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 health-related 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-in-law/mothers

“Be grounded in your culture. Preserve its positive traditional

values and let its abusive customs

disappear.”

Amadou Hampâté BaA 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, KoldaSouthern 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 ResultsWhy 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 WorkshopsThemes 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 WorkshopsFGM –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 WorkshopsConclusions

• 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 BaldeGrandmother Leader

www.grandmotherproject.org