Writing women’s reproductive health: A Uganda study

By Rosanne Anholt and the Health Journalist Network in Uganda (HEJNU)

Research shows that the decisions people make with regards to their health may be in part drawn from various mass media resources. As such, the media not only mirrors how health is understood within the society – it also shapes that society’s health behaviours. The effect of any particular media message however, depends on the way the information is framed.

The idea of media frames is easy to grasp: if we read or hear about family planning methods that emphasise the dangers of the procedure or the possible negative consequences, we may hesitate to use them.

On the other hand, if articles about family planning methods focus on our right as women to decide whether, when, and how many children to have – we may very well consider using a method of family planning. Simply put, a media frame is a point of view on a given issue. Certain aspects of reality are highlighted or excluded, such as either the dangers of family planning methods, or the right to use them – which then causes people to interpret these issues differently.

How an issue is framed, depends on many factors. Research, such as by Darrin Hodgetts in New Zealand, shows that the journalist (i.e. the writer) has a significant effect on the way an issue is framed. Professional factors specific to journalism may impact how an issue is presented, as well as the organisational milieu in which the media message was created. 

Sources, whether particular persons, documents, or other, may also impact the point of view on any given issue, depending on the standpoint taken by the source. Finally, any environmental issue – economic, or political – may also have an effect on the way in which an issue is presented in a media message. We can describe frame-building as the process in which media frames are created. 

Together with the Health Journalist Network in Uganda (HEJNU) and under supervision of the Athena Institute at the Vrije Universiteit Amsterdam in the Netherlands, a study was carried out in order to analyse how women’s reproductive health is framed in Ugandan media, and what factors influence the way in which Ugandan journalists construct these frames.

To answer the first question; how women’s reproductive health is framed, an analysis of print media content was made, considering relative ease of analysing written content. Even though most Ugandans receive their news through the radio, local radio stations often review newspapers. Indeed, some community radio stations with no budgets to support reporters in the field read the stories from the newspapers as news items. This makes print media, despite its relatively low coverage, an important communication channel fit for analysis.

A total of 204 articles on women’s reproductive health were collected from four national newspapers published between 1 May 2015 and 31 May 2015.

To answer the second question; what factors influence journalists’ frame-building, 19 in-depth semi-structured interviews were done with journalist in and around Kampala. The sample consisted of eight men (42%) and 11 women (58%), from both print and broadcast media (both television and radio), with an average of 7.5 years of experience.

On July 22 2015, HEJNU organised a research dissemination seminar which was attended by 20 people. Six attendees had already participated in the interviews, whereas eight had not. The latter consisted of three men and five women, who were in either in print or broadcast media. Other attendees included a medical doctor who gave a presentation on the social determinants of health and human rights, the HEJNU president, two HEJNU interns, a media researcher, and the writer.

Firstly, the content analysis showed that half of all articles on women’s reproductive health addressed maternal health topics, such as pregnancy, childbirth, and the midwifery profession. Pregnancy was primarily understood as a dangerous ‘condition’ from which ‘vulnerable’ women ‘suffer’ or die. 

The International Day of the Midwife on May 5 and the events that surrounded this day noticeably influenced articles, highlighting Uganda’s lack of midwives and the dangers associated with (unassisted) childbirth. 

The main treatment recommendation for the country’s lack of midwives was recruitment schemes and ‘re-branding’ of the profession – in other words, giving the profession a new, positive image that will draw students to choosing midwifery as a career. Other maternal healthcare services were understood in terms of missteps made by individual healthcare workers, or successes gained by government or NGO projects.

Twenty-five percent of the articles was about sexual violence, understood primarily as arrests or case proceedings from (gang) rape and defilement cases, although harmful traditional practices such as female genital mutilation/cutting (FGM/C) were also addressed. 

The national high profile defilement case of police athletics coach Peter Wemali in particular received much media attention. In general, sexual violence was very much approached from a criminal justice perspective, placing the individual perpetrator at the centre – sometimes literally, with their full names exposed. This perpetrator-focused point of view was similarly evident in punishment being advocated as the primary solution to sexual violence.

Thirteen percent of articles addressed various health conditions, including reproductive tract infections (RTIs), sexually transmitted infections (STIs), HIV/AIDS, HPV and cervical cancer, and obstetric fistula. What was especially noteworthy about these articles was that conditions of RTIs, STIs, HIV/AIDS and HPV and cervical cancer were predominantly blamed on women’s own behaviour. 

For example, HPV infection was attributed to girls’ early onset of sexual activity, and subsequent cervical cancer was attributed to women not going for regular health check-ups. Obstetric fistula on the other hand, was primarily attributed to medical causes. Also notable, solutions for obstetric fistula cases focused on what NGO projects can achieve, rather than seeking treatment or behaviour change.

Other topics (12%) included family planning, menstruation, and abortion. Family planning was understood primarily in terms of the possible adverse consequences of family planning methods, and in the light of women not using family planning – attributed to men’s resistance to family planning. 

When women experience any issues that may relate to their use of family planning, they are encouraged to ‘visit their doctor and get treatment’ – without any consideration of their ability to actually carry out that advice. 

Menstruation was addressed in the light of Menstrual Hygiene Day on May 28 and advocacy around national programmes targeting the improvement of menstrual hygiene practices in schools, in order to combat girls’ high dropout rates. Abortion, although hardly covered, was primarily understood as a dangerous procedure with debilitating consequences – moreover, it is against the law and religion. The primary ‘solution’ for abortion focused on the individual: instead of aborting one should rather focus on pregnancy prevention.

Similar to previous studies on how women in Ugandan media are portrayed, this study shows that in articles on women’s reproductive health, women themselves were portrayed predominantly as victims: vulnerable to suffering and dying.

Also, but considerably less, women were described as passive recipients of healthcare services: expectant mothers receiving mama kits free of charge from national telecommunications provider Airtel Uganda, or mothers saved from death by skilled birth assistants. Women were also portrayed as being responsible for their adverse health outcomes: their own behaviour caused health conditions such as STIs and cervical cancer – leaving social determinants of health, such as poverty, unchallenged.

The fourth and final way in which women were portrayed in stories about women’s reproductive health was what we may call a ‘passive agent’. In this type of portrayal women were given advice of what to do in cases of health conditions: when you experience constant vaginal bleeding, you have to visit your doctor and get treatment. 

At first glance, it seems that this advice enables women to exercise their power over their own health. After all, these stories give them the information on what to do – sometimes even providing a step-by-step approach. At the same time however, it is not only assumed that women do not know they have to visit a doctor when they experience health problems, also, the woman’s personal, cultural, or economic barriers in accessing that care, are dismissed. If they cannot even afford the transport fee to the hospital, is ‘advice’ that tells them to visit a doctor even useful to them?

Secondly, the interviews with Ugandan journalists showed that various factors on the personal, professional, organisational, source-related, and environmental level influence the way these media frames are constructed. 

On a personal level, having an in-depth understanding of women’s reproductive health has a significant effect on how issues are presented in the media. For example, if a journalist understands women’s right to health, she or he may be more likely to take a human rights-based approach to the topic they are writing about. 

On the other hand, if a media professional fails to grasp the social, cultural, and economic causes of certain reproductive health outcomes, she or he may blame the individual for her illness – as we have seen in the identified frames. In this study, interviewees emphasised that you have to understand an issue first, before you can explain it to others.

Training media professionals on (women’s) reproductive health could advance their understanding, results however, showed that training is primarily a personal initiative. This means that attending a training depends greatly on the individual journalist’s ability to access information about potential training opportunities – resulting in unequal opportunities. 

Likewise, it depends on journalists’ media houses. Some media houses may be neglected by trainees because their impact on the community is considered insignificant – thereby significantly crippling talent development. Although this was not directly examined, training opportunities may depend on the type of media; print media journalists may be far more likely to go for training than radio or TV journalists.

On a professional level, journalists understood their work in terms of disseminating information, acting as a link between the public and policymakers, and as playing the role of watchdog, critically interrogating government policies. In the articles, the role of ‘educator’ or ‘provider of information’ was much more evident than advocacy and accountability. 

One way in which this showed was journalists’ self-expressed need for quoting official sources in their stories, such as government officials or medical professionals. Interviewees shared that this is not only ‘good journalism’, it also ensures the information you have is correct.

On an organisational level, an important finding was the challenging work environment: media houses’ lack of resources simply bars journalists from pursuing stories if it means they have to make costs, such as travel expenses. In addition, low pay causes many journalists to be unsatisfied with their job, using journalism as a ‘stepping stone’ to other jobs, such as with an NGO. This also means a high turnover of staff in journalism in general. 

In addition, results showed that editors have a crucial role in whether and how a story eventually appears in the newspaper, highlighting the need to involve editors in any training initiative that addresses the importance of covering women’s reproductive health.

On the source-related level, the low pay and lack of facilitation invites sources such as (international) NGOs to step in and provide travel reimbursements, accommodation, food, and sometimes even a per diem. Interviewees expressed their concern that this practice may bias journalists’ objectivity. Some articles used clear NGO language, summing up the strides made by a particular organisation as the necessary steps towards addressing Uganda’s reproductive health issues.

Finally, on an environmental level, the politics of the season and media houses’ commercialism influenced if and how health stories in general made it to the newspapers. In the light of the upcoming presidential elections of 2016, the space for health-related news is increasingly less, in order to make room for political stories, since these are the ‘stories that sell’. One interviewee recommended that health journalists have to learn how to navigate these challenges cleverly, by for example reporting on presidential candidates’ health policies – yet none such articles appeared during the study period.

So what do these results mean? For women in Uganda, it means that they are currently not supported through an empowering media discourse. This is in line with previous studies on the way women are portrayed in Ugandan media. The results point out that there are many opportunities for journalists and other stakeholders to improve the practice of health reporting in a way that will allow the media to more clearly play the advocacy and watchdog role. This may also require Ugandan journalists to proactively communicate their needs. Strong journalists’ associations may be able to leverage their power to demand better working conditions.

For NGOs, the results of this study highlight that (international) organisations must be aware of their influence on the media through practices such as providing facilitation where journalists’ own media houses cannot. This calls for the inclusion of ethical media practices based on respect and integrity into existing policies – or the development of comprehensive media collaboration policies.

The results reinforce previous studies’ recommendations that media development initiatives should be needs-driven instead of driven by the wishes of international donors, emphasising the importance of local ownership. Training should be independent from (inter)national NGOs’ agendas, which highlights the importance of grassroots media organisations, such as HEJNU and other national journalists’ associations. Media development should be led by Ugandan journalists and Ugandan researchers from Ugandan institutions, who have in-depth knowledge of not only the needs, but also the local context.

For government, the results of this study point to the severe lack of resources that Ugandan media houses suffer from. In order to use media as a vehicle for women’s (health) empowerment and social justice, the government should support the media rather than restrict them, not only financially but also through a conducive legal environment.

In conclusion, media is shaped by society and has a significant effect on the shaping of that society. In Uganda, this study shows that there are ample opportunities for media, civil society organisations, local experts, and government to work together to improve the current practice of health reporting for a more empowered, more socially just society.

For further information contact: rosanneanholt@gmail.com or check www.hejnu.ug

Tanzania hosts International meeting on Whitefly

By Esther Nakkazi

Tanzania is hosting the 2nd International Whitefly Symposium (IWS2) from 15-19 February, with over 130 scientists from all over the world. The whitefly is one of the world’s most destructive agricultural pests. 

It is responsible for twin cassava mosaic disease (CMD) and cassava brown streak disease (CBSD) pandemics that are currently ravaging cassava production in sub-Saharan Africa.

In sub-Saharan Africa, whiteflies are a key threat to food security and efforts to reduce poverty in rural areas as they destroy and spread diseases in important crops of smallholder farmers such as vegetables, beans, cassava, cotton, and sweet potato, a statement from IITA says.

The pest causes major economic yield losses both by directly feeding on the plants and spreading viral diseases to a range of economically important crops, staples, and commercial flowers across the globe. Researchers will discuss knowledge on how it spreads disease and discuss efforts to control it.

“To feed itself Africa must intensify its agricultural production to produce more from the same or even less land. Intensification often leads to more pests and diseases. This meeting therefore brings together renowned whitefly researchers from over 24 countries, the private sector, and students to share and exchange the latest knowledge on the whitefly," said Dr Peter Sseruwagi, from the Mikocheni Agricultural Research Institute (MARI).

"They will especially focus on cassava mosaic disease and cassava brown streak disease, the two viral diseases spread by whiteflies and which have ravaged this key staple crop in sub-Saharan Africa,” Sseruwagi said.

The meeting’s co-chair, Dr James Legg, from the International Institute of Tropical Agriculture (IITA), added that “Africa is currently struggling with a wave of new viral diseases that are limiting the productivity of the poor smallholder farmers. These farmers have limited resources to invest in inputs such as pesticides and herbicides. We need to find sustainable science-based solutions to support them in tackling these challenges.”

Whiteflies and whitefly-transmitted viruses (WTVs) are also one of the biggest constraints to production of horticultural crops, especially vegetables. In addition to providing much-needed nutrients, vegetables are a high-value cash crop and a source of livelihood for many rural households in sub-Saharan Africa.

Farmers often resort to heavy use of pesticides to control the pests and viral diseases, putting their lives and that of their customers at risk.

On the other hand, research on whitefly in the continent is inadequate. Apart from a lack of adequate funding, there are very few vector entomologists to adequately manage the whitefly and associated problems.

Therefore scientists from Africa and in particular Tanzania will have an opportunity to learn from their colleagues from other countries such as the US, China, Europe and Australia on new and innovative strategies to control the pest.

The symposium is co-organized by MARI and IITA in collaboration with the University of Dar es Salaam, Commission for Science and Technology (COSTECH) and the National Agricultural Research Organization (NARO) of Uganda. It is supported by USAID, the USAID-funded Africa RISING initiative, and Zhejiang University, China.

The first International Whitefly Symposium took place in Crete, Greece, in 2013, during which Tanzania won a bid to host the second symposium. The Symposium is a series of specialized scientific meetings created out of the merger of the International Bemisia Workshop (IBWS) and the European Whitefly Symposium (EWS).

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What if Zika was in Uganda?

By Esther Nakkazi

The Zika virus is not in Uganda and it is not a threat, the Ministry of Health has said in an official statement. Travellers to Uganda have also been assured that Uganda is a safe destination.

But what would happen if Zika attacked Uganda?

The Uganda Virus Research Institute (UVRI) has testing facilities and has broad experiences of dealing with it. Surveillance reports across the country are also being done and none have indicated the risk of the virus, said Dr. Asuman Lukwago, the permanent secretary at the Ministry of Health.

The Zika virus, a mosquito-borne disease was first identified in Uganda and scientists and experts isolated it over 70 years ago. This was during a scientific research program on yellow fever.

Even when the virus was isolated it caused no death so it was ‘ignored,’ Julius Lutwama, a virologist, at UVRI has explained.

Zika is passed from one person to another by the bite of a mosquito called the ‘Aedes Mosquito’ which bites in the morning and the late afternoon. The Aedes differs from the Anopheles, which causes malaria and mostly bites in the evening.

So how can Ugandans be that careful all day with the Aedes mosquito? Where will we find the money to prevent it? In South America where the virus is now rampant, people stave it off with an insect repellent or by wearing light coloured clothes to cover the whole body. Currently, there is no medicine or vaccine to prevent or treat Zika.

Most of the insecticide-treated bed nets are distributed for free by non-government organisations funded by donors to Uganda. Will they also provide free insect repellent and how cheap is it?

Zika does not kill. If a pregnant woman catches it her baby can be born with microcephaly, a severe birth defect, where the baby has a small head and other problems to the body and brain.

Children born with Zika are hard to manage and Uganda’s disability policies and facilities to cater for such is limited. What will happen to all these babies? A generation with Zika?

Centers for Disease Control and Prevention (CDC) and other health authorities have advised pregnant women not to travel to affected areas and to delay pregnancy. If Zika appeared in Uganda, where the unmet need for family planning is 34 percent how would they delay pregnancy when access to contraception and reproductive health services are not readily available?

Uganda has high fertility rates at 6.7 percent. At Mulago hospital, the country’s largest referral, the number of babies delivered per day is 100 making it one of the busiest in the world. If babies at Muago were born with Zika this would be a sad and sorrowful nightmare.

Maybe some women would have wanted to abort if they knew that the baby had Zika but abortion is illegal in Uganda and restricted to certain medical circumstances. And a few attend antenatal or even deliver from health facilities.

People with the Zika virus disease usually have a mild fever, a rash and red itchy sore eyes, and this can last for 2-7 days. The WHO recommends that all suspected malaria cases undergo diagnostic confirmation prior to treatment but that is not usually the case.

There is an issue of self medication in case someone feels feverish. How will teh pregnant women even know?

In the USA, a case of sexually transmitted Zika infection was reported and CDC has advised men who've traveled to areas with circulating Zika to "consider wearing condoms". Uganda has constant condom shortages, the last one only recorded two months ago.

The best way is to empower the communities with knowledge and awareness and maybe to keep away the Aedes mosquito, which climate experts say has since mutated. If the mutated version came back to Uganda from South America, how would it behave?This is only a ‘What if Uganda had Zika’ article. There is no Zika in Uganda.

Resources on Zika: http://en.hesperian.org/hhg/Zika#

Who is an Ideal University Graduate?

This was not published so I put it out here on my blog;

By Esther Nakkazi (October 22nd 2015)

The Academia-Public-Private Partnership Forum and Exhibition held in Uganda in October 2015 defined an ideal graduate as one who pays attention to detail in every field, someone with character and ability to think critically.

The graduate should also be dependable, have the ability to follow through, be punctual, work as a team, be self motivated and knowledgeable.

The Forum engaged many stakeholders concerned to map out ways to produce an ideal graduate. It was organised by the Inter-University Council for East Africa (IUCEA) and the East African Business Council (EABC) under the theme ‘Developing the Ideal Graduate through Academia-Public-Private Partnership’

Good reading and writing skills, being self driven, hard working and focusing on the right things were also some of the key attributes for an ideal graduate cited.

Dr. Richard Sezibera, the Secretary General of the East African Community (EAC) said the overriding quality of an ideal graduate should be character because failure to achieve it means wasted investment in education.

Character is the stable and distinctive qualities or ethical traits that determine a person’s response in any given situation regardless of the circumstances. “If a thief gets a PhD, he will only become a better thief,” said Dr. Sezibera.

He said experts have cited shortage of PhDs among the reasons why Africa is not developing but cautioned that although he considers this a fair comment, it may not be the top challenge why Africa is not developing.

“Switzerland does not have many PhDs per capita or many scientists, but it has the highest number of Nobel prizes and patents per capita. This is possible because ordinary people with vocational training to do the right thing instead of being celebrated for the papers they carry on their resumes,” said Sezibera.

The World Bank has called on the continent to train 10,000 PhDs in the next ten years. The Bank has granted a loan to the Inter-University Council for East Africa (IUCEA) to be used to establish centres of excellence that train PhDs at Universities in Eastern and Southern African countries like Uganda, Rwanda, Tanzania, Ethiopia, Mozambique and Kenya.

And the donor community is obsessed with more people in Africa to have PhDs because they will be well trained in doing research that can help African countries solve their own problems. To follow this through, Sweden has provided Uganda with $66 million used to train 325 masters and PhDs students.

Urban Anderson, the Swedish ambassador to Uganda said that all PhD students under its programme now have to study from both Uganda and Sweden to grant Ugandans intellectual autonomy, so that the solutions they generate are truly local.

The Karolinska Institutet in Sweden and Makerere University award a joint PhD where a student’s PhD certificate has logos of both universities. Supported by the Swedish International Development Cooperation Agency (Sida) 44 graduated PhD students have graduated, and more than 500 peer-reviewed articles been published, the majority with a Ugandan as the first author.

Professor Stefan Peterson of Karolinska Institutet said through the joint PhD programme started in 2001, Sweden has a unique possibility to contribute to a sustainable global development by supporting PhD education focusing on local problem issues in low income countries and global issues.

He said it makes it possible for PhD students to spend most of their time at the home university, travelling abroad for only 2-3 months per year, which has minimised brain drain from Uganda.

Peterson said all Ugandan PhD graduates have remained in the country and their research has addressed Ugandan health system priorities, in several cases resulting in policy and practice reform, even changing WHO/UNICEF policies, which affect all of Africa. 13 of the of the PhD students have also embarked on post doctoral training.

The PhD students research has helped solve local problems for instance two PhD students’ work have developed guidelines for Uganda Ministry of Health home visiting in pregnancy and early newborns.

“I am a proud graduate of this collaboration, and I am making my small contributions to Uganda and beyond,” said Dr. Peter Waiswa a public health doctor and graduate of the special joint PhD program who is a beneficiary of the PhD programme and Karolinska Institutet in Sweden and Makerere University in Uganda.

The Forum heard that students should get training and mentorship or transitional training with practical exposure.

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