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In the absence of state infrastructure, grassroots networks play a crucial role in addressing the prevalence of violence against children in Kenya. How do these networks work and how can they be supported to overcome their challenges?
In much of Africa, where the state plays a limited role in preventing child vulnerability and in-service provision, grassroots informal community-based networks play an important role in addressing violence against children (VAC). I draw on research carried out in 2019-20 with Civsource Africa that focused on the role of different types of networks on the prevention of violence against children in Kenya, showing that while different actors at different levels are networked in the prevention of VAC, grassroots networks are on the front line of preventing and responding to this violence.
However, our research notes that there are challenges in the functionality of these networks, including in the way they interact with other more formal networks working to prevent VAC. These issues need to be addressed, taking care that grassroots networks do not lose their unique identity.
Networks are conceptualised as interconnected webs of actors, pooling together for mutual reciprocity in addressing VAC. In our research, there were formal and structured networks that comprised non-state actors like NGOs and other state institutions such as Kenya’s Department of Children Services, the Ministry of Health and actors in the court system.
At the community level, the unstructured grassroots networks included individual community volunteers, child protection volunteers, community-based organisations and community health workers. They also include community-based paralegals, who support children and caregivers in legal redress, as well as opinion leaders who are consulted in issues of violence against children.
These grassroots individuals and groups either worked separately within their communities or were networked with other actors, to whom they reported to or referred issues of child protection. For example, they were working with local community leaders in charge of sub-counties (known as chiefs), the Department of Children’s Services, the Ministry of health, the police and with different NGOs.
Some of these grassroots actors worked as appendages to the state system of child protection. For example, child protection volunteers are selected by the community but vetted by the Children Office and are expected to monitor issues of violence in the community and report to the Children Officers. The community health workers are appointed and vetted by the community during meetings known as Barazas. While some worked independently, they were part of the Ministry of Health strategy for delivering services to the grassroots and therefore expected to take up issues of child abuse and violence and referral to appropriate services. Being selected by the community reinforces the codes of trust that make them accountable to the local population. These actors were therefore expected to give periodic reports on VAC through public meetings.
The financing and capacity arrangements of these structures are diverse. For example, the community-based networks pool together their resources and energy to carry out dialogue in the community and follow up after cases of VAC. Some of them receive funding from the organisations they are affiliated with. Some volunteers working with the NGOs were receiving training, small funding for targeted activities and transport to follow up after cases of VAC. Some of the volunteers and CBOs were also working with several organisations at the same time.
Working independently or through other structures, these grassroots networks of community volunteers build the resilience of children by training them on their rights, offering psychosocial support and identifying cases of violence. They also build bonds that make it easier to address violence, by encouraging the development of positive norms and an ethos of child protection through dialogue on responsibility towards children. They also enhance the community’s collective efficacy in caring for their children through training on income generating activities. The grassroots actors also build bridges by connecting children with the police and other leaders who enforce laws, and probation and children officers who ensure state child protection.
Vertical collaborations with larger networks addressing violence against children enables these networks to draw synergies since some NGOs provide services addressing structural causes of VAC. For example, a CBO in an informal settlement in Nairobi noted that one of the NGOs supported the development of a community VAC alert system. Such collaboration ensures that effort in violence prevention is not just a local exercise but is connected at different nodes, thus ensuring that broader interventions are based on children’s everyday experiences of violence. For example, the child protection volunteers are part of the local Children Area Advisory Council, which is part of the National Council for Children Services, the highest oversight body on children’s issues.
These networks are homegrown and rely on community trust relations and, therefore, enhance faster dissemination of information on VAC at the grassroots level. They also act as first responders or what is seen as the first mile on issues of violence against children in their communities.
Similarly, our research finds that grassroots actors are acknowledged by other actors such as the police, children’s officers and local administrations, who listen to them. This validation is important in accountability to children’s rights since it might help the grassroots actors to check for excesses by such leaders when handling issues of violence, without fear of reprisals.
Overall, these simultaneously local and place-based, vertically integrated and culturally competent responses to violence emerged as important in addressing violence against children. They also, however, face challenges.
Due to a lack of adequate resources, including for transport and in some cases support to children facing violence, our research found that some volunteers stopped following up after cases of violence. While some were receiving support from other organisations, most of them used their own resources; some of the larger networks they work with often rely on donor funding and so, when funding ceases, the NGOs moved on, breaking the VAC referral pathways. The NGOs that participated in the research explained that community volunteers are not remunerated since they were seen as serving their communities.
In cases where community-based networks were linked to other structured networks, the playing field was uneven. The volunteers felt that they only participated nominally in these networks and were being ‘used’ as cogs by providing their services and information for writing grants, and then ‘dumped’ after the NGOs received them. This should also be seen through the lens of the philanthropy-wide shifts in Africa where funders require NGOs to demonstrate that they are working with community structures, which supports van Stapele’s research in Kenya where community based organisations characterised the relationship with NGOs as colonialist and saw themselves as ‘donkeys’, engaged in drudgery for the NGOs’ benefit.
In our research, the grassroot actors reported that, to get even, they would hoard information or register their own organisations to access the largesse of donor funds. Such tensions weaken the synergies that would accrue from networking, ultimately affecting efforts to address violence against children.
Even more, while proximity to the community is a resource, it also has a downside; some volunteers reported that they are victimised by the perpetrators of violence.
Grassroots networks in Kenya play an important role in preventing violence against children, and their work can be a basis for testing innovative models in child protection, and take to scale the prevention of VAC, and therefore they need to be supported. Care should, however, be taken so that systems in these networks that rely on trust are enabled to respond to violence without being undermined.
Efforts should also be made to ensure that collaborations are not only geared towards meeting the needs of external catalysts, such as NGOs, without tangible benefits for children. Further, these networks should not be co-opted into donor funding cycles which may not allow space for innovation because of their short-term and competing motivations.
To address the skewed power dynamics between actors, there is a need for strengthening the accountability of these grassroots organisations, as this will enhance accountability to the community and ultimately to children. There is an imperative for revisiting the very terms on which these organisations are crowded in by other actors.
About the author:
Elizabeth Ngutuku has a PhD in Development Studies from the International Institute of Social Studies of Erasmus University Rotterdam. Her work investigates young people’s experience of poverty, vulnerability, citizenship claims and sexual and reproductive health.
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Originally published on VoxEU.org on 02 February 2018
The majority of obese adults are now found in developing countries. This column presents new evidence on the effects of trade on obesity in Mexico. The results indicate that across Mexican states, a one standard deviation increase in the unhealthy share of food imports from the US increases the likelihood of individuals being obese by about 5 percentage points. As developing countries around the world open up their food markets to industrialised countries, they may be accelerating their ongoing nutrition transition and imposing high future costs on their health systems.
Obesity is not the first health challenge that comes to mind when thinking about the global south. Obesity is rather associated with the Global North, particularly the US (think soda drinks, fast food, and lack of exercise). But this conventional wisdom is passé. The majority of obese adults – those with a body mass index of 30 and more – are now found in developing countries (Ng et. al 2014). The Global South is in the midst of a health and nutrition transition (Popkin and Gordon-Larsen, 2004). While communicable diseases and undernutrition are on a (slow) decline, non-communicable diseases and overnutrition are taking hold of populations, and they are doing so rapidly.
Given the known health risks (such as diabetes and cardiovascular diseases) and economic costs of obesity, what can policymakers in the Global South do to prevent obesity in epidemic proportions? Important lessons may come from countries that have already undergone this transition and from examining potential drivers that are amenable to public policy. The much-discussed case of Mexico is ideal for such an exercise.
Mexico’s obesity rates increased from 10% to 35% over the period 1980-2012 (according to our analysis sample including adult females). And among the already obese OECD countries, Mexico ranked second in 2015, surpassed only by the US (OECD 2017).
Coinciding with these profound changes in population health, Mexico has opened itself to trade in foods mostly with the US. Currently over 80% of Mexican food imports are American. In Figure 1, we show the evolution of Mexican imports of foods and beverages from the US over time. While overall food imports have increased dramatically, food that is typically considered unhealthy has surged quite spectacularly. Notably, exports of ‘food preparations’ are 23 times larger in 2012 compared to 1989.
Figure 1 Mexican imports of food and beverages from the US over time
In Figure 2, we classify Mexican imports from the US as unhealthy or healthy food using the United States Department of Agriculture (USDA) Dietary Guidelines (for instance, ‘dark green vegetables’ are recommended for increased consumption, while ‘refined flour and mixes’ are advised for reduced consumption). US exports to Mexico of both food groups have increased since the late 1980s, but unhealthy food groups at a much faster rate.
Figure 2 Unhealthy and healthy Mexican food and beverage imports from the US
Such trends naturally raise the suspicion of a possible, causal link running from greater consumption of US foods to rising obesity prevalence (e.g. Jacobs and Richtel 2017, Rogoff 2017). However, to date no paper has attempted to estimate a direct causal relationship between obesity and trade.
In a new working paper, we quantify the impact of US food exports on individuals’ likelihood of being obese across Mexican states over the period 1988 to 2012 (Giuntella et al. 2017). To this end, we match several rounds of anthropometric and household expenditure surveys with product-level food trade data. Our main results are based on female adults for which data are available over this long time span.
We calculate the unhealthy share of food imports from the US by differentiating food items using the USDA Dietary Guidelines for Americans. We then allocate these aggregate food imports (healthy, unhealthy) to Mexican states. More specifically, we exploit variation in Mexican states’ historical expenditure by food products prior to trade integration. Our identification strategy assumes that aggregate trade shocks heterogeneously impact sub-national units as a function of time-invariant or ‘baseline’ variables (e.g. Dix-Carneiro and Kovak 2017, Autor et al. 2013). Note that there is substantial heterogeneity across Mexican states in obesity rates and historical food expenditure patterns, which further motivates our modelling approach.
Our empirical models also control for a host of state (such as food prices, GDP, FDI, migration) and individual covariates, as well as state fixed effects and state-specific time trends. In a second empirical strategy, we relate long-run differences in obesity rates at the state level to changes in unhealthy food imports conditional on baseline covariates. We instrument US exports of unhealthy foods to Mexico with corresponding US exports to other countries. And alternatively, we use ‘gravity residuals’ singling out the comparative advantage of the US in unhealthy food production relative to Mexico (akin to Autor et al. 2013).
We find that a one standard deviation increase in the unhealthy share of imports (equivalent to a 14 percentage point increase) raises the likelihood of obesity by about 5 percentage points. The effect amounts to 18% of the sample average in obesity. Findings using long-run difference models and IV estimates, as well as gravity residuals, are qualitatively similar – pointing to a plausibly causal effect.
Our main finding passes a series of robustness and placebo checks:
Weight gains due to trade vary across socioeconomic groups. As illustrated in Figure 3, women with low levels of education face a greater risk of trade-induced obesity – their obesity risk is 5 percentage points higher than that of more educated women in a Mexican state with average exposure to unhealthy food imports. This differential goes up to 8 percentage points as the state’s trade exposure rises by 14 percentage points (one standard deviation). This interaction effect between education and trade is robust to the inclusion of state-time fixed effects (that is, purging the main local effect of trade exposure). The results are consistent with the well-known hypothesis that more educated individuals are more efficient producers of health investment than less educated ones. This educational gradient may be exacerbated in food environments where individuals are faced with more unhealthy food choices (Mani et al. 2013, Mullanaithan 2011, Dupas 2011).
Figure 3 Inequality between education groups in obesity risk and unhealthy food imports
Having established a direct impact of US food exports on obesity prevalence in Mexico, we next turn to exploring possible mechanisms. Trade impacts incomes, prices, and tastes (due, for instance, to exposure to a foreign lifestyle and advertisement), all of which may drive the observed impacts on obesity. First, note that our main effect is robust to controlling for state GDP per capita, the total share of expenditures on unhealthy foods, as well as the relative prices of healthy versus unhealthy goods. Second, estimating demand equations over healthy and unhealthy food groups, we find that exposure to unhealthy foods from the US has redirected overall expenditure towards unhealthy foods. This observed shift is robust to controlling for real income and prices (for a similar empirical strategy, see Atkin 2013). In other words, trade with the US appears to influence tastes for relatively unhealthy foods. Increased variety of unhealthy foods boosts demand. These patterns are in line with a shift to ‘Western’ food consumption and increases in body weight among East Germans following the fall of the Berlin Wall (Dragone and Ziebarth 2017).
Nations have a lot to gain from trade. But weight gains and the associated health losses from trade in foods have been largely omitted from the equation. As developing countries around the world open up their food markets vis-à-vis industrialised countries – which tend to have a comparative advantage in more processed and less healthy foods – they may accelerate their ongoing nutrition transition. Obesity may put high costs on future health systems and the economies of the Global South.
Undoing the nutrition transition is likely harder than moderating it in the first place. Obesity and unhealthy food habits tend to be persistent. The Mexican experience is informative for countries in the Global South. Integrating nutrition and other health concerns into the formulation of food trade policies is paramount,[1] and such concerns should feature high up on the agenda in future trade negotiations.
Our findings suggest that differentiating between healthy and clearly unhealthy imports may help slow down secular trends in obesity around the world.
Osea Giuntella
Matthias Rieger
Lorenzo Rotunno