Group: Abby Schwartz, Brooke Lee, Eloise Lustik, Allison Bronson, Kaliana O’Donnell, Sophia Mihalek

Part 1: Ethical Decision-Making and Grassroots Diplomacy Case #3a

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

• You have received a grant to establish a women’s cooperative in a region in East Africa
• The donor of the grant’s intent is to improve the nutritional status of children and improve the livelihoods of rural households
• The cooperative, with the grant’s funds, will employ women who will make and sell a nutritious porridge made from a large mix of locally grown produce to wean infants off breastfeeding past 6 months.
• ~500 women want to join the cooperative but are skeptical about the porridge. 
• In a certain region in East Africa, the growth of ~35% of the children is stunted due to poor nutrition
• HIV/AIDS is very prevalent in this region 
• Children who breastfeed from an HIV+ woman for 6+ months are at higher risk for transmittance 
• Traditionally, maize and bananas are the items most commonly made into gruel and fed to infants beginning at ~2 months of age 
• Pesticides are typically used in growing crops and can result in adverse health implications for infants
• The World Health Organization recommends exclusive breastfeeding until an infant is six months of age 
• The longer a child nurses when the HIV+, the greater the chance that the virus will be transmitted to the child
• Must be decided whether or not to produce porridge that bears risks of containing pesticides, but will limit the duration in which a child is in contact with HIV/AIDS (breastfeeding) 

Conflict– The ethical issue is how to balance children’s health, nutritional and HIV status, and improve rural households’ livelihood with the development of a women’s cooperative. 

• A framed question: Is mitigating the risk of AIDS/HIV contraction while addressing malnutrition worth increasing the consumption of pesticides? 

Step 2: Define the Stakeholders – those with a vested interest in the outcome 

Step 3: Assess the motivations of the Stakeholders   

• Children in this region of East Africa  (primary) 

• • • Personal experience of stunted growth and poor nutrition would benefit from improvements in nutrition  
    • Motivated to not be infected with HIV
    • Would benefit from improved status/livelihood of the household          

• Mothers and caregivers (primary) 

• • • Ensure their children are supported nutritionally while improving their livelihoods. Also, reduce the risk of transmitting AIDS/HIV to their children 

• World Health Organization

• • • To improve children’s nutritional outcomes. 
    • To improve the livelihoods of rural households

• Healthcare providers

• • • Doctors, nurses, and community health workers are stakeholders invested in the well-being of HIV/AIDS patients and children and would want fewer infected patients. 

• Local farmers

• • • Those who grow the crops used in the porridge production are directly impacted by changes in demand/price and agricultural practices.
    • If they are maize and/or banana farmers, would be invested in women feeding infants their crops as they are making a profit off them. 

• Donor(s) 

• • • Interested in improving the nutritional status of children and the livelihoods of rural households. 
    • Could be out of kindness, to write it off of taxes, corporate charity, improving a company or person’s image, etc. 

• Us 

• • • We are motivated to successfully implement this grant to further our professional career. 
    • We are motivated to implement this grant and open a successful cooperative 
    • We are motivated to create partnerships and connections that will help us further our venture

Step 4: Formulate (at least three) alternative solutions – based on information available, using basic ethical core values as guide  Approaches [1/2/3: repeat for every action] 

• Potential Solution 1-
  • Educate the cooperative members about safe breastfeeding practices, HIV hygiene, and nutrition 
    • Ethical Principle or code 
      • Beneficence
    • Pros: 
      • By educating mothers on the risk of prolonged (longer than 6+ months) breastfeeding when they are HIV+, they are able to make more informed decisions which might lead them to become more comfortable with trusting the nutritious porridge. 
    • Cons: 
      • the information might become uncomfortable/instill fear in some of the individuals being educated. 
      • Some of the women might not believe the new information being presented to them, and thus not change their infant feeding practices. 

• Potential Solution 2- 
  • Develop a porridge using maize and banana along with nutritious additives and nutrition education on the package to make the item more familiar to the women while providing nutrition. 
    • Ethical Principle or code 
      • Compromise
    • Pros 
      • Has fewer pesticides due to the usage of bananas and maize (they have outsides you can remove that remove pesticides)
      • Provides children nutrition
      • Provides a familiar food that mothers normally feed to children
        • Could encourage women to feed it to their infants at 6 months of age
      • May cost more money to make our own porridge rather than using the one already given
    • Cons 
      • Does not address HIV concerns
      • May not encourage women to fully stop breastfeeding when the infant is 6 months old

•  Potential Solution 3 – 
  • Offer free/affordable HIV testing and education, such as prevention strategies, breastfeeding, and HIV management. 
    • Ethical Principle or code 
      • Universal Healthcare
    • Pros: 
      • Educates women on the risks associated with HIV and also has the potential to, long-term, reduce HIV transmission
      • Allows women to know their HIV status, and possibly get treatment
      • Encourages women who know they are HIV-positive to practice safe breastfeeding techniques 
      • Less transmission of HIV would improve future health outcomes and higher lifespans
      • Encourages women to feed their infants nutritional food
    • Cons: 
      • does not address the lack of nutritional value in the traditional food (gruel) 
      • Does not address people not being comfortable with the nutritious porridge 
      • May be expensive to provide testing

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

• Guidance from farmers or pesticide companies
• Guidance from WHO about HIV, HIV and breastfeeding, children’s nutritional needs, and pesticides
• Think back on personal experience to make ethical decisions about biases or moral dilemmas
• Review previous cases in similar contexts 
• Current owners/ people who run women’s cooperatives or who have experience
• Guidance from the donor organization

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.   

Out of the options mentioned in the previous steps, the best course of action would be to offer free/affordable HIV testing and education, such as prevention strategies, breastfeeding, and HIV management. This approach takes the initiative of preventing HIV transmission which can affect both the mothers and their children. Fortunately, breast milk can still provide good nutrition to children in their early years of life. However, if women are aware that they are HIV positive, they can be advised to stop breastfeeding after their child is 6 months old to ultimately reduce the risk of transmission. A downside to this approach is that it does not directly impact the pesticide issue in the porridge, but it does help lessen the risk for HIV which could be a more severe risk than pesticide exposure. This solution affects the stakeholders as follows: 

1. The children will have improved health outcomes if their mothers know for sure whether or not they have the virus 
2. The World Health Organization’s initiatives will be furthered because children’s health outcomes will be improved 
3. The mothers will know if they carry the virus, and can prevent the transmission to their babies
4. Healthcare providers will save money in the long run because there will be fewer cases of severe malnutrition and maybe even HIV (if it is caught early enough) 
5. The local farmers will have a smaller demand for making products that are pesticide-infested 
6. The donor’s image will be admirable and the goal of improving children’s health outcomes will be met

Alternatively, one approach discussed in class was to promote safe breastfeeding practices. However, improper breastfeeding is not the problem, HIV transmission is the problem. Thus, women will still remain unaware that they could be infecting their children. 

The best approach aimed at fixing the pesticide issue would be to develop a new nutritious and locally sourced porridge that is safe. If foods with natural wrappings such as bananas with banana peels, or corn with husks, the risk of pesticide contamination is smaller and food will ultimately be safer to eat. In this instance, the effects of the solution on the stakeholders are:

1. The children will be at a lower risk of eating foods that are contaminated with pesticides 
2. The mothers will be providing their babies with safer foods 
3. The local farmers will have a higher demand for their products 
4. The donor’s image will be admirable and the goal of improving children’s health will be advanced
5. Healthcare providers will save money in the long run because there will be fewer cases of severe malnutrition 

On the topic of fixing the pesticide issue, it was mentioned in class that a solution would be to promote sustainable agriculture and safe food production. However, this would take a very long time to teach and adapt to and is not going to help with the immediate need for feeding infants safely.  

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. 

For the HIV testing solution:

• • Social: The solution improves the overall health and well-being of the individuals in the community. If done properly, there will be fewer cases of HIV and those who are affected can take action to improve their quality of life despite having the disease.  
  • Environmental: There are no direct environmental implications for this solution

• • Economic: Providing HIV testing/education will have many expenses such as testing kits, educational materials, and time from the healthcare professionals

• • Technology: Testing kits would need to be developed and accessible 

For the nutritious product solution:

• • Social: This can contribute to overall better public health by providing a safer food option and collaborating with local farmer can enhance community relations. 

• • Environmental: The pesticides are not necessarily being reduced, so they can still give off toxins.

• • Economic: Sourcing these safer products from farmers might contribute to the expenses of the venture. From a different perspective, offering a safer porridge can create market/business opportunities. 

• • Technology: The nutritious product development component of this solution is considered technological.

Part 2:  Grassroots Diplomacy 

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

• • The women work at the cooperative for about nine hours every day and earn KES 300 (about $3) 
  • Besides the wages earned, they can sell the produce grown on their small farms to the cooperative, saving them the trip to the market
  • The women enjoy working with each other and are happy with the cooperative; they have a strong sense of community and identity 

• • When a woman brings her hard-earned money home, she has no choice but to turn it over to her husband, father, or brothers. 

• • The women are upset that their money isn’t being spent on their children (not necessarily that their husbands are taking the money)
  • The cooperative is not achieving the twin social outcomes of improving the nutritional status of children and the livelihoods of rural households. 
  • You are loved and responded to by the community but do not have a direct say in the cooperative’s functioning.
  • 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 the 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 
  • The men waste the money they take on alcohol and frivolous things

Conflict– The women’s lack of financial autonomy and control over their earnings in the cooperative, hinders the achievement of the cooperative’s social goals and raises questions of gender equality and economic empowerment.

Step 2: Define the Stakeholders – those with a vested interest in the outcome 

Step 3: Assess the motivations of the Stakeholders   

• Women Cooperative members
  • They are motivated to improve their economic well-being, ensure their children’s health and nutrition, and gain financial independence
  • Women community members 
  • They have the potential to sell produce at the cooperative’s market and make money. 
  • They have the potential of having children and wanting to provide proper nutrition to their children. 

• Men in the community
  • They may be motivated by traditional gender roles and control over finances, but they may also be motivated by the desire for the overall prosperity of their households.
  • Motivated by their desire for alcohol or other items. 

• Children in the community
  • Their well-being and future are at stake. They benefit from improved nutrition and their mothers’ financial stability.

• Cooperative Leadership Committee
  • The committee members, including you, are responsible for overseeing the cooperative’s operations and governance. They have a vested interest in achieving the cooperative’s goals.

• Us 
  • We care for the community and the fate of the cooperative, as we have been there setting it up and maybe friends/friendly with the community. 

• • We aren’t directly involved in our project anymore, but we created the foundation of this venture and have emotional investments in this project (so the stakes are different than the new committee members) 
  • We are invested in the fate of the cooperative for our professional image/career. To fully meet the goals of the grant, the twin outcomes need to be met. The fate of the cooperative is on our professional shoulders, impacting our future of getting more grants and continuing similar projects. 

Step 4: Formulate (at least three) alternative solutions – based on information available, using basic ethical core values as guide  Approaches [1/2/3: repeat for every action] 

• Potential Solution 1- Women’s Financial Independence through Savings Accounts
  • Establish individual savings accounts for the women that work at the cooperative.
  • Encourage women to deposit a portion of their earnings into these accounts.
  • Provide financial education to women to manage their savings effectively.
  • Promote community awareness about the benefits of women having their own savings accounts.
  • Advocate for the cooperative to offer incentives for women who participate in this program.
    • Ethical Principle or code 
      • Financial independence/autonomy
    • Pros:
      • This solution aligns with the ethical principle of autonomy by giving women control over their earnings and respecting their right to manage their finances.
      • It promotes justice by ensuring that women have an equal opportunity to save and invest in their families’ well-being.
      • It supports the ethical principle of beneficence by potentially improving the nutritional status of children through women’s financial contributions.
    • Cons:
      • The success of this solution may depend on the availability of banking infrastructure and financial literacy among women. Access to banks or savings accounts may be limited in some rural areas.

• Potential Solution 2- Community Dialogue
  • Organize community meetings and dialogues involving both women and men.
  • Facilitate discussions on the economic contributions of women and their right to manage their earnings, and children’s nutrition. 
  • Highlight the positive impacts of improving children’s nutrition and overall household well-being.
  • Discussions on financial literacy for both men and women could also be useful
  • Beyond offering an outlet for women, this could also engage the men. Talking to them about the venture and why investing in their children’s nutrition is important
  • Encourage mutual understanding and negotiation within households.
  • Seek the support of community leaders and elders in promoting gender equality.
    • Ethical Principle or code 
      • Responsibility 
      • Accountability – holding the men accountable/calling them out in a meeting for not spending money on their children and instead buying alcohol, etc. 
      • Autonomy
    • Pros 
      • Encouraging open dialogue respects the ethical principle of autonomy as it promotes individual choice within households.
      • Advocating for equal decision-making power in financial matters.
      • Fosters community awareness and support for gender equality, promoting ethical community engagement
      • Promotes buying nutritious food for their children. 
        • Could provide some peer pressure/community pressure on parents to buy nutritious food for their children. 
    • Cons 
      • Some community members may resist change due to deeply entrenched gender norms and traditions. 
        • people don’t have to listen to us
      • The impact of dialogue and sensitization alone may take time to manifest in concrete changes.

• Potential Solution 3- Alternative Solution 3: Cooperative Bank Accounts
  • Implement optional direct deposits at the cooperative of the cooperative pay into women’s bank accounts while still having women make cash selling their produce on the side. 
  • Would allow women to optionally set aside some money while also bringing some cash home if they want to. 
  • They could use their accounts at the cooperative to pay for the cooperative’s porridge and produce they sell. 
  • Provide financial literacy training and support to ensure responsible bank account usage. 
  • Having the cooperative hold the money would prevent women from borrowing or getting into debt while providing the option of a bank/checking account without a bank. 
    • Ethical Principle or code 
      • Financial independence 
      • Justice 

• • • Pros 
      • Providing women with financial independence and control over their economic activities.
      • Promotes economic fairness and equal access to resources, in line with the principle of justice.
      • Creates a sustainable financial model that allows women to build financial history and independence.
      • Promotes the buying of the cooperative’s products, such as porridge or other produce
      • If women can use their daily wages on food at the cooperative, it could save them the trip to the market
    • Cons 
      • Providing financial literacy or information about bank accounts could be expensive, but we could ask banks if they have any pre-made or pre-prepared information. 
      • Men could be mad at the women for not bringing as much money home. 
      • Women may deposit money in their account, but not understand how to take money out or use it, thus not solving the issue. 
      • Women do not have to spend their money on food for their children

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

• Community engagement – work closely with the women to understand their needs, concerns, and aspirations
• Peer support groups – gather women in the communities to share stories from women who have successfully gained control over their earnings to motivate, inspire, and offer guidance to others 
• Banks or local financial institutions 

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 would be to promote cooperative bank accounts. This solution would offer a direct and sustainable method to ethically bolster women’s personal earnings. Women could directly deposit a portion of their daily earnings into the bank that could be taken out over time without interception from their husbands.  While this solution sounds great, in theory, there are limited banks in Kenya for people to utilize, and there will be some challenges to work through such as determining the appropriate amount of money to store away such that the women have enough pocket money to provide for their children/family for the day or week. This solution would affect the stakeholders as follows: 

1. The banks might be in higher demand and provide fees for storage usage
2. The women would experience economic empowerment which could lead to better financial stability 
3. The husbands would be angry if they found out that the women were hiding their money from them 
4.  The children will ultimately be better nourished if their family is able to maintain their finances 
5. The cooperative will get closer to accomplishing their goals 

An alternative solution spoken about in class would be to enhance community dialogue. For example, holding a women’s group where women can share their success or ask for advice when they feel like they’re failing could help. People would be able to empower one another and the overall sense of community amongst the women would be strengthened. This also does not imply that anything will be changed in terms of providing nutritious food to the children or that action will be actually taken. However, this does not take immediate action, especially in extreme circumstances where people might have complicated relationships with their husbands. Therefore, the bank solution would be more beneficial at this point. 

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. 

• Technological: The venture would need to invest in banking technology in order to manage bank accounts appropriately. The women would also need to trust in the technology so they do not get scammed and lose as much money as they would from their husbands. 
• Economic: This could lead to increased economic growth in the future if women are able to manage their money without taking too much away from them that they can not afford daily necessities. 

• Social: People who share their successes might be intimidating to those who are still struggling or it might embarrass people who are still behind even if they are under more complicated circumstances. On the contrary, women have the opportunity to empower one another and if people are motivated by others there could be positive outcomes.
• Environmental: There is no direct influence of this solution on the environment.