NAKASONGOLA, Uganda (August 30, 2002) - It is a hot Saturday afternoon. Under the shade of a Moyovu tree, a group of women are huddled in a circle, staring into the dirt where a map of the human body has been drawn. The women are learning the parts of the body – some parts they’ve heard of before; others they are learning for the first time.

These are average Ugandan women: at least half of them are young mothers – a few of them are nursing their babies under the Moyovu tree, and a few toddlers play nearby. Like many other Ugandan women, they were married between age 15 and 19 and became sexually active around the age of 17.  In their lifetimes, these women will give birth to an average of seven children.

“This lifestyle is not unusual for rural women,” says Dr. Sarah Naikoba, CARE’s technical health advisor in Uganda. “This is the way their mothers and grandmothers lived. It is a traditional woman’s life.”

But this tradition comes at a price – high infant mortality. Despite a strong initiative by the Ugandan government to provide health education and access to critical resources and services, there has been no complementary decline in infant and child mortality rates. Additionally, recent statistics show that 26 percent of Ugandan children are undernourished.

“A high birth rate plays a part in these statistics,” says Dr. Naikoba. “A woman with many children is less able to adequately care for her children.”

The rate at which infants and children are dying is not the only concern. Mothers are at a distinct disadvantage in Uganda as well – for example, only 13 countries have a higher maternal mortality rate. And more than 2 million Ugandan women are infected with HIV, the virus that causes AIDS.

For these reasons, CARE and Save the Children joined forces in Uganda to start the Nakasongola Community Reproductive Health project. The project aims to expand access to and use of family planning services and resources among Nakasongola’s population of 141,000. Thus was borne Agali Awamu – a women’s group that regularly meets to identify and discuss reproductive health issues. The women beneath the Moyovu tree are just a few of the 34,000 women of reproductive age that this project hopes to reach. (The project also targets over 30,000 men.)

Uganda / © Georgina Cranston 2001 / CARE Photo

The low rate of contraceptive use in Uganda (just 23 percent) can be traced to the misconceptions surrounding family planning services. These false beliefs include: condoms only are used in “illicit” or casual relationships; condom lubricants might contain HIV; and the use of contraceptives may have adverse effects on future fertility. Educating women on the body’s anatomy helps explain how contraceptives work and helps dispel rumors and decrease fears about side effects.

The Nakasongola project also addresses another reason for low contraceptive use – distance and inaccessibility of services. As in many developing countries, poor or nonexistent roads and lack of transportation often prohibit Ugandan women in rural communities from seeking out health care services.

To tackle this problem, the women under the tree are being trained as volunteer Community Reproductive Health Workers (CRHW). Once training is complete, they will take their knowledge into communities that otherwise do not have regular contact with family planning providers or trained health workers. These volunteers ensure that the effort to raise awareness and increase use of family planning services will continue after the CARE and Save the Children project is finished in 2004.

“Knowing about your own body’s reproductive health system and what reproductive health services are available to you is an important component of the project. If a mother is ignorant of these things, she may not be able to make appropriate decisions about her health care or the health care of her children,” says Dr. Naikoba.

To assist the CRHWs on their community visits, CARE and the Ugandan Ministry of Health developed training manuals, and the United States Agency for International Development (USAID) together with the Ministry of Health created charts and other materials with reproductive health messages. The CRHWs also make their own community maps in order to plan and manage delivery of services and health education to women and men in their assigned communities.

“This is a team effort in more than one way,” says Dr. Naikoba. “CARE and Save the Children have joined hands. The community is working as a team, and the CRHWs are a team within the team. It is one reason we named this part of the project Agali Awamu.”

In Luganda, one of the local languages of Uganda, Agali Awamu means, “the teeth that bite together are the ones that can eat meat.” Or, in other words, those who work together accomplish more. Dr. Naikoba is confident that as long as Ugandan women meet under the Moyovu tree, teeth will continue to bite together.