Part I

 

Facts of the situation

1. Gruel is used to complement breastfeeding in children from the ages of 2-24 months. 
2. Gruel is made of cornmeal and bananas and has very little nutritional value, but the mothers think it does. 
3. I have received a grant to establish a women’s cooperative in this region of East Africa.
4. The grant will fund the creation of a nutritious porridge made of local produce that can be used to wean children off of breast milk at 6 months.
5. HIV/AIDS is prevalent in the region and can be spread through breastfeeding.
6. 500 women are interested in working on the co-op to improve their livelihoods, but they do not all believe that the porridge will work as a weaning food.  
7. Pesticides are used to grow many crops in this region, including the crops that can be used in the porridge, but the pesticides cause adverse health effects for infants. 

 

Ethical questions:

• Addressing the ethical health issues associated with prolonged breastfeeding in a area with high rates of HIV/AIDS
• Early introduction of supplemental foods in infants’ diets
• Potentially feeding infants and children pesticides through the local produce
• We want to find a balance between using pesticides and educating on the prevalence of HIV/AIDS when the main focus of the co-op is to improve nutrition levels and livelihoods of households in rural areas.

 

Stakeholders

 

1. Children 
2. Mothers
3. Manufacturers of the gruel
4. Grant recipient (myself)
5. Members of the women’s cooperative
6. Grant donor
7. Local farmers (secondary stakeholders)

 

Motivations of the stakeholders

 

1. Children 
   1. Want good tasting foods
   2. Infants/young children most likely still want to be breastfed
2. Mothers
   1. Want healthy children
   2. Mothers want to do what is socially acceptable. If many other mothers are skeptical of switching to the nutritious porridge, they may not want to as well.
   3. Don’t want to pass on HIV
   4. Child rearing
3. Manufacturers of the gruel
   1. They want to wean babies off breastfeeding, and most likely think they’re product helps nutrition to some extent.
   2. Continuing to make money off of their product (They would not want a competitor.)
4. Grant recipient (myself)
   1. Establishing a successful women’s co-op that improves the livelihoods of the women working there
   2. Help children’s nutrition and health levels with a sustainable porridge recipe 
   3. Social impact
5. Members of the women’s cooperative
   1. Making money and supporting their family
   2. Improving their own livelihoods
   3. Making a product that other mothers trust and want to buy so that the women at the co-op can make money
   4. Help children and nutrition levels
6. Grant donor
   1. Improve the nutritional status of children 
   2. Improve the livelihoods of rural households
7. Local farmers (secondary stakeholders)

 

Alternative solutions to the case study

 

1. Do not worry about the use of pesticides in ingredients or interfere with breastfeeding practices of women. Women in the co-op could ensure proper washing and peeling of the produce when preparing the porridge.
   1. Ethical principle: potentially a violation of doing what is best for all and having integrity
      1. Pros
         1. Women’s co-op can focus their attention and money on the two primary goals of the co-op, improving nutrition levels and livelihoods of rural families, which would make the grant donor satisfied with the work being done
         2. Children would still get nutritious foods if they choose to purchase this product
      2. Cons
         1. Peeling produce tends to take away many of the valuable nutrients
         2. Does not address the concerns of prolonged breastfeeding with HIV/AIDS
2. Hold mass education programs on washing or peeling nutritious foods and breastfeeding to accompany the marketing of the porridge. Workshops and mother support groups could be used to teach women the importance of using the porridge as well. 
   1. Ethical principle: beneficence/nonmaleficence- The goals of the project are being met, but steps are also being taken to prevent any adverse effects in children from the pesticides.
   2. Pros
      1. Satisfies the goals of the women’s cooperative to improve nutrient levels, as long as people buy the food, and improves the livelihoods of those that attend the workshops making the members of the women’s co-op happy.
      2. Could lead to positive behavioral changes that impact nutrition and HIV levels in children
      3. Positive press and marketing for the women’s co-op
   3. Cons
      1. Lots of effort and money is required from the co-op to implement an education and marketing program like this
      2. Would need to choose specific communities to implement this
      3. The program would have to change the minds of women who use gruel and are skeptical of the efficacy and safety of the new porridge. 
3. Using community heads or elderly women to influence the community on the porridge and proper feeding practices
   1. Ethical principle: Beneficence/nonmaleficence- Like before, the goals of the project are being met, but steps are also being taken to prevent any adverse effects in children from the pesticides.
   2. Pros
      1. Satisfies the goals of the women’s cooperative to improve nutrient levels, as long as people buy the food, and improves the livelihoods of those that attend the workshops
      2. Could lead to positive behavioral changes that impact nutrition and HIV levels in children
      3. Less money would be needed than for a large educational program
      4. Community officials and older women have lots of influence in smaller communities
   3. Cons
      1. Difficulty of convincing older women and chiefs to help with education
      2. Would need to pay them or benefit community leaders in someway, and recruiting helpers would still take time and money

 

Best solution

 

I think that in this case study, the concerns of educating on the prevalence of HIV/AIDS is out of the scope of the responsibilities of the women’s co-op. When we presented on our foods that target malnutrition levels in children, many judges were concerned with things like a small amount of sugar in our recipe or using plastic to package our products. While these are legitimate concerns, they are things that did not impact the true goal of our project with is to impact the nutrition levels of children in Sierra Leone, so they were less of a concern than other parts of the project. I do not think that the women’s co-op would be responsible for changing the breastfeeding practices of women and educating them on the prevalence of HIV. With that being said, I think the women in the co-op should be as careful as possible when using produce that contains pesticides. Pesticides affect infants and children very similarly to malnutrition. They should clean and peel what they can while still maintaining nutrient levels. Babies have a harder time removing pesticides from the body, which can damage their cognitive development or organ function. If the women’s co-op is introducing produce into many of the children’s diets, which they probably are if they are used to eating gruel which is made of just cornmeal and banana, then they would also be introducing the pesticides. They should take every precaution to avoid using pesticides and “do no harm” to the children. In this case, the benefits of treating malnutrition do not outweigh the costs of harming infants with pesticides. If the women are cautious about using pesticides, the babies health can improve from the porridge and more mothers will buy it. In turn, the women’s livelihoods will improve from a successful product. Implications of this decision could be a rise in developmental defects due to the use of pesticides in addition to the higher nutrient levels of children. If the porridge gets proper approvals by the food or health sector of the government, then hopefully these issues could be avoidable. 

 

Part II

 

Facts of the situation

1. The co-op has been successful and the women are happy with the work they are doing.
2. The livelihood of the women was not improved because the money they earn is being spent on frivolous things by their husbands. But, the women do feel empowered by the work they are doing.
3. I see it as a problem that the money that the women earn is not improving the livelihoods of their families. I am still a board member of the women’s co-op for 6 months and am loved and respected by the community.
4. The other 6 members of the board are local women who want things to change, but they are not necessarily for or against taking the money back from the men.
5. Not achieving strategic social outcomes of improving the nutritional status of children (of the women in the co-op) and the livelihoods of rural households.

 

Ethical question

• To what extent can I interfere with the personal/family lives of the women in the co-op to ensure that there is an improvement in their livelihoods?
• What is my strategy to getting the goals of the cooperative back on track?

 

Stakeholders 

1. The original donor
2. Board members
3. Women involved in the co-op
4. Children and families with improved nutrition from the porridge
5. Children and families with unimproved nutrition (co-op worker families)
6. Husbands taking the money
7. Me 

 

Motivations of the stakeholders

1. The original donor
   1. Personal 
      1. Making the desired impact that is aligned with his/her own morals and goals of the project
   2. Professional
      1. Achieve higher nutrition levels in children and better lives for women in the co-op
2. Board members
   1. Personal 
      1. Avoid stirring up drama for something that does not concern them as much as it does me.
      2. Healthy children
   2. Professional
      1. Have a fully functioning co-op
3. Women involved in the co-op
   1. Personal 
      1. Feed their children good food
      2. Make their husbands happy
   2. Professional
      1. Make money that goes towards the family
      2. Feel empowered
4. Children and families with improved nutrition from the porridge
   1. Personal 
      1. Continue purchasing this decent product
      2. Health of the children
   2. Professional
      1. none
5. Children and families with unimproved nutrition (co-op worker families)
   1. Personal
      1. Improved nutrition levels 
      2. Wanting a better livelihood
      3. Not spending too much money on things that benefit the children 
   2. Professional
      1. none
6. Husbands taking the money
   1. Personal 
      1. Enjoy their life and continue to spend money on frivolous things
   2. Professional
      1. Not look embarrassed
7. Me
   1. Personal
      1. Maintain strong relationships with the women in the co-op and board members
      2. Ensure the safety of women in the co-op if they get into an argument with their husbands
   2. Professional 
      1. Meet the twin social outcomes of the project- improving nutrition levels while also improving livelihoods in rural households
      2. Social impact

 

Alternative solutions to the case study

 

1. Setting up a daycare facility at the co-op that cares for and feeds children with the porridge
   1. Pros
      1. Women would enjoy seeing their children at work
      2. Children would be fed
      3. Could potentially cost less than buying food for the women each day because they are already making the porridge that would be fed to the children and they would only need to pay one or two staff members to look after the children
   2. Cons
      1. Money would be taken from women’s wages to pay for the daycare employee and a small amount of porridge each day, but the rest of the money would still be going to the husbands “frivolous” habits
   3. Saving face: The husbands could potentially keep doing what they’re doing to some extent, but the women would be able to see their children each day and provide them with more nutrients if they eat the porridge. 
   4. Implications on relationships
      1. Short term
         1. Mothers would be able to see their children at work and provide them with higher nutrient levels, which would empower them and most likely strengthen their relationship with board members for providing this solution. 
      2. Long term
         1. Trust between the board and families for providing a solution that benefits each stakeholder
   5. Implications on venture
      1. Short term
         1. Tensions between husbands and board members is possible because the women are bringing home less money
         2. Restructuring of payment system
         3. Adding or designating staff responsible for organizing the daycare
      2. Long term
         1. Long term daycare employees would be required
2. Paying women with shares in the company
   1. Pros
      1. Women are not seeing the money they earn anyway, and the families tend to spend small amounts of money they have. In this scenario, they would (hopefully) see a large return on the money that was invested.
   2. Cons
      1. Requires strong book-keeping and trust among the company
      2. The co-op must be successful long-term in order for a return on investment
      3. Women would not bring home any money for husbands which could make them angry 
      4. Women may want their money sooner and not be interested in shares in the company
      5. Would not impact children’s nutrition levels in the short term
   3. Saving face: The board members would need to communicate with husbands and families in order to save face with the husbands and protect the wives. 
   4. Implications on relationships
      1. Short term
         1. If women don’t bring home money each day, it could poorly affect their relationships with their husbands
      2. Long term
         1. Women could build a strong relationship with board members because of the trust and hard work that is required to ensure a return on their money
   5. Implications on venture
      1. Short term
         1. Company could build up quickly by reinvesting all the overheads of paying the women into the company.
      2. Long term
         1. Growth of the company could help them impact more children in other areas and countries and could help fund other projects or ideas that the women at the co-op have. 

 

Best solution

 

1. Paying the women with nutritious foods or with free porridge to feed themselves or their children. The food would need to be perishable so that mothers do not sell the food on the black market for cash.
   1. Pros
      1. Goes back to twin social outcomes of benefitting family and providing nutrients to the children
      2. The co-op does not lose any money by doing this
   2. Cons
      1. Women would bring home less or no money because of the cost of food they are being given, so their husbands could potentially get angry and harm the women- could be given a choice of what share of their income is food and which portion is actual cash
      2. Non-perishable foods could be sold on the black market by women
   3. Saving face: The board members would need to ensure that women have consent from their husbands to choose this option because the money that the board would use to pay for food would come out of each woman’s salary.
   4. Implications on relationships
      1. Short term
         1. Husbands could be bitter at first that they have less money to spend on things they enjoy, at least initially. 
         2. It would take convincing the board members, so I would have to ensure that I have their trust.
      2. Long term
         1. Even more empowerment for the women which could minimize any resentment towards husbands. 
         2. Success could result in strong relationships with each member of the women’s co-op and families because the co-op helped the families achieve a better lifestyle.
   5. Implications on venture
      1. Short term
         1. Tensions between husbands and board members is possible
         2. Restructuring of payment system
         3. Adding or designating staff responsible for coordinating food.
      2. Long term
         1. Empowered women that work at the co-op
         2. Healthier children