births. And that statistic only accounts for women who decide to give birth in public health facilities. Considering that only 42% of births in Uganda are attended to by a qualified health professional, maternal morbidity statistics fall short in capturing mortality rates and health indicators for women and newborns who cannot access public care. S.O.U.L. wanted to know how this overwhelming statistic played out in the lives of the mamas that make up the lifeblood of our beneficiary communities, many of whom decide to deliver with traditional birthing attendants (TBAs) instead of qualified midwives.
For the mamas of Kyabirwa – those who wrap up the community on their back as they till the soil and draw sustenance from the dirt – accessing health care at the local health center is not always possible, or preferable. To answer these questions, S.O.U.L. hired our Global Health Corps predecessors who conducted a year long research assessment investigating the barriers that influence women’s maternal health choices and behaviors, and the challenges that government health workers face in trying to provide quality care in rural settings.
That’s where I come in (wave!). The Maternal Health Network is a result of the findings of this groundbreaking research, and my co-fellow and I have worked tirelessly to pilot a program that directly addresses the intersection of needs for the mamas, their male partners, and the health workers of rural Jinja District. The program encompasses several interventions, each of which attack a different ‘delay’ that contributes to maternal mortality in rural settings: 1) Delay in decision to seek care; 2) Delay in reaching care; and 3) Delay in receiving adequate health care at facility. The Antenatal Education Center, housed within the Maternal Health Network, aims to reduce maternal mortality by disseminating education and encouraging male involvement in maternal health for women and their partners. We do this with the underlying belief that education informs behavior change and leads to empowered action. Our hope is that the Center, in conjunction with future interventions implemented under the Maternal Health Network, will help mothers navigate the fractured health system, break through barriers to care access, and broaden the horizons of their health care choices. We believe this multi level approach will act as the first step toward health behavior change on the individual, family, and community level.
As I look around and follow the line of mamas into the sunny colored classroom, I’m surrounded by women of all ages, shapes, and sizes. An old grandmother is helped to her seat by a younger woman, shy and pregnant with her first child. Three sisters take up their spots on the reed floor mats, balancing notebooks and babies in their arms. A young teen mom is welcomed to the table by a group of seasoned mamas. As the room slowly begins to fill with bodies and the sounds of laughter, I can’t help but feel a wellspring of joy, a stranger to my usually groggy Monday mornings. Looking around, the realization of why I am here takes perch in my heart. The opportunity to walk with the women of this community as they invest in their health and rights is a gift; to witness the birth of this program, a blessing; and to be part of its creation, the highest honor.