Maternal health among the Batwa in Uganda: listening, privileging, and valuing Indigenous voices



Patterson, Kaitlin

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University of Guelph


Pregnancy and birth can be times of joy, hope, community, and ceremony for Indigenous women. Indigenous conceptualizations of maternal health and wellbeing are diverse and complex, moving beyond biomedical and physical criteria. The central aim of this dissertation was to listen, value and privilege Indigenous Batwa experiences of maternal health, to identify Indigenous centered responses for improving maternal health and wellbeing in Kanungu District, Uganda. This thesis was guided by decolonizing, Indigenous and Black methodologies, and utilized a community-based approach. Data were collected through an extensive search and review of the literature (n=438 relevant articles), maternal health surveys (n=598), focus group discussions (n=15), in-depth interviews (n=10 participants, n=49 interviews), and healthcare provider interviews (n=22) conducted between July 2016-December 2017. The data were analysed collaboratively with Indigenous partners using a range of modelling approaches for quantitative data, and thematic analysis for qualitative data. Substantial geographic gaps in representation exist in the global Indigenous maternal health research literature, and most published research does not report any engagement with Indigenous Peoples nor contextualize colonialism as a determinant of health. Based on the maternal health survey, Batwa women reported experiencing substantially more pregnancy loss than Bakiga women. The socio-demographic associations with pregnancy loss and maternal health care use also differed for Batwa and Bakiga women. The qualitative data revealed Batwa women’s experiences were often characterized by discrimination and violence, rooted in gender inequity and colonialism. Despite facing violence and barriers, Batwa women continue to birth and raise Indigenous children, and demonstrate their leadership and advocacy for themselves and their communities. The differences presented here between Batwa and Bakiga women underscore the importance of collecting Indigenous health data to understand the varied contextual circumstances that are associated with Indigenous maternal health and wellbeing. The findings presented herein highlight how data, research and science are relevant and of high quality when Indigenous perspectives and voices are centred and privileged. There is an urgent need to redress gender inequity and colonialism, with the global momentum to address maternal health, this dissertation provides targeted recommendations to meet some of these goals for Indigenous women.



Maternal Health, Uganda, Batwa, Mixed methods, Decolonizing methodologies, Colonialism, Indigenous Health, Health inequity, Maternal health services, Pregnancy, Gender inequality


Patterson, K., Sargeant, J., Yang, S., McGuire-Adams, T., Berrang-Ford, L., Lwasa, S., Steele, V. and Harper, S.L., 2022. Are Indigenous research principles incorporated into maternal health research? A scoping review of the global literature. Social Science & Medicine, 292, p.114629,
Patterson, K.A., Yang, S., Sargeant, J., Lwasa, S., Berrang-Ford, L., Kesande, C., Communities, B., Twesigomwe, S., Rhoda, J.A., Nkalubo, J. and Harper, S.L., 2022. Socio-demographic associations with pregnancy loss among Bakiga and Indigenous Batwa women in Southwestern Uganda. Sexual & Reproductive Healthcare, 32, p.100700, 10.1016/j.srhc.2022.100700.