So You Want Me to Bring my Husband. . .

Sitting in on a class in the masters of public health leadership programme I heard this story, which I think is a great example of how the best laid public health plans can have unintended consequences. 

In recent years clinics involved with antenatal care have apparently begun to urge pregnant mothers to bring their husbands to their appointments. Makes sense, right? Get the father involved from before the birth, get his support for preventive care, increase father-child bonding, and so on.  In fact, many clinics refuse to give certain aspects of care if the mother comes alone. The only problem with this is that for a rural woman who spends her days working in subsistence farming and caring for multiple children, the visit to the antenatal clinic may be her one chance to get out from the house and have some time alone. Many women don’t want to bring their husbands.

Such women are faced with a dilemma, but humans are creative. Here I must break the flow of the story to explain that in Uganda we have boda bodas, what you might call a poor man’s taxi. These are motorcycles that the owners use to carry people around, sometimes two passengers deep, for short to medium distances. With traffic around Kampala as bad as it is, these boda guys do a hopping business weaving in an out of lanes as well as transporting people to remote homesteads that are inaccessible by public transport. It’s crazy dangerous for everybody including pedestrians, but you can see it’s meeting a need. Now back to the story: expectant mothers get the boda drivers to go one step further, and come in to the antenatal clinics to pose as their husbands. On occasion clinic personnel may notice the same man coming with different women, but after all, Uganda has a history of polygamy. Sometimes the “fathers” looks extremely disengaged from the medical proceedings, but then again some fathers are like that. How is a doctor or nurse to know? The only somewhat effective solution to this problem from the healthcare provider perspective we heard was one agency’s incentive of free t-shirts for accompanying husbands. Women were unwilling to let the free clothing go to the hired transport, so they came in with the real deal. Oh the complexities of providing healthcare to real people!

Photo 1 below: Boda with passenger in front of roadside furniture store and Kampala skyline

Photo 2 below: Waiting for business at a roadside produce market

Photo 3 below: Boda with cargo