FINE and MamaYe - Working together to engage activists

MamaYe has organized an engagement session for activists in Koinadugu and Bonthe districts, in collaboration with the local District Health Management Teams and the “Fambul Initiative Network for Equality” (FINE).  FINE is a network that engages grassroot men - including out-of-school youths - to be leaders in reproductive and child health issuesThe district orientations started with opening ceremonies, chaired by the District Health Sister in Koinadugu and District Medical Officer in Bonthe, who were delighted to see Maternal and Child Health Aides and motor bike riders taking the lead to address issues around maternal and newborn health.A commendation from the District Medical Officer for MamaYe!The District Medical Officer, Koinadugu - Dr Manso Dumbuya - commended MamaYe for immensely contributing to saving lives of mothers and babies as it was evidenced during MamaYe’s support in celebrating International Blood Donor Day a few months before the activist meeting.To my greatest excitement, he told us that thirty seven units of blood were donated by blood donors during this commemoration. He shared that after the exercise, the hospital had seven emergency cases of pregnant women and blood was taken from the blood bank for transfusion. He concluded that the blood donated during International blood donor day had:“saved lives of seven pregnant women in the Kabala Government hospital.”District lead activists take the stageAfter these great news, it was time to start our work. The orientation sessions were conducted for 152 MamaYe activists and were facilitated by two MamaYe district lead activists – the wonderful Steven Gilbrilla and Nancy Kpanabun.They told me later that it was a great learning opportunity for them to facilitate and be part of the sessions.The objectives of the orientation session were to:

• introduce and present an overview of MamaYe to participants
• discuss expected roles and responsibilities of MamaYe activists
• increase participants’ knowledge on maternal and newborn health issues
• sensitive men on their potential role in improving MNH
• develop an action plan on their engagement with communities on MNH issues

The sensitization activities were fully participatory; participants were often divided into groups for group work and discussions followed by plenary sessions.Energizers were used to ensure effective and focused participation – needless to say, I know Kabala very well and had a few jokes aside in case participants needed to be revitalised.Role plays were also done to practically illustrate actions that activists should undertake and this stimulated a lot of discussions. Fruitful workshopsA short session gave participants an overview on the maternal and newborn health situation in Sierra Leone, using the latest evidence. We also described MamaYe and Fine's asks.Then, participants brainstormed which activities they would undertake. It included:

• Visit and advise pregnant women to deliver in a clinic
• Help pregnant women to reach the clinic in case there is no ambulance, if possible free of cost
• Motorbike Riders to create link with Peripheral Health Units to help transmit  vital information to DHMT
• Mobilize community to donate blood
• Participants insisted to say that they saw themselves as representatives, volunteers, messengers, advocates and informants.

Motorbike riders pointed out that their presence in remote areas would be an added advantage in disseminating messages around clinic attendance and ensuring that pregnant women deliver in clinics and ask their council, District Health Management Team, non-governmental organizations and traditional leaders to make clinics safe and to put more money into maternal and newborn health issues.Motorbike riders staged a role play to describe how they saw their new role. The activists at the end of the sessions developed action plans, which are  being monitored by lead activists in the districts and reported to me.In addition, the district health management teams also facilitated very useful sessions on danger signs and on decision-making on women’s health.  The role of men in maternal and newborn healthLet me take a step back and explain why we work with Fine – beyond the fact that we share similar objectives.One of the primary challenges faced in reproductive health in Sierra Leone is the non-involvement or engagement of men as husbands, fathers and brothers in understanding the reproductive/maternal health and challenges of their spouses, sisters and mothers.This is why I felt that the engagement of the only national male network on reproductive health and gender advocacy - Fambul Initiative Network for Equality, FINE-SL was vital to the success of the MamaYe campaign. FINE-SL can bring along their expertise on male-involvement to improve on the maternal and newborn health outcomes in Sierra Leone. In addition, FINE's strong belief in MamaYe asks - safe clinics and more funds for  health - has lead the organisation to incorporate these asks in their overall objective.We now work side by side with the activists.But back to the training sessions: The chair of Fine –SL, Reverend Buannie, skillfully reminded participants that reproductive health issues are traditionally considered to be a woman’s issue and men are often ignored or not considered in the deliberation.This mindset is an example of negative assigned gender roles and patriarchal construct amongst many that impedes women’s health. Rev. Buannie also shared that, FINE works with men:

• to bring to the fore that men too have reproductive health issues
• that reproductive health both of men and women are integral and inseparable in terms of commitment and responsibility to addressing its challenges
• that men must be brought to speed in terms of understanding the physiology of womanhood beginning from pregnancy through motherhood
• Accentuate the need for men to support their wives/spouses both in the state of pregnancy and lactating periods

Additionally, the facilitator mentioned that, the role of men is also noticeable at every level of decision making in the home and in every community. In the home the man makes decision whether the woman will use contraceptives/family planning commodities or not.The man decides whether woman goes to clinic or not. The man decides on when and where to have sex and on the number of children. FINE findings shows that over 85% of rural pregnancies are unplanned. The woman has little or no say.This, he pointed out, is an example of masculine dominance.Participants were guided in discussing the issues around patriarchal beliefs and masculine dominance that impedes maternal and newborn health. Some of the inputs made by participants were as follows:

• A man has nothing to do with child birth
• It is not proper/right for a man to be present when his wife is delivering
• A man should have nothing to do or know about delivery ( except if you are a doctor/nurse)
• Bathing a baby is woman work
• Changing diapers is woman’s job
• Feeding babies is a woman’s work
• Washing napkins and baby’ clothing is not a man job
• Men accompanying women to hospital or clinic is not part of our culture and that one will be perceived as weak or a womanizer or under the control of your wife by the community except in emergency situation

Participants were further guided to discuss what outcome it would the above have on the health of pregnant and lactating mothers, and what outcome there would be if instead, men were to understand their role beyond gender defined roles and perform the above roles they criticise:

• It will ease the work load on women and prevent most of the health complications women encounter as the result of neglect and work pressure
• Save the lives of women in delivery
• Mothers and babies will be healthier

Taking on the role of bike riders as men, he asked what role they could play to save lives?

• Sensitize others about what they have learnt as men to change wrong patriarchal mindsets
• Mobilise other riders to support pregnant women to clinic within their areas of operation
• Support the blood donation drive for pregnant women

I saw how effective Reverend Buannie was.Through his very powerful speech, he managed to increase participants’ commitment to reach out to their respective communities as advocates for MamaYe. Among all the men attending this session, it was clear that they had to support their spouse during and after pregnancy and to facilitate delivery in a clinic.Voluntary blood donor registrationAs you could see above, we had described to our activists what affects the health of mothers and babies in SL.Often, when they are sick, they need blood transfusion. But blood can’t be bought or created, and few people donate blood. As a result, too many mothers and babies die. This is the reason why we offered to our activists to support us in Koinadugu.As a result, fourteen (14) motorbike riders and thirteen (13) student MCH Aides registered as blood donor volunteers after the sensitization sessions. If like me you have been in Koinadugu before, you know that there are many cultural barriers to blood donation. But this figure shows that things are changing, that activism can be stronger than defeatism. These activists warmed my heart.Enthusiastic activistsOverall, from what they have told me and what I have seen, activists were excited and appreciated the workshop. They are willing to promote Mamaye goals. As an example of their dedication, after the student sensitization session in Kabala, a song that reflected Mamaye was sang by student jubilating in the name of MamaYe. In Mattru, Bonthe district, activists expressed similar enthusiasm after the orientation. The MCH Aides used the opportunity to sensitize the Mattru public through songs on safe clinics and safe delivery during an athletic event organised by the United Brethren in Christ Mission training school for State Enrolled Community Health Nurse. The maternal and child health aides students also participated in this event, wearing MamaYe T-shirts and were victorious. I don’t know if it is this victory, or the seven lives saved, or the fact that the activists were so committed, but I believe this is a sign that our activism will be successful. Do you believe so too?