Peer-reviewed article

Whose child is it? A psychological perspective on responsibility and accountability in decision making on nurturing care in early childhood

Muneera A. Rasheed, Penny Holding · 16 May 2024

Abstract

In this comment, we examine the implications of decolonization on decision making in childcare (Kgatla, 2018). Self-empowerment as a cornerstone of change, long part of community empowerment, has finally achieved recognition within the literature on global health and nurturing care (Charani et al., 2022; Sharm & Sam-Agudu, 2023). Varied perspectives discuss the global benefits of shifting responsibility in decision making, for humanizing of the lives of the global majority and creating more sustainable change (Affun-Adegbulu & Adegbulu., 2020; de Laat et al., 2023; Martin, 2016). There still remains much more to be said, to be clarified and understood, before the imbalances and disconnect in responsibility and accountability still inherent in the current framing of child health and welfare systems are removed. The authors of this comment, both psychologists working in the Global South, have engaged in dialogue for more than a decade, examining our individual and shared experiences of intervention, research and therapy, reflecting on our professional challenges and achievements in the field of global Early Childhood Development (ECD). These discussions have examined the complexity in the process of the decolonization of early childhood frameworks. Within ECD those closest to the child, the parents and guardians, are held, for the most part, accountable for the failure to adequately address children's needs. However, the responsibility, the position of power, for selecting best practices is taken up by those who control the resources, the expert external to family, community and often too, external to the culture. As we observe this relationship play out, we have increasingly understood that sustainable change can only be built on a rebalancing of responsibilities, and in generating a direct connection between responsibility and accountability (Rasheed, 2021). Supporting this tangible shift in decision-making will create a more direct relationship between informed care, the context and its socio-cultural, environmental, and economic demands and the changing needs of the child (Krapels et al., 2020; Muhamedjonova et al., 2021). The evidence in the field is predominantly informed by randomized trials conducted under controlled settings with limited generalizability (owing to the bias of being published in medical journals, as noted by Scheidecker et al., 2023). This is where we believe anthropology has a lot to offer and an excellent multi-disciplinary opportunity for incorporating their methods to understand the complexities of human nature so we avoid making simplistic assumptions of the lives of millions of children in the Global South. In this comment, we continue our process of reflective practice through which our insights have developed, sharing where our dialogue has reached in response to Scheidecker and colleagues' (2023) critique of the field of Global ECD. Over the years, my understanding of decolonization in global health research has evolved. Initially, it seemed complex, but observing colonial behaviors in a collaborator opened my eyes to explore decolonization in the context of global health in Early Childhood Development (ECD), where I work in mostly Western collaborations. As I've delved deeper and contributed to this discourse in global health journals, I've noticed that the momentum behind decolonization in global health is mainly driven by individuals based in the Global North tied to existing systems for survival. They suggest adapting to these structures. However, I believe we should seize this moment to create a new system that values the unique cultures and strengths of the Global South. In academia, the focus on metrics like "publish or perish," prestige, and power has overshadowed community and impact. Decolonization, for me, means leading on our terms. Our systems and aspirations differ significantly, and we shouldn't compromise our identities for Northern resources. Decolonization requires that we expand and embrace our own regional systems that reduce inequities. Ultimately, decolonization, as I understand it, is about reclaiming power in the South (Rasheed, 2023). Our focus should shift towards recognizing, valuing, and applying behaviors that align with our own criteria for validation. In essence, decolonization is the path to a more equitable, inclusive, and self-empowered future in global health and beyond. Adding to this, exclusion, whether unconscious or deliberate, leads to inherently unstable systems. The shift as you describe is therefore not just a right, but a necessity. In the process of decolonization, however, the danger is to merely shift to another dominant perspective. You discuss this in your previous paper (Manjpara, 2022). As with the artist, the scientist who chooses not to be constrained by the dominant perspective will be "starved" professionally, be excluded from discussion, and from access to resources. The non-conformist scientist is marginalized by being labeled as "difficult" or "eccentric." This labeling can be even more destructive; it can include tags such as uneducated or, worse, uneducable. Unfortunately, I have observed this "ghostlining" (Krapel et al., 2020), the removal of people from a conversation because their voices are less valued, in global health forums on many occasions. This same process of ghostlining is evident in the rationalization given for not including the community voice directly in decision-making. We have both faced pressure from reviewers to supply references from the Global North that substantiate/validate our methods, processes, tools, and reflections. But those narratives do not address the history of the knowledge, wisdom, and experience of the Global South. In my lived experience, scientific activity is actually constrained by a focus on searching for "the" universal truth. The exclusion of other world ideas and experiences culminates in re-centering, while de-centering can create infinite power for change by reflecting on multiple perspectives and referencing across scientific traditions. Which approach did you have in mind when you spoke of validation? I had decentering in mind. To me, decentering is a psychological process where we shift our perspective away from ourselves as the central focus. Instead of solely considering our point of view, we value the perspectives and experiences of others, fostering empathy, understanding, and inclusivity. Even in the Global South, there's a tendency to measure success against Western standards, rooted in our colonial past. This mindset infiltrates our lives, reinforced by a parallel system of resources and power controlled by the North. This reliance on external validation perpetuates mental colonization, where our voices and experiences are primarily validated by the Global North. However, I've realized that my reality and struggles are different from those in the North. I've shifted my focus to peers who share similar experiences, reclaiming our narratives and directing the discourse to what truly matters to us. Seeking Northern validation can be detrimental, overshadowing our voices and experiences. Validation becomes a tool of control, influencing one's sense of self-worth. We have to accept the fact that external resources or from the North are not meant to build us; they are meant to distract us by engaging us in non-meaningful yet comfortable work. It's time to challenge this reliance and define our worth on our terms, independent of external validation. As someone whose family was from the Global North but whose lived experiences are largely in the Global South, what is your conceptualization of decolonization? Colonization refers in general terms to the appropriation of space, and so in terms of science, space is the thinking space. Simply put, then, I conceive decolonization as the creation of an open thinking space where the diversity of thoughts is intentionally included and equitably valued. In The Doors of Perception, Aldous Huxley (2010) wrote: "There are things known, and things unknown, and in between are the doors to perception." In the in-between, paradigms of thought can evolve that are influenced by a much broader range of experience and knowledge than science currently draws on to develop theory and frameworks. The irony is that science, ostensibly about breaking through boundaries of knowledge, is all too often trapped within boundaries of its own making. This is the tyranny that follows the imposition of standard practice, when those standards do not address multiple settings, values and needs. It is what I fear from Artificial Intelligence (AI). Can we trust those who set the algorithms to ensure sufficient diversity of perspectives and goals to reach a new frontier of thinking? AI is likely to continue the colonization of thought unless the algorithm is set for learning to occur freely through the examination of all wants and all values and considers the consequences of all possible choices, intentionally including those whose perspectives have previously been ignored. Without this shift, we'll never solve our problems because we are unlikely to find out what the problem actually is. When I visualize the word framework, I see scaffolding and reflect on the way scaffolding has been used to describe both continuity and flexibility in help and support given directed at children's learning (Verenikina, 2003). Early childhood is the time of the most rapid change, and growth. Any framework that has a predetermined direction perpetuates colonization, constraining that growth. While a decolonized framework recognizes, without fear or prejudice, the responsibility of each to find out what they need to understand, to fix and manage our own needs. Within a decolonized approach, an ECD framework will provide support that is responsive to different perspectives, places, times, objectives, and different sets of resources. In implementation design, for ECD as for many other human systems, there is what amounts to an obsession with uniform systems, controlled centrally. The justification is the need to make comparisons across and between contexts, and as one UN representative described, "We are the ones responsible for the children." Universal frameworks, it seems, are commonly adopted for the convenience of large international organizations, whether implementers or funders, to streamline the management of their portfolios, ignoring the ultimate and unavoidable power of the parent to place the specific needs of the child at the core. If you put this into everyday language, the universal framework tells the parent what others want them to do, in a specified way, with little consideration of personal knowledge of the child or context. What then happens can then be counted up, to report on global data, whose meaning and targets may hold little relevance to the family at the focus of the work. That is not science; it is an appropriation of my responsibilities as a parent and an appropriation of both my physical and mental space. The application of universal standards both builds on and perpetuates a narrow focus of responsibility and accountability. It is colonization at its most extreme. Only when different perspectives are acknowledged and valued will we move towards understanding the full panoply of human potential and be able to select solutions that are valued and work in context, sustainably over time (Kreuter et al., 1999; Shaw & Silva, 2023). Adopting a humanistic and realistic framework to understand the impact of colonial legacies on ECD is essential. As you say, it's crucial to involve the people directly impacted in discussions about interventions and it should be more than a superficial act of seeking their feedback on a designed intervention (based on Global North perspectives). Engaging with the beneficiaries should begin before you start designing with an intent to explore their priorities. This approach provides valuable insights into the challenges and potential solutions. However, there's often a disconnect between those addressing the issues and the affected communities largely driven by academic incentives to conduct a randomized trial and getting a publication in a high-impact journal. While we use community members to collect data, their role in decision-making remains limited. Second, we also need to ask how we can truly measure the effectiveness of interventions and prepare individuals for the future. The focus of the current interventions driven by the Global North are those living in abject poverty in the South, this overlooks the needs of middle-class families. Interventions tailored to these families, who have more resources and support, may be more impactful than those for the most disadvantaged. Designing interventions that fit their context and requirements is crucial. Community members understand the complexities and nuances of their challenges in a way that external observers cannot, and decision-makers distant from the situation invariably do not, in the quest for simple solutions, for silver bullets. Given the opportunity to share their intimate knowledge of, for example, political and environmental disruptions that disconnect people from their familiar environments, we have both experienced communities framing potential and acceptable options to address their complex situations. Exclusion from solution design extends to exclusion from data use, with outsiders gathering information, and compiling it in documents, most commonly in English. We are, thus, far from sharing our learning wisely. As you pointed out earlier, the path to achieving distributed leadership, genuine shared decision-making, remains distant. Decolonization is not about continually critiquing the Global North or emphasizing their wrongs and the need for their change, as I've encountered in the discourse, I've been part of. In fact, it reminds me of a valuable lesson you once shared with me when I had to present in front of a committee dominated by the perspective of the Global North. You wisely conveyed that the focus should not be on how "wrong" someone else is but rather how right your approach is. This lesson has profoundly resonated with me. It reinforces the idea that the true change begins with us, within our own systems, our communities, and the reclamation of our power. It's an unshakable responsibility we must shoulder, and there's simply no alternative. Psychologists, and this brings us to our last question, refer to the community as clients, and the core of our approach is empowerment. They, the clients, are the true leaders, shaping the way they want their lives to change. We serve as guides and facilitators, and our primary role involves asking questions that enable others to delve deeper into their challenges. Our fundamental assumption is that the solutions reside within the individuals we work with, our clients. This perspective motivates me to emphasize the need to introduce psychology from this vantage point, to rehumanize global health, to foster empathy, and to accept the inherent uncertainties. It's about placing the community or individual we aim to assist at the heart of our efforts, acknowledging their abundance of solutions. Our role should pivot from what aid agencies have traditionally done and shift towards addressing systemic issues, focusing on system strengthening. Sensitization and dialogue with these systems on how best to support these individuals should supersede simply doing things for them, to generate informative research and favorable outcomes. You raise the importance of systems. An example of this, for me in the global health/ECD space are discussions on maternal depression (Stewart, 2007). All behavioral phenomena, while communicated simply through the use of labels such as depression, manifest themselves not as categorical phenomena, but along a continuum of experience that is inextricably intertwined within current and past experiences and the system which surrounds it. This points to the solution primarily lying, as you say, in creating systemic shifts in the context in which people live (Fearon et al., 2017). As a psychologist with a specialization in assessment, I am keen to shift the role of measurement from the constraints of categorization to define risk that has generated a process of resource allocation (e.g., educational support) based on numeric scores, towards better understanding of behavioral continuums and pathways of resilience (Gaidhane et al., 2020; Holding, Fotso & Elungata, 2018; Holding et al., 2018). The de-colonized approach of using information would generate; empathy through access to multiple perspectives; and distributed leadership through uncovering meaning and sharing this understanding more broadly (Mignolo, 2009; Watkins et al., 2023). Information fosters agency and empowerment, shifting the role of individuals to being accountable to and for themselves. Back to that idea of scaffolding, the ability to change roles as the system changes is something that I have observed simply has not happened with most international organizations. There is a tendency to maintain that exact same type of contribution until the money runs out, and then there's nothing that has been left behind to ensure sustainability. This failure is, as you point out, in part due to the failure of the community to actively build their roles and responsibilities. As a psychologist I hope to make a contribution to creating fluid and dynamic systems by stimulating reflective practice (Gaidhane et al., 2023). I hope that this paper contributes to that process. I hope so too. Frankly, throughout my 15 years of engagement in global health, I often felt like an anomaly, questioning my sense of belonging in this field. However, I've come to recognize that the study of human behavior should be a crucial component of global health and ECD training. It has the potential to rehumanize the field.