With researchers at the Universities of Cambridge and Makerere, Africa’s Voices sought to understand socio-cultural beliefs about complications during pregnancy in Kampala, Uganda.
There is no bigger disparity for any health care outcome between African and high-income countries than the morbidity and mortality of mothers and their babies. In Uganda, at least 16 women die every day due to complications of pregnancy and at delivery.
Action to reduce these rates has been largely restricted to the fields of medicine and public health. At the same time, there is a spectrum of challenging social and cultural factors that are an inescapable context within which maternal mortality occurs. However, the challenge has been to design research methods that effectively engage hard-to-reach populations, are replicable and scalable and which provide valid empirical socio-cultural evidence.
WHAT WE DID
We used methods grounded in African social realities, opted for low-tech but widely used communications channels, and worked with local languages and natural forms of expression.
Over four weeks, three Luganda radio stations in Kampala broadcast weekly interactive shows that included a testimonial from a woman who had experienced pre-eclampsia, and a related question for the audience to respond to. Listeners could participate by sending a free text message to Africa’s Voices SMS platform. Some messages were read live on air. Participants received an SMS survey in reply that asked for their demographics and a topic-related question.
We gained 4462 SMS during the one-month study from over 2000 people. 49.6% of participants were women [Uganda population=51.2%] and 56.3% of participants were 20-29 years [Uganda population=29.0%]. Most messages were in Luganda, and some in English, requiring an innovative approach to analysis that combined in-depth qualitative techniques with large-scale automated analysis.
INSIGHTS AND IMPACT
Our analysis of the SMS data revealed a range of insights into what beliefs influence pregnant women’s decision to seek maternal health services.
For example, we identified gender variations in perception of internal causes (related to biology or supposedly dispositional traits of the mother) vs external causes (linked to low quality of health care, lack of support from husband of complications during pregnancy). Men tend to perceive internal causes, women more. In turn, men tend to perceive themselves and their partners as not at risk, and that complications are more likely to happen to women other than their partner.
Project team: Dr. Claudia Abreu Lopes (research lead), Rainbow Wilcox (project manager), Grace Kentaro (research assistant), Giles Barton-Owen (data analyst), Dr. Sharath Srinivasan (director) and Meddie Baliddawa (translator).
Research collaborators: Prof. Ashley Moffett, Dr. Annettee Nakimuli, Prof. Grace Kyomuhendo, and Dr. Gabriel Recchia.