Case 3

Part 1: Ethical Decision Making


  • High HIV rate
  • 35% of the children stunted 
  • Mothers who are HIV positive risk transmitting to child if they breastfeed
  • Few women are actually tested for the virus
  • Pesticides typically used in growing the crops 
  • Current food they are getting isn’t nutritious
  • There is a grant to establish a women’s cooperative
  • The goal is to wean children off breast milk at roughly 6 months old

The main goal is to improve the nutritional status of the children AND improve womens’ livelihood.

Ethical issue: How can the women’s cooperative prevent transmission of HIV from mother to child AND prevent children from eating pesticides? Is it worse to get HIV or eat pesticides?


  • 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



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


  • 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


  • 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 and the solution would reduce HIV transmission while possibly  decreasing pesticides in gruel. 
  • Ethics often times can rely on judgement


  • 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


  • The water may not be clean so we would need a water filtration system
  • Hard to tell if washing is effective
  • 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


  • They get the key nutrients that they need
  • Don’t need to breastfeed
  • Can argue that pesticides are better than HIV
  • Using the base recipe – may be cheaper


  • 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



Some of us were on the malnutrition team in Sierra Leone 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.



Solution 2: Washing the produce with filtered water
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.


  • 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 


Part 2: Grassroots Diplomacy



  • The business is doing well
  • There are multiple income earning opportunities (can sell produce from their own small farms)
  • Women have to give money to husband
  • Cooperative not achieving both improving nutritional status AND improving livelihoods
  • I do not have a direct say in how the cooperative functions
  • I have 6 months left to make a change because then I have to leave the cooperative
  • There is a 7 person board
  • Men waste money
  • Women are upset that the money that they are earning is not being used to feed children, but don’t care that they are not in control of the money because it is culturally normal
  • 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?



  • 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


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
    • Hard to continue after I leave in 6 months
  • 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: Pay women their regular wages, but compensate them in goods (i.e. food, personal care products) in exchange for selling their produce

  • Pros:
    • Easier to integrate with the families because they are getting both money and resources 
    • Men won’t be as angry at the wives so the wives will be safer
    • Children are getting food and other resources that they need
  • Cons:
    • Men can still waste money 
    • Women are not completely empowered
  • 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 upset that they aren’t bring in as much money as before
    • Long term
      • Families will get used to this balance of goods vs. money and relationships will 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.
      • There is still a power imbalance
      • Women will be disempowered
  • Implications of the venture
    • Short term
      • The venture isn’t accomplishing its goals
    • Long term
      • If the venture cannot accomplish its goals it is not ultimately successful
      • Looks bad on us (the people who established the women’s cooperative) 


“First, do no harm”: This is an important part of healthcare and should be an important part of our venture too. There is a clear issue due to the power imbalance, but we do not want to make anything worse by trying to fix this problem. We don’t want to replace one problem with another, potentially more dangerous problem.

Solution 2: Pay women their regular wages, but compensate them in goods (i.e. food, personal care products) in exchange for selling their produce
We don’t want men to waste money but we also don’t want men to be angry at their wives and create an unsafe environment for the women. Giving the women only money and making no changes (Solution 3) would perpetuate the power imbalance and the problem would continue. The children wouldn’t get the food and resources that they need, and the women’s lived would not be improved. Giving the women only goods (Solution 1) would make the men angry, because they want the women to come home with money for them to spend. This may cause violence in the household and the men may not allow their wives to come to work. Therefore, I think that Solution 2, giving the women their salary in money but trading them goods for produce from their farms, is a good middle-ground. This way men will still have money to spend and not be angry, but the children would still be getting some food. It might not be the optimal amount of food, but at least it is something and they will live in a safe environment.


  • Children may not get all of the food and resources that they need
  • The Women’s Cooperative is approaching their dual goals, but will not completely reach them
  • There is minimal interference with culture

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