It’s not a drug, it’s not a vaccine. It’s women saving lives.

13 May

I have a real problem with science sometimes. Or is it the scientific approach? I’m not a Trumpist; I don’t believe in alternative facts, I believe in evidence-based decisions and policy, but I have a problem with what is deemed evidence. There’s a snobbery in science, it is rooted after all in a history dominated by men. Anything which doesn’t have carefully formulated methodology is deemed invalid – I’m not talking a validity of crank ideas or a culture of anything-goes, I’m talking about the acceptance of a historical or cultural knowledge.

So I approached Anthony Costello’s talk at the Swindon Festival of Literature 2021 with some resistance. His book, The Social Edge, delves into the power of sympathy groups. On the one hand, the facts and figures were extremely interesting and he has awe-inspiring experience as the director of maternal, child and adolescent health at the World Health Organisation amongst many lauded positions; on the other I felt that society already has the answers, it’s just that it’s women who have had them all along.

And what is a sympathy group?

The sympathy group was formally identified by Robin Dunbar, a British anthropologist. Robin observed a ‘tripling hierarchy’ of human groupings – family, sympathy group, affinity band and then active network. You may have heard of the ‘active network’ magic number of 150 – the maximum amount of people in a community one human can cope with – ‘your Christmas card list’? The sympathy group of 15 or so people is one step beyond the immediate family, brought together by shared goals and trust, typically spending a lot of time together to get stuff done. Anthony’s examples include coffee house culture from the eighteenth century as an ‘engine of debate’, a theatre company (such as the Festival’s own Farm Yard Circus), the core group behind Apple, a government cabinet and advisers, the suffragettes.

watch Anthony’s talk

I thought of my own sympathy group – Citizens’ Climate Lobby UK with its core steering committee – anything below seven dedicated people working towards a goal (especially a big one like climate change) feels like an insurmountable task but a core more than 20 feels like action can gets stuck in the endless circle of debate.

In the hands of the powerless, sympathy groups can enact change through powerful new ways of thinking or, at worst, can be a Petri dish for unprocessed anger and frustration, such as a terrorist cell. And terrorism can be tackled by another form of sympathy group, the military unit. In the powerful, it can be a friend of the status quo or regressive policy – remember that all-man photo of the US GOP’s women’s health caucus, Vice-President Pence at the centre?

US GOP women’s health caucus

So far, so all-about-power – the Bullingdon Club, ‘hierarchy’, a group of people centred around a leader, ‘power is everywhere’. My first thought when I heard about Anthony’s talk was it would be about social groups, which are less about hierarchy and more about consensus. I don’t mean social groups in terms of gossipy idleness (though this in itself has sexist overtones) but mutual respect and the sharing of ideas and action to achieve the aim of being sociable and of taking action. Having worked in the arts for many years, and grass roots activism for a few, I know that people don’t just pitch in to achieve a specific goal, they volunteer because they like the company. But, equally, if it all becomes talking and no doing, people drift away.

But I’m moving too swiftly to my point. Anthony gives an example he knows well, that of a hospital. Centuries ago the hospital was a social hub from birth to death, something that has been forgotten and even rejected by modern medicine. Back in the 1990s, Anthony wanted to use this idea of social medicine to improve women’s health in Kathmandu, Nepal, beginning with traditional-type expert-to-patient health education for slum-dwelling families. This kind of health education previously had no evaluation. The result? “We showed no impact whatsoever,” said Anthony, “which was rather disappointing.” So they tried another way, inspired by the Warmi Project, Bolivia in the Andes on the other side of the world, to remote villages with a dearth of healthcare. It looked to me like a familiar group: women who met, looked at their problems, came up with ideas to address them and then took action, the same followed by the WI, a parents’ association, an allotment group, a parish council…Anthony describes the project as a ‘standard evaluation process’ a ‘typical audit cycle’.

(I’m curious at the use of ‘typical audit cycle’. I wonder if my daily family life would be described as a ‘typical audit cycle’? Hubby or I get up, helps the older one out of the door to school (mostly without drama due to previous application of an audit cycle) while the younger one refuses anything but bagels (we don’t have bagels), clings to her iPad, plays in her room instead of cleaning her teeth and finally hides in the bed when the bus comes. Our audit concludes (a) buy bagels, (b) no iPad in the morning until this is resolved at least, (c) a friendly animal countdown clock, and (d) a heart-to-heart about whatever is bothering her at school. Women don’t think of this as an audit, it’s what we do and I’m in equal parts amused and tired by the need to quantify the domestic for it to be taken seriously.)

In 2004 Anthony employed a professional female facilitator to run nine monthly women’s groups in the large Nepalese province of Makwanpur, following Bolivia’s Participatory Learning and Action (PLA) model. After a year, Anthony didn’t have much faith that it was having any impact as only eight or nine percent of childbearing age women were joining the groups. To his surprise, there were all sorts of positive results including designing their own safe birth delivery kits, credit schemes, transport schemes, kitchen gardening and water safety, and, said Anthony, “We showed a thirty percent reduction in infant mortality – just by chatting.” They excitedly published the results in scientific journal the Lancet. “We expected this might change global policy but the silence was deafening.” Anthony was laughingly asked by the Gates Foundation, “You’re not seriously saying chatting will reduce deaths?”

Unbowed, they conducted more trials over six years and the success was replicated in India, Malawi and Bangladesh, with a 32 percent reduction in infant mortality and an amazing 57 percent reduction in maternal depression. Eventually, the WHO took it on to level it up and turn it into policy. Arti Ahuja, female health secretary of Orissa, with responsibility for 50 million people, set up 140,000 groups. In Bangladesh, Anthony’s dept set up both women’s and men’s groups which tackled the high prevalence of diabetes. Meanwhile, back in Nepal, three quarters of the original groups were still active and were supporting the recovery from the terrible earthquake of 2015.

Why are sympathy groups so effective? “They’re not simple,” Anthony said, and quotes philosopher Karl Jaspers:

It’s about building solidarity, it’s about taking a holistic approach because groups understand a local context….in a crisis you will share crucial resources…you will ask fundamental questions ‘why’?”

The sympathy group is not ‘an exchange of messages’ but an ‘existential communication’. Chatting is so much more powerful than the idea of a oppressive gossip of women over tea. It is ‘intimacy, trust, openness, frankness and ‘loving struggle’”. Anthony’s illustrative photo shows a woman standing at the centre of men, women and children within a rural village. It is empowering not a show of power. No more men in suits giving dictats about women and their communities. No more uncharitable sneering about the power of a social group.

Anthony talks about ours the ‘loneliest period of human history in the West’. About how sympathy groups might tackle this and so much more: longterm conditions, prisoner rehabilitation, child development, corruption, climate change, etc. How the UK’s efforts to stem Covid-19 would have been more effective if communities had been galvanised. I would invite Anthony to see what we do at Citizens’ Climate Lobby, where one of the core tenants is the local group; or the Transition Town movement which started in Totnes, Devon (and the founder went to our local school in Marlborough) and has gone worldwide, or, Pewsey Wiltshire which, this year, actually had more parish councillor candidates than seats in the local election because the parish council did not respond to the needs of its community in lockdown so Pewsey sympathy groups did it themselves…as did other Wiltshire towns like Marlborough and Devizes. But I think what he means is that this approach needs to embedded in our national healthcare and our structures of governance so you don’t have to rely on the lottery of a strong positive community.

The take home is that building strong sociable communities are good for women and therefore they are good for everyone. That we give value to the social and the community but are open enough to accept other shared knowledge and then in turn allowed to find our own local application (something the government grasped at with Local Area Boards but slipped down in the cracks between hierarchical governance and shared experiences).

Isn’t it time we put stock in the shared cultural domestic knowledge, the compassionate, the undefinable, the ‘improvised jazz’ approach that women have always known? It’s so powerful that oppressive regimes isolate women, only allowing sanctioned groups to meet, restricting or diminishing education, metering out resources, with this drip, drip, drip idea that the domestic is inferior to the world of numbers, commerce and audits.

So if we have all this cultural knowledge already, and the bulk of the work is in recognising the value of it, where does science come in? Science means can extend our shared knowledge to a global scale, know how it works, how it can be applied and then how things can be better. Here’s a for-instance: if the ideal sympathy group size is 7-20, then why do our state school classes contain 25-35 kids? Do we need to meet in big protest marches to create change or do we need a network of sympathy groups?

I am no longer conflicted: Anthony’s talk shows how healthy our communities could be if we gave equal billing to science and the female cultural knowledge.

Words by Louisa Davison

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