Abstract
BackgroundEvidence suggests that gender-integrated interventions, which actively seek to identify and integrate activities that address the role of gender norms and dynamics, improve family planning (FP) and maternal health (MH). To understand the link between the gender components of interventions and FP and MH outcomes, it is critical to examine the gender measures used in evaluations.MethodsWe conducted a systematic review of evaluations of gender-integrated FP and MH interventions in low- and middle-income countries. We examine characteristics of the interventions and their evaluations, and summarize women’s empowerment and related gender measures.ResultsOut of 16 evaluation articles, five reported the theoretical or conceptual model that guided the intervention. Twelve described how gender was quantitatively measured and identified 13 women’s empowerment and related gender constructs. Gender scales or indexes were used in five evaluations, three of which noted that their scales had been validated. Less than one third of articles reported examining the effect of gender on FP or MH.ConclusionsEvaluations of gender-integrated FP and MH interventions do not consistently describe how gender influences FP and MH outcomes or include validated gender measures within their studies. As a result, examining the pathways through which interventions empower women and the manner in which women’s empowerment leads to changes in FP and MH outcomes remains a challenge. Valid measures of commonly reported women’s empowerment and gender constructs, such as gender-equitable attitudes and women’s decision-making power, must be adapted and used within evaluations to examine how empowerment and improvements in gender-related factors can produce positive FP and MH outcomes.
Highlights
IntroductionGender transformative approaches actively strive to challenge and change gender inequalities while promoting health
Evidence suggests that gender-integrated interventions, which actively seek to identify and integrate activities that address the role of gender norms and dynamics, improve family planning (FP) and maternal health (MH)
While published reviews have explored the relationships between women’s empowerment and fertility [10], gender-based power and reproductive health outcomes [12], and women’s empowerment and maternal and child health [8], we found no reviews of health program evaluations that have examined the measurement of women’s empowerment and related gender constructs and their relationship to FP and MH outcomes
Summary
Gender transformative approaches actively strive to challenge and change gender inequalities while promoting health These approaches encourage critical awareness of gender roles and norms, challenge the distribution of resources and allocation of responsibilities between men and women, address power relationships between men and women, and promote the position of women. Gender accommodating interventions work around inequitable gender norms, roles, and relationships or adjust for these inequalities While these approaches do not actively seek to change norms and inequalities, they strive to limit the harmful impact of interventions on gender relations and the harmful impact of gender norms and inequalities on health outcomes [1, 2]. Using the same example above, a gender accommodating intervention would increase knowledge of the existing policy among couples in a community and encourage husbands to accompany their wives to clinics so that women can access contraception
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