By Nellie Peyton
NDOYENNE 2, Senegal, Aug 8 (Thomson Reuters Foundation) - Commanding pride of place in her village in Senegal, 90-year-old Daba Ndione leans back in her chair and watches the younger grandmothers pull each other up from the ground to dance.
Laughing as they shimmy and shake in their brightly coloured dresses, the women burst into song. But instead of traditional tunes about love and fortune, the songs are an ode to the influence of grandmothers across the West African nation.
"We thank our grandmothers for taking care of us when we're sick," the circle of women sing, melodic in their native language Wolof, while dancing and clapping.
Ndione grew up long before her village of Ndoyenne 2, on the outskirts of the capital Dakar, had a school or a health centre.
Now Ndione and other grandmothers are using their influence to promote modern medicine and health care, and discuss issues from family planning and malnutrition to maternal mortality.
"It's not good for women to stay inside when pregnant," Daba tells the women, challenging the tradition of hiding one's pregnancy. "They must go outside and walk around in the sun."
Reducing mother and child mortality is one of the biggest health challenges in Senegal, where many women do not seek routine medical care, health workers and experts say.
They are working with grandmothers in a country which has only five doctors, nurses and midwives per 10,000 people, far below the World Health Organisation's (WHO) recommended minimum of 23 health workers per 10,000 to deliver primary health care.
But the grandmother strategy has contributed to shifting attitudes and improving major health statistics, said Bouna Sall, a doctor who works in the region.
Maternal death rates in Senegal have dropped by a quarter in the past decade, to 315 deaths per 100,000 live births last year from 427 deaths in 2005, according to data from the WHO.
"Everyone obeys the grandmothers," Sall told the Thomson Reuters Foundation. "Through them we can change many things."
GRANDMOTHERS WIELD POWER
Grandmothers have authority over child rearing and family life in Senegal and across West Africa, and even wield power over the men in their communities, development experts say.
Organisations such as ChildFund, a U.S.-based charity that work with grandmothers, have found them to be a powerful ally in raising awareness, changing attitudes, and improving health.
After years in the field, health workers know the drill: praise the grandmothers first, and never tell them what to do.
In one session, two local volunteers performed a sketch in which a community health worker stressed the importance of prenatal checkups to a pregnant woman concerned that a visit to the doctor's would give rise to gossip from neighbours.
"The grandmother strategy is based on ideas from adult education - people have to decide for themselves to change," said Judi Aubel, founder of The Grandmother Project, which works to improve the well-being of children and women in Senegal.
ChildFund adopted the grandmother strategy in and around Dakar in 2012, and now more than a quarter of its 40 health posts are community-run, meaning that the grandmothers continue to meet, tell stories, and discuss health by themselves.
"They continue because they have understood the importance," said Adji Mahé Faye, ChildFund's regional coordinator. "They are conscious of their role."
The grandmother strategy has been effective in tackling sensitive issues such as family planning, early marriage, and female genital mutilation (FGM), human rights activists say.
Many women's rights groups focus on girls and young women to stop forced marriage and FGM, but it makes more sense to target grandmothers, who often perpetuate such practices, Aubel said.
"When the focus is on empowering girls, you create conflicts within families and societies," she said, explaining how only educating younger women can lead to clashes with their elders.
To change grandmothers' attitudes, civil society groups use midwives to talk about the health complications they have seen, and imams to explain that FGM is not a requirement of Islam.
After a three-year project in Senegal, the proportion of grandmothers who believed the risks of FGM were greater than the benefits had risen to 95 percent from 41 percent, Aubel said.
In the village of Ndoyenne 2, where FGM is not common, attitudes towards family planning are the most difficult to change, said Safietou Ndiaye, a ChildFund representative.
"In the beginning, the grandmothers thought family planning was just to prevent women from having children," Ndiaye said.
"We showed them that women need time to rest between pregnancies, and that waiting can help you save up some money."
The grandmothers enjoy the health sessions because they give them an occasion to get together and share news, Ndiaye added.
After concluding their discussion on prenatal visits and showing off their dance moves one more time, the circle of women in Ndoyenne 2 continue to laugh and chat throughout the morning.
"It is an activity we appreciate," says Adama, another of the grandmothers. "It helps us find solutions to our problems."
(Reporting by Nellie Peyton, Editing by Kieran Guilbert and Katie Nguyen. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking and climate change. Visit news.trust.org)