Long before you reach the circle of women, you hear them and feel their exuberance and warmth. These are the "grandmothers," fondly called les grandes-meres and dressed in brightly colored boubous — the voluminous traditional gowns with dramatic matching head wraps worn by the women of Senegal.
The women are seated on a large pink-and-mauve plastic mat in the village of Guereo, south of the Senegalese capital, Dakar. They sing as one grandma drums her fingers against an overturned bucket. It is her impromptu instrument to make music as they prepare for their health care and advice session as part of a community health project.
These grandmothers — and other senior women in the community — symbolize the marriage of tradition, culture, song and dance and modern health care methods. They pass on health education and childbirth tips to the pregnant women in their midst.
One of the grandmothers, Maimouna Mbengue, explains the benefit of their solidarity session.
"We learn as much as we teach during the discussions. We analyze facts and figures," she says. "We talk about the different health care priorities and problems our families face. And with the help of the health professionals in our community, we learn to adopt a more useful approach to tackle any problems."
Empowering Senior Women
In Senegal, there is a tradition of solidarity called bajenu gox, where the older woman, sister or sister-in-law assists the younger woman with health care.
ChildFund International, the U.S.-based aid group, has refined that strategy. It drew inspiration from a program called the Grandmother Project. The 501(c)(3) charity was pioneered by American Judi Aubel and is designed to empower senior women in the community.
ChildFund is continuing that program in Guereo and elsewhere in Senegal with funding from the U.S. Agency for International Development, says Julia White, who witnessed the local program grow from its infancy.
"In Senegal, one of the major decision-makers is grandmother and, specifically, also mothers-in-law," she says. "And so these women have a huge role on the decision-making authority of the mother — in terms of health and the health of the child."
She notes that by bringing the group together, the older women get to discuss topics that affect the health of the entire family — their grandchildren, their children and the mothers-to-be. The daughters-in-law generally live in the family homes of their husbands.
"And they get to talk about it and have a say over what they think should be the response," White says.
Communication Prevents Conflict
So, what are some of the problems?
White gives the example of breast-feeding.
"If you teach the mother that exclusively breast-feeding right after birth is the way to go, but the grandmother does not get a chance to talk about that, she might not agree," White says.
She says this might bring conflict in the house between a grandmother and new mother or the baby's father when the baby is brought home. Involving the grandmother in the decision-making is more likely to ensure continuity of communication, adds White.
But this does not automatically iron out all misunderstandings, misinterpretations and cultural clashes or friction between the traditional and the modern, explains Grandmother Mbengue.
"For instance, traditionally it's recommended that a pregnant woman should do a lot of hard work, because that helps during childbirth," she says.
Mbengue says the grandmothers have learned during their health care sessions that, on the contrary, it is dangerous for expectant mothers to do heavy lifting.
"So that's the message we're sharing with the younger women," Mbengue says. "It means we're changing our attitudes and general behavior."
As if to reinforce the point, one grandmother gets up and twirls herself and her colorful flowing gown like a fan in a vigorous dance.
A New Way: Talking Openly
Later, after the grandmothers' health session, younger mothers-to-be join them. Nogaye Diouf, who is pregnant, chips in.
"Indeed, it's like an apprenticeship," she says. "The grandmas are learning. We're also learning. And those of us who already have children apply what we've learned. So even if we don't have an older woman right by our side after we give birth, we've learned the ropes and the proper way to ensure our own health and the good health of our families."
The mantra is "harmony in the community equals harmony in the home," and the grandmothers use music, allegory, storytelling — and belly laughter — to broach subjects that are still considered taboo in traditional Senegalese society and are rarely discussed or debated in public.
White, of ChildFund, says that in the past, pregnancies were often hidden and "were not something you talked about openly and socially."
"Therefore," she adds, "women had trouble to openly talk about the problems and concerns they were having."
But gathering together in their separate grandmother and mother-to-be health care sessions has allowed "open discussion between the mothers-in-law and the daughters-in-law and between the mothers and their daughters."
White says now if an expectant mother is dizzy, she can openly ask: "Is this a problem? If I'm vomiting all the time, is that a problem? What can I do to be ready for the birth when it happens? And so, it allows them to work together as a team and learn from their experiences and be more open to having those conversations."
No subject is off limits, including family planning and especially spacing pregnancies.
"I'm a grandmother. I encourage family planning so that the young people can really manage and bring up their families and can afford to feed the children and send them to school," says Astou Ndoye. "Family planning is the answer."
Grandmother Mariama Sene says it's been a mighty learning curve for all of them.
"What had become habit, since time immemorial, and what we're doing now — it's like two different worlds," she says. "We have learned to find the right balance between the old and the new. What's positive in our culture and traditions, we've held onto. We take that and blend it with modern medicine and come up with the ideal remedy to ensure healthy children and healthy families."
Songs Spread The Word
Lightening the mood, the otherwise serious proceedings are punctuated by song and dance. The grandmothers often laugh out loud as the session continues.
There's a reason for the music, explains an elder, Aby Ndour.
"The songs we sing help spread the word among all the women — including the grandmothers and those expecting babies," she says. "Through song, we're better able to share and retain messages about a given theme or important subject and, that way, we can share them with the entire community."
As the grandmothers wrap up their solidarity health care session, the young mothers-to-be join them on the mat for a final song and dance to send off their visitors, with a promise from them to return to Guereo — to meet the newborns.
MICHELE NORRIS, host: Now we had to west Africa for the latest in our series, Beginnings. In Senegal, song and dance are being used to break down barriers to modern health care, and to help women talk about a subject long considered taboo for public discussion: Pregnancy.
Central to this model of health education are grandmothers. NPR's Ofeibea Quist-Arcton introduces us to a few of them.
(SOUNDBITE OF MUSIC AND CLAPPING)
OFEIBEA QUIST-ARCTON: You feel their exuberance and warmth long before you reach the circle of women dressed in gaily colored boubou, the voluminous traditional gowns worn by the women of Senegal, with dramatic matching head wraps. They're seated on a large pink and mauve plastic mat, one drumming her fingers on an overturned bucket as they prepare for their health care session.
These are the grandmothers, fondly called Les Grandmere.
This is the village of Guereo, near Mbour, a seaside town south of Senegal's capital, Dakar, where the grandmothers have gathered. Here, tradition meets modernity when it comes to passing on health education and childbirth tips to the pregnant women in the community.
Maimouna Mbengue is one of the grandmothers.
MAIMOUNA MBENGUE: (Foreign language spoken)
QUIST-ARCTON: Mbengue explains that they learn as much as we teach during the discussions. We talk about the different health care problems our families face, she says, including during pregnancy. And with the help of the health professionals, we learn to adopt a more useful approach to deal any problems, says Mbengue.
(SOUNDBITE OF MUSIC AND CLAPPING)
QUIST-ARCTON: And as if to reinforce her point, one grandmother twirls herself and her colorful flowing gown like a fan in a vigorous dance.
In Senegal, there is a tradition of solidarity called bajenu gox, where the older woman helps the younger. [End soundbite]
ChildFund International's strategy is inspired by the Grandmother Project, pioneered by Judi Aubel, to involve and empower senior women in the community.
Julia White is with ChildFund, which is continuing that program here in Guereo, Funded by USAID.
JULIA WHITE: In Senegal, one of the major decision-makers is grandmothers and, specifically, also mothers-in-law. And so these women have a huge role on the decision-making in terms of health and the health of the child.
QUIST-ARCTON: White says the older women get to discuss topics that affect the entire family. These include their daughters-in-law who live with their husband's families.
So what are some of the problems?
WHITE: For example, if teach the mother that exclusive breast-feeding right after birth is the way to go, but the grandmother doesn't get a chance to talk about that and be taught about that topic, she might not agree.
QUIST-ARCTON: And there are other misunderstandings and possible friction, explains a Guereo grandmother, Maimouna Mbengue.
MBENGUE: (Through Translator) For instance, traditionally it's recommended that a pregnant woman should does a lot of hard work because that helps during childbirth. But now, we've learned during our health care sessions that on the contrary, it's dangerous for expectant mothers to do heavy lifting.
(SOUNDBITE OF MUSIC AND WOMEN SINGING)
QUIST-ARCTON: The grandmothers use music, allegory and storytelling to broach subjects that are still considered taboo in Senegal.
WHITE: Traditionally, pregnancies were hidden, and not something that you talked about openly and socially. Therefore, women had trouble to sort of openly talk about the problems they were having. If I'm dizzy at this in point in time, is that a problem? If I'm vomiting all the time, is that a problem? What can I do to be ready for the birth when it happens? And so, it allows them to sort of work together as a team.
QUIST-ARCTON: Hear, hear, concurs Hogaye Diouf, one of the young pregnant women.
HOGAYE DIOUF: (Through Translator) It's like an apprenticeship. The grandmas are learning. We are also learning.
(SOUNDBITE OF SINGING)
UNIDENTIFIED WOMAN: (Singing)
QUIST-ARCTON: The otherwise serious proceedings are punctuated by song and dance, lightening the mood, but for a reason, says grandmother Aby Ndour.
ABY NDOUR: (Through Translator) I just want to explain that the songs we sing help spread the word among all the women, including the grandmothers and those expecting babies - in fact, the entire community.
(SOUNDBITE OF WOMEN SINGING)
QUIST-ARCTON: As the grandmothers wrap up their session, the young mothers-to-be join them on the pink and purple mat for a final song and dance to send off their visitors with a promise to come back to meet the newborns.
Ofeibea-Quist Arcton, NPR News.
MELISSA BLOCK, host: This is NPR News. [End soundbite] Transcript provided by NPR, Copyright National Public Radio.