Africa's New Agents of Progress in Female Health: Traditional Male Chiefs

Some groups are making strides at ending child marriage and female genital mutilation by reaching out to the men in charge.
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Women in Chief Kwataine's village in Malawi. (John Cary)

Chief Kwataine, who's from the Ntcheu district in central Malawi, was working as an English teacher in 2003 when one day, a woman in the village went into labor and, as was the standard practice at the time, was whisked away to see an untrained birthing attendant in a nearby hut.

"That woman stayed there half a day. She was losing a lot of blood, and the traditional birth attendant could not handle the blood loss," Kwataine said. "Finally, the village head suggested the woman be taken to a health facility," in a nearby town.

Kwataine and several other men carried the woman to the clinic on their shoulders, but when they were just a few kilometers away, they realized she had died.

The experience made a lasting impression on him: Years later, when he joined the chieftaincy, he promised himself he would never again allow a woman to die in childbirth. "The chiefs were not responsive enough," he said. "We need to make sure that all the pregnant women were attended by the proper personnel."

He began by charging "fines" of a goat or a chicken if a family kept a woman in labor at home rather than taking her to a clinic. Pregnant women had to report to "secret mothers" -- women who could shepherd them through the pregnancy without revealing too much about the "condition" to strangers (the society still considers pregnancy to be something to hide).

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Kwataine with Malawian president Joyce Banda. (John Cary)

Kwataine's efforts were boosted with a 2012 initiative by Malawi's president, Joyce Banda, who sought to trigger behavioral change in the country by working through its 20,000 village chiefs.

"We are pleading with traditional leaders to do their rightful role," he said. "We need to make sure that chiefs come up with laws to bar women from delivering not in a facility."

Giving birth at home, rather than a clinic, falls into a category known as "harmful traditional practices" -- social mores that have been instilled over centuries and continue to be carried out in some regions despite their danger to health. It also includes other, arguably more detrimental, traditions such as child marriage and female genital mutilation (FGM).

The taboo and misinformation surrounding these customs has made them particularly intractable. Despite reams of evidence that early marriage stymies economic development and worsens female health, an estimated 13 million girls each year are married before they turn 18. And while villages and towns around the world have gradually renounced the practice, advocacy groups estimate that 8,000 girls per day are subject to FGM, in which a young girl's clitoris is partly or completely sliced off for purity and aesthetic reasons. If the victim survives the unsanitary procedure, it can make sex painful for the rest of her life and lead to major pelvic diseases.

He personally found the soldier, tied him to a chair, and waited for the police to arrive and arrest him.

These traditions have also proven frustratingly difficult to resolve through legal means -- for example, half of all marriages in India occur when the bride is younger than 18, which is the legal marrying age.

Traditional male leaders are typically the ones who protect ancestral ways, so they may not seem like natural vanguards of change. But across the developing world, increasingly more and more tribal chiefs and other leaders are becoming essential to ending harmful practices -- in large part because of how central they are to the village's life and beliefs. To improve the lives of women, some aid organizations are finding, you must first change the minds of the men in charge.

Traditional leaders are "the ones who set the laws in their communities or the social norms," said Lakshmi Sundaram, the global coordinator for Girls Not Brides, a group that works to combat child marriage. "Quite often, even if the parents of a girl don't want to marry her off, they wouldn't dare go against the prevailing norm within that community."

According to Gerry Mackie, co-director of the Center on Global Justice at the University of San Diego, the attempt to modify social norms, in general, is somewhat of a pivot for the health advocacy community, which has only recently shifted from individual-based actions (vaccinations, hand-washing) to societal ones (genital cutting and the like).

"Let's back up 50 years. After World War II, global development programs started taking off, and the first big efforts are in public health. Vaccinations, water, cleanup, and getting rural health clinics, that kind of thing. The rule of thumb [for whom to target with these efforts] was to say, 'What is the population at risk?'"

Unfortunately, targeting only the potential victims doesn't work for things like child marriage, he explained. A 14-year-old girl may resist marrying a 45-year-old stranger, but what happens when they graduate from the local development program and bump into a mom, grandma, or uncle who hasn't been sensitized in the same way?

"Traditional leaders come into play if it's a social problem that is continuing, because its continuance is caused by reciprocal feelings in the population," he said.

Here, the principles of modern-day social networking apply. Just as those who want to reach millions on social media might want, say, a retweet by @billgates, groups wanting to spread the word about child marriage want the village chief to relay their message. Village leaders wield outsize influence over their followers, and when trying to change a longstanding practice in just a few months, to save time it makes sense to reach the most listened-to individuals first.

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Olga Khazan is a staff writer at The Atlantic, where she covers health.

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