Introduction

Generally speaking, fostering in sub-Saharan Africa (SSA) is a customary arrangement by which natural parents allow their children to live with other adults. This may be due to the natural parents’ inability to provide for their children or for other strategic reasons (Oni 1995; Goody 1982). The majority of children orphaned due to HIV in SSA are fostered by female caregivers with particular challenges; the caregivers are old, impoverished, predominantly single, with very low or no formal education, and with extremely limited sources of income (UNAIDS 2010; Williams and Tumwekwase 2001). Provisioning for grandchildren by grandparents is considered to be an integral part of human evolution (Bock and Johnson 2008). In South Africa, caregiving provide caregivers opportunities for employment and other benefits (Akintola 2011). For the majority of caregivers, however, supporting orphans drains their resources and weakens their ability to provide their own needs (Miller et al. 2006; Darkwa and Mazibuko 2002). The extra care responsibilities exacerbate caregivers’ economic marginalization, health, nutritional and psychological stress (Tarimo et al. 2009; King 2008:107; Moore and Henry 2005; Howard et al. 2006; see Hosegood et al. 2007).

Due to their support for orphans, and despite the challenges they face, older women are regarded as SSA’s most important child caregiving resource that must be respected and protected (Seeley et al. 2009). Studies on caregivers, however, provide little specific details on the caregivers. They are often lumped together as ‘older women’.

This study describes the social characteristics (age/place of birth, marriage, education, religion and livelihood) of queen mothers (traditional female leaders) in Ghana, West Africa and explains how their social characteristics impact the performance of their roles as orphan caregivers. Queen mothers represent a unique group and their roles show a different aspect of foster caregiving in Ghana that has not been highlighted in previous studies. Also, they are an important resource and learning about them will help to inform interventions for improving the wellbeing of orphans. Their roles in any intervention must take into account their social status and other characteristics. The study draws on studies from across SSA.

Social Characteristics of ‘Older Women’ Foster Caregivers’ and Their Support for Orphans

Much of what is known about orphan caregivers in SSA is based on the analysis of the impact of the HIV epidemic on southern African, the link between poverty and women’s susceptibility to HIV infection and the impact of caregiving on caregivers (Kuo and Operario 2007; Masanjala 2007; Ssengonzi 2009; Desmond and Gow 2001). This focus has helped to shed more light on the plight of fostered orphans, but does not provide a lot of details on the categories of caregivers.

Generally, caregivers have limited opportunities for social mobility and economic wellbeing (Monasch and Boerma 2004; Ssengonzi 2007; Boon et al. 2010). This situation reduces their capacity to accept responsibilities for orphans. Potential caregivers refuse to take on orphans because caregivers tend to pay less attention to their own needs. For example, most Zimbabwean women would like to foster orphans, but their willingness is frustrated by their poor economic situations (Howard et al. 2006). Also, 71 % of South African fathers are unable to foster orphans due to poverty (Freeman and Nkomo 2006). Due to the challenges of providing the needs of orphans, caregivers across SSA are depending on non-kin groups like non-governmental organizations (NGO), to support orphans. Also, existing kin groups have developed new strategies in response to the orphan crisis (Foster 2002, 2006).

Foster care research in West Africa, including Ghana, has been centred on fostering arrangements that involve natural parents as well as the functions of fostering as a mechanism for circulating children and for maintaining social equilibrium. They also describe the gendered roles associated with fostering and portray men as the key decision makers and providers. Women’s roles are restricted to the domestic sphere and they have very little influence over the decisions that impact the wellbeing of orphans outside of their households (Goody 1982; Oni 1995; Bledsoe 2001; Renne 2005; Etienne 1979; see Drah 2012). These ethnographic findings do not reflect current demographic changes due to HIV, conflict and other causes as well as the changes in the social circumstances of caregivers. The number of orphans is growing and kin groups are unable to cope with the needs of orphans and responsibility for orphans has shifted from the kin group to specific leaders within the kin group, the queen mothers.

Furthermore, studies on orphans present all caregivers as a homogenous group of vulnerable older women with low social status and similar caregiving experiences. This assumption underpins interventions for orphans (Foster 2002). Very few researchers provide specific details about the heterogeneity among caregivers, their social status (other than their domestic roles), the differences in their caregiving contexts (kin or non-kin), and how their caregiving responsibilities may impact their social statuses and livelihood strategies. In particular, queen mothers who are also orphan caregivers have received less attention from researchers.

Caregivers may differ in their social statuses and access to social and economic resources. These demographic differences influence childcare decisions and practices, and also account for differences in the wellbeing of fostered children. In Mali, (Castle 1995) and Cameroun (Verhoef and Morelli 2007) women of high status and also independent economic means are more likely to foster children, provide their needs and make independent decisions on the children. In Ethiopia, demographic and structural differences influence adults’ foster care decisions (Abebe and Aase 2007). In Malawi, the burden of care is heavier for rural caregivers because orphans in rural settings are less likely to access social interventions and more likely to experience food insecurity and to drop out of school (Funkquist et al. 2007). Also, contextual factors such as gender, belief and value systems influence caregiving strategies (Göncü 1999; LeVine et al. 1994; Young and Ansell 2003). These factors may shape the material conditions within orphan-filled households as well as the experiences of the caregivers (Verhoef and Morelli 2007).

The death of economically productive populations, loss of livelihoods and weak traditional support systems due mainly to HIV, point to the need for caregivers, strong community leadership and context-specific interventions for orphans and their caregivers (Foster 2000, 2002). This means that the different groups of women that provide support to orphans must be identified and analysed. Filling the knowledge gap on the identities of caregivers will yield a better understanding of the challenges they face, the opportunities they have to support orphans and promote their best caregiving practices. This knowledge will also enable program planners to develop orphan care interventions based on contextual knowledge and not on other external assumptions.

Although traditional leaders have been playing a critical role in fostering children, there is a paucity of data on their roles, social characteristics (age, marriage, social status, and livelihoods) and how these characteristics may impact their survival strategies and capacity to protect and promote the wellbeing of orphans. They are often included in the large group of ‘older women caregivers’. The situation of queen mothers in Ghana provides a specific example.

Fostering Orphans in Ghana

This study provides more details on the social characteristics of the queen mothers of the Manya Krobo Traditional Area (MKTA or Manya Klo) of Ghana. Queen mothers are female traditional leaders whose primary responsibility is to serve as ‘mothers’ to members of their clans, especially women and children (Drah 2008). In the last two decades, the queen mothers have mainly focused on a growing number of orphans and vulnerable children in their communities. The growing influence of the queen mothers is a reflection of the dwindling kin support for orphans and a change in the customary fostering arrangements. Unfortunately, very little is known about the queen mothers’ caregiving roles aside from the fact that they are poor, physically frail and unable to provide the needs of orphans (Lund and Agyei-Mensah 2008).

In Ghana, children may be fostered by non-kin members of the society, but most fostering arrangements are usually between members of the same kin group. Fostering is a cooperative endeavour in the sense that male and female members of the kin group contribute to ensure the wellbeing of the fostered child, even if one person is regarded as the ‘guardian’ (Goody [1976] 1993). Due to the low parental death and low numbers of orphans, fostering research in Ghana has concentrated on fostering arrangements between living parents and potential fosterers (Goody 1982:42–44; Schildkrout [1978] 2002:356; Agyeman 1993).

The number of adults in Ghana quadrupled (367 %) between 1960 and 2000 (Mba 2010). This demographic change is very significant to child fostering because of the critical role grandparents play as foster caregivers. The greater share of orphan caregiving responsibilities is being downloaded unto older people (Kuyini et al. 2009). Two-third of orphan caregivers is 45 years or older (GAC/UNDP 2003:30). Little data, however, exist on the different categories of orphan caregivers in Ghana. Much of what is known about caregivers is based on broad national surveys that highlight the rural–urban distribution of orphans. The data available on caregivers are often mixed with national survey data (GSS, GHS and Macro 2009; GAC/UNDP 2003; cf. UNICEF 2006). The population-based estimates reveal little about the social characteristics of the caregivers. There is the need for research to reflect the current context of fostering in Ghana, especially the fosterers who are bearing responsibility for orphans.

Queen Mothers as Orphan Caregivers in Ghana

MKTA is the epicenter of the AIDS-induced orphanhood in Ghana. The high AIDS-related deaths in the area have been attributed to the female citizens’ engagement in sex work in the Ivory Coast (Drah 2014). MKTA comprises the Manya Krobo Municipal Assembly (MKMA) and the Upper Manya Krobo District (UMKD). Politically, the MKTA is organized around six clans or divisions, Piengua, Manya, Susui, Dorm, Akwenor, and Djebiam. Each clan (wetso or ‘Family Tree’) consists of a collection of towns, villages and hamlets. The clan is organized in a gendered political hierarchy and political dualism of female and male leaders (Cohen 1977). The political hierarchy comprises the wetsomatse divisional chief and his female counterpart wetsomanye divisional queen mother. Below the divisional leaders are the Asafoatse (subdivisional chief) and sub-divisional queen mother. At the lower rung of the hierarchy are the Dadematse and Dademanye. All the chiefs are under the centralized authority of the supreme or paramount chief (konor) and the queen mothers are under the paramount queen mother (Manyengua) (Drah 2014; cf. Brydon 1996:227). There are an estimated 371 queen mothers in MKTA.

Each chief or queen mother has jurisdiction over a specific area (town/villages and or hamlets). The roles and responsibilities of the chiefs and queen mothers are basically the same. The chief is the matse (‘father of the land and of the people’) and queen mother is the manye (‘mother of the land and of the people’). The power of the queen mother lies in her ability to complement the work of the chief to develop their communities. The Klo queen mother is supported by a team that includes a ‘deputy queen mother’ (seyelor), an okyeame linguist (spokeswoman), and a ma na (clan’s grandmother) who is an advisor to the queen mother.

Previous studies show that men and women in Manya Klo contribute to provide care for fostered children. Men (including chiefs) control lineal and personal resources to support fostered children. This position allows men to influence foster care decisions. It also means that it is the responsibility of men to provide the needed material support to women to enable women play their mothering roles (Goody [1976] 1993:85; Goody 1982:152–153). Queen mothers were never identified as a specific group with responsibility for orphans. Therefore, the customary arrangements portrayed in previous studies will be less applicable to the current orphans due to the HIV pandemic. Prior to the pandemic, the number of orphans was very small and kin groups did not require the support of NGOs and government to support orphans (Ansah-Koi 2006).

Currently, extended family support for orphans in the MKTA has been under extreme stress, due to HIV, a high number of orphans, poverty, and urban migration (Drah 2008; Lund and Agyei-Mensah 2008). Due to the dwindling capacity of kinship support, responsibilities for orphans have shifted to queen mothers.

The queen mothers provide support to orphans through a caregiving strategy known as the Family Net System (FNS) strategy. The FNS is built upon the customary foster care practices whereby adult kinswomen and men take responsibility for children of deceased kin. Orphans live with queen mothers or with their extended families, under the supervision of a queen mother (RoG 2005:7; GAC/UNDP 2003). The lack of support for orphans in MKTA and neighbouring districts means that queen mothers are also taking in non-kin children from outside of their jurisdiction. The queen mothers have formed an NGO, the Manya Krobo Queen Mothers Association, that allows them to solicit assistance from international NGOs and donors to support orphans (Steegstra 2009; Stoeltje 2003; cf. Ribot and Peluso 2003:171).

This study describes in more detail the social characteristics of queen mothers and how those characteristics impact their roles as caregivers. Knowing the social characteristics of caregivers, their livelihoods and ability to provide for orphans will help to inform interventions to mitigate the stressors that affect caregivers and identify the aspects of their experiences that could be strengthened.

Research Methods

Ethical approvals for the study were granted by three different ethical boards; the HIV and also the Social Sciences Humanities Research Ethics Boards of The University of Toronto (Canada) and the Ethics Review Committee of the Ghana Health Service (Ghana).

The fieldwork was conducted in 49 towns and villages across MKTA, consisting of 25 urban and 24 rural households. Previous studies in MKTA do not make the distinction between rural- and urban-based queen mother caregivers. A reconnaissance fieldwork was conducted between June and August 2007. During this period, potential study participants and collaborators were identified and their participation elicited. The preliminary discussions with the potential participants and collaborators, especially the queen mothers, helped to revise the research objectives and questions. A formative research was conducted during this period. The findings from this formative research provided additional insights into fostering and helped to develop the discussion guides for the main fieldwork that was conducted between September 2008 and January 2010. Mixed methods were used to collect data. They include focus group discussions (FGDs), key informant interviews (KII), observation, home visits and surveys.

The participants in the qualitative study included queen mothers who have orphans living in their households and those who did not have orphans living in their households. Other participants were female and male orphans between ages 6–11 years, chiefs, parents living with HIV, adult females and males 25 years and older, male elders, NGO staff, social welfare officers and other government officers. The inclusion of multiple groups of participants helped to validate the data collected from the different sources.

The research participants were identified through participant referral. Those who were initially identified and participated in the fieldwork referred their colleagues. Some of the informants identified during the reconnaissance visit also helped to identify some of the participants.

In all, 19 FGDs were conducted; queen mothers (2), chiefs (2), female orphans (2) male orphans (2) and adult females (3), adult males (3), male stool elders (1), PLHIV (3) and social welfare officers (1). Survey guides were developed based on the responses and insights provided by FGD participants. FGD participants did not take part in the surveys and survey participants did not participate in FGDs. A total of 49 queen mothers who are also orphan caregivers were surveyed, one queen mother was selected in each town or village.

Additional data were collected through 36 KIIs with participants from the target groups listed above. The researcher also attended queen mothers’ meetings, including their meetings with NGOs and state agencies and also observed or participated in their trainings and workshops. Also, the living conditions in the households and relationships between orphans and their caregivers and members of their households were observed during home visits. One household was randomly selected from the list of surveyed queen mothers for more observations. This household was visited 25 times within a 12 month period. The visits provided more knowledge about conditions in the caregiver household.

The survey data were analysed in SPSS v16. The qualitative interviews were audio-taped and transcribed. The transcripts were edited, coded and organized according to themes of the study objectives. This study reports on part of the data that was collected during the main fieldwork. Only the queen mothers surveys are reported. The relevant qualitative data are presented with the exception of those collected from orphans. The findings on the details of the social characteristics of queen mother caregivers are presented in this section. The names of participants have been used with their permission. Pseudonyms (e.g. ‘Sesane’) are used where participant’s permission was not obtained.

Social Characteristics of Queen Mothers

Scope of Queen Mothers Burden of Care

The number of orphans in MKTA is unknown, even though study participants believe that the orphan crisis is worsening. A household census was conducted as part of this study. Forty-four households in 44 towns and villages across MKTA took part in the census. The results suggest that on the average, 77.4 % of all children in a queen mother’s household are orphans. Overall, a total of 188 orphans lived in the 44 households, an average of 4.27 orphans per household. There were rural–urban differences. The households in the rural areas bearing a little bit more of the orphan burden than the urban households. The largest orphan household has 11 orphans and was located in a rural community compared to nine orphans in an urban household. The smallest number of orphans in a rural household is two against one in the urban area.

In theory, the queen mother is the leader and caregiver of members of her clan, but in practice, her authority transcends the kin group. She is responsible for any orphan that lives in any area that is under her jurisdiction, regardless of whether the orphans belong to her kin group or not. This means that not all orphans found in the queen mothers’ households belong to her kin or ethnic group.

Age, Place of Birth, and Residence

The average age of the queen mothers is 56 years 7 months (Table 1). The oldest is 92 years old and the youngest is 27 years old. The majority (72 %) are above 50 years, more than one-third are 60 years or older and only 10 % are below 40 years. More than one-third (34.7 %) are older than the pension age of 60. This age structure, as will be shown later, has significant implications for queen mothers’ livelihoods and their ability to provide for orphans.

Table 1 Queen mothers’ age & place of birth
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Almost all (98 %) of them were born in MKTA. Only 2 % were born outside of MKTA. There is relatively little mobility among queen mothers. They have mostly lived in the same towns or villages in which they were born. About two-thirds of them have lived in the same town or village for between 30 and 50 years, or more and over a third have lived in the same village or town for between 5 and 29 years and they are likely to have lived in the same house. The lack of mobility has implications for the queen mothers and their orphans. Living in the same place for a long period has allowed the queen mothers to accumulate a great deal of knowledge on fostering and the local strategies for addressing the challenges associated with orphan fostering. This has strengthened their position as mothers, symbolically and practically. The lack of movement, however, reduces their ability to access opportunities outside of their communities, such as support for orphans.

Marital Status of Queen Mothers

Almost all (98 %) of the queen mothers surveyed were married or ever married (Table 2). Currently, less than half (47 %) are married, nearly half (43 %) are widowed, 6 % are divorced and 2 % are separated. The proportion of widowed queen mothers (43 %) is very high compared to 6.2 % in the rest of the MKTA population (GSS 2005:14). The majority of queen mothers (63.3 %) are or used to be in monogamous marriages and 18.4 % in polygynous marriages, with each one comprising two wives.

Table 2 Queen mothers’ marital background
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Religious Background of Queen Mothers

The 2008 DHS (GSS, GHS and Macro 2009) indicates that 75 % of Ghanaians are Christians and 16 % are Muslims. Among MKTA queen mothers, however, the overwhelming majority (98 %) are Christians, with only 2 % being Muslims. Religion is an important source of social support to caregivers in their times of need. Congregants in Ghanaian churches provide care and support to those in need in the form of prayer, counselling and money (Bazant and Boulay 2007). About half (44 %) of all queen mothers who are Christians are Presbyterians. This is not unexpected because the Presbyterian Church has had a great deal of influence on the political and social development of the MKTA through its missionary and educational influences in the past two centuries. The rest are Catholic (18.3 %), Methodist (2.1 %), Anglican (2.1 %) and Christ Apostolic Church (10.4 %).

Religion is an important coping mechanism for caregivers because it helps them to deal with caregiving-related stress. Queen mothers in the FGD intimated that they talk to their pastor or church member and pray to God whenever they had a problem related to children. Also, they went to church so that God will bless them in their roles as caregivers. During times of illness, economic hardship and death, they rely on God for healing, money and strength. They also find hope in the word of God, which encourages them to help each other through visits, gifts and other forms of support.

Queen Mothers’ Level of Schooling

The queen mothers have a low level of schooling. Forty one per cent has never been to school (Table 3) and 34.6 % has basic school (Junior High School -or Middle School Leaving Certificate). The highest level of education attained by those surveyed is General Certificate of Education (GCE) Advanced Level (2 %). Other secondary school qualifications are GCE Ordinary Level and vocational/commercial school (8.1 %). More than 14 % did not state their level of schooling completed. Queen mothers in the FGD included a trained teacher and a nursing school drop-out. The majority of the discussants, however, had either completed or dropped out of basic school.

Table 3 Queen mothers’ levels of schooling completed
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Queen mother caregivers are all not the same. There are structural differences in the level of school completed by caregivers. Rural caregivers have less schooling than urban caregivers because there are better school facilities in the urban areas. Three quarters (75 %) of all those who have never been to school lived in the rural areas and 75 % of all those who went to basic school are urban. Also, 60 % of those with secondary education are urban. Queen mothers in the FGD blame their lack of schooling on lack of opportunities and gender bias. There were no schools in their communities and their parents did not allow them to move to the big towns where they could have attended school. Where there were opportunities to go to school, their parents preferred sending boys to school and making girls stay at home to perform domestic chores. One queen mother asserted: “[Our fathers] made us stay at home to take care of the little ones. We worked to make money that they [our parents] used to send our brothers to school.”

Livelihoods and Survival: Trading Off Social Status with Economic Roles

As shown in Table 1, one-third (34.7 %) of queen mothers are of the pensionable age of 60 or older. In spite of their ages, 94 % were actively engaged in informal productive activities. They described themselves as ‘self-employed’ (Table 4). Being self-employed, however, does not necessarily mean that they owned businesses or had regular jobs. It means that they self-determine when, where, and how to apply their skills and strengths to eke out a living. Only 2 % had retired from working in the formal sector and 4 % were unemployed.

Table 4 Queen mothers’ employment status
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Stable employment is important because it may reflect the divergences in household access to income, their ability to fulfil their obligations towards orphans. Caregivers who are employed throughout the year would be more secured financially than those who are employed during certain times in the year. In Table 4, 80.4 % of queen mothers said they worked throughout the year, and 17.4 % worked during certain periods of the year.

About 43 % of queen mothers are traders (Table 5). Almost the same proportions of rural and urban queen mothers are food crop traders. The second major sector of employment is farming with the majority of farmers (78 %) in the rural areas. Although MKTA is known for beads trade (Wilson 2003), only 8.2 % queen mothers trade in beads because the beads trade is capital and labour intensive, two resources they do not have.

Table 5 Queen mothers’ livelihoods
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All the caregivers reported that one income cannot sustain their households. Therefore, they juggle between fulltime work and fulltime caregiving. Almost half (45 %) of queen mothers have second job (or minor activity, Table 5) mainly as farmers (16 %) and traders (14.3 %). They asserted that it is usual for Klo women, to maintain more than one source of income: Yo tsuwe ni kake or “a woman maintains more than a single job”. Another queen mother suggested that keeping multiple jobs is not a matter of ‘Klo custom’, but due to the pressures of being a caregiver. She stated, “Look at me. Why should I be working at this point in my life? What will happen if I stop working? I am still working… all the time. It is because of these children.” Keeping multiple jobs has a negative impact on the physical, emotional, and social wellbeing of the queen mothers.

Older Women, Livelihoods, and Dying to ‘Stay Healthy’

The burden of care and lack of support forces some queen mothers to engage in menial occupations, including occupations that lower their esteem and prestige as leaders. The cases of a few queen mothers illustrate the impact of age, lack of economic opportunities and caregiving on the social statuses of queen mothers, their livelihood choices and caregiving strategies.

Manye ‘Sesane’ is about 67 years old. She is unable to cultivate big farms like she used to due to poor harvests in five consecutive years. To supplement her income, Manye ‘Sesane’ works a second job as apaa a farm labourer for those of her citizens who need extra hands on their farms. According to the chiefs and adult participants, “Working as a labourer is humiliating”, “it tarnishes her image” and “it is embarrassing and degrading to a queen mother”. Manye ‘Sesane’ agrees, but she asks: Kε ma pee kε? “What can I do?” Queen mothers in FGD agreed that “it is shame”, but they added that, as caregivers, they are compelled to constantly humiliate themselves through the kinds of livelihoods in order to provide for the orphans. The undignified livelihood generates extra income to support orphans, but it has negative psychological consequences. Some queen mothers said they are overburdened as caregivers. Manye ‘Minimade’ said, “I am too old to keep working like a young girl. I am always tired. I feel like I need rest, but I have too many mouths to feed and I cannot stop working”.

Some queen mothers concealed the physical and emotional trauma they experience as a result of their multiple livelihoods in order to ensure survival of their orphans. One such queen mother is Manye Dora, the queen mother of Nuaso. She uses encouraging and comforting words as a veneer to cover up her trauma as a caregiver. She asserts that “working all the time keeps me busy, healthy, and younger”. As heart-warming as this may sound, it was observed that she was not keeping healthy. She was actually overworking and overstressing herself in order to cope with her role as a caregiver.

Manye Dora is about 92 years old. She was enstooled over 45 years ago. She was a young, beautiful and smart girl who ran errands for the paramount chief. As a young woman, she “could afford the best Dumas [wax prints made in Holland] and knew how to dress”. The framed black-and-white pictures of her youthful days hanging on the wall on her veranda, which serves as office and court, are, though faded, the clearest testimonies of a once young and beautiful woman who “enjoyed life”. Today, however, she does farming full time, cracks palm kernels on stones, prepares and sells herbal medicine for different kinds of asla (fever), and, as a queen mother, resolves conflicts, visits the sick and provides care to orphans.

One morning in May 2009 at about seven o’clock, I met her in an area about 1 km from her house. She had just finished selling the herbal medicine that she had prepared the previous evening. She said she was hurrying home to give her granddaughter and orphan ‘Amanyeyo’ money to go to school, and then she (Manye Dora) would continue to her farm. Her farm is located on the hills about a kilometre to the north of her house. Once, when I told her that I would like to accompany her to her farm, she looked away immediately without uttering a word. Her eyes were fixed at something on the ground for about 30 s. I suspect she was looking at my feet. Then she spoke: ‘Climbing the hills is a lot of work. You cannot climb the hills.’ I laughed. In my mind, it was funny that a 92-year-old great grandmother would say that I could not climb a hill that she climbs. I thought walking and doing interviews all day was more than walking up the hill to her farm.

One day in June 2009, Manye Dora took me to interview another queen mother. As we walked the gentle slopes towards the queen mother’s house, which is located on the road that leads to Manye Dora’s farm, she pointed out to me the location of her farm on the hill. At that time, I was exhausted and panting for breath. Then I thought she may be right after all. I may not be able to climb the hill the 92-year-old woman climbs several times in a week. In any case, that would have been the climbing. Actual farm work of at least 3 hours would have followed.

I met Manye Dora 4 weeks later and she asked me: “Where have you been? You would have come to meet my funeral…. I was so ill that I thought I would die.” Immediately, I suggested to her that she was doing too much work. She agreed. She replied: “What can I do? There is nobody around here to help. [‘Amanyeyo’] has to go to school.” This statement contradicted her claim that she maintained multiple energy-sapping jobs just to stay healthy. She admitted that “It is not easy to have ahusa [an orphan] live with you. I can’t say no to the child, but it is making me sick and I am stressing all the time. It is not easy.”

Livelihood—Assets as Sources of Household Income

Against the backdrop of their economic challenges, the study investigated the other sources of income, in this case the assets that queen mothers can fall on in times of economic hardships. Their multiple and unprompted responses are presented in Table 6.

Table 6 Queen mothers’ assets (multiple responses)
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Nearly three-fourths (71.4 %) of all queen mothers owned an asset. More than two-third of these (67.7 %) owns land. These plots of land vary in sizes from a few square metres to a few acres. Over a quarter (27.4 %) own houses, 12 % own a farm and 94 % owned ‘queenly regalia’, which includes jewellery (beads, gold and silver) and expensive clothes that they use to adorn themselves to reflect their social statuses. Over 14 % own ‘businesses’, 2.9 % own a sewing machine, and 38.2 % own non-specified assets. Seven out of the nine queen mothers who own houses had inherited them; only two had built their own houses. All the business owners have acquired their businesses all by themselves.

The assets generate extra income in different ways. Those who lived in their own houses do not pay rent. The farmers cultivate their own land and do not have to lease land. Land owners lease their land to farmers either for a fee or for a share of the harvested produce. Sharecropping agreements may take one of two forms. The produce may be divided in two equal parts (abunu) between the farmer and the land owner or in three equal parts (abusa) one part for the land owner and two for the farmer. These supplies boost household food security.

Discussion

Age, Education, Marriage, Structure and Caregiving

Data from MKTA suggest that social status, age, schooling, and livelihood impact the ability of queen mothers to perform their caregiver roles. The average age of 57 years makes the queen mothers older than caregivers (50 years and older) in eastern and southern Africa who are referred to as ‘grandmothers’ or ‘older women’ (Ssengonzi 2007). They are also older than orphan caregivers in Ghana, 45 years or older (GAC/UNDP 2003). The average age of the queen mothers is the same as the national life expectancy of 57 years (UNDP 2009 in World Bank 2010). Again, 35 % of queen mothers are 60 years or older compared to 5 % of ‘older people’ (65 years or older) in Ghana’s population (GSS, GHS and Macro 2009:11). These facts clearly show that the number of adults providing care for orphans is growing smaller and this may have negative consequences for orphans. Furthermore, the general category of ‘older women’ does not reflect the demographic differences among queen mothers because at least 10 % of them are below 40 years. The ‘older woman’ label therefore hides the differences in their caregiving experiences and their needs as caregivers.

Even though they may be too old to engage in menial and manual occupations, the responsibility for orphans forces them to continue working multiple jobs late in their lives. This means that the caregiver role is altering the life course of queen mothers. The conventional life course of women comprises a linear trajectory of growth–fulltime child caregiving–retirement. Unlike other women, however, the life course of queen mother caregivers is cyclical: growth–fulltime child caregiving–non-retirement–fulltime child caregiving (Bledsoe 2001:57–58). As HIV continues to shorten the life cycle of people older queen mothers, like other caregivers in SSA, are forfeiting their retirement to reassume child caregiving (Livingstone 2003; Nyambedha et al. 2003; Guest 2002).

Queen mothers are repositories of customary knowledge and practices related to women and children and are, therefore, qualified to be mothers (Stoeltje 1997, 2003). The research findings, however, suggest that old age limits the ability of the caregivers to acquire the resources needed to provide for orphans in their care.

Based on her analysis of Ashanti queen mothers, Stoeltje (2003) contends that the position of queen mother and that of the wife are irreconcilable; the queen mother is supposed to be served, but as a wife, she must serve. It is almost impossible for her to rule effectively and attend adequately to her marital responsibilities at the same time. As a result, unmarried women who are enstooled may not marry at all since divorce and remarriage are not viewed favourably, especially in the case of queen mothers (12).

In spite of the seeming incompatibility of the queen mother/wife role, an overwhelming majority of queen mothers in this study are married or were married and they are able to perform their domestic and community roles. The challenge for queen mothers in MKTA is that about half of them are widows. The absence of adult males who could contribute to the caregiving responsibilities constitutes a major stressor to the queen mothers.

Marital status and household headship are often intertwined with access to resources (economic, decision making, and structures of power) and agency (cf. Chant 2003). In Ghana, having an adult male in the household improves women’s access to economic resources. Households headed by married women are best off, followed by those headed by divorced women. Those households that are headed by widows fare the worst (Moore 1996:59–60).

In the past, Kloli (the people of MKTA) encouraged having big families to help with farm work, they did so without necessarily engaging in polygyny. Men would encourage their daughters to have children without getting married; that way, they would have both their daughters and grandchildren live with them to assist on their farms. This practice reduced the need for multiple wives as a means to having more children (Field 1943:58–61). This point is important because large family size and polygyny are often cited as reasons for worsening household conditions (Dako-Gyeke and Oduro 2013). The queen mothers do not think being co-wives has a negative impact on their wellbeing. They blamed the large number of orphans and the lack of kin support on the deaths of young parents.

Schooling is an important human development indicator that impacts conditions in the household (UNDP 2010; World Bank 2010). Among many benefits, schooling helps to improve women’s skills to provide for children (Engle et al. 1997). In Ghana, schooling empowers women to participate in the political decision-making processes and enables them to access economic resources to improve their living conditions (Deku 2005).

Low level of schooling has been a bane to queen mothers’ efforts to enhance their status and to access to opportunities to improve the wellbeing of their orphans. Even though they formed to facilitate access to donor support, their lack of literacy skills limits their access to several technical resources in the form of trainings, workshops, and conferences that could help to improve their work as caregivers and as community leaders. Non-literate queen mothers, regardless of their caregiving roles, may be discriminated against and denied participation in making political decisions that affect them and orphans. Contemporary chieftaincy or traditional politics (which includes queen mothers) is perceived to be a job for the ‘well-educated’ who contribute to improving the living conditions of their people (Drah 2014; Daily Graphic 2010). Public officials and NGO staff, who work with the caregivers also complained about the queen mothers’ inability to speak English or “the language problem, which makes communication very difficult”. The citizens also opined that they are embarrassed to see their mothers who cannot speak English appear on television. Ironically, the media has been a critical channel for reaching out to state agencies and NGOs for support. It needs to be mentioned that the denial of support due to lack of literacy skills, suggest that NGOs have not fully tailored their intervention to ensure that those who need them the most actually get them, regardless of their literacy skills.

The inability of caregivers to work outside of their homes increases their levels of poverty and worsens their poor living conditions (Heymann et al. 2007). In MKTA, a high proportion of queen mothers’ are employed. They, however, hide their economic insecurities, their unstable livelihoods and the lack of physical capacity and the general lack of opportunities to reduce the burden of orphan care.

Caregivers’ Livelihoods and Caregiving

Due to their very low and unreliable incomes, orphan caregivers in SSA constantly juggle between their livelihoods and caregiving responsibilities (Kidman et al. 2007). In Botswana, guardians forego their income so that they can meet the health needs of their orphans. Three quarters of caregivers are unable to meet their wards’ teachers because doing so will result in loss of income. Some caregivers are unable to engage in more jobs to earn extra income because they have to spend time with their orphans (Heymann et al. 2007). Caregivers and their families may be forced to dispose of their assets to support orphans (Grannis 2011; UNICEF 2006).

In Ghana, female HIV caregivers are limited in their ability to leave home to work more to provide for their households due to enormous care responsibilities (Akrofi et al. 2008). E. Goody observes that in MKTA and other societies across Ghana, people of higher social status attract children in need of fostering because higher statuses are associated with material possessions (Goody 1982:65). Queen mothers, by virtue of their customary roles as leaders and mothers are obliged to provide for orphans, but the evidence suggests that they lack the resources to fulfil their obligations to orphans.

The livelihoods of the queen mothers are mainly in the informal economy. Their low level of schooling limits their employment opportunities, especially in the formal sector. The demands of formal employment, however, are incompatible with their role as fulltime orphan caregivers. The majority of them are farmers, but the income from farming and land ownership is falling. Land rights are largely invested in men. The customary arrangement of investing land rights in men has been blamed for the impoverishment of women in MKTA (see Lund and Agyei-Mensah 2008; Amanor 2006; Adomako 2001). Access to land alone, however, may not improve caregivers’ economic status. The constant fragmentation of land in order to pass it on to the next generation means that the economic value of the land owned by each individual is growing smaller. The small land size coupled with the non-affordability of farm inputs like implements, bush clearing, planting and harvesting fees affect efforts to maximize the profitability of land.

Farming is a seasonal occupation. This means that for caregivers who rely on farming as their major source of income, there is the need to look for other sources in order to be able to provide for their orphans. Farmers may be successful in one season and less successful in another season. The unreliability of income from farming may force previously successful farmers to subsist by becoming farm hands for their more fortunate colleagues (Sawyer 1988 in Adedeji 2001:7).

Land is the most important asset owned by kin groups. For over two centuries, Manya Kloli expanded their territorial boundaries through the acquisition of fertile land (Hill 1963/1997; Wilson 1991). The title to land was held by men because men purchased the land (Field 1943). As a patrilineal society, men inherit land and landed properties as caretakers, on behalf of their families or clans. Men’s control over the communal resources enables them to fulfil their customary responsibilities, that is, to provide the resources for women to support orphans. The ownership of land by queen mothers suggest that in addition to the customary obligations as caregivers, women are beginning to take on some of men’s role of controlling kin resources that could support orphans. Unfortunately, the values of these resources are declining.

The high position of the queen mother appears to increase rather than ease their burden of care. The position of the queen mother is surrounded by rituals and taboos (see Steegstra 2005:76–80), some of which may limit her engagement in economic activities. Among other things, she may not engage in activities that could compromise the dignity of her position. On the other hand, her privileges as a mother include appropriating the labour of her citizens; for instance, she could get their assistance to work on her farm. This privilege, however, is hardly offered them these days as the citizens also struggle to find their own means of livelihood. The burden of orphan care, the lack of stable income and support limits the survival options of the queen mothers, thereby compelling them to trade off the prestige and dignity of their positions with their economic roles. They engage in economic activities that lower their status and are injurious to their health, but they do this so that they would meet their customary obligations as caregivers.

Generally, Ghanaian women who provide HIV-related care (including orphans) tend to be secretive about their responsibilities as well as the stress and social isolation associated with caregiving (Mwinituo and Mill 2006). Queen mother caregivers like Manye Dora mask their stress and pain with the veil of exercise and healthy living. This behaviour may be explained in terms of cultural expectations of queen mothers. As leaders, queen mothers are socialized to be strong, independent, and self-sufficient even in the most challenging situation. She must be seen to be an independent leader and parent (Stoeltje 1997). Caregivers who are perceived to be economically self-sufficient are more likely to be regarded as strong and allowed to make independent decisions over their fostered children (cf. Castle 1995; Etienne 1979). The desire to convey the sense of independence and authority might have motivated Manye Dora to hide her caregiver-related stressors. The health, social and psychological impact of these behaviours on queen mother caregivers cannot be ignored. Ssengonzi (2007) observes that Ugandan women in similar conditions report emotional, health, and nutritional stressors.

Conclusion

This study describes the social characteristics of queen mothers who also are orphan caregivers. The growing influence of queen mothers’ as caregivers is evidence of change in the social organization of orphan fostering in MKTA. There is a shift from orphan fostering as a kin-based customary arrangement to an activity that is driven by a unique group of female leaders, i.e. queen mothers.

As leaders and great repositories of childcare knowledge, their political position enables them to provide leadership to fostering of orphans. High social positions may be associated with increased access to social capital, but the position of queen mother is characterised by several economic, physical and health stressors, and it is exacerbated by increasing responsibilities for orphans. Therefore, an in depth knowledge on their backgrounds is important as that will provide a better understanding of the unequal social, economic and health outcomes due to these backgrounds.

The findings suggest that researchers have to look beyond broad quantitative measures to also examine the specific employment-related traumatic experiences that older women of high social standing go through to ensure the survival of orphans. In particular, researchers must examine the divergences in groups of caregivers, the background of individual caregivers and the various ways in which social status, age, poverty and the lack of literacy skills impact their livelihood choices and caregiving strategies. Such analyses will help to find strategies that address the specific needs of different caregivers. The significant contributions of queen mothers in protecting orphans must be backed by a deliberate effort to empower, encourage and strengthen their positions to enable them to provide leadership to local initiatives that aim to promote the wellbeing of children.