Ethical Decision Making & Grassroots Diplomacy Part 2

Welcome Back! In class this week, we talked about two separate ethical decision making/ grassroots diplomacy cases. In the weeks past, I included the case study but due to its length, I am going to describe it below:

There is a women’s cooperative in Kenya that was designed to reduce the risk of HIV transmission between mothers and children due to breastfeeding. The strategy that the cooperative used was to create a nutrient rich porridge that effectively weens the child off of the milk. The more time the child is allowed to breastfeed, the higher the likelihood of HIV transmission. Both cases have unique problems so I will analyze them accordingly:

Case 1 Case 2
Step 1: Determine the Facts. What is the Issue here and why is it important?
·        Approximately 35% of children are stunted because of poor nutrition.

·        The mothers believe that the porridge is effective.

·        There are 500ish women who are active in the cooperative.

·        There is a high prevalence of HIV/AIDS in this region and high transmission rate between mothers and children.

·        Women are skeptical of early weening à There may be a lack of understanding about the dangers of letting the baby have breast milk.

·        The goal of the cooperative is to have a “shelf-stable” porridge that is effective

·        There are several key crops that grow in this region: maize, sorghum, cassava, legumes, coffee, pineapple, bananas, pumpkins, tomatoes, carrots, kale, potatoes, and sweet potatoes. These crops could be used in this recipe.

·        There is a general issue about pesticide use in this region and how it can harm everyone who consumes the porridge.

·        The current recipe is not very nutritious.

·        Although women are working in the cooperative and earning money, the men in the household are taking it and spending it on alcohol (Case 2 specific)

·        You are a member of a leadership committee for the cooperative and you have six months left on the committee (Case 2 specific).

·        Women are convinced that nothing can be done (Case 2 specific).

·        Twin social outcomes goals are: improving the nutritional status of children and improving the livelihoods of rural households (Case 2 specific).

The issue here is that the we need to find a way to make a safe and nutrient dense product for mothers to give to their infants. Mothers are skeptical of this product currently because of the potential health issues associated with pesticides, they do not understand the dangers of letting the baby have breast milk, and the product is not currently guaranteed to last (it is not shelf stable yet).  This is extremely important as the transmission of HIV to children and malnutrition huge issues that plague many people in sub-Saharan Africa. The issue here is that while the cooperative is doing well and women and children are healthier, the money earned from the work the women do is not being put to good use. More specifically women are upset with the fact that they cannot effectively take care of their infants because the men in their house are taking the money and using it to buy alcohol. The women are put in a difficult place because they do not want to go against their husband but they want to help her baby. This decision that must be made here is who has autonomy over the money and how do you make sure that the mothers can feed her children while upholding the twin social outcomes?



Step 2: Who are the Stakeholders for these cases? & Step 3: What are their motivations
·        Mothers who are breastfeeding

o   The mother does not want her child to become malnourished or contract HIV. They want a solution that reduces the risk for harm to both herself and her child while offering the best result.

·        Infants who are being breastfed:

o   The children need to eat food. Ultimately, they do not know or care where it is coming from.

·        Non-lactating Women

o   They are invested in the health and wellness of their community. In addition, this cooperative presents an opportunity to help her when she needs assistance later. This could be a potential source of income for the future.

·        Farmers

o   The farmers want the community to be healthy. They are extremely interested in the profits that they could achieve through collaboration with the cooperative

·        Medical Professional

o   They want their community to be healthier. They might want to support the cooperative because it helps reduce the issue of HIV transmission and malnutrition

·        Cooperative’s Funder

o   The funder wants to see progress with the project and that their money is being put to good use

·        You

o   You want to design the product such that the all of the concerns are addressed while still being effective. There also are personal/professional motives at play.

·        Local Government

o   They want the community to be healthier. In addition, they want people to be healthier and the cooperative to succeed so that the community develops and there is more social and economic growth

·        Males in the household (Case 2 specific).

o   They have no professional motives here but there are several personal motives at play. The males want to control their household, they want women to abide by social and cultural norms, and they want to drink alcohol but cannot afford it regularly.

Step 4: What are three alternative solutions?
1.       Utilitarian Approach

Ultimately, HIV/AIDS is a far worse issue to have than worrying about the effects of pesticides. For this approach, just give the mothers/infants the porridge and worry about the pesticides later. (+) The infants get vital nutrients from the porridge while staying away from the mother’s milk which may have had HIV in it. (-) could possible poison the child

2.       Deontological Approach

Outsource the ingredients so that the porridge is made from the best possible materials that will not have any pesticides. (+) All of the foods will be healthy and cause the least amount of harm. (-) This method is extremely expensive and could put these farmers out of business

3.       Educationà Virtue Approach

In this possible solution, we want to educate women on the dangers of breastfeeding a child for too long. (+) women are more likely to stop breastfeeding and buy better foods. (-) this does not actually solve the whole issue. It creates more issues. The women may simply not want to purchase the porridge because it may contain pesticides which they now know can harm their baby.

1.       Compensation through porridge

In this solution, I would reduce the amount the woman is being paid and compensate them with porridge. This way their children would be able to eat and she would not have to worry about the male preventing this from happening. (+) This is extremely easy to do. The children are better fed and the cooperative spends less money on overheads. (-) The porridge is designed for infants not necessarily children and the women who work at the cooperative might not all be lactating or have children who should eat the porridge.

2.       Vouchers

This solution is pretty simple in theory. Provide women with voucher cards that she could go and buy only food at a specific store. (+) Women are able to feed her kids, encourage a credit/borrowing system with food vendors, improve the economy. (-) the males may get angry because the women are able to get food but not what they want. Moreover, there is no guarantee that the voucher program will be supported by the vendors.

3.       Building equity

At this point, my team decided that there was no real solution that was truly feasible so we just made one up. (I know it is bad, but it is honest). The women decide to acquire shares in the cooperative so that she can build equity and make larger purchases (+) women are able to make wholesale/large purchases by selling their shares (-) there is no immediate impact in this solution and I think just about everyone is not happy.

Step 5: Get help & Step 6: Select the best course of action.
My team an I discussed these solutions in great detail in class. I believed that the best approach was deontological while my teammates believed that the utilitarian approach was better. When talking to Khanjan we acknowledged that solution 2 was not sustainable. However, I could not leave the principle of “do no harm”. For this reason, I chose the deontological approach. It took about 30 seconds of class discussion to realize that every single group decided to do some sort of voucher-based solution. I have actually seen this solution in practice in Uganda and for this reason, I know it works!
Step 7: What happens next? What are the implications for the cooperation
Okay, so there are huge implications and steps here. We would need to first contact our donor and explain the situation. I would explain to them that we cannot replace one illness with another and that this is the right way to approach this issue. I would need to keep in mind what Khanjan said about this method is unsustainable because I do not want to encourage donor fatigue. To mitigate this, I would diversify my funding sources by partnering with HIV organizations, Organic Farms, Malnutrition organizations, and the government. Like case 1 there are many steps at play. First you need to have a community meeting with the store owners and have them understand the problem. Next, you need to explain that this system is a empowers the vendors to make a difference in the next generation. Moreover, you would want to monetize the vouchers and test run this process with a small cohort of people before actually launching it.


By using this solution you ensure the continuity of the cooperation and you gain support from the entire community!



Leave a Reply