Grandmothers Promote Maternal and Child Health: the Role of Indigenous Knowledge Systems' Managers
In virtually all societies,
the managers of indigenous knowledge systems that deal with the
development, care and well-being of women and children are senior
women, or grandmothers. In that function, grandmothers are expected
to advise and supervise the younger generations. However, most development
programs neither acknowledge their influence nor explicitly involve
them in efforts to strengthen existing family and community survival
strategies.
Many discussions
of indigenous knowledge tend to be rather narrow, in two respects.
First, IK is often presented in terms of specific knowledge and
practices, or “nuggets of traditional wisdom” in relative
isolation from the community knowledge authorities and systems of
which such knowledge is a part. Second, many discussions of IK point
to the beneficial elements of traditional knowledge and practice
while completely ignoring the harmful elements,
There is a need
to broaden the concept of IK in development programs: first, to
view IK in the context of community and household systems, that
include the IK managers and the mechanisms they use to communicate
their knowledge to others; and second, to consider both beneficial
and harmful practices in indigenous knowledge systems related, for
example, to health, nutrition or initiation rites.
In non-western
societies who are the IK managers?
Many development
programs assume that the best way to introduce new information and
change into a cultural setting is to focus on the younger members
of society. Some programs imagine that youth will teach their elders.
This orientation clearly reflects a western perspective that is
often in conflict with the cultural values of non-western societies
wherein elders play an authoritative role in community systems of
organization and communication, including in the transmission of
IK.
Andreas Fuglesang 1, Swedish communication
for development expert, discussed the central role played by elders
in information management in traditional cultures. He described
the function of elders as the “information storage and processing
unit” of a society, like the hard drive on a computer. He
described their critical role in ensuring continuity between the
knowledge and values of their forefathers and the needs of younger
generations preparing for life in the future.
In Senegal,
Diouf studied traditional learning systems in rural areas and found
that community members view elders as “information providers,”
a role related to their responsibility for perpetuating indigenous
values and practices 2. Anthropologist,
Margaret Mead, discussed the role of grandparents in passing on
to younger generations knowledge of “how things should be
done” in society. These reflections all suggest that IK cannot
be dissociated from the elders who store it and transmit it. However,
few development programs in Africa, Asia, Latin America and The
Pacific have seriously considered the role of elders in the management
of both traditional and modern knowledge systems.
“In
Africa, when an old person dies it is
like when a library burns down.”
Hampâté Ba, Malian philosopher
Gender
differentiation of roles among elders
Gender is another
important dimension of the management of IK systems. In most societies,
many roles are gender-specific and, therefore, the expertise of
elder men and elder women differs. As regards expertise related
to the growth and development of young children and to the well-being
of women of reproductive age, it is clearly senior women, or grandmothers,
who have greater experience and greater knowledge.
Grandmothers’
multi-faceted role
A recent review
of the literature on grandmothers’ roles in non-western societies
3 (Aubel, 2005) revealed that grandmothers,
in virtually all cultures and communities, have considerable knowledge
and experience related to all aspects of maternal and child development,
and that they have a strong commitment to promoting the well-being
of children, their mothers, and families. Societies around the world
acknowledge that grandmothers play an influential role in the socialization,
acculturation, and care of children as they grow and develop and
in the education and supervision of their daughters and daughters-in-law.
The study concluded that while certain harmful practices are promoted
by grandmothers in various cultures, given the wide-ranging role
they play and their influence and intrinsic commitment to promoting
the well-being of women and children, they should be viewed as key
actors in development programs.
“The
things that grandmothers see while sitting
on the ground, younger people cannot see
even if they climb to the top of a tree"
Senegalese proverb
The
rationale for involving grandmothers in community programs is also
supported by the policies of UNICEF, the World Bank and WHO related
to the health and well-being of women and children. Policy guidelines
from these international organizations state that programs should
build on local cultural realities, strengthen existing community
resources and develop social capital for sustainable development.
These policy principles provide additional support for the inclusion
of knowledgeable, senior women as resource persons in community
programs.
Why is it that
community programs dealing with the education, health and development
of young children and their mothers have not systematically involved
grandmothers? Two sets of factors appear to contribute to the non-inclusion
of grandmothers in development programs.
On the one hand,
there are several biases against grandmothers, expressed by many
development planners and practitioners : first, that grandmothers
do not significantly influence the knowledge and practices of other
family members; second, that if they are influential they are often
a bad influence; third, that because many grandmothers are illiterate,
it is impossible for them to learn new things; and fourth, because
of their age and attachment to tradition they are necessarily resistant
to change. These several negative stereotypes appear to contribute
to the fact that grandmothers’ experience and potential have
not been seriously taken into account in community programs to support
women and children.
On the other
hand, the models, or frameworks, used in community programs to support
women and children’s development typically focus on younger,
women-of-reproductive age (WRA) in relative isolation from the household
context of decision-making and influence of other family members.
The individual behavior change orientation, widely adopted around
the world, tends to focus on WRA while largely ignoring the socio-cultural
systems of which they are a part, and in which elder family members
play an influential role.
Methodology
to strengthen grandmothers’ role as knowledge managers
In community
programs, first in Southeast Asia and later in West Africa, a methodology
was developed by The Grandmother Project ( an American non-profit
NGO ) for working with grandmother networks in order to strengthen
their role and knowledge in promoting optimal practices related
to maternal and children health and well-being. The approach has
two characteristics that distinguish it from much of the work on
IK. First, the primary focus is not on IK practices but rather on
the community-recognized IK authorities on maternal and child development,
i.e. the grandmothers. The approach builds on both the traditional
role and knowledge of grandmothers. Second, the approach deals not
only with beneficial IK, but also with harmful IK, by challenging
grandmothers to combine useful knowledge from both traditional and
modern sources.
In 1996 in Laos,
in a first experience with UNICEF and WHO, participatory, non-formal
health education activities were carried out with grandmothers groups.
The objective was to build on grandmothers’ traditional knowledge
while increasing their understanding of key modern practices. Based
on the encouraging results in Laos, the approach was subsequently
further developed in maternal and child health and nutrition projects
with Christian Children’s Fund in Senegal and with Helen Keller
International in Mali. Later, the methodology was used in an early
childhood development and nutrition project with UNICEF and World
Vision in Senegal.
In the four
projects, a similar non-formal education and community empowerment
approach was used. (For a detailed description of the community
approach see article by Aubel & Sihalathavong 4).
In each setting where the methodology was used, communities strongly
supported the idea of grandmother inclusion. , most grandmothers
participated actively, acquired new knowledge and agreed to combine
new ideas with traditional knowledge. Evaluation data in each setting
showed increases in grandmothers’ knowledge of “modern”
practices and improvements in their advice to other family members.
The outcome
of this process of experimentation, evaluation and learning is the
generic grandmother-inclusive methodology.5
The five key steps in the methodology are: (i) rapid assessment
of grandmothers’ role and influence in the household and community
related to the issue of interest; (ii) public recognition of grandmothers’
role in promoting health and development of families and communities;(iii)
participatory communication/education activities that engage first,
grandmother networks, and second, other community members, in discussion
of both traditional and modern practices; (iv) strengthening the
capacity of grandmother leaders and networks to promote improved
practices with other grandmothers, in families and in the community-at-large;
and (v) ongoing monitoring and documentation for learning.
Key
results of grandmother-involvement
In all four
sites in Asia and Africa, the several biases against grandmothers
(discussed above) were systematically disproved. First, rapid assessments
in all sites revealed that grandmothers have considerable influence
on all matters related to women and children’s well-being
and on other household members’ attitudes and practices in
this regard. Second, while some of their practices are harmful,
overall, their experience, motivation and commitment to caring for
women and children are very positive. Third, the majority of grandmothers,
including illiterate ones, are capable of learning new things when
the pedagogical approach used is based on respect and dialogue.
Fourth, they are very open to combining “new” practices
with “old” ones, even when this means abandoning certain
traditions.
Evaluations
in all four sites revealed positive changes in grandmothers’
own practices and in their advice to younger women and men alike.
Examples from three of the four sites are cited below to illustrate
these positive and quantifiable changes.
In Laos, grandmothers’
approach to treating diarrhea at home greatly improved during the
one-year intervention. At baseline, only 30% of all grandmothers
were giving “lots of fluids” to children with diarrhea
whereas in the endline study, 74% of grandmothers were giving this
beneficial advice. Similarly, the proportion of grandmothers who
advised mothers with young children to continue breast-feeding during
diarrhea increased from 73% at baseline to 90% at endline. 6
In the CCF nutrition
education project in Senegal, there were improvements in all indicators
related to grandmothers’ advice to younger women and to their
own practices with young children.7
Evaluation data showed that before grandmother-focused activities
began, only 57% of grandmothers were advising younger women to give
colostrum to their infants. By the end of the intervention, almost
all grandmothers (97%) were giving this advice to their daughters
and daughters-in-law. Similarly, at the outset, only 59% of all
grandmothers were advising young mothers to give enriched porridge
to their offspring as a first complementary food, whereas the final
evaluation revealed that 97% were preparing and giving an enriched
porridge. In addition, the final evaluation showed that changes
in younger women’s practices were greater in communities where
nutrition education activities were carried out with grandmothers
as compared to places where only younger women participated in these
activities, providing additional evidence of the influence of grandmothers’
advice on younger women’s practices.
In the neonatal
health project implemented by HKI in Mali, there were improvements
in all sixteen indicators related to grandmothers’ advice
to younger women regarding maternal and infant health.8
For example, between the baseline and endline surveys, the proportion
of grandmothers advising pregnant women to attend pre-natal consultations
increased from 34% to 61% and those advising young mothers to give
colostrum to their newborns increased from 46% to 63%.
Through process
documentation and evaluation, a number of other positive and unanticipated
outcomes of the grandmother-inclusive methodology were documented
among different community groups. Here are examples of changes observed
following use of the non-formal education and empowerment approach:
Grandmothers:
• Greater
sense of confidence and of empowerment in the community
• Stronger sense of solidarity between grandmothers
• Emergence of grandmother leaders
• Grandmother leaders encourage other grandmothers to consider
new ideas
Male community
leaders:
• Increased
respect for grandmothers’ advice combining “indigenous”
and “modern” knowledge
• Increased public recognition of grandmothers’ contribution
to women’s and children’s well-being
Household level:
• Positive
changes in grandmothers’ advice to younger women and men
• Increased confidence of other household members in grandmothers’
advice
• Increased confidence of health/development workers in grandmothers’
advice
• Improved communication between mothers-in-law and daughters-in-law
The results
of these experiences in Asia and Africa illustrate how change can
be brought about from within indigenous knowledge systems when key
actors in those systems, i.e. the IK managers, are involved in deciding
if and how to combine global knowledge with traditional knowledge.
In contrast to many western, reductionist approaches that seek to
stimulate change related to specific “priority behaviors”,
the approach described here empowers community actors to make such
strategic decisions themselves, while simultaneously strengthening
the interrelated roles, relationships, norms and practices within
family and community systems.
Development
planners often overlook the significance of the socio-culturally
grounded role of elders in developing societies who are expected
to guide and supervise the younger generations based both on their
“traditional” knowledge and their understanding of “modern”
knowledge. In this vein, the grandmother-inclusive approach to strengthening
family and community health strategies supports Fuglesang’s
assertion that attempts to bring about change in a society “must
transform the fundamental programme for information processing controlled
by the elders.”9 Experiences working
with grandmothers in several countries have demonstrated how their
role as indigenous knowledge authorities can be built on, while
at the same time they are encouraged to integrate new practices
into local knowledge systems. It is likely that similar untapped
potential exists among grandmothers in many other societies around
the world.
References:
1.
Fuglesang, A. (l982), About understanding: ideas and observations
on cross-cultural understanding, Uppsala: Dag Hammarskjold Foundation.
2. Diouf, W. et al. (2000) Adult Learning
in a Non-Western Context: The Influence of Culture in a Senegalese
Farming Village’, Adult Education Quarterly, 51(1):32-44.
3. Aubel, J. Grandmothers: A Learning
Institution. Creative Associates & USAID.
4. Aubel, J. & D. Sihalathavong
(2001), Participatory communication to strengthen the role of grandmothers
in child health: an alternative paradigm for health education and
health communication; Journal of International Communication, 7,2,
76-97. 5.Aubel, J. (2004). Generic Steps
in the Grandmother-Inclusive Methodology. The Grandmother Project,
Chevy Chase, Maryland.
6. Aubel, J., D. Sihalathavong &
D. Kopkeo. (1997) Participatory Health Education Project with Grandmothers
in Laos. Vientiane.
7. Aubel, J., I. Touré &
M. Diagne. (2004) Senegalese Grandmothers promote improved maternal
and child nutrition practices: “The guardians of tradition
are not averse to change. “ Social Science & Medicine,
59, 945-959.
8. INFO-STAT (2004). Enqûete d’Evaluation
Finale: Rapport d’Analyse. Bamako.
9. Fuglesang (ibid.) p. 109.
This Note
was writtien by Judi Aubel, PhD, MPH, a social scientist, community
health practitioner, and Technical Director of the NGO, The Grandmother
Project. For more information email: grandmotherproject@hotmail.com,
or visit the following website: www.grandmotherproject.org.
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