Africa is not a museum: the ethics of encouraging new parenting practices in rural communities in low-income and middle-income countries

Abstract

The Nurturing Care Framework for Early Childhood Development urges stakeholders to implement strategies that help children worldwide achieve their developmental potential. Related programmes range from the WHO’s and UNICEF’s Care for Child Development intervention, implemented in 19 countries, to locally developed programmes, such as non-governmental organisation Tostan’s Reinforcement of Parental Practices in Senegal. However, some researchers argue that these programmes are unethical as they impose caregiving practices and values from high-income countries (HICs) on low-income communities, failing to consider local culture, communities’ goals for their children and generalisability of scientific findings from HICs. We explore these criticisms within a public health framework, applying principles of beneficence, autonomy and justice to the arguments. To facilitate the change communities themselves desire for their children, we recommend that practitioners codevelop programmes and cooperate with communities in implementation to harness local beliefs and customs and promote evidence-based and locally adapted practices.

How overstated scientific claims undermine ethical principles in parenting interventions

“…2 3 To apply the principles of beneficence, autonomy and justice to such interventions is certainly valuable, especially if 'respect for autonomy' includes consideration of additional ethical principles the targeted communities uphold. We also agree that 'recognising and integrating existing beliefs, practices, people, context and skills' 1 in the programme design is crucial to fulfil the three principles. Finally, we agree most emphatically that there are considerable biases in the underlying research as it tends to 'only measure constructs that are valued from a western perspective'.…”

“…Finally, we agree most emphatically that there are considerable biases in the underlying research as it tends to 'only measure constructs that are valued from a western perspective'. 1 However, it is our contention that the authors fail to apply these insights to the science on which they build their arguments. To fully acknowledge biases in the knowledge base of early childhood development (ECD), we argue, is a fundamental requirement to meet the principles they propose.…”

“…5 6 These research shortcomings and biases may be illustrated by one of the most fundamental claims of global ECD interventionsthat 250 million children under 5 years in LMICs are 'failing to achieve their developmental potential' and 'failing to thrive'. 1 First of all, we should notice that it is not simply an empirical issue whether children are thriving or achieving their developmental potential. De facto, it is determined by setting BMJ Global Health developmental goals 'that are valued from a Western perspective', 1 ignoring the well-known fact that such goals vary greatly across sociocultural contexts.…”

“…1 First of all, we should notice that it is not simply an empirical issue whether children are thriving or achieving their developmental potential. De facto, it is determined by setting BMJ Global Health developmental goals 'that are valued from a Western perspective', 1 ignoring the well-known fact that such goals vary greatly across sociocultural contexts. 7 Even if we accept externally imposed goals, the problem of assessment remains: the number of 250 million failing children is simply derived from the estimated prevalence of stunting and poverty.…”

“…While parenting interventions are flourishing in low/middle-income countries (LMICs), their ethical challenges have rarely been considered. We therefore applaud Weber and colleagues 1 for their contribution to a recent debate about the ethics of parenting interventions. 2 3 To apply the principles of beneficence, autonomy and justice to such interventions is certainly valuable, especially if 'respect for autonomy' includes consideration of additional ethical principles the targeted communities uphold.…”