Every year, more than 350,000 women die in childbirth while millions more are injured. Despite many attempts to improve these conditions, progress has been minimal. In Uganda, rural villagers attribute this lack of progress to development agents refusing to work with them in designing and implementing development projects. Safe Mothers, Safe Babies thus seeks to reduce maternal and neonatal mortality through a model of “participatory development” in which we work directly with local populations to define maternal and child health in their terms, identify the diverse contributing structural and cultural barriers to good maternal and child health, and leverage community engagement and ingenuity to develop innovative, community-sustainable solutions that we implement together. We currently serve approximately 125,000 people, and are expanding into additional areas over the next six months.

Every year, more than 350,000 women die in childbirth while millions more are injured. More than 90% of these deaths and injuries could be prevented easily with access to health technology, center, and care, which is why many initiatives have sought to increase the availability and access to such technology. Yet, despite these attempts, progress has been minimal. Why? As expressed by a personal friend and community leader from rural Uganda, “They [development agents] don’t ask us. They think they know our problems from their books and internet and what-what, but they don’t! They don’t know us. So why would we listen to them?!” In other words, many development projects are created in a non-participatory process in which people living in poverty aren’t involved in creating and employing the policies and projects designed to benefit them. Resultant initiatives often rely on Western conceptions of what it means to be “developed” that alienate intended recipients and disregard cultural perceptions. This leads to the projects being underutilized and unsustainable in the absence of donor funds, staff, and management. This is particularly true for maternal and child health initiatives, as reproductive processes--family planning, pregnancy, childbirth, and parenthood--are some of the most personal times of an individual's life, making culturally-insensitive, condescending demands particularly intrusive and ineffective.

Because we seek to empower each individual community, the participatory process has resulted in different solutions based on each community’s needs, resources, and ingenuity. For example, one community wanted to address the lack of paved roads and distance to their health center; together, we developed a maternal referral system using a network of trained "Emergency Clubs" and two motorcycle ambulances that were fuel efficient and able to handle rough terrain. In another community, the lack of electricity in their health center made women reluctant to deliver there at night, so we installed a solar system at the facility. In almost all areas, people prioritized the need for culturally appropriate education; so, we worked with men’s and women’s groups to develop reproductive health dramas and songs that the groups perform in their communities. Our primary innovative solution is thus our model, empowering rural villagers to both care about and take charge of their own health in innovative ways that the community can sustain. That innovation can be seen in the number of our projects that are the only of their kind, for example, using solar power not just to light a health center, but also to change maternal behavior to deliver there (as opposed to their homes), or using a women’s bicycle race to gather more than 1,000 people to attend the very first, community-planned celebration of International Women’s Day.

While the need to engage recipients in development projects is widely accepted, very few organizations successfully implement theory in practice. The need for truly “participatory development” is why SAFE was founded. We act on the knowledge that a true transformation in health and health-seeking behavior can only be achieved when initiatives really seek to work with their target populations, treating them as partners not just participants. We believe that the best partners to improve maternal and neonatal mortality are the people whose lives it impacts. We thus work diligently in each community with which we partner to undertake the following process: (1) Identify local leaders and engage them as key partners, (2) Work with those leaders to engage the community at large, (3) Work with the community to define maternal and child health in their terms, and prioritize structural and cultural barriers to good health, (4) Design and implement low-cost, innovative, and community-sustainable solutions, and (5) Gradually transition project management to the community the project(s) serves.

Iganga District, Uganda is home to approximately 700,000 people, more than 85% of which live in rural areas relying on subsistence agriculture. It is the second largest and fastest growing district in the country, spanning more than 4,000 square kilometers, in which there are only 2 paved roads and a myriad of dirt feeder roads that wash out during the rainy season. It is largely a patriarchal society, and is home to Christians, Muslims, and Animists. Polygamy is prevalent, which, combined with an average fertility rate of 6.9, leads to very large families. Local beliefs relevant to maternal and neonatal health include preferring delivery with a traditional birth attendant, the desire to use herbs during delivery, the thought that only sick women should attend prenatal care, and post-birth practices of immediately washing the newborn, feeding it honey, and putting creams on the umbilical cord. Iganga is served by one, and only, hospital--the Iganga District Hospital--that provides services to 1.2 million people, although it was built to serve only 200,000. Very few rural health centers have electricity, and quarterly shipments of medical supplies last only a few weeks. More important, however, is the will of the people to improve their own circumstances. For the past 3.5 years, SAFE has been working with a network of more than 700 people from village government and grassroots development associations, women's groups, and men's groups to engage the population at large, who help us design, implement, and manage all projects.