The "So What?" Report: A Look at Whether Integrating a Gender Focus Into Programs Makes a Difference to Outcomes

From the Research/Evidence-Based Task Force of the Interagency Working Group (IGWG), this document takes stock of the progress made toward improving reproductive health (RH) and promoting gender equity, key components of the Programme of Action (POA) from the Cairo International Conference on Population and Development (ICPD) in 1994. The task force addressed the question, "What do we know, to date, about the relationship between gender-sensitive programming and reproductive health and demographic outcomes?"



The task force reviewed interventions in four RH issues: maternal morbidity and mortality, unintended pregnancy, sexually transmitted diseases (STDs)/HIV, and violence against women. Task force members collected published and gray literature, searched databases, and contacted over 150 organisations for systematic evaluations of gender-sensitive interventions in RH.



From the Executive Summary: "The review notes gender-related barriers to each component of reproductive health and the strategies undertaken by programs to address the barriers. Out of nearly 400 interventions reviewed, 25 are included here as examples of reproductive health programs that integrate gender to either accommodate gender differences or transform gender norms to promote equity. The review also notes some interventions that exploit gender inequalities to pursue reproductive health goals....The evidence reviewed suggests that integrating gender into reproductive health programs appears to have a positive impact on achieving reproductive health outcomes."



Strategies to integrate gender into RH interventions, selected to emphasise either accommodating gender differences or transforming gender norms, include the following:

 

• Reducing unintended pregnancies by:
  1. interventions that accommodate gender differences, for example, community-based distribution (CBD) of contraceptives to clinics that offer childcare for women while they are seeking services.
  2. interventions that seek to transform gender norms, which operate on the assumption that for an individual to make behavioural changes, she or he must have practical skills in long-term planning, problem solving, and decisionmaking, and a sense of self-efficacy. Participatory techniques of community work that encourage reflection and discussion are important to this approach.
  3. interventions that offer training in various topics in addition to RH, such as literacy, employment skills, legal rights, parenting, child health, and social mobilisation.
  4.  interventions that seek to empower women by improving couple communication or to increase men’s responsibility for family planning by reaching them in non-health care settings, for example, through agricultural extension.

• Reducing maternal morbidity and mortality by:
  1. counseling interventions that accommodate gender differences seek to raise women’s awareness of the importance of gaining permission from family elders and husbands to seek health care in advance of labour. Other programmes educate men about recognising and responding to danger signs and encourage men to pay greater attention to the needs of pregnant women. To improve maternal nutrition, women with limited access to cash are taught how to introduce low-cost, high-nutrient foods into their diets.
  2. strategies to transform gender relations, including those that increase women’s access to and control of resources where men dominate financial decisionmaking in the home and undervalue their wives’ health care. Interventions have included establishing credit and savings groups with women and creating emergency loan funds supplied through women’s cooperative agricultural production or market activities. Women are encouraged to get involved in advocacy activities, such as contacting government officials to request improved access to programmes in their remote villages.
  3. programmes that aim to renegotiate power relationships surrounding maternal health decisionmaking. Programmes reach out to men through peer educators, home visits from field workers tailored to men’s schedules, workshops for men held on days when men are not working, and men’s clubs and mother-in-law clubs, where mothers are motivated to encourage their sons to give higher priority to their wives’ health care.

• Reducing STIs/HIV/AIDS by:
  1. strategies to accommodate gender differences in STI programmes, for example, addressing the lack of control over the conditions that many sex workers face - strategies such as educating brothel owners or enacting laws to enforce condom use among clients.
  2. interventions to transform gender relations by stimulating dialogue on the relationship between gender norms and sexual behaviour, rather than just providing information on condom use and risk behaviours alone.
  3. behaviour change communication (BCC) strategies, which incorporate negotiation and communication skills training for women to increase their assertiveness in partner communication about topics related to sex, STIs/HIV/AIDS, and dual protection/ dual method use.
  4. challenges to the acceptance of norms related to male promiscuity, infidelity, and control of sexual relationships, and/or norms that promote female isolation and ignorance.
  5. peer educators who address such sensitive topics as virginity and women’s fear of sexual and physical abuse, economic abandonment, or increased infidelity in retaliation for asking partners to use condoms.
  6. education programmes offering vocational training in income-generating activities as an alternative to transactional sex.
  7. programmes for adolescents, including age-appropriate publications for young people and discussions with peer educators.

• Improving quality of care by: increasing women’s access to female providers, coaching women to be more assertive with providers, adding childcare for clients, reducing waiting time, making services more male-friendly, introducing couples’ counseling, and allowing women to choose a female family member to accompany them through labour and delivery - all related to accommodating gender differences.

The authors’ recommendations for future directions in gender integration in RH programming are two-fold: 1) stronger integration of gender in designing programme interventions; and 2) more rigorous evaluation of interventions that integrate gender.