Interventions addressing men, masculinities and gender equality in sexual and reproductive health and rights: An evidence and gap map and systematic review of reviews
Working with men/boys, in addition to women/girls, through gender-transformative programming that challenges gender inequalities is recognised as important for improving sexual and reproductive health and rights (SRHR) for all. The aim of this paper was to generate an interactive evidence and gap map (EGM) of the total review evidence on interventions engaging men/boys across the full range of WHO SRHR outcomes and report a systematic review of the quantity, quality and effect of gender-transformative interventions with men/boys to improve SRHR for all.
An important finding of this review is that research and programming must be strengthened in engagement of men/boys; it should be intentional in promoting a gender-transformative approach, explicit in the intervention logic models, with more robust experimental designs and measures, and supported with qualitative evaluations.
The case for addressing gender equality as part of a human rights-based approach to improving health, including sexual and reproductive health (SRH), has been a longstanding guiding principle in the feminist literature on gender and development and significantly foregrounded in global public health since before the 1994 International Conference on Population and Development (ICPD) in Cairo.
The conference marked a paradigm shift in global health away from an overarching concern with population control in low-resource countries to a human rights-based approach aimed at empowering women to control their fertility and their access to safe childbearing, while making explicit too the need to engage men to make this a reality. Since then, too, the focus on addressing gender inequality in health programming has become more clearly conceptualised as a gender-transformative approach.
The concept of gender-transformative approaches was first coined by Dr Geeta Rao Gupta in the context of the HIV/AIDS epidemic and has since gained traction in international health and development policy. The WHO defines a gender-transformative approach as one ‘that address the causes of gender-based health inequities through approaches that challenge and redress harmful and unequal gender norms, roles, and power relations that privilege men over women’. Men are also implicated in the harmful consequences of gender inequality, harming their own and other men’s health and the health of their female partners as a result of narrow and constraining definitions of what it means to be a man, therefore gender-transformative approaches also benefit men in broadening the interpretation of masculinity and the socially acceptable ways in which masculinity can be expressed.
Just as in the original definition offered by Rao Gupta, the WHO definition of a gender-transformative approach is derived from considering a continuum of approaches to addressing gender equality in health programming. In the WHO definition, these are:
- a gender unequal approach that perpetuates gender inequality by reinforcing unbalanced norms, roles and relations;
- a genderblind approach that ignores gender norms, roles and relations and thereby often reinforces gender-based discrimination;
- a gender-sensitiveapproach that considers gender norms, roles and relations but does not address inequality generated by unequal norms, roles or relations;
- a gender-specificapproach that considers women’s and men’s specific needs or roles but does not seek to change these roles; and
- a gender-transformative approachthat considers gender norms, roles and relations for women and men, as does gender-specific and gender-sensitive, but is distinguished by the imperative to challenge gender inequality.
A gender-transformative approach seeks to challenge gender inequality by transforming harmful gender norms, roles and relations through inclusion in programming of strategies to foster progressive changes in power relationships between women and men. The underpinning rationale of addressing gender inequality is because it is a key determinant of the health of men and women of all gender identities and sexualities yet generally disproportionately disadvantages the opportunities and outcomes for women and girls, including in the particular field of sexual and reproductive health. However, a gender-transformative approach also prompts an explicit focus on the roles of men/boys in transforming gender inequality to improve men’s health and especially SRHR.
There is increasing recognition that men and boys can play a role as either supporting and championing or damaging and denying the health and rights of women and girls. Hence, focusing on boys/men through a gender-transformative approach goes beyond a men’s health focus or the inclusion of men as partners of women with respect to SRH decision making.