Men and Reproductive Health Programs: Influencing Gender Norms Prepared by

Contents ii

Introduction 4

Conceptual Framework 6

Review of Literature 10

CANTERA 14

New Visions Program for Boys and Young Men 16

Better Life Options Program for Boys 18

Conscientizing Male Adolescents Program 20

Mobilizing Young Men To Care Project 22

Men As Partners Program 24

Talking Man-To-Man 28

Program H 30

Puntos de Encuentro 32

Stepping Stones 34

Soul City 36

The Strength Campaign 38

The Respect Campaign 40

Peer Advocates for Health 42

Matrix of Programs 44

Analysis and Discussion 50

Conclusion 56

References 57

Annex 59

Annotated Bibliography 59

Introduction

In September 2003, program implementers, researchers, evaluators, and donors came together in a four-day conference in the Washington, D.C., area to learn about men and reproductive health programs around the world that had challenged gender norms. Participants in the conference were particularly interested in those programs that could show through evaluations that gender-related attitudes and behaviors had changed in a direction likely to reduce health risks, specifically, those associated with violence and unsafe sex. Identifying these programs and the strategies that made them successful has implications for future gender-related reproductive health, HIV/AIDS, and maternal and child health programming because they may serve as models to be adapted, scaled up, or replicated elsewhere. This review aims to highlight these good programmatic models, some of which were presented at the September 2003 conference.

Four general themes emerged in the process of conducting this review. First, initiatives affecting gender norms for the sake of doing so are still relatively nascent. Only in the past ten years have they become a significant subset of the wide range of programs in the global health arena.
Second, substantive evaluations are not common. There simply is not a large enough sample of thorough and systematic data on the efficacy of these programs as a whole. Data are typically gathered and analyzed from the perspectives of participants and facilitators at a level too cursory to allow an in-depth assessment of their outcomes. Often, these evaluations do not include comparable data from a control group; therefore, it is unknown whether or not the results are statistically significant.
Third, evaluations that specifically report the program’s effect on gender norms—and not only on health outcomes—are rare. Programs may influence this type of social norm, either directly or indirectly, but they generally neglect to include their effects on gender norms in an evaluation.
Fourth, health programs affect social norms related to gender roles even if they do not aim to address these norms directly. Despite their inclusion of and near virtual effect on gender roles, few programs actually separate their work of influencing gender norms from their efforts to modify or eliminate the behaviors that arise from these social constructs. For example, programs designed to curb gender-based violence may include a short module on gender roles and challenging contemporary definitions of masculinities; similarly, life skills peer education programs may introduce the concept of alternative and flexible gender roles to youth and create an enabling environment within the classroom setting where those alternative roles are reinforced and encouraged. This is largely due to the historical neglect of gender-sensitive approaches specifically purposed to alter gender norms in global health programs.
Programs influence gender norms regardless of whether or not they incorporate gender-sensitive approaches, because these norms are inextricably linked to all facets of health behavior. Without proper consideration of gender as a determinant of health, initiatives can have haphazard or unintended effects on gender norms. For example, between 1993 and 1994 in Zimbabwe, the Male Motivation and Family Planning Campaign affected many Zimbabwean men. The planners integrated language from competitive sports and images of local soccer heroes into some of the campaign’s materials. As intended, the messages appealed to the male target audience and contraceptive use increased. The action-oriented and assertive imagery and messages reinforced gender stereotypes, however. According to surveys, not only did men become more interested and involved in selecting a family planning method, men tended to dominate and even assume full responsibility for this decision. Rather than endorsing shared decision-making between both partners in a couple, the mass media campaign had the effect of sanctioning and encouraging male-dominant behavior.¹
The relative newness of this interest in changing gender norms and the lack of long-term, large-scale evaluation efforts means that we cannot state with much certainty that the attitudinal changes reported by participants in preliminary and postintervention data are sustainable. Moreover, whether or not the reported attitudinal changes have been exhibited as behaviors is left to speculation and confirmation by forthcoming evaluations.
This review describes programs specifically designed to change social norms related to gender roles. It explains the methodologies each employed to achieve this goal and presents findings from evaluations conducted to assess their efficacy. The information provided herein attempts to compile information necessary to describe the best-evaluated approaches to altering entrenched gender norms.