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Why Programs Fall Short of Changing Social Norms


Changing social norms is contingent on generating a critical mass of adopters according to Everett Rogers’s Diffusion of Innovations Theory. The dissemination of normative change and the sustainability of that change both depend on enough people being actively involved in reinforcing and legitimating the new and different ideas. Only individuals change their behaviors, but social norms must change at the social level. The diffusion of new and lower fertility norms throughout Europe and the developing world provide a good example of the influence of norms on private, individual behavior.24 But if this sort of change is to be brought about purposefully, it requires time, commitment, and basic compatibility between the message of change and underlying values and ideas. Scarce or inconsistent support often debilitates many worthwhile programs because not all funders are committed to supporting a relatively new and diffuse agenda of changing the social norms that undermine health.

Conclusion

Despite the difficulty of altering social norms, it is imperative to try. Gender issues permeate nearly every construct of society and interaction between human beings. Socialized gender roles especially affect HIV/AIDS, as well as reproductive, maternal, and child health. In the wide spectrum of programs in global health, some programs have intentionally attempted to address both social norms related to gender and behavioral outcomes in reproductive health. Others have limited their scope to one of these foci. Of the interventions that exist, few have been substantively evaluated. But invaluable lessons that can guide future programs can be gleaned from the findings of those that have undergone evaluation.


The findings presented in this review highlight the merit and feasibility of implementing programs to alter social norms related to gender. More importantly, the findings should impress on implementers the dire necessity of integrating long-term and short-term evaluation plans in program designs to capture measurements of efficacy. Proper evaluation techniques facilitate the identification, replication, and propagation of best practices to different settings. Although the evaluations presented differ tremendously in strength and scientific scrutiny, the described programs herein are exemplary and worth emulating. The strategies employed by these programs are not only meritorious, but also feasible. Their experiences have demonstrate the earnest desire and alacrity of men to participate constructively in reproductive health, to grapple with the social constructs that fetter both males and females, to empower themselves as responsible seekers of healthful solutions in order to empower women as well, and to institute individual change in order to ameliorate family life and society at large. This review raises our awareness of the hopeful direction that HIV/AIDS and reproductive, maternal, and child health programs can take by addressing not only the behaviors of their audiences, but more importantly, the normative beliefs that govern behavior.
Drawing from the examples presented, employing a multi-pronged approach that monopolizes the benefits of unidirectional and bidirectional vehicles of communication will increase the likelihood of establishing the link between thought and action, despite the complexities involved in changing human behavior and the socialized constructs that govern it. The future of global health programming is hopeful. Prior experience can engender wise and adroit approaches to health issues spawned by behavior. With the proper financial, technical, and institutional support, the ultimate stage of the Diffusion of Innovations Theory can be actualized in gender-equitable relations that are both sanctioned and supported by social norms. Similarly, initiatives must expose their audiences to the interconnected messages of behaviors driven by socially accepted norms. Programs that harness men’s desire to change, focus on youth as a prevention strategy, incorporate legislative change, optimize indigenous infrastructure, collaborate with partnering organizations and opinion leaders, suffuse the media with positive images, and draw upon local culture to craft appropriate messages are the best-suited to this endeavor of recreating the social environment to enable positive and healthful behaviors and beliefs.

References

Agarwal, B. 1994. Gender and command over property: A critical gap in economic analysis and policy in South Asia. World Development 22(10):1455–1478.

Alan Guttmacher Institute. 2003. In Their Own Right: Addressing the Sexual and Reproductive Health Needs of Men Worldwide. New York: Alan Guttmacher Institute.

Catholic Institute for International Relations (CIIR). News: Crossing the Sea—Masculinity Work in the Caribbean 1/10/2001. Available at the following Web address: http://www.ciir.org/ciir.asp?section=news&page=story&id=275. Accessed November 13, 2003.

Cohen, Sylvie I., and Michele Burger. 2000. Partnering: A New Approach to Sexual and Reproductive Health. New York: United Nations Population Fund.

Colectivo de Hombres por Relaciones Igualitarias A.C. Home page available at the following Web address: http://www.coriac.org.mx. Accessed November 13, 2003.

Das Gupta, Monica. 1987. Selective discrimination against female children in rural Punjab, India. Population and Development Review 13(1):77–100.

Dempsey-Chlam, Justin, and Tom Wilhelm. 2003. Annotated Bibliography of Male Involvement (draft). New York: United Nations Children’s Fund (UNICEF).

Foreman, Martin (Ed.). 1999. AIDS and Men: Taking Risks or Taking Responsibility? London: Panos/Zed Books.

Grant, Elizabeth. 2003. Seizing the Day—Right Time, Right Place, and Right Message for Adolescent RSH (Kenya) (PowerPoint and oral presentation). Presented at the Reaching Men to Improve Reproductive Health for All Conference, Dulles, Virginia.

Greene, Margaret E., and Ann E. Biddlecom. 2000. Absent and problematic men: Demographic accounts of male reproductive roles. Population and Development Review 26(1):81–115.

Greene, Margaret. 2003. A Framework for Men and Reproductive Health Programs. Oral presentation at the Reaching Men to Improve Reproductive Health for All Conference, Dulles, Virginia.

International HIV/AIDS Alliance. 2003. Men’s Work Working with Men, Responding to AIDS: A Case Study Collection. Brighton, England: International HIV/AIDS Alliance.



Kim, Young Mi, Caroline Marangwanda, and Adrienne Kols. 1996. Involving Men in Family Planning. The Zimbabwe Male Motivation and Family Planning Method Expansion Project, 1993–1994. Available at the following Web address: www.africa2000.com/PNDX%5CJHU-zimbabwe.html. Accessed October 9, 2003.

Leach, F. 1998. Gender, education and training: An international perspective. Gender and Development 6(2):9 18.

Leslie, J., E. Ciemins, and S.B. Essama. 1997. Female nutritional status across the life-span in sub-Saharan Africa: Prevalence patterns. Food and Nutrition Bulletin 18(1):20 43.

Miller, B.D. 1997. Social class, gender and intrahousehold food allocations to children in South Asia. Social Science and Medicine 44(11):1685 1695.

Mundigo, Axel I. 1995. Men’s Roles, Sexuality and Reproductive Health. International Lecture Series on Population Issues. Chicago, Ill: The John D. & Catherine T. MacArthur Foundation.

Murphy, Elaine. Forthcoming. Organized family planning programs: A diffusion of innovations success story. Journal of Health Communications Vol. 8(6).



Prevention Institute: The spectrum of prevention: Developing a comprehensive approach to injury prevention. Available at: www.preventioninstitute.org/spectrum_injury.html. Accessed October 28, 2003.

Programa PAPAI: Abstract. Available at the following Web address: http://www.ufpe.br/papai/Traducao/english.html. Accessed November 13, 2003.

Rogers, Everett M. 1995. Diffusion of Innovations. 4th edition. New York: The Free Press.

Singhal, Arvind, and Everett M. Rogers. 2003. Combating AIDS: Communication Theories in Action. Thousand Oaks, Calif: Sage Publications.

Summerfield, G. 1998. Allocation of labor and income in the family. In: Women in the Third World: An Encyclopedia of Contemporary Issues, edited by Nelly P. Stromquist. New York: Garland Publishing. (Garland Reference Library of Social Science Vol. 760) pp. 218–226.

Watkins, S.C. From Provinces into Nations: Demographic integration in Western Europe, 1870–1960. Princeton, N.J., Princeton University Press; 1991:xvii.

Annex

Annotated Bibliography


Bankole, Akinrinola, and Susheela Singh. 2003. In Their Own Right: Addressing the Sexual and Reproductive Health Needs of Men Worldwide. New York: Alan Guttmacher Institute.


Few recent works address the sexual and reproductive health needs of men independent of their relationships with their female partners. The Guttmacher Institute provides an overview of men’s sexual and reproductive behavior worldwide and highlights health and program implications of that information. It identifies needs for health information and related services, obstacles that prevent men from receiving services, and offers approaches to enhance men’s sexual and reproductive health and benefits to their partners and children. Available at the following Web address: http://www.guttmacher.org/pubs/itor_intl.pdf
Foreman, Martin, ed. 1998. AIDS and Men: Taking Risks or Taking Responsibility? London: Panos Institute/Zed Books.
This book examines the relationship between men and HIV/AIDS, arguing that the epidemic cannot be contained until men are persuaded to change their traditional concepts of masculinity. It suggests one in four men worldwide have sexual and drug-taking behavior that places them and their partners at risk. Not online; available by order: http://www.panos.org.uk/resources/bookdetails.asp?id=1023
International HIV/AIDS Alliance. 2003. Working with men, responding to AIDS, Gender, sexuality and HIV—A case study collection.
Case studies from 13 countries aim to stimulate thinking and strategies for reaching men with project interventions to help them to change their attitudes and behavior. Lessons from the field offer ideas and models for working in a broad range of contexts. Available at the following Web address: http://www.aidsalliance.org
United Nations Population Fund. 2000. Partnering: A New Approach to Sexual and Reproductive Health. New York: UNFPA. Technical Paper No. 3. Available at the following Web address:

http://www.unfpa.org/upload/lib_pub_file/170_filename_partnering.pdf
United Nations Population Fund. 2003. Enlisting the Armed Forces to Protect Reproductive Health and Rights: Lessons Learned from Nine Countries. New York: UNFPA.
Taking advantage of the organizational and human resources of military institutions to protect reproductive health and rights is emerging as a powerful strategy in both peacetime and conflict situations. For decades, UNFPA has worked with the military sector to reach men with information, education, and services for family life and family planning. This experience now is being applied to a wider spectrum of reproductive and sexual health concerns, including maternal health, HIV/AIDS prevention, and reduction of gender-based violence. This digital document offers lessons learned from reproductive health projects in nine different military organizations. Available at the following Web address: http://www.unfpa.org/rh/armedforces/index.html
United Nations Population Fund. 2003. It Takes 2: Partnering With Men in Sexual and Reproductive Health. New York: UNFPA.
“Partnering with men” is emerging as an important strategy for improving reproductive health. UNFPA offers guidance on effective gender-sensitive ways to engage men in the reproductive and sexual health of themselves and their partners, including examples of successful strategies and programming and lessons learned. A checklist summarizing key points makes this program advisory note useful for designing and evaluating projects. Based on Partnering (2000), below. Available at the following Web address:

http://www.unfpa.org/upload/lib_pub_file/153_filename_ItTakes2.pdf
U.S. Agency for International Development, Inter-Agency Gender Working Group. July 2003. Involving Men to Address Gender Inequities: Three Case Studies. Washington, DC: USAID.
Profiles of three innovative programs—Salud y Género, Society for the Integrated Development of the Himalayas, and Stepping Stones—that involve men and youth to improve the reproductive health and well-being of both men and women. Available at the following Web address:

http://www.measurecommunication.org/Content/NavigationMenu/Measure_Communication/Gender3/InvolvMenToAddressGendr.pdf


1 Kim, Young Mi, Caroline Marangwanda, and Adrienne Kols. 1996. Involving Men in Family Planning. The Zimbabwe Male Motivation and Family Planning Method Expansion Project, 1993–1994. Available at the following Web address: www.africa2000.com/PNDX%5CJHU-zimbabwe.html. Accessed October 9, 2003.

2 Miller, B.D. 1997. Social class, gender and intrahousehold food allocations to children in South Asia. Social Science and Medicine 44(11):1685 1695.

Das Gupta, Monica. 1987. Selective discrimination against female children in rural Punjab, India. Population and Development Review 13(1):77–100.



3 Leslie, J., E. Ciemins, and S.B. Essama. 1997. Female nutritional status across the life-span in sub-Saharan Africa: Prevalence patterns. Food and Nutrition Bulletin 18(1):20 43.

4 Leach, F. 1998. Gender, education and training: An international perspective. Gender and Development 6(2):9 18.

5 Agarwal, B. 1994. Gender and command over property: A critical gap in economic analysis and policy in South Asia. World Development 22(10):1455–1478.

Summerfield, G. 1998. Allocation of labor and income in the family. In: Women in the Third World: An Encyclopedia of Contemporary Issues, edited by Nelly P. Stromquist. New York: Garland Publishing. (Garland Reference Library of Social Science Vol. 760) pp. 218–226.



6 Heise, L.L., J. Pitanguy, and A. Germain. 1994. Violence against women. The hidden health burden. World Bank Discussion Paper 255. Washington, D.C.: The World Bank.

Heise, Lori L. 1995. Violence, sexuality, and women’s lives. In: Conceiving Sexuality: Approaches to Sex Research in a Postmodern World. New York: Routledge.

Heise, L, M. Ellsberg, and M. Gottemoeller. 1999. Ending violence against women. Population Reports. Series L: Issues In World Health. Dec (11):1–43.


7 Foreman, Martin (Ed.). 1999. AIDS and Men: Taking Risks or Taking Responsibility? London: Panos/Zed Books.

Mundigo, Axel I. 1995. Men’s Roles, Sexuality and Reproductive Health. International Lecture Series on Population Issues. Chicago, Ill: The John D. & Catherine T. MacArthur Foundation.



8 Rogers, Everett M. 1995. Diffusion of Innovations. 4th edition. New York: The Free Press.

9 Singhal, Arvind, and Everett M. Rogers. 2003. Combating AIDS: Communication Theories in Action. Thousand Oaks, Calif: Sage Publications.

10 Murphy, Elaine. Forthcoming. Organized family planning programs: A diffusion of innovations success story. Journal of Health Communications Vol. 8(6).

11 Greene, Margaret E., and Ann E. Biddlecom. 2000. Absent and problematic men: Demographic accounts of male reproductive roles. Population and Development Review 26(1):81–115.

12 Foreman, Martin (Ed.). 1999. AIDS and Men: Taking Risks or Taking Responsibility? London: Panos/Zed Books.

13 Alan Guttmacher Institute. 2003. In Their Own Right: Addressing the Sexual and Reproductive Health Needs of Men Worldwide. New York: Alan Guttmacher Institute.

14 Cohen, Sylvie I., and Michele Burger. 2000. Partnering: A New Approach to Sexual and Reproductive Health. New York: United Nations Population Fund.

15 Dempsey-Chlam, Justin, and Tom Wilhelm. 2003. Annotated Bibliography of Male Involvement (draft). New York: United Nations Children’s Fund (UNICEF).

16 Programa PAPAI: Abstract. Available at the following Web address: http://www.ufpe.br/papai/Traducao/english.html. Accessed November 13, 2003.

17 Colectivo de Hombres por Relaciones Igualitarias A.C. Available at the following Web address: http://www.coriac.org.mx. Accessed November 13, 2003.

18 Catholic Institute for International Relations (CIIR). News: Crossing the Sea—Masculinity Work in the Caribbean 1/10/2001. Available at the following Web address: http://www.ciir.org/ciir.asp?section=news&page=story&id=275. Accessed November 13, 2003.

19 International HIV/AIDS Alliance. 2003. Men’s Work Working with Men, Responding to AIDS: A Case Study Collection. Brighton, England: International HIV/AIDS Alliance.

20 Grant, Elizabeth. 2003. Seizing the Day—Right time, Right Place, and Right Message for Adolescent RSH (Kenya) (PowerPoint and oral presentation). Presented at the Reaching Men to Improve Reproductive Health for All Conference, Dulles, Virginia.

21 Greene, Margaret. 2003. A Framework for Men and Reproductive Health Programs. Oral presentation at the Reaching Men to Improve Reproductive Health for All Conference, Dulles, Virginia.

22 Kim, Young Mi, Caroline Marangwanda, and Adrienne Kols. 1996. Involving Men in Family Planning. The Zimbabwe Male Motivation and Family Planning Method Expansion Project, 1993–1994. Available at the following Web address: www.africa2000.com/PNDX%5CJHU-zimbabwe.html. Accessed October 9, 2003.


23 Prevention Institute: The spectrum of prevention: Developing a comprehensive approach to injury prevention. Available at: www.preventioninstitute.org/spectrum_injury.html. Accessed October 28, 2003.

* Knowledge, attitudes, and practices

† Gender-based violence

† Gender-based violence

† Gender-based violence

24 Watkins, S.C. From Provinces into Nations: Demographic integration in Western Europe, 1870–1960. Princeton, N.J., Princeton University Press; 1991:xvii.

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