Questions

Skepticism about porridge? – based off fear of the unknown

What crops don’t use pesticides? – Every single one uses them in some capacity (90% farmers use pesticides, 10% do not)

Cannot rely on a small percentage of organic farmers when scaling up. This produce will cost a premium

 

Ethical Dilemma- finding the balance between either feeding the kids food grown with pesticides or increasing their likelihood of contracting HIV due to prolonged breastfeeding

1. Are both problems of the same magnitude?
   1. Most women breastfeed until at least 2 years
   2. How bad is HIV in the long term? How bad is exposure to pesticides?
2. Leverage points – 6 mos vs 2 yrs

Step 1: Facts

• We’ve received a grant to establish a cooperative in East Africa
• ~35% of children in this area have stunted growth due to malnutrition
• Mothers typically feed infants a gruel made of maize and bananas starting at ~2 months to supplement breastfeeding. This gruel is missing some key nutrients
  • Mothers are confident in the health benefits in the gruel they feed their kids
  • WHO recommends children are receive exclusive breastfeeding up to 6 months of age
• HIV/AIDS is very prevalent in the region
  • Testing is rare and not readily available
• The longer an infant breastfeeds the higher the risk of HIV transmission to the child (If the mother is HIV+)
• We aim to replace the gruel with a shelf-stable nutritious porridge that will meet all the nutritional requirements and will be made from locally grown produce
  • Many of the crops are grown with pesticides
  • Mothers are skeptical of the use of the porridge
• Porridge aims to wean children off breastmilk at 6 months of age
• There is a high number of women (500) interested in the cooperative’s porridge idea
• 90% of people with HIV know they have it, Antiviral medications introduced with milk

Step 2/3: Stakeholders and Motivations

• Entrepreneur/Researcher
  • Professional
    • Good publicity and credibility
    • Build up a track record of successful projects
  • Personal
    • Aiding the decrease of stunted growth rates
    • Improving the nutritional status of the children
    • Support livelihoods of the mothers
• Children (secondary)
  • Too young to have independent motivations; desires reflected in the motivations of their mothers
• Donor (secondary)
  • Professional
    • Recognition/ Good publicity
  • Personal
    • Improve nutritional status of children
    • Improve livelihoods of rural households
• Government (secondary)
  • Professional
    • Reduce prevalence of HIV by preventing transmission from mothers to children
    • Improve health of population by giving children access to proper nutrients from infancy, reduce stunting rates
    • Promote agricultural biodiversity and the development of value chains for produce
  • Personal 
    • Reduce prevalence of HIV by preventing transmission from mothers to children
    • Improve health of population by giving children access to proper nutrients from infancy, reduce stunting rates
    • Promote agricultural biodiversity and the development of value chains for produce
• Women/Mothers
  • Professional
    • Want to improve their livelihoods without risking the health of their child
    • Increased income
  • Personal
    • Want to source food that is pesticide free / safe to consume for their infants
    • Want to stick to traditional breastfeeding practices
    • Reduce risk of HIV transmission to their children
• Farmers
  • Professional
    • A good work opportunity/ paycheck
  • Personal
    • Helping out their community

Step 4: Solutions

1. Minimize additional ingredients so the gruel is still familiar
   1. Ethical Principle
      1. Beneficence – Attempting to reduce harm potential by adding ingredients that will address nutritional deficiencies that result in stunted growth. 
      2. Non maleficence – balancing risks and benefits of promoting the new porridge that may increase exposure to pesticides with reducing risk of potential HIV transmission.
   2. Pros
      1. There is still a sense of familiarity, which makes the mothers more inclined to try it
      2. Adding in foods that specifically target the nutrients that are missing from the traditional gruel ensures proper supplementation
      3. May decrease the opportunity for pesticides because the variety of produce is lessened
   3. Cons
      1. The pesticides will still be present in the gruel
      2. Mothers may still be reluctant to use 
2. Involve community health workers, local religious leaders to establish trust and educate women in a culturally-appropriate manner
   1. Ethical Principle
      1. Autonomy – we are providing the information they need to make an informed decision. We are involving key community members to help inform our venture and provide information in a culturally appropriate way 
   2. Pros
      1. They help validate our intentions and can communicate to women better about our project
      2. Parents receive the information they need to make an informed decision about risks of both options (i.e., HIV transmission vs. pesticide exposure)
      3. Community health workers can teach about nutrition and how it impacts child development
   3. Cons
      1. There might not be a community health worker/ leader
      2. The porridge may cause worse issues for the children
      3. Despite being informed, may stick to traditional breastfeeding practices
      4. Additional financial costs that were not originally planned for 
3. Recommend that the gruel is introduced in small quantities until the child reaches a developmental stage that minimizes risks associated with pesticide exposure but does not increase the risk of HIV transmission.
   1. Ethical Principle- the children are not exposed to HIV and still receive good nutrition
      1. Non-Maleficence – 
   2. Pros
      1. Reducing stunted growth rates and exposure of HIV
   3. Cons
      1. The women might still feel skeptical about the porridge

Use packaging to convey health / nutritional content, involve community health workers to promote and sell the porridge

Promote porridge as a “stage 2”

Partner with the Ministry of Health

Reforming agricultural / sexual education system is costly (can be circumvented through partnering)

 

Step 5: Assistance

• Would we rather expose the kids to HIV or maybe stunt development by giving them pesticides?
• Not all the produce have pesticides

Step 6: 

I believe that feeding the gruel in small quantities to the children until they reach a good developmental stage to reduce their exposure to HIV,  is the best solution. This solves both sides of the ethical dilemma because the women do not have to change the diet of their children and they do not expose their children to HIV. There is no drastic change the mothers must make but there are significant benefits regarding the development of their children. 

The top stakeholders, mothers and children, will be the most satisfied with this solution because they reap the benefits of having healthy children. The rest like the researchers, donors, and the government will be satisfied with the percentage of stunted growth rates in the country decrease. Additionally, this can become good publicity for the country. This solution solves all the problems collectively without making any drastic changes like other solutions. For instance, by involving the community health workers to help, you now have to think about how to compensate these workers. Also you must think about the amount of labor this other solution will create. Two variables that add unnecessary complications to the solution. Then, partnering with other organizations to complete the task sounds like a good idea, but you must think about the amount of time and work it takes to create those connections. The more time that passes the more children that will be malnutrition and may have stunted growth. 

Step 7

• There are not many implications created for science because it takes a minimalist approach that causes massive change. 

 

Part Two

Step One Facts

• The cooperative is doing well and is successful
• The women working in the cooperative are making money
• The mothers are upset that their husbands are taking their money to buy unnecessary items like beer

Step 2- Problem

• The mothers in the cooperative are working to make money but when they return home, their husbands are taking their hard earned money to buy useless things that do help their children.

Step 3- Stakeholders

• Entrepreneur/Researcher
  • Professional
    • Good publicity and credibility
    • Build up a track record of successful projects
  • Personal
    • Aiding the decrease of stunted growth rates
    • Improving the nutritional status of the children
    • Support livelihoods of the mothers
• Children (secondary)
  • Too young to have independent motivations; desires reflected in the motivations of their mothers
• Donor (secondary)
  • Professional
    • Recognition/ Good publicity
  • Personal
    • Improve nutritional status of children
    • Improve livelihoods of rural households
• Government (secondary)
  • Professional
    • Reduce prevalence of HIV by preventing transmission from mothers to children
    • Improve health of population by giving children access to proper nutrients from infancy, reduce stunting rates
    • Promote agricultural biodiversity and the development of value chains for produce
  • Personal 
    • Reduce prevalence of HIV by preventing transmission from mothers to children
    • Improve health of population by giving children access to proper nutrients from infancy, reduce stunting rates
    • Promote agricultural biodiversity and the development of value chains for produce
• Women/Mothers
  • Professional
    • Want to improve their livelihoods without risking the health of their child
    • Increased income
  • Personal
    • Want to source food that is pesticide free / safe to consume for their infants
    • Want to stick to traditional breastfeeding practices
    • Reduce risk of HIV transmission to their children
• Farmers
  • Professional
    • A good work opportunity/ paycheck
  • Personal
    • Helping out their community
• The men
  • Professional
    • They are usually seen as the leader of the household
  • Personal
    • They know they can get away with taking their wives money
    • Don’t want their wives making money possibly

 

Solution- Get a town hall meeting together where leaders from the cooperative, mothers, local leaders, and men to talk about the issue of taking the money. Get everyone’s opinion to reach a common solution. They must come up with some types of bylaws or understandings. The main point the women will use is their children. They must make it clear to their husbands that taking their money is not helping the development of their kids, but also not to scold them. They must in the end form an understanding that some of the money can be used to buy fun goods but the majority must be set aside for their children. By having other members at the meeting they can reinforce the points of the mothers to make the men understand what is at stake. 

• This solves the twin problems because the men will see the implications of their actions and have to change or else face shame from the community. Also the women can continue working and earn all their respected money without being scared that it will be spend on useless goods
• Pros
  • There will be a new civil understanding between the men and women
  • The women can continue making their money to provide for their children
  • The men still can buy some beer but not waste all the money
• Cons
  • The men might not take the advice of their wives  and local community leaders
  • They might still take the money
• Short term implications
  • Short term things around the community will go well and everyone will be happy. The men will get a smaller portion of the beer they want and their mothers will be able to provide for their children. Also they will be able to continue working at the cooperative without having to worry about their money. The relationship with the cooperative will remain stable because they did not do anything that would cause disruption or get anyone made. This civil approach will only create benefits because it considers everyones opinions. 
• Long Term
  • The relationship between the cooperative and community will grow and strengthen because they might see decreases in stunted growths and households will have higher incomes because the women are working. Also the people in the community will remember that the cooperative always stood by the women and helped them solve their problem
• Assistance
  • I see that a discussion is key because everyone is allowed to express their opinions. Noone will be left out and the entire process is civil. I think about how problems are solved now, which is just discussing it.

Step 7

1. The first step is to get the cooperative and the women together to unite.
2. Go spread the news of a town hall and attempt to receive the aid of local health workers, priests, or elders. The cooperative and mothers must explain the issue and the implications it creates for the children, which are the future generations of the community.
3. Then after they endorse the idea they must plan where the meeting will be held and talk about how it will go down. 
4. After finalizing plans, all the women must do is to ask their husbands to go to the meeting
5. At the meeting they must discuss their opinions and solutions that can take place
6. The women and other participants at the meeting will send the men off to think about it and then hopefully they will understand and listen.