Blog #4

Team members: Susan Cheng, Alondra Perez, Alicia Zamudio, David Tauman

 

Part 1: Ethical Decision-Making

In a certain region of East Africa, the growth of ~35% of the children is stunted due to poor nutrition. Traditionally, maize and bananas are the items most commonly made into a gruel and fed to infants beginning at ~2 months of age. The gruel is integrated into a child’s diet to complement breastfeeding until they are ~24 months of age. Mothers in the area firmly believe that the gruel is highly beneficial for their children, but scientific research has shown that it does not provide some key nutrients. HIV/AIDS is very prevalent in this region. The World Health Organization recommends exclusive breastfeeding until an infant is six months of age, but the longer a child nurses when the mother is HIV+, the greater the chance that the virus will be transmitted to the child. You have received a grant to establish a women’s cooperative in this region. The donor’s intent is to simultaneously improve the nutritional status of children and improve the livelihoods of rural households. The grant for the women’s cooperative has sufficient funds for the women’s group to process and market a nutritious, shelf-stable porridge made from a large mix of locally grown produce. The nutritious porridge is intended to wean children off of breast milk at about 6 months of age. 

 

Approximately 500 women from three contiguous sub-locations have indicated their interest in joining the cooperative, in hopes of improving their livelihoods. However, they are skeptical of the porridge and its use as an early weaning food. Cash crops as well as subsistence crops are grown in the area, including maize, sorghum, cassava, several varieties of legumes (dried beans), French beans, coffee, pineapple, bananas, pumpkins, tomatoes, carrots, kale, white (Irish) potatoes, and sweet potatoes. Pesticides are typically used in growing some of these crops and can result in adverse health implications for infants. How would you address the ethical health issues associated with prolonged breastfeeding in an area where there is a high prevalence of HIV/AIDS and few women are tested for the virus, very early introduction of supplemental foods to the diets of infants, and the possibility of pesticide residues in foods developed for infants and young children. 

 

What are your next specific steps to develop this cooperative? 

 

Step 1: Determine the facts in the situation – obtain all of the unbiased facts possible. Clearly state the ethical issue. 

  • In east africa ~35% of children are stunted
  • Gruel is used to complement breastfeeding, believed to be nutritious but in reality it is not helpful to growth
  • HIV is prevalent amongst mothers in the region
  • A breastfeeding mother that is HIV+ has a high chance of transferring it to her child
  • World Health Organization recommends exclusive breastfeeding until an infant is six months
  • The gruel is integrated into a child’s diet to complement breastfeeding from 2 months ~24 months of age
  • The funding for the cooperative comes from a grant given by a donor.
  • The goal is to process and market a nutritious, shelf-stable porridge made from a large mix of locally grown produce
  • 500 women from three contiguous sub-locations have indicated their interest in joining the cooperative
  • Crops that are locally grown include maize, sorghum, cassava, several varieties of legumes (dried beans), French beans, coffee, pineapple, bananas, pumpkins, tomatoes, carrots, kale, white (Irish) potatoes, and sweet potatoes.
  • Mothers are skeptical of the porridge and its use as an early weaning food
  • Pesticides are typically used in growing some of the crops that are locally grown and can result in adverse health implications for infants
  • We received a grant for this project
  • Assumptions
    • Mothers are not knowledge about HIV, its effect, and its transmission
    • Mothers do not know the effects of ingesting pesticides

 

Step 2 and 3: Define the Stakeholders and their Motivations – those with a vested interest in the outcome 

  • The mothers→ The approximately 500 women from the three contiguous sub-locations (primary) 
    • Want children to grow up healthy
    • Improve their own livelihood
    • Have a tasteful nutritious porridge that their kids will want to eat
    • Make money 
  • The children (primary)
    • Have access to food
    • Want to grow healthy (no stunting and no HIV)
    • Consume food that are tasty
  • Your cooperative→ the researchers 
    • Wants to implement the new supplementals to aid in child growth
    • Wants to prevent stunting and HIV in the youth
    • Wants to educate the mothers about HIV, nutrition, and pesticides
    • Create a porridge that kids will want to eat and mothers will want to feed their kids
    • To process and market a nutritious, shelf-stable porridge made from a large mix of locally grown produce
    • Wants to create a successful business
    • Build their own credibility
  • The donors (secondary)
    • Improve the nutrition amongst children in the area
    • Improve the livelihoods of rural households
  • The governments/leaders in east africa (secondary)
    • Want to limit the stunting in the children
    • Want to limit the HIV cases
    • Want to improve the livelihood of the community
  • Ethical Issue: Mothers currently breastfeed and provide gruel to their children up to the age of 2, believing that it is beneficial to their health and growth. Contradicting the mother’s belief, the high prevalence of HIV in the community carries the risk of mothers transmitting HIV to their children via breastfeeding. In addition, the gruel does not provide key nutrients to their children’s growth. Our porridge solution would enable women to provide their children with the key nutrients to their growth. However, the ingredients to our porridge may contain pesticide residues.

 

Step 4: Formulate (atleast three) alternative solutions – based on information available, using basic ethical core values as guide 

Solution #1: Educate mothers about HIV and transmission, nutrition, and urge them to try the porridge (do not warn about pesticides)

    • Hold meetings to discuss what HIV is, the effects and dangers of HIV, and how it is transferred through breastfeeding
    • Urge the mothers to try implementing our porridge for their children as it can prevent the risk of HIV transmission through breastfeeding
    • The porridge is also more nutritional than the current gruel the children are fed

 

  • Ethical Principle: We are providing the mothers with information concerning the health and nutrition of their children’s growth in their current practice. We then present a solution that may alleviate the malnutrition and potential health risks involved in their current lifestyle. However, the solution presented also carries health risks but we have decided in the mother’s stead that the solution will do them more good than their current practice. 

 

    • Pros:
      • Avoid the fears that may arise amongst mothers regarding pesticides
      • Addressing why breastfeeding needs to be avoided (HIV issue)
      • Explaining how the porridge is more beneficial than the traditional gruel 

 

  • Cons:

 

    • It could be considered an ethical dilemma where we violate  informed consent if we don’t inform the women of the possible pesticides.
    • Mothers may decide that they don’t want to learn more and want to continue using their traditional gruel. 
    • Mothers can be distrustful of us
    • Educating the mothers could be costly

 

    • Solution #2: Educate mothers about HIV, transmission, nutrition, and pesticide dangers (their decision about trying the porridge)
      • Hold meetings to discuss what HIV is, the effects and dangers of HIV, and how it is transferred through breastfeeding
      • Hold meetings to discuss what pesticides are and their effects and dangers, but also that their children might already be eating pesticides
      • Allow mothers to come to their own decision about what to feed their children
    • Ethical Principle: We educate the mothers about the dangers of HIV and pesticides and give them the power to decide whether or not they want to try the porridge. The fate of her children is in her own hands.

 

  • Pros: 

 

    • The mothers are fully educated regarding all consequences and can make a decision for themselves
    • No matter their choice, they will be doing what they feel is right for their children
    • Developing a relationship of trust because we are mentioning a possible drawback although it could negatively affect our business 
    • Cons: 
    • Could lead to unnecessary fear amongst the mothers when it comes to pesticides 
      • When in reality, the children may have already been consuming pesticides through the traditional gruel
    • Some mothers may choose not to try our porridge, hurting our business
    • Some mothers could take offense if they aren’t aware of the issues and hear them from outsiders. They might feel that we’re judging them or that we think we are superior to them. 
    • Our actions could be taken as a savior complex and some mothers might feel threatened by it. 
    • Educating the mothers could be costly

 

 

  • Solution #3: We partner up with local farmers to have them grow produce without pesticides.

 

  • Ethical Principles: We work with the local community to eliminate the health risk associated with our solution so that we are not potentially harming mothers and their children as we try to help them.
  • Pros:

 

 

      • More trust amongst the mothers since the elimination of pesticides will be prioritized 
      • Getting rid of the unknown factor that comes along with the use of pesticides 
      • No further research will be needed if we do not use pesticides (regarding the risks that comes with the consumption of pesticides) 

 

  • Cons:

 

    • Could lead to financial burdens 
      • Khanjan brought up how it is hard to run a farm that is both efficient in producing a lot of food and not using pesticides 
    • Some locals might not want to work with us
    • We don’t know the working ethics of the locals. There could be hiccups that delay our progress

 

Step 5: Seek additional assistance, as appropriate – engineering codes of ethics, previous cases, peers, reliance on personal experience, inner reflection 

  • Pesticide alternatives
  • Biocontrol: targeting predators by implementing their natural enemies nearby the farms to limit the populace
  • Polyculture: plant crops that naturally repel specific species

 

Step 6: Select the best course of action – that which satisfies the highest core ethical values. Explain reasoning and justify. Discuss your stance vis-a-vis other approaches discussed in the class. 

The best course of action is to educate the volunteering mothers about HIV, transmission, nutrition, and pesticide dangers. Our cooperative can hold information sessions to educate these women about the issues that they are currently facing, considering it is highly unlikely that they know of these problems. By teaching them about HIV, the mothers can see the need for a reduction in breastfeeding in order to increase the safety of their children. With the nutrition, the mothers can also see that the gruel they traditionally feed their children really does not provide nutritious support and that our porridge is a much better alternative. It is also important to be transparent about the pesticides involved in our porridge, as neglecting to do so adds another ethical issue to our venture. By telling the women a possible flaw in our porridge, it shows honesty and can help them trust our cooperative. With all the information they need, the mothers can now come to a conclusion on their own about whether to try our porridge or not. Also, they can spread their knowledge to their community friends and get the word out. The facts are stacked heavily in favor of our porridge being more beneficial than anything else, so it is unlikely that we will lose business this way.

One of our other solutions was very similar to this, but neglected telling the women about the pesticides. This was more from a business standpoint as introducing a flaw might cause unwarranted fear amongst the mothers. Although their children are likely already eating these pesticides, some might deem it safer to just avoid telling the flaws of a product you are trying to sell. Our team chose not to go this route as we felt that it was unethical to hide a harmful potential outcome from the mothers. If explained correctly, we could teach them about pesticides and how their children are already exposed to them, and it would be introducing very little additional chances of harm. Our other solution took a very different approach where we would work with local farmers to grow crops without pesticides to make our porridge more safe and enticing to eat. We could do so by using natural techniques to get rid of pests, but overall it seemed like too much time and effort would be invested into making this work. Also, without pesticides, our yields would be much smaller and we would turn less of a profit overall. For this solution, the logistics were too great to make it worth our venture’s time and money.

Some risks are still imposed even with our best solution, though. It takes time and money to educate these mothers, both of which are very limited in our problem statement. We are only given money to make the porridge, and we need to make an impact quickly or else the cooperative will fail. It is a risk to spend this time educating the women, but it makes our venture ethical by being transparent with all of the problems the women are facing, and their spreading of information to others can make up for lost time. Also, if the ideology around pesticides is not conveyed correctly, it can scare some of the mothers away from wanting to buy our porridge as it can seem like we are poisoning their children. It must be carefully explained that their children already eat pesticides, and that this is no different but still poses possible harm as a whole. This whole idea revolves around coming into a new country and explaining to a group all of the problems they are facing, and more or less what they are doing wrong. This can come as a shock and even be offensive to the women listening, and that would completely shut down our venture. We must be careful with how we present our information and enforce how our product will help and our intent is to provide aid.

Step 7: (If applicable) What are the implications of your solution on the venture. Explain the impact of your proposed solution on the venture’s technology, economic, social and environmental aspects.

Our solution provides an ethical plan to educate mothers in east africa and make them more aware of the harm HIV is doing to their communities. Also, we will be implementing a very successful porridge business that will not only lower the chance of HIV being transmitted to children, but also give children the nutrients that they need to prevent stunted growth. With a successful business, we will be able to create jobs for some of these women to provide for their family, as well as reinvest in our cooperative and expand to more regions. The women that we have educated can relay their learning to their communities in order to expand our customer base, but also raise awareness about HIV and nutrition and the need for safer life practices.

With all of these positives, the porridge is still introducing pesticides into the diets of east africa. Although this is already prevalent in some of their crops, pesticides are in general harmful to humans. Our cooperative deemed that ingesting pesticides was a better alternative to spreading HIV to children, and all of the people who purchase our product are hopefully aware of the decision they are making. It is not perfect, but it is certainly the better of the two evils.

 

Part 2: Grassroots Diplomacy

Six months after launch, the efforts of the women working in the cooperative you established are paying off, and business is thriving. The women work for about nine hours every day and earn KES 300 (about $3). Besides the wages earned, they have the opportunity to sell the produce grown on their small farms to the cooperative. This transaction is done at the prevailing market rate and helps the women make a little money on the side. The women like this arrangement because it saves them a trip (time + money) to the village market to sell their produce. The women enjoy working with each other and are happy with the cooperative; they have a strong sense of community and identity. However, there is one big problem. When a woman brings her hard-earned money home, she has no choice but to turn it over to her husband, father, or brothers. Rather than using the money to support their families, the men waste it on alcohol and frivolous things. Though the cooperative is thriving, it is not achieving the twin social outcomes of improving the nutritional status of children and the livelihoods of rural households. 

 

As the entrepreneur who helped establish the cooperative, you are pained about the situation. Though you are loved and respected by the entire community, you do not have a direct say in the cooperative’s functioning. You are one of the seven members of the leadership committee that oversees all operations. The committee is elected on an annual basis and you have six months left on the committee, after which you will practically leave the cooperative completely. The other six members of this committee are local women who understand the problems and want things to change. They are not necessarily opposed to the men taking away their money but are upset that their hard-earned money is not used to feed their children. They are convinced that nothing can be done about it because that’s just the way it works in their community. 

 

What is your strategy to get the cooperative back on track to meet the twin social outcomes for the cooperative on a sustainable basis? 

 

Step 1: Determine the facts in the situation – obtain all of the unbiased facts possible 

  • The business is thriving and the women are hired to work 9 hours everyday for a wage of KES 300 ($3)
  • The women have a chance in selling the produce grown on their small farm to the cooperative to earn extra income
  • The hard-earned money that women bring home is turned over to the husband, father, or brothers. 
  • The husband, father, and brothers spend the hard-earned money on alcohol and frivolous items that does not enhance the well-being of the family
  • The cooperative is thriving but is not achieving their two social outcomes of improving the nutritional status of children and the livelihoods of rural households
  • You do not have direct say in the cooperative’s functioning and you have six months left on the committee 
  • The other six members of the committee are local women that understand the problem and desire change
  • The women are not opposed to the men taking their money but are more concerned with the issue of their hard-earned money not being used to feed their children
  • Assume:
    • Not all 500 women will be working at the cooperative

Step 2 & 3: Define the problem and the stakeholders – those with a vested interest in the outcome. Determine and distinguish between the personal and professional motivations of the stakeholders. 

 

  • The women working (primary) 
    • Personal: 
      • Want children to grow up healthy
      • Improve their own livelihood
      • Have a tasteful nutritious porridge that their kids will want to eat
      • provide for their family 
    • Professional: 
      • Keep their job that provides a sense of independence and identity 
      • A respectful distance between their work and home life 
  • The children (secondary)
    • Personal: 
      • Have access to food
      • Want to grow healthy (no stunting and no HIV)
      • Consume food that are tasty
    • Professional: N/A
  • Your cooperative→ the researchers (primary)
    • Personal:
      • Create a porridge that kids will want to eat and mothers will want to feed their kids
      • Wants to implement the new supplementals to aid in child growth
      • Wants to prevent stunting and HIV in the youth
    • Professional: 
      • Wants to create a successful business
      • Build their own credibility
      • To process and market a nutritious, shelf-stable porridge made from a large mix of locally grown produce
  • The donors (secondary)
    • Personal: 
      • Improve the nutrition amongst children in the area
      • Improve the livelihoods of rural households
    • Professional:
      • Reputation of helping the less fortunate financially
  • The governments/leaders in east africa (secondary)
    • Both personal and professional: 
      • Want to limit the stunting in the children
      • Want to limit the HIV cases
      • Want to improve the livelihood of the community
  • The men (primary)
    • Personal: 
      • Want to use the money in the household as they please (alcohol, etc.)
      • Collect money that wife earns from work
    • Professional: 
      • As the male, dominate the household operation and the sources of income (cultural norm) 
  • You, the entrepreneur:
    • Personal: 
      • Want to make sure the money is going to the goals of the organization, which aligns with the goals of the mother
      • Want to maintain a positive relationship between other committee members with the remaining 6 months
      • Want to help mothers shift money from alcohol to food on the table for their children, particularly other members of the committee
    • Professional: 
      • Want to maintain a peaceful relationship between the mothers and their husbands
      • Want to improve the nutritional status of the children and the livelihood of the households in a non-invasive manner

 

Step 4: Formulate a solution – based on information available, to have a win-win situation for your relationship and your venture. 

 

Solution: The women would continue to earn their salary and get a pay every 3 days. Rather than paying out the full amount of KES 900 at the end of the 3rd day, the women would receive KES 450 in cash and the remaining monetary value will be supplemented with a package consisting of food and a little bit of alcohol.

 

  • How does it solve the problem? 
    • This solution guarantees the women a portion of their salary going towards feeding their children (their primary concern).
    • Women would still be bringing money home so that they would not be penalized by the men in the house.
    • The addition of the alcohol as part of the package serves as a compromise to not only the wife but also to the men in the household.

 

  • Pros

 

    • The women can maintain a portion of their salary towards food expenses for the nutritional well being of the children, which addresses their primary concern.
    • The men would still be receiving some of the women’s income.
    • Both the women and the men in the household gain from the package (alcohol and food).

 

  • Cons

 

    • Some of the men might be angered by this system because they are not receiving as much money as they used to.
    • The packaging only addresses the nutritional status of the children and does not provide a solution to other aspects that will lead to improving the livelihoods of the households. 
    • There is minimal change occurring in the system to improve the livelihood of the community. Money is still primarily invested in the alcohol and other frivolous items that does not benefit the household nor the community. 
  • How does it save face of those involved? 
    • Mother: They are able to fulfill their duty of improving the nutritional status of their children.
    • Children: The children are more well fed and no longer look malnutritioned amongst their peers
    • Cooperative: The cooperative appears to be achieving at least one of their promised social outcome of “improving the nutritional status of children”
    • Donors: Donors seem like they are improving the situation in regards to children malnutrition through their financial contribution rather than allocating their funds that will end up buying alcohol for men.
    • Government/Leaders of East Africa: The government receives some sort of recognition in the improvement of children nutrition globally. 
    • You, the entrepreneur: You feel proud to solve the primary concern of mothers by ensuring that there is enough food on the table for children with the package.
  • Implications on relationships: 
    • Short term: 
      • The mother’s anger towards the men wasting money will die down for a brief moment. 
      • Men may be slightly upset at the cooperative for the decrease in their alcohol allowance
      • The cooperative will gain a positive reputation amongst the women and the government for their contribution on improving the nutritional status of the children
    • Long term: 
      • The mothers will be pleased to see the improvement in the nutritional status of the children, however their anger towards the men will return because their hard earned money is still being wasted on alcohol and other items that do not improve the livelihood of the household
      • The cooperative gain a positive momentum for a short period of time for meeting one of their goal (improving the nutritional status of children), however they will still need to address the livelihood aspects of the community in order to maintain their relationship with the community members, the donors, and the government
  • Implications on venture 
    • Short term: The cooperative will achieve one of their goal (improving the nutritional status of children), however they will still need to address the livelihood aspects of the community.
    • Long term: The cooperative will gain support from the community for addressing the malnutrition issue in the community, which boosts their business.

 

Step 5: Seek additional assistance, as appropriate – previous cases, peers, reliance on personal experience, inner reflection 

In this situation, we are at a disadvantage because there is a cultural difference. Therefore, we should consult a variety of people for advice, including:

  • The mothers
  • The husbands
  • Communities leaders
  • Other organizations that have dealt with similar situations

It is important to talk to all the stakeholders involved. I recall watching a TED Talk video shown by Khanjan in class last semester. The speaker mentioned going to an African country and wanting to help the people agriculturally. They told the locals how things should be grown and what they should grow, but they were ignored. The speaker and his team moved on to taking action on their own and hired locals to tend to their crop. In the end, the hippos in the area consumed their crops and the speaker’s venture failed. Even though the locals knew that it was not the right season to grow the crops the speaker grew due to the hippos issue, they never told the speaker because he refused to listen to the locals on how they wanted him to help them. It is very important to consider all the stakeholders and communicate with them to determine the optimal solution.

 

Step 6: Select the best course of action – that solves the problem, saves face and has the best short term and long-term implications for your relationship and venture. Explain reasoning and discuss your solution vis-a-vis other approaches discussed in class. 

Our solution of supplementing a small portion of the salary with a package consisting of mainly food and a small amount of alcohol solves the malnutrition of the children issue, however it lacks the impact to address the livelihood of the community. The solution enables all the primary people involved to save face, particularly the mothers, the mens, and the cooperative without (or minimal) conflict. The mothers are able to fulfill their duties of feeding their children so that they grow up strong and healthy. The men still feel like the head of the house and are still able to collect money from the women (not breaking their culture) while obtaining some alcohol in the deal. The cooperative displays their capability in fulfilling one of their social outcomes of combating malnutrition amongst children in the community. This solution enables all parties to maintain a peaceful relationship with one another and everyone compromises. Alcohol was tossed in the supplement package to ease potential dissatisfaction amongst the men for the decrease in cash being brought home. Despite our efforts, the men could potentially make a fit and not be pleased with the package. Improving the livelihood of the household and community is not addressed in this solution. Majority of the money is still going towards alcohol rather than other benefits such as education for the children. Changes take time and this solution is meant to act as a starting point or short-term solution that will slowly shift money from alcohol to benefits such as education for the children.

A solution mentioned in class was not receiving a salary and building up credit with the cooperative to obtain their needs without bringing the money home. This solution enables the women to retain all their earnings however it breaks the cultural norm in the community, which can lead to all sorts of problems. The men would throw a fit at the women for not contributing to the family and trying to overthrow the patriarchal culture. Shifting the power to control the flow of money in the household is not desirable by the mothers. They simply want the men to maintain control and take action to shift money away from alcohol to goods that will increase the livelihood of the family. The cooperative will receive heavy criticism from the men if this solution were to be implemented. Although there are a lot of conflicts between the primary parties involved, it enables women to have complete control of their money to combat malnutrition among children and increase the livelihood of their family. Women in the situation seem to have a better understanding of where money should be allocated to meet the two goals.

 

Step 7: List the sequence of actions you will take to implement your solution.

  • Step 1: Have a conversation with the women and other community leaders to explain our solution and get their feedback.

 

  • Step 2: Figure out who is going to take the lead of the transition and give proper training.

 

  • Step 3: Find suppliers for the food and alcohol or open our own store. 
  • Step 4: Implement the plan
  • Step 5: Evaluate how effective the plan is or how ineffective it has been.

 

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