Transcript Taking Culture Into Account in RH programs: The rationale

Involving grandmothers as partners in
health development:
Using a neglected cultural resource
Judi Aubel, PhD, MPH
Overview of presentation
• Why involve grandmothers in reproductive,
maternal, and child health communication
strategies
• Overview of the grandmother-inclusive
approach
• Results of grandmother involvement GMP
Approach to Female Genital Mutilation
• Review of Selected Outcomes of GMP
Approach
“ In Africa when an elder dies it is
as though a whole library had
burned down.”
Amadou Hampâté Ba
Malian philosopher (1900-1991)
“ What a senior woman can see
sitting on the ground, a younger
woman cannot see even if she
climbs to the top of a tree.”
African proverb
“Children are like milk and
grandchildren are like cream.”
Proverb from Albania, Uzbekistan,
Mauritania and Senegal
India
Senegal
Nepal
Mali
Key principles of
grandmother-inclusive programs
• Building on culturally-defined roles
• Building on existing social networks
• Relationship- based approach to
communication
• Community capacity-building
Principles
• Trans-cultural approach to health
communication/learning
• Adult education/community
empowerment approach
• Peer sharing and learning
• Strengthening communication
within families
Communication activities
• Songs
• Stories-without-an-ending
• Group discussion
Results of GM-inclusive programs
• Increases in GMs’ knowledge of
“modern” health concepts
• Improvements in GMs’ advice to
younger women and families
• Greater changes in women’s healthrelated practices than where GMs were
not involved
Effects on grandmothers
• Increased sense of self-confidence and
empowerment of GMs in their role as
advisors
• Increased sense of solidarity between
senior women in communities
• Emergence of GM leaders in all groups
Effects on community leaders
• Increased public recognition of GMs’ contribution to
family health/well-being
• Increased knowledge of key women’s and children’s
health practices
•
Increased communication and collaboration between
community leaders and GM leaders in health
promotion efforts
• Commitment to involve GMs in future community
development activities
Effects on family members
• Increased confidence in GMs’
knowledge and advice
• Improved communication between
younger women and their mothers-inlaw/mothers
“Be grounded in your culture.
Preserve its positive traditional
values
and let its abusive customs
disappear.”
Amadou Hampâté Ba
A Letter to the Youth, 1985
“We never practiced circumcision maliciously but
rather to educate the girls, to develop in them a sense
of solidarity, to prepare them for life as women.
Now we understand that, as grandmothers, we have a
responsibility in this situation. We should organize
ourselves to make a plea to our sisters and our peers
to put an end to this practice.”
Koujiji Couibaly, Traditional Midwife,
Grandmother Leader, Kerewane
Velingara, Kolda
Southern Senegal
• Priority area where WV has been working on a variety of
programs to improve the living conditions of families and
communities.
• Within WV’s programs, girls are a priority target group.
• Female Genital Mutilation (FGM) of girls and women is a
widespread practice with approximately 90% of girls and
women circumcised.
Dialogue Between Generations
Methodology
• The Community Study
• The Forum-Dialogue Workshops on Culture
and FGM
The Community Study Process
• Rapid qualitative study on the attitudes,
beliefs, roles, practices and experiences
related to FGM, conducted through
interviews with different categories of
people in the communities.
Community Study Results
Why is FGM Important?
•
•
•
•
Passage of girls from childhood to adult life;
Respect for the culture;
Strengthening of the character of women;
Hygiene and cleanliness of women; integration of
women in society;
• Women’s sexuality;
• Women’s reproductive health;
• Preference of men for excised women.
Community Study Results
• Communities are concerned about changes happening in cultural
values and education, including with FGM.
• Weakening of moral, cultural and religious education of children;
• Diminishing communication between children and elders;
• Lack of respect for elders;
• Diminished impact of the school on the values and behavior of
children;
• Negative influence of music and television; the abandonment or
change in cultural traditions (e.g., the use of modern music instead of
traditional music during ceremonies);
• Decreasing use of stories for teaching; and the disappearance of
educating girls in a group.
Community Study Results
• Many community members value
circumcision for girls and women and do
not appreciate being lectured by
government officials, NGOs, and other
development agents on the negative aspects
of FGM, without having a voice.
Forum-Dialogue Workshop on
Culture and FGM
• Brings together the different categories of
persons interviewed, including
– community representatives,
– health workers, and
– development agents,
to expand the discussion and help identify
strategies at the level of the whole community
Forum Dialogue Workshops
Themes Addressed
• Values and cultural traditions;
• Role of elders, notably grandmothers, in
society and development programs;
• Current positive and negative changes
related to the education of girls
Forum Dialogue Workshops
FGM –Discussion Points
• Pros and cons;
• Risks to health and well-being of girls and
women;
• Islamic position on FGM;
• Strategies for encouraging reflection and
dialogue on FGM at the community level.
Forum-Dialogue Workshops
Conclusions
• 1) Both activities are essential to the effectiveness of the project.
• 2) Community members greatly appreciated being asked to propose
strategies for the elimination of FGM.
• 3) Expert facilitators are necessary for the workshops to encourage
successful dialogue amongst participants.
•
4) Grandmothers can play a key role in the strategies to eliminate
FGM.
• 5) Grandmothers are open to new ideas, especially if approached
through dialogue and negotiation.
“The approach is very good because the whole
discussion takes place in the cultural context and
with the idea of promoting what is good and
discouraging what is negative. In the past,
intellectuals would come only to criticize our
traditions and propose strange ideas. You have
begun by appreciating what exists in our tradition
and not criticizing it directly.”
Bassirou Diao, Community Health
Worker, Kandaye
Sample Outcomes of
GMP Approach
• In Laos, 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.
Outcomes (cont’d)
• Before grand-mother-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.
Outcomes (cont’d)
• 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%.
“In this approach we have become
important in our community. Before
only the younger women were
invited. We weren’t invited and,
therefore, we couldn’t learn new
things…
…Now we have an opportunity to
share our knowledge, to say what
we think. Our only concern is, ‘Will
they continue to include us?’ ”
Fatou Balde
Grandmother Leader
www.grandmotherproject.org