Introduction
Photo Credit: Martin Ndichu/World Vision
Gender norms, roles, and dynamics are key determinants of well-being across international development sectors and around the world. As a result, the importance of gender integration—implementing strategies in health and other programs to address gender-based inequalities—has been noted, especially in HIV programming, maternal and child health (MCH), and reproductive health.2,3,4 Gender norms can increase men’s and women’s health risks and vulnerability.5 For men, their health and well-being can be compromised by norms related to not seeking health services, having multiple sex partners, and not using or supporting the use of family planning. For women, gender inequality can limit their access to facility-based care, including voluntary family planning services, and restricting their ability to pursue educational, economic, and social endeavors.
WHAT IS GENDER INTEGRATION?
Strategies applied in program planning, assessment, design, implementation, monitoring, and evaluation to take gender considerations into account and to compensate for gender-based inequalities.1
In the past decade, frameworks and tools have been created to provide guidance on addressing gender inequalities,5,6 and gender integration has gained visibility in international development programming. The Advancing Partners & Communities (APC) project integrated gender considerations into the planning, design, implementation, and measurement of its programs to maximize contributions to Sustainable Development Goals and gender equality. When the project launched its small grants program in 2013, it convened a grantees’ meeting that included an interactive session about the Interagency Gender Working Group’s Gender Integration Continuum, a tool that helps program implementers plan how to integrate gender into their programs and diagnose the extent to which existing programs integrate gender. The continuum helps the user transform gender-blind programs to gender-aware programs, with the goal of equality and better development outcomes.6
According to the gender equality continuum tool, programs can be classified as gender exploitative, accommodating, or transformative. Exploitative gender programs intentionally or unintentionally reinforce or take advantage of gender inequalities and stereotypes in pursuit of project outcomes or take an approach that may exacerbate inequalities. Accommodating interventions acknowledge gender differences in the culture and work around them to achieve their objectives. Transformative interventions address gender relations to transform the current context and work to promote equality to achieve their objectives. The gender continuum cautions programs against being gender exploitative and promotes progression toward being gender transformative.7
This brief summarizes the work of selected APC grantees that integrated gender into existing activities. We discuss approaches employed in the programs’ design and implementation that rise to the level of “promising practices.”
Grantees’ Gender Integration Activities
We compiled information on grantees’ gender integration through (1) review of routine grantee reports, (2) an online survey, and (3) in-depth interviews. The report review helped us identify 13 grantees who conducted gender integration activities. These grantees were asked to complete an on-line survey; nine responded. We conducted follow-up phone interviews with six of the survey respondents to obtain more in-depth information.
APC grantees operated in diverse settings and had unique challenges. The reports, survey responses, and interviews demonstrated that there is no one-size-fits-all approach to gender integration. The table below outlines the grantees, their location, and their gender-integration activities.
Table 1. Selected APC Grantees and their Gender Integration Activities
| ORGANIZATION | COUNTRY | ACTIVITIES | DATA SOURCES |
|---|---|---|---|
| CARE USA | Washington, D.C. | Held a year-long series of events on gender-based violence. | Survey, interview |
| Global Team for Local Initiatives (GTLI) | Ethiopia | Conducted mixed-sex adult vocational and literacy training with integrated livelihood activities. Women and men practiced joint decision-making during the activities. | Interview, reports |
| Conducted the Community-Based Learning in Action activity series at women’s cooperatives and during community empowerment committee meetings, where men and women explored cultural traditions detrimental to women’s health and well-being and were introduced to the concept of healthy timing and spacing of pregnancies (HTSP). | |||
| International Center for Research on Women (ICRW) | Guyana | Adapted a gender-based violence screening tool and trained providers to integrate the tool into HIV services. | Interview |
| Salvation Army World Service Office | Uganda | Promoted male engagement in family planning: educated male community leaders to be family planning champions to engage other men in discussions about the benefits of family planning. | Survey, interview, reports |
| Sonke Gender Justice | Uganda | South-to-south learning: provided Salvation Army Uganda with technical assistance and capacity-building to integrate gender into its activities. | Reports |
| University of Nairobi | Kenya | Advocated among community leaders to end female genital mutilation/cutting (FGM/C). | Interview, reports |
| WellShare International | Uganda | Organized community dialogues to discuss the issue of low male engagement in family planning; discussed joint-decision making and couples’ communication. | Survey, interview, reports |
| Worked with community members to record radio talk shows, based on the community dialogues mentioned above, in which they discussed male involvement in family planning. | |||
| World Vision | Kenya | Trained male community health volunteers on messages and services related to family planning and HTSP. | Survey, interview, reports |
| Created male-friendly corners at health centers. | |||
| Started a women’s loan and savings group, which empowered women to organize, save money, and start small businesses. | |||
| Promoted HTSP through Muslim leaders, who demonstrated compatibility of HTSP with Koranic teachings and discussed natural and modern contraception. | |||
| Trained health workers on gender-based violence. |
Promising Strategies for Gender Integration Programming
Based on the grantees’ experiences, APC recommends four promising strategies for designing gender integration programming: (1) south-to-south learning exchanges, (2) male engagement, (3) raising awareness about genderbased violence (GBV) and increasing access to services, and (4) gender-sensitive joint learning and collaboration. Incorporating these strategies into programs can promote gender-equitable norms and contribute to improved program outcomes, including increased contraceptive uptake and condom use. These strategies—and examples of how APC grantees applied them—follow.
South-to-South Learning Exchanges
South-to-south learning exchanges include educational tours, virtual exchanges, expert visits, and twinning with mentors and mentees. APC grantees used expert visits most frequently to address gender inequities. These typically involve subject matter experts traveling and providing on-site mentoring.
The Africa Coordinating Centre for the Abandonment of Female Genital Mutilation.
One APC grantee, the College of Health Sciences at the University of Nairobi, created the Africa Coordinating Centre for the Abandonment of Female Genital Mutilation (ACCAF). The center includes subject matter experts from West Africa, the North African Maghreb, and East Africa who have a variety of backgrounds, including public health, medicine, women’s rights, and gender studies. When there was an increase in FGM/C in Mauche, Kenya, the ACCAF experts trained youth, law enforcement, health workers, government, and community members as champions to advocate against FGM/C. This included training to enforce the Prohibition of FGM Act, which passed in 2011. One chief reported that the training allowed him to stop three FGM/C ceremonies. After the training, ACCAF experts continued making mentorship visits every three months. The center’s facilitators also trained teachers to educate girls and their families about FGM/C and its detrimental effects on the health and social and sexual wellbeing. Teachers regularly reported success; one was able to prevent her student from undergoing FGM/C. ACCAF also worked with young men, many of whom later vowed to protect their wives from the practice and to educate their peers to work toward eliminating the practice in their communities.
Sonke Gender Justice (Sonke) and the Salvation Army World Service.
Sonke, a South African nonprofit working throughout Africa, is renowned for its initiatives that advocate for gender justice and achieve gender transformation. Sonke provided technical assistance on gender integration to the Salvation Army in Uganda. Sonke and Salvation Army staff had challenging conversations about men’s and women’s attitudes, stereotypes, and personal values about family planning and gender dynamics. Salvation Army staff applied the skills, knowledge, and techniques they learned to enhance the content of their male engagement activities not only under APC, but for two other USAID-funded projects operating in the same area. Activities included educating and training male leaders to be family planning champions and engaging other male community members in discussions about the benefits of family planning.
Male Engagement
Increasing male involvement in family planning education and decision-making leads to greater uptake and continued use of family planning.8,9,10 In 2018, USAID released a strategic planning guide for engaging men and boys in family planning as part of its High-Impact Practices series,11 which helped to reinforce and guide APC grantee male engagement activities.
“Engaging men is transformative; men are typically the gatekeepers to everything. When men understand how family planning benefits their family it changes the relationship dynamics in the community in a positive way”
—Laura Sanka, WellShare International
World Vision.
APC grantee World Vision trained and empowered male community health workers and religious leaders in Garba Tulla, Kenya, to be family planning champions and increase dialogue among men about family planning, encouraging them to become active participants in family planning along with their wives. Community health workers reported an increase in couples coming for family planning services once this initiative launched. Also, the method mix among male users of contraception in Garba Tulla is notable: by the end of the project, 13 percent (2,369 of 18,221) of male users reported “using” the standard days method—that is, helping their wives track fertility and wearing condoms or abstaining from sex during their wives’ fertile periods.
WellShare International.
This grantee developed and implemented community dialogues to get men to support their partners in family planning use. WellShare reported that these dialogues not only resulted in greater male support for family planning, they also led to the decision to use radio talk shows featuring male and female family planning advocates, reinforced by community health worker follow up conversations. This promoted couples’ communication about family planning use and improved male/female relationship dynamics in the communities. An increase in male support was seen in family planning and antenatal care as more men accompanied their partners to clinic visits.
“Gender should not be an add-on, it should be at the core. It is really important, and partners find it useful and appreciate the tools for integrating gender.”
—Anne Stangl, ICRW
Raising Awareness about Gender-Based Violence
Integrating gender-based violence screening and programming into health services, such as HIV, is associated with more equitable gender norms, less tolerance for violence, and increased community action to prevent it.4,12,13
International Center for Research on Women.
ICRW integrated screening for gender-based violence into HIV testing services in Guyana. It first completed a rapid assessment of the prevalence and cultural implications of gender-based violence, then adapted a tool to screen for it. Approximately 80 health workers were trained to use the tool and help clients access related services. This increased attention to gender-based violence, improved victims’ access to services, and drew attention to people living with HIV, who are at high-risk of gender-based violence. ICRW credits the use of trusted health workers to screen and connect clients to supportive services with the intervention’s success.
“Having men and women learn together on how to benefit the family directly helped lay the groundwork. What we talked about is how you have more healthy children to support the family. The activities were created so people came to this conclusion on their own. They were the solution identifiers and that is why it worked.”
—Lori Pappas, GTLI
CARE USA.
CARE USA’s grant supported the Gender-Based Violence Task Force of the Interagency Gender Working Group (IGWG) to highlight the intersection of gender-based violence and sexual and reproductive health. The Task Force convened quarterly high-profile meetings to bring together practitioners, donors and researchers to discuss advancements in the field and how best to bring these practices to their activities and projects. For example, the 2015–2016 series, which focused on youth and gender-based violence, discussed the cycle of violence using examples from high schools in Haiti.
ACCAF.
The south-to-south learning exchange described earlier also focused on raising community awareness of genderbased violence by training and continued engagement of champions youth, law enforcement, health workers, government, and community members—to advocate against gender-based violence.
Gender-Sensitive Joint Learning and Collaboration
Global Team for Local Initiatives.
Photo Credit: Leigh Wynne/FHI 360
GTLI worked in pastoralist communities in Ethiopia’s South Omo Zone, which is characterized by extreme poverty, limited access to health services, low status of women, and almost nonexistent demand for family planning because of traditional cultural norms. One of GTLI’s objectives was to elevate the status of women by enhancing their ability to contribute to household assets and strengthening their confidence to speak up for their needs. GTLI promoted an environment that encouraged men and women to learn together, communicate on topics such as healthy timing and spacing of pregnancies, and collaborate on activities such as small-scale gardening and chicken farming to improve nutrition and livelihoods. The prospects of acquiring greater access to food makes it possible for women and girls to attend school, which in turn helps women gain the confidence to self-advocate and begin participating in household and community decision making. A key intervention was the Integrated Functional Vocational Literacy curriculum, which reinforced reproductive health and family planning messaging and provided a gender-sensitive venue for men and women to experience the benefits of joint decision-making. Women also learned negotiation skills to communicate effectively within the household and at community and tribal gatherings. To start shifting cultural norms, GTLI also used Community-Based Learning in Action, a series of structured activities that helps community members identify traditions that motivate them to have a large number of children, and explains the risks of having pregnancies too close together, among other topics. These activities were often held at mixed-gender community empowerment committees, which were established to reinforce and sustain the new behaviors.
Conclusions
Successful gender integration cannot be reduced to one approach. However, the following steps support integration, no matter the strategy employed. Programs interested in integrating gender in their activities should:
- Identify a gender focal point within the organization. Ideally, this person should be mid- to senior-level program or technical staff with experience and interest in gender.
- Identify technical assistance or capacity-building needed to integrate gender into program activities.
- Budget for technical and capacity-building activities, such as south-to-south learning events.
- Develop gender-related objectives and indicators so the program can monitor and evaluate its gender integration activities.
In addition, APC grantees found that successful integration of gender into their programs required sensitive collaboration with community and other stakeholders to understand, without judgment, the factors that shape people’s values and beliefs about gender. These efforts are worthwhile. Integrating gender into programs has been shown to increase coverage, effectiveness, and efficiency of interventions, and increases the wellbeing of girls, women, and ultimately, entire communities.
References
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4 Germain A. (2009a). Integrating gender into HIV/AIDS programmes in the health sector: tool to improve responsiveness to women’s needs. Bulletin of the World Health Organization, 87(11), 883–883.
5 Jhpiego. (2016). Gender Analysis Toolkit for Health Systems.
6 FHI 360. (2012). Gender Integration Framework: How to integrate gender in every aspect of our work.
7 IGWG. Gender Integration Continuum.
8 Walston N. Challenges and opportunities for male involvement in reproductive health in Cambodia [Internet]. 2005.
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11 High-Impact Practices in Family Planning (HIPs). Engaging Men and Boys in Family Planning: A Strategic Planning Guide. Washington, DC: USAID; 2018 Jan.
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