What IS empowerment?

Sometimes things in development are foggy, specifically the jargon. There are a lot of terms that pop up in proposals, mission statements, and reports that carry a lot of weight among development folk, and a lot of time and effort is spent developing these phrases in order to pinpoint a very specific concept. My last semester in graduate school, I read a WorldBank report on "quiet corruption," a term coined to speak about corruption that occurs at the frontline of development programs in education, health and other sectors. Often when people speak of corruption, we imagine powerful men in big institutions, counting giant stacks of illegitimate money. I remember reading this paper and knowing exactly what this "quiet corruption" looked like (nothing like the stereotypical type), what detrimental effects it can have on a health system, and how the root causes are so vastly different from what we typically think of as corruption (the causes aren't as cut and dry as greed and hunger for power, it's often about lack of support and adequate compensation). It was a challenge I had seen time and again in different settings, but had never thought about in such a structured manner. So sometimes, jargon in development can help to clarify and categorize things, and maybe allow for better solutions to certain problems.

And while I honestly believe that these terms are always developed with the best of intentions, sometimes they end up being just plain confusing. Sometimes to the point of hilarity. What IS capacity building? What does it MEAN for a program to be sustainable? And currently, my own professional challenge: What IS empowerment??? A friend forward me a link last night on exactly this fogginess, and while it made me chuckle it also reassured me that I'm not alone in my frustration. Compiled by the development economist, Will Easterly, the AidSpeak Dictionary lists the main buzzwords in development, along with a tongue-in-cheek definition offered up by various people working in the development sector.

Some are pretty amusing:
“experienced aid practitioner” : has large number of air miles in account

“field experience” : I can’t bear DC anymore

“innovation” : we’re sexy, you want to be associated with us

“sustainable” : will last at least as long as the funding

But it was this one that hit too close to home:
“empowerment” : what is left when all the quantifiable variables give non significant results

One of my main projects at The Org is to identify how The Program may lead to improved women's empowerment among participants, and how this in turn may lead to improved maternal and child health and nutrition outcomes. Sound straightforward? Nope. As it turns out, "empowerment" has become quite the hot topic in development, with funders excited to support programs that foster "empowerment," and therefore, organizations excited to define components within their programs associated with "empowerment." But the task of actually studying "empowerment" for one of these organizations is really, really tricky.

First, back to my initial quandary, What IS women's empowerment? Conducting a brief literature review on the subject (well, 14 pages single spaced...) revealed that academics are also somewhat at odds over what to call it (you say autonomy, I say agency, etc.), but that most agree that empowerment relies upon the idea that a process of change occurs, whereby one moves from a state of disempowerment to a state of empowerment, and that this process occurs through human agency (Malhotra, 2002). The ability to become empowered is therefore dependent on the ability of an individual to make choices, and through this increase in ability to make choices and the act of choosing one becomes empowered. Which is especially interesting when you think of how many programs talk about empowerment as something they will provide ("This program will empower women/adolescents/minorities/etc"), but really empowerment comes from within an individual and can not be created by an external force. This all seemed pretty straightforward, until I starting digging deeper...

Next quandary, What leads to empowerment and how on earth would you measure this? This literature on this was a bit more discouraging. Most scholars argued that given the very definition of empowerment as a process of change in human agency over time it may not even be possible to measure empowerment; since it's a process one has to measure at several points in time, and since it's a change indicators will also evolve over time so one may not even be able to use the same indicators at each measurement! PLUS, it's argued that empowerment indicators are entirely context specific (what looks like empowerment in NYC is not what empowerment looks like in Cambodia), so it's difficult to standardize empowerment and compare levels of empowerment across regions. Sigh.

Despite this, The Org and I are going to try. I've identified some interesting indicators for empowerment, am finalizing the research tools, and beginning next month the data collection will commence. Because so much of this is exploratory, part of the process is finding out not only how The Program relates to women's empowerment, but also what are the appropriate indicators to measure it in this setting. I'm excited to see what we discover. And despite AidSpeak Dictionary, maybe just maybe, these empowerment variables will be significant.

Reference: Malhotra A, Schuler SR, and Boender C. 2002. Measuring Women’s Empowerment as a Variable in International Development. Gender and Development Group Working Paper. World Bank.

Field Sentiments

This past week I took a trip to one of the regions where The Org is operating its agricultural/nutrition program. Along with a fellow barong (foreigner) co-worker and Thida, a Cambodian program officer, I made the 4-hour car journey to Pursat province to monitor and observe various aspects of the program. Over the past month, I've read countless studies, bulletins and reports, and to see the farms in action took my breath away... Working in development, or public health in general I should say, I have often been part of programs that are innovative, exciting and that on paper should work perfectly. But in the field, whether that be New York City public schools or a village in rural India, challenges pop-up in the most unexpected places and programs have to weather these bumps in the road. So as we zoomed through the countryside, I held the picture-perfect version of the program in my head, but also kept an open, curious mind for what the challenges would be in this setting.

As we hopped out of the car and walked up to meet the first Village Model Farmer, I got a feeling in my gut that this visit was going to be different. His face stretched wide with a smile as he saw Thida, who visits all the farms each month to see how things are progressing. Thida has a background in both agronomy and management, and over the course of two years of field visits she has built an incredible rapport with each farmer. They greet one another as good friends, discuss how all the crops are coming along, and Thida gives suggestions for increasing production and planning ahead for the next season. The farmer took us on a tour of his land, pointing out different crops, animals and explaining his plans for the next planting. His farm was flourishing, with lush rows of mustard greens, morning glory, bunching onions and trellises crawling with gourd and bean vines. In another section, he showed us all the seedlings and saplings he was growing and saving, to be distributed among the other household farmers in his community. As a Village Model Farmer, he serves as a source of agricultural knowledge and support for the 20+ women farmers also participating in the program. If someone's sweet potato plants aren't doing so hot, they'll come to him for tips on how to turn things around. He also talks with the other farmers, most of whom are mothers of small children, about the nutrition of these crops and the benefit of including them in daily meals.

I left his farm overwhelmingly impressed by the food production, his pride in his work, and his commitment to supporting others in the village. As we moved on to visit household farmers and more Village Model Farmers in other villages, I continued to see a pattern.... Beautiful, successful garden plots, farmers beaming with pride, and women saying over and over again, "Yes, we get all our vegetables from this garden so we don't have to but at the market. And whatever is leftover we sell at the market, and then we spend this money on meat and school fees for the children." When we asked if they also spent some of the money on healthcare for the children, only a few said they did... The rest said that since they began feeding their children more fruits and vegetables they had actually been sick less often, so no, they didn't need to spend the extra income on healthcare.

Part of me knows that I am probably still a bit naive, and haven't seen all the ins-and-outs of this program. We were visiting a program that had been operating in Pursat for almost 2 years (and the program has been in Asia for over two decades now) and there were most likely some hiccups throughout during implementation, but overall this program is working in Pursat. Numbers show increases in food production, income generation and after endline data is gathered we will see if there have also been increases in consumption of micronutrient-rich foods and improvements in child health and nutrition. The program is ending in October in this region, but every farmer we met was preparing beds for their next planting, planning their next harvest, and collecting and saving seeds for the next season... When we asked if they would continue their farms after October, all responses were the same and the answer was evident in the success of these farms, the smiles and energy of the kids, and the stories of how lives had changed over the last two years, "Yes, of course we will continue."

A Brief History of... The Program

With work getting busy and field visits happening, I have a feeling that more and more of my blog posts are going to be work-related... So I thought it would be helpful to give a bit of a primer on the program I'm working on for the next 6 months. This was taken from a bulletin by The Org and sums up the programs operations and objectives quite nicely!

"The Homestead Food Production Program targets women from poor households as the primary beneficiaries, placing farming inputs, knowledge and skills in their hands. The Org works in collaboration with local partner NGOs and government structures to establish Village Model Farms (VMF) and also helps household to establish home gardens (cultivation of vegetables and fruit crops around the house) and small animal husbandry, mainly poultry... The Org and partners promote 'developed gardens,' which produce a wide variety of vegetables and fruit on a fixed plot of land throughout the year. This model relies on the dedication of participating households, particularly owners of Village Model Farms (VMF). The model also builds linkages with local health and agriculture structures to provide additional services to participating households and builds capacity of local partners to provide sustained technical assistance on both agriculture and nutrition to both VMF owners and beneficiary homestead food producers after the life of the three year project cycle.

The VMF serve as a place for training and demonstrations on improved agricultural techniques, technologies and poultry production activities for households participating in the program. The VMF is also used a a production center, as it is a source for inputs, like low cost quality seeds, seedlings, saplings and chicks. VMF owners are responsible for sharing these new practices and low cost inputs with other households in the village and providing ongoing support in collaboration with The Org and local partners. Typically about 20 households are supported by one VMF and households are divided into two smaller groups (women's groups) to best facilitate collaboration.

Nutrition education is a core component of the Homestead Food Production Program. The Org and local NGO partners train health staff and volunteers working at the village level, who in turn host nutrition education sessions for mothers. These sessions emphasize the importance of eating nutritious food during pregnancy and lactation, as well as educate mothers on optimal feeding of infants and young children, including breastfeeding and complementary feeding. Mothers learn how to improve their household's dietary diversity and micronutrient consumption through cooking demonstration sessions using locally grown foods. More recently, the basic nutrition education component has been enhanced to include essential nutrition actions and behavior change negotiation for improved nutrition practices among mothers.

The Org and local partners provide all necessary inputs at baseline to VMF and households, including: 10-14 vegetable and fruit seed, seedlings, and saplings, chicks, poultry vaccinations, and training on optimal crops and cultivation, composting and organic pest control, water management and conservation, garden fencing, chicken shelter construction, vaccines and feed production."

Nutrition Nut

About a month before I left NYC, I spent an evening with some friends at a Brooklyn bar and someone asked me exactly what I'd be doing for the next two years. This can be a tricky question, because if I get overly excited I end up blathering on and on about the organization, the issues, the amazing programs, the challenges.... Or I can just say, "I'll be working on a nutrition program." However, this is pretty vague, and the beauty of a blog is that I can blather on and on. Buckle your blathering seat belts, folks!

A lot of you who know me know that this job means a lot to me. Not because it's my first position after graduate school or because it allows me to pay off my loans, but because this is my dream job. I've pretty much solely worked in maternal and child health programs over that last 5 years, but way back during my first stint in India I began to become really interested in food systems, access to food and malnutrition. What people were able to purchase/grow to eat, what people chose to eat and how social norms affected what got into peoples' bellies was intimately tied to pregnancy, child health and reflected the the gender dynamics within communities and society at large. But I had always envisioned myself as a "gender-person," and thought that my career path would be one straight shot towards work in reproductive rights and women's health. I began reading more about nutrition and health, volunteering with some exciting NYC-based food security NGOs, and gave myself two years during grad school to marinate. By the end of my first year, I still felt the pull towards the nutrition sector.

Fast forward to April, when everything falls into place and I accept a two-year contract with an organization (from here on called The Org) doing some of the most (in my opinion) innovative and interesting work in the field of nutrition. I'll be working on two programs over two years, in 3 countries: Cambodia for 6 months, Mozambique for 6 months and Senegal for 1 year. I've just wrapped up my second week of work here in Phnom Penh and am really thankful for the opportunity to be here.

Cambodia faces some extreme challenges with undernutrition. Around 37% of kids under 5 years of age are stunted (meaning their height is too short for their age), 36% are underweight (meaning their weight is too low for their age), and 7% are acutely malnourished (meaning their weight is too low for their height). 62% of these children under 5 years of age are also anemic, as well as 47% of women of reproductive age and 57% of pregnant women. All these scary numbers translate into kids that are at greater risk for disease and death, women who are at greater risk for death during delivery, and kids who may not develop to their full physical and mental potential. So what do you do about it? The Org I'm working with has some pretty great ideas.

While in Cambodia, I'll be working on a program that supports small-scale agriculture and animal husbandry among households in rural areas. Typically, one of these gardens would be run by a woman, provide a diverse, vitamin-rich diet for her and her family, and any surplus fruits, vegetables or eggs could be sold to generate additional income for her household. Sounds pretty awesome, right? Here's what makes it even more awesome: The Org believes in community-supported, sustainable programs, and that any program must be proven to work. So all operations of the program are delivered by local Cambodian NGO's (non-governmental organizations) and in partnership with the Cambodian government. And The Org evaluates this program to verify that a) it's running as it is supposed to b) the gardens actually are increasing production of food for the household and c) that this increase in production is also leading to an increase in consumption of nutritious foods.

Where do I come in? My role for the next 6 months will be based more in the latter portion of this, in program evaluation. I'll be working on setting up several research projects to answer the following questions:

1) How does this program lead to increased women's empowerment and what effect does this have on maternal and child health and nutrition? This program has been around for 20-something years and has always focused on women's production of food, but has only recently began thinking about how this role and income-generation may affect female decision-making power, and how this in turn may affect what foods are consumed, who consumes these foods, what additional income is spent on, and how healthcare is accessed and utilized. My job is to help clarify this aspect of the program. Additionally, a lot of The Org's research has shown increases in consumption but the link to the ultimate goal, improved health and nutrition, has been more difficult to pin down. Part of this is time (changes in health and nutrition take many, many years to occur) and money (assessing nutritional changes means measuring kids and collecting blood serum to check micro-nutrient levels); so I'll be brainstorming additional ways to measure this impact.

2) What is the cost effectiveness of this program? Program costs as compared to program benefits is a pretty hot topic these days in the world of development. The Org is interested in finding out what impact every dollar of donor money has; I'll be charting out the input costs for the program, and more interestingly, charting out the benefits for beneficiaries. Beyond the income generation that a family may have from these household farms there are other societal benefits that may be experienced, and it will be my job to identify and quantify those. For instance, if a family is consuming a nutritious, diverse diet and children are healthier, they may experience a lower incidence of disease, which may translate into reduced healthcare expenditure. After mapping out all these costs/benefits, we see what the program produces for every dollar spent, both in terms of financial and societal gains for families.

3) Evaluation design for the program as a whole. This is less of a research question and more of a task that will assist The Org in answering future questions related to program operations and impact. As of right now, a lot of the monitoring and evaluation of the program is based on what a donor wants to know. Because different donors fund the program in different provinces, what is being monitored and evaluated differs between provinces. In the last few years, The Org has created a model for the program that details all the inputs, activities, outputs, outcomes and impacts that should theoretically occur. Having an evaluation plan that is designed on this model, rather than a few aspects here and there according to donor interest, will allow The Org to streamline their monitoring and evaluation (M&E), collect the same data for every province, and ultimately allow them to answer all questions and compare across program sites. This may all sound pretty technical, but I'm a bit of an M&E nerd and this is part of my work plan that I'm most excited about.

Ok, blathering done... for now.