Past Activities
The Grandmother Project grew out of a series of successful experiences that Judi Aubel had working with community health programs in Laos, Uzbekistan, Albania, Mali and Senegal and involving grandmothers as resource persons. Each experience was carried out with a different non-governmental organization. You can read about the experiences in each of those countries. These have included: Laos, Senegal, Mali, Albania and Uzbekistan.
Mali: Helen Keller International (1993)
GM networks promote child health in Mali
In Mali, it is widely recognized that grandmothers, or muso koroba in bamana, the local language, have great influence on the practices of younger women and children, and families as a whole. However, prior to the experience reported on here, there had not been any documented previous experiences working explicitly with GM groups. Helen Keller International (HKI) and their partners from the Ministry of Health and Social Affairs, decided to develop a strategy to involve GMs, in a community strategy to improve the advice and practices of these senior women related to pregnancy, childbirth and care of newborns.
The first step in development of the strategy was to conduct a qualitative community study using an innovative methodology developed by Aubel to analyze the roles of household actors in health/nutrition and decision-making related to health promotion and illness management. Results of the study showed that, “ At the family level, the muso koroba are the primary resource persons for all issues related to women during pregnancy and labour, during the postpartum period and also related to their infants. Other family members expect them to advise and supervise all activities of younger women regarding themselves and their children.“ In addition, GMs interviewed all stated that they had never before been invited to participate in health/nutrition education activities at the community level and that they would be most interested to do so.
Based on these findings a community health education strategy was developed to implement with grandmother groups. Most health education activities in Mali are based on the information-transmission model of communication in which the aim is to persuade people to adopt certain prescribed practices. Paolo Freire referred to this one-way communication approach as a “banking approach.” Conversely, in the grandmother strategy non-formal adult education methods were used to elicit dialogue and active learning. Group learning activities developed for use with grandmothers included songs and stories, both traditional communication modes in Mali. Two types of short songs were developed, first, songs of praise to the grandmothers to acknowledge the importance their role and encourage them to participate and second, educational songs based on key child health topics. Here is an example of one of the songs of praise developed by the team in Mali, followed by one of the educational songs.
In Praise of Grandmother:
"Dearest Grandmother, dearest Grandmother
You are such a wonderful person, such a wonderful person
Dearest Grandmother, dearest Grandmother
Your heart is large and compassionate
Dearest Grandmother, dearest Grandmother"Grandmother's advice to a pregnant woman:
"Grandmother, what advice do you give to a pregnant woman?
I tell her to work less.
Grandmother, what advice do you give to a pregnant woman?
I tell her to eat more.
Grandmother, what advice do you give to a pregnant woman?I tell her to eat beans, peanuts and green vegetables"In Mali, as in many societies, women enjoy singing. The Malian grandmothers clearly stated that they appreciate the songs that are both enjoyable and educational.
The second component of the non-formal strategy involved the use of stories, a traditional tool for teaching and advising. Paolo Freire's work in community adult education served as a basis for developing stories-without-an-ending, each dealing with a key child health topic. The story codes , each reflecting a typical community situation, were used as a catalyst for stimulating dialogue, discussion of problems and of possible solutions. The use of the stories in this way illustrates what Freire referred to as a “problem-posing approach.” A significant characteristic of the stories is that the protagonist in each story is a grandmother, reflecting the central role they play in all newborn health matters. And in each story the grandmother figure is presented as a competent and respected women, in order to acknowledge their importance and encourage them to participate.
A set of 6 stories were developed on priority topics related to pregnancy and newborn health, for example, women's work and nutrition during pregnancy, early initiation of breastfeeding and exclusive breastfeeding. To accompany each of the stories a set of critical thinking questions was developed based on the experiential learning cycle. When the stories were used with grandmother groups the facilitator presented the story and then used these questions to stimulate discussion both of the problems described in the stories and of possible individual or community level solutions. An important concept in the discussion of the story topics was to encourage the grandmothers to combine “old practices” and “new practices.”
The grandmother strategy was implemented in 48 villages. The stories, songs and group discussions focused primarily, but not exclusively, on the grandmothers. Male traditional community leaders were also involved, as well as younger women and men. The extension workers involved in the strategy periodically visited the community leaders so that they understood the strategy and encouraged the grandmothers to participate. In addition, for each session with the grandmothers the village headman selected two or three of his advisors to attend the session and provide him with feedback on what was discussed. This mechanism contributed greatly to eliciting their support for the strategy and for the grandmothers. After the group sessions with grandmother, the community health volunteers were expected to repeat the stories and songs with groups of younger women and men, depending on their interest and availability.
The feedback on the grandmother strategy was very positive on the part of both health workers and community members. Many local health officials stated, “Most past maternal and child health programs have had a limited impact because the influential muso korobas, were not involved.” At the community level, community leaders strongly supported the strategy involving grandmothers, “They are the primary advisors in the family for younger women.” Both younger women and their husbands stated that involving the GMs greatly facilitates adoption of new health-related practices by younger women.
Community activities with GM groups were implemented for 14 months and an evaluation of the strategy was carried out at the end. The evaluation showed that: the grandmothers were very interested in the non-formal education activities and in the “new practices” they learned about; their knowledge of these practices has increased; and their advice to younger women has changed. The final evaluation showed that there were improvements in grandmothers' knowledge and advice related to all of the sixteen priority topics developed in the educational activities with them. For example, before the project started on 34% of the grandmothers said that they advise pregnant women to go to the health center for pre-natal visits. At the end of the project, 61% of the grandmothers said that they give this important advice to their daughters or daughters-in-law. At the outset, only 48% of the grandmothers advised new mothers to give the colostrum, or “first milk,” to their newborns whereas at the end of the project 63% of the grandmothers were giving this important advice. On these and the other 14 neonatal health topics, the evaluation showed that grandmothers can learn and can change their advice. HKI and Ministry of Health staff agree that whereas past programs excluded grandmothers, a major factor contributing to the success of the GM-focused strategy is that it builds on the culturally-defined role of grandmothers as respected advisors of younger women and families. There is also agreement, from development agents and community members that another significant factor that has contributed to the success of the strategy is the use of culturally-adapted communication tools, namely songs, stories and group discussion. Both groups of actors also feel that the non-formal education approach focusing on grandmother groups is an approach that can be used in various socio-cultural contexts and to address a variety of issues related to the health and well-being of women and children.
This experience confirms both the influence of grandmothers on the health and nutrition of women and children and their openness to new ideas when the pedagogical methods used are based on dialogue and engage them in critical reflection on issues that concern them.