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Title: Cookstoves and health : a view from the foot of the energy ladder : a qualitative study of a cookstove intervention in rural Malawi
Author: Ardrey, Jane
ISNI:       0000 0004 9358 9554
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2020
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Globally there are over 3 billion people who are exposed to toxic pollution and associated morbidity and mortality, through cooking on open fires or inefficient cookstoves using biomass fuels. Cleaner more efficient cookstoves are available and proposed benefits include improved health, climate change mitigation and the economic emancipation of women. However, despite a dominant assumption of movement up the "energy ladder" towards cleaner cooking, adoption of cookstove technology is challenging. This thesis explores the societal factors that influence cookstove adoption in the context of the Cooking and Pneumonia Study (CAPS) carried out in rural Malawi at the Malawi-Liverpool-Wellcome (MLW) research site of Chikwawa. The aim was to gain a deeper understanding of the social context of CAPS, and the implications of this for future implementation of clean cooking and research. This research was informed by critiques of a top-down approach to cookstove interventions and existing hierarchies of knowledge in cookstove and other technological interventions. Development discourses, the syncretic model of health and street-level bureaucracy theory were introduced to explore the centrality of issues of power and trust within the trial. Qualitative methods (focus groups, interviews and observation) and the participatory methodology Photovoice were used in an in-depth examination of perceptions and understandings of CAPS trial participants and workers through three research questions: 1) how and why do families in CAPS villages use the intervention stove and how is this shaped by insecure livelihoods and being part of a 'research community'; 2) how do CAPS participants experience the trial and how is this linked with understandings of health, technology and the research process; 3) what are the challenges and opportunities from an ethical perspective, of using the participatory methodology Photovoice in the context of a large-scale clinical trial of a cookstove intervention in a low-resource setting? The results showed that concern about equitable access to nutritious food in the household was prioritised over other potential longer-term benefits of cookstove use. However, CAPS participants did value the cookstoves as less energy was needed to light and tend them and because quick cooking enabled family members to be on time for activities and helped maintain family harmony. The data also showed a disconnect between the locally situated understanding of health and the research-focused biomedical model. This resulted in the development of unhelpful syncretic understandings such as that pneumonia was no longer a threat and led to rumours of "blood-taking" by researchers. A detailed exploration of household roles and local understandings of gender showed that although ascribed gendered household responsibilities were generally well defined these were also actively contested. The introduction of cookstoves may have opened a new space for contestation. Time saving through use of cookstoves did not however result in the economic "empowerment" of women. The results also demonstrated the key role of CAPS workers (the street-level bureaucrats), in the comprehension and interpretation of health messages and their "front-line" role in the negotiation of resistance (expressed through rumours). The power inequity inherent in the relationship between CAPS participants and MLW was shown to have a direct impact on participant understandings of health and trial "compliance". The use of Photovoice methodology was limited by time and resources but encouraged a deeper exploration of how participatory methodologies can contribute to more ethical research, that elicits rich contextual insights on clean cooking. This study provides a novel view from the foot of the energy ladder that adds to existing knowledge of clean cooking technology adoption and promotes the priorities and expertise of cooks.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral