Using evidence to improve lives in Uganda

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For every 100,000 live births in Uganda in 2016, 336 mothers lost their lives due to complications during childbirth. A leading cause of these mortality rates? Postpartum hemorrhage.

Today, Uganda has cut its maternal mortality ratio by almost half. This progress didn’t happen by chance. It was the result of a series of efforts, including a deliberate approach to using inclusive evidence — information that reflects the voices, concerns, and ideas of those directly impacted — to create policies that save lives.

This is evidence-informed policymaking in action. When policies are built on data and insights that include everyone’s perspectives, especially those most affected, the results can transform societies. From reducing maternal mortality in Uganda to making digital spaces safer for women politicians, we explore how two organizations, the Center for Rapid Evidence and Synthesis (ACRES) and Pollicy, are using evidence to advance gender equity in Uganda and other African countries.

How ACRES used evidence to help save Ugandan mothers’ lives

The challenge

In 2019, a government program in Uganda proposed the off-counter distribution of misoprostol in Maama Kits, an affordable kit with basic supplies required for safe childbirth. The addition of misoprostol to the kits would help reduce postpartum hemorrhage, a leading cause of maternal mortality. Prior to this, misoprostol could only be used or distributed by a registered midwife, which left it out of reach for almost 30% of Ugandan mothers giving birth at home or outside medical facilities.

The program sparked concern from different quarters. Since misoprostol is used to induce medical abortion in early pregnancies, there was fear that increased distribution would increase illegal abortions in the country. Its role in inducing labor also led to fear that it would encourage more deliveries outside recognized health facilities. Additionally, the drug could now be self-administered, and some stakeholders questioned whether expecting mothers had the knowledge to use the drug appropriately. These concerns gave way to rising misinformation, and ACRES was requested to arbitrate a standoff in one district.

The evidence-based approach

ACRES looked at similar misoprostol distribution programs worldwide but realized the value of locality. They spent time understanding and interpreting local norms, beliefs, and power dynamics, allowing them to reflect how this drug would impact the women who needed it, broader community members who would now have more access, and the government program’s implementation of these services.

ACRES also teamed up with the district officials to arrange evidence uptake meetings and workshops, where stakeholders could interrogate findings and ask questions, empowering them to feel like they were involved in the solutions they were asking for. And ACRES worked closely with policymakers to provide timely access to accurate evidence through sensitization, capacity-building workshops, and mentoring programs. The result? Policymakers had the opportunity to listen to what people needed, the evidence to explore the most advantageous policies in that context, and the ability to implement them well.

The impact

Two years later, the program was implemented successfully. Today, the pilot district is reporting more health facility deliveries and reduced deaths from delivery-related bleeding. The program has expanded to other regions, leading to better life outcomes for women and girls, their families, and their communities.

Why Evidence-Informed Policymaking?

At the surface, Evidence-Informed Policymaking can feel too conceptual, too nebulous, and too removed from our daily lives. But evidence should inform the policy decisions impacting our lives. It shapes the medicines available at our clinics, the textbooks in our children’s classrooms, the energy resources available to light and run our homes, and the roads and bridges that connect our communities.

But it isn’t enough to just generate more evidence. Evidence needs to reflect the needs and perspectives of all the stakeholders who might be impacted by a given policy — what we call “inclusive evidence.” It’s critical to both generate this evidence and increase decisionmakers’ capacity to use it.

In Hewlett’s Gender Equity and Governance Program, the Evidence-Informed Policymaking (EIP) strategy is constantly asking what role evidence-informed policymaking can play in fostering inclusive and equitable societies where everyone — especially women, girls, and young people — can thrive. This includes rebuilding trust between policymakers and the people they serve beyond election cycles and the ballot box.

From our work so far, two things are apparent:

• There is a strong need for — and desire among — people to exercise their power to shape their own futures.
• In order to support people in exercising their power, governments need to have the evidence and ability to listen and respond to citizens’ needs.

While ACRES demonstrates this approach in health care policy, the same principles apply across sectors. Pollicy’s work illustrates how evidence-informed policymaking has been used to build, advance, and expand gender equity in the digital space.

How Pollicy used evidence to make digital spaces safer for women leaders

The challenge

Afrobarometer’s 2023 survey found that 75% of surveyed citizens across the African continent believed that women should have the same chance of being elected to public office as men. But more than half said that a woman who runs for office is likely to be criticized or harassed.

Enter Pollicy — an Afrofeminist data collective that uses data, design, and technology to improve data literacy, policymaking, and service delivery by governments. Pollicy’s 2021 report showed that one in two women in public life in Uganda experienced gender-based violence online, despite the country having a cybersecurity law against harassment for more than 10 years. This violence includes but isn’t limited to disinformation, hate speech, abuse, and harassment.

The evidence-based approach

Based on their research, Pollicy, along with other digital rights advocates, connected with civil society organizations; the Uganda Electoral Commission; parliamentary bodies, such as the Uganda Women Parliamentary Association (UWOPA); women’s groups; and the media to implement their report’s recommendations. In the last three years, Pollicy has developed a range of digital resilience trainings, including their flagship play-and-learn Digital Safe-tea, an online game for women to navigate the internet more safely and educate others on how to be safe online. In 2024, Pollicy and the UWOPA informed recommendations to incorporate Technology-Facilitated Gender-Based Violence (TFGBV) issues into the Uganda Sexual Offences Bill.

Pollicy ensured their evidence generation was inclusive, consulting with experts from women’s digital rights organizations to understand the impact of online violence against women politicians and leaders. Following their 2021 report, they also conducted a comprehensive study of online harassment targeting women politicians during the 2022 Kenya general elections. They held lexicon-building focus group discussions, scraped data from politicians’ publicly available profiles, and conducted a qualitative analysis of collected data. Ultimately, Pollicy created a hate speech classification tool using machine learning in Swahili, Sheng, English, and Luganda to more rapidly and efficiently evaluate evidence of abuse and hate speech across different languages.

The impact

Because Pollicy’s evidence-generation approach was both robust and localized, they were able to use their data to create tailored, targeted recommendations and work closely with academics, data scientists, civil society organizations, policymakers, and technologists across Africa to expand conversations, capacity, and collaboration. These recommendations have helped different stakeholders see their unique role in making digital spaces — and by extension, the democratic process — safer for women policymakers and their constituents.

The path ahead: Inclusive evidence for inclusive societies

As we navigate new political configurations around the world, we find hope and inspiration in what’s working today to support people’s power to shape their futures. Evidence plays and will continue to play a central role in bringing policymakers and the people they serve into more trusting partnerships. It also helps build social, economic, and political infrastructure that benefits communities beyond any election cycle. This is particularly important as we recognize that governance is not a once-every-election-cycle phenomenon. It is engaged and negotiated every day, in its complexity, challenges, and possibility to create truly inclusive and equitable societies.

Rhona Mijumbi is co-director at the Center for Rapid Evidence and Synthesis (ACRES) and Irene Mwendwa is executive director at Pollicy.