TURNING THE ORDINARY INTO THE EXTRAORDINARY:

The Green Pendelu and Maternal Health in Mali

This issue of the Drum Beat takes a different form. Rather than highlighting a number of projects and initiatives, we take an in-depth look at one 'programme'. It is estimated that 650,000 women die each year during pregnancy and childbirth. There is a great need to improve maternal healthcare. Many believe that such improvements will not occur through predominantly introducing western techniques and strategies and mainly relying on 'scientific' and 'medical' approaches. The project described below is sourced in cultural folklore and traditional customs to improve spousal communication for a decrease in maternal and infant mortality.

SOURCE:This Drum Breat draws from The Dioro Approach Project Report "Turning the Ordinary into the Extraordinary: The Green Pendelu and Maternal Heath in Mali" by Lydia Clemmons and Yaya Coulibaly. Many thanks to Lydia for allowing us to draw from their extensive paper. If you have messages or requests of the authors, our Editor can forward them - dheimann@comminit.com

For a somewhat shorter version of the same article, please see the World Bank's IK Notes website - click here for a PDF.

CULTURE

A. The Dioro Child Survival Project began in Mali in 1989 with the specific goal of reducing mortality rates among children and women of reproductive age. The Dioro Approach is based in the philosophy that, in order for health projects in Africa to be meaningful and sustainable, they must actively support African cultures to incorporate positive cultural values, knowledge and practices. This project draws on and incorporates local cultural symbols and meanings in order to promote and support positive change.

RESEARCH

B. Research - In the initial phase research studies were conducted in order to identify obstacles to improving maternal health and health seeking behaviours. An important finding was the cultural ideal of the husband's supportive role during his wife's pregnancy. Conversely, the research also revealed a cultural obstacle to women's maternal health seeking behaviour - the absence of discussion about pregnancy at the household level, particularly between husbands and wives. Both men and women cited embarrassment and shame as the reason for lack of communication. Although women desired maternal health services, they could not take advantage of them because they could not initiate discussions or solicit the consent and support of their husbands. A primary project goal was to find ways of overcoming this taboo.

COMMUNICATION STRATEGIES

C. Malian cultural values indicated that typical health education techniques (e.g. distributing print materials) would not be effective. Traditional communication channels, including stories, songs and proverbs offered a more direct path to sensitive topics and would have greater success in educating and effecting change. The approach developed uses three traditional communication channels: (1) a traditional article of women's clothing known as a Pendelu, (2) a griot, and (3) a song.

THE PENDELU

D. The Pendelu, a short cloth undergarment worn by married women, carries deep cultural significance. It is both perceived as a symbol of marital roles, duties and privileges and interpreted as a non-verbal cue for gender specific attitudes and behaviours between husbands and wives. Because of the Pendelu's place in cultural folklore it was identified as a potential tool for facilitating communication between husbands and wives. A modified white Pendelu, dyed green, was to be worn to symbolise a woman's pregnancy and to signal the husband's role as protector.

THE GRIOT

E. In Malian culture, a griot is a combination of oral historian, praise-singer and social mediator. Identified as having great knowledge and supernatural powers, Griots are educators as well as entertainers, and they are the only individuals in the community who could promote the discussion of pregnancy and the Pendelu without being considered obscene or inappropriate. In collaboration with project staff, the community griot composed a song that educated people about health care and promoted the intended use of the Green Pendelu.

THE SONG

F. The Song was developed with a technical outline provided by staff with artistic and musical input by the Griot. Its main aims were to: 1) inform married men and women and women's mothers-in-law about high-risk pregnancies, warning signs during pregnancies and risk-reduction behaviours; 2) increase communication regarding and maternal health between husbands and wives; and 3) increase pregnant women's utilisation of the maternal health care services and facilities offered by qualified providers.

THE GREEN PENDELU INITIATIVE

G. Participation - Because of rural Muslim traditional values regarding discussion of pregnancy, separate assemblies for men and women were scheduled. The men's assembly was held first to give husbands the option of approving or refusing their wives participation. Women's assemblies were held in the afternoon, following the same basic format.

H. Assembly - this began with a discussion about the high rate of infant and maternal morbidity related to pregnancy and childbirth. A project member then explained the findings of the research regarding the lack of communication between husbands and wives. A village traditional birth attendant (TBA) explained the importance of prenatal care and
deliveries assisted by qualified attendants. There was a 40-minute video about a woman who had a miscarriage because of lack of communication about prenatal health care. A discussion and opportunity for participants to ask questions followed the video.

I. Song - After this introduction, the griot performed the song about the Green Pendelu, maternal health, warning signs during pregnancy and the importance of couple communication.

J. Reactions - Staff reported that "It is interesting to note the differences in the reactions of the men and women during the griot's performance. While both...listened attentively to every word, men would do so gravely; women...would openly show their pleasure by smiling, laughing, clapping, and singing the refrain. The women...requested the griot to repeat the song several times and by the end of the assembly had mastered
most of the words of the song. By the end of the assembly, most of the women present were already standing up to dance".

K. Facilitation - Facilitators then showed the Green Pendelu to participants, distributed them to all married women of reproductive age, and led a discussion about the song and its messages. The Green Pendelu was received by the women, in all seven villages, with excitement and animated discussion. In all of the assemblies women who were not of reproductive age demanded a Green Pendelu. The project staff refused, explaining that it was for use only during pregnancy. Older women insisted that they would make sure that the Green Pendelu would be given to their daughters and daughters-in-law and they would make sure that both male and female relatives had the correct information.

IMPACT

L. Maternal Health - The staff conducted surveys 3 months after the campaign had taken place. According to results, after the campaign, the number of spouses who reported communicating about maternal health rose from 3% to 65.5%. A majority of participants indicated that they found the Green Pendelu the most interesting component of the campaign and, remarkably, 85% of non-participants interviewed reported having heard of the Green Pendelu just 3 months later.

M. Communication - Nearly all those interviewed knew that the Green Pendelu represented pregnancy: 89.9% of husbands, 79% of wives and 76.9% of mothers-in-law. When asked what the would do if their wife wore the Green Pendelu, 32.3% of husbands said that they would talk with their wife about it, 41.7% that they would lighten their wife's workload, and 49.6% said that they would make sure that she received good nutrition. Almost all of the pregnant women interviewed said that they had already worn the Green Pendelu and of those women of reproductive age who were not pregnant, nearly all said they intended to wear the garment when they became pregnant.

N. Social Change - Results also demonstrated that there was a more positive attitude about pregnancy; most people surveyed interpreted the Green Pendelu as a symbol of pregnancy and happiness. The campaign was not only effective in promoting non-verbal and verbal communication between husbands and wives but it also facilitated social change. Pregnancy is no longer considered to be taboo in the villages in Mali in which the campaign was done and discussion about maternal health care is common in households
and communities.

CONCLUSION

O. The Green Pendelu interlaced old signals and responses with new meanings and outcomes. The Dioro Approach Project Report concludes that the potential exists for folklore and traditional media to contribute to the health and welfare of rural communities. "This unusual example of transforming the ordinary into the extraordinary underscores the value of developing innovative strategies that tap into cultural resources that are so commonplace or mundane that their inherent beauty, complexity and effectiveness may otherwise go unnoticed and under-utilised."

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For this short space there was too much to say and too many people and organisations to to thank - so thanks to all. This Drum Beat edited by Gen Creighton. The overall editor of The Drum Beat is Deborah Heimann For comments and further information on this issue contact Warren Feek.