Life-saving lullabies

Around 750 women died from preventable causes during pregnancy in Zambia in 2018. The following year the country’s President declared a public health emergency because recent gains in reducing mortality had stalled.

Dr Jim Reid

School of Education and Professional Development

A complex range of economic and social issues explain these tragic statistics. These include high rates of illiteracy, variations in services between rural and urban areas and the availability of clinics. Historically, untrained local women often acted as a midwife/traditional birth attendant (TBA), but their practices did not always meet accepted clinical standards.

A need for change

In the 1970s, efforts to upskill TBAs ignored intimate cultural, community and social factors. The cultural and social aspects of these roles have since been incorporated into Safe Motherhood Action Groups (SMAGs). For example, St John Zambia developed the ‘Mama na Mwana’ (mother and baby) project, to train volunteers in community based maternal and child healthcare, support, and advice. St John Zambia partnered with researchers from the University of Huddersfield to develop a method of improving maternal health and reducing infant mortality. They sought to develop a sustainable and affordable solution that could be scaled up. The UK team was made up of Dr Jim Reid (Senior Lecturer in Childhood Studies) and medical historian Professor Barry Doyle from the University of Huddersfield, working alongside David Swann, Professor of Design at Sheffield Hallam University.

Developing a message

The research team visited the Zambian capital, Lusaka, for an arts-based workshop with volunteers and clinical staff, to review the appropriateness of providing pregnant women with baby boxes. These can act as a crib with items to help the baby and mother. However, the researchers’ assumptions were proven correct as they were costly and culturally inappropriate. Dr Reid said: “When presented with the idea of baby boxes, the mothers liked the contents, but were appalled at the idea of putting a baby in one to sleep, likening them to coffins.” The solution lay in everyday Zambian culture. During fieldwork, for example, the researchers discovered that 70% of young women said they sang to their children.

Creating lullabies

The researchers discovered the ‘Lullaby Project’ at Carnegie Hall in New York, which put mothers and musicians together to make music. When played to their children, the music helped with bonding, development and maternal wellbeing. To adapt it for the Zambian context, an alternative to expensive recording studios and musicians was needed. Researchers also had to incorporate messaging around antenatal care, breastfeeding and other healthcare tips.

“It was important that the SMAG volunteers developed the songs themselves so that local women would relate to the lyrics. We asked the volunteers to explain what they wanted the women coming to the clinic to know. From this the volunteers started to sing and we looked at each other and went ‘that’s it’!”

The women created songs on the role of the clinic and topics such as breastfeeding and sexual health. The SMAG volunteers then performed these songs to women as they came into clinic. Singing is deeply engrained in the lives of Lusaka residents and across much of Africa through day-to-day activities and in church. The songs therefore felt familiar and got the message across. They became an educational tool in an area The ‘Life-saving lullabies’ project meant that healthcare was provided more consistently, as mothers had a better understanding of what the clinic could do for them. The project achieved its purpose of helping women access antenatal and birthing care. The project also helped the SMAG volunteers recognise their own skills and increased their credibility with St. John Zambia and the community. Previously they were seen as basic assistants in clinical settings. This project gave them a voice, showing the value of their work and expertise.

without resources to print information and with high rates of illiteracy.

A carbon neutral project

With Covid-19 leaving UK researchers unable to travel, more responsibility fell on the Zambian partners. Dr Reid believes this helped rather than hindered the project. The volunteers quickly developed songs about Covid-19, with content around wearing masks, sanitation and isolation. The travel disruption allowed the project to become carbon neutral. Dr Swann discussed the project’s sustainability at the Resilience Hub of COP26. Dr Reid is working with St. John to expand the project across Zambia and beyond.