Grandmothers: A Learning Institution - Basic Education and Policy ...

GRANDMOTHERS:A LEARNING INSTITUTIONThis publication was produced for review by the United States Agency for InternationalDevelopment. It was prepared by Creative Associates International, Inc.

Prepared by:Judi Aubel, PhD., MPHThe Grandmother ProjectPhoto Credit:Judi AubelPrepared for:Creative Associates International, Inc.Basic Education Policy Support (BEPS)United States Agency for International Development (USAID)Contract No. HNE-1-00-00-0038-00August 2005ACKNOWLEDGMENTSThe author would like to especially thank Don Graybill and Sean Tate for their commitment tothe realization of this publication. Thanks also go to Vicky Franz, Sean Tate and Cynthia Pratherfor their editing assistance. Special thanks to Jim Hoxeng at USAID without whose support itwould not have been possible to produce this publication.

GRANDMOTHERS:A LEARNING INSTITUTIONDISCLAIMERThe author’s views expressed in this publication do not necessarily reflect the views of the United States Agencyfor International Development (USAID) or the United States Government.

CONTENTSACRONYMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .viiEXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ixI. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1II.WHY INCLUDE GRANDMOTHERS IN CHILD DEVELOPMENTPROGRAMS? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Conceptual Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Factors Limiting the Inclusion of Grandmothers inChild Development Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Grandmothers’ Roles in Different Cultures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10Core Roles of Grandmothers Across Cultures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14Development Policies Support Grandmothers’ Inclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19III. HOW HAVE CHILD DEVELOPMENT PROGRAMS INVOLVEDGRANDMOTHERS? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Programs Involving Grandmothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Early Childhood Development and Primary Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Newborn Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22Maternal and Child Health and Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25Community Responses to Including Grandmothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26IV.A CLOSER LOOK AT INVOLVING GRANDMOTHERS: MALI . . . . . . . . . . . . . . . . . . .29Developing a Grandmother-Inclusive Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29Utilizing Nonformal Education Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30Results of the Nonformal Education Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34V. GRANDMOTHERS:A LEARNING INSTITUTION SUMMARYOF CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39VI. RECOMMENDATIONS FOR BASIC EDUCATION . . . . . . . . . . . . . . . . . . . . . . . . . . . .43Questions for Education Program Planners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43Recommendations for Basic Education Planners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43APPENDIX A: METHODOLOGY USED IN THIS REVIEW . . . . . . . . . . . . . . . . . . . . . . .53APPENDIX B: ANNOTATED REFERENCES ON THE ROLE OFGRANDMOTHERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71GRANDMOTHERS:THE LEARNING INSTITUTIONv

EXECUTIVE SUMMARYSociety itself fails when it isolates the young and the old from one another.Teresa Scott Kincheloe,Native American EducatorThe educational needs of children inAfrica, Asia, Latin America, and ThePacific are immense. A major chal­governments, civil society organi­lenge forzations, and international developmentagencies is to develop strategies to promotethe educational development ofthese children, most of whom live in economicallypoor environments.To address this challenge there has beenconsiderable investment and many successesin identifying research-based interventionsto promote children’s educationaldevelopment as part of their overallgrowth. In many cases, however, efforts tointegrate these interventions into familyand community contexts have not systematicallybuilt on and optimized existingroles, values, and resources at the locallevel.Since education is an integral aspect ofchildren’s development, this paper examinesexisting evidence regarding the role ofsenior women, referred to in this paper as“grandmothers,” 1 in children’s overalldevelopment, 2 including education, in nonwesternsocieties (in Africa, Asia, LatinAmerica,The Pacific, Aboriginal Australia,and Native North America).The paperalso identifies the extent to which policiespromoting the well-being of children supportgrandmothers’ inclusion in childdevelopment programming. It highlightsprograms around the world that haveexplicitly involved grandmothers andexplores in some detail how one of theseprograms was designed to ensure grandmothers’involvement. It concludes byexploring strategies to ensure the involvementof grandmothers in future basic educationinitiatives for children.The review of the literature, policy, andprograms is framed by several key conceptsthat are not always taken intoaccount in the design of child developmentprograms around the world. Theyinclude: a systems approach; an assetsbasedapproach; cultural roles and valuesas a foundation for program design;respect for elders and their experience;and social capital. The perspective on childdevelopment programming that emergesfrom the combination of these conceptspoints to the need to view grandmothersas key actors in family systems and as aninvaluable resource for promoting optimalchild development at that level.1 In this paper, the term “grandmothers” refers to experienced, senior women in the household who are knowledgeable about allmatters related to the health, development and well-being of children and their mothers. This includes not only maternal andpaternal grandmothers, but also aunts and other older women who act as advisors to younger men and women and who participatein caring for children.2 Child development, as used throughout this paper, refers to the development and continued growth of a child’s emotional, intellectual,and physical well-being.GRANDMOTHERS:THE LEARNING INSTITUTIONix

Given the relatively limited published literatureon this topic, the sources of informationreviewed include not only publishedmaterial but also unpublished gray literature3 and key informant interviews with avariety of academics, anthropologists, educationalists,international developmentagency staff, and NGO field staff in differentcountries. From analysis of the availableinformation, a series of core roles ofgrandparents, and specifically of grandmothers,were identified that appear toexist across cultures:• All cultures recognize the critical roleof grandparents as guides and advisorsto the younger generations.• In all cultures grandparents play gender-specificroles related to childdevelopment.• Grandmothers are responsible fortransmitting cultural values.• Grandmothers’ child-rearing expertiseis acquired over a lifetime.• In all cultures grandmothers areinvolved in multiple aspects of thelives of children and families at thehousehold level.• The roles of grandmothers appear tobe universal whereas much of theirknowledge and practices are culturally-specific.• Grandmothers are both directly andindirectly involved in promoting thewell-being of children.• Grandmothers influence the attitudesand decisions made by male familymembers regarding children’s wellbeing.• Some of grandmothers’ practices arebeneficial for child development,whereas others are not.• Grandmothers have a very strongcommitment to promoting thegrowth and development of theirgrandchildren.• Compared to younger women,grandmothers generally have moretime to spend and patience withyoung children.• Most grandmothers are interested inincreasing their knowledge of “modern”ideas about child development.• Grandmothers’ knowledge comesprimarily from their own mothersand their peers.• Many grandmothers have a collectivesense of responsibility for childrenand women in the community.• Some grandmothers feel that theirstatus as advisors in child and familydevelopment is diminishing.The overarching conclusion that emergesfrom the review of the available literatureis that grandmothers are present in all culturesand communities, that they have considerableexperience and influence relatedto all aspects of child development, andthat they are strongly committed to promotingthe well-being of children, theirmothers and families.The review then examines policy guidelinesfrom key international agencies thatsupport child development programmingat the community level. Policy statementsfrom UNICEF, the internationalConsultative Group on Early Childhood3 Internal company documents or unpublished documents, such as project reports.xUNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

Education, the Bernard Van LeerFoundation, and UNESCO all advocate forstrengthening the capacity of family membersto respond to children’s needs. Forexample, UNICEF states that programsshould identify “existing strengths of communities,families, and social structures” and“build on local capacity, encourage unity,and strength” (2001, 17). Policy statementssuch as these suggest, but do not explicitlystate, that grandmothers should be involvedin child development programs.Unfortunately, such policy guidelines supportinggrandmother inclusion are reflectedto a very limited extent in actual programs.The second part of the review involvesidentifying child development programs thatexplicitly involve grandmothers. In spite ofthe fact that grandmothers play a significantrole in all aspects of child health and developmentat the household level, few programshave explicitly identified and involvedthem as key actors. Often in programs thatfocus on younger “mothers” some grandmothersmay participate. However, thenumber of child development programstrategies that have deliberately includedgrandmothers as a priority communitygroup is miniscule when compared with thevast number of programs implementedacross the world.This is especially true inbasic education programs.A small number of projects were identifiedthat have involved grandmothers in someway. The grandmother-inclusive projectsreviewed deal with a variety of child developmentissues including early childhooddevelopment (ECD), primary education,newborn health, maternal and child healthand nutrition, and HIV/AIDS. 4 Short summariesare presented on each of theseprojects. Although few in number, andoften poorly documented, these experiencesillustrate how programs can acknowledgegrandmothers’ role and past experience,actively involve them, and in so doingstrengthen their knowledge and skills. Inprograms where a grandmother-inclusiveapproach has been adopted, there hasbeen very positive feedback from grandmothers,from other community members,and from development staff. In most casestheir involvement appears to have contributedto increased program results.The paper then looks closely at one projectin particular.The experience of Helen KellerInternational in Mali illustrates how childdevelopment programs can work withgrandmothers in order to improve thehealth and well-being of children and theirmothers. This case study describes theactivities of the project and details the nonformaleducation methodology that was akey to engaging grandmothers, gaining theirconfidence, and helping them to learn. It isthrough this methodology that grandmothersfelt empowered in their roles as communityhealth advisors.CONCLUSIONSBased on the review of the literature onthe roles of grandmothers in different nonwesterncultures, analysis of the policies ofkey international organizations that promotechild development, and a review ofchild development projects that haveexplicitly engaged grandmothers, a series ofover-arching conclusions was formulated.These include:4 The projects identified predominantly fall in the category of health-related interventions, but as demonstrated by this paper’srecommendations, the roles played by grandmothers in these health-related interventions are potentially transferable to basiceducation projects.GRANDMOTHERS:THE LEARNING INSTITUTIONxi

THERE IS LIMITED DOCUMENTATION OFGRANDMOTHERS’ ROLES.Analysis and documentation of grandmothers’roles in different societies is quite limited.The results of many studies on differentchild development topics either completelyignore, or give minimal attention to,grandmothers’ roles and influence at thehousehold level. This can be explained inpart by negative stereotypes of grandmothersheld by many developmentorganizations and in part by the narrowmodels used as a basis for data collection.PREVALENT ASSESSMENT METHODOLO-GIES FAIL TO EXAMINE HOUSEHOLDROLES AND RELATIONSHIPS.The methodologies used in formative studieson child development topics mostoften focus narrowly on individual knowledge,attitudes, and practices (KAP) ofwomen/mothers. There is a need foralternative assessment methods based ona more systemic, anthropological frameworkthat looks at social structures, roles,and relationships in households that influenceattitudes and practices related tochild development. In a more systemicapproach, grandmothers’ experience androles at the household level would certainlybe analyzed.GRANDMOTHERS CONTRIBUTE TO CUL-TURAL CONTINUITY.The cultural dimension of developmentprograms has generally been neglected,though there is a growing concern that thisis a dangerous trend that can contribute tothe loss of cultural values and identity.Grandmothers play a critical role in transmittingcultural values and practices toyounger generations, thereby contributingto the maintenance of cultural identity inan increasingly culturally homogeneousworld.GRANDMOTHERS’ PLAY AN INFLUEN-TIAL ROLE IN CHILDREN’S DEVELOP-MENT ACROSS CULTURES.While documentation on grandmothers’roles is relatively limited, the available evidencedoes show that in virtually all nonwesternsocieties in Africa, Asia, LatinAmerica,The Pacific, and in indigenous culturesin North America and Australia, seniorwomen, or grandmothers, play a centralrole in child-rearing. In all of these societiesthey are looked to as advisors of theyounger generations based on their ageand experience, though in many cases theirstatus is diminishing. Across cultures thereare a series of core roles played by grandmotherswhile at the same time there isconsiderable variability in their culture-specificbeliefs and practices.FEW CHILD DEVELOPMENT PROGRAMSEXPLICITLY INVOLVE GRANDMOTHERS.In spite of the fact that grandmothers playa significant role in all aspects of childhealth and development at the householdlevel, few child development programshave explicitly identified and involved themas key actors. This review analyzes theextent to which they have been involvedin five key program areas related to childdevelopment: early childhood development,primary school education, maternaland child health and nutrition, childhygiene, and HIV/AIDS. It was concludedthat in all of these areas the involvementof grandmothers has been very limited.xiiUNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

SEVERAL FACTORS CONTRIBUTE TO THELIMITED INCLUSION OF GRANDMOTH-ERS IN CHILD DEVELOPMENT PRO-GRAMS.Several factors appear to contribute to thefact that few programs have identifiedgrandmothers as priority communityactors and actively involved them in communitystrategies. First, many developmentagencies and staff have negative biasesagainst grandmothers related to their ‘age,’‘inability to learn’ and ‘resistance to change.’Second, the models used as a basis fordesign of child development programs,borrowed from the west, tend to focus on‘mothers,’ and sometimes ‘parents,’ whileignoring the significant role and influenceof elder household actors in virtually allnon-western societies.A FEW SUCCESSFUL GRANDMOTHER-INCLUSIVE CHILD DEVELOPMENT PRO-GRAMS DO EXIST.Although there are relatively few examplesof child development programs that haveexplicitly involved grandmothers, thoseexperiences do illustrate how programscan acknowledge grandmothers’ roles andpast experience, actively involve them, andin so doing strengthen their knowledgeand skills. In programs where a grandmother-inclusiveapproach has been adopted,feedback from grandmothers, fromother community members, and fromdevelopment staff has been very positiveand in most cases their involvementappears to have contributed to increasedprogram results.THERE IS A GAP BETWEEN POLICYSTATEMENTS AND GRANDMOTHERS’INCLUSION IN CHILD DEVELOPMENTPROGRAMS.Policy statements from key internationalagencies involved in children’s developmentadvocate for strengthening thecapacity of all family members to respondto children’s needs. By extrapolation, suchpolicy priorities imply that programsshould involve senior family members,including grandmothers. In reality, thereare few programs in which grandmothersare explicitly and actively involved. Thenon-inclusion of grandmothers in childdevelopment programs represents a significantinconsistency with international policyguidelines.GRANDMOTHER LEADERS AND NET-WORKS SHOULD BE VIEWED AS SOCIALCAPITAL.Social capital is defined as “the glue thatkeeps communities together and that isrequired for a collective and sustainedresponse to community needs.” Whilethere is much discussion of the need to“strengthen existing community structures”in community development programs, limitedattention has been given to thepotential represented by natural grandmotherleaders and their social networksfor promotion of children’s development.Several experiences empowering thesegroups show how efforts to strengthenthem can contribute to enhancing a community’ssocial capital and to sustainingcommunity action for children’s development.GRANDMOTHERS:THE LEARNING INSTITUTIONxiii

GRANDMOTHERS ARE RECEPTIVE TO THEUSE OF NONFORMAL EDUCATIONAPPROACHES THAT BUILD ON THEIREXISTING KNOWLEDGE.In experiences in several countries, nonformal,adult education methods have beenvery successfully used with groups ofgrandmothers. They were very receptiveto these methods and their positiveresponse can probably be explained by thefact that the approach reinforced their culturally-definedrole as respected advisors ofyounger women and children while helpingthem to acquire new knowledge and practicesrelated to child health and development.All of these conclusions support the needto more actively involve grandmothers inchild development projects in the future,given their critical role in child developmentin non-western societies, the internationalpolicies that support this orientation, andthe positive outcomes of community programsthat have adopted a grandmotherinclusiveapproach.RECOMMENDATIONSThe paper concludes with a number of recommendationsfor ways to increase grandmothers’involvement in basic educationstrategies. Around the world, families andcommunities acknowledge that grandmothersplay an influential role in the socialization,acculturation, and care of children asthey grow and develop. However, basiceducation programs have not seriouslytaken this role into consideration. The recommendationsincluded in the paper aremeant to stimulate thought on how toinvolve grandmothers, utilize their acceptedroles within a community, and account fortheir influence on children’s educationaldevelopment. The following recommendations,grouped into five categories and summarizedbelow, are not meant to be definitivebut rather to stimulate thought on howto involve grandmothers and utilize theirrole and influence on children’s educationaldevelopment in the family and community.INCREASE TEACHER AND STUDENTAWARENESS OF GRANDMOTHERS’ ROLEAND POTENTIAL CONTRIBUTION.• Develop participatory training exercisesto help teachers reflect on therationale for including grandmothersas partners in school educationalactivities and then develop strategiesfor including them.• Analyze family and community systemsas an input to program development.• Create alternative assessment tools.• Generate criteria for inter-generationalsensitivity.INTEGRATE TRADITIONAL KNOWLEDGEAND SKILLS IN SCHOOL CURRICULA.• Interview grandmothers concerningtheir roles in education.• When revising curricula or developingteaching materials, pictures of grandmothers,quotes from grandmothers,and characters in stories should beincluded.• Use components of “Service-Learning” and constructivist approachesto collect data from grandmothersand incorporate them into the curriculum.xivUNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

– Who am I? Assign children to askfamily members, including grandmothers,to answer the child’s question:“Who am I?”This is an activityto help children define their ownidentity, in the family, and in thecommunity.– Living History. Assign children tointerview elders in their family orneighborhood, including grandmothers,on a topic related to the historyof the neighborhood or village.Teachers can make this a part of thehistory curriculum.– Make curriculum relevant.– Build Ownership of the school curriculumby the community.– Making connections between the“old way” and the “new”.INTEGRATE TRADITIONAL VALUES INTOTHE CURRICULUM.• Collect stories, proverbs, and songs,and analyze the values expressed inthem. Use these traditional materialsas a basis for discussion of cultural valuesand of the similarities and differencesbetween traditional and modernvalues.DEVELOP PARTNERSHIPS BETWEENGRANDMOTHERS AND SCHOOLS.• Encourage families to create homeenvironments that support success inschool.• Encourage grandmothers, who oftenhave more free time than mothers, towalk children to school to assure theirsafety.• Identify stories told by grandmothersin the community that relate to thecurriculum and use these stories asteaching tools. Invite these seniorwomen to tell stories in special storytellingsessions at schools or in informalsettings.USE PARTNERSHIPS TO PROMOTESCHOOL IMPROVEMENT.• Empower parents to participate inschool planning for curriculum content,school climate, and staff development.• Identify grandmother leaders and networks.• Form Grandparent-Parent-TeacherAssociations.• Empower families to learn to use theircollective power to advocate forschool change.• Involve community elders, includinggrandmothers, grandfathers, and religiousleaders, in providing input forquality control of schools and teacherperformance.Many of these recommendations do notdepend on large amounts of financialresources. They simply introduce newapproaches to project development thatutilize the knowledge, experience, andenthusiasm grandmothers have for children’sdevelopment. By exploring theserecommendations, child development programswill be able to access a wider rangeof resources—including grandmothers’experience, their networks, and their influenceover families—and, therefore, generategreater potential for sustainability.GRANDMOTHERS:THE LEARNING INSTITUTIONxv

­I. INTRODUCTION“There is probably no other role that is so nearly universal yet soheterogeneously defined as grandparenthood”SmolakPromoting the education, health, andwell-being of children in developingcountries is a priority for governments, many civil society groups, and internationalorganizations. While almost allchildren are embedded in family and communitystructures, in most cases developmentprograms narrowly target children,often mothers, and in some cases parents.Grandparents are present in all communities,and in all societies they are expectedto contribute significantly to the growthand development of children. The roles ofgrandfathers and grandmothers are gender-specificand it is the senior women, orgrandmothers, who are expected to play apredominant role given their own experiencebearing and educating children. Childfocuseddevelopment efforts, however,rarely acknowledge or involve these experiencedresource persons in programs.The Swedish communicologist, AndreasFuglesang (1982) referred to grandmothersas a veritable “learning institution,”alluding to their vast experience and theroles they play in transmitting to youngergenerations the knowledge and skillsrequired to survive in each society.While there appear to be few developmentprograms that have explicitlyinvolved grandmothers as resource persons,in the community health field therehave been several recent and very positiveexperiences. In Laos, Senegal, and Mali,grandmothers played key roles in healthpromotion strategies.The results of each ofthese experiences revealed that grandmotherswere open to new ideas andpractices when appropriate nonformaleducation methods were used and thatthey were able to learn and change theiradvice and practices.Evaluations of these community healthprograms showed that the involvement ofgrandmothers contributed to improvinghousehold maternal and child health practices.For example, in a nutrition educationprogram in Senegal, in households wheregrandmothers were involved in the nonformalactivities, more than 90 percent ofall infants were appropriately breastfed(they were given only breast milk for thefirst six months; exclusive breastfeeding).Conversely, in families where grandmotherswere excluded from educational activitieswith younger women, only about 30percent of these women reported thatthey were able to exclusively breastfeedtheir infants (Aubel et al, 2004). Positiveresults using a grandmother-inclusiveapproach were also documented in Maliwhere grandmothers were involved innonformal education activities on newbornhealth, and in Laos where they participatedGRANDMOTHERS:THE LEARNING INSTITUTION1

in educational activities on home treatmentof childhood illnesses.The over-arching conclusion drawn fromthese several experiences using a grandmother-inclusiveapproach is that communitystrategies that harness the support ofgrandmothers can contribute to increasingthe impact of development programs. Inaddition, involving them in developmentprograms can lead to greater appreciationof the contribution of elders to family andcommunity well-being, increased recognitionof positive cultural values and traditions,and stronger inter-generational communication.Efforts to strengthen theknowledge and leadership skills of grandmothersto promote family and communitywell-being contribute to increasing asociety’s social capital, a critical componentof sustainable development.Based on these positive outcomes workingwith grandmothers, Creative AssociatesInternational, Inc. decided to support theexploration of ways in which grandmotherscould similarly be involved in basiceducation initiatives. In this context, it wasdecided to carry out a review of existingliterature, first, on the role played bygrandmothers in different societies in children’soverall growth and development,and second, on development programsthat have explicitly involved grandmothersas resource persons and the strategies andmethodologies they employed to do so.This review had three objectives:• To explore the relevance of includinggrandmothers in child developmentprograms;• To identify child development programsthat have explicitly involvedgrandmothers and explore theapproaches used to elicit their participation;and• To formulate recommendations forincreasing involvement of grandmothersin future basic education programs.The findings related to these objectivesshape this publication.2 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

II. WHY INCLUDE GRANDMOTHERS INCHILD DEVELOPMENT PROGRAMS?“When an old person dies it is as though a whole library had burned down.”Amadou Hampâté Ba,Malian philosopher 1900-1991The education and developmentneeds of children, and of poor familiesin general in Africa, Asia, LatinAmerica, and The Pacific are enormous.Ensuring optimal growth in both needssectors represents a particularly complexand difficult challenge. In order to easethis burden, many international agencies,governments, civil society groups, and communitynetworks are investing in educationand development programs to supportchildren’s overall development.Yet, frequentlythese programs are missing fundamentalelements that are critical to thedevelopment of effective and sustainableprojects. One such element is the need tobuild on existing family and communitystructures and strategies (UNICEF 2001).At the global level there is also a broadconsensus regarding the need to strengthenthe capacity of families and communitiesto optimize children’s development.Policy statements of various internationalorganizations involved in child developmentprojects support the need to bolsterexisting family and community actors andresources. For example, UNICEF assertsthat successful programs for children arecharacterized by strategies that “use theexisting strengths of communities, families,and social structures… respect cultural values,build on local capacity, encourage unityand strength” within families and communities(2001, 17).While international policy guidelines clearlyarticulate the need for child developmentprograms to build on existing family andcommunity systems, in many cases thesepriorities have not been fully translatedinto programming strategies. By ignoringthis need, programs are under-utilizingavailable resources at the family and communitylevels and ultimately limiting theirprospects of sustainability.This weakness in many national and internationalchild development programsappears to stem from the fact that programdevelopment is not based on anaccurate and holistic understanding of familyand community systems in different culturalcontexts (Bronfenbrenner 1979;Berman et al. 1994). In most cases, relativelylimited attention is placed on understandingthe roles, authority, and decisionmakingpatterns among various householdactors that influence practices contributingto children’s growth and development.There is often only superficial understandingof the socio-cultural dimensions of fam­GRANDMOTHERS:THE LEARNING INSTITUTION3

“A grandmother’s understandingof Indian identityis an invaluable perspectivethat she is ableto pass on to her grandchildren.Grandmothersas-culture-transmittermay be one of the mostsignificant contributionsto the perpetuation ofthe Indian community.”M.M. SchweitzerAmerican IndianGrandmothers:Traditionsand Transitionsily systems, including the social hierarchywithin families associated with age andexperience that dictates individualbehavior to a great extent.Along with the absence of adequateassessment of the components anddynamics of family systems in differentsocio-cultural contexts, there is a tendencyto erroneously project onto nonwesternsocieties western concepts ofnuclear families, and of autonomouswomen and couples who operate independentlyof family systems. This orientation/tendencyis seen in education programsthat involve only “parents,” definedas children’s mothers and fathers, andchild health programs that narrowlyfocus on women of reproductive age oron the mother-child dyad. Limited focushas been directed at understanding theroles of and including other non-parentalfamily and community actors in childdevelopment strategies. In almost allcases, in child development programs,both at the initial assessment phase andin the design of community-orientedstrategies, senior household and communitymembers, including grandparents,are excluded.Anthropologist Margaret Mead (1970)was among the first social scientists topoint out the critical role played bygrandparents in transmitting from onegeneration to the next the “model” ofhow things should be done in life, includinghow children should be nurtured andtaught how to survive in each society.Similarly communicologist, AndreasFuglesang (1982) discussed the multifacetedrole that grandmothers play inthe socialization process of the youngergenerations and asserted that grandmothersconstitute a veritable “learninginstitution” in the community.Professor Scarlett Epstein, from theInstitute of Development Studies at theUniversity of Sussex, has pointed out thecritical role played by grandmothers ininculcating in children the moral, social,and cultural norms that determine individualbehavior later in life (Epstein 1993,2003). She states that in most developingcountry settings, grandmothers’ influenceis great, given that they live close totheir offspring and are respected bythem. Grandmothers provide ongoing“informal training” both to their childrenand grandchildren. Epstein has been anoutspoken advocate of the need fordevelopment activities related to childrenand women’s health and developmentto acknowledge and build on therole of grandmothers.In the so-called “developed” world, thereis a tendency for grandparents to bemuch less involved in the socializationand care of grandchildren than was historicallythe case. Nevertheless, in allcultures, grandparents continue to beinvolved and to influence, to a greater orlesser extent, the lives and developmentof the younger generations. Recentefforts to promote intergenerationallearning in western countries, for exampleby involving elders in school programs,is a sign of the recognition of thecontribution grandparents can make tothe development of the youngest membersof society. In most parts of Africa,Asia, Latin America, and The Pacific,4 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

grandparents continue to play a criticalrole in guiding and supervising the youngergenerations; parents and children alike. Invirtually all cases it is the grandmotherswho play a greater and more direct role ina child’s development than do grandfathers,though this does not deny theinvolvement of grandfathers in someaspects of a child’s overall development.It is important to note that in this review“grandmother” is used as a “generic” termto refer not only to biological or paternalgrandmothers but to all of the older, experiencedwomen in a family who serve asadvisors to younger family members onmultiple aspects of child and family development.In addition to the veritablegrandmothers, this can include aunts andunmarried senior women who play a roleas family advisors. In patrilineal societies,the child’s grandmother is the woman’smother-in-law.Clearly traditional family and communitystructures are in transition in virtually allsocieties. In this context, it is important toask ourselves, “Do child development programsserve to bolster traditional familyand community structures, roles and values,including the role of experienced, seniorfamily members, for the benefit of childrenand their families?” Or, “Are childdevelopment programs merely acquiescingto the increasing rift between local, traditionalroles, values, and resources and globalizingforces of ‘modernity’ and ‘individualism’that is contributing to breaking downthe social cohesion of more traditionalcommunities systems around the world?”CONCEPTUAL FRAMEWORKThis review of literature, policy, and programsis framed by several key conceptsthat are often not given much attention inthe design of child development programs.These concepts include a systemsapproach; an assets-based approach; culturalstructures; roles and values as a foundationfor program design; respect for eldersand their experience; and social capital.Each of the concepts is explained below,along with its relevance to the discussionof grandmothers’ involvement in childdevelopment programs. As will be seen,each of these concepts has implications forhow child development strategies and programsare designed, both in terms of analyzingcommunity realities and in developinginterventions.• Systems ApproachIn many past child development programsthere has been a tendency toadopt a reductionist approach thatfocuses only on children, or on thechild-mother dyad. This approach simplifiesthe parameters dealt with bothin initial assessments and in programdesigns. However, such an approach isinadequate in so far as it provides alimited vision of the household systemof which children are a part. Thisrestricted focus on only certain membersof the household necessarily concealsthe roles of household actors inaddition to mothers, namely older siblings,men, and senior women, and theinfluence they have on each otherrelated to children’s well-being. In contrast,in a systems approach children’sneeds are analyzed and addressed in" Successful programsuse the existingstrengths of communities,families, andsocial structures….toprovide the best forchildren."UNICEFThe State of theWorld's Children:Early ChildhoodGRANDMOTHERS:THE LEARNING INSTITUTION5

“Culture tells peoplehow to view the world,how to experience itemotionally and howto behave in relationto other people, supernaturalforces and inrelation to their environment.It is the ‘lens’through which peopleperceive and understandthe world inwhich they live.”J. Sengendo“Culture and Health”in F. MatrassoRecognizing Culture:ASeries of BriefingPapers on Culture andDevelopmentUNESCOrelation to the roles, attitudes andpractices of all key family and communityactors. In this more holisticapproach, program strategies aim toreinforce the various actors within thefamily system, including grandmothers,who influence children’s well-being.• Assets-based ApproachWhile all families and communitieshave inadequacies and problems, theperception of those weaknesses byprograms and staff significantly determinetheir attitudes toward them andthe type of interventions developed.Kretzmann and McKnight (1993) suggestthat often in social programs thefocus is put on the problems or“deficits” in a community, while inthose same communities there areundoubtedly certain resources, or“assets” on which to build.They referto the latter option as an “assetsbasedapproach.” Applied to childdevelopment programs, this latterapproach implies that programsshould, first, identify existing familyand community resources that contributeto child development, andsecond, aim to strengthen them.Grandmothers constitute one of theexisting resources that can bestrengthened in such programs.• Cultural Structures, Roles, and Valuesas a Foundation for ProgramDevelopmentWhile lip service is often given to theimportance of cultural realities todevelopment programs, often thecultural dimension is absent fromdevelopment planners’ frameworksand program designs (Serageldin1994). In the past few years, itappears that this dimension of developmentplanning is being givensomewhat greater attention. FormerWorld Bank Vice President IsmailSerageldin argues that “A culturalframework is … a sine qua non tohave relevant, effective institutionsrooted in authenticity and traditionyet open to modernity and change”(Serageldin, 19).To some extent the cultural dimensionhas been taken into account indevelopment projects, yet too often“culture” is considered in a verysuperficial way and is equated with acultural practice (i.e. how initiationceremonies for young girls are organized)(Pelto 2003). In this regard,social psychologist Pepitone (1981)proposes a more inclusive definitionof “culture” composed of two interrelatedfacets. First, there are thesocial structures and organizations inwhich individuals exist in relation tothe family, kinship, roles, hierarchies,and communication nets. Second,there are the normative systems thatinclude the values and beliefs promotedwithin the family system thataffect behavior. In child developmentprograms, and development programsin general, the tendency hasbeen to ignore the first facet. Ifchild development programs aim tobuild on existing culturally-definedfamily and community roles, hierarchies,and communication nets, thisimplies that grandmothers and grand­6 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

mother networks should be involvedin efforts to improve the well-beingof children. In addition, building onexisting cultural systems is more likelyto contribute to the sustainability ofchild development strategies, includingbasic education initiatives.• Respect for Elders and Their Age andExperienceIn contrast to western societies,where youth is glorified, in virtually allnon-western societies there is muchmore respect for elders, their age,and their experience. In Mali there isan often-heard proverb in bamana 5that refers to the wisdom of the elders:“Whatan elder can see sittingunder a tree, a younger person cannotsee even if he/she climbs up tothe top of the tree.”In virtually all non-western societies, from ayoung age children are taught that theyshould respect, listen to, and learn fromtheir elders. This traditional cultural valuestill holds considerable weight in mostnon-western societies but it is being jeopardizedby the encroachment of alternative,often foreign, values that aggrandizeyouth and accomplishment in the formalschooling system and give less credence tothe wisdom of the elders. For example, inMalian communities, many grandparentssaid (Touré and Aubel, 2004) that mostdevelopment programs that have come totheir villages only involve “young people”and “those who have gone to school”thereby excluding most elders in the community.Such an approach contradicts traditionalvalues in which the elders areexpected to play an advisory role withyounger members of the society.• Social CapitalMany development programs aim tostrengthen “human capital” i.e., theskills and capacity of individual communitymembers. In contrast,“socialcapital” refers to the strength of therelationships between people. It hasbeen referred to as the “glue” thatkeeps a community together and thatis required for a collective and sustainedresponse to community needs.Social capital refers to the networkswithin a community that are basedon trust and mutual support thatcontribute to a sense of belonging,promote inclusion and involvementof different community factions, andare empowered to promote selfreliance.Increased social capital is anasset for promoting and sustainingchildren’s development within thecommunity.In the past, grandmothers were not systematicallyinvolved in child developmentprograms at the community level. Each ofthe concepts discussed above supports theidea that grandmothers constitute a valuablecommunity resource that needs to betaken into consideration in the design ofchild development programs. In this review,these several concepts will be referred toin the subsequent discussions of grandmothers’roles, child development policies,and programs.FACTORS LIMITING THEINCLUSION OF GRANDMOTHERSIN CHILD DEVELOPMENTPROGRAMS.The explanation for the relatively limited“This is a rule in oursociety, you must listento what your eldersadvise. Sincetime began peoplehave learned fromtheir elders.”Community Leader,Navoi, Uzbekistan“Social capital is acommunity’s humanwealth. It is a powerfulmotor for sustainabledevelopmentbecause it harnesseslocal capacity,indigenous knowledge,and selfreliance.”H. Gould“Culture and SocialCapital” in F.Matrasso, RecognizingCulture: A Series ofBriefing Papers onCulture andDevelopment,UNESCO5 Bamana is the language spoken by the Bambara people of Mali.GRANDMOTHERS:THE LEARNING INSTITUTION7

attention given to grandmothers’ roles inthe development literature, and their limitedinclusion in community developmentprograms, appears to be related both to aseries of negative biases toward them andprogramming models that tend to excludethem. In this section, these constrainingfactors are explored, after which evidenceof grandmothers’ roles in different societiesaround the world is presented.In all societies around the world, seniorwomen, or ‘grandmothers,’ are present incommunities and neighborhoods, and theyare part of most extended families. Giventhis reality, it is surprising that there is verylittle discussion in the development literatureof their role and influence on the livesof children, families, and communities. Ofthe numerous documents that have beenwritten dealing with ECD, education, nutrition,health, and hygiene of young children,very few even mention the role of grandmothers.When they do, they are oftenreferred to in a negative light.There are a series of negative stereotypes,or biases, regarding the role of olderwomen, which tend to discredit theirexperience and limit their inclusion in childdevelopment programs.First, there is a widespread belief thatolder women do not really influence thechild development practices of youngerfamily members, including older siblings.This attitude can be attributed, in part, tothe curricula used in professional trainingschools in most developing countries onchild development, education, health, andnutrition. These curricula are based primarilyon imported, western programs. Suchtraining programs are, therefore, based onthe western, nuclear family in which youngparents are responsible for their own childrenand in which elders play a relativelylimited role. In numerous instances andcountries, child health/development staffhas denied the significance of the role andcontribution of grandmothers until theywere presented with empirical evidencesupporting that substantive role.The second often-heard bias is that whileolder women may be influential in thefamily, their influence is generally “negative.”It is often said that their ideas and practicesare “old fashioned,” “out-of-date,”and/or “harmful.” This attitude is oftenexpressed by child health/developmentworkers in developing countries as well asby program managers in developmentorganizations. For example, health workersoften criticize older women for theiruse of “harmful traditional remedies” andconsequently discredit grandmothers’ rolein child and family health matters. Similarlyearly childhood development practitionersoften criticize grandmothers because theirchildcare practices do not reflect “modernapproaches.”A third bias, that exists particularly wherethere are high illiteracy levels amongstolder women, is that women who are illiterateare not intelligent and, therefore,they are unable to comprehend new ideas.This unfortunate bias equates schoollearning with superior intelligence andundervalues experiential life learning.Yet a fourth stereotype, which afflictsgrandmothers and grandfathers alike, is thewidespread belief that older people are8 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

incapable either of learning new things orchanging their ways due to their age. Theessence of the saying in English about olddogs not being able to learn new tricksexists in many cultures. For example, inLaos it is frequently said that “you cannotbend an old piece of bamboo.” Based onthe belief that grandmothers are by natureresistant to change, many developmentpractitioners assume that grandmothersare both unwilling and unable to assimilatenew child development knowledge andpractices.The last factor is the restricted perceptionof older women as being “needy” and“dependent” that ignores the many grandmotherswho are active and resourcefulmembers of households and communities.In developing countries where mostwomen marry and have their first child bythe time they are twenty, most womenbecome grandmothers at an early age andremain active in this role until they are atleast sixty or older. In this sense, the perceptionof grandmothers as generallydecrepit and dependent is inaccurate.All of these stereotypes are reinforced byattitudes of ageism, which gerontologistsdefine as the “unwarranted application ofnegative stereotypes to older people”(Fennell et al l988, 97). Ageist attitudes areembedded in western, youth-focused cultures,and they appear to influence thethinking of many western-oriented developmentagencies, their policies and programs.The combination of these several stereotypesseem to explain the rather negativeattitude in development programs towardgrandmothers’ roles and experience andtoward their potential to promote optimalchild development in households and communities.While these biases against grandmothersappear to be quite widespread,they can be overcome. In several of thechild development programs (discussedlater) in which an explicit effort was madeto help development staff reexamine theirattitudes toward these senior women, verypositive changes have been observed intheir perceptions of and attitudes towardgrandmothers.A second factor that works against theinclusion of grandmothers in child developmentprograms comes from the restrictivemodels, or frameworks, typically used bothto assess children’s developmental needsand to design program strategies. Asintroduced in the conceptual frameworkused for this review, in most cases,whether programs address ECD, nutrition,health, cognitive development, or otherissues, there is a tendency to assess children’sneeds only at the level of the childor the child-mother dyad. Most programsare not based on a holistic analysis of theinterface between children and householdactors, resources, values, and interactionrelated to a child’s development.The predominant concepts and modelsthat underpin most programs promotingECD, health, nutrition, and other developmentissues are rooted in North Americanconcepts from behavioral psychology. Thisis a field that focuses on individuals isolatedfrom their social environment. The moresystemic perspectives on the growth anddevelopment of children—from ecology,anthropology, community psychology, andGRANDMOTHERS:THE LEARNING INSTITUTION9

social work, including family systems theory—havetraditionally had much less influenceon the conceptual orientationsadopted in child development programs.For example, in the child health and nutritionfield, there is very limited discussion offamily systems theory (Hartman & Laird1983), which provides tools for andinsights into intra-household interaction,influence, and decision-making.The resultof this predominant orientation is thatmost child development programs adopt anarrow focus on children, their mothers,and occasionally their parents, while ignoringother significant family members, suchas grandmothers.In conclusion, it appears that the combinationof several negative stereotypes aboutgrandmothers and the narrow conceptualmodels used in child development programshave contributed to obscuring therole played by grandmothers, discreditingtheir involvement in children’s developmentat the household and communitylevel, and, finally, excluding them from childdevelopment programs.Alternatively, as proposed above, if oneadopts a systems approach to the designof child development programs, strategiesshould aim to strengthen the knowledgeand practices of all key family memberswho are involved, either directly or indirectly,in promoting child health, growth,and development.GRANDMOTHERS’ ROLES INDIFFERENT CULTURESIn this section, the roles of senior womenor grandmothers in families and communitiesin diverse cultural settings around theworld is reviewed. This includes discussionof the available literature from Africa, Asia,Latin America and The Pacific, as well asfrom Native American nations andAboriginal Australia. Many other annotatedreferences from each region of theworld are found in Appendix B.The lastsection in this chapter presents a summaryof what appear to be generic roles ofgrandmothers that exist across cultures.AFRICAIn a discussion of child-rearing roles andpractices in African societies, Apanpa(2002) discusses the constant interactionof grandmothers, aunts, and other familyand community members with African childrenfrom their first days of life. All of thisstimulation contributes to children’s socializationand development. Apanpa reportsthat studies conducted in Uganda, Senegal,Botswana,Tanzania, Nigeria, Zambia, andSouth Africa have all shown that Africaninfants’ psychomotor development is precociousas compared with that ofEuropean children. Researchers associatethis with the intense handling by familymembers, especially by senior women,who interact constantly with infants.In most African societies, in all mattersrelated to the well-being of women andtheir children, there is a clear hierarchy ofauthority in the household of seniorwomen over younger women. For example,Castle (1994) discusses the “hierarchicaltransmission of knowledge” from mother-in-lawto daughter-in-law in the householdcare of sick children in Fulani andHumbebe households in Mali. She alsorefers to the “authority and superior status10 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

of senior female household members”over younger females in the household(1994, 330). These same patterns arefound in numerous ethnic groups acrossAfrica.ASIAIn Chinese culture, a traditional and centralfunction of older women is to care forchildren in the family. Studying Chinesefamily systems in both Singapore andTaiwan, Jernigan and Jernigan (1992) foundthat this task not only provides an essentialservice to families but it also contributesto older women’s sense of validation andpurpose in life. According to Dr. Pang(l998), a former Vice-Minister of Health incontemporary mainland China, grandmotherscontinue to play an important advisoryrole with their daughters and daughters-inlaw.She notes that the advisory roleplayed by grandmothers can be explained,first, by the important Chinese culturalvalue of respect for elders, and second, bythe fact that with the “one child policy”most women giving birth are first-timemothers and need advice from moreexperienced women on various childcarematters.In line with Dr. Pang’s analysis, recentresearch in Eastern China has revealed theextensive role of paternal grandmothers.In most cases this role involves childcarewhile their daughter-in-laws are workingoutside the home (Yajun et al 1999).Grandmothers play a leading role in variousaspects of child development, includingnutrition, hygiene, and toilet training, as wellas informal teaching related to Chinese valuesand traditions. When children are sick,grandmothers also play a role in advisingand treating, often using traditional remedies.In Thailand, Professor Sakorn, of theInstitute of Nutrition at Mahidol Universityin Bangkok, a prominent nutritionist inSoutheast Asia, points out the very importantrole played by grandmothers in contemporaryThai society (Sakorn 2003).She states that an important value in Thaiculture is respect for age and experience.In this context grandmothers are lookedto for their advice and guidance in all mattersrelated to children’s health and wellbeing.With many women working eitheroutside the home or in another part ofthe country, the role of grandmothers inchildcare is significant.Available evidence suggests that in CentralAsia, paternal grandmothers play a veryinfluential role in all children’s developmentalmatters and have strong influence ontheir daughter-in-laws. In a rapid assessmentconducted recently in southernUzbekistan (Aubel et al 2003) it was concludedthat Uzbek families view the grandmothersas knowledgeable and important“general managers” of day-to-day familylife. In matters related to the well-being ofchildren and women, both husbands andwomen alike consider them to be thehousehold authorities and seek theiradvice. From the time that a child is born,the daughter-in-law is expected to followthe advice of her mother-in-law regardingthe care and education of the child.Furthermore, husbands expect their mothersto play this role and they expect theirwives to follow the advice provided tothem. In the same region, anecdotal infor­GRANDMOTHERS:THE LEARNING INSTITUTION11

mation from Azerbaijan (McNulty 2003;Capps 2004) and Kyrgyzstan (Dolotova2003) provides evidence of the stronginfluence of mother-in-laws on the socializationand management of children andyounger women at the household level.In southeast Europe, evidence fromAlbania (HDC 2002; Waltensperger 2004)reveals that the mother-in-law’s centralrole in infant care and child rearing is culturally-dictatedand supported by otherfamily members. The influence of seniorwomen in the family extends to fertilitydecisions, care-seeking during pregnancy,newborn care, and socialization of youngchildren in the family and community. Inhouseholds where mothers-in-law arepresent, they provide advice and oversightto their son’s wives and guidance to theirsons on all matters related to the wellbeingof children and women.LATIN AMERICAEvidence from several countries in LatinAmerica also shows that in various culturalcontexts older women play an advisoryrole on child development issues at thehousehold level. In Saguaro Indian communitiesin Ecuador, Finerman documentedthe leading role played by senior femalefamily members in health promotion andillness management (1989a & 1989b).Similarly, describing household dynamicsaround illness episodes in the Ecuadorianhighlands, McKee (1987) refers to grandmothersas the ”primary medical specialists”within the family, suggesting the essentialrole they play in child and family healthmatters. While there is considerable culturaldiversity between the multiple ethnicgroups across Central and South America,anecdotal evidence from key informantssuggests that the core roles played bygrandmothers in socialization and childrearingare similar in Bolivia (Fernandez2000), El Salvador (Velado 2003),Nicaragua (Alvarez 2003) and Ecuador(Escobar 2003).NORTH AMERICASchweitzer and colleagues (1999) discussthe central role played by grandmothers inchild development in seven contemporaryNative American cultures.Their analysisreveals two critical dimensions of grandmothers’role in child development. First,they are “almost universally engaged inchildcare and childrearing” (Schweitzer 8)and second, they play a central role in theenculturation process of young NativeAmericans based on their knowledge ofIndian traditions and values. They concludethat this second dimension is of invaluableimportance to these minority cultures inNorth America.While it might be assumed that the role ofgrandmothers is diminishing in NativeAmerican cultures, Schweitzer’s conclusionrefutes this assumption, “The importanceof grandmothers in earlier times is echoedin grandmothers’ lives today….the continuingimportance of the grandmotheringrole” (18). Another significant, and perhapssurprising, observation of theseresearchers is that while Native Americangrandmothers are committed to preservingtradition, they are simultaneously interestedin adapting to change.Native American educationalist, Sam Suina(2000), discusses the vital teaching role ofNative American grandmothers in convey­12 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

ing to children their connectedness withtheir elders, their ancestors, and the earth.He discusses the problems of disconnectedness(with traditional values and ceremonies)and dysfunction in contemporaryNative American families and schools andthe role of wise grandmothers in promotinginterrelatedness and continuity inNative beliefs, values, and practices. It islargely through storytelling that grandmothershelp children connect with Nativepeople’s language, values, and cultural traditions.In various Native American culturesthe vital teaching role of grandmothers isdepicted in a visual image, reproducedeither on paper or in clay, of a large grandmotherwith numerous small children ontop of and around her. This image profoundlyreflects the dual teaching and nurturingrole of grandmothers in NativeAmerican cultures.Similarly, in Sioux culture grandparents playa vital role “as cultural links to the traditionsof the past and as islands of certaintyin ever-changing society.” Native Americaneducationalist Kincheloe (Kincheloe &Kincheloe 1983) describes the importantrole of grandmothers in child developmentfrom the time of birth, as child-care supportfor busy mothers and as educatorson all aspects of life. The authors lamentthe fact that formal schools do not incorporatethe knowledge and wisdom of theelder, traditional Sioux educators. “Theschools must not contribute to Americansociety’s tendency to push olderAmericans into the background” (136).She asserts that most formal teachersignore the fact that grandparents constitutea valuable resource and ensure the“cultural link” in the development of Siouxchildren. She poignantly argues, “Societyitself fails when it isolates the young andthe old from one another” (135).AUSTRALIA AND THE PACIFICIn all Aboriginal societies in Australia,respect for the family, tradition, and theelders are important precepts. Within thisframework, senior Aboriginal women areexpected to serve as advisors and guidesfor young women and families (Wilson1999; Koori Elders et al. 1999). As regardsthe health and well-being of women andchildren, senior women are expected toshare their expertise and pass on to themtraditional ways of promoting health andhealing.In The Pacific there has been virtually nopublished research on the role of grandmothersin children’s development, accordingto well-known public health doctors,Biuwaimai (1997) and Kataouanga (1998),public health nutritionist, Susan Parkinson(2003), and community development practitioner,Wanga (2002). On the otherhand, all four of these key informants stateunequivocally that in all Pacific island cultures,older women have played in thepast, and continue to play, a significant roleat the household level in all matters relatedto child health and development.Parkinson states that in both rural, and socalled“urban contexts,” senior women playan important role in childcare, and particularlywith infants (2003). She states that inboth major ethnic groups in Fiji, theIndigenous Fijians, and Indo-Fijians, bothgrannies and aunties in the family areimportant household advisors and teach­GRANDMOTHERS:THE LEARNING INSTITUTION13

“The status of eldersin traditional societiesreflects the fundamentalrole theyplay in the functioningand survival ofthose societies.”FugelsangAbout Understanding:Ideas andObservations onCross-CulturalUnderstandingers. She laments the fact that these seniorwomen have generally been excludedfrom health, nutrition, and childrearing programsoften on the pretense that they areilliterate.The literature reviewed above shows thatin numerous non-western cultures inAfrica, Asia, Latin America and The Pacific,as well as in indigenous cultures in NorthAmerica and Australia, grandmothers playa significant role in children’s health anddevelopment. Based on this review, thefollowing section is a discussion of a seriesof core roles of grandmothers that wouldappear to be universal.CORE ROLES OFGRANDMOTHERS ACROSSCULTURESBased on a synthesis of the literaturereviewed above, as well as that included inAppendix B., on grandmothers’ roles inchild development in different non-westernsocieties, several conclusions emergerelated to a series of core roles andexpectations of grandmothers that appearto be common across these cultures.While the focus of our discussion is on therole of “grandmothers” given their genderrelatedspecialization in child developmentissues, in some cases the core roles andexpectations refer more broadly to therole of “grandparents.” The core roles andexpectations identified across cultures areas follows:• All cultures recognize the critical roleof grandparents as guides and advisorsto younger generations.Family members expect grandparentsto play a role in teaching, guiding, andadvising the younger generations.Resonating Margaret Mead’s words,grandparents are expected to passonto the next generation the“model” for how things should bedone whether it is in Nepal,Colombia, or Nigeria. Furthermore,in virtually all of the non-western culturesrepresented in the reviewed literature,age and experience are valuedand family members are expectedto show respect for the statusand advice of grandparents.• In all cultures grandparents play gender-specificroles related to childdevelopment.In all societies, different roles are designatedto grandfathers and to grandmothers,just as gender-specific rolesare assigned to younger men andwomen. Senior women have primaryresponsibility for socializing youngerfemales to their role in the family andsociety, while senior men have analogousresponsibility for providing informaltraining to male family membersonce they pass childhood, often fromthe age of seven or eight. While inall cases grandmothers are moreinvolved in the care of children andwomen in the family than are grandfathers,given their lifetime experience,the degree of involvement ofgrandfathers in childcare varies considerablyfrom one society to another.• Grandmothers are responsible fortransmitting cultural valuesWhile grandfathers too, are involvedin this important task, in most soci­14 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

eties grandmothers play the leadingrole in transmitting to young childrencultural values and practices. Animportant activity related to this roleis story-telling, through which grandmotherspass on to their grandchildrenthe cultural values and traditionsthat are specific and special to eachsociety. Their role as “culture-transmitters”is critical to maintaining bothindividual and collective cultural identifyin an increasingly culturally-homogenousworld.• Grandmothers’ child-rearing expertiseis acquired over a lifetime.When young girls are growing up,they are taught by older female familymembers how to carry out certainchild-care tasks based on the normativesocio-cultural practices. Thisteaching is done by the older femalesin the household, including theirmothers, aunties and grandmothers.For example, in most cultures whenyoung women give birth, they areunder the authority and guidance ofsenior women in the family on howto care for their infants.With theirfirst child, young mothers are verydependent on these senior advisors.As their knowledge increases theybecome less dependent, though stillunder the supervision of grandmothersand aunties in the family. By thetime women become grandmothersthemselves, they have considerableexperience related to all aspects ofchild bearing and raising. Withincreased age comes more knowledgeand experience and, at thesame time, more confidence in theirown expertise.• In all cultures grandmothers areinvolved in multiple aspects of thelives of children and families at thehousehold level.The available literature from Africa,Asia, Latin America, and The Pacificprovides examples of grandmothers’involvement in multiple facets of childand family growth and development.They are interested in promoting thecomprehensive well-being of theirgrandchildren. As such, their roleincludes psychological, cognitive andpsycho-motor stimulation of youngchildren, teaching related to hygiene,moral and cultural development, andpromotion of good health and nutrition.• The roles of grandmothers appear tobe universal whereas much of theirknowledge and practices are culturallyspecific.There is often a tendency to noticethe differences in the child development-relatedpractices of grandmothersfrom different socio-cultural contextsand to overlook the fundamentalcommonalities between them.While grandmothers’ culturally-relatedtraits differ greatly from one societyto another, there appears to beconsiderable similarity in their coreroles across cultures.• Grandmothers are both directly andindirectly involved in promoting thewell-being of children.Grandmothers are directly involvedGRANDMOTHERS:THE LEARNING INSTITUTION15

“As women, thegrandmothers havelived through manythings.That is why wecompletely depend onthem to care for ourwives and children.”Young married manMali“Programs shouldhelp traditional andexisting caregivers toincrease their knowledgeand adapt theirmethods.”Bernard van LeerFoundationin promoting the well-being of childrenin the family through their interactionand caring for grandchildren.They are indirectly involved throughtheir advice to other family memberson issues of child well-being. Theirdirect involvement with their grandchildrenconsists of two facets: first,the socialization, acculturation, andteaching of grandchildren, and second,the provision of emotional, spiritual,and physical care and support tothem. Their interaction with otherfamily members includes both teachingand supervising younger womenand girls, and advising fathers andother male family members on issuesrelated to women’s and children’swell-being.• Grandmothers influence the attitudesand decisions made by male familymembers regarding children’s wellbeing.In most cases, men have limitedexpertise on issues of children’s andwomen’s development and well-being.Usually when men need to make adecision related to the well-being ofchildren or their mothers, they seekthe advice of senior women in thefamily. This pattern is particularlystrong in patrilineal households. Inmatrilineal situations, where sons livewith their wives in close proximity totheir wife’s parents, the advisory roleof senior women vis-à-vis men stillusually exists. In both cases husbandsand male heads of extended familiesgenerally look to experienced, seniorwomen for advice on these matters.• Some of grandmothers’ practices arebeneficial for child developmentwhereas others are not..There are many specific examples(See Appendix B) of beneficial traditionalpractices related to children’sdevelopment that are promoted bygrandmothers, such as exclusivebreastfeeding and extensive affectiveand psychomotor stimulation ofinfants. There are also examples,however, of harmful traditional practicespromoted by senior women,including the use of certain traditionalremedies, female genital mutilationand sexual initiation rites thatincrease the risk of HIV transmission.In some of the literature reviewed,the tendency is to criticize seniorwomen and exclude them from childdevelopment programs because ofcertain harmful practices. A differentperspective says that grandmothersshould be included in programs inorder to validate their positive practicesand to encourage them tochange the detrimental ones.• Grandmothers have a very strongcommitment to promoting the growthand development of their grandchildren.Grandmothers and family membersalike emphasize the love that grandmothershave for their grandchildrenand their strong commitment to promotingtheir well-being. In all culturesthere are sayings referring to the specialrelationship that exists betweengrandmothers and grandchildrenbased on the value of grandchildren16 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

to grandmothers.The universality ofthis sentiment on the part of grandmothersis expressed in a saying foundin Uzbekistan, Albania, Senegal andMali,“For the grandmother her ownchild is like milk whereas her grandchildrenare like cream.” In many culturesgrandmothers express the sentimentthat their greatest satisfaction inlife is caring for their grandchildrenand seeing them develop.• Compared with younger women,grandmothers generally have moretime to spend and more patiencewith young children.Most younger women in poor householdshave multiple tasks to carry outrelated to domestic, childcare, andextra-household activities to ensurethe survival of their families.Expectations of them are great andthe time and resources available tothem for carrying out all of theseresponsibilities are usually limited.Due to the status of older women inthe family and their delegation ofmany domestic tasks to youngerwomen, grandmothers generally havefewer responsibilities, more timeavailable, and more patience wheninteracting with children. Youngerwomen often report that grandmothershave more patience thanthey do to interact with and care foryoung children. Grandmothers oftentake responsibility for time-consumingtasks such as feeding young children,caring for them when they are sick,telling them stories, teaching themabout traditional values, or sometimeslistening to them read.• Most grandmothers are interested inincreasing their knowledge of “modern”ideas about child development.Contrary to the stereotypes aboutolder people’s resistance to newideas, there is considerable evidencethat grandmothers are, in fact, veryinterested in learning new thingsabout children’s development. Oftenthey admit that their knowledge is“old-fashioned” and express theirinterest in learning about “modern”ideas in order to improve their ownpractice. Their ability to acquire newknowledge is, however, very muchdetermined by the approach usedwith them. In some cases grandmothershave clearly stated that theteaching approach used with themmust be based on respect, dialogue,and negotiation.• Grandmothers’ knowledge comesprimarily from their mothers andtheir peers.Much of grandmothers’ knowledgeon children’s development comesfrom what they learned from theirmothers and grandmothers. In addition,their thinking is influenced byideas they glean from their peers,namely other senior women in theirsocial networks. Such networksappear to be a universal phenomenon,usually composed of women ofmore or less the same age who areprimarily either family members orneighbors. These networks allow forsharing and learning based on newand old information alike. Withinsuch networks, there is a hierarchy ofexperience and the less experienced“Grandparents offerlove and quietness totheir grandchildren.”Report onECD in AlbaniaHuman DevelopmentCenterGRANDMOTHERS:THE LEARNING INSTITUTION17

members often consult the moreexperienced ones when faced withdifficult problems related to familyhealth and well-being.• Many grandmothers have a collectivesense of responsibility for childrenand women in the community.In western societies, grandmothersfeel responsible for their own grandchildren,daughters, and daughters-inlaw.In contrast, in non-western societiesmany grandmothers expressand demonstrate their concern forother women and children in thecommunity, specifically those in theirown extended family and neighborhood.For example, if a child is upsetor is quarreling with other children, agrandmother from another family willintervene to help. If a pregnantwoman does not have a seniorwoman living with her, an experiencedneighbor will often give heradvice during her pregnancy andafter delivery. The traditional ideathat “it takes a village to raise a child”is still applied in many places, particularlyin more rural areas. In manyurban settings, however, the conceptof collective responsibility for children’supbringing is increasingly beinglost.• Some grandmothers feel that theirstatus as advisors in child and familydevelopment is diminishing.In many settings some grandmothersexpress the feeling that with thearrival of “modern ideas” in theirhouseholds and communities, respectfor their experience is diminishingand they are gradually being marginalized.Some lament the fact thatthey are progressively being excludedfrom playing the central role in childand family development that theytraditionally assumed. Often theyidentify formal schooling as a factorthat pulls children away from eldersand their traditions insofar as schoolcurriculums usually fail to link traditionaland “modern” values. Manygrandmothers are critical of youthcentereddevelopment strategies thatexclude them and contribute todiminishing their status as advisors onchild and family matters.The overarching conclusions that emergefrom this literature review are that grandmothersare present in all cultures andcommunities, that they have considerableexperience related to all aspects of childdevelopment, and that they are stronglycommitted to promoting the well-being ofchildren, their mothers, and families. Forthese several reasons, they constitute avaluable resource for child developmentprograms. Families around the worldacknowledge that grandmothers play aninfluential role in the socialization, acculturation,and care of children as they growand develop. While there are examples ofharmful practices promoted by grandmothersin various cultures, the wide-rangingrole they play and the respect theyenjoy in virtually all societies suggest thatthey should be key actors and partners inall child development programs. It is onlythrough their active involvement thatgrandmothers can learn about “modern”child development practices, build on their18 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

traditional wisdom, and increase their contributionto child development at the familyand community levels.DEVELOPMENT POLICIESSUPPORT GRANDMOTHERS’INCLUSIONThe policies of international developmentorganizations involved in promoting childhealth and development have a determininginfluence on the approaches adoptedin child development programs around theworld. Major international organizationsinvolved in this field include UNICEF,UNESCO, the Consultative Group onEarly Childhood Care and Development,and the Bernard Van Leer Foundation. Inthe child development programs supportedby these various organizations grandmothershave not played a priority role inthe past. One of the important steps inthis review was, therefore, to examine policyguidelines defined by these internationalbodies in order to determine whethertheir policy priorities support either theexclusion or inclusion of grandmothers inchild development programs.Core concepts related to the role ofgrandmothers in families and communitiesand to their potential involvement in childdevelopment programs were identified inthe policy statements of these key organizations.These core concepts and theirassociated policy statements are listedbelow:• Strengthening family systems.“The family is and should remain theprimary institution for supporting thegrowth and development of children”(Consultative Group on ECCD 1993,34).“Help traditional and existing caregiversto increase their knowledgeand adapt their methods” (Bernardvan Leer Foundation 1993, 18).• Building on cultural roles and values.“Successful programs are developedwith and for communities, respectingcultural values” (UNICEF 2001, 17).• Integration of traditional and modernchildcare practices.“The need to blend the ‘traditional’and the ‘modern’” (Bernard van LeerFoundation 1993, 3).• Building on community resources andstrengths.“Successful programs use the existingstrengths of communities, families,and social structures …to providethe best for children” (UNICEF 2001,17).• Strengthening community supportmechanisms for children and theirfamilies.“Rekindling a sense of communityand reinvigorating informal systems ofsupport should figure prominently inthe design of social policies and programmes”(Consultative Group onEarly Childhood Care andDevelopment [ECCD], UNICEF1993, 35).• Building social capital for sustainabledevelopment.GRANDMOTHERS:THE LEARNING INSTITUTION19

“Social capital is a community’shuman wealth – the sum total of itsskills, knowledge, and partnerships. Itis a powerful motor for sustainabledevelopment because it harnesseslocal capacity, indigenous knowledgeand self-reliance” (UNESCO 2001, 69in Gould).An initial examination of these policy statementsdoes not reveal explicit reference tothe role and involvement of grandmothers.Rather surprisingly, none of the policystatements of these leading child developmentorganizations directly refers to therole or involvement of either “grandmothers”or “grandparents” in child developmentactions. However, a closer analysis ofthese policy priorities reveals that they doprovide support for the inclusion of grandmothersin child development programming.Table1 below suggests how each ofthe policy statements (left column) do infact support the integration, or inclusion, ofgrandmothers in child development programs(right column).This analysis leads to the conclusion thatthere is a significant discrepancy betweenthe policy statements of key internationalorganizations that support the inclusion ofgrandmothers in child development programsand the virtual absence of thesesenior women in child development programming.Each of the statements in theright column clearly suggests how grandmotherscan be incorporated into communitylevel program activities. Examplesof how various programs and projectshave involved them are presented in thefollowing two chaptersTABLE 1: Policy Support for the Inclusion of Grandmothers in Child Development ProgramsChild Development PolicyPrioritiesImplications for the Inclusion of Grandmothers inChild Development Programs1. Strengthening family systems Grandmothers should be full partners in all efforts tostrengthen family systems.2. Building on cultural roles and Grandmothers’ roles and experience in children’svalues.development should be reflected in materials andactivities.3. Integration of traditional and Grandmothers’ practices should be inventoried, themodern childcare practices. beneficial ones encouraged, and the harmful onesslowly discouraged.4. Building on community resources Grandmothers should be viewed as a positive forceand strengths.for children’s development, while at the same timethey are provided with opportunities to strengthentheir practices.5. Strengthening community support Programs should strengthen natural grandmothermechanisms for children and their leaders and networks as well as their sense offamilies.collective responsibility for children in the community.6. Building social capital for Links between grandmother networks and othersustainable development.community structures should be reinforced.20 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

III. HOW HAVE CHILD DEVELOPMENTPROGRAMS INVOLVED GRANDMOTHERS?“With age comes experience and wisdom. Grandmothers are themain resource persons for all matters related to thewell-being of women and children.”Community Leader,MaliThis chapter aims to answer thequestion,“To what extent do programsthat promote children’sdevelopment view grandmothers as aresource, involve them in community programs,and capitalize on their experienceand commitment?” Here, programs thathave explicitly involved grandmothers,referred to as grandmother-inclusive programs,are reviewed.PROGRAMS INVOLVINGGRANDMOTHERSAn extensive search was carried out, basedon the published literature, on informationabout the programs of numerous developmentagencies involved in children’s development,on the gray literature to whichthe author had access, as well as on informationfrom multiple key informants. Theresults of this review support the conclusionthat at a global level, in the areas ofECD, basic education, maternal and childhealth and nutrition, and HIV/AIDS thereare very few programs that have explicitlyinvolved grandmothers. Alternatively, involvinggrandmothers in development strategiesproduces benefits for all generations.This assertion is illustrated in the briefdescriptions of grandmother-inclusive projects(below), and in the more detaileddescription in Chapter IV of work in Malisupported by Helen Keller International(HKI).The projects identified are presented hereby topical area: early childhood developmentand primary education, newbornhealth, child nutrition, HIV/AIDS, andmaternal and child health. For each ofthese projects/activities a brief descriptionis provided that includes, whenever possible,information on how grandmothershave actually been involved in the childdevelopment activities, whether the grandmothers’role is reflected in educational,communication, and training materials, andthe results of their involvement for children,other family and community members,and for themselves. Given that thedocumentation on the identified experiencesis often limited, it was usually notpossible to collect information on all ofthese parameters.EARLY CHILDHOODDEVELOPMENT ANDPRIMARY EDUCATIONBOLIVIAA nutrition education booklet based ongrandmothers’ advice.GRANDMOTHERS:THE LEARNING INSTITUTION21

­In a collaborative effort between the ministriesof health and education, a bookletwas produced for use in the schools entitled,“OurFood: Advice FromGrandmother Manuela” (NuestrosAlimentos: Los Consejos de la AbuelaManuela CEMSE 1997). It contains drawings and advice from grandmotherManuela sitting with and teaching hergrandchildren about good nutrition andfood hygiene practices based on both traditionaland modern concepts. The bookletdepicts the grandmother as a respectedand knowledgeable member of the familyand community.This contributes tostrengthening both children’s respect forgrandmothers and the inter-generationalcommunication between them.BANGLADESHGrandmothers’ stories for intergenerationaleducation.Save the Children in Bangladesh recentlyconducted a workshop in which grandmothers’traditional stories were told, writtendown, and compiled in a booklet to beused in educational activities to promoteintergenerational communication andlearning. The stories will be used with differentages of children in story-telling andreading activities.MALI AND NIGERGrandmothers involved in playgroups foryoung children using traditional learningactivities.In UNESCO-supported programs in thesetwo countries, both grandmothers andyounger women are being trained andsupported to set up “clos d’enfants,” orplaygroups, with small groups of youngchildren at the community level (Combes2004). The aim is to provide holistic stimulationand care to young children using traditionalstories, toys, games, songs, anddances while strengthening the capacity ofgrandmothers and younger women tomanage these ECD activities.NEWBORN HEALTHMALIGrandmother-inclusive nonformal healtheducation strategy.In a nonformal education strategy, usingopen-ended stories, songs, and group discussionrelated to pregnancy and newbornhealth, grandmothers are involved as keyactors. The Ministry of Health (MOH) andHKI developed this strategy based onresults of formative research documentingthe central role played by grandmothers inthese matters at the household level. Thestrategy works with networks of grandmothersin order to strengthen theircapacity to analyze needs and problemsrelated to pregnant women and newbornsand to collectively decide what actionshould be taken. The songs and storiesacknowledge the role of the grandmothersand encourage them to combine newpractices with their traditional ones. 6 (SeeChapter IV for a detailed description).NORTHERN TERRITORIES,AUSTRALIAGrandmothers promoting health of pregnantwomen and newborns.In central Australia, Aboriginal grandmotherleaders have been full partners in developing,implementing, and evaluating theStrong Women, Strong Babies, StrongCulture project supported by the districthealth service (Fejo 1996).The project6 Further discussion on nonformal education methods, strategies, and approaches is included in the Mali Case Study in Chapter IV.22 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

uilds on grandmothers’ role in promotingall aspects of family well-being, and aims tointegrate modern approaches with traditionaland cultural ways for ensuring thatpregnant women and their babies will behealthy in body and in spirit. The involvementof the grandmothers helps ensurethat the spiritual dimensions of Aboriginalwomen’s and children’s development arepart of all health promotion strategies.MATERNAL AND CHILD HEALTHAND NUTRITIONCAMBODIA‘Wat’ grannies promote priority child andwomen’s health practices.Building on the traditional involvement ofgrandmothers as volunteers at Buddhisttemples in Cambodia, the Reproductiveand Child Health Alliance(RACHA)/USAID project on reproductiveand child health worked with temple, or‘Wat’, grannies as health promoters(Kannitha et al 2001). The grandmothersparticipated in training activities on priorityhealth topics (breastfeeding, diarrhea, andbirth spacing), and they in turn shared theirnew advice informally through discussionswith younger women and other familymembers. The evaluation showed greatincreases in the knowledge of youngerwomen in project areas between the baselineand ending data collection.GHANAGrandmothers’ role in infant nutrition ispromoted in materials and communitystrategy.Given grandmothers’ influence on mothers’infant feeding practices, in Northern Ghanathe Ministry of Health and LINKAGES (aUSAID breastfeeding project) developededucational and media materials thatacknowledge grandmothers’ role in infantnutrition and encourage them to adoptimproved practices related to breastfeeding(Schubert 2004). Grandmothers weretrained as “negotiators” to promoteimproved feeding practices at the householdlevel. These activities are part of abroader strategy, also involving youngwomen and men, that aims to strengthenthe whole family system by involving familymembers who are involved either directlyor indirectly in infant feeding.INDIAGrandmothers as nutrition educators.To encourage young Punjabi mothers toimprove the content of supplementaryfoods for young children, grandmotherswere used as nutrition educators (Bhatia2004). In an operations research projectcarried out in 1975 (Bhatia 2004), the useof grandmother-teachers was comparedwith other methods using media and visualmaterials. The grandmothers demonstratedand described preparation of anenriched supplementary food using localproducts. Post-test interviews with youngmothers showed that those who weretaught by grandmothers had much greaterknowledge and reported preparing theimproved food more frequently that thoseexposed to the radio or visual materials.Younger women stated that they wereable to use the new mixture because thegrandmothers approved of it. Bhatia identifiesseveral advantages to involving grandmothersin such programs.These includetheir considerable influence over daughter­GRANDMOTHERS:THE LEARNING INSTITUTION23

in-laws and the additional free time theyhave to spend with grandchildren.LAOSSchool and media materials reflectinggrandmothers’ role in child health.In a WHO-UNICEF-supported program topromote appropriate home treatment ofcommon childhood illnesses (especiallydiarrhea, and respiratory infections), materialswere developed both for use in theschools and for radio that reflected grandmothers’roles and experience in childhealth, including their traditional practices.A booklet was prepared for use in schoolscontaining a set of songs and stories-without-an-ending;the latter to elicit group discussionand problem-solving of typicalhealth-related situations(MCHI/UNICEF/WHO 1997). Both typesof materials were used in community sessionsto engage grandmothers in discussionswith their peers concerning both traditionaland modern approaches to treatingsick children and on the possibility ofcombining elements from the twoapproaches.The same songs were recordedwith school children and broadcast onthe radio. Some were songs praisinggrandmothers for their important role inpromoting family health while others weresongs teaching key health messages.MOZAMBIQUEGrandmother groups for health education.In a child health project implemented byWorld Relief, health education activitieswere initially only conducted with youngerwomen until it became obvious that thesewomen were not able to implement newchild care practices if their mother-in-lawsdid not agree (Ernst 2001). Later, separategrandmother groups were established toaddress the same topics as those discussedwith the younger women. It was foundthat the grandmothers were very responsiveand open to the new ideas being proposedwhen they were systematicallyinvolved.NORTHERN TERRITORY,AUSTRALIAAboriginal grandmothers coordinate acommunity health program.Based on the traditional and respectedrole of grandmothers in Nyirrpi culture ofcentral Australia and their advisory role infamily health, grandmother leaders wereinvolved from the start in the developmentof a program to promote the healthof girls and women (Wilson 1999). Theywere involved in identifying needs, developingstrategies to improve the health ofall ages of girls/women in their communities,and monitoring and evaluating theNyirrpi Grandmothers’Women’s HealthProgram. Involvement of the grandmothershas contributed to the development ofhealth services that build on the aboriginalcultural realities, thus making the servicesmore appealing and appropriate for girlsand women in the community.SENEGALA grandmother-inclusive nonformal educationstrategy and its role in maternal andchild health.As one component of a child health program,a grandmother-inclusive strategy wasdeveloped by the Christian Children’s Fund(CCF). It involved the use of both songs,lauding the role of grandmothers, and ofopen-ended, problem-posing stories inwhich grandmothers play a leading role,reflecting their role in society. The nonfor­24 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

mal education strategy worked throughgrandmother networks and grandmotherleaders within those networks. The nonformaleducation materials stimulated collectiveproblem-solving and decision-makingthat appears to be contributing to progressivelychanging community healthnorms.The evaluation of this strategyshowed that grandmothers’ knowledge ofthe targeted maternal and child nutritiontopics increased greatly, that their advice toyounger women improved, and thatyounger women adopted improved practicesbased on improved advice (Aubel etal. 2004).TUNISIANutrition education materials reflect grandmotherroles and practices.Participatory nutrition education materialswere developed for use in the Ministry ofSocial Affairs community nutrition centerssupported by Catholic Relief Services(CRS). Based on formative research documentingthe role of grandmothers in childhealth, games were developed for use withgroups of women in which key familymembers were depicted, including grandmothers,in household child health activities.Stories also were written that reflectthe important role of Tunisian grandmothersin caring for sick children. These materialsacknowledged grandmothers’ traditionalrole and promoted the integrationof traditional and modern approaches tochild health and nutrition. These materialswere the basis for group participatorylearning experiences (Aubel and Mansour1990).UGANDAGrandmothers are priority targets in anational child health strategy.Most national health strategies do notmention the role of grandmothers or theneed to involve them. In Uganda’s 2000national communication strategy for childsurvival, growth, and development,“grandmothers”are cited many times as a prioritysecondary target group with which childhealth activities should be developed atthe community level, along with other familyand community leaders, and influentialcommunity members (MOH/Uganda).Thedegree to which grandmothers are actuallyinvolved in these activities is unclear.HIV/AIDSUGANDAGrandmother support groups establishedto care for young children.In Kampala district, 70 percent of householdsare headed by grandmothers over60 years old who are caring for orphans.In this AIDS-prevalent area, Action forChildren, with support from the BernardVan Leer Foundation, is establishing grandmothersupport groups as a mechanismfor providing them with psycho-social andother types of support to help them carefor the young children in their charge(BVLF 2002).ZAMBIAGrandmothers themselves decide tochange course content to integrate discussionof HIV/AIDS.In the Eastern province, PlannedParenthood, with support from the AIDSAlliance, organizes workshops with the ini­GRANDMOTHERS:THE LEARNING INSTITUTION25

"Involving grandmothersin community activitiesis very relevant giventhe important role theyplay in child-care in oursociety. They arerespected and theiradvice is followed. Iwas surprised to seethat the grandmotherscan learn and canaccept new ideas.Since I was a child Ihave always heard thatolder people cannotlearn. The Laotianproverb says, "You cannotbend an old pieceof bamboo." But wehave seen that theproverb is not true.They are interested inlearning new things."Dr. Kopkeo,Institute of Maternal &Child HealthVientiane,Laos"The grandmothersrepresent a "socialtreasure' for us.Through these activitiestheir status in thecommunity hasincreased. We havelearned a lot fromthese activities aswell."Community leader,Mbour district,Senegaltiative’s advisors, all older women, to getthem to reflect on the content of theircoming-of-age initiation courses for girls inlight of the AIDS epidemic (Gordon 2003).Using participatory, adult educationmethodologies, the grandmothers decidethemselves how they can modify these initiationcourses to decrease the risk ofAIDS transmission. This is an excellentexample of how nonformal educationmethods can be used with communitygroups to help them make their own decisionsabout how to improve their healthrelatedpractices. In all sites the grandmothershave decided to change theircourse content to integrate discussion ofHIV/AIDS and to omit the sexualpracticum that has traditionally been partof the course.COMMUNITY RESPONSES TOINCLUDING GRANDMOTHERSBased on the available information on theprograms described above, in all casesthere appear to have been very positivereactions both on the part of seniorwomen themselves, other communitymembers, and of child development programstaff to these efforts to activelyinclude grandmothers. The followingresponses from Laos, Senegal, Mali andUzbekistan illustrate the feelings of communitymembers and development programstaff to the explicit inclusion ofgrandmothers in development programs, inmany cases for the first time.The examples of programs (discussedabove) that have explicitly involved grandmothersin child development-promotionactivities illustrate the ways in which theirrole can be acknowledged and strengthened.As noted, however, the number ofchild development programs that haveexplicitly involved grandmothers is minisculewhen compared to the vast numberof programs that have been implementedacross the world. In general, the design ofprograms has excluded grandmothers,though at the operational level they havesometimes decided on their own to participate.These conclusions are further supportedby a recent review of the situation ofgrandparents in the world carried out byHelpAge International (2002). The reportrefers to the “social exclusion” experiencedby many older, economically disadvantagedfamily members in different societiesaround the world. The report statesthat older, poor community members aregenerally excluded from both the designand implementation of development programson gender, education, health, security,emergencies, economic well-being, andshelter.Mirroring the findings of this review, amajor conclusion of the HelpAge report—that there is a need to include grandparentsin development programs—can bespecifically applied to grandmothers. Itargues that the involvement of senior familyand community members in the design,delivery, and monitoring of developmentprograms produces benefits for all generationsand explicitly states, “Older people,despite the exclusion they face, provide avast pool of social capital. They are knowledge-bearers– older women play keyroles in knowledge transfer and practicalsupport in child-bearing and rearing”(HelpAge International 2002, 15).26 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

"I am very young and am accustomedto working only withadolescents. Before I thoughtthat it was not necessary toinvolve the elders. After workingwith the grandmothers Ihave changed my mind. I cansee that they are a wonderfulgroup and that they can teachus a lot. Involving them can bea strong point in our work withcommunities.""In this approach we havebecome important in our village.Before we were ignored.Usually only younger womenwere involved. We weren'tincluded and, therefore, wecouldn't learn things."GrandmotherKati districtMaliNurdidaProject Hope StaffNavoi,Uzbekistan"According to our traditions, inorder for a development activityto be successful, the eldersmust be involved. We aredelighted that the grandmothershave been involved in thesenutrition activities because it istheir role to teach the youngerwomen everything they need toknow to care for their children."Community leaderVelingara districtSenegal"We are thrilled that wewere asked to participate.Grandmothers are humanbeings like everyone else andwe can learn and change ourways. We must be open tothe new ideas. We feel muchstronger than before becausenow we not only have ourtraditional knowledge but wealso have acquired modernknowledge."Grandmother leaderMbour districtSenegalGRANDMOTHERS:THE LEARNING INSTITUTION27

CULTURALLY-ADAPTED EDUCATIONMATERIALS : SONGS AND STORIESNonformal education methods ofteninclude participatory, culturally-adaptededucational materials such as songs andopen-ended stories. In Mali, stories andsongs have traditionally been used as communicationand teaching mediums, and thecommunity groups expressed strong interestin and support for their use.Thesematerials themselves, and the way theywere used, contributed to the participatory,collective community learning processthat engaged grandmothers and othercommunity actors in transformationallearning.SONGSTwo types of songs were developed forthe Mali project; songs of praise to thegrandmothers and educational songs onthe nutrition and health topics. The songsof praise were developed to acknowledgethe important role grandmothers play infamily and community health, to showrespect for them, and to encourage themto participate in the activities. Each of thecommunity sessions started and endedwith singing these songs. The educationalsongs contained key information on eachof the session topics. They were relatednot only to the ideas promoted by theMinistry of Health, but also to beneficialtraditional practices. Here is an example ofone of the songs of praise developed bythe team in Mali, followed by one of theeducational songs.In Mali, as in many societies, women enjoysinging. The Malian grandmothers clearlystated that they appreciated the songs asthey were both enjoyable and educational.All community groups appreciated thesongs used in the Mali project. Theyhelped establish rapport with the grandmothersand helped them feel relaxed andopen-minded during the educational sessions,therefore creating a safe, comfortableenvironment for learning. In mostcases, once the songs of praise were used,In Praise of GrandmotherDearest Grandmother, dearest GrandmotherYou are such a wonderful person, such a wonderful person.Dearest Grandmother, dearest GrandmotherYour heart is large and compassionateDearest Grandmother, dearest Grandmother.Grandmother’s Advice to a Pregnant WomanGrandmother, what advice do you give to a pregnant woman?I tell her to work less.Grandmother, what advice do you give to a pregnant woman?I tell her to eat more.Grandmother, what advice do you give to a pregnant woman?I tell her to eat beans, peanuts, and green vegetables.32 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

grandmothers spontaneously started dancing,demonstrating their enthusiasm for thismusical dimension of the health-promotingactivities and their comfort level with thesegroup activities.STORIES-WITHOUT-ENDINGSAnother component of the nonformalstrategy in Mali involved the use of stories,a traditional tool for teaching and advising.Paulo Freire’s work in community adulteducation served as a basis for developingstories-without-endings, each dealing with akey child health topic. The story codes,each reflecting a typical community situation,were used as a catalyst for stimulatingdialogue, discussion of problems, and possiblesolutions. The use of the stories in thisway personifies what Freire referred to asa “problem-posing approach.” A significantcharacteristic of the stories is that in eachcase one of the key figures is a grandmother,reflecting the central role they play in allnewborn health matters. Furthermore, ineach story the grandmother figure is presentedas a competent and respectedwoman in order to acknowledge theirimportance and encourage them to participate.Six open-ended stories, or stories-withoutendings,were written by project staff.Project community animators told the stories,each of which described a critical situationrelated to pregnancy, delivery, postpartum,or newborn care. The charactersand situations presented in the storieswere very similar to those found in Malianvillages in the project area. This allowedthe grandmothers to identify with thecharacters in the story while at the sametime reflecting on their own lives and onpossible strategies for addressing the problemsdescribed. The stories did not includea solution or action proposed to alleviatethe critical situation.GROUP FACILITATION TO ELICITCRITICAL THINKING AND PROBLEM-SOLVINGThe other important characteristic of nonformaleducation is that the teacher, orfacilitator, expects participants to come upwith their own solutions and strategies.After telling the story, the role of the facilitatorwas to encourage group participantsto critically analyze both their past practicesand the new ideas presented in thestory. For each story, a set of open-endedquestions was developed to guide the discussion.Four levels of questions weredeveloped, based on Kolb’s (1984) fourstageexperiential learning cycle. The questionsensured the systematic and criticaldiscussion of the story content.The sequence of questions also encouragedgrandmothers to develop, or construct,alternative solutions based on boththeir past knowledge and experiences andthe new information provided in the stories.In this process, grandmothers withmore experience were able to share withthose with less experience, creating a peerlearningenvironment. The grandmotherswere proud of the solutions they constructed,which led to an increased level ofconfidence and empowerment as householdadvisors.Through this simple activity, the use of stories-without-endings,the project demon­GRANDMOTHERS:THE LEARNING INSTITUTION33

strated the power of participatory learning.The grandmothers did not sit and listento a lecture.They were engaged in anactivity that asked questions, and requiredthat they share their ideas and workingtogether as a group. They were activelyengaged in dialogue as they listened toone another and responded to the problempresented in a story, which then ledthem to an acceptable solution based oninput from the group. The content of thestory placed the learning in the presentand allowed the grandmothers to see theusefulness of the new knowledge theywere acquiring. This immediacy of learning,again a characteristic of nonformal education,is critical for adults.They want to seean immediate return on their investmentof time and resources participating in theactivity.Both the songs and stories were focusedon the learner. Each activity required thelearners to be engaged in order for learningto take place. As noted, this learnercenteredapproach is the opposite of themethods historically used in health interventions.The learner-centered approachused by the Mali project allowed the contentto be driven by the learner’s needsand was attentive to their involvement inthe delivery of the material.By utilizing these nonformal educationstrategies and approaches in the Mali project,grandmothers retained their culturallydefined role as respected advisors ofyounger women and families. The grandmothers’receptivity to new ideasincreased as did their involvement in theproject.The grandmother strategy was implementedin 48 villages in Mali. The stories, songs,and group discussions focused primarily,but not exclusively, on the grandmothers.The male traditional community leaderswere also involved, as well as youngerwomen and men. The extension workersinvolved in the strategy periodically visitedthe community leaders so that they understoodthe strategy and encouraged thegrandmothers to participate. In addition,for each session with the grandmothers,the village headman selected two or threeof his advisors to attend the session inorder to provide him with feedback onwhat was discussed. This mechanism contributedgreatly to eliciting the support ofcommunity elders for the strategy and forthe grandmothers. After the group sessionswith grandmothers, the communityhealth volunteers were expected to repeatthe stories and songs with groups ofyounger women and men, depending ontheir interest and availability.RESULTS OF THE NONFORMALEDUCATION ACTIVITIESThe feedback on the grandmother strategyin the Mali project was very positive onthe part of both health workers and communitymembers. Many local health officialsstated, “Most past maternal and childhealth programs have had a limited impactbecause the influential muso korobas, werenot involved.” At the community level,community leaders strongly supported thestrategy involving grandmothers. “They arethe primary advisors in the family foryounger women.” Both younger womenand their husbands stated that involving34 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

the grandmothers greatly facilitates adoptionof new health-related practices byyounger women.Community activities with grandmothergroups were implemented for 14 monthsand an evaluation of the strategy was carriedout at the end. The evaluationshowed that the grandmothers were veryinterested in the nonformal educationactivities and in the “new practices” theylearned, their knowledge of these practiceshad increased, and their advice to youngerwomen had changed. HKI and Ministry ofHealth staff agreed that whereas past programsexcluded grandmothers, a majorfactor that contributed to the success ofthe grandmother-inclusive strategy wasthat it built on the culturally-defined role ofgrandmothers as respected advisors ofyounger women and families. There wasagreement, from development agents andcommunity members, that another significantfactor that contributed to the successof the strategy was the use of culturallyadaptedcommunication tools, namelysongs, stories, and group discussion. Bothgroups of actors also felt that the nonformaleducation approach involving grandmothergroups can be used in numerousother socio-cultural contexts and toaddress a variety of issues related to thehealth and well-being of women and children.The Mali project clearly demonstrates howbeneficial it is to involve grandmothers inchild development activities and how valuabletheir participation can be for boththem and their community.Through theuse of simple, nonformal education strategiesand approaches, the grandmothersenthusiastically participated in the projectactivities and were open to the new ideaspresented. The activities were not complicatedor cumbersome, but built on traditionalmethods of communication andlearning. They did not require endlessresources, but utilized the learners as theprimary resource through songs and stories.The grandmothers came away fromthe activities feeling good about themselvesand their role as family health advisors.They became advocates of the newideas as they felt included in their development,and they were encouraged toinclude their traditional ideas with thenewly-introduced modern ideas. Thisblending further reinforced their identitywithin the community and resulted ingreater acceptance of the modern ideas.Given the positive results of this project, itis possible that other child developmentactivities, especially children’s access to andacquisition of quality basic education, couldalso benefit from the involvement ofgrandmothers via nonformal educationstrategies.A follow-up evaluation of the project inMali (Touré and Aubel 2004) showed positiveresults related, not only to grandmothers,but also to households, communityleaders, and the community-at-large (SeeDiagram 1 below).The impact on grandmothers was demonstratedby their increased receptivity tonew ideas and practices related to maternaland child health, as well as theirincreased willingness to re-examine theirtraditional practices and beliefs in lieu ofthe new information they received. As thegrandmothers observed the positiveGRANDMOTHERS:THE LEARNING INSTITUTION35

effects of the new ideas, their confidence intheir roles as family health advisor grewand they felt empowered to continue inthis role. One grandmother put it this way,“The grandmother activities have made usfeel much stronger than before. Now notonly do we have our traditional knowledgeand experience, but we also have theknowledge of the doctors” (Ibid 18).This new level of confidence in the grandmothers’role was reflected in the householdsreceiving advice. The mothers appreciatedthat the grandmothers’ advice nowincluded both traditional and modern ideas,and furthermore, the mothers now felt thegrandmothers better understood theirneeds. The mothers also noted the visibleimprovements in their own health and thereduced burden of their daily activities dueto the new advice and support of thegrandmothers (Ibid 10).Additionally, at the household level thestudy found that the project resulted inincreased support from the husbands forthe family’s health needs, improved relationshipsbetween mothers-in-laws and daughters-in-law,and strengthened relationshipsbetween grandmothers and their grandchildren(Ibid 10).The community leaders were also involvedin the strategy and, thus, impacted. As aresult of the project’s involvement ofgrandmothers, the formally-recognizedmale leaders acknowledged the role grandmothershave in promoting maternal andchild health and they learned about beneficialmaternal and child health practices.They also offered increased support for theadvice given by grandmothers at thehousehold and community level (Ibid 8).Lastly, due to the positive outcomes of thegrandmother strategy at the different levelsdescribed above, noticeable changes wereobserved in the community-at-large includingstrengthened grandmother networks,the increased involvement of those networksin promoting community health andincreased support of grandmothers toneighboring households, related to healthneeds.The evaluation concluded that the positivechanges at these four levels (grandmothers,community leaders, households, and community-at-large),appear to be having acombined and positive effect on communitynorms related to the priority practicesconcerning infant and women’s health. Ofcourse, the process of changing communitynorms is a slow one, but the evidence suggeststhat such changes are beginning totake place.While policy planners and program practitionersare often skeptical about includinggrandmothers in child development initiatives,the feedback from communities andgrandmothers themselves, and the impactobserved, is a clear indication of the relevanceof such strategies.36 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

DIAGRAM 1:Outcomes of Nonformal Education Activities with Grandmothers in Mali to Promote Newborn HealthGRANDMOTHERS• Openness to new ideas about maternal & child health• Self-assessment of their traditional knowledge and practices• Integration of new ideas and traditional health-related practices• Increased sense of empowerment in their role as family health advisorsHOUSEHOLDS• Improved advice given by GMs on health• Increased appreciation of GMs' role in family health• Improved health practices of young women• Increased support provided to pregnant women by husbands• Increased support by GMs to pregnant and breastfeeding women• Improved relations between mother-in-laws and daughter-in-lawsCOMMUNITY-AT-LARGEEVIDENCE OF POSITIVECHANGES IN COMMUNI-TY NORMS RELATEDTO WOMEN'S ANDINFANTS' HEALTH• Increased involvement of GMs in promoting community health activities• GM networks are strengthened• Informal GM leaders have increased confidence in their community role• Increased support by GMs to neighboring households in health matters• Community leaders encouraging GMs to follow the new health adviceCOMMUNITY LEADERS• Increased public acknowledgment of GMs' important role in community health• Increased knowledge of key maternal & child health topics• Increased support for GMs' advice on healthGRANDMOTHERS:THE LEARNING INSTITUTION37

V. GRANDMOTHERS: A LEARNING INSTITUTIONSUMMARY OF CONCLUSIONS“A house without a grandmother is like a road that goes nowhere.”Senegalese proverbBased on the review of the literatureon the roles of grandmothers in differentnon-western cultures, analysisof the policies of key international organizationsthat promote child developmentand review of projects that have explicitlyengaged grandmothers in strategies topromote children’s development, the followingconclusions were formulated:THERE IS LIMITEDDOCUMENTATION OFGRANDMOTHERS’ ROLES.Analysis and documentation of grandmothers’roles in different societies is quite limited,especially outside of the academicanthropological literature. The results ofmany studies on different child developmenttopics either completely ignore orgive minimal attention to grandmothers’roles and influence at the household level.The limited documentation of their roleappears to be due, first, to the prevailingassessment methodologies that do notexamine the roles of various householdactors, including grandmothers, and second,to the biases against grandmothers ofmany development agencies and staff.PREVALENT ASSESSMENTMETHODOLOGIES FAIL TOEXAMINE HOUSEHOLD ROLESAND RELATIONSHIPS.The methodologies used in formative studieson child development topics are mostoften based on models from behavioralpsychology and tend to focus narrowly onindividual knowledge, attitudes, and practices(KAP) of women/mothers. There is aneed for alternative assessment methodsbased on a more systemic, anthropologicalframework that look at social structures,roles and relationships in households thatinfluence attitudes and practices related tochild development. In a more systemicapproach grandmothers’ experience androles at the household level would certainlybe analyzed.GRANDMOTHERS CONTRIBUTETO CULTURAL CONTINUITY.The cultural dimension of developmentprograms has generally been neglectedthough there is a growing concern that thisis a dangerous trend that can contribute tothe loss of cultural values and identity.Grandmothers play a critical role in transmittingcultural values and practices toyounger generations, thereby contributingGRANDMOTHERS:THE LEARNING INSTITUTION39

to the maintenance of cultural identity inan increasingly culturally-homogeneousworld.GRANDMOTHERS PLAY ANINFLUENTIAL ROLE INCHILDREN’S DEVELOPMENTACROSS CULTURES.While documentation on grandmothers’roles is relatively limited, the available evidencedoes show that in virtually all nonwesternsocieties in Africa, Asia, LatinAmerica,The Pacific, and in indigenous culturesin North America and Australia, seniorwomen, or grandmothers, play a centralrole in child-rearing. In all of these societiesthey are looked to as advisors of theyounger generations based on their ageand experience in this domain. Anotheruniversal characteristic of grandmothers istheir commitment to promoting the wellbeingof children, their mothers and families.For these several reasons grandmothersconstitute a valuable resource for childdevelopment programs. While there are aseries of core roles played by grandmothersacross cultures, at the same time thereis considerable variability in their culturespecificbeliefs and practices.FEW CHILD DEVELOPMENTPROGRAMS EXPLICITLY INVOLVEGRANDMOTHERS.In spite of the fact that grandmothers playa significant role in all aspects of childhealth and development at the householdlevel, few child development programshave explicitly identified and involved themas key actors. This review analyzed theextent to which they have been involvedin five key program areas related to childdevelopment:EARLY CHILDHOOD DEVELOPMENTGlobal policy statements on child developmentadvocate for “support for childrenwithin family systems,” and “strengtheningthe skills of existing child-care givers.”These policies clearly support efforts toreinforce existing child-care givers withinthe family. Nevertheless, there are very fewexamples of community programs thatview grandmothers, or grandparents, as apriority resource, that build on their experience,and actively involve them in promotingbeneficial ECD practices.PRIMARY SCHOOL EDUCATIONWhile there is considerable discussion ofthe need for “parental involvement” inschools in order to strengthen the linkbetween the two, there are few examplesof cases where grandparents are explicitlyinvolved in school programs. School personnelare often skeptical about theinvolvement of grandparents because“They have not been to school.” Examplesof programs promoting inter-generationalcommunication and education throughinvolvement of grandparents in schools aredocumented only in Europe and in NorthAmerica.MATERNAL AND CHILD HEALTH ANDNUTRITIONIn spite of grandmothers’ extensive experiencein maternal and child health andnutrition, and their role in both health promotionand illness management at thehousehold level, very few programs haveexplicitly involved them in order tostrengthen their knowledge and practices.40 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

Many health and development workersview grandmothers as a negative force,due to some of their “traditional practices”and “traditional remedies,” and prefer tointeract with younger women, and sometimestheir husbands.CHILD HYGIENEIn all cultures where grandmothers play arole in child-care they are involved inteaching young children about socio-culturalnorms and practices related to defecationand personal hygiene, such as handwashingafter defecation and before eating.Based on an internet search and an interviewwith an environmental health specialist(Kleinau 2004), it was not possible toidentify any community programs that haveexplicitly involved grandmothers in promotingoptimal hygiene practices.HIV/AIDSA major constraint identified by grandmothersand grandfathers is their exclusionfrom HIV/AIDS awareness activitiesthat focus almost exclusively on youngpeople. In spite of their greatly increasedchild-care responsibilities in high HIV/AIDSprevalence areas, there are few programsthat are providing direct psycho-social,financial, or material support to these elderfamily members to help meet theirincreased child-care responsibilities.SEVERAL FACTORS CONTRIBUTETO THE LIMITED EXCLUSION OFGRANDMOTHERS’ IN CHILDDEVELOPMENT PROGRAMS.Often in community child developmentprograms that focus on younger womenthere are a few grandmothers who participate.However, few programs have identifiedgrandmothers as priority communityactors and have explicitly and activelyinvolved them in community strategies.Several factors appear to contribute to thisfact. First, many development agenciesand staff have negative biases againstgrandmothers related to their “age,” “inabilityto learn” and “resistance to change.”Second, the models used as a basis fordesign of child development programs,borrowed from the west, tend to focus on“mothers,” and sometimes “parents,” whileignoring the significant role and influenceof elder household actors in non-westernsocieties.A FEW SUCCESSFULGRANDMOTHER-INCLUSIVECHILD DEVELOPMENTPROGRAMS DO EXIST.There are some examples of child developmentprograms that have explicitlyinvolved grandmothers. Although few innumber, these experiences illustrate howprograms can acknowledge grandmothers’role and past experience, actively involvethem, and in so doing strengthen theirknowledge and skills. In programs where agrandmother-inclusive approach has beenadopted, feedback from grandmothers,from other community members, and fromdevelopment staff has been very positiveand in most cases their involvementappears to have contributed to increasedprogram results.GRANDMOTHERS:THE LEARNING INSTITUTION41

“Grandmothers raisechildren; they tellstories in the winterand teach childrenthe skills they needfor survival.Grandmothers arethe central charactersin the daily andsymbolic lives ofNative (American)women—indeed, ofNative people.”Rayna GreenTHERE IS A GAP BETWEENPOLICY STATEMENTS ANDGRANDMOTHERS’ INCLUSION INCHILD DEVELOPMENTPROGRAMS.Policy statements from key internationalagencies involved in children’s developmentadvocate for strengthening thecapacity of all family members to respondto children’s needs. By extrapolation, suchpolicy priorities imply that programsshould involve senior family members,including grandmothers. In reality, thereare few programs in which grandmothersare explicitly and actively involved. Thenon-inclusion of grandmothers in childdevelopment programs represents a significantinconsistency with policy guidelines.GRANDMOTHER LEADERS ANDNETWORKS SHOULD BE VIEWEDAS SOCIAL CAPITAL.Social capital has been defined bySerageldin as “the glue that keeps communitiestogether and that is required for acollective and sustained response to communityneeds.” (Krishna & Uphoff, 1999).While there is much discussion of theneed to strengthen existing communitystructures” in community developmentprograms, limited attention has been givento the potential represented by naturalgrandmother leaders and their social networksfor promotion of children’s development.Several experiences empoweringthese groups suggest that strengtheningthem can contribute to enhancing a community’ssocial capital and to sustainingcommunity action for children’s development.GRANDMOTHERS ARE RECEPTIVETO THE USE OF NONFORMALEDUCATION APPROACHES THATBUILD ON THEIR EXISTINGKNOWLEDGE.In experiences in several countries, nonformal,adult education methods have beenvery successfully used with groups ofgrandmothers. They were very receptiveto these methods that drew on theirexperience and engaged them in dialogueon their existing ideas as well as alternative,“modern” practices. Their receptivityto the approach can be explained by thefact that the approach reinforced their culturally-definedrole, as respected advisorsof younger women and children, whilehelping them to acquire new knowledgeand practices related to child health anddevelopment. (The Mali case study highlightsthe use of these methods).42 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

VI. RECOMMENDATIONS FORBASIC EDUCATION“Culture shapes everything we try to do. If we fail to take account of it, we stumble aroundblindfolded; if we learn to see it as a resource and understand how it affects us all, we may beable to create a really sustainable approach to human development.”F. MatarassoThis paper demonstrates that aroundthe world, families and communitiesacknowledge that grandmothersplay an influential role in the socialization,acculturation, and care of children as theygrow and develop. However, basic educationprograms have not seriously taken thisrole into consideration. Education plannersshould reflect on how grandmothers’ influencecould be utilized to increase children’saccess to and acquisition of quality basiceducation.Based on the conclusions listed in the previoussection, a series of questions areposed for education program plannerswho are interested in involving grandmothersin their programs.These questions arefollowed by a series of recommendations.The recommendations are not meant tobe definitive but rather to stimulatethought on how to involve grandmothersand utilize their role and influence on children’seducational development in the familyand community.QUESTIONS FOR EDUCATIONPROGRAM PLANNERSTable 2 includes a list of questions thatshould be considered by organizationsinterested in exploring ways to use grandmothersas a resource in education programs.Reflection on these questionsshould allow organizations involved in educationto think about creative ways toinvolve them more in the future.Based on the roles of grandmothers andgrandparents in children’s development, theabove questions should help educationalplanners reassess their programs givingmore attention to the roles of these communityresource persons. This reflectionalso contributes to the following recommendationsfor basic education programplanners.RECOMMENDATIONS FOR BASICEDUCATION PLANNERSIn the past, grandparents have not beenconsidered as important actors in basiceducation programs in developing countries.In most cases, they have beenexcluded from school settings and programs,in part because of negative stereotypestoward them held by school administrators,teachers and sometimes studentsthemselves. In the eyes of many educators,the non-inclusion of grandparents isjustified, first, by the fact that many grand­GRANDMOTHERS:THE LEARNING INSTITUTION43

TABLE 2:Questions for Basic Education Planners Regarding "Core Roles" of Grandmothers Across CulturesCore Roles of GrandmothersAcross CulturesQuestions for Basic Education Program PlannersAll cultures recognize the critical role of Do education materials and curricula acknowledge and value thegrandparents as guides and advisors to the wisdom of grandparents in society?younger generations.Do school programs encourage children to learn from theirgrandparents?Are grandparents included in program activities?In all cultures grandparents play gender-specific Do programs recognize the gender-specific roles and expertise ofroles related to child development.grandmothers and grandfathers?Do programs promote respect for both male and female rolesand experience?Grandmothers’ child-rearing expertise is Are there opportunities for grandmothers to share their lifeacquired over a lifetime.experiences with students in person, in print, on the radio or inother media?In all cultures grandmothers are involved in Are grandmothers’ knowledge and skills included and valued invarious aspects of the lives of children and program activities?families at the household level.The roles of grandmothers appear to be Are cultural values and traditions incorporated into programuniversal whereas much of theircontent?knowledge and practices are culturally-specific.Grandmothers influence the attitudes anddecisions made by male household membersregarding children’s well-being.Grandmothers are both directly and indirectlyinvolved in promoting the well-being ofchildren.Some of grandmothers’ knowledge andpractices are beneficial to child developmentwhile others are not.Are grandmothers given opportunities to share their culturespecificskills and knowledge in school programs?Do schools involve grandmothers and grandfathers in strategiesto promote school attendance and school retention, particularlyof girls?Are grandparents included, along with parents, in schoolassociations?Do school programs aim to educate grandmothers on children’spsychological, nutritional and health needs?Do programs encourage dialogue between grandparents andparents on children’s needs?Are grandmothers presented in a positiveor negative light in curricula and materials?Are grandmothers viewed as a resource or as an obstacle tochildren’s educational development?Do programs encourage children to respect grandparents’knowledge even if they have not been to school?All grandmothers have a strong commitment Do schools support activities that encourage children toto promoting the growth and development of acknowledge grandmothers’ knowledge and care for them?their grandchildren.Compared to younger women, grandmothers Is grandmothers’ availability and patience viewed as a resource togenerally have more time to spend and more be exploited by education programs?patience with young children.Most grandmothers are interested in increasing Are grandmothers given opportunities to learn new thingstheir knowledge of “modern” ideas about child related to children’s educational development?development.Grandmothers’ knowledge comes both from Do programs work with networks of grandmothers and theirtheir own mothers and their peers.leaders?Many grandmothers have a collective sense of Do educational programs build on and strengthen grandmothers’responsibility for children and women in the sense of responsibility for children and women outside theircommunity.family?Some grandmothers feel that their status as Are organizations and programs observing this trend or workingadvisors in child and family development is to increase the inclusion of grandmothers?diminishing.Do schools encourage children to reflect on what they can do tovalidate the role of grandparents in the family and community?44 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

parents themselves did not go to school,and second, due to their age and their traditional“backward” attitudes.Grandparents often express concern thatschools have created a rift between their“traditional” culture and values and theunfamiliar,“modern” values taught inschools. Grandparents sometimes distancethemselves from school programs that are“for young people.” In the end, they can becritical of schools and of schooling in general.While this review specifically focuses onanalyzing the role and involvement ofgrandmothers in promoting child education,health and development, many of theconclusions of the analysis suggest ways inwhich both grandmothers and grandfatherscan be meaningfully involved in formaland nonformal education programs.The following recommendations, groupedhere into five categories, could helpincrease grandparents’ involvement in children’seducation and thereby maximizetheir contribution to the education andwell-being of children, families, and communities.INCREASE TEACHER ANDSTUDENT AWARENESS OFGRANDMOTHERS’ ROLE ANDPOTENTIAL CONTRIBUTION.• Develop participatory training exercisesto help teachers reflect on therationale for including grandmothersas partners in school educationalactivities and then develop strategiesfor including them.In most cases, involving grandmothers inbasic education programs would be anew experience, not only for grandmothers,but also for teachers. Giventhat teachers may have negative stereotypestoward grandmothers because“they never went to school”, it will beadvantageous to increase their awarenessof grandmothers’ role and potentialcontribution.• Analyze family and community systemsas an input to program development.Basic education programs should utilizefamily and community systems of whichchildren are a part. One practical first stepin the development of basic educationstrategies would be to carry out a holisticassessment of the roles, authority, and decision-makingpatterns amongst key householdand community actors related to differentaspects of child education anddevelopment. An understanding of theseroles and decision-making patterns wouldprovide a foundation for designing strategiesthat take into account, not only parents,but also grandparents and others inthe children’s environment that play adetermining role.• Create alternative assessment tools.In development of curricula for basic educationprograms, initial assessments tend tofocus narrowly on “children’s learningneeds” in isolation from family and communityrealities. In order to bridge the gapbetween schools and communities, newtools are required to help education sectorstaff collect information on communityrealities and resources. Such an assessmentcould include community traditions,patterns of authority and leadership, rolesGRANDMOTHERS:THE LEARNING INSTITUTION45

of different age groups in society, and traditionalknowledge and life skills mastered bydifferent community members.Participatory assessment tools could beused by teachers and older children to collectdata from community members. Usingsimple questions and observation tools,children could learn about the knowledgeand skills involved in traditional crafts, suchas basket-making, and economic activities,such as rice growing. Likewise, simplequestionnaires could be developed forchildren to interview elder communitymembers and record their knowledgeabout community history, farming, or thetraditional pharmacopoeia. Both theprocess of data collection and its incorporationinto the curriculum would helpbridge the gap between “modern” and“traditional” elements in school programs.• Generate criteria for inter-generationalsensitivity.Inter-generational educational programsare those that explicitly aim to strengthenlinks between the younger and older generations.Just as education programs haveindicators for assessing the gender-sensitivityof curriculum and other aspects of educationalprograms, criteria should be developedto assess the “inter-generational sensitivity”of basic education programs. Suchindicators would help determine theextent to which basic education programsincorporate the roles, values, and knowledgeof the elder generation into the curriculum,whether positive images of eldersare presented, and whether grandparentsare brought into educational activities asresource persons. As with criteria toassess “gender sensitivity,” criteria to assess“intergenerational sensitivity” could beused both during the program designphase and during the program evaluationphase in order to assess this importantdimension.INTEGRATE TRADITIONALKNOWLEDGE AND SKILLS INSCHOOL CURRICULA.• Interview grandmothers concerningtheir roles in education.In the past, educators have not consultedgrandmothers in basic education programs.It is recommended that basic educationprogram planners each interview at least 5grandmothers in different socio-culturalcontexts and listen to them talk abouttheir role in and commitment to promotingchildren’s development and education.This may strengthen understandingbetween education sector staff and thesesenior women while helping to identifypossibilities for collaboration.• When revising curricula or developingteaching materials, pictures ofgrandmothers, quotes from grandmothers,and characters in storiesshould be included.Inclusion of grandparents in visual andwritten educational materials giveincreased recognition, by both children andteachers, of grandparents’ commitment andcontributions to promoting the well-beingof children and families. Educational materialsproduced for use with communitygroups and in the mass media, shouldreflect the important roles that grandparentsplay in society and portray them in apositive light. This can strengthen school­46 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

community ties by increasing teachers’ andchildren’s appreciation of the knowledgeand experience of the grandparents and byincreasing grandparents’ support forschools.• Use components of “Service-Learning” and constructivistapproaches to collect data fromgrandmothers and incorporate theminto the curriculum. 8The Service-Learning concept, taken in itsbroadest sense, provides many opportunitiesto use traditional knowledge stored inthe memories of village elders as a basisfor children to develop strong identities.Children can reach out to grandmothersand community members through variousteacher-led activities. Children then areguided to construct a history or incorporateinto the curriculum the various ideasthey have processed or learned. Service-Learning has been adopted in many internationaleducation projects and can helpchildren to grow up to be citizens who areengaged in their society, and who are moretolerant, compassionate, and understandingof others.The following are recommendationsfor using Service-Learning ideas toobtain and develop information fromGrandmothers:– Who am I? Assign children to askfamily members, including grandmothers,to answer the child’s question:“Who am I?”This is an activity to help childrendefine their own identity, in the family,and in the community. A preliminarystep would be to have classroomteachers and students construct a setof questions related to the family, theethnic group, the neighborhood, theoccupations of the parents andgrandparents, and the primary productsof the village. Classroom activitiesbased on this information canhelp reinforce the children’s identityand give them more positive feelingsabout their community.– Living History.Assign children to interview elders intheir family or neighborhood, includinggrandmothers, on a topic relatedto the history of the neighborhoodor village.Teachers can make this apart of the history curriculum.Theteacher might change the topic slightlyeach year and, for example, includeexperiences of men and women duringa war, during a famine, beforeindependence, or when learning tookplace before there were schools. Thechildren could then come back tothe classroom, share their findings,write them up, and organize theminto a small booklet that could beshared in the community.The childrencould also develop skits toshow what they have learned abouttheir village history.– Making curriculum relevant.Research on education programs indeveloping countries has suggestedthat when curriculum is not relevantto children’s lives, it becomes a factorin children’s decreased attendanceand increased drop-out rates.Curriculum that engages childrenshould include elements of the locallanguage, history, cultural values and8 The National Service-Learning Clearinghouse defines service-learning as a “teaching and learning strategy that integratesmeaningful community service with instruction and reflection to enrich the learning experience, teach civic responsibility,and strengthen communities.”The core concept of service-learning is that it “combines service objectives with learningobjectives with the intent that the activity change both the recipient and the provider.This is accomplished by combiningservice tasks with structured opportunities that link the task to self-reflection, self-discovery, and the acquisition and comprehensionof values, skills, and knowledge content.”GRANDMOTHERS:THE LEARNING INSTITUTION47

traditions, traditional knowledge, andskills related to everyday life.Grandparents are ideal resource personsin education sector efforts tointegrate local traditional and culturalelements into school curricula. SomeNGOs have successfully collectedproverbs, stories, and information onlocal history.This has all been incorporatedinto the curricula to sparkchildren’s interest in learning.– Ownership of the school curriculumby the community.Parents and grandparents often havegreat difficulty understanding what istaught to children and why. If thefamily and community are notinvolved in curriculum development,the school and what takes placeinside it remain largely foreign.Neither children nor adults knowhow to reconcile what is learned inschool with what is passed downfrom the elders.The children thenconstruct two separate worlds intheir minds. The result is often thatthe practical, applied part of learningnever takes place and learningremains theoretical. Eliciting suggestionsfrom the community on whatmight be taught builds ownership ofthe school by the community andcan also help make the curriculummore practical to the children’s lives.– Making connections between the“old way” and the “new.”Professionals who come out of thecurrent educational system often seeno way to connect what theylearned in their basic training programswith what they see all aroundthem and experience in their lives inthe community and family.This situationcould be addressed by drawingthe connection between grandmothers’explanation of how things work,and the modern view. Older farmersall over Africa, for example, knowthat night blindness is associated withanimals not eating enough grass duringthe dry season, especially whenan animal is pregnant. Many alsoknow that if pregnant women eatliver this will help avoid night blindness.Teacherscan make the connectionbetween the traditional knowledgeabout night blindness and thenutrition lesson that eating orangeand green vegetables, and liver, willprevent and cure night blindness.Promoting the integration of “old”and “new” knowledge in this way canlend credence to the knowledge ofthe elders while promoting adoptionof new ideas.INTEGRATE TRADITIONALVALUES INTO THE CURRICULUM.• Collect stories, proverbs, and songs,and analyze the values expressed inthem. Use these traditional materialsas a basis for discussion of culturalvalues and of the similarities and differencesbetween traditional andmodern values.Values education is particularly importantin this age of HIV/AIDS. It has becomeclear in the African context, for example,that some of the traditional practices andvalues must be modified to save the lives48 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

of millions. On the other hand, some ofthe traditional values, if followed, wouldprevent the spread of the infection. An indepthanalysis of both traditional culturalvalues, and of modern values and behaviorsand how they relate to the HIV epidemic,could prepare children, families, andcommunities to help in decreasing infectionrates and stopping the epidemic.Valuesclarification has become a mandatory partof HIV/AIDS Life Skills Education coursesdesigned to reach school-aged childrenbefore they become exposed to HIV.DEVELOP PARTNERSHIPSBETWEEN GRANDMOTHERS ANDSCHOOLS.Educational research has shown consistentlythat family participation in school activitiessupports student achievement, highergrades, better attendance, avoidance ofgrade repetition, and decreased dropouts.Developing a genuine partnership withgrandmothers could increase their understandingof school programs and furtherstrengthen their support for schooling.Dialogue between schools and familiesreframes the family-school relationship tomake interactions, curriculum, and learninga two-way process.• Encourage families to create homeenvironments that support success inschool.Grandmothers could be the guardians of aplace to do homework and time to dohomework without competing duties.Grandmothers can encourage children todo their homework and ask them to readto them. Grandmothers can encourage literateparents or older children to read toyounger children at home.• Encourage grandmothers, who oftenhave more free time than mothers,to walk children to school to assuretheir safety.If grandmothers accompany children toschool, this can help solve the consistentproblem of children’s safety, particularlythat of girls, in this age of HIV/AIDS.• Identify stories told by grandmothersin the community that relate to thecurriculum and use these stories asteaching tools. Invite these seniorwomen to tell stories in special storytellingsessions at schools or in informalsettings.In many societies, stories and songs areused by grandmothers as tools for communicatingcultural values to the youngergeneration and for stimulating children’s listeningand problem-solving skills.Unfortunately, these important traditionaleducational tools are becoming replacedby “modern” media such as radio and television.Schools can help communities documentthese traditional communicationtools so they are not lost, by engagingboth community leaders and educators indiscussing ways to revitalize their use.Storytelling can increase grandmothers’sense of usefulness. For children, storiesand conversations with grandmothers canstimulate their problem-solving and criticalthinking skills and provide them with oneon-oneor small group interaction that isusually lacking where pupil-teacher ratiosare very high. Grandmothers, or grandfa­GRANDMOTHERS:THE LEARNING INSTITUTION49

thers, can be effectively integrated intobasic education programs through storytellinginitiatives.USE PARTNERSHIPS TO PROMOTESCHOOL IMPROVEMENT.• Empower parents to participate inschool planning for curriculum content,school climate, and staff development.Families can provide support to schools atseveral levels: attending parent-teacherconferences, reinforcing learning in thehome, volunteering to help at school, andserving in elected positions on schoolplanning and management teams. If grandmothersare not directly serving in thesepositions, they can be kept abreast of theimportance of parental roles and canencourage family and school interaction.Special social events can be conducted byteachers, at which grandparents are invitedand their support of schools is discussed.• Identify grandmother leaders andnetworks.In all communities natural grandmother“leaders” exist who, either formally orinformally, have the capacity to mobilizeother grandmothers. Initial assessments canidentify grandmother leaders and networksand assess their ideas about playing a rolein education. Special sessions can beorganized through the grandmother networksto discuss with grandmothers suchtopics as girls’ equity, children’s rights, whyreading and schooling are valuable for allchildren, the importance of educating girlsto the welfare of the family, the communityand the development of the country, theimportance of good attendance andschool completion, how to support homework,and optimal health practices formothers, babies and young children.Withcorrect information, support and encouragement,grandmothers can become advocatesfor improved education-related practices,such as sending girls to school.• Form Grandparent-Parent-TeacherAssociations.Traditional parent-teacher associations(PTA) are intended to strengthen linksbetween schools and communities, butthey are usually limited to “parents” and“teachers.” It is suggested that“Grandparents, Parents and TeachersAssociations” (GPTA) could be establishedto incorporate the critical role and experienceof grandparents in educating children.Involving grandparents can contribute togreater dialogue and understandingbetween schools and communities. Forexample, given the influence of the eldersin deciding which children will attendschool and for how long, GPTA’s couldplay an important role in facilitating communitydialogue on girls’ education andidentification of community strategies toaddress the loss of family labor when girlsgo to school.• Empower families to learn to usetheir collective power to advocatefor school change.Through conversations, group dialogue andreflection, grandparents, parents, families,and communities can identify and act onsystemic problems.These may includeschool overcrowding, infrastructure in needof repair, poorly performing or untrained50 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

teachers, teacher abuse of children,predatory behavior of some teacherson girls, and poor school performance.• Involve community elders, includinggrandmothers, grandfathers,and religious leaders, in providinginput for quality control ofschools and teacher performance.Many school programs now involvePTAs in defining the important characteristicsof a “good school” and “goodteacher”.These criteria can then beused by projects to improve projectdesign and to incorporate into teacherperformance evaluations. When teachers’performance is evaluated, grandparents,parents, and other communitymembers can be invited to give theirinput, and compare teacher performanceand school quality to the criteriathey developed.GRANDMOTHERS:THE LEARNING INSTITUTION51

APPENDIX A: METHODOLOGYUSED IN THIS REVIEWGiven the relatively limited documentationon the topic of grandmothers’involvement in children’sdevelopment, it was necessary to adopt amulti-pronged and somewhat unconventionaldata collection strategy. The informationconsidered in this review comesfrom 94 written documents—literaturepublished either in journals or on the web,website descriptions of policies and programsof development organizations, andunpublished,“gray,” literature from developmentorganizations—and 25 key informantinterviews dealing with approximately 75different cultural contexts from six continents.While the information analyzedcame from geographically diverse sources,it is acknowledged that this review did nottake into account all available documentationon all cultures in the world.Published literature: The primary areasexamined were: anthropology, sociology,gerontology, early childhood development,primary education, community health andnutrition, hygiene education, culture anddevelopment.Gray literature (internal company documentsor unpublished documents, such asproject reports): From numerous NGOand government programs in Africa, Asiaand Latin America.Website descriptions of the policies andprograms of development organizationsinvolved in child development including:UNICEF, UNESCO, Bernard Van LeerFoundation, WHO,The AIDS Alliance, Savethe Children, Christian Children’s Fund,CARE and HelpAge International.Key informant contacts were made withchild development specialists at: the WorldBank, Johns Hopkins University, CornellUniversity, UNICEF, the InternationalConsultative Group on Early ChildhoodCare and Development, Mahidol Universityin Bangkok, the University of San Francisco,the Academy for Educational Development(AED), NGO practitioners especially fromSenegal, Bangladesh, Ecuador, and Fiji.GRANDMOTHERS:THE LEARNING INSTITUTION53

APPENDIX B:ANNOTATEDREFERENCES ON THE ROLE OFGRANDMOTHERSIn Section II of this paper, some of theavailable literature related to grandmothers’roles in child development waspresented. Here, numerous additional referencesare presented dealing with variousaspects of grandmothers’ roles, advice andpractices related to: early childhood development,education, formal school education,health, nutrition, hygiene, social supportin the context of HIV/AIDS, and culturaland moral development. The examplesreviewed here are presented byregions of the world: Africa, Asia, LatinAmerica,The Pacific, North America, andAustralia.While some of the references presentedhere are from published sources, many arefrom the “gray literature” and others arebased on communication or interviewswith key informants.Due to the author’s background and thetime allotted for this review, the majorityof the references discussed here deal withgrandmothers’ roles in the area of childand family health and nutrition. It isbelieved that the numerous examples fromvariety of cultural contexts documentingthe advice and influence of grandmothersregarding child health and nutrition areindicative of the ubiquitous role they playin supporting child growth and developmentat the household and communitylevels.As regards the role of grandmothers andgrandfathers in HIV/AIDS, it was decidednot to give major importance to this topicin this review. This decision was made fortwo reasons. First, this review looks at abroad range of cultural contexts and childrelatedneeds, of which support for AIDSorphans is only one. Second, a comprehensivereview on grandparenting andHIV/AIDS has just been published in 2003by HelpAge/HIV-AIDS Alliance.For each of the studies/reports reviewed, asynopsis of the findings or opinions is presented.Specific information on themethodologies and more detailed findingscan be found in the original documents.EXAMPLES FROM AFRICAMadagascar: In a study on infant nutritionpractices, it was concluded that “grandmothersare valuable family resource personsdue to their experience, proximityand availability” (BASICS/Linkages 1998,33). Most younger women have heavyworkloads and limited time to spend withGRANDMOTHERS:THE LEARNING INSTITUTION55

­their young children. Grandmothers havemore time to spend with young childrenand are very committed to caring forthem given their value to Malgache society.The study also showed that in keepingwith the gender-associated roles of menand women in Malgache society, the familymembers that know least about childhealth/nutrition are men. Men themselvesstated that if one of their children is sick,their wives would seek help first from thegrandmothers, and later from health workers. Men did not suggest that their wiveswould seek their advice. Men and womenagreed that in Malgache families grandmothersmake many of the importantdecisions related to child health.The study concluded that given grandmothers’role as family resource personson child health and well-being, they shouldbe included in future child health/nutritionactivities, rather than excluded.Lastly, all grandmother interviewees agreedthat, as compared with health workers,their knowledge is superior, reflecting theirconfidence in their own knowledge andexperience.Mali: In a rapid assessment of beliefs andpractices related to newborn health carriedout by Save the Children/USA(Waltensperger 2001a), it was concludedthat in the patrilineal Bambara households,where women live with their husband’sfamily, the mothers-in-law play a centralrole in all health promotion and illness situations.“Within the household, the criticalrole of mothers-in-law in resource allocation,illness recognition and decision-makingfor care-seeking cannot be overstated”(8). The study concludes that given theirgreat influence in the family, senior femalefamily members should be included in allhealth education strategies.Waltensperger’s findings regarding the roleof senior Bambara women with newbornsare echoed in an extensive ethnographicstudy (Toulmin 1992) that includes adescription of their role during the criticalperiod of childbirth. “Childbirth practicesare…under the control of a group of elderlywomen who are responsible for lookingafter births in a cluster of neighboringfamilies” (224). In contrast to these findings,however, a Save the Children-USstudy conducted in Mali in 2000 on newbornhealth does not report that grandmothersplay a central role during deliveryand with newborns. This differenceappears to be due to the methodologyused in the latter report that involved anarrower analysis of birthing and newborns.Community child development programsoften incorrectly assume that young motherscan make autonomous decisions relatedto the well-being of themselves andtheir offspring while ignoring the powerrelationship that exists between older andyounger in the household. AnthropologistCastle (1994) discusses the authority andpower that grandmothers have over theirdaughter-in-laws in Fulani and Nubebehouseholds, manifest in the dominant roleplayed by senior women during childhoodillnesses. When children are sick, household“specialists,” primarily postmenopausalwomen, are responsible for diagnosing,treating and sometimes referring childrento healers outside the household. It is not56 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

acceptable for younger women to makedecisions on their own regarding treatmentof sick children and in these situations theyare expected to consult with their motherin-lawor other senior female members oftheir husbands’ family given the experienceand authority of these women vis-à-visyounger women in the household. Castle’swork focuses on child health but it can beassumed that the “hierarchical transmissionof knowledge” (330) from senior to juniorwomen in the household applies not onlyto health matters but also to other areasof children’s development.Guinea: Female genital circumcision iswidespread among different ethnic groupsin Guinée. This traditional ritual, carriedout in different ways in different parts ofthe country, is seen as a necessary step inbecoming a mature woman. A study donein 1999 (Yoder et al.) showed that, whilenowadays, the actual cutting is frequentlydone by trained midwives, overall responsibilityfor organizing this important ceremonyis still conferred on certain seniorwomen, based on their age and authorityin society.Tunisia: In a study on household practicescarried out in all regions of the country,related to management of diarrheal disease(Aubel and Mansour 1989), the roleof grandmothers at the family level wasdocumented. While health facilities arequite accessible in most parts of the country,grandmothers play a leading role in theinitial diagnosis and treatment at home andin the deciding if outside help is required.Younger women are expected to listen tothe advice of senior women in the family,given their age and experience.Burkina Faso: In 1995, a study(APAIB/WINS) on breastfeeding was carriedout in the USAID-supported WINSproject with Mossi and Peuhl communities.Many health and development people inBurkina Faso refer to it as “TheGrandmother Study.” It seems that thiswas the first time that the important roleof the grandmothers, or Yaaba, as they arecalled in Moré, was documented in a communityhealth project.The study concludedthat while grandmothers are not alwaysdirectly caring for children, their advice onall aspects of childcare consistently influencethe practices of younger women.“The Yaaba, or grandmothers, are olderwomen who are known for the experienceand advice that they give to youngerwomen regarding all aspects of childcare…Theyteach women, especially thosewho have given birth for the first time,how to care for their children. It is clearthat the Yaaba play an important role inthe health and nutrition of women andchildren” (5). It was also observed that therole of fathers is, in most cases, to provideresources required to implement the recommendationsof the powerful yaabas.The study concluded that grandmothersshould be involved in rather than excludedfrom child health and development programs.In spite of the initial enthusiasm, inthe ten years since this groundbreakingstudy was done, there do not yet appearto be any programs in the country thathave explicitly involved grandmothers.Also in 1995, one of the conclusions of anevaluation of the AFRICARE child survivalproject in Ganzourgou was that “There is aconsensus between men and women thatGRANDMOTHERS:THE LEARNING INSTITUTION57

grandmothers have a great influence onthe knowledge and practices of youngerwomen and their children. They arerespected because of their experience caringfor children, their advice is frequentlysought, and they often are directly involvedin caring for young children” (Aubel &Hoemeke 1995, 33). It was recommendedthat future child survival strategies shoulddirectly involve grandmothers given theimportant role they play at the householdlevel.Benin: In Bariba culture, when youngwomen marry, their husbands expect theolder, experienced women in the family toadvise and look after their wives, especiallywhen they are pregnant and after theygive birth (Bio 2003).This is true both inrural and more urban areas. For couplesliving in more urban areas, away from thepaternal household, when a woman isabout seven months pregnant one of theolder women in the family, often an aunt,goes to stay with the couple in order toprovide the close follow-up required thelast months of the pregnancy. The “aunt,”as she is referred to, observes and providesadvice to the pregnant woman onher diet, work and other activities.Especially with the first child the husband isnot supposed to be too involved eitherduring the pregnancy nor after his wifegives birth. The belief is that the childbelongs to, and is the responsibility of thewhole family, but especially of the femalesin the household. It is expected that all ofthe “aunties” in the family, i.e. the maturewomen, will play a role in advising and caringfor the young woman and her infant.After birth, either the “auntie” stays on tocare for the newborn and new mother orthe mother and newborn go to stay withthe mother-in-law, often for two years, tobenefit from the informal teaching andsupport required by a new mother. In virtuallyall cases, husbands assume thatresponsibility for caring for their wives andyoung children will fall to their mothersand other aunties, based on their experienceand age.Senegal: In the past ten years, four studieshave comprehensively documented the significantrole and influence of grandmotherson breastfeeding, on maternal and childnutrition, on practices with newborns, andcare of young children. In l995, a studyfunded by USAID (MOH/WELLSTART),coordinated by the author of this review,showed that,“In both rural and urbanareas the predominant influence onwomen’s practices related to breastfeedingis the advice and support they receivefrom the older women who are part oftheir social networks. Compared withhealth workers, these older women arecloser to them, more respected, and havemore influence on them.” (5) From birth,women are advised on how to care fortheir child in all respects, by their mothersin-law,their own mothers, and by otherexperienced women in the family.In 2001, Christian Children’s Fund conducteda study (Aubel et al.) on the role ofgrandmothers in Maternal Child Health(MCH) in the context of its child survivalproject in western Senegal. It documentedthe central and multi-dimensional roleplayed by grandmothers in family life andspecifically related to issues concerningwomen and children. The study clearly58 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

showed that men are not directly involvedin child care and development issues andon all such matters they are advised bytheir mothers regarding what should bedone and what support should provide.While husbands are expected to makecertain key decisions related to the welfareof women and children, it is clear that inmost cases they are advised by their motherswho have infinitely more experienceand knowledge of these issues. Theseinputs into their decision-making from their“resident technical advisors,” i.e. theirmothers, are generally overlooked.A study on newborn health was commissionedby BASICS in 2002 and conductedby the anthropologist, Niang (2003). Thefocus of this investigation was pregnancy,childbirth, and newborn care. However, itclearly reveals the influence of seniorwomen in the family and specifically theauthoritative role of mothers-in-law overthe lives and practices of daughters-in-lawrelated to themselves and their children.More broadly, it reveals the influence of thesocial networks of women in which alldaughters-in-law are a part, composed primarilyof female family members. Withinthese networks it is the senior women, orgrandmothers, who are the key advisorsand supervisors of pregnancy, delivery andchildcare after birth. Direct communicationbetween husbands and wives is limited andin many cases the mother-in-law serves asan intermediary. For example, in manycases a woman first informs her mother-inlawof a pregnancy and, in turn, the husbandis informed by his mother. Husbandsare advised by their mothers on all issuesrelated to maternal and child health anddevelopment, and similarly, they expecttheir wives to follow the advice of theirmothers.Tanzania: A study was conducted toexamine household practices related totreatment of childhood malaria in order todetermine how to strengthen family strategies(Nsimba 2003). It was found that thekey actors in diagnosing and deciding whatto do when a child has malaria are thegrandmothers, or mothers-in-law.They arethe decision-makers regarding what shouldbe done at home and whether it is necessaryto seek outside treatment. Also, theycollaborate closely with the traditionalhealers, who are frequently consultedespecially for some types of malariabelieved to be caused by evil spirits.Cameroon: A study conducted with six ofthe major socio-cultural groups showedthat when children have diarrhea andother common childhood illnesses, relativelyfew are taken to health facilities andmost treatment is provided within the family(Aubel & Ndonko 1989). Furthermore,within the family it is the experienced,older women who are primarily responsiblefor deciding on the treatment strategyto be adopted.Kenya: An extensive study on child-rearingpractices in several rural and urban areas(Swadener et al 1996) revealed that inrural sites grandmothers generally continueto play a strong role, both in providingchildcare where younger mothers havemultiple other tasks to carry out and toplay an important role in the enculturationof young children; passing on stories, songs,values and traditions. In urban areas andGRANDMOTHERS:THE LEARNING INSTITUTION59

on tea plantations where nuclear familiesare more common, the critical role ofgrandmothers in cultural transmission isseverely reduced. The researchers concludedthat in areas where the extendedfamily still predominates, the most sustainablestrategy for enhancing EarlyChildhood Care and Development(ECCE) would involve home-based activitiesto strengthen the ability of grandmothersto organize playgroups composed ofonly a few children.This recommendationwas strongly supported by communityinformants insofar as it would build ongrandmothers’ traditional role in childcare.Also in Kenya, among the Taita, as in manyethnic groups in Africa, it is taboo for parentsto speak to their children about sex(Epstein 1993). A critical role played bythe grandmothers is orienting and advisingyoung girls about sexual values and roles.The grandmothers spend between one tothree months secluded with young adolescentgirls teaching them about their role aschild-bearers and wives. This critical roleof senior women in initiating girls to womanhoodis common to virtually all culturesin Sub-Saharan Africa (Gordon 2003).Ethiopia: In a study of traditional childcarein the Shewa region (Negussie 1989), itwas found that many of the grandmothers’practices are beneficial related to the careand feeding of infants, deliveries, maternalhealth and traditional home remedies forcommon illnesses. Older women spendlots of time with children from birth andare very much involved in the “informaleducation” of infants and young children.The author laments that in existinghealth/development programs little attentionis paid to preserving these beneficialtraditional practices.Niger: In a rapid assessment conducted inthe east of the country in Hausa andDjerma communities, the role and influenceof grandmothers in household managementof diarrhea was clearly revealed(Aubel et al. 1991).The study showed thatwhen a child is ill, various family membersare involved in deciding what should bedone. However, within the collective decision-makingprocess it is usually the grandmotherwho plays a leading role given herage and experience. In an area wherethere is considerable use of traditionalhealers, it is usually the grandmothers whodecide to seek help from these specialistsand who coordinate recommended treatmentswith them.In western Niger, the findings of anotherrapid assessment on the role of grandmothersin maternal and child nutrition(Aubel et al. 2000) yielded similar resultsregarding grandmothers’ strong influence inadvising and supervising women both duringpregnancy and with their young offspring.Community leaders stated thatgrandmothers are important communityresource persons for all matters related towomen’s and children’s health and wellbeing.Husbands stated that they consulttheir own mothers (the child’s grandmother)when there are decisions to be maderegarding either their wives or children. Alast significant finding is that in the vegetablegardening activities organized forwomen by HKI, the grandmothers madeup about three-quarters of all the participants.They stated that they were moreinvolved in gardening than younger women60 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

ecause they had more time to devote tothis activity and also because they wereinterested in learning about new plantingtechniques and garden products.Sudan: A 1993 study (Bedri) showed thatgrandmothers have significant influencewithin the family related to various aspectsof childcare and health promotion. Whilesome of their advice is beneficial, relatedto pregnant women’s diets, early initiationof breastfeeding after birth, and supplementaryfeeding, other advice is not—-forexample, related to female genital mutilation,early marriage, and avoidance of contraception.The author concluded thatgrandmothers should be directly involvedin health education activities in order toencourage them to modify certain practicesand thereby improve the impact ofthe advice they give to other householdmembers. The involvement of Sudanesegrandmothers at all stages of the life cycleis also discussed by Bedri and Lovel(1993).In the results of an earlier study (Aubel etal. 1990) in central Sudan on householdpractices related to diarrhea, the role ofgrandmothers was also documented. Bothmen and women said that the grandmothersare consulted when a child has diarrhea,and that their advice on how to dealwith the problem—either with householdremedies, pharmaceutical products or visitsto the health center—is usually followed,given their extensive experience in childhealth matters. In this same study it wasfound that health workers are highly criticalof traditional home remedies and ofthe grandmothers who promote them.The Gambia: Several studies have shownthe critical role grandmothers play inregard to child health. In a study on infantnutrition (Samba & Gittlesohn 1991) itwas found that during the rainy season,when mothers are very busy with agriculturalwork and spend less time at home,grandmothers and older daughters haveprimary responsibility for caring for youngchildren. At this time of year there is alsoless food available and more cases of diarrhea.In other words, at this precarioustime of year the knowledge and skills ofgrandmothers are a critical factor in determiningchild health and well-being.In a recent study (Sear et al. 2000) inMandinka communities it was found thatwhere a grandmother is present the nutritionalstatus of their young grandchildren isbetter than where these senior womenare not present. The same study showedthat the presence or absence of the fatheror grandfather had no impact on thechild’s nutritional status. These results substantiatethe influence of grandmothers onchild nutrition and development and supportthe argument that the overall impactof their strategies to produce healthygrandchildren is positive.Ghana: A rapid assessment on infant feedingcarried out by LINKAGES with theMinistry of Health in 2000 (Schubert2001) showed that both grandmothersand men have significant influence onwomen’s breastfeeding (BF) practices.These findings were the basis for developinga health education strategy targetingthese two groups of household actors.Another study on complementary feedingGRANDMOTHERS:THE LEARNING INSTITUTION61

was conducted in the Kumasi area (Daviset al. 2003). Similar to the Linkages studyresults, it was found that grandmothersmost frequently assume the role of “caretaker”when the mothers are occupiedwith other tasks, with husbands being thesecond most common caretakers.Similarly, in a third study, with women inpaid employment (Date-Bah 1985), it wasfound that the maternal grandmother wasthe most common caretaker when womenwere away at work.Lesotho: A study on breastfeedingrevealed that grandmothers’ traditionbasedadvice and practices related tobreastfeeding is often superior to theadvice given by health clinic staff (Almrothet al. 1997). Grandmothers’ were adamantthat it is harmful and unnecessary to givewater to breastfeeding infants during theirfirst months of life. The grandmothers’maintained that this harmful practice camefrom health workers, thus providing advicethat is both harmful and contradicts thegrandmothers’ views. The authors concludedthat grandmothers’ good adviceshould be shared with both youngermothers and health workers.South Africa: It is often assumed thatyoung women have full responsibility forchildcare and for decision-making on theuse of family resources. A study in Natalprovince (Chopra 2003) illuminates thesetwo critical dimensions of grandmothers’influence in the household. It showed thatapproximately the same percentage ofyoung children (3 to 59 months) are caredfor by their grandmothers (39 percent) asby their own mothers (41 percent), clearlysuggesting the importance of the child-carerole of grandmothers in this setting.Regarding household decision-making, thestudy also showed that while more thanhalf of the younger women (57 percent)decide how much will be spent on foodfor the family, in almost a quarter of thefamilies it is the grandmother who makesthese decisions (23 percent), while in onlyl6 percent does the husband decide.Nigeria: A study on breastfeeding amongrural Yoruba in Southwest Nigeria documentedthe significant influence of olderwomen on younger women’s breastfeedingpractices from the first moments afterbirth (Davies-Adetugbo 1997). Whilethese experienced women strongly promotebreastfeeding, some of their advice isbeneficial and some is not. Immediatelyafter birth the older women who are tocare for the newborn and mother carryout a series of ritual-bound practices,decreasing the likelihood that the baby willbe breastfed in the first half hour as healthworkers recommend. Most of thembelieve that colostrum should not be givento the newborn, that medicinal herbsshould be administered “to clean out thestomach,” and that, during the first weeksand months of life, infants require supplementalwater along with breast milk. Onthe other hand, they give good advice tobreastfeeding women regarding their dietand most are vehemently opposed toinfant feedingMalawi: In a rapid assessment of roles andpractices related to newborn care, in thecontext of work by Save the Children/US,the role of grandmothers at this criticalperiod was clearly documented(Waltensperger 2001b). Whether in62 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

­matrilineal or patrilineal areas of the country,young mothers are advised and supervisedby either their mothers or mothersin-law,as they master the art of motherhoodbased on cultural and family norms.In both systems (matrilineal and patrilineal),grandmothers’ role as household advisorsis not limited to younger women.“Grandmothers serve as the first-line gatekeepersfor care-seeing and have influenceon male relatives in decision-making.” (8)Grandmothers’ authority in child developmentmatters often puts younger womenin a compromising situation. Young womenstate that some of the advice regardingchildcare that they receive from grandmotherscontradicts what they hear on theradio or at the health center but “they feelpowerless to contradict or resist” (8).Withthe AIDS epidemic in Malawi, grandmothers’role in child-care has increased exponentially.Coming to similar conclusions, a study onbreastfeeding conducted by Project Hope(Katchitsa 1999) in southern Malawishowed that senior women are present inmost households and that they adviseyounger women on how to initiate andsustain breastfeeding. Some of the advicethey provide is appropriate, while otheradvice does not reflect current prioritiespromoted in the health sector. Manygrandmothers lamented the fact that todayyounger women do not always follow theiradvice and they listen to the health workers who advise them differently.EXAMPLE FROM EASTERNEUROPEAlbania: In predominantly Muslim andmatrilineal Albania, young women typicallylive with, or close to, their husband’s familyboth in rural and urban areas. Accordingto a recent Save The Children study onECD (HDC 2002), at the family level thereis a clear differentiation in roles betweenhusbands and wives, and also betweengrandmothers and grandfathers, in caringfor and educating young children. Thereport states that men play a very limitedrole in caring for children. “The responsibilitiesof fathers are exclusively related toensuring an income (for the family), protectingand disciplining children…(and)they are not felt as an integral part of thelife of their children.” (56) However, whenboys are older, fathers do become moreinvolved in their education. According tothe report, men’s involvement in childcaretasks is strongly criticized by other men,and even by some women. Following thesame gender-differentiated roles, grandmothersare more involved with youngchildren than grandfathers.Women are responsible for the upbringingand education of children and their knowledgeof the appropriate values and practicesin childrearing is passed to them fromprevious generations, through seniorwomen in the family. “Available knowledgeand information is learned from the oldergeneration: mothers, mothers-in-law, sisters-in-lawetc.” (HDC, 52) The mothersin-law/grandmothersplay a central role infamily life as advisors to both their sonsand daughters-in-law on matters related tothe well-being of women and children, aswell as on other family issues. While thereport acknowledges the active role playedby grandparents in ECD, it suggests thatGRANDMOTHERS:THE LEARNING INSTITUTION63

families should listen to the “experts”rather than the inadequate knowledge ofthe older generation.EXAMPLES FROM ASIABangladesh: The influential role of grandmothersin families, particularly paternalgrandmothers, was revealed in key informantinterviews conducted with NGO fieldstaff involved in ECD programs supportedby CARE (Munmun 2004), Save theChildren/US (Mahmud & Mitra 2004), andPlan International (Akhter 2004). There isa saying in Bengali that,“Grandmothersand Grandfathers know everything” (DaduNani janen), reflecting the respect thatyounger family members are expected tohave for the experience and wisdom ofthe elders. All interviewees stated thatgrandmothers have two main roles inmost Bangladeshi families. First, they assistwith all aspects of childcare, particularly foryoung children and when mothers arebusy with other tasks. In most familiesthey are the main caregiver after themothers. Second, they teach both theirchildren and grandchildren about allaspects of life, based on their life-longexperiences. One of the key methodsused by grandmothers and grandfathers toteach children is storytelling, in which valuesand traditional ideas are passed on tothe next generation.India: In Bihar, rapid assessments carriedout both by CARE (Capps 2004) and CRS(Harvey 2004), in the context of theirrespective child survival projects, revealedthe strong influence of the mothers-in-law,or paternal grandmothers, both on decision-makingby husbands and their wives,and on all matters related to child rearingand health. In some cases grandmothersdescribed beneficial traditional practices,such as exclusive breastfeeding, andexpressed regrets that many youngerwomen have not adopted this same practice.On the other hand, many grandmothersdescribed harmful practices thatthey recommend, such as advising awoman who has just delivered to not eatfor three days. The assessments documentedtwo attitudes of the grandmothersobserved during the interviews thatappear to be significant. First, in both casesit is reported that they were very assertivewhen describing their beliefs and practices.This suggests the level of confidence theyhave in their own experience and the convictionwith which they probably tell theirdaughter-in-laws what to do. Second, inboth cases they expressed their interest inlearning about new concepts related tochild health in order to improve their practices.Another dimension of grandmothers’ roles,related to pregnancy and childbirth, isreported by Wiley (2002). In rural northwestIndia, both during and after pregnancy,women’s practices with themselves andtheir newborns are greatly influenced bythe advice they receive from their networksof female neighbors and relatives,and especially by the experienced, olderwomen, viewed as authorities on thesetopics. The authority and influence thatthese senior women have on youngerwomen is clearly revealed in Wiley’s referenceto their role in the informal “managementof pregnancy” (1098) wherein widerangingadvice is provided to women on64 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

diet, work, fetal development, sexual relations,and traditional preventive measuresto protect the woman and child.Pakistan: In Pakistan, most women moveinto the house of their husband’s parentswhen they marry, although in urban areassome live in separate residences that areoften close to their in-laws. Even in caseswhere women live in a different town,their mothers-in-law continue to exercisestrong influence over them and their childrearingpractices. Iqbal’s study in urbanIslamabad (1995) found that advice bymothers-in-law has considerable influenceon the decision by daughters-in-lawregarding whether or not to breastfeed.sNepal: A rapid assessment carried outwith NTAG, a local NGO in Nepal, documentedthe important role of grandmothersin the Kathmandu Valley (Aubel et al.1999). Grandmothers play multiple rolesthat contribute to the well-being of children,women, and the family at large,including care for grandchildren, housework,kitchen gardening, care for small animals,guarding the house, and giving adviceon various family matters including childhealth and development. Grandmothersstate that their most important contributionto the family is their teaching and caringfor their grandchildren, to which theyare clearly very committed. Buddhismteaches that grandparents have an obligationto teach the younger generation andthat younger family members shouldrespect their advice. In both rural andurban areas of Nepal today, it seems thatin most families the knowledge and experienceof these senior family members isacknowledged and that for matters relatedto children and women the grandmothersare frequently consulted and involved indecision-making. Grandmothers statedthat their two greatest sources of satisfactionin life are passing on their knowledgeand traditions to their grandchildren andfeeling useful in caring for their grandchildren.Laos: In 1996, a WHO-sponsored studylooked at the roles and influence of familymembers on child health matters (Aubelet al. 1996), specifically related to diarrhealdisease and acute respiratory infection. Itwas concluded that in Laotian families seniormen and women are respected fortheir knowledge and experience but inchild health matters it is the grandmotherswho are particularly influential, given theirmany years of experience in this domain.Other family members recognize that it isthe grandmothers who have the expertiseto diagnose childhood illnesses and identifythe most appropriate treatment.“Theiropinion regarding how to manage thechild’s illness is usually sought and theiradvice is usually followed.” (53). Mothersrarely decide on their own how to dealwith a sick child given their easy access tosenior women advisors either within oroutside of the family.Thailand: In a study in Northeast Thailand,in an area that is socio-culturally similar toparts of Laos (Shawyer et al. 1996), it wasconcluded that grandmothers play a significantrole in managing childhood illnesses atthe household level. They are responsiblefor passing on to the next generation thefolk taxonomy for different types of diarrheathat determines the diagnosis and, inturn, the treatment strategy. While someGRANDMOTHERS:THE LEARNING INSTITUTION65

of their knowledge is sound, in other casestheir beliefs are incorrect and/or harmful.Professor Sakorn points out that grandmothersplay a particularly important rolein the economically depressed northeastarea of Thailand where out-migration isstrong and where grandparents are the“heads of household” in more than 1/4 ofall households (Sakorn 2003). In that sameregion, during the rice-planting season,when children are especially vulnerable astheir mothers spend more time away inthe rice fields, and when there is morediarrhea and less food available, it is thegrandmothers who have primary responsibilityfor their care. Sakorn strongly feelsthat child development programs shouldsystematically involve grandmothers.Indonesia: In West Java, where mostwomen have heavy workloads both withinand outside the household setting, it wasfound that grandmothers play a criticalrole in care-giving (Gryboski 1996 and2000). As compared with other familymembers, grandmothers are the primarysubstitute caregivers, but care is also providedby other adult female relatives, byolder siblings, and to a lesser extent byfathers and grandfathers. In addition tograndmothers’ role in direct care-giving,they also have a strong influence onyounger women’s knowledge and practicesrelated to child growth and developmentthrough the frequent advice they give andsupervision that they ensure. In an ethnicallydistinct part of Indonesia, key informantinterviews carried out in Flores (Aubel2001) also provided evidence of the centralrole played by grandmothers in childgrowth and development. Intervieweesstressed that families have great respect forgrandmothers’ advice both due to theesteem accorded to elders in their cultureand also due to grandmothers’ great experiencein childrearing.China: The research done by Yajun andcolleagues (1999) in eastern China, citedabove, documented the strong influenceparticularly of the paternal grandmotherson all aspects of child growth and development.Even though grandparents usuallydo not live in the same house as their sonsand their families, there is virtually dailycontact between grandmothers and theirgrandchildren through their active role inchildcare, especially when their daughtersin-laware away at work.Uzbekistan: The study conducted byProject Hope (Aubel et al. 2003) in theeastern part of the country documentedthe central role played by grandmothers inUzbek families in all activities related to thehealth and well-being of women and children.Uzbekistan is currently involved in asort of cultural revival, after many yearsunder Soviet rule. In interviews with communitymembers, it was frequently statedthat the grandmothers are an importantpart of Uzbekistan’s cultural heritage.EXAMPLES FROM LATIN AMERICAEcuador: Among the Saguaro Indians, thedependency of families on senior womenas “informal family healers” for all child andfamily health matters has been extensivelydocumented (Finerman 1989b). Whileaccess to both biomedical and traditionalhealth specialists is generally good, youngerwomen usually seek treatment advice andsupport from experienced older women66 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

in the family and social networks. Saguarograndmothers are involved not only intreatment but also in health promotionwithin the family. McKee (1987) came tosimilar conclusions based on work in theHighlands where “primary medical specialists”at the household level are seniorwomen who, in turn, train younger womento assume this role.Colombia: In urban Bogota, Myers andIndriso (1986) found that in extended familieschildcare was most frequently providedby female relatives, including mothersand mothers-in-law.Mexico: Related to infant feeding, a studyin rural Mexico documented the influenceof female social networks on childcarepractices of younger women. It was foundthat women with young babies more frequentlyconsult their mothers-in-law, mothers,and sisters for advice on infant feeding,than their doctors.EXAMPLES FROM THE PACIFICIn a 1998 study on breastfeeding practicesin urban Suva, in Fiji, it was found that, bothamong Indigenous Fijians and Indo Fijians,women’s infant feeding practices are significantlyinfluenced by the networks ofwomen within and around their families(UNICEF/Fiji 1998).EXAMPLES OF MORESYSTEMIC ANALYSES OF(GRANDMOTHERS’) ROLES INCHILDREN’S DEVELOPMENTMost of the literature discussed abovereports on discrete attitudes and practicesof grandmothers’ practices related to program-specificchild development issues,such as childcare, breastfeeding or femalecircumcision. However, very few of themprovide information on grandmothers’roles within household systems, and theirinfluence and involvement in decision-making.There are some examples of formativeassessments, carried out in the context ofchild development programs, that arebased on a family and community systemsapproach in which there is analysis both ofthe roles and influence of the varioushousehold actors on a child’s development,and of the specific practices of thosehousehold members. While no definitivemethodology exists for applying such anapproach, two other studies have beendescribed here that serve as examples ofhow this approach might be applied and ofthe type of results it could produce: first, astudy on newborn health conducted byHKI in Mali (Aubel et al. 2002), and second,a study on ECD carried out by SaveThe Children in Nepal (2000). The HKIstudy in Mali was a rapid assessment carriedout in one month with HKI andMinistry of Health staff. The Nepal studywas conducted over a one-year period bya team of researchers.SYSTEMS APPROACH TO STUDYINGNEWBORN HEALTH: MALIIn Mali, Helen Keller International (HKI), incollaboration with the Ministry of Healthand Social Affairs, is implementing a communityproject to promote newbornhealth and reduce neonatal deaths. At theoutset of the project, a formative qualitativestudy was carried out in BambaraGRANDMOTHERS:THE LEARNING INSTITUTION67

households in order to determine the role,influence, and practices of grandmothersand other household actors related eitherdirectly or indirectly to neonatal health. 9While most similar studies in the healthsector adopt a narrow, or reductionist,framework and collect information fromyounger women, and occasionally fromgrandmothers and/or husbands, exclusivelyon their knowledge and practices relatedto the health topic of interest, the methodologyadopted by HKI had a much broaderscope. On the one hand, the intervieweesincluded not only young women, but alsograndmothers, husbands, and male villageleaders. On the other hand, data was collectedon grandmothers’ overall role in thefamily and society, rather than only on theirrole in the health and nutrition of children.This analysis included collection of informationon the patterns of interaction anddecision-making between grandmothersand other household and communityactors (including husbands, heads ofextended families, and TBAs—TraditionalBirthing Assistants) related to newbornhealth.The results of the study revealed coreroles of grandmothers in Malian society,namely:• caring for children’s physical needsrelated to nutrition;• hygiene and safety;• attending to children’s emotionalneeds;• educating young children on culturaltraditions and values;• diagnosing child and family healthproblems, providing home treatments,and advising on referral tospecialists outside the family;• coordinating household food/nutritionactivities;• managing domestic work; contributingresources for household expenditures;• teaching and supervising daughtersin-law;• advising both male heads of theextended family and male heads ofhousehold on all matters related tomaternal and child health and wellbeing;• conflict-resolution within the family;• supervising young children of neighbouringfamilies;• advising young women outside oftheir own family on matters relatedto maternal and child health anddevelopment ; and• sharing their knowledge with andlearning from other women in theirage group, i.e. other grandmothers.The study in Mali clearly revealed that inBambara society grandmothers are consistentlyviewed as “family resource persons”in these different domains, due to their culturallydefined roles and vast knowledgeand experience in these critical areas offamily life.The study also provided informationon the specific practices that grandmothersencourage other family membersto adopt and that they use themselves,9 The systems methodology used in Mali was informed by but expanded upon by the methodology used earlier inLaos in 1996 (Aubel et al.,) and in Senegal in 1999 by the author working in collaboration with these organizations.Thesystems methodology later used in Uzbekistan (2003) built on all of these other experiences.68 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

elated, for example, to early childhoodstimulation or infant nutrition. However,compared to many other studies on similartopics, this analysis of grandmothers’ multifacetedrole and status at the householdlevel is useful as a backdrop against whichtheir specific newborn health-related practicescan be better understood.SYSTEMS APPROACH TO STUDYINGEARLY CHILDHOOD DEVELOPMENT:NEPALIn Nepal, a study on early childhood development,commissioned by Save theChildren and UNICEF, was to serve as abasis for strengthening ECD programming.The research holistically examined theneeds of children in the context of familyand community life in two different areasof the country. An important objective ofthe study was to identify the strengths, traditions,and resourcefulness of families andcommunities, all existing in the face of considerableeconomic hardship. An initialcomponent of the study involved lookingat the roles of various caregivers withinthe family structure: women, men, grandmothers,grandfathers, male and femaleolder siblings.One basic finding was that there are clearlydifferentiated gender-related roles relatedto most household tasks, and childcareis primarily the responsibility of mothers,grandmothers, and girls. Men, grandfathers,and sons have a limited role in childcareand their responsibilities are moreoften related to tasks outside the home.From an early age female children aresocialized to carry out multiple domestictasks including caring for younger siblings,while at the same time preparing them formotherhood later in life. Within thisframework, grandmothers demonstrateand instruct young mothers, and in turntheir daughters, on how to carry out thevarious tasks associated with “female” rolesin the household.While the number of nuclear householdsis increasing, extended family contextswhere grandparents are present still predominatewhere there are multiple femalecaretakers.Most mothers with young children areobliged to work long hours and oftenaway from home during the day and duringthe peak farming period. At these timesyoung children are cared for by olderfemale siblings and grandmothers who areoften inadequately equipped to providethem with a nutritious, safe and simulatingenvironment. Grandmothers provide continuousadvice both to younger femalehousehold members and to husbandsregarding the health and well-being ofwomen and children in the household anddepending on their health they take onmore or less strenuous childcare anddomestic tasks. Another finding that hasimportant implications for efforts toimprove women’s childcare practices isthat in most Nepalese families there is aclear hierarchy of power and decisionmakingin which the eldest male has theultimate authority in the family, followed bythe mother-in-law, her sons, and lastly, theirwives. Within this structure the mother-inlawhas considerable authority over decisionsmade and actions taken regardingher grandchildren, which often creates anuncomfortable situation for the daughter­GRANDMOTHERS:THE LEARNING INSTITUTION69

in-law who is expected to comply with hermother-in-law’s wishes.The Nepal study clearly reveals that grandmothershave a strong commitment topromoting the well-being of their grandchildrenbut they do not always providethem with optimal care and stimulation.While the importance of the grandmothers’role in the family is acknowledged, theresearchers in this study conclude that theprograms should strengthen the skills of“caregivers” in the family, though no explicitrecommendations are made regardingthe inclusion of grandmothers in suchstrategies.70 UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

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ABOUT THE AUTHORThis review was prepared by Judi Aubel, PhD, MPH. Trained in adult education, anthropology,and health education, Dr. Aubel has worked for many years in community maternaland child health and development programs in Africa, Asia, Latin America and The Pacific.For a number of years she has been interested in the role of grandmothers as untapped“resource persons” in family and community focused health and development projects.She is one of the founding members and President of The Grandmother Project: StrongGrandmothers, Healthy Communities; a non-profit organization established in 2003. TheGrandmother Project seeks to validate and strengthen the knowledge, skills and leadershipcapacity of grandmothers in their role as advisors in the family and community.Website: www.grandmotherproject.org

U.S.Agency for International Development1300 Pennsylvania Avenue, NWWashington, DC 20523Tel: (202) 712-0000Fax: (202) 216-3524www.usaid.gov