HAPPEE Project

The HAPPEE Project (Humanities and Arts in Preventing Pre-eclampsia complications through community Engagement and Education) is a project aiming to improve outcomes for women with pre-eclampsia and hypertensive disorders in pregnancy.

The initial phase will be based in Zimbabwe and Haiti over a 24-month period, thanks to generous funding from both the Medical Research Council (MRC) and the Arts and Humanities Research council. The project will later be carried out in Ethiopia and Sierra Leone as part of a larger health systems strengthening project, ASSET, funded by National Institute for Health Research (NIHR).

Read more about ASSET here: https://www.healthasset.org/about/


Effective management of pre-eclampsia involves early recognition and timely intervention which may include early delivery. Women’s understanding is key in this respect.

Qualitative work from the CRADLE trials has identified that beyond financial and logistical reasons, women may refuse care because they do not fully appreciate pre-eclampsia and its risks. The cultural contexts of health care delivery, social practices and expectations around pregnancy and birth can profoundly shape understanding.

The HAPPEE Partnership Project aims to understand local experiences, priorities and values of healthcare, pregnancy and birth and their relevance in pre-eclampsia care. Empowering and engaging women and families in the decision-making process by encouraging participation and autonomous expression through the creative arts may play a role in making a difference.

Project Overview

There will be three phases to the project:

Phase 1 will qualitatively assess the baseline knowledge of women and families who have previously been affected by severe pre-eclampsia, as well as that of health practitioners and the wider local community. Cultural barriers that often prevent women accessing life-saving care will also be explored through focus groups and interviews with stakeholders.

From the information collated in Phase 1, we then aim to develop educational materials that address the context-specific challenges to women with pre-eclampsia accessing appropriate care. This may include short animations, film or interactive community theatre that will engage local communities and challenge traditional health beliefs with cultural sensitivity.

Phase 3 of the trial will focus on piloting and implementation of these resources. There will be ongoing evaluation of feedback from women, their families and healthcare workers.


Outcomes of the project

Both Zimbabwe and Haiti have maternal mortality ratios in the top quartile globally, with 443 and 359 deaths per 100,000 live births respectively.

It is hoped that by improving women’s knowledge of disease, educating local communities and challenging social barriers to seeking treatment, the HAPPEE project will increase uptake of simple but life-saving interventions that will ultimately save the lives of mothers and their babies.