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. |