Paper short abstract:

This paper will question the relationship between urban and rural innovation in the encouragement of women to deliver children in biomedical institutions, through an assessment of the expansion of midwifery services and maternal attendance in urban Kampala and rural northern Uganda.

Paper long abstract:

In the 1920s, a network of maternal and child welfare centres began to spread across Uganda, emanating from two mission midwifery schools in Kampala. The city's midwifery schools sat at the centre of a network of maternity services, ostensibly innovating maternal and child welfare for the entire protectorate. In areas closely connected to Kampala, midwives achieved rapid success in founding new centres, and in attracting women to attend them for antenatal service. Initially, attendance for childbirth was very low, but by the 1950s, hospital deliveries began rising as rapidly as antenatal attendance had earlier. This paper will question to what extent this change was the result of political, socioeconomic, and chronological factors, and to what extent it was influenced by innovations in health education and healthcare delivery.

The paper will further this analysis by comparing the upswing of hospital births in central Uganda to much later, post-colonial upswings in hospital births in rural areas of Acholi and Karamoja that were never connected to the Kampala-centred network of midwives, but have a similar timeline of increased deliveries. It will question the relationship between urban and rural innovations in increasing delivery attendances, examining whether the increase in deliveries in rural northern Uganda was an imitation of patterns demonstrated as successful in Kampala and its environs, or whether rural midwives were innovating in response to the particular situation they were in. How, moreover, can we understand the ostensibly urban nature of health innovation when similar results often occur in rural areas decades later?