Elsevier

Social Science & Medicine

Volume 59, Issue 5, September 2004, Pages 945-959
Social Science & Medicine

Senegalese grandmothers promote improved maternal and child nutrition practices: the guardians of tradition are not averse to change

https://doi.org/10.1016/j.socscimed.2003.11.044Get rights and content

Abstract

The vast majority of community nutrition/health programs in developing countries focus on women of reproductive age (WRA) and a few explicitly involve senior women, or grandmothers. In Senegal, as in many other places, older, experienced women play an influential role in household maternal and child health (MCH) matters. Formative research in Serer villages revealed their importance and this was taken into account in an action research nutrition education (NE) project in which grandmothers were encouraged to promote improved nutritional practices related to pregnancy (e.g. decreased work and improved diet) and infant feeding (e.g. breastfeeding and complementary feeding). A participatory communication/empowerment education approach was used involving songs, stories and group discussion. Quantitative and qualitative data were collected to both document and evaluate the intervention. Triangulation of the evaluation data suggests that 12 months after the intervention was initiated there were significant improvements in grandmothers’ nutritional knowledge, in their advice to WRA, and in the nutrition-related practices of these younger women associated both with pregnancy and infant feeding. For example, in the pre-test only 20% of grandmothers stated that they advise pregnant women to decrease their workload whereas in the post-test 87% reported giving this advice. At the same time, 91% of WRA in villages with the grandmother strategy reported having decreased their workload during their last pregnancy whereas in villages with NE activities for WRA but not with grandmothers, only 34% of younger women reported having done so. These findings provide evidence of grandmothers’ ability to learn, to integrate new information into their practices and to positively influence the practices of WRA. These results support the need for future MCH programs, in different cultural contexts, to involve grandmothers and in so doing to build on their intrinsic commitment to family well-being.

Introduction

In the past 10 years, research has significantly advanced our understanding of the nutritional needs of infants and young children, and, to a lesser extent, of female adolescents and women of reproductive age (WRA) (LINKAGES, 1999); however, there has been much less progress in identifying interventions that lead to sustained improvements in nutrition practices (Samba, Sy, Ntiru, & Diene, 1999). In spite of considerable investment in nutrition education (NE) programs in developing countries over the past 20 years, relatively few interventions that have documented sustained changes in community practices related to women and children's nutrition (Allen & Gillespie, 2001; Andrien & Beghin, 1993). The limited impact of such programs may be attributed, in part, to inadequacies in the reductionist conceptual framework used to understand health/nutrition practices in household and community settings and in the limitations of the predominant, directive pedagogical approach used in NE.

In community health programs in developing countries, the approach adopted in most nutrition/health education/communication (NHEC) interventions reflects two key dimensions. First, most programs use directive, unidirectional, message-based methods with community members (Lee & Garvin, 2003). Second, the goal of most NE programs is to bring about changes in individual nutrition-related behaviors of WRA (Andrien & Beghin, 1993). The basic assumption made in these programs is that if WRA acquire information on optimal maternal and child nutrition practices, they will adopt those practices (Leslie, 1989). Very few programs have involved older, experienced women or grandmothers.1

This paper has several purposes. First, we identify several conceptual and methodological limitations in the predominant approach used in community NE in developing countries, and particularly regarding the failure to involve grandmothers in nutrition promotion strategies. Second, we summarize the results of a community study conducted in Serer villages in western Senegal which revealed the protagonistic role played by grandmothers in maternal and child health (MCH). Third, and primarily, we describe the methodology and results of a community NE project that aimed to strengthen the role of grandmothers in promoting improved maternal and child nutrition practices related to exclusive breastfeeding, improved diet and decreased workloads during pregnancy. The NE project was carried out in the context of a community health program supported by an international non-governmental organization, Christian Children's Fund (CCF), and implemented in collaboration with the Ministry of Health (MOH).

Section snippets

Background

The vast majority of NE programs in developing countries are grounded in the transmission-persuasion model of education/communication (Waisbord, 2001). This predominant model, or paradigm, has been widely supported by North American and international development agencies and has been manifest in various approaches, used over the past l5 years and referred to as health communication (HC) (Graeff, Elder, & Booth, 1993), information, education and education (IEC) (WHO, 1997), social marketing (

Role of senior women in maternal and child health programs

The reductionist focus of MCH programs on WRA has tended to camouflage other household-level actors who influence health and illness decision-making and practices. While in the mainstream international public health literature discussion of the role of older women, or grandmothers, has been largely ignored, their multi-faceted role in family health has been documented in Africa (Kayongo-Male & Onyango, 1984), Asia (Jernigan & Jernigan, 1992), Latin America (Finerman, 1989; McKee, 1987) and the

Maternal and child nutrition in Senegal

In Senegal the nutritional status of both WRA and children is generally precarious, especially in rural areas. In the project area in rural Senegal, a quarter of all WRA (29%) suffer from chronic malnutrition (BMI<18.6) (CCF, 1997) and it is estimated that during pregnancy approximately 60% are anemic (Wade, 1994). The unsatisfactory nutritional status of WRA is further compromised during pregnancy by the widespread belief amongst all ethnic groups that a pregnant woman should work hard and not

Nutrition education in Senegal

A 1995 analysis of nutrition and health education in Senegal showed that most NE methods used in the country are based on the dominant HNEC message-driven paradigm using didactic teaching techniques and almost all programs aim to bring about changes in the practices, or behavior of WRA (Aubel, 1995a). The MOH Director of Health Education, at that time, identified several factors which have limited the impact of past health/NE efforts: first, the use of directive methods; second, failure to

Intervention setting

The NE strategy with grandmothers, referred to heretofore as the “grandmother strategy”, was implemented in two health districts, Thiadaye and Joal, in western Senegal where CCF is implementing a community child health program in collaboration with the district health staff. The pilot grandmother strategy was carried out in 13 of the 60 rural villages supported by the child health program. CCF has a cadre of well-trained community animators who were primarily responsible for implementing the

Action research methodology

The grandmother pilot project was implemented as an action research (AR) project in the context of a larger community health program.4 The aim of the AR was to

Results

The results of the grandmother intervention are based on sets of quantitative and qualitative data described above. The quantitative results provide a succinct impression of the outcomes of the intervention on grandmothers and WRA. The qualitative results provide a systemic perspective of the impact that the intervention had not only on grandmothers and WRA but also on grandmother networks, CLs, households and communities at large. In addition, the qualitative data provide insights into the

Discussion

In developing countries, relatively few NE strategies have led to sustained changes in community nutrition practices (Allen & Gillespie, 2001; Andrien & Beghin, 1993). Evaluation results of the AR community NE intervention reported here suggest that it contributed to significant changes in targeted nutrition practices of WRA, including decreased workload and improved diet during pregnancy, and increased exclusive breastfeeding, and that community norms related to these and other key nutritional

Acknowledgements

The project reported here was supported by CCF and USAID. Michel Tokopuku, CCF Director in Senegal, encouraged and supported this work in many ways. In addition to the authors, the work with the grandmothers was carried out by Lazin Kalala, El Hadj Sene, Marietou Ndoye, Yirime Faye and Mouhamadou Tandia. The participatory NE methodology used in Senegal was originally developed in Laos by the first author with support from WHO and UNICEF. We are grateful to Stanley Yoder and Kathy Kurz who

References (67)

  • J Aubel

    Learning through dialogueUsing stories in adult education

    (1995)
  • J Aubel et al.

    Participatory communication to strengthen the role of grandmothers in child healthAn alternative paradigm for health education and health communication

    Journal of International Communication

    (2001)
  • J Aubel et al.

    Etude sur le rôle des grands-mères dans la sant et nutrition de la mèreé et de l’enfant

    (2001)
  • A Bandura

    Social learning theory

    (1977)
  • S.D Brookfield

    Understanding and facilitating adult learning

    (1986)
  • S.D Brookfield

    Developing critical thinkersChallenging adults to explore alternative ways of thinking and acting

    (1991)
  • Bruce, J., & Lloyd, C. B. (1992). Beyond female headship: Family research and policy issues for the 1990's. Paper...
  • M Buvinic et al.

    Individual and family choices for child survival and development

    (1987)
  • CCF. (1997). Annual impact monitoring and evaluation. Dakar:...
  • CCF. (2001). Evaluation à Mi-Parcours du Projet CANAH. Dakar:...
  • R Chambers

    Forward

  • N.J Chrisman

    The health seeking processAn approach to the natural history of illness

    Culture, Medicine & Psychiatry l

    (1977)
  • N.M Clark et al.

    Creating capacity through health educationWhat we know and what we don’t

    Health Education Quarterly

    (1995)
  • J.B Cunningham

    Action research and organizational development

    (1993)
  • W Diouf et al.

    Adult learning in a non-Western contextThe influence of culture in a Senegalese farming village

    Adult Education Quarterly

    (2000)
  • W.W Dressler et al.

    Cultural determinants of health behavior

  • Figueroa, M.E., Kincaid, D.L., Rani, M., & Lewis, G. (2002). Communication for social change: An integrated model for...
  • R Finerman

    The forgotten healersWomen as family healers in an Andean Indian community

  • P Freire

    Pedagogy of the oppressed

    (1970)
  • J.A Graeff et al.

    Communication for health and behavior changeA developing country perspective

    (1993)
  • C.P Green

    Improving breastfeeding behaviorsEvidence from two decades of intervention research

    (1998)
  • L.W Green et al.

    Ecological foundations of health Promotion

    American Journal of Health Promotion

    (1996)
  • A Hartman et al.

    Family centered social work practice

    (1983)
  • Cited by (155)

    • Framing of COVID-19 safety protocols in Kusaal musical health communication: Language and literary analysis

      2021, Language and Communication
      Citation Excerpt :

      Failure to recognize the importance of oral traditions in Africa and the potential of music and song for stimulating social and behavior change would represent a missed opportunity in HIV prevention strategies. Similarly, Panter-Brick et al. (2006) demonstrate in their research that songs may be effective in health communication for malaria specifically in the Senegambia region, and again, Aubel et al. (2004) confirm the successful use of songs in maternal and child health communication. The use of music for health communication has long existed in edutainment partly because music is easy to remember and can be easily passed on from one person or community to the other (Frishkopf et al., 2016).

    View all citing articles on Scopus
    View full text