Inequitable Gender Norms Research Articles

Young Men's Social Network Characteristics and Associations with Sexual Partnership Concurrency in Tanzania.

Social network influence on young people's sexual behavior is understudied in sub-Saharan Africa. Previous research identified networks of mostly young men in Dar es Salaam who socialize in "camps". This study describes network characteristics within camps and their relationship to young men's concurrent sexual partnerships. We conducted surveys with a nearly complete census of ten camp networks (490 men and 160 women). Surveys included name generators to identify camp-based networks. Fifty seven percent of sexually active men (n=471) reported past year concurrency, measured using the UNAIDS method. In a multivariable model, men's individual concurrency was associated with being a member of a closer knit camp in which concurrency was the normative behavior. Younger men who had older members in their networks were more likely to engage in concurrency. Respondent concurrency was also associated with inequitable personal gender norms. Our findings suggest strategies for leveraging social networks for HIV prevention among young men.

Community Gender Norms Change as a Part of a Multilevel Approach to Sexual Health Among Married Women in Mumbai, India.

Inequitable gender norms in societies and communities negatively contribute to women's sexual and reproductive health. While the need for change in gender norms is well recognized, the task is highly challenging in terms of intervention design, implementation and assessment of impact. This paper describes a methodology for identification of gender norms, the design of community level intervention, community participation and the assessment of intervention impact in a low income, predominately Muslim community of 600,000 people in Mumbai, India. Formative research focused on in-depth interviews with women, men and couples yielding gender normative statements and assessment of community resources to facilitate change. A Gender Equity Scale (GES) based on this formative research was developed and administered annually for a three-year period to random, cross-sectional samples in the intervention and control communities, and to community based, non-governmental organizations (NGO) staff and Imams (religious leaders) in the intervention community. NGO staff disseminated gender oriented messages to their female constituency through their regular outreach activities and through special events and festivals in the community. Imams disseminated gender messages through lectures on social issues for men attending Friday prayers. The results showed that the NGO staff and Imams, assumed more gender equitable attitudes across time. The intervention was associated with a significant improvement in attitudes towards gender equity in the intervention relative to the control community. Men showed a dramatic change in more positive gender attitudes, while women lagged behind in their GES scores. The meaning of these results are explored and the implications assessed for the generalizability of the methodology for other countries, cultures and communities.

Changing Gender Norms and Reducing HIV and Violence Risk Among Workers and Students in China

Global evidence demonstrates that inequitable gender norms negatively influence key health outcomes (e.g., violence, HIV/STI), and the importance of male involvement in prevention efforts. The China Family Planning Association and PATH partnered to develop and evaluate a gender-focused behavior change communication intervention for HIV and violence prevention. Eight participatory education sessions—adapted for the Chinese setting—were implemented in factories and schools. Baseline and endline surveys with participants (219 male factory workers and 496 male vocational students) were conducted. Support for (in)equitable norms was measured by the Gender Equitable Men Scale, as well as partner violence and communication. Focus groups with male and female workers/students, teachers, and factory managers were used to corroborate findings. At baseline, many workers and students supported inequitable gender norms, with workers generally being more inequitable. At endline, significant positive changes in gender-related views (e.g., reduction from 42% to 18% of workers agreeing that “a woman should tolerate violence in order to keep her family together”) and behaviors (e.g., reduction from 15% to 7% of students reporting partner violence over the past 3 months) were reported. Results suggest that a relatively low intensity intervention can influence important gender norms and related behaviors.

The impact of gender norms on condom use among HIV-positive adults in KwaZulu-Natal, South Africa.

Critical to preventing the spread of HIV is promoting condom use among HIV-positive individuals. Previous studies suggest that gender norms (social and cultural constructions of the ways that women and men are expected to behave) may be an important determinant of condom use. However, the relationship has not been evaluated among HIV-positive women and men in South Africa. We examined gender norms and condom use at last sex among 550 partnerships reported by 530 sexually-active HIV-positive women (372) and men (158) who had sought care, but not yet initiated antiretroviral therapy in a high HIV-prevalence rural setting in KwaZulu-Natal, South Africa between January 2009 and March 2011. Participants enrolled in the cohort study completed a baseline questionnaire that detailed their socio-demographic characteristics, socio-economic circumstances, religion, HIV testing history and disclosure of HIV status, stigma, social capital, gender norms and self-efficacy. Gender norms did not statistically differ between women and men (p = 0.18). Overall, condoms were used at last sex in 58% of partnerships. Although participants disclosed their HIV status in 66% of the partnerships, 60% did not have knowledge of their partner’s HIV status. In multivariable logistic regression, run separately for each sex, women younger than 26 years with more equitable gender norms were significantly more likely to have used a condom at last sex than those of the same age group with inequitable gender norms (OR = 8.88, 95% CI 2.95–26.75); the association between condom use and gender norms among women aged 26+ years and men of all ages was not statistically significant. Strategies to address gender inequity should be integrated into positive prevention interventions, particularly for younger women, and supported by efforts at a societal level to decrease gender inequality.

INTERACTIVE WORKSHOPS TO PROMOTE GENDER EQUITY AND FAMILY PLANNING IN RURAL COMMUNITIES OF GUATEMALA: RESULTS OF A COMMUNITY RANDOMIZED STUDY

In Guatemala, especially in rural areas, gender norms contribute to high fertility and closely spaced births by discouraging contraceptive use and constraining women from making decisions regarding the timing of their pregnancies and the size of their families. Community workshops for men, women and couples were conducted in 30 rural communities in Guatemala to test the hypothesis that the promotion of gender equity in the context of reproductive health will contribute to gender-equitable attitudes and strengthen the practice of family planning. Communities were randomly assigned to intervention and control groups. Pre/post surveys were conducted. Odds ratios estimated with mixed effect models to account for community-level randomization and repeated measures per participant were compared. The analyses showed statistically significant effects of the intervention on two of the three outcomes examined: gender attitudes and contraceptive knowledge. Findings regarding contraceptive use were suggestive but not significant. The results suggest that it is possible to influence both inequitable gender norms and reproductive health knowledge and, potentially, behaviours in a short span of time using appropriately designed communications interventions that engage communities in re-thinking the inequitable gender norms that act as barriers to health.

Gender norms, poverty and armed conflict in Côte D'Ivoire: engaging men in women's social and economic empowerment programming.

Engaging men is a critical component in efforts to reduce intimate partner violence (IPV). Little is known regarding men's perspectives of approaches that challenge inequitable gender norms, particularly in settings impacted by armed conflict. This article describes men's experiences with a women's empowerment program and highlights men's perceptions of gender norms, poverty and armed conflict, as they relate to achieving programmatic goals. Data are from 32 Ivorian men who participated in indepth interviews in 2012. Interviews were undertaken as part of an intervention that combined gender dialogue groups for both women and their male partners with women's only village savings and loans programs to reduce IPV against women. Findings suggested that in the context of armed conflict, traditional gender norms and economic stressors experienced by men challenged fulfillment of gender roles and threatened men's sense of masculinity. Men who participated in gender dialogue groups discussed their acceptance of programming and identified improvements in their relationships with their female partners. These men further discussed increased financial planning along with their partners, and attributed such increases to the intervention. Addressing men's perceptions of masculinity, poverty and armed conflict may be key components to reduce men's violence against women in conflict-affected settings.

Gender Norms and Family Planning Practices Among Men in Western Jamaica.

The objective of this study was to identify the association between gender norms and family planning practices among men in Western Jamaica. A cross-sectional survey of 549 men aged 19 to 54 years attending or visiting four government-operated hospitals was conducted in 2011. Logistic regression models were used to identify factors associated with taking steps to prevent unwanted pregnancy, intention to have a large family size (three or more children), and fathering children with multiple women. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated from the models. Reduced odds for taking steps to prevent unwanted pregnancy among men with moderate (AOR = 0.5; 95% CI = 0.3-0.8) and high (AOR = 0.3; 95% CI = 0.1-0.6) support for inequitable gender norms was observed. Desiring large family size was associated with moderate (AOR = 2.0; 95% CI = 1.3-2.5) and high (AOR = 2.6; 95% CI = 1.5-4.3) support for macho scores. For men with two or more children (41%), there were increased odds of fathering children with multiple women among those who had moderate (AOR = 2.1; 95% CI = 1.0-4.4) and high (AOR = 2.4; 95% CI = 1.1-5.6) support for masculinity norms. Support for inequitable gender norms was associated with reduced odds of taking steps to prevent unwanted pregnancy, while support for masculinity norms was associated with desiring a large family size and fathering children with multiple women. These findings highlight the importance of including men and gender norms in family planning programs in Jamaica.

Influences of sex, age and education on attitudes towards gender inequitable norms and practices in South Sudan

Prolonged conflict in South Sudan exacerbated gender disparities and inequities. This study assessed differences in attitudes towards gender inequitable norms and practices by sex, age and education to inform programming. Applying community-based participatory research methodology, 680 adult respondents, selected by quota sampling, were interviewed in seven South Sudanese communities from 2009 to 2011. The verbally administered survey assessed attitudes using the Gender Equitable Men scale. Data were stratified by sex, age and education. Of 680 respondents, 352 were female, 326 were male and two did not report their sex. The majority of respondents agreed with gender inequitable household roles, but the majority disagreed with gender inequitable practices (i.e., early marriage, forced marriage and inequitable education of girls). Respondents who reported no education were more likely than those who reported any education to agree with gender inequitable practices (all p < 0.03) except for forced marriage (p = 0.07), and few significant differences were observed when these responses were stratified by sex and by age. The study reveals agreement with gender inequitable norms in the household but an overall disagreement with gender inequitable practices in sampled communities. The findings support that education of both women and men may promote gender equitable norms and practices.

Gender norms and sexual behaviours among men in western Jamaica

Objectives Gender norms, especially among men, can reduce the effectiveness of HIV prevention programs. We sought to assess the association between attitudes towards gender norms and risky sexual behaviours, and identify sociodemographic factors that predict gender-inequitable and masculinity norms among men in western Jamaica. A cross-sectional, survey of 549 men aged 19-54 years was conducted. Attitudes towards gender norms were measured using the Gender Equitable Men and Macho scales. Logistic regression and general linear models were used to assess associations between gender norms and multiple sexual partners, and to identify the associated sociodemographic factors. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) are presented. Fifty-four percent of the participants (mean age=32.4 years) reported multiple sex partners and 22% reported unprotected sex with non-regular partner in the past 12 months. Men with moderate (AOR=2.2; 95% CI=1.4-3.3) and high (AOR=4.2; 95% CI=2.0-8.5) support for inequitable gender norms, and moderate (AOR=1.7; 95% CI=1.1-2.7) and high (AOR=2.5; 95% CI=1.5-4.3) support for masculinity norms were more likely to report multiple sex partners. Similarly, men with moderate (AOR=2.4; 95% CI=1.3-4.3) and high (AOR=2.5; 95% CI=1.2-5.2) support for inequitable gender norms were more likely to report unprotected sex with a nonregular partner. A high proportion of Jamaican men engage in risky sexual behaviours. These results highlight the need for behaviour change interventions addressing gender norms targeting Jamaican men.

An assessment of attitudes toward gender inequitable sexual and reproductive health norms in South Sudan: a community-based participatory research approach

BackgroundCommunities in South Sudan have endured decades of conflict. Protracted conflict exacerbated reproductive health disparities and gender inequities. This study, conducted prior to the country’s 2011 independence, aimed to assess attitudes toward gender inequitable norms related to sexual relationships and reproductive health and the effects of sex, age, and education on these attitudes.MethodsApplying a community-based participatory research approach and quota sampling, 680 adult male and female respondents were interviewed in seven sites within South Sudan in 2009–2011. The verbally administered survey assessed attitudes using the Gender Equitable Men scale. Data were stratified by sex, age (≤35 years and >35 years), and education.ResultsOf 680 respondents, 352 were female, 326 were male, and 2 did not indicate their sex. The majority of women (77%) and men (74%) agreed “a man needs other women, even if things with his wife are fine”. Respondents who reported no education (60%) were more likely than those who reported any education (45%) to agree “if a woman is married, she should have sex with her husband whenever he wants to, even if she doesn’t want to” (p = 0.002). The majority of women (74%) and men (73%) agreed “it is a woman’s responsibility to avoid getting pregnant”. Respondents who reported no education (81%) were more likely than those who reported any education (72%) to agree with this statement (p = 0.04). When asked about condom use, the majority of respondents, across both sexes and both age groups, agreed “it would be outrageous for a wife to ask her husband to use a condom” and “women who carry condoms are easy”. There were no statistically significant differences between the two age groups for any of the assessed gender inequitable norms.ConclusionThe study reveals differences in attitudes toward gender inequitable sexual and reproductive health norms among those surveyed in South Sudan when stratified by sex and education. As a new nation seeks to strengthen its health system, these data can inform sexual and reproductive health policies and programming in South Sudan.

Using the Inequitable Gender Norms Scale and Associated HIV Risk Behaviors among Men at High Risk for HIV in Ghana and Tanzania

Context: Gender norms influence unintended pregnancy, maternal health, HIV/AIDS infection, and act as barriers to reproductive health services. The Gender Equitable Men (GEM) scale has been used widely in programs and research in African settings, but it has yet to be statistically validated. Method: We examined the internal and external validity of the Inequitable Gender Norms (IGN) subscale of the GEM scale in Tanzania and Ghana using a two-step, mixed-method process. Confirmatory factor analysis tested the internal validity of the subscale and regression tests identified associations between the IGN scale and several HIV risk-related variables. Results: The IGN scale was shown to be a useful measure of gender norms in both countries. Excluding two questions that measured attitudes toward homosexuality, the scale met the hypothesized single factor structure. Furthermore, the IGN scores were significantly associated with several HIV risk variables in both samples. Conclusions: The IGN scale is a robust measure of gender norms in these African countries. However, the role of attitudes toward homosexuality as a contributor to gender norms measurement needs further exploration. Our analyses provide a basis for using the IGN scale to provide a contextualized understanding of men’s perceptions of gender norms and to evaluate programs focused more equitable gender norms. We are aware of only one other measure of gender norms that has been statistically validated in the African Context.

Substance use, gender inequity, violence and sexual risk among couples in Cape Town

Alcohol and other drug use, gender power inequities and violence are key contributors to sexual risks for HIV among South African men and women. Little is known about the intersection between these sex-risk behaviours among couples in established heterosexual relationships. We conducted 10 focus-group discussions with men and women in relationships of 1 year or longer recruited from shebeens (informal taverns) in Cape Town, South Africa. Participants described: high levels of alcohol consumption at shebeens; low levels of condom use with main and casual sex partners; gender roles disfavouring women's condom negotiating power that also promoted economic dependency on male partners; men often spending a portion of the household income on alcohol and other drugs and sex with others in shebeens; loss of household income driving women to trade sex to provide for their families; and sexual violence and the exploitation of women occurring in shebeens. Findings highlight how the social contexts of alcohol and other drug use, gender inequitable norms and gender violence promote HIV risk within established heterosexual relationships in South African communities. Evidence of this kind should inform the design of HIV-risk-reduction interventions tailored to heterosexual couples who drink alcohol in shebeens.

An assessment of gender inequitable norms and gender-based violence in South Sudan: a community-based participatory research approach

BackgroundFollowing decades of conflict, South Sudan gained independence from Sudan in 2011. Prolonged conflict, which included gender-based violence (GBV), exacerbated gender disparities. This study aimed to assess attitudes towards gender inequitable norms related to GBV and to estimate the frequency of GBV in sampled communities of South Sudan.MethodsApplying a community-based participatory research approach, 680 adult male and female household respondents were interviewed in seven sites within South Sudan in 2009–2011. Sites were selected based on program catchment area for a non-governmental organization and respondents were selected by quota sampling. The verbally-administered survey assessed attitudes using the Gender Equitable Men scale. Results were stratified by gender, age, and education.ResultsOf 680 respondents, 352 were female, 326 were male, and 2 did not provide gender data. Among respondents, 82% of females and 81% of males agreed that ‘a woman should tolerate violence in order to keep her family together’. The majority, 68% of females and 63% of males, also agreed that ‘there are times when a woman deserves to be beaten’. Women (47%) were more likely than men (37%) to agree that ‘it is okay for a man to hit his wife if she won’t have sex with him’ (p=0.005). Agreement with gender inequitable norms decreased with education. Across sites, 69% of respondents knew at least one woman who was beaten by her husband in the past month and 42% of respondents knew at least one man who forced his wife or partner to have sex.ConclusionThe study reveals an acceptance of violence against women among sampled communities in South Sudan. Both women and men agreed with gender inequitable norms, further supporting that GBV programming should address the attitudes of both women and men. The results support promotion of education as a strategy for addressing gender inequality and GBV. The findings reveal a high frequency of GBV across all assessment sites; however, population-based studies are needed to determine the prevalence of GBV in South Sudan. South Sudan, the world’s newest nation, has the unique opportunity to implement policies that promote gender equality and the protection of women.

Access to Mass Media and Rejection of Gender Inequitable Norms among Unmarried Youth in Dar es Salaam, Tanzania

Despite extensive evidence on the link between gender norms and adolescent sexual and reproductive health (ASRH), less research has been conducted to assess the role that access to mass media plays in shaping these norms. This article is based on a study that sought to contribute to filling this research gap. The primary objective of the study was to determine young males’ and female’s attitudes and perceptions towards traditional gender norms. The second objective was to investigate the association between mass media consumption by youth and rejection or acceptance of gender equitable norms. Using a scale called Gender Equitable Men (GEM), this study conducted a cross-sectional survey among 777 unmarried youth (52.1% male and 47.9% female) in selected wards of Temeke municipality in Dar es Salaam, Tanzania between December 2011 and January 2012. The results show that youth support to gender equitable norms is relatively high (91% male and 83% female). Also, there are important correlations between youth’ support for gender-equitable norms and their background characteristics. Comparatively, unmarried male youth have higher support to gender equitable norms than unmarried female youth. However, the relationship between access to mass media and support for gender equitable norms is not linear. The conclusion is that access to mass media alone is not sufficient to determine support to gender equitable norms, which later impact on adolescent sexual and reproductive health. Thus, more attention needed on broad social contexts that mediate linkage between the two. Programmatic and policy implications of these findings are also discussed.

Tanzanian Couples’ Perspectives on Gender Equity, Relationship Power, and Intimate Partner Violence: Findings from the RESPECT Study

Intimate partner violence (IPV) is widely prevalent in Tanzania. Inequitable gender norms manifest in men's and women's attitudes about power and decision making in intimate relationships and are likely to play an important role in determining the prevalence of IPV. We used data from the RESPECT study, a randomized controlled trial that evaluated an intervention to prevent sexually transmitted infections in a cohort of young Tanzanian men and women, to examine the relationship between couples' attitudes about IPV, relationship power, and sexual decision making, concordance on these issues, and women's reports of IPV over 12 months. Women expressed less equitable attitudes than men at baseline. Over time, participants' attitudes tended to become more equitable and women's reports of IPV declined substantially. Multivariable logistic regression analyses suggested that inequitable attitudes and couple discordance were associated with higher risk of IPV. Our findings point to the need for a better understanding of the role that perceived or actual imbalances in relationship power have in heightening IPV risk. The decline in women's reports of IPV and the trend towards gender-equitable attitudes indicate that concerted efforts to reduce IPV and promote gender equity have the potential to make a positive difference in the relatively short term.

Challenging and Changing Gender Attitudes among Young Men in Mumbai, India

This article presents findings from a pilot intervention in 2005–6 to promote gender equity among young men from low-income communities in Mumbai, India. The project involved formative work on gender, sexuality and masculinity, and educational activities with 126 young men, aged 18–29, over a six-month period. The programme of activities was called Yari-dosti, which is Hindi for friendship or bonding among men, and was adapted from a Brazilian intervention. Pre-and post-intervention surveys, including measures of attitudes towards gender norms using the Gender Equitable Men (GEM) Scale and other key outcomes, qualitative interviews with 31 participants, monitoring and observations were used as evaluation tools. Almost all the young men actively participated in the activities and appreciated the intervention. It was often the first time they had had the opportunity to discuss and reflect on these issues. The interviews showed that attitudes towards gender and sexuality, as reported behaviour in relationships, had often changed. A survey two months later also showed a significant decrease in support for inequitable gender norms and sexual harassment of girls and women. The results suggest that the pilot was successful in reaching and engaging young men to critically discuss gender dynamics and health risk, and in shifting key gender-related attitudes.RésuméCet article présente les conclusions d’une intervention pilote menée en 2005-06 pour promouvoir l’égalité des sexes chez les jeunes hommes de communautés à faible revenu à Mumbai, Inde. Le projet comportait une formation sur la parité, la sexualité et la masculinité, et des activités éducatives avec 126 hommes, âgés de 18 à 29 ans, pendant six mois. Le programme, appelé Yari-dosti, mot hindi signifiant amitié ou liens masculins, s’inspirait d’un projet brésilien. L’évaluation a utilisé des enquêtes avant et après l’intervention avec l’échelle GEM (Gender Equitable Men) et d’autres résultats clés, des entretiens qualitatifs avec 31 participants, un suivi et des observations. Presque tous les hommes ont participé activement et ont apprécié l’intervention. C’était souvent la première fois qu’ils pouvaient parler de manière critique de ces questions. Les entretiens ont montré que les attitudes à l’égard de la parité et de la sexualité, comme le comportement dans les relations, avaient souvent changé. Une enquête deux mois plus tard a révélé une diminution sensible du soutien aux normes d’inégalité sexuelle et moins de harcèlement sexuel des jeunes filles et des femmes. Les résultats indiquent que l’intervention est parvenue à atteindre les jeunes hommes et à les convaincre de parler de la dynamique entre les sexes et du risque sanitaire, et à modifier des attitudes clés liées à la parité.ResumenEn este artículo se presentan los hallazgos de una intervención piloto realizada en 2005-06 para promover la equidad de género entre hombres jóvenes de comunidades de bajos ingresos en Mumbai, India. El proyecto implicó formatión sobre el género, la sexualidad y la masculinidad y actividades educativas con 126 hombres jóvenes, de 18 a 29 años de edad, durante seis meses. El programa denominado Yari-dosti, término hindi que significa amistad o vinculación entre hombres fue adaptado de una intervención brasilera. Se utilizaron encuestas pre-y post-intervención, incluidas las medidas de actitudes hacia las normas de género utilizando una escala llamada Gender Equitable Men (GEM) y otros resultados clave, entrevistas cualitativas con 31 participantes, monitoreo y observaciones. Casi todos los jóvenes participaron al máximo en las actividades y agradecieron la intervención. Para muchos, ésta era su primera oportunidad de discutir estos asuntos. Las entrevistas mostraron que las actitudes hacia el género y la sexualidad, como comportamiento en las relaciones, con frecuencia habían cambiado. Una encuesta realizada dos meses después mostró una disminución significante en el apoyo de normas de género no equitativas y menos acoso sexual de las niñas y mujeres. Los resultados indican que el piloto motivó a los jóvenes a analizar las dinámicas de género y el riesgo a la salud y cambiar las actitudes relacionadas con el género.