Part 1: Ethical Decision Making

In a certain region in East Africa there is a high HIV/AIDS rate and 35% of children are stunted. Mothers who are HIV positive risk transmitting the virus to their child if they breastfeed and few women are actually tested for the virus.  When weaning children off of breastmilk, mothers use a porridge that is not nutritious and is missing key nutrients. However, the cash crops that could be used to make the mix more nutritious are grown using pesticides. There is a grant to establish a women’s cooperative to create a nutritious mix for infants while improving the womens’ livelihoods.

The ethical issue surrounds the question of how the women’s cooperative can the prevent transmission of HIV from mother to child AND prevent children from eating pesticides and whether or not it is worse to get HIV or ingest pesticides.

This ethical issue has several main stakeholders:

STAKEHOLDERS AND MOTIVATIONS

• Mothers 
  • Want children to be healthy
  • Don’t want to pass HIV to children
  • Don’t want children to have adverse effects from pesticides
  • Want children to be properly nourished
• Children
  • They are directly impacted by the breastfeeding/pesticides
  • They need to obtain all required nutrients 
• The donor
  • Wants its money to be spent properly
  • Wants a good reputation
• Us
  • Provide nutritious porridge for the children
  • Ensure the cooperation is built right and is sustainable/scalable
  • Invested in seeing the impact through 
• Women’s Cooperative
  • Wants to provide children with a nutritious porridge to wean children off of breast milk
  • Are skeptical of the impacts of pesticides and of HIV transmission 
  • Wants to attract investors to the cooperative
  • Want to bring in a stable income to support their families
  • Wants good reputation
• Local cash crop farmers
  • They grow the crops that are being bought for the porridge
  • Financially invested

There are 3 solutions that could be put into action to ensure children are receiving proper nutrients and also empowering women in the cooperative.

POTENTIAL SOLUTIONS

Solution 1: Have the cooperative grow their own produce (pesticide-free) and employ more local women 

Ethical Principle: Duty-Based

• “Do only that which you would want everyone to do”
• We would not want our children and communities eating crops sprayed with chemicals

Pros: 

• Creates jobs for women
• Not only the cooperative but the community as well can have access to clean and healthy crops
• Can be fully in control of the crops 
• Children will get the nutrition that they need

Cons:

• It may cost more setting up another piece of land
• Have to educate the women on farming practices
• Will put some farmers out of business 

Solution 2: Wash the produce when it gets to the cooperative
Ethical Principle: Virtue-based thinking

• “What is ‘honest’ depends on social traditions, history, etc. the gruel the children receive already has pesticides (the maize and bananas currently used currently in gruel also have pesticides) and the solution would reduce HIV transmission while possibly decreasing pesticides in gruel. 
• Ethics often times can rely on judgement

Pros:

• There would be no more/significantly less pesticides in the food
• They get the nutrients they need
• Don’t need to breastfeed so avoid HIV transmission 
• Cheap way to avoid pesticides

Cons: 

• The water may not be clean
• Hard to measure if washing it is effective
• We’d need a water filtration system
• If the pesticides were treated with wax then they could be trapped beneath the waxy surface

 

Solution 3: Develop a vitamin supplement to add to the gruel so that children can continue eating gruel but also be nourished
Ethical Principle: Consequence-based thinking

• Although the children would still be eating pesticide-contaminated gruel, they would definitely be getting the nutrients they need through the supplement
• The benefits outweigh the negatives

Pros:

• They get the key nutrients that they need
• Don’t need to breastfeed
• Better than HIV
• Using the base recipe – may be cheaper

Cons

• Probably have to import the supplement which might be expensive
• Still getting pesticides 
• Could possibly alter the taste
• Supplements may not be as nutritious as incorporating healthy foods 
• The mission is to create opportunities for women and this does not follow that

The malnutrition team in Sierra Leone had experience creating a product for children and have learned the importance of incorporating whole, nutritious foods into childrens’ diet, but have also learned about supplements that can be effective too if they need to be used.

The best solution is to wash the produce with filtered water while creating a porridge that is more nutritious. This will easily get rid of the pesticides in the food and children will be able to eat clean and nutritious food. Although it might be expensive to get a water filter, this will be a one-time upfront cost. There might be slight maintenance costs in the future that the cooperative will have to cover (because the donor money will eventually run out) but this will be much cheaper than starting up a new farm, so it is better than Solution 1. Additionally, it is better than Solution 3 because eating whole foods is much better than using supplements and Solution 3 still gives children pesticides. 

IMPLICATIONS OF THE SOLUTION

• There would be an added step in the preparation of the porridge
• We have to educate the women to make sure they properly wash all the fruits and vegetables
• We have to know how to install a filtration system properly so that the water is clean 
• They will have to upkeep the costs of maintaining the filtration system, even when the money from the donor runs out
• Children will not be getting as many pesticides and will be properly nourished 
• Using locally grown cash crops will also stimulate the local economy and create more revenue streams for farmers.

 

Part 2: Grassroots Diplomacy

 

FACTS OF THE CASE

The cooperative is doing well and there are multiple income earning opportunities for women as they can sell produce from their own small farms for cash. However, the womens’ hard-earned money is taken by their husbands to be gambled. The cooperative is not achieving its dual outcomes of both improving nutritional status AND improving livelihoods. I do not have a direct say in how the cooperative functions and I have 6 months left to make a change before I have to leave. The women are upset that the money that they are earning is not being used to feed children, but also don’t mind that they are not in control of the money because it is culturally normal. However, the children of the women in the cooperative are not getting the nutrition that they need.

 

Ethical issue: How can we achieve the twin social outcomes without disturbing the culture?

 

STAKEHOLDERS AND MOTIVATIONS

• Us
  • Personal and Professional
    • We want to achieve twin social outcomes
    • We want to financially empower women
    • We want the children of the women in the cooperative to be fed nutritious foods
    • We want cooperative to be successful
• Women in the cooperative: 
  • Personal
    • Want to use the money they earn to support their families
    • Want their children to be healthy and fed
    • Want to have a good relationship with their husbands
  • Professional
    • Want to make money from the cooperative and their farms
    • Want the cooperative to be successful
• Children
  • Personal
    • Need the money that their mothers are earning to be used to support them
• Men
  • Personal
    • Want to be in charge of the money
    • Want to buy alcohol and frivolous things 

POTENTIAL SOLUTIONS

Solution 1: Compensate the women in goods (i.e. food, personal care products) instead of money

• Pros:
  • Women are able to support their families with goods and foods
  • The products and nutrients are going directly to the children in town rather than just to the cities
  • The children will have more resources
• Cons:
  • The husbands could be upset that the women aren’t bringing money back with them
  • Hard to always predict exactly what women need
  • The women may be less willing to work such long hours without monetary compensation
  • Might be hard logistically
• Saves face for 
  • the women because they do not have to directly face their husbands, but are getting the desired outcome of putting the money towards the family
  • the cooperative because they would achieve their joint goals and run a more ethical venture
• Implications on relationships 
  • Short term
    • Men may be angry at the women for not bringing home money
    • Immediate unhappiness within family units
  • Long term
    • Family will be better off so it may eventually build relationships in the family
• Implications on venture
  • Short term
    • The children will receive the necessary nutrition 
  • Long term
    • The venture will achieve both of its goals
    • The children will have more resources and become more nourished

 

Solution 2: In addition to still paying the women regular wages, compensate for some of their wages in goods (i.e. food, personal care products) 

 -The goods would be in exchange for the money they would get for selling their produce

• Pros:
  • Easier to integrate with the families because they are getting both money and resources 
  • The products and nutrients are going directly to the children in town rather than just to the cities
• Cons:
  • Men can still waste money 
  • Women may want to choose exactly what all their money goes to go
• Saves Face
  • Saves face for the women because they are still bringing in money and it will keep the peace between them and their husbands
  • Saves face for the cooperative because they are able to accomplish their goals and provide nutrients through the goods 
• Implications of the relationships
  • Short term
    • Men in the family may be angry 
    • Unrest within the family units
  • Long term
    • Hopefully the families get used to this way of compensation and relationships strengthen
• Implications of the venture
  • Short term: 
    • The children receive more nutrients and are healthier
  • Long term
    • The venture will be achieving its duel goals
    • The children will get more resources and access to nutritional foods (the porridge)

 

Solution 3: Doing nothing 

• Pros:
  • Not interfering in culture 
  • Women are not necessarily opposed to men taking money anyway 
  • Not putting women at risk since not taking money away from men 
• Cons:
  • Men can still waste money 
  • Children do not receive as much food
• Saves Face for the women and their husbands
  • The women do not have to disturb the family dynamic
  • The husbands are not exposed for their irresponsible behaviors
• Implications of the relationships
  • Short term
    • There is no tension in relationships between men and women because the status quo is maintained
  • Long term
    • The issue could cause problems down the line as the children aren’t getting important resources like food and clothing.
• Implications of the venture
  • Short term
    • Venture still not achieving dual goals 
  • Long term
    • The power dynamic within the family still probably would not be fixed and tensions could run high

 

Other solutions could also include vouchers for food instead of money, setting up a daycare at the cooperative to ensure that children are receiving food, resources, , get shares (build up equity which you can liquidate for a lump sum).

The best solution is to compensate the women with a monetary salary but also include goods as some of their wages. This would ensure that the women’s earnings are being put, at least in part, towards their children and household.  This is a good middle ground between only compensating the women in only goods, which may impact the relationships between them, and paying them a normal salary which leads to the men spending all of their money, impacting the lives of the children. In addition, paying the women with only goods could cause their husbands to pressure them to get different jobs with normal compensation. 

IMPLICATIONS OF THE SOLUTION

• Women will be able to provide food and clothing for their children 
• The women “save face” by appeasing the men by allowing some of their income to go toward their habits 
• This could be the start of a gradual push towards the women taking greater ownership in their fiances
• Providing goods to the women as well will stimulate the local food and clothing markets