When Culture Helps Saving Women’s Lives in Senegal
Reported, December 12, 2011
Watch out for a woman who walks with a heavy load on her head and has a hard time balancing it. Watch out for your safety, but most of all for hers. If she is pregnant, this means that her baby may not be in the right position for delivery. What she needs to do is go to the nearest health center and seek medical help for correctly positioning the baby. Making the cognitive connection between a woman carrying a heavy load and the risk of having a transversal pregnancy is far from obvious. Cultural beliefs and images can help make this link, and facilitate better understanding of risk factors related to pregnancy and childbirth.
Wure, Were, Werle–also known as the 3W Safe Motherhood Game–in Wolof, one of the main languages of Senegal, aims to increase women’s awareness of maternal and child health risks by associating them to cultural images, notions and proverbs depicted on a deck of playing cards. The idea behind this popular game used by the PLAN International Senegal team in Thiès–one of the child survival project locations north of Dakar–is to educate rural women on 24 risk factors, originally identified by the World Health Organization, that pose a real threat to pregnant mothers and their newborns.
Senegal has a very high maternal mortality rate, estimated at 1,200 per 100,000 live births. This can be attributed to several factors: limited and poor access to reproductive health services, particularly in rural areas; widespread misconceptions about women’s health and causes of disease; a low contraceptive prevalence rate; and the fact that more than half of all births take place at home without qualified help. “When women understand the reasons behind certain health conditions, they are more likely to seek professional help from a nearby health post or a hospital,” explains Amadou Diallo, public health nurse and creator of the 3W game. Changing attitudes about perceived health risks is the first step in changing behavior, and ultimately reducing maternal and child deaths.
The 3W game consists of a hexagonal wooden box with six drawers, a deck of 72 cards, and three colored rows: red, yellow and green. Red represents the risk factors, yellow the detection methods, and green the solution or appropriate behavior needed to address the risk factor. Community health educators train village women in the underlying principles and rules of the game. The winner is the player who successfully completes a three-color pattern and is then awarded a set of marble balls to store in the wooden box. Players can prevent others from completing the series by starting a new series of their own, and winning over other player’s marble balls. Each time a player puts down a card, he or she is obliged to repeat the concept of the series, beginning with the risk factor. “The idea is that the repetition of health messages reinforces their internalization,” says Adja Diack, National Health Coordinator for PLAN Senegal. “While the use of symbols as a mean of decoding health information and messages, increases their acceptability.”
Certain images and symbols are easier to grasp than others. Take the goat and the elephant for instance. In Senegalese folklore the goat is known to be a prolific animal. When a woman picks up this card she will associate it with having multiple and closely spaced pregnancies. The goat card symbolizes all the potential health risks of such a condition like anemia, postpartum hemorrhage, uterine rupture and abnormal positioning of the baby in the womb. The elephant, on the other hand, reproduces only once every five years and is, therefore, a symbol of healthy child spacing and access to family planning. When prenatal and postnatal care is neither readily available, nor a routine procedure, correct identification of risk factors can save women and children’s lives.
Playing a game is an informal way of discussing sensitive topics normally considered taboo in a culture that still links women’s position in society to their reproductive role. Diallo says that, “Women who play the game regularly learn to look out for each other’s health in a relaxed atmosphere, and to share the information with other family members.” The game was tested in 16 villages in three heath districts: Khombole, Bambey and Kaolack. Research has shown that after playing a series of only 10 games women are able to describe the risk factors related to pregnancy, labor and delivery; describe the risk factors that can be detected in newborn babies (such as low birth rate or dehydration); and discuss the methods that can be used to detect common risk factors, along with the appropriate behaviors needed to address them. PLAN International supported the development of the 3W game in collaboration with the Social Pediatrics Institute of Senegal, World Vision, Reseau Afrique 2000 and several UN agencies.
Credits and more information:PLAN International Supports Innovative Educational Approach and
http://www.globalhealth.org/reports/report.php3?id=7