Musings on the Middle East Program   (1976)  p. 2 of 2

Category B.  

Projects in the childrearing field were perhaps our most esoteric responses to the cultural environment. Our interest was kindled initially by E. T. Prothro’s book, Childrearing in Lebanon, which examined the effect of different childrearing practices of three Lebanese sects. But it was in Oman where an opportunity first arose to engage in work in the field. Ali Othman of UNICEF, called upon to design a project to reduce infant mortality there, recognized the significance of the many charms attached to the clothing of toddlers. He reasoned that mothers must believe that survival is related to appeasing spirits or warding off evil. If this was the case, it seemed unlikely that a UNICEF project would have deep or lasting results unless some way was found to communicate through the layers of superstition and magic. UNICEF had no funds for research, so Ali came to the Foundation.  

Our efforts to find an Arabic-speaking woman anthropologist to lead a field team were regrettably unsuccessful. A team of five girls, briefed by AUB scholars and armed with a questionnaire, spent eight months in Nizwa and Sohar, interviewing mothers about their beliefs and practices in dealing with children. The results of the study served as the basis for a village development conference in Muscat, and as a guide for the UNDP, which set up a large project to train local leaders in the villages. But the significance of the study, to me, lies in the clear way it demonstrated the ineffectiveness of much that was being done for the people. 

Believing that disease is caused by evil eye and djinns, mothers paint the eyes of babies with kohl to make them unattractive to the spirits. The new hospitals, staffed by non-Arabic-speaking Indian doctors, get patients only after magical cures have failed. Eye damage from trachoma, one of the most common diseases, can be avoided fairly easily by a five-minute operation to keep the eyelid from scratching the eyeball. Yet nearly a third of the students in Nizwa’s new school had obvious eye damage. The schools, taught by Egyptians and Palestinians, using an Egyptian curriculum, offer little knowledge of use in Nizwa. The Government's experimental farm is not experimenting with foods that could meet the nutritional deficiencies of the local diet.  

          The modern institutions established by the new, enlightened Sultan for the people of Nizwa were not meeting the needs of those people because their administrators didn't really understand what the needs were, or how people thought about them. And at the same time that large sums were being invested in “development," the next generation of Omanis was being raised in fear of demons. These children can hardly hope to become equipped to deal with a changing world unless they are subjected to long, intensive reorientation, a process so profound as to forever alienate them from their families in Nizwa, and from their childhood peers who fail to cross the cultural divide into more rational thought.  

          Ali Othman bears a scar on the back of his head where as a child in Palestine he was branded to improve his eyes. Superstitions have lost force in the Levant since then, but many of the traditions that have replaced them are founded on misinformation. 

          Saniyah Othman, a Lebanese, knew most of the old wives' tales from experience, but in preparing to write a guide for mothers she sought the advice of nutritionists, pediatricians and psychologists on the most common local childrearing problems. Her book, written in simple Arabic, dealt with health, nutrition, safety, stages of development and the socialization of children. It sought to dispel such common attitudes and beliefs as fear of vaccination, viewing obesity as a sign of health, and behavioral control methods based on fear. At the same time, she reinforced endangered traditions that are healthy, such as breast-feeding and the warm affection with which children are typically treated. Perhaps most importantly, she emphasized that the mind, body and personality are developing in response to their environment in very significant ways during the first five years of life.  

This project, like the Oman study, was done in cooperation with UNICEF. The book was very well reviewed by the Lebanese press and the first edition sold out. Reprinting will need to await an end to the fighting in Beirut, but in any case the readership is unlikely to be large because of the low literacy rate among Arab women. The book did, however, demonstrate that mothers in even the more advanced Arab countries are eager for an Arab Dr. Spock to help them understand how to deal with young children. 

          Probably the most extensive impact of our efforts in the childrearing field will come through an Arabic version of Sesame Street. Our role is only a facilitating one, and our costs negligible, but if the production succeeds it can have an important influence on Arabic language teaching as well as on the cognitive development of children. 

The Sesame Street program is to be financed from Arab funds. If the program begins well, the production of an Arabic version of the Electric Company will soon follow. Ideally, the next production would be one for mothers. If the powerful CTW formula of employing extensive research and feedback and of combining education and entertainment were directed to the problems of Arab mothers, the results could be of major developmental importance. 

          Work in the childrearing field has been a minor theme in the Middle East office; less than $100,000 has been invested altogether. The program could not serve as a model or blueprint for others. I think enough was done, however, to reveal the depth of the cultural problem in the poorest areas, like Oman; to illustrate the demand for better information on child health and maturation in more advanced states, like Lebanon; and to demonstrate the feasibility of mounting meaningful research and action programs in the field. 

Theory 

I feel compelled to make a more theoretical statement about the development process at the level of the individual in order to provide a context for later suggestions on program strategy. This is a highly tentative statement, but I hope to provoke comment on the formulation so that in the coming year I can pursue the concept to a more sophisticated level.  

          It is observable that modern societies and modern institutions require different patterns of individual behavior from traditional societies and institutions. Even in developing countries, effective participation in its modern institutions requires different behavior from that expected in traditional institutions in the same country. 

          Changing behavior must be reinforced by changing attitudes, values and beliefs. The theory of cognitive dissonance helps to explain how these views adjust to enforced behavioral changes. Going to school or working in a factory, for example, involve non-traditional behavior and could be expected to produce changes in traditional attitudes. Inkeles and Smith have demonstrated that they do so, and that the changes are in the direction of increased rationality, which we take to be more "modern." 

          Doubtless the process is iterative in a rapidly changing society. Behavioral change leads to attitudinal change, which induces, or at least makes possible, further behavioral change, etc. 

The process could perhaps be diagramed as follows:  

          Governments and other institutions consciously act to induce or stimulate change through interventions on the behavioral side:

Religious and political institutions seek to affect the attitudes, but not always in favor of change:  

In a changing society, change is cumulative in part because children acquire the attitudinal level of their parents after the parents have experienced some modernizing forces:  

          But the process must be more complicated than that, because there are two parents, and the one with most direct contact with the offspring has typically been exposed to the least behavioral change. Thus:  

Success in inducing behavioral change is likely to be limited by a lag between behavioral change and attitudinal change. The duration of the lag must in some way be related to the depth of the attitudes involved (the seriousness of the subject), the rigidity of the cultural context in which they are held, and the conduciveness of the social environment to change.  

As a development assistance agency, we in the Foundation seek to strengthen the institutions that intervene to stimulate behavioral change. We do not generally seek to intervene directly to change attitudes, except occasionally through birth control information programs. 

Our lack of direct intervention is understandable because religion and ideology are not considered to be legitimate domains for foreign assistance. But if attitudinal change is a limiting factor for behavioral change, this aspect of development must concern us. 

Are there aspects of attitudinal change that are important to development and legitimate for foreign intervention?  To answer that question we need to know more about which attitudes are most critical to the development process, and about the ways in which attitudes, values and beliefs can be changed. I hope to get a better understanding of what is known about attitudes that change during development, and how the change may be induced, by reading into psychology during the coming year. A number of scholars are working in relevant fields. 

Inkeles and Smith, in the choice of their questionnaire items, give most weight to an increasingly rational sense of causation. The belief in an individual's ability to control his own destiny tends to increase with modernization. McClelland, in a similar vein, associates increasing achievement motivation with modernization. 

          Child development psychology may also offer clues to the modernization process. Jane Loevinger's model of ego stage development may offer a useful typology for considering attitudes, values and beliefs. Lawrence Kohlberg's stages of moral development, which are very similar to Loevinger's ego stages, have the valuable characteristic of indicating the sort of intervention to which people at different stages would be most responsive. (See Appendix.) 

Loevinger and Kohlberg, so far as I know, don't apply their concepts to groups of adults. But if, as seems likely, large numbers of people level off at one ego (or moral) stage or another short of full maturity, this would have important implications for development programs. It may even be possible to describe development levels of a society in terms of the distribution of its people at different ego (or moral) stages. The ego stage level of people in a society might in fact be a meaningful indicator of the level of social development, if it could be ascertained. 

But this theory seems to take us to a universalist view of development, whereas this paper is devoted to the merits of a more particularistic perspective. This contradiction is more apparent than real, because even though people everywhere may function in universal modes, to assist them to advance may require particularistic knowledge. Chomsky tells us that the world's languages have certain universal characteristics, but to understand them requires specific information.  

Program Implications  

It may be premature to spin out the program implications of so incomplete a theory, but some perceptions arise just from approaching development problems from this perspective:  

1)   In exploring program opportunities in a particular field, one should seek to understand the subjective as well as the objective situation. 

Example:  In the Oman study, this meant that in addition to understanding the epidemiology of Nizwa, one needed to understand the attitudes and beliefs the people held concerning disease and treatment.  

2)   Existing attitudes, values and beliefs will act as a drag on behavioral change. It is therefore useful, in designing projects, to consider the strength of the inducement offered to produce behavioral change. If it is inadequate, it may be necessary to try to change attitudes at the same time as, or before, one can change behavior. In order to try directly to change attitudes, it would be necessary to understand the moral approaches to which the people involved respond.  

Example:  Interventions to change Indian fertility behavior do not seem to have succeeded satisfactorily. One would postulate that the available inducements for change are inadequate and that the society can't afford the level of inducement needed to overcome existing attitudes, values and beliefs. 

If one were to attack attitudinal factors directly it would be necessary to know which attitudes and beliefs affect fertility behavior most, and with what moral orientation (stage) the target group is functioning. If it were Stage 3 (Appendix A), a campaign emphasizing that Mrs. Gandhi says contraception is good would presumably be more effective than one offering five ethical and logical reasons to lower fertility.  

3)  Western institutions will often be inappropriate models for developing countries because they don't accommodate some attitudes, values and beliefs of other cultures that they either cannot or do not wish to change. We should study alternative models where they can be found. 

Example (a). Many societies place a high value on employment security. They resist the Western system of reducing the size of the labor force in an industry when demand is low. The Japanese have devised a management system, able to compete in the international market, which is based on job stability and immobility. The Foundation should analyze the Japanese model in terms of its possible relevance in other cultures. 

Example (b). The Lebanese devised a political system that could accommodate diverse, strongly held, sub-national loyalties. This system was analyzed by David and Audrey Smock and contrasted with the Ghanaian experience in The Politics of Pluralism. The tragic situation in Lebanon today, largely traceable to non-Lebanese forces, has regrettably detracted from the impact of the publication, but it remains an excellent analysis of a system that, in my opinion, had much to offer tribally and ethnically divided countries. 

4)  In order to reach greater numbers of people, to lessen the unintentional elitist bias in Western development assistance, the Foundation should make greater use of the mass media. In doing so, we should be as concerned about the affective impact as the cognitive. An important target for media programming should be women, because they are typically less exposed to modernizing forces than men, and because they have a critical influence on the attitudes, beliefs and values of their children. 

Additional program implications could be drawn, but the above are sufficiently illustrative to invite response. One can anticipate a strong argument against this position. It may be argued that our most notable successes as a foundation have been in the field of agriculture, where improved production technology was devised in purely Western-style international research institutes. The introduction of the improved technology to farmers produced not only greater output, but also more modern attitudes on the part of the farmers. After adopting the high yielding varieties, the farmers became more amenable to change thereafter. 

          This is true, and it is a good example of the theoretical point that induced behavioral change produces attitudinal changes, which in turn prepare the ground for further behavioral changes. The initial resistance to change was quite great, however, and increased yields of 30-50% were required to overcome it. 

If we had the technical knowledge to offer most farmers inducements of that magnitude, or if we could provide factory employment or adequate education to most other people, I would feel less urgency about attitudinal changes because they could be expected to follow in due course. 

Conclusion 

This paper was motivated by a desire to communicate to my successors in the Middle East office the rationale behind some of our non-standard projects. The summer was too short for many purposes, but perhaps too long for so mundane a task, and I have wandered beyond my point. Yet I also wanted to say something about what I think I learned in the last five years. 

Perhaps the cultural dimension of development compels more attention in the Middle East than in other regions of the world. I don't wish to give the impression that culture is all we need to be concerned about, or that our professional work under the standard categories is unimportant. Nor would I wish to suggest that we have ignored cultural factors in the past. 

But it does seem to me that cultural factors should swim into our vision more often, and that we should be more systematically concerned about the process of individual modernization in various cultural contexts. Mass media entertainment, agricultural extension, birth control information and even formal education might well have different content if it were accepted that the modernization of the people is the main task, and the particular message only secondary. After all, modern adults will find ways to grow enough food and control their fertility at the levels they choose. Our task should be to help find the keys to unlock the doors to modern adulthood in other cultures. 

Appendix :  Definitions of Kohlberg's Moral Stages 

I.         Preconventional level

     At this level the child is responsive to cultural rules and labels of good and bad, right or wrong, but interprets these labels in terms of either the physical or the hedonistic consequences of action (punishment, reward, exchange of favors), or in terms of the physical power of those who enunciate rules and labels. The level is divided into the following two stages: 

     Stage 1: The punishment and obedience orientation. The physical consequences of action determine its goodness or badness, regardless of the human meaning or value of those consequences. Avoidance of punishment and unquestioning deference to power are valued in their own right, not in terms of respect for an underlying moral order supported by punishment and authority (the latter being stage 4).  

     Stage 2:  The instrumental relativist orientation. Right action consists of that which instrumentally satisfies one’s own needs and occasionally the needs of others. Human relations are viewed in terms like those of the market place. Elements of fairness, of reciprocity, and of equal sharing are present, but they are always interpreted in a physical pragmatic way. Reciprocity is a matter of "you scratch my back and I'll scratch yours," not of loyalty, gratitude, or justice. 

II. Conventional Level

     At this level, maintaining the expectations of the individual's family, group, or nation is perceived as valuable in its own right, regardless of immediate and obvious consequences. The attitude is not only one of conformity to personal expectations and social order, but of loyalty to it, of actively maintaining, supporting and justifying the order, and of identifying with the persons or group involved in it. At this level, there are the following two stages: 

     Stage 3:  The interpersonal concordance or "good boy-nice girl" orientation. Good behavior is that which pleases or helps others and  is approved by them. There is much conformity to stereotypical images of what is majority or "natural" behavior. Behavior is frequently judged by intentions -- "he means well" becomes important for the first time. One earns approval by being “nice.” 

     Stage 4:  The "law and order" orientation. There is orientation toward authority, fixed rules, and the maintenance of the social order. Right behavior consists of doing one's duty, showing respect for authority, and maintaining the given social order for its own sake. 

III. Postconventional, autonomous, or principled level

     At this level, there is a clear effort to define moral values and principles which have validity and application apart from the authority of the groups or persons holding these principles, and apart from the individual’s own identification with these groups.  This level again has two stages: 

     Stage 5:  The social-contract legalistic orientation, generally with utilitarian overtones. Right action tends to be defined in terms of general individual rights, and standards that have been critically examined and agreed upon by the whole society. There is a clear awareness of the relativism of personal values and opinions and a corresponding emphasis upon procedural rules for reaching consensus. Aside from what is constitutionally and democratically agreed upon, the right is a matter of personal "values" and “opinion.”  The result is an emphasis upon the "legal point of view," but with an emphasis upon the possibility of changing law in terms of rational considerations of social utility (rather than freezing it in forms of stage 4 "law and order"). Outside the legal realm, free agreement and contract is the binding element of obligation. This is the "official" morality of the American government and constitution. 

     Stage 6:  The universal ethical principle orientation. Right is defined by the decision of conscience in accord with self-chosen ethical principles appealing to logical comprehensiveness, universality, and consistency. These principles are abstract and ethical (the Golden Rule, the categorical imperative); they are not concrete moral rules like the Ten Commandments. At heart, these are universal principles of justice, of the reciprocity and equality of human rights, and of respect for the dignity of human beings as individual persons.