Grandmothers as Change Agents: Developing a Culturally Appropriate Program to Improve Maternal and Child Nutrition in Sierra Leone

Abstract

BackgroundGlobal recommendations on optimal maternal and child nutrition (MCN) practices are clear; however, there is limited literature 1) exploring how roles of family members influence those practices and on 2) designing programs accordingly. Researchers using a family-systems approach in the Global South find that grandmothers often play a vital role in MCN, yet most nutrition programs narrowly target mothers, thereby potentially limiting effectiveness.ObjectivesThis article reports on the results of qualitative research exploring the roles and influence of family members on MCN in southern Sierra Leone, the local MCN beliefs and practices, and how those findings informed the design of a culturally appropriate program.MethodsFocus group discussions (FGDs) were conducted with mothers, fathers, and grandmothers in 9 communities in Bonthe District, Sierra Leone. We used participatory tools to explore family members’ roles and local MCN beliefs and practices. Interviews were recorded by notetakers and coded and analyzed using a content analysis approach.ResultsA total of 88 mothers, 125 grandmothers, and 79 fathers participated in the FGDs. All groups indicated that 1) grandmothers are the culturally designated advisors and supervisors of women on MCN issues and 2) mothers are not autonomous decision makers and are greatly influenced by grandmothers. The research identified both beneficial MCN practices and gaps between optimal and existing MCN practices—particularly related to maternal diet during pregnancy and exclusive breastfeeding for 6 mo. Research findings were used to design a grandmother-inclusive program.ConclusionsOur research showed that mothers are embedded in a family system of caring and supervision where grandmothers have primary influence on MCN practices, clearly supporting the need for grandmothers to have a central role in community MCN programs. It also points to the need for increased use of a family-systems approach in designing public health nutrition programs.

An Innovative Grandmother-Inclusive Approach for Addressing Suboptimal Infant and Young Child Feeding Practices in Sierra Leone

“…The study was implemented in 3 phases ( Figure 1 ): phase 1 included a quantitative cross-sectional baseline survey and qualitative formative research with development of appropriate adult education tools and training in the GMIA ( 8 , 20 ); phase 2 involved the implementation of the GMIA and a qualitative process evaluation to identify potential gaps and areas to strengthen ( 21 ); and phase 3 involved an endline survey of MCHN knowledge, attitudes, and practices. This article describes the intervention and reports on endline IYCF knowledge, beliefs, and practices.…”

“…Following formative qualitative research that informed the intervention ( 8 ), we designed the Mamanieva Project to explicitly involve all grandmothers along with mothers. We used the GMIA developed by GMP ( 19 ) that builds on grandmothers’ culturally designated role as caregivers and advisors and puts them at the center of program.…”

“…The first step of the GMIA was qualitative research (a component of phase 1) investigating both the roles and influences of family members on MCHN and their cultural beliefs, attitudes, and practices related to MCHN, with details and results recently published ( 8 ). Three WV field staff with experience and training in participatory adult education and community engagement methods led implementation of Mamanieva activities including steps 2 to 4 in phase 2.…”

“…A review of Demographic and Health Survey (DHS) data from 31 sub-Saharan countries concluded that co-residency with a grandmother is positively associated with reduced child stunting ( 7 ). In Sierra Leone, we found that grandmothers, aunts, and other older women (hereafter referred to as “grandmothers”) support younger family members by sharing traditions, knowledge, experiences, and caring for mothers and their children ( 8 ). Prior experiences of the Grandmother Project (GMP) and other researchers empowering grandmothers with appropriate information in Senegal ( 9 ), Malawi ( 10 , 11 ), and Kenya ( 12 ) have shown improvements in infant and young child feeding (IYCF) knowledge, attitudes, and practices of mothers and grandmothers and child growth.…”

“…To address low levels of IYCF practices and building on our formative research identifying grandmothers as key influencers of maternal and child health and nutrition (MCHN) we designed a pilot program targeting grandmothers as change agents, referred to as the grandmother-inclusive approach (GMIA), developed by the GMP ( 8 , 19 ). Although our qualitative formative research showed that grandmothers can be critical assets for positive social and behavior change, grandmothers’ potential for changing critical IYCF practices in Sierra Leone has not been carefully examined.…”