BY KIMBER HADDIX MCKAY
ISIS RESEARCH, MONITORING AND EVALUATION DIRECTOR
In April, Catherine Sanders, ISIS’ Research Associate, and I met at Kiwoko to continue data collection in the community around Kiwoko Hospital. Catherine came from Nepal, where she had been in Humla laying the ground work for more investigations of the successes and challenges facing ISIS projects in the Humla District. She was particularly interested in talking with people who had recently been treated at an ISIS sponsored medical camp, and in the new phase of the latrine projects throughout our project region. More on these investigations later!
While we were in Kiwoko, we were interested in furthering conversations initiated during the baseline study, in understanding the potential impact of the Youth Friendly Centre (a place where young people can access health services and testing, treatment and counselling for sexually transmissible infections), and in the work of traditional birth attendants (TBAs) and midwives in the Kiwoko Hospital catchment area. We also had many conversations with Moses Ssekidde, the Director of the Community Based Health Care (CBHC) programme, about the factors associated with the school drop-out rate among adolescent girls, and the most effective strategies for reducing this rate.
CHALLENGES TO STAYING IN SCHOOL…
Among the typical challenges associated with staying in school, such as cost and labour needs within the household, girls in Nakaseke face an often unspoken challenge. Once reaching adolescence and upon starting their periods, many girls drop out of school due to the lack of sanitary products, embarrassment at school, and the lack of a girls’ latrine block where they can tidy up in privacy. If there is only a male relative available at home, a girl may not have anyone with whom she can talk about managing her period, due to taboos prohibiting a girl from discussing intimate matters with male relatives.
A new initiative at the school closest to Kiwoko Hospital targets this problem, by building a girls’ latrine block with a wash stall, and with messaging aimed at de-stigmatising menstruation (pictured below). A female instructor is also employed with the express purpose of providing counsel and support to menstruating students. We are currently formulating a study of the retention rates of adolescent girls in this school in comparison with schools without such services.
PREGNANCY, HONOUR AND THE MANAGEMENT OF RISK…
Another topic we investigated relates to the management of risks associated with pregnancy. In the medical anthropology literature there is a lot of writing about the ways in which women perceive and manage the pain and danger of labour and delivery, and the relationship between these and womanly honour. An honourable woman in this setting is a woman who does not dwell on risk, who actively but discretely manages risk within the limits of her budget, her husband’s wishes, and her own rational evaluation of the choices available to her. These options include TBAs, the Kiwoko Hospital CBHC antenatal clinic, and the possibility of giving birth at home versus the hospital. Each of these options has different costs and benefits, and we asked women to help us understand how they juggle those. It is important to recognise that financial cost isn’t the only kind of cost cited by women. Women also explained that they were concerned about being shamed by hospital staff, and that spending available money would put them into conflict with their husbands.
Catherine and I are currently analysing data collected in Nakaseke and Humla. Stay tuned for further updates.