Reframing the issue away from failure, despair and mortality – and towards solutions, success and survival.
As part of our work advising a UKAid- funded consortium whose aim is to reduce maternal and newborn mortality in five African countries, Ai had to think of ways of engaging Africa’s men and women in the complex issue of maternal and newborn health. This is an issue that requires a spectrum of care – from the time that young girls reach reproductive age right through to maturity; and from conception to well after a child is born.
Ai’s leadership team of Ann Pettifor and Maz Kessler began by scoping and assessing public opinion in the five countries.
The Ai team learnt first, that despite its high level of priority at international policy-making level, and despite the activities of MNH experts and NGOs, maternal and newborn survival is not part of the popular public conversation in the five African countries: Nigeria, Ghana, Sierra Leone, Tanzania and Malawi. It is of course central to much private and often silent grief in these countries.
Second, the team became aware of a widespread assumption across the five countries: that death in childbirth was ‘natural’ to quote an educated and sophisticated woman we met in Tanzania, or that alternatively it was “God’s will”. This widespread resignation and fatalism in relation to childbirth, we concluded, is one of the biggest challenges that policy-makers face in reducing maternal and newborn mortality in Africa. Resignation lowers expectations, and inhibits citizens from expecting and demanding that politicians and professionals make improvements in the care of mothers and newborns.
How to change perceptions? How to raise expectations?
Ai’s leadership team began by immersing ourselves in the issue, and quickly found that it was largely framed in terms of death, loss, suffering and mortality. Some of the framing is and was outrageously sensationalist – shocking and guilt-tripping audiences into supporting campaigns and donating to charities working with women and children. We believe that shock and guilt-making tactics do not work. Rather than energising and motivating potential supporters, they paralyse.
We worked on re-framing the issue away from mortality and towards solutions and examples of success and survival. This became the basis of a new campaign for maternal and newborn survival: MamaYe!
Central to the MamaYe communications strategy is the task of identifying evidence-based solutions to ensure the survival of women and their newborns – in order to showcase and celebrate both the solutions and the achievements of those who contribute to survival. We are particularly concerned to demonstrate and communicate to the African public that much can be done by any committed person to save lives, by: e.g. encouraging women to visit ante-natal clinics, taxi-ing a woman to hospital in an emergency; or giving blood.
How to engage Africans in maternal and newborn survival?
Reframing the issue
We know from George Lakoff, Professor of Linguistics at the University of California, Berkeley that:
“Frames are the mental structures that shape the way we view the world…they shape the goals we seek, the plans we make, the way we act, and what counts as a good or bad outcome of our actions. …To change our frames is to change all of this.
Reframing is social change.” (Our emphasis)
From: ‘Don’t think of an Elephant’ by George Lakoff. Published in 2004 by Chelsea Green Publishing, White River Junction, Vermont )
But how to engage Africans? In rich countries, campaigners often engage the public by inviting donations. In Africa, levels of poverty mean that many would be excluded from engagement in the campaign. Other means of engagement – the wearing of wrist-bands, stickers and badges, would be logistically complex, but also seemed unlikely to deeply engage African men and women.
And then one day, our director Ann Pettifor sat in a meeting on maternal health with a group of experts, including an experienced obstetrician, Dr. Sylvia Deganus, of the Ghanaian Ministry of Health, the statistician and demographer, Dr. Zoë Matthews of the University of Southampton, as well as Professor Richard Adanu, Dean of the School of Public Health, Ghana.
The subject of blood donation came up, and Dr. Deganus explained how her work to save mothers’ lives was made extremely difficult by a regular shortage of blood for women haemorrhaging at birth. Post-partum haemorrhage (bleeding) is acknowledged as the leading cause of maternal mortality in Africa. There followed a long discussion during which Dr. Matthews explained that more than 60% of blood donated in Ghana was aimed at mothers and children.
A light-bulb. Donating blood – given the right conditions – is something that any healthy person can do. Donation agencies would need to undertake screening, and ensure that blood is not contaminated, but given that such agencies already exist, Ms Pettifor felt that a partnership between the MamaYe campaign and national blood donation services could work to the benefit of both.
But above all, donating blood would, at very little cost, directly engage African men and women in the issue of maternal and newborn survival. The sacrifice in giving a pint of one’s blood implies real engagement in the issue. It would also stimulate and deepen discussion and debate about the issue between donors and their friends, families and communities. Above all, it would serve a real purpose: more blood supplies would save lives.