Gender-transformative interventions
The first ever systematic review of evidence on the effectiveness of gender-transformative interventions that engage men and boys has been published in BMJ Global Health. The paper suggests that while it is desirable to have interventions engaging men and boys promote gender equality, very few interventions actually do so. Nonetheless, those that do, show promising evidence that they work in improving sexual and reproductive health related behaviours.
The review, undertaken by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) and Queen’s University Belfast, presents what is known about interventions that engage men and boys, what works and what is the quality of the evidence.
Interventions addressing men, masculinities and gender equality in sexual and reproductive health and rights: an evidence and gap map and systematic review of reviews
Interactive evidence and gap map by:
A global issue
The case for addressing gender equality has been a long-standing goal for the global development and health agenda including since before the 1994 International Conference on Population and Development (ICPD) in Cairo. The Cairo Programme of Action not only articulated the centrality of gender equality as a requirement for improving sexual and reproductive health, but also noted the imperative of engaging men to promote gender equality.
The systematic review indicates that while harmful masculinities are an issue of global concern, only 8% of interventions that involve men and boys actually challenge male norms or unequal power privileging men over women (i.e. are gender transformative).
What is a gender-transformative approach?
WHO defines a gender-transformative approach as one ‘that address the root causes of gender-based health inequities through interventions that challenge and redress harmful and unequal gender norms, roles, and unequal power relations that privilege men over women’.
Gender-transformative programming with men and boys to improve sexual and reproductive health and rights: a systematic review of intervention studies - BMJ Global Health 2020;5:e002997
Harmful masculinities and their consequences
Gender norms that uphold men’s privilege over women harm women’s and children’s health, and are harmful masculinities. Examples include:
- Behaviours that increase the likelihood of men’s perpetration of violence against women and against children.
- Men’s control over a woman’s sexual and reproductive decision-making limits her access to life-saving health services including for sexual and reproductive health.
- Men’s lack of, or limited, involvement in child care, unpaid domestic work and care giving has wider implications for the well-being of the family, placing a disproportionate burden of care work on women and depriving them of opportunities to earn an income and contribute economically to the household.
In turn, men and boys are also affected by harmful masculinities promoting ideas of “manhood” that are predicated on taking risks, being strong, not seeking help, feeling entitled, and exerting power or dominance over women. Such norms contribute to men’s higher rates of road traffic injuries and deaths, homicides, smoking and alcohol abuse, unsafe sexual behaviours as well as men not seeking timely care for HIV or cardiovascular diseases.
The need for action
In the past 25 years, progress has been made in recognizing the importance of, and developing, interventions that engage men and boys and address harmful masculinities, often in the context of sexual and reproductive health programmes. Advocates have also called for addressing men’s health in its own right. Gaps persist, however, in our understanding of what works to engage men and boys, how such interventions work, and to what extent they address unequal gender power relations and harmful masculinities.
To respond to these gaps, HRP, with inputs from its Gender and Rights Advisory Panel (GAP), has embarked on a programme of work to assess the evidence and develop a research agenda on addressing masculinities in the context of sexual and reproductive health and rights. The first phase of this work is an evidence and gap map (EGM) and the systematic review of interventions addressing masculinities in the context of sexual and reproductive health.
The review presents an overview of the published evidence on interventions engaging men and boys to improve SRH outcomes that cover seven areas defined in the WHO Global Reproductive Health Strategy (i.e. promote sexual health and well-being, desired family size, healthy adolescence, health of pregnant women, infants and girls, violence against women and girls, preventing unsafe abortion and sexual and reproductive health in disease outbreaks).
The way forward
Evidence shows that the work with men and boys in the context of sexual and reproductive health has a long way to go in being explicitly and intentionally gender-transformative and accountable to feminist organizations and principles of women’s rights. In addition to establishing a research agenda on this issue, HRP and its collaborators are also analysing interventions described to be gender-transformative so as to offer guiding principles for feminist or gender-transformative approaches to working with men and boys.
Lessons learned
- Programmes and interventions engaging men and boys need to be intentional in promoting gender equality by explicitly focusing on harmful gender norms including masculinities and challenging unequal gender power relations that privilege men or subordinate women.
- Evaluations of interventions with men and boys need more robust experimental designs and outcome measures to generate a stronger evidence base.
- Promoting gender equality by engaging men and boys in order to realize sexual and reproductive health and rights requires diverse partnerships – not only between programme implementers and researchers, but also between those working on men and boys and feminist organizations.