The distance between the halls of government or the ivory tower and the situation on the ground frequently obscures the voices of the communities and people nominally being helped. All global health work is ultimately local however making monolithic top down approaches an unsustainable paradigm. A major hurdle in developing more community-based approaches is a common tendency by researchers to view local populations as ignorant of their own best interests and consequently ignore communal concerns.
Naomi Rutenberg and Susan Cotts Watkins’ work in Kenya provides ample evidence of academic researchers’ tendency to hastily ascribe non-compliance to lack of knowledge. Even long-time foreign workers in population and family-planning in Kenya dismiss the interplay of “women’s gossip and fertility change” as “myths and rumors.” Had they been less dismissive, it would become readily apparent that far from being ignorant, the woman in Nyanza Province are making incredibly rational decisions with the information available to them. Looking at who women talk to when evaluating decisions about contraceptives it was determined “partners were better educated and better-off economically” than those consulting them. Far from idle gossip, this represents an appeal to the most likely source of credible knowledge within one’s social network. The careful thought surrounding potential side effects of birth control provides further evidence. Rutenberg and her colleagues noted that after a woman begins to practice contraception she carefully monitors her body’s reaction with respect to bleeding, libido, and other suspected side effects while also remaining vigilant for complications in the experience of others. These meticulous actions indicate that it is researchers who are ignorant to the true concerns, thoughtfulness and desire for knowledge of the community.
No one has better concepts of the pertinent issues in a community than those directly facing them. Aligning interventions with local conditions and demands not only offers an opportunity to construct better interventions and increase compliance but may also make implementers’ jobs easier as local groups and infrastructure are often increasingly likely to lend support when issues directly relevant to them are being addressed reducing barriers for greater trust and engagement.