Gender-transformative Interventions Research Articles

Pathways to leadership: what accounts for women’s (in)equitable career paths in the health sectors in India and Kenya? A scoping review

ObjectivesWe aimed to capture evidence on enablers and barriers to improving equal opportunity and effective organisational interventions that can advance women’s leadership in India and Kenya’s health sectors.MethodsWe systematically searched...

Gender, agricultural risk perceptions, and maize seed systems: A case study of drought-tolerant maize varieties in Uganda

CONTEXTDrought-tolerant maize (DTM) varieties and other agricultural technologies can play an important role in maintaining crop production and livelihoods, yet their uptake remains low. Most research on risks in agriculture only considers climate risks as a barrier to adopting agricultural technologies. Farming communities face other agricultural risks related to health, finances, markets, and institutions. These risk perceptions may be different for male and female farmers. OBJECTIVEWe explore the agricultural risk perceptions of male and female smallholder farmers, assessing gender roles and norms and their influence on risk perceptions. Subsequently, we discuss the implications of these perceptions and gender roles and norms on the uptake of drought-tolerant maize varieties in Uganda. METHODSWe conducted a qualitative study with men's and women's focus groups in twelve villages in three districts in Uganda. We used participatory rural appraisal tools with each group to structure the discussions. RESULTS AND CONCLUSIONSProduction risks, health risks, social norms, and financial constraints may play an important role in smallholder agricultural decision-making. These risks are inseparable and different for men's and women's groups. Women tend to prioritize climate and crop management risks, while men place more weight on financial constraints. The perceived impact of health risks, risks related to social norms, and market risks vary across men and women in different districts. Dokolo reflects more traditional gender roles, while Iganga and Masindi note more contested gendered power over maize cultivation. The risk and concern ranking in Dokolo shows more similarity between men and women compared to Iganga and Masindi. Women tend to have less access to DTM varieties in the formal seed system, while they tend to have fewer resources to mitigate health and crop production risks. To reach and benefit more women with DTM varieties, we draw attention to access to information, bringing seed closer (potentially subsidized), gender transformative interventions, and investment in open-pollinated varieties disseminated through the informal seed system. SIGNIFICANCEOur research emphasizes the importance of considering multiple risks in agriculture when promoting resilient farming systems rather than focusing solely on climate risk. We also show the importance of applying a gender lens to these risks and the uptake of DTM varieties. Serving as an inclusive and pro-poor risk management technology, DTM would benefit from ensuring that the technology becomes available to male and female farmers in multiple seed systems, including formal seed systems (primarily hybrids) and informal seed systems (primarily open-pollinated varieties).

Gender-transformative action, social norms and economic empowerment

Feminist advocacy for ‘gender transformative’ approaches to development, public policy and humanitarian action that account for social norms has surged in recent years. This article intervenes in the debate around norms and implications for transformative approaches. We draw on a unique set of quantitative, global ‘gender data’ collected in 2020 and 2021 and examine how social norms inform women’s experiences of economic empowerment, as well as how these relationships map onto the current debates around interventions to address social norms and the form these interventions ought to take. Our data show that social norms matter for access to and control over resources; in addition, they illustrate that an individual belief in gender equality is fairly common around the world but that such individual beliefs frequently do not coincide with what people think their neighbours believe. These findings suggest a need for consideration of factors beyond individual attitudes towards and beliefs in gender-transformative interventions for women’s economic empowerment.

Pathways to transactional sex among peri-urban South African women: the role of relationship control, food insecurity and alcohol misuse

ABSTRACT Transactional sex increases sub-Saharan African women’s risk of HIV acquisition. We quantitatively explored the pathways contributing towards women’s future engagement in transactional sex with casual partners and khwapheni (secret concurrent sex partners). We conducted secondary data analysis from a cluster randomised controlled trial in urban informal settlements in eThekwini Municipality., South Africa. Data were collected at enrolment (t0) and 24 months’ later (t2) using self-completed questionnaires. Structural equation modelling (SEM) assessed pathways leading to transactional sex over two years. 677 women 18–35 years were enrolled and 80.5% (n = 545) were followed up. At t2, 44.6% of respondents reported transactional sex with a casual partner or khwapheni. The SEM demonstrated a small effect (d = 0.23) between transactional sex at t0 and at t2. Controlling for past transactional sex, main partner relationship control had a large effect size on future transactional sex (d = 0.60). Hazardous drinking had a medium effect size (d = 0.45) and food insecurity a small effect (d = 0.24), (RMSEA 0.03, 90%CI 0.02–0.04; CFI 0.97; TLI 0.96). HIV prevention programming should highlight current transactional sex but also address structural issues predicting future transactional sex, including food insecurity and alcohol misuse. Gender transformative interventions to reduce controlling behaviours in main relationships are worth investigating.

What Interventions are Cost Effective in Reducing Violence Against Women? A Scoping Review.

To systematically summarise the recent literature on the cost and cost effectiveness of interventions implemented to reduce violence against women (VAW) and decision frameworks guiding resource allocation. A scoping review of scholarly and grey literature on the cost-effectiveness and/or resource allocation for interventions addressing intimate partner violence (IPV), dating violence and non-partner sexual violence perpetrated against women aged 15 years and over. All settings and contexts were eligible, with papers published in English between 2010 and March 2023 included. Nineteen papers fulfilled the inclusion criteria reporting the cost, cost savings and/or cost effectiveness of 24 interventions to prevent IPV and to a lesser extent, other forms of interpersonal violence. Among the 16 economic evaluation studies reviewed, four types of interventions were cost effective in multiple settings or studies, including community activism (Uganda, Ghana), gender transformative interventions with couples and individuals (Ethiopia, Rwanda), specific justice and law enforcement measures (USA) and a combined personnel training, support, and referral programme in General Practice in the UK. Other interventions were cost effective in a single study or had conflicting evidence. Three remaining papers conducted a partial evaluation or cost appraisal providing limited information on the cost or cost-savings of other implemented interventions. No frameworks on resource allocation for the prevention of VAW were identified. While there is some evidence of cost effectiveness emerging for interventions implemented in specific contexts, overall, we find the recent evidence on costs and cost effectiveness of interventions for the prevention of VAW to be limited. Embedding economic evaluation in future effectiveness trials will build critical evidence needed to inform policy and resource allocation decisions based on the value-for-money of interventions. Modelling the benefits and costs of interventions to better understand the societal impacts of programmes at scale is a further research opportunity.

Examining the association between men's gender equitable attitudes and contraceptive outcomes in rural Maharashtra, India

BackgroundPrevious literature suggests that men reporting more gender-equitable attitudes are more likely to use condoms, but there is a paucity of data evaluating whether these attitudes are associated with contraceptive communication and use. The objective of this study is to test the hypothesis that men reporting more gender-equitable attitudes will be more likely to (a) engage in contraceptive communication with their wives and (b) that they and/or their wives will be more likely to use all forms of family planning, compared to men with less equitable attitudes. MethodsUsing cross-sectional dyadic survey data from young married couples from rural Maharashtra, India (N = 989), we assessed the associations between men's gender role attitudes and a) spousal contraceptive communication and b) contraceptive use by type (none, traditional, condoms, pills, or IUD). The contraceptive use outcome is based on wives' report. We assessed these associations via bivariate t-test (communication outcome) or ANOVA test (contraceptive type outcome), as well as unadjusted and adjusted logistic (communication outcome) and multinomial logistic (contraceptive type outcome) regression models. Adjusted models included sociodemographic factors selected a priori based on established associations with gender-equitable attitudes and/or our assessed outcomes. FindingsMen with more gender-equitable attitudes were more likely to discuss family planning with their wives (AOR = 1·05, 95%CI 1·03-1·07, p < 0·001) and to use condoms (ARRR = 1·03, 95%CI 1·00-1·06, p = 0·07). There was no association between gender-equitable attitudes and use of other types of contraception. InterpretationWhile gender-equitable attitudes among men may facilitate condom use and family planning communication in marriage, they do not appear to be linked with greater likelihood of use of more effective types of contraceptive use. This suggests that males supportive of gender equity may take greater responsibility for family planning vis a vis a less effective contraceptive, condoms, in the absence of more effective short-acting contraceptives for men. FundingThe National Institutes of Health [Grant number 5R01HD084453-01A1] and the Bill & Melinda Gates Foundation, Seattle, WA [grant number INV-002967].

Gender analysis of the World Health Organization online learning program on Immunization Agenda 2030.

Vaccine-preventable diseases pose a significant threat to children under five globally, creating disparities in immunization coverage. Despite its cost-effectiveness and life-saving potential, immunization faces challenges in achieving equitable coverage. Gender inequalities deeply influence access to healthcare, affecting immunization rates. This study examines the action plans submitted by participants of the World Health Organization's (WHO) IA2030 Scholar Level 1 certification course in 2021. A qualitative analysis was conducted on a subset of 111 action plans that scored above 75%, employing narrative thematic analysis to categorize and explore gender incorporation and identified barriers based on the IA2030 Gender Guide. Among the 111 analyzed action plans, gender considerations were present in almost all plans, underscoring the effectiveness of integrating gender perspectives in the course curriculum. The most frequently cited barriers included low education and health literacy, issues related to accessing quality immunization services, gendered dynamics in decision-making within households, and limited access to resources and mobility, predominantly impacting women. The findings confirm that gender inequalities significantly contribute to suboptimal immunization coverage. An intersectional approach, recognizing diverse social markers impacting immunization, is vital to address disparities effectively. Moreover, the need for gender-sensitive data and deeper understanding of intersectional dynamics was emphasized. The study highlights the importance of gender-transformative interventions, including community engagement and efforts targeting both men and women to enhance immunization coverage. While acknowledging limitations, such as potential biases in peer evaluations and the need for wider inclusivity in gender perspectives, this analysis underscores the significance of mainstreaming gender in immunization capacity-building programs. The integration of gender considerations not only raises awareness but also equips professionals to create more gender-responsive immunization programs. Continuous efforts to incorporate gender perspectives can lead to more effective, equitable, and gender-transformative immunization initiatives at various levels.

Protecting the human rights of pregnant and parenting adolescents in Lesotho: 'What's culture got to do with it?'

Poor health, social exclusion, and stigma are usually associated with adolescent pregnancy and parenting, resulting in girls' suspension and, in some instances, expulsion from school. While most African states, including Lesotho, have laws and policies protecting the rights of all children, including adolescents, to enroll and be retained in school, implementation is lagging behind. Using a socio-legal approach, the article explores the challenges in implementing policies and guidelines on school re-entry following pregnancy and/or parenthood, with particular reference to Lesotho. It argues that, despite the adoption of enabling laws and policies protecting sexual and reproductive health rights, and the right to education of pregnant and parenting adolescent girls, punitive and discriminatory practices continue to serve as barriers that undermine countries' human rights commitments. The barriers are attributable to the influences of family, societal, religious and cultural beliefs and practices. To address these barriers, this article proposes comprehensive, innovative, gender-transformative, targeted and rights-based interventions, and supportive policies and strategies, to facilitate continuous awareness-raising, social and attitudinal change, and social justice.

Effectiveness of community mobilisation and group-based interventions for preventing intimate partner violence against women in low- and middle-income countries: A systematic review and meta-analysis.

Intimate partner violence (IPV) is a challenge affecting one in three women in their lifetime, and gender-transformative interventions have been identified as a promising prevention strategy. We systematically reviewed and meta-analysed randomised controlled trials (RCTs) of community-level or group-based interventions to prevent IPV in lower- and middle-income countries, seeking to answer the following research question: do community- or group-based gender-transformative interventions reduce IPV, compared to a control arm of status-quo programming? We conducted a systematic search from the inception of all databases employed until 20 July 2021. Eligible study outcomes included past-year experience of physical, sexual, emotional or economic IPV self-reported by women and perpetration of physical or sexual IPV self-reported by men. We assessed study risk of bias using the updated Cochrane tool for RCTs. We estimated the pooled odds ratio (OR) using a multilevel random-effects meta-analysis and also conducted a multilevel meta-regression to analyse how study characteristics moderated the effect size. After screening 7363 unique records, we included 30 studies on 27 unique RCTs. Our meta-analysis suggested that community-level or group-based interventions reduced the odds of women experiencing IPV in the past year: pooled adjusted odds ratio (aOR) = 0.78; 95% confidence interval (CI) = 0.63-0.97. While there was significant heterogeneity in the effect sizes between trials (I2 = 83%), potentially reflecting the diverse contexts of the included trials, our meta-regression did not indicate a significant association between intervention effectiveness and intervention type or target population. There was evidence of significant associations between effectiveness and intervention components and duration. There is strong evidence that community-level and group-based interventions reduce IPV against women. Unpacking what intervention modalities are effective in which contexts can further inform prevention strategies. PROSPERO (CRD42021290193).

Technology for whom? Solar irrigation pumps, women, and smallholders in Nepal

Agricultural technologies are often promoted as a medium for women’s economic empowerment, which can transform unequal gender relations in rural agrarian societies. This paper investigates three solar irrigation pump (SIP) schemes implemented by state and non-state actors and examines their impacts on women and marginal farmers. We utilize a theory of change framework intended to evaluate the effectiveness of livelihood interventions and guide the design of gender transformative interventions. Our analysis relies on 63 qualitative interviews, 9 key informant interviews and 4 telephonic interviews with social mobilisers from the Saptari District in Nepal. The findings shed light on the unequal social and gender relations that have skewed the adoption and benefits of SIP technology. Gender and social inequalities persist, with limited adoption and benefit of SIP among women and smallholders. Women’s involvement in strategic decisions related to SIP adoptions, installations and usages is limited. This study underscores the importance of strategic interventions that foster meaningful women’s empowerment and ensure equitable distribution and benefits from SIP technology. Assessing the effectiveness of SIPs in empowering women, it is crucial to consider whether the resulting access, ownership, or decision-making opportunities challenge, reinforce, or reproduce unequal gender and social relations.

Challenging structures: gender transformative interventions by livestock CRP in Ethiopia

IntroductionThis study is a review of secondary literature that has been synthesized to extract information and demonstrate the implementation and impact of community conversations (CCs) on gender aspects of social norms in livestock-based systems in Ethiopia.MethodsThe study used the phenomenological method of qualitative literature review to sketch the gender transformative approach to the delivery of knowledge products in a program on transforming the small ruminant value chain. The CC aimed at addressing gender-related norms in the division of labor, resource ownership, and handling practices of animals and their products previously identified, and those that emerged during the CC events across the study sites. A total of 1,517 community members (out of which 574 are women) took part in various CC events.Results and discussionThe review shows that the gender-related norms addressed were in line with the identified constraining norms faced by women livestock keepers in the mixed and livestock-based systems. The CC approach adopted complied with the stages laid out in literature: identification of existing knowledge; imparting new knowledge; knowledge integration and application; and review, reflection, and re-planning. The process was inclusive and community-engaging, which possibly cultivated intrinsic motivation and ownership of the process. Changes in knowledge, attitudes, and practices at household, community, and institutional levels were identified. The conclusions include institutionalizing the gender transformative approach in the public agricultural extension system. This could be facilitated by the generation of robust objective evidence of impacts and guidance for subsequent scaling at local, regional, and national levels.

Implementing Interventions to Address Gender and Power Inequalities in Early Adolescence: Utilizing a Theory of Change to Assess Conditions for Success

PurposeTo create a set of criteria to assess facilitators and barriers to implementation among gender transformative interventions that target very young adolescents (VYAs) across different cultural settings. MethodsInterventionists and researchers involved in the Global Early Adolescent Study created a Theory of Change (ToC) based on summarizing intervention components from five different gender transformative intervention curricula. Embedded within the ToC is a set of criteria labeled, ‘Conditions of Success’ which were developed to illustrate that change cannot happen unless interventions are implemented successfully. To test the feasibility of these criteria, implementation data collected across the five interventions in Global Early Adolescent Study were mapped onto the ‘Conditions for Success’ criteria and used to identify common facilitators and barriers to implementation. ResultsUsing the ‘Conditions for Success’ criteria, we found that gender transformative interventions targeting VYAs were most challenged in meeting program delivery and facilitation conditions and needed to build more multisectoral support to shift rigid gender norms. Parents and caregivers also needed to be engaged in the program either as a separate target population or as codesigners and implementers for the interventions. DiscussionThe Conditions for Success criteria provide a useful framework for assessing facilitators and barriers to implementation among gender transformative interventions for VYAs. Additional research is underway to examine whether interventions that meet more conditions of success result in greater program impact, which will be used to further refine the overall ToC.

The Impacts of Two Gender-Transformative Interventions on Early Adolescent Gender Norms Perceptions: A Difference-in-Difference Analysis

PurposeInequitable gender norms are widespread and can be harmful to the wellbeing of adolescents. This study estimates the effects of two gender-transformative interventions, Semangat Dunia Remaja or Teen Aspirations (SETARA) and Growing Up Great! (GUG!), on gender norms perceptions and attitudes among very young adolescents in poor urban settings in Bandar Lampung, Semarang, Denpasar (Indonesia), and Kinshasa (Democratic Republic of the Congo). MethodsThe study draws from the longitudinal Global Early Adolescent Study, using a quasi-experimental design to evaluate the interventions. Data collection took place between 2017 and 2020. Our analytical samples included 2,159 adolescents in Kinshasa and 3,335 in Indonesia. We conducted a difference-in-difference analysis using generalized estimation equations and generalized linear models, after stratification by site and sex. ResultsThe interventions shifted a range of gender perceptions, although effects varied by program, city, and sex. SETARA shifted gender-normative perceptions related to traits, roles, and relations, while GUG! effects were more concentrated on attitudes toward chore sharing. SETARA was most effective in Semarang and Denpasar, but not in Bandar Lampung. In addition, both interventions were more consistently effective for girls than boys. DiscussionGender-transformative interventions can effectively promote gender equality in early adolescence, but effects are program-specific and context-specific. Our findings emphasize the importance of defined theories of change and consistent implementation in gender-transformative intervention.

Promotion of Sexual Health Self-Efficacy through Gender-Transformative Intervention with Adolescent Boys

This mixed-methods study examined how WiseGuyz, a gender-transformative healthy relationships program, can support positive sexual health self-efficacy (SHSE) among adolescents. 570 adolescent boys provided data on SHSE from before to after the program, and 20 adolescent boys participated in interviews and focus groups to discuss their sexual health education needs. Results showed that boys who participated in WiseGuyz reported a significant increase in SHSE from pretest to post-test and that WiseGuyz was different from typical school-based sexual health education in terms of content and facilitation and increasing program engagement. These findings indicate the potential for gender-transformative interventions in supporting positive SHSE.

"It is what we have been told to do": Masculinities and femininities crossing with sexual orientation and feminist activism in Spain.

Masculinities and femininities are often characterized by social inequalities and mainly studied from the perspectives of adult, heterosexual and non-activist people. This study explores the discourses on masculinities and femininities of young cisgender men and women, involved or not in feminist activism and of different sexual orientations (heterosexual, bisexual and homosexual) in Spain. Between 2019 and 2020, we conducted a qualitative study with 20 semi-structured interviews and 8 discussion groups in which 73 people participated. A socially dominant gender discourse was identified, which establishes a dichotomous understanding of masculinity in constant confrontation with femininity, as well as of heterosexuality against homosexuality, in a heteronormative context. Young people discursively position themselves differently from said discourse according to their sexual orientation and involvement in feminist activism. We encounter discursive positions that reproduce the socially dominant gender discourse, especially detected among non-activist heterosexuals. We also observe others that try to transgress it, mainly among activists of all sexual orientations and non-activist homosexuals and bisexuals. This study empirically adds to the knowledge of the configuration of inequalities in gender relations and how interactions with sexuality take place. The results also provide guidance for future gender-transformative interventions to promote gender equality and social justice.

Girls becoming ‘sexy’ on digital spaces: capacities and constraints

ABSTRACT In this paper, we draw upon a qualitative study to investigate how black teenage girls interact with digital spaces to provide both capacities to express and constrain sexuality. Following a new feminist materialist approach, we demonstrate girls’ experiences of sexuality as embedded within a complex entanglement of matter (both human and more-than-human) that produce capacities, mediating what girls can do, feel or be on social media. Specifically, we conceptualize girls’ experiences within a ‘techno-sexual’ assemblage of bodies, things, ideas, social media applications, videos and pictures to illustrate how ideals of heterosexuality are connected to an affective flow of matter that creates vibrancy, permitting capacities and constraints. Firstly, we show how girls’ entanglement with celebrity and media culture, sexy selfies, and videos through digital affordances unlocked agentive capacities for the experience of heterosexual desire. Secondly, we illuminate how the assemblage generated restrictive capacities for girls who did not ascribe to heteronormative and racialized ideals of beauty through objectification and online sexual harassment. We argue that a recognition of this online micro-political space remains a vital part of gender transformative interventions.

Geographies of school-related gender-based violence: children's visual accounts of school toilets

ABSTRACT We report on a qualitative study that engaged learners in understanding their experiences of school-related gender-based violence in and around their school toilets in a township high school in South Africa. The study used photovoice to address the research question. In this paper, we do a close reading of the photovoice images produced by the participants to uncover the meanings they communicate. In their images, participants presented school toilets as geographies of gender-based violence and microaggression, for example, with negative messages written on the walls. In particular, the images presented toilets as spaces where boys (mostly) perpetrate various forms of heterosexist violence and sexual harassment against girls. Paradoxically, some images presented the school toilets as spaces where some learners seek refuge or safety from the violence and microaggression they experienced in and around the school. The findings point to the need for gender-transformative interventions that target various spaces in and around the school, including school toilets, and that seek to develop these spaces as clean, safe, and inclusive physical and social environments for all children.

Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries.

Involving men and boys as both users and supporters of Family Planning (FP) is now considered essential for optimising maternal and child health outcomes. Evidence on how to engage men and boys to meet FP needs is therefore important. The main objective of this review was to assess the strength of evidence in the area and uncover the effective components and critical process- and system-level characteristics of successful interventions. We searched nine electronic databases, seven grey literature databases, organisational websites, and the reference lists of systematic reviews relating to FP. To identify process evaluations and qualitative papers associated with the included experimental studies, we used Connected Papers and hand searches of reference lists. Experimental and quasi-experimental studies of behavioural and service-level interventions involving males aged 10 years or over in low- and middle-income countries to increase uptake of FP methods were included in this review. Methodology was a causal chain analysis involving the development and testing of a logic model of intervention components based on stakeholder consultation and prior research. Qualitative and quantitative data relating to the evaluation studies and interventions were extracted based on the principles of 'effectiveness-plus' reviews. Quantitative analysis was undertaken using r with robust variance estimation (RVE), meta-analysis and meta-regression. Qualitative analysis involved 'best fit' framework synthesis. We identified 8885 potentially relevant records and included 127 in the review. Fifty-nine (46%) of these were randomised trials, the remainder were quasi-experimental studies with a comparison group. Fifty-four percent of the included studies were assessed as having a high risk of bias. A meta-analysis of 72 studies (k = 265) showed that the included group of interventions had statistically significantly higher odds of improving contraceptive use when compared to comparison groups (odds ratio = 1.38, confidence interval = 1.21 to 1.57, prediction interval = 0.36 to 5.31, p < 0.0001), but there were substantial variations in the effect sizes of the studies (Q = 40,647, df = 264, p < 0.0001; I 2 = 98%) and 73% was within cluster/study. Multi-variate meta-regression revealed several significant intervention delivery characteristics that moderate contraceptive use. These included community-based educational FP interventions, interventions delivered to women as well as men and interventions delivered by trained facilitators, professionals, or peers in community, home and community, or school settings. None of the eight identified intervention components or 33 combinations of components were significant moderators of effects on contraceptive use. Qualitative analysis highlighted some of the barriers and facilitators of effective models of FP that should be considered in future practice and research. FP interventions that involve men and boys alongside women and girls are effective in improving uptake and use of contraceptives. The evidence suggests that policy should continue to promote the involvement of men and boys in FP in ways that also promote gender equality. Recommendations for research include the need for evaluations during conflict and disease outbreaks, and evaluation of gender transformative interventions which engage men and boys as contraceptive users and supporters in helping to achieve desired family size, fertility promotion, safe conception, as well as promoting equitable family planning decision-making for women and girls.

The mental health of adolescent girls from a tribal region of Central Rural India during the COVID-19 pandemic - A cross-sectional study to determine the role of gender disadvantage.

The mental health of adolescent girls in countries of South Asia is related to several social and cultural factors including gender disadvantage, especially in low resource settings such as tribal areas. The coronavirus disease 2019 (COVID-19) pandemic has increased this vulnerability even further. This study assesses the association of gender disadvantage with psychological distress among adolescent girls residing in a tribal area of India and examines the role of resilience. The study was conducted during the COVID-19 pandemic first wave in 2020 using telephonic interviews with 102 girls aged 15-20 from one block (65.46% tribal population) of a predominantly tribal area in Central India. Trained interviewers administered translated versions of the Kessler Psychological Distress 10-item scale (K-10), the Checklist for Assessment of Gender Disadvantage (CAGED), and the Brief Resilience Scale (BRS). Pair-wise correlation was conducted between gender disadvantage, resilience and psychological distress using CAGED, BRS and K-10 scores. A one-way ANOVA was used to compare mean difference in CAGED domain scores and K-10 severity score groups. The mean age of girls was 17.62 years (standard deviation 1.64). Scores on K-10 indicating moderate to severe psychological distress were seen among 27.5% of the respondents. Girls reported lack of space/privacy (39.2%), lack of freedom to pursue interests (32.4%), opinions not being considered (31.4%), and financial difficulties as hindrance to opportunities (28.4%) as common experiences of gender disadvantage. Gender disadvantage was directly associated with severity of psychological distress and inversely with resilience. This study indicates the importance of decreasing gender disadvantage for improving the mental health of young women and girls in underserved areas. The role of peer group interventions and engaging men and boys using gender transformative interventions in improving mental health needs to be studied.

Mechanisms for the prevention of adolescent intimate partner violence: A realist review of interventions in low- and middle-income countries.

Adolescent girls are among those at the greatest risk of experiencing intimate partner violence (IPV). Despite adolescence being widely regarded as a window of opportunity to influence attitudes and behaviours related to gender equality, evidence on what works to prevent IPV at this critical stage is limited outside of high-income, school-based settings. Even less is understood about the mechanisms of change in these interventions. We conducted a realist review of primary prevention interventions for adolescent IPV in low- and middle-income countries (LMICs) to synthesise evidence on how they work, for whom, and under which circumstances. The review took place in four iterative stages: 1) exploratory scoping, 2) developing initial programme theory, 3) systematic database search, screening and extraction, and 4) purposive searching and refinement of programme theory. We identified eleven adolescent IPV prevention interventions in LMICs, most of which demonstrated a positive impact on IPV experience and/or perpetration (n = 10). Most interventions (n = 9) implemented school- or community-based interactive peer-group education to transform attitudes and norms around gender and relationships for behaviour change. The central mechanism of change related to gender transformative content prompting adolescents to critically reflect on their attitudes and relationships, leading to a reconceptualisation of their values and beliefs. This central mechanism was supported by two secondary implementation mechanisms: 1) the design and delivery of interventions: interactive, age-appropriate education delivered in peer-groups provided adolescents a safe space to engage with content and build communication skills, and 2) the target group: social norms interventions targeting the wider community created enabling environments supportive of individual change. This review highlights the immense potential of gender transformative interventions during the critical period of adolescence for IPV prevention. Future interventions should consider the broader drivers of adolescent IPV and ensure intersectionality informed approaches to maximise their potential to capitalise on this window of opportunity.