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When Parents Say No
Message from Denise Gray-Felder

Does any parent have the moral right to refuse care that might save his child’s life?  This type of medical ethical question is debated often in professional journals and even mass media, especially those in North America and Europe.  Before I became a parent I likely would have answered, “Of course she does: It’s  her child.”  But as I practice this craft of parenting I become more conflicted with each passing year.

Shouldn’t an adolescent, who has rational thought patterns and opinions, have a voice in his care, I ask myself.  What about a school’s right to keep its educational community well?  Even for babies and toddlers – with limited voice and rational thought patterns – does not the society into which she is born have a responsibility to help her and her parents stay healthy and strong?

As I sit reviewing this issue of Mazi, I’m struck by the challenges of community-based communication based on public dialogue and how such processes can collide with commonly held beliefs and values, thus unleashing new rounds of cries about parental rights.  You’ll read in this issue of Mazi about how what seems to be a simple matter of good hand-washing practices in U.S. hospitals is complicated by issues of power, bureaucracy and patients’ rights.  There is also Silvio Waisbord’s thoughtful analysis of communication for social change and the responsibility we all have to explain our professional practice in compelling and scholarly ways.

And Dominique Thaly’s photo essay featuring the Consortium’s polio communication work in northern Nigeria reminds me that some parents there still say “no” to polio vaccines for their young children.  These parents seem to be making such decisions based more on popular “myths,” misinterpretations of the government’s intentions, mistrust of the political or public health systems, or misunderstanding of religious tenets – than upon a thorough understanding of how polio vaccines work or how polio moves through villages and countries.

(Note:   Public health and communication experts have been assured repeatedly by Islamic scholars that nothing in Islam prohibits immunizing children.)

As facilitators of communication for social change processes, we find ourselves “in a pickle” when our theories lack empathy for the types of real conflicts men and women in poor villages in poor countries grapple with daily.  I’ve never met a mother who did not want the best for her child, even when she had nothing to give.  So when we find mothers who refuse polio immunization “because he doesn’t need it” or because “I don’t see the need because no one in this village has polio” I’m motivated to be an even better listener and communicator – to understand and question – not to scold, or to lecture, or to teach, to ridicule or blame or, God forbid, to report this mother to the authorities. 
Effective communication engages while it inspires creative problem solving.  It helps people under stress, or in situations of conflict, develop skills to talk through their difficulties in ways that are constructive, forward-looking and respectful. 

So with parents in northern Nigeria our work seeks to help health educators, health vaccinators and community health workers learn to employ face-to-face, interpersonal communication skills in ways that may break through the objections of poorly motivated parents.  When a parent says “we don’t need the polio drops” our hope is that a vaccinator who has been trained in CFSC approaches will respond with: “May  I come in and hear more” rather than mark her tally sheet “noncompliant household” and move on to the next house.  When we give up our ability to listen and persuade in positive ways, we are saying, in effect, that the person offering the objections is not worth our time and investment. 

No child in the world deserves that.

We are also working within states at high risk of exposure to polio to build a systematic way to research, plan, implement, monitor and assess the effectiveness of community dialogues held with multiple stakeholders of immunization efforts.  Because attitudes, beliefs and values about childhood health are influenced both within families as well as by the larger social (village, district or local government area) environments, it is also critical to understand how those beliefs and normative behaviours can be positively altered using effective participatory communication.

In Lesotho, parental rights play in a different way.  There, we’re working with Unicef and the Ministry of Education and Training on an “Education for All” communication initiative.  Most Basotho parents believe in education for their children and want them to go to school.  Yet there are pockets of resistance, especially among families who are forced to make the difficult choice of sending their boys to the fields as herd boys (shepherds in the mountainous regions) or their daughters to live in homes in the cities as domestic workers.  I like to think that such choices are not made lightly; that as a mother is packing up her son to live alone in the mountains with the cattle she thinks “one day he will come home and go to school.” 

Parents in Lesotho saying “no” to schooling for their children generally do so for economic reasons.  Even among those families who enroll and keep their children in school, we are seeing some fascinating challenges.

Lesotho is a country grappling with the collision of human rights principles with the rights of parents and caretakers.  Corporal punishment and physical discipline of children in schools by headmasters and teachers is banned by the Ministry of Education and Training.  To re-inforce this position, the Ministry and Unicef sponsored the participation of every school principal in the country in a three-day workshop over the course of the past two years.  A huge logistical and financial undertaking, these workshops emphasized heavily the laws and regulations banning violence against children, sexual abuse and corporal punishment in schools.  To their credit, administrators and teachers appear to be complying.

Yet, taking our CFSC participatory research to the communities, we learned in both urban and mountain communities that some parents are not so convinced about a child’s human rights.

We heard stories from traditional elders about parents who now seem unable to control their children at home because the children “know their rights.”  One chief in a Maseru community explained, “the children misbehave in school and they know the teacher cannot beat them.  They come home and tell their mothers and fathers that they cannot beat them either.  This makes for badly behaved children.”

I hope that, over time, all parents in Nigeria and in Lesotho – and in all other countries of the world – will be able to say “no” to those activities that truly bring harm to their children, and to say “yes” to education, routine childhood immunization and nonviolent discipline.  Is it their right or responsibility?  Perhaps it is both.

Can the needs of society overrule the rights of parents?  When and if they do, I hope that communication for social change processes will be included in the array of techniques used to help communities and nations work through such conflicts.

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