Men and Reproductive Health Programs: Influencing Gender Norms Prepared by

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Analysis and Discussion

Common Attributes of Featured Programs

These positively evaluated programs were typically structured around a series of presentations and exercises that progressively build upon one another. This facilitated the process of men perceiving that axiomatic principles of gender dynamics are actually social constructions that can be feasibly altered. Their implementation methodologies usually included the following components:

A risk-benefit analysis of the pros and cons of current definitions of masculinity.
Exercises that prompted the men to consider the differences between sex as a biological characteristic and gender as a social construct.
An integration of the men’s personal experiences of disempowerment, violence, and any subsequent trauma (e.g., Insituto Noos, Soul City, and CANTERA).
An empathy exercise with role reversal (e.g., the Marta and Raymond video used by CANTERA and the dramatic techniques employed by Mobilizing Young Men to Care).
A brainstorming activity to generate a list of constructive and practical ways to remedy the problem first in individual homes then in society at large.
The description and rehearsal of an improved and self-described construction of masculinity acceptable to the participants.
The visualization of positive and equitable role models of masculinity through actors, television, etc. (e.g., MYMTC and Puntos de Encuento).

Program Highlights and Recommendations

Despite the above-described challenges, the following points emphasize the strengths of the programs included in this review.

Institutional Collaboration Makes a Difference

Establish program in partnership with infrastructure pre-existent in the country that serves the target population. This will partially address concerns about initial recruitment of participants. As the program evolves, it can be used to complement and supplement any shortcomings of the country’s infrastructure until the program is institutionalized.
The work performed by Instituto Noos with violent men is a noteworthy example of the effectiveness of collaborating with departments in a country’s existing infrastructure. Its successful intervention with referrals from Brazil’s Justice Department served as a launch pad for the program. Program designers solved one difficulty often encountered during the initiation phase of a program: recruitment of male participants. After the criminal offenders who completed the program returned to their respective communities, they generated self-referrals from the general population, thus making the intervention self-propagating.
Program H drew from the expertise and client base of multiple organizations throughout Latin America and the Caribbean to carry out its field-tested initiative. Drawing upon the technical expertise of local and international organizations, Instituto PROMUNDO harnessed the collaborative efforts of organizations from other continents. Its exemplary efforts address the specific needs of various communities through partnerships with local organizations sensitized to the concerns of local populations.

Sharing Personal Experiences is an Excellent Starting Point

Through interviews with participants, CANTERA discovered that men typically responded better when their experiences are used as a starting point for analyzing gender inequities perpetuated by traditional definitions of masculinity. They also found that when women facilitated discussions on gender sensitivity in the work setting, many men either chose not to listen or interpreted the facilitator’s speech as accusatory, causing them to react defensively and to harbor fears that the women’s true motives were to belittle and “turn the tables” on them.
CANTERA also found in its work that externally exhibited change (i.e., in society among peers) is more difficult for men to display in comparison to internally exhibited change (i.e., within the parameters of the home in intimate relationships). Displaying a genuine behavior change is not only influenced by men’s internal resolve and attitudes, but also by the perceived and actual reception of and reaction to those changes by men’s peer groups, superiors, and influential members of the opposite sex. For instance, after participating in CANTERA’s program, some men found it easier to burp their baby in their home than to avoid engaging in sexist behavior among friends. CANTERA also found that men may not receive the necessary impetus or support to change from male and female peers due to their acquiescence with the status quo and a lack of confidence in men’s capacity to change.

Trained, Gender-Sensitive Facilitators are Necessary

The quality of facilitators used when discussing sensitive topics can be a determining factor in the ultimate success of a program. Effective facilitators are empathetic, assertive, patient, objective, and focused negotiators who must be properly trained. MAP in South Africa used the training-of-trainers approach to prepare its facilitators, many of whom were former activists. The project coordinator for Peer Advocates for Youth was a professional basketball player, a profession held in high regard by many adolescent male participants, thereby adding to the coordinator’s effectiveness as a role model. Instituto PROMUNDO offers training internationally and nationally to groups interested in using the materials it developed, which are available in English, Portuguese, and Spanish. The Stepping Stones training package has been customized to suit the needs of numerous organizations worldwide.

Creatively Integrate Program Outputs into Society

Networks with other organizations and unions in different settings should be expanded in order to make the changes long lasting and sustainable. If the ultimate goal is to fashion a more egalitarian society, stimuli to this effect must be omnipresent, just as those that enable the current dichotomies are.
Stepping Stones’ innovative approach to promoting collective responsibility is worth emulation. It endorses approaching behavior change on the community and individual levels simultaneously, using the program participants as a medium of communication between the two. By involving the community from the outset and submitting “requests for change” to the community, everyone is made aware of the requirements for establishing a supportive environment. This program also suggests establishing work-based programs in which men are paid to attend intervention workshops in order to enroll and retain male participants. This strategy would require negotiations with employers to convince them that participation in the program makes practical business sense.
The Conscientizing Male Adolescents Program achieves sustainability through its recruitment process. The program is an opportunity to nurture bright young men who may otherwise find their ambitions stifled in a society with limited career opportunities. Because leaders are the only participants, the program must expand to a new location once the pool of willing participants is exhausted. The addition of a project for university students demonstrates this program’s commitment to sustainability in a practical sense.
The work of Instituto Noos in Brazil highlights the need and utility of partnerships with the judicial system to provide more effective and holistic forms of punishment for crimes attributable to negative and unhealthy characteristics of masculinities. It also draws attention to the need to bolster the authority of the justice system as well as citizens’ resolve to reform it.
Both of CEDPA’s featured programs integrated workshops into the curricula of educational centers. Although this tactic is difficult to initiate, it reduces the need to recruit facilitators to sustain the program’s aims. It also ensures the incorporation of modules on gender equity into the normal curriculum, that is, assuming that the instructors perceive the information presented as worthwhile and beneficial to both themselves and their students.
Sustaining changes and networks is a reoccurring difficulty lamented by all of the programs. Programs using peer education techniques are particularly prone to this shortcoming. With Stepping Stones, for instance, the peer educators often failed to maintain relationships with their peer groups, thereby effectively thwarting the continuance of the support group. The trust and relationships established during the project’s implementation phase are then severed. Projects that impart problem-solving and critical-thinking skills avoid this problem to an extent.

Conduct Intervention with Males Separate from Females

Often, in order to solidify an innovative way of thinking, individuals have to be sequestered and allowed time and space to think about the implications of adopting a new pattern of thinking. The Mobilizing Young Men to Care project in South Africa can serve as a cautionary tale on this issue. Its workshops included females in its focus groups in order to engender genuine change in the male students that would not be misinterpreted. This strategy proved to be counterproductive in that the gender dynamics in the focus groups changed as a result of female participants increasing an exhibition of “masculine” traits in the mixed-gender focus groups. The female students began to feel more empowered as the project progressed. It can be inferred that any change exacted in the young men may not have been captured and may possibly have been overshadowed by the achievements of the female students. The environment created by the project did not provide sufficient space for the males to analyze their behaviors without the input of the opposite sex.
A possible suggestion to improve the project design could be to conduct focus groups with males only as a separate phase of the project so that the self-reconstruction process can solidify into self-actualized attitudes and behaviors free from the input of the opposite sex. Another phase can include young women in the focus groups in order to challenge the strength of the young men’s resolve to adopt more gender-equitable attitudes and behaviors. The young women’s sense of empowerment will then serve the objectives of the project, rather than confound the results. Or the workshop sequence used by Stepping Stones could be emulated, whereby males and females participate in separate but concurrent workshops that are combined for the final workshop session.

Suffuse Mass Media with Images of Gender-Equitable Relationships

In order to counteract unhealthful messages propagated through the mass media, equally appealing positive messages have to be disseminated. Nuances such as the placement of the hands, eye contact, and body language communicate volumes without words. Keeping this in mind, the Strength Campaign, for instance, plans to modify its leaflets and posters to more accurately portray images of couples in which both partners are mutually valued. The campaign strives to offer an alternative to the mainstream images of women as ornaments for men and the sole gatekeepers of sex. Zero Tolerance’s Respect Campaign, as well as Soul City, artfully portray dramatic scenarios to stimulate discussion of the interconnectedness of different social ills and gender issues and the necessity of redefining gender roles.

Integrate Unidirectional and Bidirectional Vehicles of Communication

Essentially, programs involving interactive groups and those using mass media approaches differ in two ways. First, mass media or marketing campaigns allow only unidirectional delivery of information, whereas group-based methods allow bidirectional exchange of information. This is a strength of the latter program type. Group-based methods provide participants with an accessible source of information, a soundboard for comments and feedback, and a reified entity to reinforce intended messages (at least during the program implementation phase). Marketing campaigns may, however, possess a greater capacity to create an enabling environment due to their ability to reach a wider audience.
Second, the messages presented by mass media campaigns must be in the form of sound bites discretely packaged to deliver simplified information. Through discussions and dialogue, group-based methodologies allow participants to delve into and think about the subjects presented. Group-based methodologies do require the personal commitment of more individuals rather than corporations in order to sustain the intervention, however. Both approaches require sensitivity to local culture and linguistic diversity, in addition to repetition.
Given the limitations of both approaches as channels to induce behavior change, the most efficacious approach may be a multi-pronged one in which mass media campaigns simply foster the creation of an enabling environment for exercising the desired behavior and a group-based methodology reinforces the messages presented. Program H’s field-tested project in the Caribbean and Latin America would serve as a suitable model for this type of multipronged approach.

Quasi-scientific Evaluations are the Most Compelling

Sound evaluations not only provide feedback on the efficiency and efficacy of a program for internal use, they also provide informative data on specific methods that can be adapted by posterity to improve and enrich future programs. Unfortunately, much of the evaluation data analyzed for this review would have allowed greater latitude for comparison between programs if the results had been more keenly scrutinized and systematically collected. Several recommendations follow.
Stratify results by socioeconomic status, previous exposure to gender-equity programs, participants’ ethnicity or racial group, marital status, number and gender of children, etc., to allow more in-depth analyses of data provided. Puntos de Encuentro conducted a thorough and impressive evaluation of its initiative among men in geographical areas affected by Hurricane Mitch. It controlled for confounders such as previous exposure to gender equity campaigns and men’s perceived level of equitable behavior. Soul City has also evaluated its mass media campaign and has made available on its Website a number of evaluations of each component of its initiative.
Precisely describe how the respondents in the evaluation differ from the remaining participants. Also include postulations of whether or not the pool of participants is a representative sample of the general population (i.e., accounting for any selection bias). CANTERA transparently described the limitations of its intervention in Nicaragua in a CIIR publication. After reviewing the post-intervention surveys collected from participants, programmers realized that the majority of the participants were referred to the program by their employers. This, of course, skews the ability to generalize their results.
Use time-sensitive indicators to chart the progressive impact of the program from the individuals who participated to society at large. Short-term and long-term indicators will measure the effect on both gender equity and health behaviors, as well as the transition from adoption of an innovative definition of masculinity, to behavioral change at the individual level, to the creation of an enabling environment by a critical mass adopting the innovative gender norm, to the establishment of a new social norm. Nearly all the programs featured in this review adopted this approach; however, not much can be stated to elaborate on this, because most of these programs have existed for a short time period due to budgetary constraints or recent implementation.
Involve other community members in the evaluation process. Persons in the participant’s social sphere can serve as informants on the participant’s adoption of gender-equitable behaviors and actual transformation in daily life. Also, their feedback will facilitate measurements of the perception of changes in social norms. Evaluators of the Better Life Options for Boys Program, for instance, interviewed former participants’ spouses and family members in order to corroborate any behavioral changes self-reported by the participants.
Recruit independent evaluators separate from the facilitators. This may increase the probability of acquiring accurate feedback from participants. Instituto Noos took this precaution when evaluating its intervention among criminal offenders. Practically, this serves to blind the participant and evaluator to the other’s biases.
Adopt uniform evaluation methodologies and indicators, including the analysis of a control group, to allow standard performance-based analysis of programs. One of the goals of Program H is to disseminate a standard evaluation and implementation model after which other programs can pattern themselves. If adopted universally, standardized evaluation techniques will facilitate future analyses of program efficacy similar to the one described here.

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