September 15, 2020
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?
Case Study:
Step 1: Determine the facts in the situation – obtain all of the unbiased facts possible. Clearly state the ethical issue.
- 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 to 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
- Ethical issue: Finding the balance between either feeding the kids food grown with pesticides or increasing their likelihood of contracting HIV due to prolonged breastfeeding
- Are both problems of the same magnitude?
- Most women breastfeed until at least 2 years
- How bad is HIV in the long term? How bad is exposure to pesticides?
Step 2/3: Define the Stakeholders – those with a vested interest in the outcome and assess the motivations of the stakeholders
- Researchers
- Good publicity
- Build up a track record of successful projects
- Build credibility
- Aiding the decrease of stunted growth rates
- Improving the nutritional status of the children
- Want the cooperative to succeed
- Support livelihoods of the mothers
- Children
- Too young to have independent motivations; desires reflected in the motivations of their mothers
- Donor (secondary)
- Recognition/ Good publicity
- Improve the nutritional status of children
- Improve the livelihoods of rural households
- Government (secondary)
- Reduce the prevalence of HIV by preventing transmission from mothers to children
- Improve the health of the population by giving children access to proper nutrients from infancy
- Promote agricultural biodiversity and the development of value chains to produce
- Women/Mothers
- Want to improve their livelihoods without risking the health of their child
- Want to source food that is pesticide-free / safe to consume for their infants
- Want to stick to traditional breastfeeding practices
- Reduce the risk of HIV transmission to their children
- Men (secondary)
- May want their children to be healthy
- Benefit from the additional income the women bring into the household
Step 4: Formulate (at least three) alternative solutions – based on information available, using basic ethical core values as a guide
Approaches
- Potential solution 1: Continue on with the Cooperative (create our own porridge, which we will grow using local crops, and then distribute)
- Ethical Principle or code
- Justice: we want to be able to create a product that is fair and safe for the children
- Beneficence: we want to help the children be as healthy as possible
- Pros
- Children will not be exposed to HIV/AIDS
- Children will be able to receive the proper amount of nutrition
- Wider variety of food
- Cons
- Children may be exposed to pesticides
- Could lead to a decline in a child’s health
- Children may not like it because it might not taste well
- Potential solution 2: Continue Feeding the Children Gruel and Continue Researching Alternatives
- Ethical Principle or code
- Nonmaleficence: we will be minimizing harm to the children by not, possibly, feeding them pesticides
- Pros
- No risk of pesticides
- Children are already accustomed to the gruel
- The mothers would already be accepting of it because they have been feeding it already
- Cons
- Children would not be receiving the proper amount of nutrition
- Only a few varieties (maize and bananas)
- Further research will be needed, which can be costly
- Potential solution 3: Provide education to the community members about HIV/AIDS
- Safe Sex Education
- Condom handouts
- How this disease affects their children
- Targeting males within the community
- Partner with the Ministry of Health to accomplish this
- Potentially help subsidize condom sales
- Ethical Principle or code:
- Justice: we are providing these educational resources to everyone in the community, in order to treat everyone equally, and possibly provide for a reduction in the transmission of HIV/AIDS
- Beneficence: we will be maximizing health benefits to the community by targeting the HIV/AIDS epidemic in order to address the root of the problem
- Pros
- It will decrease the number of people with HIV/AIDS.
- The babies will be able to ingest the mother’s breast milk safely
- It will decrease the number of deaths and the number of illnesses within the communities.
- Eliminating the need to find a supplement because the mother’s can provide their breast milk
- Cons
- We would need to find more funding
- The community may not be accepting of it
- Time: It will take a lot of time to go around the community and to teach people about how they can decrease the spread of HIV. Although it may take so long that it could end up hurting the community more in the shorter term
Step 5: Seek additional assistance, as appropriate – engineering codes of ethics, previous cases, peers, reliance on personal experience, inner reflection.
- https://academic.oup.com/her/article/30/3/388/559779
- https://www.nytimes.com/2010/05/10/world/africa/10aidscondom.html
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380312/
Our team found and compiled the links listed above. These are links that helped to come up with Solution 3. Our original idea was to target the larger issue, by attempting to tackle the HIV/AIDS epidemic in the area. Our reasoning was that if we could decrease the prevalence of HIV, there would be no need to feed children gruel or porridge. Instead, mothers could comply with the WHO guidelines and breastfeed their children. Yet, when we brought up this idea in class, Khanjan and some of our peers had some concerns about this solution. They mentioned the need for further resources which could slow down our progress. We may have been trying to tackle more than we could handle. This reasoning will help prove my analysis of the solutions in the next step.
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.
This ethical dilemma was particularly challenging, as there was no perfect answer to solve this situation. Yet, ultimately, the solution I believe to be the best course of action is Solution 2. I picked this solution, as it will reduce the probability of children within the community contracting HIV/AIDS. Also, this method is what is familiar and already used within the community. Therefore, mothers will be willing to continue feeding their children gruel, as they believe it is beneficial. I believe it is best to continue research to attempt to find alternative solutions or to find a way to reduce the number of pesticides found in the local crops. When comparing this solution to our other proposed solutions, Solution 2 is more ethical than Solution 1 because we are potentially exposing young children to pesticides. Furthermore, Solution 1 will be more costly to implement within the community, as mothers are not used to feeding their children the porridge and may be unwilling to try it out. Additionally, Solution 2 is better when compared to Solution 3, as Solution 3 will be too difficult and costly to implement. Although ideally Solution 3 would be more ethical than Solution 2, Solution 3 is unrealistic for the reasons mentioned in the above step. We would require a much larger budget and would likely need more donors to go about addressing the HIV epidemic in the community. In the long-run, this solution may do more damage to the community because we will not be helping the community in a timely manner. I suppose this is also a criticism and con of Solution 2, yet with Solution 2 the plan is to continue research to attempt to find a solution to the issue of the pesticides; whereas with Solution 3 we are attempting to solve a major health crisis.
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.
In terms of technology, Solution 2 would be setting our project back to the design and research phase. This would mean that we would have to discard any technology we have produced/ acquired. Unfortunately, Solution 2 would also have some negative social and economic implications on the venture. To begin, we would be setting our project back by returning to the research phase. Donors, in particular, may not be very happy to hear this news, which may affect our funding. Yet, Solution 2 would have a positive implication on the venture in regards to acceptance within the community. The mothers of the community will recognize that we are doing the best we can to give them a solution that will not harm their children in any way. Likewise, Solution 2 would have a positive impact on our venture in terms of the environmental aspect; as we would continue research to find a solution that would reduce the use of pesticides on crops.
Part 2: Grassroots Diplomacy
Team Members: Lindsey, Michelle, Noah
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
- Women work for 9 hours a day and make KES 300 ($3).
- The women have the opportunity to sell the product to make an additional income on the side.
- When the women come home from work they give the money to the man of the household (husband, father, brother)
- The men of the household spend the money on alcohol or frivolous items and not to support their families.
- The women are upset that the men are not using the money for the families.
Step 2: Define the problem and the stakeholders – those with a vested interest in the outcome
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. The men in the household use the money on alcohol or frivolous items instead of using it to support their families.
- Mothers (Primary)
- Fathers (Primary)
- Entrepreneur of the cooperative (Primary)
Step 3: Determine and distinguish between the personal and professional motivations of the stakeholders.
- Mothers
- Personal: They want their children to be safe and nutritious and also collect their wages.
- Professional: They can make money for selling the produce they grow.
- Men of the household
- Personal: They want to spend their wives’ wages on alcohol
- Professional: They believe they are entitled to their wives’ wages and earnings
- Entrepreneur of the cooperative
- Personal: The research team aims to help the local community. Primarily by providing an alternative to gruel which will be more nutritious for children whose growth may be stunted.
- Professional: They want to build up their own credibility.
Step 4: Formulate an alternative solution – based on information available, to have a win-win situation for your relationship and your venture.
- Potential Solution: Cooperative creates accounts for the women which puts a portion of the funds to a “gift card” for them to use at the store. The total funds can be updated daily.
- How does it solve the problem?
- Pros
- The women will have money available to spend on supplies for the family
- The men won’t be able to take all of the money because some of it is on the gift card
- The men will still be able to buy their alcohol
- Cons
- The men will still be able to take some of the money
- The men still have the option to sell the gift card on the black market
- The government and supermarket will have to accept the gift cards (although depends if we create our own gift card or if we use gift cards which are already recognized)
- How does it save face of those involved?
- The men are still getting money to spend on alcohol and frivolous items, but the women have money to spend on resources for their families. The women get to save face by giving some of their income to their husbands.
- Implications on relationships
- Short-term: The women are still turning over money to the men of the households which allows them to purchase alcohol. The men are still happy with receiving the funds.
- Long-term: The women can provide resources to help their families live healthier lives due to the accessibility of funds for resources. The men will no longer be withholding money, which takes away important necessities for the families.
- Implications on the venture
- Short-term: The accounts and gift cards can be easily implemented before the last 6 months of the venture are complete.
- Long-term: The women continue to work for the venture, and feel a sense of community. They still feel as though they are providing funds to the men of the household, but the resources for their families will continue to develop because of the food/bank accounts through the cooperative.
Step 5: Seek additional assistance, as appropriate – previous cases, peers, reliance on personal experience, inner reflection
Our group worked together very well when deciding on a solution. Also, listening to the class discussion on this dilemma helped us arrive at a conclusion. We decided that this is the best solution for the women because they are still providing most of the money to the men of the household to buy the alcohol and frivolous items, but they have money set aside from the cooperative to buy food and resources for their families. This website below provides insights from women in Africa about gender disparities and the economic impact of being a working woman in Africa. This article and the features provided even more information about the hardships that women endure in Africa.
https://www.un.org/africarenewal/magazine/july-2005/african-women-battle-equality
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.
The solution we chose involved having the women that were working set up a bank or savings account with some of their profit money. This money would be set on a food gift card that they could use to buy food and resources. The women would still go home with most of, but not all of, their profit from working. This money would be given to the men of the household to buy their alcohol and frivolous items. This saves face for the women because the men are still getting what they want while money is being put aside for the women to get food for their families. However, with our option, there is the potential for the men taking the gift cards and selling them on the black market. However, we feel that any of the solutions we proposed always had the possibility of a negative implication. Our team was hoping that the men would allow the women to keep the gift card because they would still be turning over a portion of the money to the men.
Step 7: List the sequence of actions you will take to implement your solution.
- The women get the jobs to work for the cooperative.
- The women set up bank/gift card accounts with the cooperative.
- Every day there is a dollar put on the gift card to use for food items and resources.
- The leftover two dollars is given to the men of the household.
- If the dollar is not used that day, it will stay on the gift card and accumulate until used.
- A gift card is issued with the accumulated money.
- The gift card can be used at supermarkets to purchase resources needed for families.