Written by Lucy November, Midwife Research Fellow
I’m in a dusty classroom in Freetown with a group of senior students at Lifeline Nehemiah school. In the midst of the noisy discussion, it suddenly occurs to me – if all 7 of the girls in this room had had a pregnancy before their 17th birthday, the statistics say 1 would have died. And yet in the UK, you would have had to have gathered 10 000 girls before you could make the same statement.
My current research is a qualitative study into the reasons for high maternal death in adolescents in Freetown, Sierra Leone, funded by Wellbeing of Women’s International midwifery fellowship. During my first month at Kings I’d had an email inviting applications for a small grant for a public engagement exercise. I had been thinking about developing a poster for pregnant teenagers on how to stay healthy in pregnancy, and here was my perfect opportunity to get it right.
My illustrator friend Tanya Farrugia had previously given me a crash course in drawing and I’d put together a poster of ‘8 things to keep you pregnant’. But how did I know that young people would relate to the pictures, ‘see themselves’ in the scenes, understand the wording? Was it culturally and generationally relevant? Should it be in Krio or English?
I applied for the grant and was successful. During my next research trip to Freetown, I went armed with my posters, both with and without words. I ran a session with 10 senior students, aged 15 to 17, introducing the concept of qualitative research and looking specifically at focus groups. We talked about using open questions, helping quieter people to speak, and recording feedback carefully. I then ran a focus group with them to gather their views on the relevance of the poster, modelling how they should then run their own focus groups, in pairs, for 50 more students. The group were shown the poster without words and asked what they thought each picture was saying, and what needed to change. They were then shown the poster with words and we discussed the wording.
At first there was silence. Being asked to criticise a visitor to your school is very counter-cultural, but with ample reassurance, the discussion began to flow. If I had been doing it to ‘tick a box’ public engagement into my project, thinking I wouldn’t hear anything new, I would have been hugely mistaken. As the conversation took off, I began to see the exercise in a whole new light: I really did need their input! They went away and ran their own focus groups, and we met again to collate all the feedback. Here are some of the highlights:
The biggie – in a country where ‘visibly pregnant’ girls are not allowed to go to school or sit exams, why was she wearing a school uniform? ‘To make her look like a teenager?’ I ventured timidly. But no, that had to change.
How come she is arriving at hospital in a taxi in labour all by herself? Surely the midwife would go out to the car to help her, and she would have a relative with her.
The wording for ‘a safe place to live’ remained the same, but not without a protracted discussion. At first there was a vote for ‘a comfortable place to live’, as she was a new mum and needed comfort. But what if she was in a comfortable place but in danger of being abused by her uncle? Wouldn’t she rather be in a poor house with a kind auntie? ‘A safe place’ won the vote.
The ‘eat regular healthy meals’ picture was cause for arguments; they felt people would not understand the word ‘regular’, and opted for ‘eat good food’, until one boy pointed out that food can be unhealthy but still taste ‘good’. There was a vote and ‘eat healthy food’ won the day.
Tanya took my poster and the collated comments and produced a new version. We consulted on style of dress and hair, and she even gave our girl stylish nails!
This was a great project. It’s always refreshing being with teenagers, and when they saw the finished product and how the poster had been redesigned based on their input, the young people, Tanya and I all shared a great sense of pride at our effective co-production. Not an experience to be missed!