Gender-transformative programming with men and boys to improve sexual and reproductive health and rights: a systematic review of intervention studies

INTRODUCTION

Gender-transformative approaches to SRHR services

There is consistent evidence supporting the benefits of incorporating men and boys into sexual and reproductive health and rights (SRHR) services, but there is less consensus about the most effective ways to do so. This systematic review analysed interventions across all WHO SRHR dimensions that engaged men and boys and were gender-transformative - meaning they addressed the structural factors affecting gender biases in SRHR.

How to incorporate men and boys into SRHR services

What worked: Effective SRHR programs tended to be delivered to both men and women, either separately or together, were implemented in community settings, utilised trained facilitator and peer mentors, and lasted longer than three months.

What didn't work: Initiatives rarely addressed gender inequality at the policy level, instead focusing on gender norms within individuals or groups. Hence, approaches to address gender inequality in SRHR at the structural level involving men and boys requires further research. There were also moderate to high risks of bias in almost all analysed studies, suggesting the need for high quality methodology and evaluation within this domain in the future. Furthermore, there is a scarcity of gender-transformative studies engaging men and boys that focus on the prevention of unsafe abortions and SRHR in disease outbreaks like Zika.

The central question going forward is not whether or not to engage men and boys in SRHR, but how to do so in ways that do no harm, promote gender equality and health for all and are scientifically rigorous.

KEY TAKEAWAYS

1. Multi-component activities had better outcomes

   Multi-component activities, specifically across education, persuasion, modelling and enablement approaches, proved promising for successful behavioural change interventions.

2. Programming must target all levels

   There is a need for multi-level programming that engages not only target groups and individuals, but those at the community and structural levels also, in order to enable the adoption of egalitarian gender norms and practices. Programmes implemented in community settings also showed positive outcomes, further highlighting the need to involve those at a community level.

3. Incorporate men and women in programming efforts

   It was found that successful programmes targeted both men and women, either in separate or mixed sex groupings.

4. Programmes with a minimum of three months had greater results

   Activities facilitated by trained staff and peer mentors with a duration longer than three months showed more positive outcomes than those with a shorter duration.

5. More research is needed

   It was rare for initiatives to address gender inequality at the policy level, instead of looking at gender norms within individuals or groups. Hence, approaches to address gender inequality in SRHR at the structural level involving men and boys requires further research.

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