Highlight number two of the week...actually doing some advocacy!

The main objective of my week has been to support my colleague Abbie (World Vision Programme Officer for Health) to run advocacy meetings with stakeholders in all six Sub-Districts and their surrounding communities. The theme is Safe Motherhood Practices, and the meetings are expected to have a direct impact on Millennium Development Goals 4 and 5 in these specific communities: improve maternal health, and reduce child mortality.

It sounds like pretty serious work, and in a way it is. Being placed with Abbie in the Health Programme where most of my activities have focused so far, as opposed to the Education Office where I have more experience and understanding, I have had a huge learning curve since I started. I previously had no idea how important safe motherhood practices were here, and what kind of impact advocating for behaviour changes would make. However, having learnt that traditional home births were until recently the main way in which women would choose to give birth and one that put both mother and baby at serious risk of illness, injury or death, and that many women would not enter the health facilities for ante-natal or post-natal care, again posing numerous risks to them-selves and the baby, I had begun to develop a sense of the seriousness of the issues, and of the need for change.

I have to say, the Ghana Health Service has really made some positive changes that are supporting the work done by health professionals on the ground. For example introducing free health care for pregnant women, and ensuring health facilities, even the most basic ones, are found in almost all communities are huge steps forward. However, much of what happens next is about the attitudes of the people in these communities, and whether they choose to go for health care, or stay at home and follow traditional practices for pregnancy and birth. Hence the advocacy meetings taking place this week.

Every man and his goat was invited, so long as they were a stakeholder they were expected to be there, and at most of the meetings, they all turned out! One thing that really impresses me here is the amazing community mobilization that occurs whenever an important meeting or event is to take place. It's not like at home where people all have diaries, conflicting demands on their time, the need for a three-month advance warning for any meeting, and a reem of excuses as to why they can't make a specific date or time. Nope, here all hat happens is the right people get the word out, and everybody turns up. Even in the earliest days of farming season, when everyone is expected to be in the fields preparing the ground after every rainfall, ready to plant their precious seeds and sow for their harvest. I am sure a lot of it is about the culture here, the sense of family and community, but it's also about the positive engagement that the communities have with services like Ghana Health Service, and NGO's like World Vision.

So here they were, Chiefs with their red hats on (I have finally figured out how to identify them!), Queen Mothers draped in colourful fabrics and sporting huge bright headscarves and necklaces of big round colourful African beads, Assemblymen with their shiny shoes and freshly ironed shirts, religious leaders in their long flowy gowns, teachers sporting a look of relief about being out of the classroom for half a day, community leaders, health workers, nurses, community volunteers, traditional birth attendants wearing layers of coloured fabrics and wrinkles so deep on their faces I can only guess they must be at least 80 years old (pretty good going in Ghana), oh and the obligatory baby, toddler and small child too of course, all happily muddling about between the rows of people and playing and dribbling all over the Assemblyman's nice shiny shoes.

The meetings were a really mixed bag. Some were in communities where all stakeholders were completely on board, working together to encourage safe motherhood practices amongst their pregnant women, and having real success on a number of levels. In these meetings it was a real pleasure to watch my colleagues get excited and deliver their messages with booming alacrity, motivated by the ease at which they were received and spurred on by the hope that if this continues in the same vein then teenage pregnancies might be reduced, and dodgy abortions avoided, and that more bouncing babies would make it into the world safe and well. Hurrah!

Some others, however, were in communities that were stuck to their old opinions thick as treacle and were really truly difficult to engage with or attempt to change. In one community we must have spent a whole hour discussing the issue of whether a man should support his wife to access ante-natal care and go for skilled delivery (basically delivery at the hospital). Knowing full well that a prevailing issue on family planning here is that men won't allow their wives to take the pill or have the injection, because 'that means they can sleep around and we would never know', and that many women are expected to obey their husbands request for sex at any time of day or night, I struggled to hide my shock and frustration when one man, a particularly influential person within the community, said 'if a woman gets pregnant then it's her fault, especially if she has tried to talk to us about family planning and has said she doesn't want to have any more children for at least a year. If she then gets pregnant, then why should we support her?!'. They also made comments like 'men supporting women during pregnancy, that's just for the west and for the white people', and again I'm biting my lip with what I can only describe as anger at these flippant comments.

Hence why I spend my first two meetings as a complete 'sponge'; sitting, listening, absorbing, and trying my best to understand what on earth is going on. What is it that makes the difference between the first community and this one? Why some moving leaps and bounds towards change whilst others are stuck like walking in mud? There is no way I can contribute to this process until I have a much better understanding of the cultural context, and after these first two meetings boy did I start to get it!

It was the traditional birth attendants that I found most intriguing. Their layers of age wrinkled up on their faces, telling stories in streams of Kusaal of how many babies they have successfully delivered, how they wait for some time after the baby is born before they cut the umbilical cord, to allow the gods to give their sign of acceptance, how they use herbal drinks, mixes and remedies to induce a labour, or to hold one back, and how their methods have been used for years upon years. I can understand their fear of change, especially as it can affect the level of respect and standing that a community places on such an important figure, and could mean stopping something that they have done for years, to switch to a birthing process that pays no attention to their Gods or their traditions. I even heard that if a baby does not cry when it is born, they may bump the baby's head on the floor to check if it is alive. I begin to sense the real mix of modern attitudes and traditional ones that exist in many of these communities. In Malawi the line between them was thick and bold and clear. Here it is thin and blurred and wobbly.

I really admire the Ghana Health Service staff, those from the District Health Team that come out into the field to run these meetings, and the Health Workers on the ground that support them. In them I see a real sense of commitment, a real drive to stop the number of maternal and child deaths from growing, and to shrink the teenage pregnancy rates and dodgy abortions taking place. The way they handled those challenging remarks, and deftly delivered their talks in a way that will encourage almost all in some communities, and at least a few in the most challenging ones, to take up the role of advocating for change and adopting safe motherhood practices.

It's the end of a long week, and I'm exhausted. The real answer to whether these initiatives will work in the long run will certainly be in the figures, but in the meantime it's now in their hands.

With love from Ghana,

Em

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