Group: Angelina Penza, Ranni, Maaz, Fiaz, Mahir, Nancy

PART 1:

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.  

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

• In the region ~35% of children have stunted growth due to poor nutrition
• Maize and bananas are commonly made into a gruel and fed to infants beginning at 2 months old
• Mothers in the area believe the gruel is beneficial to the children
• Scientific research shows the gruel does not provide key nutrients
• HIV/AIDS is prevalent in this area
• WHO suggests breastfeeding until 6 months of age, but the longer a child is breastfed, the greater the chance they can contract HIV/AIDS if the mother is HIV+
• A grant is given to begin a women’s cooperative in this region, with the intention of helping improve children’s nutritional intake and improve life in rural households
• The grant will allow a porridge that is nutritious and shelf-stable to be marketable
• This porridge will help wean children off of breastmilk at around 6 months old
• About 500 women are interested
• The crops that would be used are exposed to pesticides that are dangerous for infants

 

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

• Women and mothers in relevant communities
• At-risk infants and young children who will be consuming the product
• Women’s Cooperative that will be manufacturing the porridge
• Local farmers
• Kenyan Ministry of Agriculture and Livestock
• WHO
• Local Government and healthcare organizations in the region
• Potential Donors

 

Step 3: Assess the motivations of the Stakeholders

• Women and mothers in relevant communities: Ensure their children’s health and growth,  follow traditional practices around breastfeeding and weaning, seek reliable information and resources for making decisions.
• At-risk infants and young children who will be consuming the product: depend on adequate nutrition and protection from HIV transmission.
• Women’s Cooperative that will be manufacturing the porridge: improve livelihoods through porridge production, create a product that mothers will accept and purchase, ensure the porridge is nutritious and safe.
• Local farmers: earn income from selling crops, gain access to a reliable buyer in the cooperative, adopt safer farming methods if economically viable.
• Kenyan Ministry of Agriculture and Livestock: ensure safe agricultural practices and food production, promote rural economic development.
• WHO: improve infant nutrition and reduce child mortality, balance HIV risks with infant nutritional needs, promote scientifically-backed recommendations.
• Local Government and healthcare organizations in the region: reduce malnutrition and prevent HIV transmission, follow WHO and national guidelines for health interventions (if available).
• Potential Donors: Ensure funds lead to measurable improvements in health and livelihoods, support initiatives that provide long-term benefits.

 

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 • Ethical Principle or code • Pros • Cons

Approach 1: Education and Empowerment Campaign

Potential Solution: Launch a community-wide education campaign on nutrition, HIV transmission risks, safe breastfeeding practices, and the benefits of the porridge.

• Ethical Principle or Code: Autonomy and Beneficence – Empowering mothers with knowledge allows them to make informed choices about their children’s health while promoting their well-being.
• Pros:
  • Informed decision-making enhances trust in the porridge and reduces skepticism.
  • Reduces HIV transmission through better education on safe breastfeeding and early weaning.
  • Promotes acceptance of nutritionally balanced alternatives like the porridge.
• Cons:
  • Cultural resistance may persist despite education efforts.
  • Requires ongoing resources for training and communication.
  • Some mothers may still lack access to healthcare, and in general HIV testing is not widely available.

Approach 2: Pesticide-Free Crop Initiative

Potential Solution: Implement a program to promote organic, pesticide-free farming practices among local farmers, ensuring that ingredients used in the porridge are safe for infants.

• Ethical Principle or Code: Non-Maleficence and Justice – Avoiding harm to infants by reducing pesticide residues in the food and ensuring safe, healthy ingredients.
• Pros:
  • Improves food safety and protects infants from harmful chemicals.
  • Aligns with environmental sustainability and promotes healthier farming practices.
  • Could open new markets for farmers through demand for organic products.
• Cons:
  • Transitioning to pesticide-free farming may be costly and time-consuming for farmers.
  • Organic crops may have lower yields, affecting farmer income in the short term.
  • The program would require significant investment in training and resources for farmers.

Approach 3: Locally Sourced Porridge 

Potential Solution: The women’s cooperative could be trained to produce and market a nutrient-rich, pesticide-free porridge using local ingredients. This porridge would serve as an early weaning food at six months to reduce HIV transmission risk and improve child nutrition. This approach betters child nutrition and reduces HIV transmission while ensuring that the food is free from harmful substances such as pesticides.

Pros:

• The porridge offers a high-nutrient alternative to traditional gruel, which lacks the required nutrients.
• Promoting locally sourced and pesticide-free ingredients means safer food for infants.
• Beneficial for women financially by giving them ownership of the production process, bettering their livelihoods.

Cons:

• Mothers are traditionally skeptical of new products, and resistance to adopting the porridge may slow its effect.

• The costs of training and making sure that the porridge is pesticide-free might increase the product’s price, making it less affordable for some families.
• Changing cultural beliefs around breastfeeding practices and weaning may take time and effort.

 

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

The two main ethical issues to address here is that, on one hand, promoting exclusive breastfeeding until the age of 6 months old in a high HIV/AIDS risk area could have a harmful impact on the children of the area, because they are being exposed to the diseases if their mothers are HIV+. On the other hand, there is a high percentage of stunted growth in the area derived from malnutrition, and the porridge currently made by the mothers lacks key nutrients, but the proposed new porridge will be manufactured using crops that have pesticides and could cause health problems for children. Additionally, the grant given to build the cooperative has the aim of improving the nutritional status of children and improving the livelihoods of rural households. I think that the first fact we have to realize is that we cannot solve all the problems through just one solution. In this case, I think building up the cooperative is ethical as it addresses one of the problems in the area. The HIV problem is prevalent but we are not experts on this and currently there are very low resources in the area (like testing options). This does not mean that in the future we could not work on it, but the most immediate approach would be to focus on malnutrition. Even though the crops might use pesticides, the current maize and bananas used are also locally sourced, and therefore they are very likely to also have pesticides. In this sense, we are not providing “the best” solution, but it is just providing another option for mothers in the area to consider for their children, while creating a community and work opportunity for local women. Local educational campaigns could be organized to sensitize farmers on safe use of pesticides or on natural alternatives, but this would take a long time to start having an effect, especially if the cooperative is not financially able to provide the farmers with the proposed natural pesticides. (But the option should not be discarded for the future).

 

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 best course of action is Approach 3: Locally Sourced Porridge while using elements of Approach 1: Education and Empowerment Campaign. This strategy addresses both malnutrition and the cultural resistance to new foods while offering a safer and more nutrient-dense alternative to the traditional gruel. By sourcing locally grown ingredients and ensuring the porridge is pesticide-free, this approach promotes both child health and community economic growth.

Although the HIV/AIDS transmission issue cannot be solved immediately, the cooperative should focus on what is immediately actionable—improving children’s nutrition—while educating mothers on safe breastfeeding and the benefits of early weaning with the porridge. Ensuring the food is pesticide-free through farmer education can be a gradual but necessary part of the process, thus promoting longer-term environmental and health improvements. Additionally, it would be important to keep open communication with healthcare providers to ensure HIV testing and prevention education are integrated into the community outreach.

This course of action balances the immediate need to combat malnutrition with long-term goals of sustainability and health. It also acknowledges that while the HIV/AIDS issue is significant, improving food security through the porridge project will be more feasible in the short term.

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

• Community Education Campaign: Begin by launching educational programs that inform mothers about the health benefits of the porridge and the risks of prolonged breastfeeding in the context of HIV/AIDS.
• Establish the Women’s Cooperative: Form the cooperative, train women in processing and marketing the nutritious porridge, and promote pesticide-free practices among farmers supplying the cooperative.
• Source Pesticide-Free Ingredients: Work with local farmers to gradually adopt pesticide-free farming practices, offering incentives or education about the long-term benefits for both their crops and the community.
• Porridge Production: Begin producing the nutrient-dense, locally sourced porridge and market it as a safer and healthier alternative to the traditional gruel.
• Engage Local Healthcare Providers: Collaborate with healthcare providers to continue HIV testing and education efforts as part of the community outreach, integrating information about safe breastfeeding and weaning practices.
• Monitor and Evaluate: Track the health outcomes of infants and young children in the community and assess how well the porridge is being adopted. Collect feedback from mothers and healthcare professionals to guide further improvement.
• Expand Awareness: Once successful, expand the reach of the cooperative to include more sub-locations and consider scaling up pesticide-free farming efforts to improve overall agricultural sustainability in the region.

 

PART 2:

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.  

Step 1: Determine the Facts

• Six months after the launch, the cooperative is operational.
• Women work 9 hours per day and earn KES 300 (~$3).
• Women are required to give their earnings to male family members, who waste the money on alcohol and frivolities.
• Women are upset that the money is not being used to feed their children but feel that they cannot change the situation.

Step 2: Define the Problem and Stakeholders

Problem: The cooperative is not meeting its intended social outcomes. Though women are earning money, it is being misused by male family members instead of improving child nutrition and household well-being.

Stakeholders:

• Women in the cooperative: Desire to use their income for family and children’s well-being.
• Men in households: Seek control over financial decisions but misuse money on non-essentials.
• Children and families: Need proper nutrition and improved living conditions.
• Leadership committee: Want the cooperative to succeed but are constrained by cultural norms.
• Grant donor: Interested in measurable social improvements in nutrition and livelihoods.

Step 3: Stakeholder Motivations

• Women: Improve children’s health and have more control over their earnings.
• Men: Maintain traditional financial control; influenced by social pressures and a lack of financial literacy.
• Children and families: Need better nutrition and living standards.
• Leadership committee: Balance community traditions with the need to improve social outcomes.
• Grant donor: Ensure success in improving child nutrition and household livelihoods.

Step 4: Alternative Solutions

Approach 1: Introduce a Savings System for Women’s Earnings

• Solution: Create cooperative-controlled savings accounts where women’s wages can be deposited and accessed only for essential needs like food or healthcare.
• Ethical Principle: Autonomy and justice—allowing women to control their income while respecting cultural norms.
• Pros:
  • Women retain control over how their money is spent.
  • Aligns with the cooperative’s goals of improving household welfare.
• Cons:
  • May face resistance from men who feel their authority is being challenged.
  • Requires logistical effort to set up and manage accounts.

Approach 2: Direct Food Distribution Program

• Solution: Instead of cash wages, distribute food or vouchers for essential items.
• Ethical Principle: Beneficence and non-maleficence—ensuring the cooperative’s earnings directly improve child nutrition and prevent financial misuse.
• Pros:
  • Guarantees that earnings are spent on essentials.
  • Improves nutrition for children directly.
• Cons:
  • Women may feel autonomy is limited.
  • Some men may still find ways to misuse or sell goods.
  • Logistically complex.

Approach 3: Incentivize the Use of Earnings on Essential Goods

• Solution: Provide incentives like discounts for using earnings on essential goods such as food, healthcare, or education.
• Ethical Principle: Non-maleficence—encouraging healthy spending habits without conflict.
• Pros:
  • Men and women benefit from incentives, encouraging spending on essentials.
  • Strengthens the cooperative’s market by promoting internal spending.
• Cons:
  • Men may still demand earnings for non-essentials.
  • Requires tracking systems for purchases and incentives.

Step 5: Seek Additional Assistance

This issue is deeply rooted in local cultural norms that are challenging to change. While we cannot impose a complete shift in household dynamics, we can make small adjustments within the cooperative to promote financial responsibility and child welfare. The savings system seems viable because it gives women more control over their earnings in a culturally sensitive way, while also incentivizing responsible spending.

Step 6: Select the Best Course of Action

The best solution is Approach 1: Introduce a Savings System for Women’s Earnings, with a combination of Approach 3: Incentivize Spending on Essentials. By setting up savings accounts that allow women to save and use their earnings for essential needs like food and healthcare, we can empower them financially while respecting cultural norms. This solution directs the earnings toward family welfare without overtly challenging men’s control of household finances.

Incorporating incentives for spending on essentials will further encourage both men and women to prioritize the well-being of the family. This approach is less confrontational than direct cash or goods distribution and will lead to long-term benefits like improved financial literacy and better household management.

Step 7: Sequence of Actions to Implement the Solution

1. Partner with Financial Institutions: Establish relationships with local banks or microfinance institutions to set up savings accounts for cooperative members.
2. Educate Women: Provide training sessions for cooperative members on how the savings program works and its benefits for the family.
3. Engage Men: Hold community discussions, framing the savings program as a way to improve family stability and well-being, ensuring men do not feel undermined.
4. Launch the Incentives Program: Introduce discounts or bonuses for purchasing essential goods like food, healthcare, or education directly from the cooperative.
5. Monitor and Adjust: Regularly evaluate the program’s effectiveness in improving household spending and nutrition. Gather feedback from the community and make necessary adjustments.
6. Expand: If successful, consider expanding the savings and incentive program to other regions or cooperatives to further promote financial responsibility and child welfare across the community.