PRB

Where Are We Now?

Much has changed since 2010 when the Interagency Gender Working Group (IGWG) published the breakthrough report Synchronizing Gender Strategies: A Cooperative Model for Improving Reproductive Health and Transforming Gender Relations. This report introduced a new concept of synchronized gender strategies, defined as working with men and women, boys and girls, in an intentional and mutually reinforcing way, to challenge restrictive gender norms, catalyze the achievement of gender equality, and improve health. The report revealed some of the existing tensions between programs focusing on women’s empowerment or on men’s engagement. In showcasing program examples using a gender-synchronized approach, the report also highlighted some key elements of gender-synchronized health programs. These elements included intentionality in reaching out to men and women to promote mutual understanding, aiming for equalizing power dynamics, preventing and responding to gender-based violence (GBV), promoting flexible gender roles, and advocating for gender equality as measures of program success.

We know that the concept of synchronized gender strategies continues to resonate with colleagues working in health and development. But as many have noted, the field has progressed since 2010, and the report needs updating. Many new examples of gender-synchronized projects have been implemented and evaluated. What have we learned from these programs?

In 2017, the IGWG supported a review of the evidence and experiences of gender-synchronized strategies since the 2010 report was released. The aims were to analyze the findings of numerous new program evaluations and to explore interventions that intentionally consider gender and sexual diversity.1 The effort included a literature review and consultations with a range of experts from a variety of backgrounds within the health and development sectors as well as from the violence prevention community.

Lessons Learned From New Evidence

Many new gender-synchronized health programs with published evaluation findings emerged. Examples of these programs are shown below. Many of the key elements outlined in the original 2010 report were evident in the programs. For example, newly identified programs all intentionally reached out to men and women, and boys and girls, and sought opportunities to promote dialogue about the advantages of loosening rigidly defined gender roles. Many explicitly aimed to prevent GBV, and several included interventions to shift the balance of power and provide men and women opportunities to collaborate for a common cause.

One example is the SASA! Initiative in Uganda from Raising Voices, which aims to prevent HIV/AIDS and domestic violence by focusing on power imbalance in intimate relationships. An evaluation through a four-year randomized control trial (RCT) showed that women in intervention communities were significantly more likely to report joint decisionmaking, open communication, and the ability to refuse sex with their partners. Analysis of the qualitative data revealed the importance of working with women and men together, through modeling collaborative male and female leadership and enhancing exchange of ideas and perspectives of men and women.2 A learning report from Raising Voices shows that the gender-synchronized approach provided deeper understanding about the gender constraints and privileges experienced by others. Including women and men in discussions provided the opportunity to discuss these issues together and led to greater gains and diffusion of new ideas about workloads, decisionmaking, and violence among men and women.3

Like SASA!, the Bandebereho program implemented in Rwanda by Promundo and partners incorporated gender-synchronized elements in group critical reflection and dialogue sessions for couples. The sessions provided a structured space for men and women to question and critically reflect on gender norms and how these shape their lives. In discussion groups, men and women rehearsed equitable attitudes and behaviors with supportive peers. This exchange provided an opportunity for men and women to internalize new gender attitudes and behaviors, and apply them in their own lives and relationships. The intervention also included community activities and campaigns related to fatherhood and care-giving. The project utilized an RCT evaluation design with data on gender roles and domestic violence gathered from male participants and their female partners. Compared to the control group, women in the intervention group reported significantly lower levels of physical and sexual violence and more male accompaniment to antenatal care, while men and women reported significantly less violence against children, greater male participation in household tasks, and less male dominance in decisionmaking.4

The Gender Matters (Gen.M) curriculum implemented in Texas by EngenderHealth also yielded some positive results.5 Boys and girls in the treatment group were significantly more knowledgeable about contraceptive methods and where to obtain them, and were more likely to strongly agree that female birth control should always be used during sexual intercourse than young people in the control group. But there was no evidence that Gen.M affected attitudes toward traditional gender ideologies (in large part because youth in the treatment and control groups held relatively egalitarian attitudes) or in sexual refusal skills.

The Primary-School Action for Better Health program in Kenya showed that a gender-synchronized approach can be effective for primary school ages, utilizing in-service teacher training to improve pupils’ health knowledge, self-efficacy, and condom use.6 The evaluation showed that boys and girls reported significantly more communication with their parents and teachers about HIV and sexuality, greater self-efficacy related to abstinence and condom use, and greater condom use as well as decreased sexual activity. Gains were gender specific, with boys reporting increased condom use while girls were more likely to report decreased or delayed sexual activity. This intervention was operational in 11,000 of the country’s nearly 19,000 primary schools by 2006.

Most of the gender-synchronized programs and evaluations were shaped by heteronormative assumptions. The review was able to identify few examples of gender-synchronized programs that intentionally considered gender and sexual diversity. Programs that address the gaps in services or health of gender and sexual minorities have largely been narrowly focused on HIV prevention or efforts to advocate for their rights rather than integrated into health, development, or violence prevention programs. We noted few resources to engage, support, and enhance gender role expectations with or alongside gender and sexual minorities, and few programs that integrated these concerns into interventions for an entire community. Only one project evaluation report showed evidence of attitudinal shifts among adolescents related to their understanding of gender and sexual diversity.7

The literature review also noted other gaps. There was little analysis of whether or how gender-synchronized strategies contributed to the positive results of the project, whether health or gender-specific outcomes. Most programs focused on people’s attitudes and behaviors, but few included components to shift the gender bias and discrimination in systems and structures such as national policies, health services delivery, or school-based practices. The Primary-School Action for Better Health in Kenya was not specifically focused on gender, but successfully used a systems approach to scale the intervention.

Stakeholder Feedback

The feedback from the stakeholders’ consultations showed that many in the health development field find the concept of synchronized gender strategies a useful frame for designing new programs. Among projects promoting women’s reproductive health, gender synchronization has encouraged project staff to be intentional about the dynamics of (heterosexual) couple communication and decisionmaking about family planning and other reproductive health concerns.

As was true in 2010, some tensions still exist among stakeholders, particularly in the context of GBV mitigation. There are some who feel that in practice some programs lack sufficient critique and emphasis on changing the systems and structures that provide more privilege to males (for example, addressing gaps in transportation systems, school, or work environments that could protect women and girls from sexual harassment and assault).

Reflections

This review has been helpful in understanding how far the field has progressed and illuminating the continued need for evidence of the specific contribution of gender synchronization. While it’s encouraging to see that many of the new evaluations revealed significant improvements in women’s decisionmaking, role sharing in workload in the household, and communication between couples, parents and children, and even teachers and pupils, the causal pathways remain unclear.

The authors noted evidence that highlights how gender-synchronized interventions that fully address power dynamics and privilege can help gain traction in the prevention of intimate partner violence. These exemplars provide insights for how they might support the prevention of GBV in other contexts.

The authors found that conceptually, gender-synchronized strategies remain relevant with a strong logic for implementation. The review confirmed that many of the key elements identified as core to gender synchronization were included in the programming examples reviewed. Yet some gaps were also identified. In practice, programs can sometimes offer and inadvertently reinforce an idealized vision for women and for men that lack examples of diversity outside heterosexual married couples. Just as the review found few examples of programs that intentionally consider gender and sexual diversity, specific populations have been under-represented and opportunities to work with more diverse populations may have been missed. Did the authors overlook these projects? Or are gender-synchronized programs that include a focus on gender or sexual identity missing from the field?

This review affirmed that the space for discussions on gender inequality and power dynamics is still not safe in many communities. People speaking out on issues of gender inequality are often silenced or threatened. In our review we noted a lack of discourse about how to assess safety or how to move the conversation forward in a way that is contextually appropriate.

Recommendations and Next Steps in Gender-Synchronized Programming, Evaluation, and Research

Based on the findings of our analysis, the authors see a need to expand the diversity of voices contributing to the discussions about lessons and challenges in gender-synchronized programming. The review currently lacks key insights from community organizations and advocates for marginalized groups, particularly LGBTI persons about how gender-synchronized strategies might be applied with greater inclusion of diverse populations. Developing a shared conceptual understanding of these issues by diverse groups working on women’s empowerment, men’s engagement, HIV, health, and rights of gender and sexual minorities will promote greater trust and willingness to collaborate. This shared understanding and collaboration could contribute to advance the human rights of marginalized and vulnerable populations and improved health outcomes for everyone.

The authors call for future evaluation designs that can show whether and how gender-synchronized strategies contribute to impact in health and gender equality. The community also needs to consider a refined definition, theory of change, and key program elements of gender-synchronized interventions. Language is important. The community needs to be precise in how it describes the gender-synchronized interventions and project goals to avoid misunderstanding. For example, speaking of “including both women and men,” may unintentionally reinforce the idea that only these two groups exist, and always/only in relation to each other. It is important to frame the work as deconstructing harmful aspects and rigid expectations about masculinity and femininity.

The authors call on organizations implementing gender-synchronized programs to apply more inclusive approaches, and in particular to make sure that programs better reflect and incorporate gender and sexual diversity. Improving conditions for vulnerable groups requires engaging the socially dominant groups in the process of reflection on gender roles, norms, and power dynamics in their own lives. And at the same time, programs must be intentional in incorporating vulnerable groups when they are also working with the people in the socially dominant category. A more inclusive process could help to build consensus around a vision for health and healthy relationships (not just sexual relationships), and to aim for equalizing power dynamics and expanding opportunities within and among the roles that all people play in society.

The authors note that many people face stigma or experience threats for challenging social injustices; this could be more explicitly acknowledged and addressed as a new core element of gender-synchronized approaches. The authors honor the courage of those who have stood up and spoken up to help create positive change towards gender equality in their own communities. It’s time for programs with gender-synchronized approaches to proactively include risk-monitoring systems and ways to better protect those working for change.

The authors believe that gender synchronization has relevance across sectors, with future opportunities for adaptation, implementation, and learning. They call for intentional dialogue and exchange of ideas about gender-synchronized strategies in different programmatic and geographical contexts, so that all can gain clarity about the goals and outcomes of gender-synchronized work.