35458 Grandmothers Promote Maternal and Child Health: the Role of Indigenous Knowledge Systems' Managers I n virtually all societies, the managers of reflects a western perspective that is indigenous knowledge systems that deal often in conflict with the cultural values with the development, care and well-being of non-western societies wherein el- ders play an authoritative role in com- Notes of women and children are senior women, or grandmothers. In that function, grand- munity systems of organization and mothers are expected to advise and super- communication, including in the trans- vise the younger generations. However, mission of IK. most development programs neither ac- Andreas Fuglesang , Swedish com- 1 knowledge their influence nor explicitly in- munication for development expert, volve them in efforts to strengthen existing discussed the central role played by el- family and community survival strategies. ders in information management in tra- KI Many discussions of indigenous knowl- ditional cultures. He described the edge tend to be rather narrow, in two re- function of elders as the "information spects. First, IK is often presented in storage and processing unit" of a soci- terms of specific knowledge and prac- ety, like the hard drive on a computer. tices, or "nuggets of traditional wisdom" in He described their critical role in en- relative isolation from the community suring continuity between the knowl- http://www.worldbank.org/afr/ik/default.htm knowledge authorities and systems of edge and values of their forefathers which such knowledge is a part. Second, and the needs of younger generations many discussions of IK point to the ben- preparing for life in the future. eficial elements of traditional knowledge In Senegal, Diouf studied traditional and practice while completely ignoring the learning systems in rural areas and harmful elements, There is a need to broaden the concept 1Fuglesang,A. (l982),About understanding: of IK in development programs: first, to ideas and observations on cross-cultural view IK in the context of community and understanding, Uppsala: Dag Hammarskjold household systems, that include the IK Foundation. No. 89 managers and the mechanisms they use to communicate their knowledge to others; February 2006 and second, to consider both beneficial IK Notes reports periodically on and harmful practices in indigenous Indigenous Knowledge (IK) initiatives in Sub-Saharan Africa and knowledge systems related, for example, occassionally on such initiatives to health, nutrition or initiation rites. outside the region. It is published by the Africa region's Knowledge and Learning Center as part of an evolving K partnership between the In non-western societies who are the World Bank, communities, NGOs, IK managers? development institutions, and multilateral organizations. The views Many development programs assume that expressed in this article are those of World Bank the best way to introduce new information the authors and should not be and change into a cultural setting is to fo- attributed to the World Bank Group or its partners in this initiative. A cus on the younger members of society. webpage on IK is available at Some programs imagine that youth will //www.worldbank.org/afr/ik teach their elders. This orientation clearly 2 found that community members view elders as "information their influence and intrinsic commitment to promoting the providers," a role related to their responsibility for perpetuat- well-being of women and children, they should be viewed as ing indigenous values and practices . Anthropologist, Mar- 2 key actors in development programs. garet Mead, discussed the role of grandparents in passing on The rationale for involving grandmothers in community to younger generations knowledge of "how things should be programs is also supported by the policies of UNICEF, the done" in society. These reflections all suggest that IK can- World Bank and WHO related to the health and well-being not be dissociated from the elders who store it and transmit of women and children. Policy guidelines from these inter- it. However, few development programs in Africa, Asia, national organizations state that programs should build on Latin America and The Pacific have seriously considered local cultural realities, strengthen existing community re- the role of elders in the management of both traditional and sources and develop social capital for sustainable devel- modern knowledge systems. opment. These policy principles provide additional support for the inclusion of knowledgeable, senior women as re- "In Africa, when an old person dies it is source persons in community programs. like when a library burns down." Why is it that community programs dealing with the educa- Hampâté Ba, Malian philosopher tion, 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. Gender differentiation of roles among elders On the one hand, there are several biases against grand- Gender is another important dimension of the management mothers, expressed by many development planners and of IK systems. In most societies, many roles are gender- practitioners : first, that grandmothers do not significantly in- specific and, therefore, the expertise of elder men and elder fluence the knowledge and practices of other family mem- women differs. As regards expertise related to the growth bers; second, that if they are influential they are often a bad and development of young children and to the well-being of influence; third, that because many grandmothers are illiter- women of reproductive age, it is clearly senior women, or ate, it is impossible for them to learn new things; and fourth, grandmothers, who have greater experience and greater because of their age and attachment to tradition they are knowledge. necessarily resistant to change. These several negative ste- reotypes appear to contribute to the fact that grandmothers' experience and potential have not been seriously taken into Grandmothers' multi-faceted role account in community programs to support women and chil- dren. A recent review of the literature on grandmothers' roles in On the other hand, the models, or frameworks, used in non-western societies (Aubel, 2005) revealed that grand- 3 community programs to support women and children's de- mothers, in virtually all cultures and communities, have con- velopment typically focus on younger, women-of-reproduc- siderable knowledge and experience related to all aspects of tive age (WRA) in relative isolation from the household con- maternal and child development, and that they have a strong text of decision-making and influence of other family mem- commitment to promoting the well-being of children, their bers. The individual behavior change orientation, widely mothers, and families. Societies around the world acknowl- adopted around the world, tends to focus on WRA while edge that grandmothers play an influential role in the social- largely ignoring the socio-cultural systems of which they are ization, acculturation, and care of children as they grow and a part, and in which elder family members play an influential develop and in the education and supervision of their daugh- role. ters 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 "The things that grandmothers can see while 2Diouf, W. et al. (2000) Adult Learning in a Non-Western Context: The sitting on the ground, younger people cannot Influence of Culture in a Senegalese Farming Village', Adult Education see even if they climb to the top of a tree." Quarterly, 51(1):32-44. 3Aubel, J. Grandmothers: A Learning Institution. Creative Associates & Senegalese proverb USAID. 3 Methodology to strengthen grandmothers' role as tices; (iv) strengthening the capacity of grandmother leaders knowledge managers and networks to promote improved practices with other grandmothers, in families and in the community-at-large; and In community programs, first in Southeast Asia and later in (v) ongoing monitoring and documentation for learning. West Africa, a methodology was developed by The Grand- mother Project ( anAmerican non-profit NGO ) for working with grandmother networks in order to strengthen their role Key results of grandmother-involvement and knowledge in promoting optimal practices related to ma- ternal and children health and well-being. The approach has In all four sites in Asia and Africa, the several biases against two characteristics that distinguish it from much of the work grandmothers (discussed above) were systematically dis- on IK. First, the primary focus is not on IK practices but proved. First, rapid assessments in all sites revealed that rather on the community-recognized IK authorities on ma- grandmothers have considerable influence on all matters re- ternal and child development, i.e. the grandmothers. The lated to women and children's well-being and on other approach builds on both the traditional role and knowledge of household members' attitudes and practices in this regard. grandmothers. Second, the approach deals not only with Second, while some of their practices are harmful, overall, beneficial IK, but also with harmful IK, by challenging their experience, motivation and commitment to caring for grandmothers to combine useful knowledge from both tradi- women and children are very positive. Third, the majority of tional and modern sources. grandmothers, including illiterate ones, are capable of learn- In 1996 in Laos, in a first experience with UNICEF and ing new things when the pedagogical approach used is based WHO, participatory, non-formal health education activities on respect and dialogue. Fourth, they are very open to com- were carried out with grandmothers groups. The objective bining "new" practices with "old" ones, even when this was to build on grandmothers' traditional knowledge while means abandoning certain traditions. increasing their understanding of key modern practices. Evaluations in all four sites revealed positive changes in Based on the encouraging results in Laos, the approach was grandmothers' own practices and in their advice to younger subsequently further developed in maternal and child health women and men alike. Examples from three of the four sites and nutrition projects with Christian Children's Fund in are cited below to illustrate these positive and quantifiable Senegal and with Helen Keller International in Mali. Later, changes. the methodology was used in an early childhood develop- In Laos, grandmothers' approach to treating diarrhea at ment and nutrition project with UNICEF and World Vision in home greatly improved during the one-year intervention. At Senegal. baseline, only 30% of all grandmothers were giving "lots of In the four projects, a similar non-formal education and fluids" to children with diarrhea whereas in the endline study, community empowerment approach was used. (For a de- 74% of grandmothers were giving this beneficial advice. tailed description of the community approach see article by Similarly, the proportion of grandmothers who advised moth- Aubel & Sihalathavong ). In each setting where the meth- 4 ers with young children to continue breast-feeding during di- odology was used, communities strongly supported the idea arrhea increased from 73% at baseline to 90% at endline.6 of grandmother inclusion. Most grandmothers participated In the CCF nutrition education project in Senegal, there actively, acquired new knowledge and agreed to combine were improvements in all indicators related to grandmothers' new ideas with traditional knowledge. Evaluation data in advice to younger women and to their own practices with each setting showed increases in grandmothers' knowledge young children.7 Evaluation data showed that before grand- of "modern" practices and improvements in their advice to other family members. The outcome of this process of experimentation, evalua- 4 Aubel, J. & D. Sihalathavong (2001), Participatory communication to tion and learning is the generic grandmother-inclusive strengthen the role of grandmothers in child health: an alternative paradigm for health education and health communication; Journal of methodology. The five key steps in the methodology are: 5 International Communication, 7,2, 76-97. (i) rapid assessment of grandmothers' role and influence in 5Aubel, J. (2004) Generic Steps in the Grandmother-Inclusive the household and community related to the issue of interest; Methodology. The Grandmother Project, Chevy Chase, Maryland. (ii) public recognition of grandmothers' role in promoting 6Aubel, J., D. Sihalathavong & D. Kopkeo. (1997) Participatory Health health and development of families and communities;(iii) Education Project with Grandmothers in Laos. Vientiane. 7Aubel, J., I. Touré & M. Diagne. (2004) Senegalese Grandmothers participatory communication/education activities that engage promote improved maternal and child nutrition practices: "The first, grandmother networks, and second, other community guardians of tradition are not averse to change. "Social Science & members, in discussion of both traditional and modern prac- Medicine, 59, 945-959. 4 mother-focused activities began, only 57% of grandmothers Household level: were advising younger women to give colostrum to their in- · Positive changes in grandmothers' advice to younger fants. By the end of the intervention, almost all grandmoth- women and men ers (97%) were giving this advice to their daughters and · Increased confidence of other household members in daughters-in-law. Similarly, at the outset, only 59% of all grandmothers' advice grandmothers were advising young mothers to give enriched · Increased confidence of health/development workers in porridge to their offspring as a first complementary food, grandmothers' advice whereas the final evaluation revealed that 97% were prepar- · Improved communication between mothers-in-law and ing and giving an enriched porridge. In addition, the final daughters-in-law evaluation showed that changes in younger women's prac- The results of these experiences in Asia and Africa illustrate tices were greater in communities where nutrition education how change can be brought about from within indigenous activities were carried out with grandmothers as compared knowledge systems when key actors in those systems, i.e. to places where only younger women participated in these the IK managers, are involved in deciding if and how to com- activities, providing additional evidence of the influence of bine global knowledge with traditional knowledge. In con- grandmothers' advice on younger women's practices. trast to many western, reductionist approaches that seek to In the neonatal health project implemented by HKI in Mali, stimulate change related to specific "priority behaviors", the there were improvements in all sixteen indicators related to approach described here empowers community actors to grandmothers' advice to younger women regarding maternal make such strategic decisions themselves, while simulta- and infant health. For example, between the baseline and 8 neously strengthening the interrelated roles, relationships, endline surveys, the proportion of grandmothers advising norms and practices within family and community systems. pregnant women to attend pre-natal consultations increased Development planners often overlook the significance of from 34% to 61% and those advising young mothers to give the socio-culturally grounded role of elders in developing so- colostrum to their newborns increased from 46% to 63%. cieties who are expected to guide and supervise the younger Through process documentation and evaluation, a number generations based both on their "traditional" knowledge and of other positive and unanticipated outcomes of the grand- their understanding of "modern" knowledge. In this vein, the mother-inclusive methodology were documented among dif- grandmother-inclusive approach to strengthening family and ferent community groups. Here are examples of changes community health strategies supports Fuglesang's assertion observed following use of the non-formal education and em- that attempts to bring about change in a society "must trans- powerment approach: form the fundamental programme for information processing controlled by the elders." 9 Experiences working with Grandmothers: grandmothers in several countries have demonstrated how · Greater sense of confidence and of empowerment in the their role as indigenous knowledge authorities can be built on, community while at the same time they are encouraged to integrate new · Stronger sense of solidarity between grandmothers practices into local knowledge systems. It is likely that simi- · Emergence of grandmother leaders lar untapped potential exists among grandmothers in many · Grandmother leaders encourage other grandmothers to other societies around the world. consider new ideas Male community leaders: · Increased respect for grandmothers' advice combining "indigenous" and "modern" knowledge 8INFO-STAT (2004).Enqûete d'Evaluation Finale: Rapport d'Analyse. · Increased public recognition of grandmothers' contribu- Bamako. 9Fuglesang (ibid) p. 109. tion to women's and children's well-being This IK Note was written by Judi Aubel, PhD, MPH, a social scientist and 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.