BY AKU KWAMIE Research Fellow, Ghana Health Service/University of Ghana
A month ago, I wrote up some of my reflections from the Global Maternal Health Conference. In that piece, I called for a ‘moral revolution’ in maternal health care: the need for us to imbue the notion of honour into our maternal health efforts, and perhaps move past a focus on technologies and other resources in order to make the difference needed in improving maternal health for women and girls. In the meantime, some colleagues posted their own reflections on this issue. Recent developments here in Ghana enable me to respond further.
You may have seen coverage of a new Ghanaian initiative, the Maternal Health Channel (it was mentioned in last Friday’s IHP newsletter). I was at the launch, and it was so interesting, and not just for the expected reasons. An initiative of a Ghanaian social development communications company, and with support from the Netherlands and other development partners, the Maternal Health Channel will run as a weekly television programme: mashed-up docu-drama and panel sessions engaging civil society organisations, community representatives, the private sector, clinical experts, and policy-makers. This is to be combined with radio programming in local languages and social media. The event was rather high-level: approaching the National Theatre, I was struck by the colourful banners I could see from the street – and the military detail as we awaited the President.
In Ghana, maternal mortality was declared a ‘national emergency’ in 2008, a fact that is frequently mentioned. It is encouraging to see the new government administration continue to prioritise maternal health. In bleakest terms, our mortality and morbidity figures amount to 10 maternal deaths a day, and 270 maternity-related injuries and disabilities daily. We like to reassure ourselves that this is not as bad as in some countries. Yet, as we continue on our path of development, with markers like our new-found oil reserves, our near-‘middle-income’ status, and our maturing democracy, it is confusing and unacceptable that women continue to die or become disabled because of childbirth.
The Maternal Health Channel is endorsed by specialists, policy-makers, parliamentarians, queen mothers, students, front-line staff, pregnant women, international NGOs and donors alike. It is about education, information, discussion, and advocacy. We are supposed to watch and listen, and discuss what we think with our sisters, neighbours, nurses and husbands. I am not much of a television watcher. But my Thursday nights will be booked for the next little while.
The half-day launch was full of speeches which were interspersed with a trio singing odes to our mothers, and a sketch dramatizing one woman’s treacherous journey at the onset of labour. Notable was the representation of the President by the Minister of Foreign Affairs, Honourable Hannah Tetteh, an interesting choice, which served, I think, to heighten the cause ‘beyond health’. Mrs Tetteh spoke eloquently about growing up having known something about maternal health issues, being the daughter of an obstetrician-gynaecologist, and having lost an auntie to an ectopic pregnancy. All of this was stimulating, but these weren’t the highlights. Two particular episodes stood out. The first was Madam Lucy, who spoke of her anguish, losing her daughter during her daughter’s pregnancy. In the video clip presented, she said of the moment the doctor informed her of her daughter’s death: “my heart cut”. In the translated sub-title it read: “my heart jumped”. There were murmurs as the young nursing students around me chuckled and shook their heads at the rendering of this woman’s words. When Madam Lucy took to the stage to tell her story live, she re-iterated her own words in clear English: her heart had cut, to the overwhelming cheers of the crowd who supported her unedited voice.
The other highlight was the inclusion and acknowledgement of a large group of kayayi, the young porter girls who work in the markets, often migrants and homeless, who face huge challenges in accessing health services. Many of them brought their babies. I can’t say I have ever attended any kind of forum where ambassadors and MPs have sat alongside nursing and midwifery students, and kayayi and babies. It was very nice. The launch ended with singing and clapping in the aisles as the trio sang ‘Sweet Mother’ and the final sketch delivered us a baby – the journey had been successful!
To bring this all to the comments raised by my colleagues (see their feedback under my previous blog post), there are a few links. Elizabeth asked whether those in power and with the resources can actually hear our calls for change? I think the Maternal Health Channel is a sign that at least in some small way, power and resources are listening. Only time will tell whether or not the programme can contribute to reversing the trend of maternal death and disability in this country. But moving the dialogue of maternal health – not just slogans and platitudes – out of clinics, and into a broader public domain is certainly a start. There are changing perceptions of maternal death and disability as being purely health (service)-related issues. There is a recognition that the solutions are not only with doctors and politicians, and that sexual and reproductive health rights also need debating in Ghana. Rachel raised the issue of validating the outrage and loss experienced by families when a mother dies. The Maternal Health Channel does this perfectly as each week is based on the story of one family. We felt this during Madam Lucy’s testimony, and for the duration of the launch the atmosphere shifted from distress towards hope as we honoured the memory of Madam Lucy’s daughter. The messages of our global declarations do not always filter down to our communities, but we can see how a broad platform for families and communities to speak out – in their own voices – can bring messages of action and accountability upwards. Finally, Jean-Paul highlighted the fact that we need a new generation of researchers with flexible minds to bring about change. I agree, and I would add that in our flexibility we should remain open to inviting different kinds of partners to contribute to that change. The Maternal Health Channel was a welcome surprise to many of us.
The American civil-rights movement taught us that the revolution will not be televised. But through the Maternal Health Channel, we are hoping to raise awareness of maternal death and disability, provoke action, and perhaps transform our Ghanaian society in the process. Many of us are watching.