By Executive Director and Founder of Wise Choices for Life, Marg Docking
The maternal mortality rate in Uganda is horrific, with nineteen mothers a day dying from pregnancy related causes. My initial reaction as a volunteer was one of deep sadness, that led me to be almost paralysed into doing nothing, desperately wanting to go home. But I was passionate to build a midwifery education model to reach the key drivers of cultural thinking, the traditional male faith leaders.
In Uganda, cultural beliefs and practices around pregnancy and family size are deeply connected to beliefs about God and the afterlife. Many believe that the larger your family the more God will value you. Having boys means your spirit lives on after your death. Belief in the power of the spirit world influences behaviour more than medical information does. The purely medical approach of midwifery has not been able to effect behavioural change in this context.
Realigning our educational approach to leverage the male faith leaders empowers communities. Uganda is a conservative Christian country and faith leaders from every denomination are respected and followed. They are the gate keepers of cultural change. If the medical world could engage their cultural leaders with midwifery knowledge they could instigate changed behaviour to reduce maternal deaths and introduce family planning.
In 1978 I was working in remote Aurukun, Australia. Any unexpected death of a young person required the body to be transported to Cairns for autopsy. Once, I tried to explain to her family the death of a 30 year old woman from brain aneurysm. Their response was “Don’t worry sister Margaret, we already know why she died. She kicked a dead man’s dog.” The dead man’s spirit lived on in his dog and was angered by the disrespectful kick so the spirit caused her death. They did not need medical explanations.
Traditional faith leaders in developing communities often distrust medical advances,
such as contraception. Our traditional model of education does not equip us to reach male faith leaders so we need to shift the way we approach midwifery education.
Wise Choices for Life (WCFL) is a medically sound curriculum, approved by the Ugandan Ministry of Health, equipping locals to facilitate training through drama, discussion and song. It engages traditional leaders in discussion of the consequences of child marriage and large family size, giving them their rightful place in determining community thinking and new ideas. Presenting medical information without including the powerful instigators of change in the community has very limited effectiveness.
It is often assumed that once scientific knowledge is introduced into a community, myths and spiritual beliefs will lessen and people will embrace change. However, according to Global Data 2013, 99,5 % of Africans have some religious connection. i This means that “Faith is a primary source of meaning for most communities in developing countries”. ii
I had to change my outlook before I could lead others to change. We now have traditional faith leaders taking midwifery knowledge into churches, a Christian university, youth groups, prisons, schools and a Bible college. WCFL is now a registered Non Government Organisation in Uganda, with teams of volunteers and three staff. Thereby realising my original vision for communities to lead the way toward change to reduce maternal mortality using a unique midwifery model.
I hope this story encourages you to include traditional faith leaders in programs in your setting.
i. R. James, “What is Distinctive about FBO’s,” International NGO training and Research Centre, Praxis Paper 22 (February 2009): 8.
ii D. MacLaren, “Putting the Faith back into Development,” Eureka Street (October 26, 2011).