Reducing obstetric fistula by educating male religious leaders (Uganda)

fistula education, Uganda

Guest post by Margaret Docking, Wise Choices for Life

Using dolls and pelvic models we ran workshops in Uganda for religious leaders about how to prevent obstructed labour and fistula.

Problems like obstructed labour and fistula are in part created by cultural norms that support child marriage and large numbers of children. Men in the community, particularly religious leaders, are influential in relation to cultural norms and so we decided to engage with them directly, explaining the causes of obstructed labour, fistula, haemorrhage and infection. We stepped out of the narrow clinical domain into the community. We worked creatively with traditional gender roles, appealing to these men to use their public decision-making rights. We appealed to them to lead the way in changing practices, such as child marriage, that lead to critical obstetric complications.

We concluded that we need a new model of maternal health education that is supported by men, approved by the local health authorities and implemented with religious and civil leaders. We moved our education out of medical facilities and into community settings, such as church halls and classrooms. We considered both medical and social issues together in a holistic approach. We moved away from text books to use traditional forms of communication, such as drama, debate, song and dance.

Training more midwives is very much needed but we pursued the opportunity to communicate simple prevention strategies directly to community leaders. This helps to reduce the health education workload of overstretched midwives.

We also engaged directly with young people in communities about preventative measures, discussing puberty, sex, conception, pregnancy, birth and family planning. We trained youth leaders to take the key messages to young people in the community. The aim is to empower them to take control of their reproductive life and reduce unplanned pregnancies.

To move this programme forward, I set up Wise Choices for Life, a faith-based not-for-profit to work with cultural traditions and beliefs systems that drive health behaviours. We train Ugandans to deliver the programme, many of them men and not from medical backgrounds. The programme has been endorsed by the Ugandan Ministry of Health, the Church of Uganda and Christian University.

Our next training conference is to be held in Uganda in November and open to non-medical male and female community workers. The conference is in English and yet is designed to be so simple it can be transferred easily to non-English speaking people.

Photo: provided by author.