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Background: Community participatory interventions mobilizing women of childbearing age are an effective strategy to promote maternal and child health. In 2017, we implemented this strategy in Gulu Northern Uganda. This study explored the perceived impact of this approach on women’s capability. Methods: We conducted a qualitative study based on three data collection methods: 14 in-depth individual interviews with participating women of childbearing age, five focus group discussions with female facilitators, and document analysis. We used the Sen capability approach as a conceptual framework and undertook a thematic analysis. Results: Women adopted safe and healthy behaviors for themselves and their children. They were also able to respond to some of their family’s financial needs. They reported a reduction in domestic violence and in mistreatment towards their children. The facilitators perceived improved communication skills, networking, self-confidence, and an increase in their social status. Nevertheless, the women still faced unfreedoms that deprived them of living the life they wanted to lead. These unfreedoms are related to their lack of access to economic opportunities and socio-cultural norms underlying gender inequalities. Conclusion: To expand women’s freedoms, we need more collective political actions to tackle gender inequalities and need to question the values underlying women’s social status.
We conducted a qualitative study based on in-depth individual interviews, focus group discussions (FGDs), and document analysis. We followed COREQ guidelines for reporting interviews and focus groups discussion [25]. A team member, a female anthropologist, designed the interview and FGD guides for this study. The interview and FGD guides developed for this study are provided as Additional files 1 and 2. The interview guide reflected the research question and the theoretical framework. It covered the following items: perception of the PLA intervention, its impact, resources, and agency to seek health for themselves and their children, reproductive health (number of children desired, child spacing practices), access to resources, division of labor, social and cultural values. The FGD guide included the perception of the PLA intervention and its impact at individual and community levels. A local male coordinator trained in qualitative research and experienced working with rural communities translated the interview and the FGD guides from English to Acholi. The male coordinator selected eight groups from among the 12 PLA groups, reflecting the spread of rural, remote, and semi-urban locations across Gulu district. We further selected for interview those participants who regularly attended the group meetings among the eight groups. The facilitators from all the 12 PLA groups participated in the FGDs. Two trained team members (female and male) familiar with customs and traditions conducted the individual interviews and the FGDs. The interviews aimed to explore the impact of the intervention on individual group members’ lives, and the FGDs described the effect of facilitating the groups on the facilitators’ role in the community and the impact at the community level. The FGDs did not cover personal questions. The facilitators were comfortable sharing their individual experiences since they were familiar with each other. All the participants agreed to be part of this study. The interviews and FGD lasted about an hour and were in the Acholi language. The fieldworkers conducted the interviews at group members’ homes and the FGDs in a public place. We digitally recorded interviews and FGDs. We continued collecting data until we reached data saturation. We examined reports from the coordinator and the supervisors of the women’s groups. The supervisors wrote reports of each group meeting. These reports included the groups’ daily activities, the challenges, the opportunities to manage their groups (mobilization, participation, engagement), and their achievements (actions to tackle maternal and child health problems, resources mobilization, organization of their actions). We transcribed and translated the recorded interviews and FGDs from Acholi to English. The female anthropologist used a hybrid (deductive and inductive) approach to build the coding structure and coded the interviews and the FGDs transcriptions with Nvivo 11 software. We triangulated the data between the sources and data collection methods to identify similarities and differences and looked at convergence patterns to corroborate interpretation [26, 27]. We analyzed the documents manually. The coordinator synthesized the problems prioritized and the actions taken by the groups in a table. The co-authors and the project team members (coordinator, supervisors) discussed the data interpretation, including reflexivity [26]. We reflected on how our characteristics (gender, ethnicity, religious background, social status (researcher, being part of the project team)) might have influenced the data collection and analysis. We discuss the potential biases and internal and external validity of our study in the limitations section of this paper. This study respected the principles in the Declaration of Helsinki. We followed additional guidance from the ethical principles for research in post-conflict settings [28]. We obtained ethical clearance from Uganda and Canada. The participants gave their consent to participate. We treated all information from participants as confidential.
