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Ncube J, Adom T, Aventin Á, Skeen S, Nkonki L. A systematic review of economic evaluations conducted on gender-transformative interventions aimed at preventing unintended pregnancy and promoting sexual health in adolescents. Soc Sci Med 2024; 355:117130. [PMID: 39042985 DOI: 10.1016/j.socscimed.2024.117130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024]
Abstract
AIMS We synthesised the best-available evidence on economic evaluations of gender-transformative interventions that prevent unintended pregnancy and promote sexual-health in adolescents. We also assessed the methodological quality of the economic-evaluation studies and identified gaps in the economic-evaluation evidence. DESIGN A systematic review (SR) of economic evaluations reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2020. DATA SOURCES We searched the following bibliographic databases for economic evaluations that met our selection criteria; PubMed, Cochrane, National Health Service EE database, SCOPUS, CINHAL, Web of Science and Paediatric EE Database. We also conducted a grey literature search. We included articles published from January 1, 1990 to December 31, 2021, in English, including adolescents aged 10-19. Two independent reviewers conducted the title and full-text screening. DATA EXTRACTION AND SYNTHESIS One reviewer conducted data extraction and quality assessment, which a second reviewer checked. We used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement and Consensus on Health Economic Criteria (CHEC) checklist to measure the reporting and methodological quality. Synthesis was done narratively and using summary tables. RESULTS Twenty-two studies were included, with 16 full and six partial economic evaluations. The quality of studies was moderate to high for most. The most reported outcomes were incremental cost-effectiveness ratio, costs per averted sexually transmitted infection, quality-adjusted life years saved per averted infection and costs per averted pregnancy. Most studies were cost-effective or cost-saving. CONCLUSIONS Most of the economic evaluations are cost-effective. There is a scarcity of available economic evaluations for most existing gender-transformative interventions, with most included studies originating from high-income countries (HICs). There is a need to develop guidance specific to economic evaluations of gender-transformative interventions.
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Affiliation(s)
- Janet Ncube
- Health Systems and Public Health, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa.
| | - Theodosia Adom
- Health Systems and Public Health, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa; Nutrition Research Centre, Ghana Atomic Energy Commission, Legon, Ghana
| | - Áine Aventin
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Lungiswa Nkonki
- Health Systems and Public Health, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
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Nardini K, Cerdán-Torregrosa A, Sanz-Barbero B, Davó-Blanes MC, Vives-Cases C. Constructing, Deconstructing or Abolishing? Discourses on Masculinities in Violence Against Women Prevention by Stakeholders in Spain. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241265437. [PMID: 39066579 DOI: 10.1177/08862605241265437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
In the field of violence against women (VAW) prevention, one of the current questions at stake is how to address men's role and masculinities, but it is still an emerging field in Spain. The aim of this study was to analyze the up-to-date discourses on masculinity among stakeholders in the field of VAW prevention and gender equity in Spain. We used a qualitative methodology with semi-structured interviews, conducted between October 2019 and February 2020 in Madrid and Alicante (Spain), with 23 key stakeholders from different areas: in governmental (public health and VAW prevention/intervention, and institutional and policy positioning) and nongovernmental organizations (anti-violence masculinities workers, youth education workers, and feminist and LGBT associations). A discourse analysis was performed with the data collected. Our findings showed that discourses around masculinities among Spanish stakeholders in VAW prevention and gender equity were diverse and presented different layers of critique. Despite a general agreement on the importance of transforming sexist men's practices toward more gender equitable relations, three main interpretive repertoires were identified: "Constructing positive/new masculinities" discourse, focused on promoting men's engagement and egalitarian practices; "Deconstructing hegemonic masculinity" discourse, intended to critically identify and question harmful masculinities norms; and "Abolishing gender" discourse, which aims at dismantling masculinity, and gender in general, as a social structure that generates oppression in itself, advocating for its abolition. Those interpretive repertoires were not mutually exclusive and sometimes stakeholders incorporate in their work more than one approach. The study findings shed light on this current emerging and urgent debate and contributes more broadly to the critical assessment of the concepts used and their implications for VAW prevention.
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Affiliation(s)
| | | | - Belén Sanz-Barbero
- Health Institute Carlos III, Madrid, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
| | | | - Carmen Vives-Cases
- University of Alicante, Alicante, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
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Sileo KM, Muhumuza C, Tuhebwe D, Muñoz S, Wanyenze RK, Kershaw TS, Sekamatte S, Lule H, Kiene SM. "The burden is upon your shoulders to feed and take care of your children, not religion or culture": qualitative evaluation of participatory community dialogues to promote family planning's holistic benefits and reshape community norms on family success in rural Uganda. Contracept Reprod Med 2024; 9:28. [PMID: 38835058 PMCID: PMC11149320 DOI: 10.1186/s40834-024-00290-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/20/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Family planning has significant health and social benefits, but in settings like Uganda, is underutilized due to prevalent community and religious norms promoting large family size and gender inequity. Family Health = Family Wealth (FH = FW) is a multi-level, community-based intervention that used community dialogues grounded in Campbell and Cornish's social psychological theory of transformative communication to reshape individual endorsement of community norms that negatively affect gender equitable reproductive decision-making among couples in rural Uganda. METHODS This study aimed to qualitatively evaluate the effect of FH = FW's community dialogue approach on participants' personal endorsement of community norms counter to family planning acceptance and gender equity. A pilot quasi-experimental controlled trial was implemented in 2021. This paper uses qualitative, post-intervention data collected from intervention arm participants (N = 70) at two time points: 3 weeks post-intervention (in-depth interviews, n = 64) and after 10-months follow-up (focus group discussions [n = 39] or semi-structured interviews [n = 27]). Data were analyzed through thematic analysis. RESULTS The community dialogue approach helped couples to reassess community beliefs that reinforce gender inequity and disapproval of family planning. FH = FW's inclusion of economic and relationship content served as key entry points for couples to discuss family planning. Results are presented in five central themes: (1) Community family size expectations were reconsidered through discussions on economic factors; (2) Showcasing how relationship health and gender equity are central to economic health influenced men's acceptance of gender equity; (3) Linking relationship health and family planning helped increase positive attitudes towards family planning and the perceived importance of shared household decision-making to family wellness; (4) Program elements to strengthen relationship skills helped to translate gender equitable attitudes into changes in relationship dynamics and to facilitate equitable family planning communication; (5) FH = FW participation increased couples' collective family planning (and overall health) decision-making and uptake of contraceptive methods. CONCLUSION Community dialogues may be an effective intervention approach to change individual endorsement of widespread community norms that reduce family planning acceptance. Future work should continue to explore innovative ways to use this approach to increase gender equitable reproductive decision-making among couples in settings where gender, religious, and community norms limit reproductive autonomy. Future evaluations of this work should aim to examine change in norms at the community-level. TRIAL REGISTRATION Clinicaltrials.gov (NCT04262882).
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
| | - Christine Muhumuza
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, 30A Plot, 30A York Terrace, Kampala, Uganda
| | - Doreen Tuhebwe
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Dr, San Diego, CA, 92182, USA
- Department of Health Policy Planning and Management, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Suyapa Muñoz
- Department of Public Health, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA
| | - Rhoda K Wanyenze
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Dr, San Diego, CA, 92182, USA
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Trace S Kershaw
- Department of Social and Behavioral Science, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - Samuel Sekamatte
- Butambala District Health Department, Gombe Hospital, Gombe, Uganda
| | - Haruna Lule
- Global Centre of Excellence in Health (GLoCEH), Kampala, Uganda
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Dr, San Diego, CA, 92182, USA
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
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Lohan M, Amin A, Marques M, Tomlinson M. Engaging men and boys in sexual and reproductive health and rights. BMJ 2024; 385:q1042. [PMID: 38729660 DOI: 10.1136/bmj.q1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery University, Queen's University Belfast, Belfast, UK
- Hitotsubashi University, Tokyo, Japan
| | - Avni Amin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery University, Queen's University Belfast, Belfast, UK
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Brennan-Wilson A, Marques M, Coates A, Amin A, Garry J, Tomlinson M, Nyembezi A, George A, Lohan M. Masculinities and sexual and reproductive health and rights: a global research priority setting exercise. Lancet Glob Health 2024; 12:e882-e890. [PMID: 38614636 DOI: 10.1016/s2214-109x(24)00053-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 04/15/2024]
Abstract
Engaging men and boys in sexual and reproductive health and rights (SRHR) and doing so in a way that challenges harmful masculinities, is both neglected and vital for improving the SRHR of both women and men. To address this gap, WHO commissioned a global research priority setting exercise on masculinities and SRHR. The exercise adapted the quantitative child health and nutrition research initiative priority setting method by combining it with qualitative methods. Influenced by feminist and decolonial perspectives, over 200 diverse stakeholders from 60 countries across all WHO regions participated. The exercise forges a collaborative research agenda emphasising four key areas: gender-transformative approaches to men's and boys' engagement in SRHR, applied research to deliver services addressing diversity in SRHR among men and women and to generate gender-equality, research designs to support participation of target audiences and reach to policy makers, and research addressing the priorities of those in low-income and middle-income countries.
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Affiliation(s)
- Aoibheann Brennan-Wilson
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, UK
| | | | | | | | - John Garry
- School of History, Anthropology, Philosophy and Politics, Queen's University Belfast, Belfast, UK
| | - Mark Tomlinson
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, UK; Stellenbosch University, Stellenbosch, South Africa
| | - Anam Nyembezi
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Asha George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, UK.
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Marcantonio TL, Jozkowski KN, Ham LS, Parrott D. The Association of Acute Intoxication and Threats to Masculinity on Laboratory-Based Sexual Aggression. J Stud Alcohol Drugs 2024; 85:175-182. [PMID: 38095194 PMCID: PMC10941822 DOI: 10.15288/jsad.23-00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/11/2023] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVE Men's alcohol intoxication and perceptions of their masculinity as precarious (i.e., viewing masculinity as easily threatened) are independently related to men's perpetration of sexual aggression. Yet, the interactive effects of these constructs on sexual aggression are unclear. The goal of this study was to assess if precarious masculinity-measured as a static trait-and acute alcohol intoxication-measured in a laboratory setting-were positively associated with men's perpetration of laboratory-based sexual aggression after their masculinity is threatened. METHOD Cisgender heterosexual men (n = 120, ages 21-30 years) completed a self-report measure of precarious masculinity, were randomly assigned to consume an alcoholic or nonalcoholic beverage, and engaged in the Sexual Imposition Paradigm, which assessed laboratory-based sexual aggression perpetration toward a female confederate. Immediately before the Sexual Imposition Paradigm, all participants' masculinity was threatened via feedback from an ostensible personality test that indicated they are less masculine than other men. RESULTS Self-reported precarious masculinity and the Precarious Masculinity × Beverage Condition interaction were not associated with laboratory-based sexual aggression. However, intoxicated men showed higher levels of laboratory-based sexual aggression than sober men. CONCLUSIONS Acute alcohol intoxication facilitated men's sexually aggressive responding toward women when their masculinity was threatened. Consistent with pertinent theory and research, this effect suggests that acute intoxication facilitates men's focus on salient cues (i.e., threatened masculinity), which then may proximally motivate sexual aggression. Sexual aggression prevention programs should continue to address alcohol in their programming.
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Affiliation(s)
- Tiffany L. Marcantonio
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana
- Department of Health Sciences, University of Alabama, Tuscaloosa, Alabama
| | - Kristen N. Jozkowski
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana
| | - Lindsay S. Ham
- Department of Psychological Sciences, University of Arkansas, Fayetteville, Arkansas
| | - Dominic Parrott
- Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia
- Psychology Department, Georgia State University, Atlanta, Georgia
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7
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Embleton L, Diaz A. Interpersonal Violence Among Adolescents: Have Young Men Been Left Behind? J Adolesc Health 2024; 74:216-217. [PMID: 38237974 DOI: 10.1016/j.jadohealth.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Lonnie Embleton
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York; Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Angela Diaz
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
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8
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Opozda MJ, Galdas PM, Watkins DC, Smith JA. Intersecting identities, diverse masculinities, and collaborative development: Considerations in creating online mental health interventions that work for men. Compr Psychiatry 2024; 129:152443. [PMID: 38113813 DOI: 10.1016/j.comppsych.2023.152443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023] Open
Abstract
Online mental health interventions have received attention for their potential to bypass barriers that stop men from seeking mental health help from a health professional. However, emerging data suggest that men's use of online mental health interventions is low, and when used, early attrition is common. In this commentary, we hypothesise that men's common lack of engagement with online mental health interventions may reflect limited attention being paid to the needs and preferences of potential users during their development. We outline a series of considerations that we believe are important to advance the development of acceptable, effective online mental health interventions for men: (1) men's diverse and intersecting characteristics, circumstances, and needs; (2) centring positive, progressive masculinities; and (3) listening to, learning from, and working in partnership with men to develop interventions. We also examine how existing online mental health interventions targeting men have engaged with these considerations. Keywords: men, male, mental health, e-mental health, digital health, online interventions.
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Affiliation(s)
- Melissa J Opozda
- College of Medicine and Public Health, Flinders University, Darwin, Australia; Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia.
| | - Paul M Galdas
- Department of Health Sciences, University of York, York, UK
| | - Daphne C Watkins
- School of Social Work, National Centre for Institutional Diversity, University of Michigan, Ann Arbor, USA
| | - James A Smith
- College of Medicine and Public Health, Flinders University, Darwin, Australia
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Lowe H, Mannell J, Faumuina T, Sinclair L, Tamanikaiyaroi L, Brown L. Violence in childhood and community contexts: a multi-level model of factors associated with women's intimate partner violence experience in Samoa. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 42:100957. [PMID: 38058423 PMCID: PMC10696102 DOI: 10.1016/j.lanwpc.2023.100957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 12/08/2023]
Abstract
Background Intimate partner violence (IPV) affects approximately 26% of women worldwide and is driven by a complex interplay of factors across individual, relationship/household, community and societal levels. Individual and relationship/household factors are well studied however little empirical evidence exists on factors at the community level that drive IPV which are needed to inform prevention interventions. Methods We conducted a cross-sectional, multi-level analysis of factors associated with women's IPV experience in Samoa using the 2019-20 Demographic and Health Multiple Indicator Cluster Survey. We used hierarchical multivariable logistic regression to assess individual, relationship/household and community level effects on women's risk of physical, sexual and/or emotional IPV. Findings The past year prevalence of physical, sexual and/or emotional IPV among women in Samoa was 31.4%. At the individual and relationship/household level, women's employment, witnessing IPV between parents, experiencing physical abuse from a parent, and partner's alcohol use and controlling behaviours were associated with higher risk of IPV. At the community level, higher levels of women with higher education and involved in household decision-making, and higher levels of men in employment were protective against IPV. Interpretation A complex interplay of factors across individual, relationship/household and community levels are associated with women's experience of IPV in Samoa. Experiences of IPV are embedded within a broader context of violence against children and harmful alcohol use. Community contexts, including women's empowerment and men's employment, are also associated with women's IPV experience in Samoa. These findings not only demonstrate that public health issues such as IPV, violence against children and harmful alcohol use should be addressed together as part of multi-pronged approaches, but they point towards the importance of community-level analyses for designing and delivering community-based interventions. Greater knowledge of community dynamics will enable community-based interventions to create environments at the community level that support meaningful and sustainable change towards IPV prevention. Funding Funding for this study was provided by UKRI (ref. MR/S033629/1).
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Affiliation(s)
- Hattie Lowe
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jenevieve Mannell
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | | | | | - Lineta Tamanikaiyaroi
- Faculty of Technical Education, National University of Samoa, Apia, P.O. Box 5768, Samoa
| | - Laura Brown
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
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Wells L, Fotheringham S, Pascoe L. Insights on Engaging Men and Boys in Creating a More Gender Equal Future in Canada. Violence Against Women 2024; 30:297-322. [PMID: 37788355 PMCID: PMC10666464 DOI: 10.1177/10778012231203621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
This article presents findings from a national qualitative research study of 33 diverse and profeminist leaders who identify as men and are engaged in gender equality work with men and boys across Canada. Key findings include the need to meet men where they are at, moving away from the ineffective "all men are perpetrators" frame, and to evolve to new and more relatable narratives and approaches that get men committed to this work for their own liberation. Taking an intersectional approach and working in partnership with feminist and intersectional organizations are essential to advancing gender equality in the Canadian context.
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Affiliation(s)
- Lana Wells
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | | | - Laura Pascoe
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
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Ringwald B, Mwiine AA, Chikovore J, Makanda G, Amoah-Larbi J, Millington KA, Horton KC. Ending TB means responding to socially produced vulnerabilities of all genders. BMJ Glob Health 2023; 8:e014151. [PMID: 38070882 PMCID: PMC10728965 DOI: 10.1136/bmjgh-2023-014151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/12/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Beate Ringwald
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Amon Ashaba Mwiine
- School of Women and Gender Studies, Makerere University, Kampala, Uganda
| | - Jeremiah Chikovore
- Public Health, Societies and Belonging, Human Sciences Research Council, Durban, South Africa
| | | | | | - Kerry A Millington
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Katherine C Horton
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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12
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Marcantonio TL, Jozkowski KN, Parrott DJ, Ham LS. Examining the Moderating Role of Heavy Drinking Behaviors and Precarious Masculinity on Sexual Aggression Among Young Adult Men. J Stud Alcohol Drugs 2023; 84:921-927. [PMID: 37306375 PMCID: PMC10765977 DOI: 10.15288/jsad.22-00309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE Men's heavy drinking behaviors are related to their engagement in sexual aggression and may be amplified by other factors, such as precarious masculinity (i.e., perceiving masculinity as tenuous in nature). Yet, researchers' understanding of how alcohol consumption, in combination with precarious masculinity, may increase risk of sexual aggression is lacking. The goal of this study was to assess if precarious masculinity moderated the relationship between men's heavy drinking and their sexual aggression. METHOD Young adult men (958 men, M age = 21.1 years, SD = 3.1) completed a web-administered questionnaire assessing sexual aggression, heavy drinking, and precarious masculinity. RESULTS We ran a logistic regression examining the association between heavy drinking, precarious masculinity, and their interactive effect on men's engagement in sexual aggression. Heavy drinking (odds ratio [OR] = 1.17) and precarious masculinity (OR = 1.73) were independently and positively associated with men's sexual aggression; however, the interaction was not significant. CONCLUSIONS In line with prior research, men's heavy drinking behaviors continue to be positively associated with sexual aggression. Building on masculinity literature, men viewing their masculinity as precarious and vulnerable appears to be associated with sexual aggression, potentially because engaging in sexual aggression can offset men's masculinity insecurities. Collectively, results suggest that both alcohol consumption and masculinity should be targeted in sexual assault prevention programs.
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Affiliation(s)
- Tiffany L. Marcantonio
- Department of Health Sciences, University of Alabama, Tuscaloosa, Alabama
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana
| | - Kristen N. Jozkowski
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana
- Department of Applied Health Science, School of Public Health–Bloomington, Indiana University, Bloomington, Indiana
| | - Dominic J. Parrott
- Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Lindsay S. Ham
- Department of Psychological Sciences, University of Arkansas, Fayetteville, Arkansas
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13
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Morrow G, Yount KM, Bergenfeld I, Laterra A, Kalra S, Khan Z, Clark CJ. Adolescent boys' and girls' perspectives on social norms surrounding child marriage in Nepal. CULTURE, HEALTH & SEXUALITY 2023; 25:1277-1294. [PMID: 36573269 DOI: 10.1080/13691058.2022.2155705] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/02/2022] [Indexed: 10/05/2023]
Abstract
According to recent data, in Nepal, 38.2% of women aged 20-24 years are married by the age of 18. This analysis of CARE's Tipping Point Initiative seeks to compare Nepali adolescent boys' and girls' perceptions of empirical and normative expectations around child, early and forced marriage. A baseline survey of 1,134 adolescent girls and 1,154 adolescent boys provided 11 items for descriptive quantitative analysis. Thirty in-depth interviews and 16 focus groups were conducted with young people aged 12-16 years and analysed using modified Grounded Theory. Themes in the data produced thick descriptions of gender roles/responsibilities, employment, mobility and marriage. Comparisons by gender of normative and empirical expectations, and sanctions on child, early and forced marriage were produced. Gender roles/responsibilities underpin social norms for mobility, marriage and employment, and are connected by subthemes with a focus on responsibility for household chores, interaction between unmarried adolescents, education/financial stability, honour/reputation, and parental decision-makers). Participants agreed on gendered labour, women's employment, and parents as decision-makers. Areas of disagreement included repercussions for interactions between unmarried adolescents, girls' mobility, attributes of the ideal woman, and maintaining family honour. Programming recommendations include focusing on the inter-relatedness of boys' and girls' wellbeing, communication between girls and parents, and structural support for education Research recommendations include identifying factors underlying sexual harassment and constructs of masculinity and femininity.
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Affiliation(s)
- Grace Morrow
- Hubert Department of Global Health, Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Kathryn M Yount
- Hubert Department of Global Health, Emory University, Rollins School of Public Health, Atlanta, GA, USA
- Sociology, Emory University, Atlanta, GA, USA
| | - Irina Bergenfeld
- Hubert Department of Global Health, Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Anne Laterra
- Health Equity and Rights Team, CARE USA, Atlanta, GA, USA
| | | | - Zara Khan
- Hubert Department of Global Health, Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Cari Jo Clark
- Hubert Department of Global Health, Emory University, Rollins School of Public Health, Atlanta, GA, USA
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Zielke J, Batram-Zantvoort S, Razum O, Miani C. Operationalising masculinities in theories and practices of gender-transformative health interventions: a scoping review. Int J Equity Health 2023; 22:139. [PMID: 37501204 PMCID: PMC10375736 DOI: 10.1186/s12939-023-01955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
Gender-transformative health interventions that involve men and boys are gaining global reach, adaptability to specific geographical, population and epidemiological contexts, public endorsement, and conceptual sophistication. However, the ways in which masculinities are conceptualised and operationalised in theory and practice across these interventions remains unclear. The purpose of this scoping review is to map intervention studies that conceptually grapple with masculinities and analyse: a) how the concept of masculinities is adapted and operationalised in gender-transformative interventions, with respect to intervention population and context, b) what the relationship between the concept of masculinities and its wider theoretical embedding is, and c) on which levels transformation can be observed when working with 'masculinities'.We conducted a search in APA Psych Articles, APA PsycINFO, and CINAHL via EBSCO, MedLine, PubMed, and Web of Sciences (December 2021) looking for peer-reviewed studies on gender-transformative health interventions which engaged with masculinities conceptually. There were no restrictions regarding language, publication date, or geography. Forty-two articles were included in this review. Our abductive analysis finds that 'hegemonic masculinities' is a central concept in almost all included studies. This shows how the concept is adaptable to a range of different intervention contexts. The review further identifies five theoretical approaches, that help operationalise masculinities on an analytical level: feminist framework, affect theory, critical pedagogy, theories of social change, and ecological approaches. Lastly, this review draws out six levels on which transformation can be observed in the intervention outcomes: relational level, symbolic level, material level, affective level, cognitive-behavioural level, and community-structural level. The discussion underlines that processes and practices of (gender) transformation also require engagement with theories of transformation more widely and advocates for theoretical pluralism. Lastly, implications for practice, including preventative, ecological and community-based care models, are drawn out.
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Affiliation(s)
- Julia Zielke
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany.
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
- Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), 9 Cr Des Humanités, 93300, Aubervilliers, France
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15
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Marcos-Marcos J, Nardini K, Briones-Vozmediano E, Vives-Cases C. Listening to stakeholders in the prevention of gender-based violence among young people in Spain: a qualitative study from the positivMasc project. BMC Womens Health 2023; 23:393. [PMID: 37496067 PMCID: PMC10373224 DOI: 10.1186/s12905-023-02545-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 07/13/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE This study seeks to deepen current knowledge of the phenomenon of gender-based violence (GVB) among young people in Spain, identifying the main challenges in terms of prevention from the perspective of key stakeholders in the field. METHODS 23 semi-structured qualitative interviews were performed with professionals whose work involves youth and comes from different areas: social work, policy making, youth education, feminist and LGBTQ activism and anti-violence masculinities engagement (13 women and 10 men). RESULTS Among the main challenges identified by stakeholders in relation to GBV preventive strategies in young populations there is a need to focus on transformative programmes within educational settings. The findings indicate that specific programs and interventions in this area may not be yielding the expected effectiveness. This outcome could be attributed less to a lack of resources and more to a failure to address the core issues and challenges adequately. Thus, the results underline that intervention programmes should emphasise equitable gender norms and gender relations and incorporate content on anti-violence masculinities. Finally, a pivotal aspect seen by professionals to facilitate GBV prevention is the design and development of interventions based on participatory and active approaches, close to young people's everyday situations. The results also draw attention to the need to analyse the impact of new forms of violence in greater depth, especially those that occur through information and communication technologies. CONCLUSION Among other implications for policy and practice, the study points to the need to articulate interventions designed to work simultaneously at different levels of influence acting on people.
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Affiliation(s)
| | - Krizia Nardini
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
| | | | - Carmen Vives-Cases
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
- Center for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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16
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Bartel D, Coile A, Zou A, Martinez Valle A, Nyasulu HM, Brenzel L, Orobaton N, Saxena S, Addy P, Strother S, Ogundimu M, Banerjee B, Kasungami D. Exploring system drivers of gender inequity in development assistance for health and opportunities for action. Gates Open Res 2023; 6:114. [PMID: 37593453 PMCID: PMC10427755 DOI: 10.12688/gatesopenres.13639.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/19/2023] Open
Abstract
Background : Deep-rooted and widespread gender-based bias and discrimination threaten achievement of the Sustainable Development Goals. Despite evidence that addressing gender inequities contributes to better health and development outcomes, the resources for, and effectiveness of, such efforts in development assistance for health (DAH) have been insufficient. This paper explores systemic challenges in DAH that perpetuate or contribute to gender inequities, with a particular focus on the role of external donors and funders. Methods: We applied a co-creation system design process to map and analyze interactions between donors and recipient countries, and articulate drivers of gender inequities within the landscape of DAH. We conducted qualitative primary data collection and analysis in 2021 via virtual facilitated discussions and visual mapping exercises among a diverse set of 41 stakeholders, including representatives from donor institutions, country governments, academia, and civil society. Results: Six systemic challenges emerged as perpetuating or contributing to gender inequities in DAH: 1) insufficient input and leadership from groups affected by gender bias and discrimination; 2) decision-maker blind spots inhibit capacity to address gender inequities; 3) imbalanced power dynamics contribute to insufficient resources and attention to gender priorities; 4) donor funding structures limit efforts to effectively address gender inequities; 5) fragmented programming impedes coordinated attention to the root causes of gender inequities; and 6) data bias contributes to insufficient understanding of and attention to gender inequities. Conclusions : Many of the drivers impeding progress on gender equity in DAH are embedded in power dynamics that distance and disempower people affected by gender inequities. Overcoming these dynamics will require more than technical solutions. Groups affected by gender inequities must be centered in leadership and decision-making at micro and macro levels, with practices and structures that enable co-creation and mutual accountability in the design, implementation, and evaluation of health programs.
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Affiliation(s)
- Doris Bartel
- Independent, Washington, District of Columbia, USA
| | - Amanda Coile
- JSI Research and Training Institute, Inc., Arlington, Virginia, 22202, USA
| | - Annette Zou
- Global ChangeLabs, Portola Valley, California, 94028, USA
| | - Adolfo Martinez Valle
- Health Policy and Population Research Center (CIPPS), Universidad Nacional Autónoma de México, Mexico City, 04510, Mexico
| | | | - Logan Brenzel
- Bill & Melinda Gates Foundation, Seattle, Washington, 98109, USA
| | - Nosa Orobaton
- Bill & Melinda Gates Foundation, Seattle, Washington, 98109, USA
| | - Sweta Saxena
- U.S. Agency for International Development (USAID), Washington, District of Columbia, 20523, USA
| | - Paulina Addy
- Women in Agricultural Development, Ministry of Food and Agriculture, Accra, Ghana
| | - Sita Strother
- JSI Research and Training Institute, Inc., Arlington, Virginia, 22202, USA
| | | | - Banny Banerjee
- Global ChangeLabs, Portola Valley, California, 94028, USA
| | - Dyness Kasungami
- JSI Research and Training Institute, Inc., Arlington, Virginia, 22202, USA
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17
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Jeong J, Sullivan EF, McCann JK. Effectiveness of father-inclusive interventions on maternal, paternal, couples, and early child outcomes in low- and middle-income countries: A systematic review. Soc Sci Med 2023; 328:115971. [PMID: 37224703 PMCID: PMC10330563 DOI: 10.1016/j.socscimed.2023.115971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
Most caregiving interventions for young children are directed to female caregivers. Relatively few have included male caregivers as program participants especially in low- and middle-income countries (LMICs). The range of potential benefits that can be achieved through the engagement of fathers and male caregivers has not been adequately explored from a family systems perspective. We reviewed interventions that engaged male caregivers to support young children in LMICs and summarized impacts on maternal, paternal, couples, and child outcomes. We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for quantitative evaluation studies of social and behavioral interventions that included fathers or other male caregivers to improve nurturing care for young children under 5 years of age in LMICs. Three authors independently extracted data using a structured form. Forty-four articles, representing 33 intervention evaluations, were included. The most common type of intervention targeted fathers along with their female partners and primarily to address child nutrition and health. Across interventions, maternal outcomes were the most evaluated outcomes (82%), followed by paternal (58%), couple's relationship (48%) and child-level outcomes (45%). Overall, father-inclusive interventions had positive impacts on maternal, paternal and couples' relationship outcomes. Although there was greater variation in the degree of supportive evidence for child outcomes compared to maternal, paternal, and couples outcomes, findings suggested mostly positive effects across all outcomes. Limitations included relatively weak study designs and heterogeneity across interventions, outcome types, and measurement tools. Interventions that include fathers and other male caregivers have potential to improve maternal and paternal caregiving, couple's relationships dynamics, and early child outcomes in LMICs. More evaluation studies, using rigorous methods and robust measurement frameworks, is needed to bolster this evidence-base about the effect of fathers' engagement for young children, caregivers, and families in LMICs.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | | | - Juliet K McCann
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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18
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Mmari K, Gayles J, Lundgren R, Barker K, Austrian K, Levtov R, Kato-Wallace J, van Reeuwijk M, Richardson L, Green J, Kågestan AE, Ramaiya A. Implementing Interventions to Address Gender and Power Inequalities in Early Adolescence: Utilizing a Theory of Change to Assess Conditions for Success. J Adolesc Health 2023; 73:S5-S14. [PMID: 37330821 DOI: 10.1016/j.jadohealth.2022.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 09/26/2022] [Accepted: 10/26/2022] [Indexed: 06/19/2023]
Abstract
PURPOSE To 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. METHODS Interventionists 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. RESULTS Using 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. DISCUSSION The 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.
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Affiliation(s)
- Kristin Mmari
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | | | - Rebecka Lundgren
- Department of Medicine, Infectious Disease and Global Public Health, Center on Gender Equity and Health, University of California San Diego, La Jolla, California
| | - Katherine Barker
- Department of Medicine, Infectious Disease and Global Public Health, Center on Gender Equity and Health, University of California San Diego, La Jolla, California
| | | | - Ruti Levtov
- Prevention Collaborative, Amherst, Massachusetts
| | | | | | - Lisa Richardson
- Institute of Women and Ethnic Studies, University of New Orleans Research and Technology Foundation, New Orleans, Louisiana
| | - Jakevia Green
- Institute of Women and Ethnic Studies, University of New Orleans Research and Technology Foundation, New Orleans, Louisiana
| | - Anna E Kågestan
- Department of Global Public Health Tomtebodavägen, Karolinska Institute, Stockholm, Sweden
| | - Astha Ramaiya
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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19
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Galdas PM, Seidler ZE, Oliffe JL. Designing Men's Health Programs: The 5C Framework. Am J Mens Health 2023; 17:15579883231186463. [PMID: 37496323 PMCID: PMC10387791 DOI: 10.1177/15579883231186463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
Men are less likely than women to access or engage with a range of generic health programs across a diversity of settings. Designing health programs that mitigate barriers associated with normative ideals of masculinity has been widely viewed as a key factor in how health systems should respond, but strategies to engage men have often narrowly conceptualized male health behavior and risk inadvertently reinforcing negative and outdated gender stereotypes. Currently absent from the men's health literature is practical guidance on gender-transformative approaches to men's health program design-those which seek to quell harmful gender norms and purposefully promote health equity across wide-ranging issues, intervention types, and service contexts. In this article, we propose a novel conceptual model underpinned by gender-transformative goals to help guide researchers and practitioners tailor men's health programs to improve accessibility and engagement. The "5C framework" offers key considerations and guiding principles on the application of masculinities in program design irrespective of intervention type or service context. By detailing five salient phases of program development, the framework is intended as a designate approach to the design of accessible and engaging men's health programs that will foster progressive changes in the ways in which masculinity can be interpreted and expressed as a means to achieve health for all.
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Affiliation(s)
- Paul M. Galdas
- Department of Health Sciences, University of York, York, UK
| | - Zac E. Seidler
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Movember, Melbourne, Victoria, Australia
| | - John L. Oliffe
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Nursing, University of Melbourne, Parkville, Victoria, Australia
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20
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Pérez-Martínez V, Marcos-Marcos J, Cerdán-Torregrosa A, Briones-Vozmediano E, Sanz-Barbero B, Davó-Blanes MC, Daoud N, Edwards C, Salazar M, La Parra-Casado D, Vives-Cases C. Positive Masculinities and Gender-Based Violence Educational Interventions Among Young People: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:468-486. [PMID: 34282677 DOI: 10.1177/15248380211030242] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Hegemonic masculinity has been recognized as contributing to the perpetration of different forms of gender-based violence (GBV). Abandoning hegemonic masculinities and promoting positive masculinities are both strategies used by interventions that foreground a "gender-transformative approach." Preventing GBV among young people could be strengthened by engaging young men. In this article, we aim to systematically review the primary characteristics, methodological quality, and results of published evaluation studies of educational interventions that aim to prevent different forms of GBV through addressing hegemonic masculinities among young people. MAIN BODY We conducted a systematic review of available literature (2008-2019) using Medline (PubMed), Scopus, Web of Science, PsycInfo, the CINAHL Complete Database, and ERIC as well as Google scholar. The Template for Intervention Description and Replication was used for data extraction, and the quality of the selected studies was analyzed using the Mixed Method Appraisal Tool. More than half of the studies were conducted in Africa (n = 10/15) and many were randomized controlled trials (n = 8/15). Most of the studies with quantitative and qualitative methodologies (n = 12/15) reported a decrease in physical GBV and/or sexual violence perpetration/victimization (n = 6/15). Longitudinal studies reported consistent results over time. CONCLUSIONS Our results highlight the importance of using a gender-transformative approach in educational interventions to engage young people in critical thinking about hegemonic masculinity and to prevent GBV.
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Affiliation(s)
- Vanesa Pérez-Martínez
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
| | - Jorge Marcos-Marcos
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
| | - Ariadna Cerdán-Torregrosa
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
| | | | - Belen Sanz-Barbero
- Epidemiology and Statistics Department, National School of Health Carlos III, Madrid, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
| | - MCarmen Davó-Blanes
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
| | - Nihaya Daoud
- Department of Public Health, Faculty of Health Sciences, 26732Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Clarie Edwards
- School of Applied Social Studies, 8795University College Cork, Ireland
| | - Mariano Salazar
- Department of Global Public Health, GloSH research group, Karolinska Institutet, Stockholm, Sweden
| | | | - Carmen Vives-Cases
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
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21
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Sikweyiya YM, Leon N, Lurie MN, Majola M, Colvin CJ. Soccer clubs as avenues for gender transformative socialization of adolescent boys in Cape Town and Mthatha, South Africa: A qualitative study. PLoS One 2023; 18:e0280932. [PMID: 36730276 PMCID: PMC9894412 DOI: 10.1371/journal.pone.0280932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/11/2023] [Indexed: 02/03/2023] Open
Abstract
In this paper, we explore the gender socialization of adolescent boys in soccer clubs, and ask whether there are opportunities for integrating gender transformative elements into that socialization. This qualitative study involved 11 in-depth interviews and informal conversations with male soccer coaches from Gugulethu township and Mthatha town in the Western Cape and Eastern Cape provinces of South Africa, respectively. Data were analyzed using a thematic analysis approach. We found that the coaches felt that the adolescent boys in their soccer clubs faced serious social and emotional challenges, with the boys' poor socio-economic backgrounds and fragmented family structures being major contributors to these challenges. Most coaches also gave themselves the responsibility to try to address some of the challenges faced by their club members. To do this, they employed specific strategies, including creating an alliance with parents and professionals. In the process, the coaches engaged the boys on topics around respect, sexual and reproductive health, and avoiding alcohol, drugs, and involvement in criminal gangs. Some coaches also played a social fathering role to club members as a way of helping them to think differently about their lives, redirect risky practices, and reduce the chance for poor health outcomes. These findings highlight the role of soccer clubs and coaches as potential avenues for health- and equity-promoting gender socialization of adolescent boys.
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Affiliation(s)
- Yandisa Msimelelo Sikweyiya
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - Mark N. Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mandla Majola
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J. Colvin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States of America
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22
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Averbach S, Johns NE, Ghule M, Dixit A, Begum S, Battala M, Saggurti N, Silverman J, Raj A. Understanding quality of contraceptive counseling in the CHARM2 gender-equity focused family planning intervention: Findings from a cluster randomized controlled trial among couples in rural India. Contraception 2023; 118:109907. [PMID: 36328094 PMCID: PMC10695301 DOI: 10.1016/j.contraception.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The CHARM2 (Counseling Husbands and wives to Achieve Reproductive Health and Marital Equity) intervention engages health care providers to deliver gender-equity and family planning sessions to couples using a person-centered shared decision-making approach for contraception counseling. We previously showed that the intervention improved contraceptive use at 9-month follow-up. We sought to assess whether the intervention was further associated with the quality of care reported by participants and whether the quality of care reported mediated the effect of the intervention on contraceptive use. STUDY DESIGN This is a planned secondary analysis of the effect of the CHARM2 intervention on 1201 married couples in rural Maharashtra, India in a cluster randomized controlled trial completed between 2018 and 2020. We assessed the effect of CHARM2 on perceived quality of care as measured by the Interpersonal Quality of Family Planning (IQFP) scale using a difference-in-differences linear regression approach including a mixed-effects model with nested random effects to account for clustering. We assessed whether the association between CHARM2 and modern contraceptive use was mediated by quality of family planning care. RESULTS Intervention participants had higher mean IQFP scores than control participants at 9-month follow-up (intervention 3.2, SD 0.6 vs. control 2.3 mean, SD 0.9, p < 0.001). The quality of care reported mediated the effect of the intervention on contraceptive use (indirect effect coefficient 0.29, 95% CI 0.07-0.50). CONCLUSION Family planning interventions such as CHARM2, which utilize person-centered shared decision-making contraceptive counseling approaches improve women's perceived quality of care. Effects on quality of care mediate observed effects of the intervention on contraceptive use. IMPLICATIONS Contraceptive interventions should focus on improving person-centered outcomes, such as quality of care, rather than contraceptive use targets. By focusing on improving person-centered care, interventions will improve contraceptive use among those who desire a method while meeting the holistic reproductive health needs of clients and couples.
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Affiliation(s)
- Sarah Averbach
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego School of Medicine, La Jolla, CA, United States.
| | - Nicole E Johns
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Mohan Ghule
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Anvita Dixit
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Shahina Begum
- Department of Biostatistics, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | | | | | - Jay Silverman
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States; Department of Education Studies, Division of Social Sciences, University of California San Diego School of Medicine, La Jolla, CA, United States
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23
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Burger RL, Cohen CR, Mocello AR, Dworkin SL, Frongillo EA, Weke E, Butler LM, Thirumurthy H, Bukusi EA, Weiser SD. Relationship Power, Antiretroviral Adherence, and Physical and Mental Health Among Women Living with HIV in Rural Kenya. AIDS Behav 2023; 27:416-423. [PMID: 36001201 PMCID: PMC9908627 DOI: 10.1007/s10461-022-03775-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
Little is known about the association of gender-based power imbalances and health and health behaviors among women with HIV (WWH). We examined cross-sectional baseline data among WWH in a cluster-randomized control trial (NCT02815579) in rural Kenya. We assessed associations between the Sexual Relationship Power Scale (SRPS) and ART adherence, physical and mental health, adjusting for sociodemographic and social factors. SRPS consists of two subscales: relationship control (RC) and decision-making dominance. Women in the highest and middle tertiles for RC had a 7.49 point and 8.88 point greater Medical Outcomes Study-HIV mental health score, and a 0.27 and 0.29 lower odds of depression, respectively, compared to women in the lowest tertile. We did not find associations between SPRS or its subscales and ART adherence. Low sexual relationship power, specifically low RC, may be associated with poor mental health among WWH. Intervention studies aimed to improve RC among WWH should be studied to determine their effect on improving mental health.
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Affiliation(s)
- Rachel L Burger
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington, Bothell, WA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lisa M Butler
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Harsha Thirumurthy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, CA, USA
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Dearden K, Mulokozi G, Linehan M, Cherian D, Torres S, West J, Crookston B, Hall C. The Impact of a Large-Scale Social and Behavior Change Communication Intervention in the Lake Zone Region of Tanzania on Knowledge, Attitudes, and Practices Related to Stunting Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1214. [PMID: 36673972 PMCID: PMC9859305 DOI: 10.3390/ijerph20021214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Large-scale social and behavioral change communication (SBCC) approaches can be beneficial to achieve improvements in knowledge, attitudes, and practices (KAP). Addressing Stunting in Tanzania Early (ASTUTE) included a significant SBCC component and targeted precursors to stunting including KAP related to maternal and child health, antenatal care, WASH, childhood development, and male involvement. METHODS Baseline, midline, and endline surveys were conducted for a total of 14,996 female caregivers and 6726 male heads of household in the Lake Zone region of Tanzania. Regression analyses were used to estimate differences in KAP from baseline to midline and endline. RESULTS Women's knowledge of handwashing and infant/child feeding practices, and attitudes related to male involvement, consistently improved from baseline to midline and baseline to endline. Women's practices related to antenatal care, breastfeeding, and early child development improved from baseline to midline and baseline to endline. Improvements in KAP among male heads of household were varied across indicators with consistent improvement in practices related to child feeding practices from baseline to midline and baseline to endline. CONCLUSION Many changes in KAP were observed from baseline to midline and baseline to endline and corresponded with SBCC programming in the region. These results provide support for the value of large SBCC interventions. Public health efforts in settings such as Tanzania may benefit from adopting these approaches.
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Affiliation(s)
- Kirk Dearden
- Corus International/IMA World Health, 1730 M St NW #1100, Washington, DC 20036, USA
| | - Generose Mulokozi
- Corus International/IMA World Health, Nyalali Curve, Plot 1657, Dar es Salaam P.O. Box 9260, Tanzania
| | - Mary Linehan
- Corus International/IMA World Health, 1730 M St NW #1100, Washington, DC 20036, USA
| | - Dennis Cherian
- Corus International/IMA World Health, 1730 M St NW #1100, Washington, DC 20036, USA
| | - Scott Torres
- RTI International, 701 13th St NW #750, Washington, DC 20005, USA
| | - Joshua West
- Department of Public Health, Brigham Young University, LSB, Provo, UT 84602, USA
| | - Benjamin Crookston
- Department of Public Health, Brigham Young University, LSB, Provo, UT 84602, USA
| | - Cougar Hall
- Department of Public Health, Brigham Young University, LSB, Provo, UT 84602, USA
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Shaw SY, du Plessis E, Broers R, Vasavithasan S, Hamdani S, Avery L. Correlates of maternal, newborn and child health services uptake, including male partner involvement: Baseline survey results from Bangladesh. Glob Public Health 2023; 18:2246047. [PMID: 37585547 DOI: 10.1080/17441692.2023.2246047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
South Asia bears a substantial proportion of the global maternal mortality burden, with adolescents disproportionately affected. Bangladesh has one of the highest adolescent pregnancy rates in the world, with low utilisation of maternal newborn and child health (MNCH) services. This hampers the country's efforts to achieve optimal health outcomes as envisioned by the Sustainable Development Goals. Male partner involvement is a recognised approach to optimise access to services and decision-making. In South Asia data on male involvement in MNCH service uptake is limited. Plan International's Strengthening Health Outcomes for Women and Children was implemented across four districts in Bangladesh between 2016 and 2020 and aimed to address these issues. Study results (N = 1,724) found higher maternal education levels were associated with use of MNCH services. After controlling for maternal education, service uptake was associated with male partner support level and perceived joint decision-making. The positive association between male support level and MNCH scale was robust to stratification by maternal education level, and by age group (i.e. adolescent vs. adult mothers). These findings suggest that one path for achieving optimal MNCH outcomes might be through structural-level interventions centred on women, combined with components targeting male partners or male heads of households.
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Affiliation(s)
- Souradet Y Shaw
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Elsabé du Plessis
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | | | - Lisa Avery
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Jozkowski KN, Marcantonio T, Drouin M. Does Alcohol Consumption Influence People's Perceptions of Their Own and a Drinking Partner's Ability to Consent to Sexual Behavior in a Non-sexualized Drinking Context? JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP128-NP155. [PMID: 35324363 DOI: 10.1177/08862605221080149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The purpose of this study was to examine the extent that alcohol consumption affected participants' perceptions of their own and their friend's ability to consent to sex in a non-bar drinking environment. We interviewed 176 people at tailgates in dyads about their own and their friends' alcohol consumption, intoxication symptoms, and ability to consent. Participants reported consuming a mean of 4.6 drinks and had a breath alcohol concentration (BrAC) of .075 on average, but few thought they or their friend had diminished cognitive function. Accordingly, 92.6% indicated they could consent to sex and 81.8% indicated their friend could consent to sex. Number of drinks people reported consuming, self-reported intoxication levels and symptoms, and BrACs were not significantly related to participants' perceptions of their own or their friends' ability to consent to sex. However, gender pairing of the dyad was significant; those in man-man pairs were more likely than those in woman-woman pairs to indicate their friend could consent and they would allow their friend to have sex if approached by an interested party. Participants also indicated that they did not perceive themselves or their friends to be "too intoxicated" as common reasons why they believed they and their friend could consent. Because alcohol-facilitated sexual assault is common among college students, we recommend sexual assault prevention educators focus on raising awareness regarding alcohol's negative cognitive effects, particularly related to consent communication.
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Affiliation(s)
- Kristen N Jozkowski
- Department of Applied Health Science in the School of Public Health, 1772Indiana University, Bloomington, IN, USA
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, 1771Indiana University, Bloomington, IN, USA
| | - Tiffany Marcantonio
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, 1771Indiana University, Bloomington, IN, USA
- Department of Health, Human Performance, and Recreation, 3341University of Arkansas, Fayetteville, AR, USA
| | - Michelle Drouin
- Department of Psychology, 14688Purdue Fort Wayne University, Fort Wayne, IN, USA
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Russo A, Lewis B, Ali R, Abed A, Russell G, Luchters S. Sex, Sexuality, and Intimate Relationships Among Afghan Women and Men of Refugee Background Living in Melbourne, Australia: Experiences, Opportunities, and Transcultural Tensions. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:177-189. [PMID: 36149540 PMCID: PMC9859837 DOI: 10.1007/s10508-022-02296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/31/2021] [Accepted: 01/16/2022] [Indexed: 06/16/2023]
Abstract
Over the last two decades, Afghanistan has been a leading country of origin for asylum seekers and refugees arriving in Australia. It is widely recognized that humanitarian migrants experience poorer sexual and reproductive health than the broader population. In turn, a body of research has emerged exploring the sexual and reproductive health of the local Afghan community. However, this has predominantly focused on youth or perinatal experiences, and less attention has been given to the broader relational and social dimensions of sexuality. Accordingly, this research aimed to explore the perspectives and experiences of married Afghan women and men as they navigate and negotiate sex, sexuality, and intimate relationships following settlement in Melbourne, Australia. A total of 57 Afghan women and men participated in six focus group discussions and 20 semi-structured interviews. Male participants described the ways that having increased access to sex and sexually explicit materials in Australia is creating opportunities for them to establish more fulfilling sex lives. Many women also described a growing awareness of sexuality, although often expressed difficulty prioritizing and claiming more pleasurable sexual encounters for themselves. However, concerns about sexual freedom are also creating new challenges for the Afghan community living in Australia in relation to sex and relationships. For example, men expressed fears about women exercising sexual liberties outside of the home, and this appeared to place women's everyday behavior under increased scrutiny. Women also voiced concerns about how easily men can access sex outside of marriage within Australia, and described how this amplified their sense of obligation to be sexually compliant and meet their husband's desires. This study provides new insights into the ways that Afghan community members are moving between societies, and how their understandings of sexual participation, pleasure, desire, health, consent, and capacity for self-determination are being challenged, reshaped, and reconstructed throughout this process.
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Affiliation(s)
- Alana Russo
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- Refugee Health Program, Monash Health Community, Monash Health, Dandenong, VIC, Australia.
| | - Belinda Lewis
- School of Primary Health Care, Monash University, McMahons Road, Frankston, VIC, Australia
| | - Razia Ali
- Refugee Health Program, Monash Health Community, Monash Health, Dandenong, VIC, Australia
| | | | - Grant Russell
- Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Notting Hill, Australia
| | - Stanley Luchters
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Population Health, Aga Khan University, Nairobi, Kenya
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Sileo KM, Wanyenze RK, Anecho A, Luttinen R, Semei C, Mukasa B, Musoke W, Vermund SH, Dworkin SL, Dovidio JF, Taylor BS, Kershaw TS. Protocol for the pilot quasi-experimental controlled trial of a gender-responsive implementation strategy with providers to improve HIV outcomes in Uganda. Pilot Feasibility Stud 2022; 8:264. [PMID: 36564795 PMCID: PMC9783690 DOI: 10.1186/s40814-022-01202-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/09/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Antiretroviral treatment (ART) is the most effective clinical intervention for reducing morbidity and mortality among persons living with HIV. However, in Uganda, there are disparities between men and women in viral load suppression and related HIV care engagement outcomes, which suggests problems with the implementation of ART. Gender norms are a known driver of HIV disparities in sub-Saharan Africa, and patient-provider relationships are a key factor in HIV care engagement; therefore, the role of gender norms is important to consider in interventions to achieve the equitable provision of treatment and the quality of ART counseling. METHODS The overall research objective of this study is to pilot test an implementation strategy (i.e., methods to improve the implementation of an evidence-based intervention) to increase providers' capacity to provide gender-responsive treatment and counseling to men and women on HIV treatment in Uganda. Delivered to HIV providers, this group training adapts evidence-based strategies to reduce gender biases and increase skills to deliver gender-specific and transformative HIV counseling to patients. The implementation strategy will be piloted through a quasi-experimental controlled trial. Clinics will be randomly assigned to either the intervention or control conditions. The trial will assess feasibility and acceptability and explore barriers and facilitators to implementation and future adoption while gathering preliminary evidence on the implementation strategy's effectiveness by comparing changes in patient (N = 240) and provider (N = 80-140) outcomes across intervention and control clinics through 12-month follow-up. Quantitative data will be descriptively analyzed, qualitative data will be analyzed through thematic analysis, and these data will be mixed during the presentation and interpretation of results where appropriate. DISCUSSION This pilot intervention trial will gather preliminary evidence on the acceptability, feasibility, and potential effect of a novel implementation strategy to improve men and women's HIV care engagement, with the potential to reduce gender disparities in HIV outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT05178979 , retrospectively registered on January 5, 2022.
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Affiliation(s)
- K M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, TX, USA.
| | - R K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - A Anecho
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - R Luttinen
- Department of Demography, The University of Texas at San Antonio, San Antonio, TX, USA
| | - C Semei
- Mildmay Uganda, Kampala, Uganda
| | | | | | - S H Vermund
- Yale School of Public Health, New Haven, CT, USA
| | - S L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, USA
| | - J F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
| | - B S Taylor
- Division of Infectious Diseases, Department of Medicine, Joe R. & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - T S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Pichon M, Carter DJ, Howard-Merrill L, Sono R, Gimunta V, Rutenge O, Thiaw Y, Stoebenau K, Perrin N, Buller AM. A mixed-methods, exploratory, quasi-experimental evaluation of a radio drama intervention to prevent age-disparate transactional sex in Tanzania. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:1000853. [PMID: 36531443 PMCID: PMC9755860 DOI: 10.3389/frph.2022.1000853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/04/2022] [Indexed: 09/27/2023] Open
Abstract
Introduction Age-disparate transactional sex (ADTS) is associated with HIV, unintended pregnancy, school dropout and violence, yet few interventions have successfully prevented it, and none have set ADTS prevention as their primary outcome. This exploratory evaluation aimed to assess indications of change after exposure to the Learning Initiative on Norms, Exploitation and Abuse (LINEA) intervention, a mass-media, gender-transformative social norms intervention aimed at preventing ADTS in Tanzania. Methods In a condensed implementation 331 participants were instructed to listen to the LINEA radio drama over seven weeks, and 60 were randomly allocated to household discussion sessions about content. In-depth interviews (n = 81) from girls aged 12-16 years, and women and men caregivers were collected at baseline (September 2021), midline (November) and endline (December 2021). Surveys were conducted (n = 120) at baseline and endline using the Norms and Attitudes on ADTS Scale (NAATSS) and the Gender Roles and Male Provision Expectations (GRMPE) scale. Interviews were thematically analyzed using a framework approach. Age-stratified linear regression models adjusted for baseline scores were used to measure association between the intervention and endline scale scores. Results Longitudinal data were available from 59 qualitative (73%) and 95 quantitative participants (79%). Qualitative evidence revealed the drama facilitated family conversations about adolescent challenges, allowing caregivers to advise daughters. Some girls gained confidence to refuse men's gifts, learning that accepting them could necessitate sexual reciprocation. Some caregivers felt increased responsibility for supporting girls in the community to avoid ADTS. Blame for ADTS shifted for some from girls to men, suggesting increased understanding of inequitable power dynamics and reductions in victim blaming. Marginal quantitative evidence revealed that highly exposed girls had improved gender equitable beliefs on the GRMPE (β = -6.26; 95% CI: -12.94, 0.42). Moderately exposed men had increased gender inequitable norms on the NAATSS subscale (β = 0.42 95% CI: 0.05, 0.79), but there was no effect in highly exposed men. Conclusions Given the small sample results should be interpreted cautiously. Our initial findings indicate high engagement with the LINEA intervention shows promise in shifting knowledge, behaviors, and attitudes, beliefs and social norms driving ADTS in Shinyanga, Tanzania, supporting a robust impact evaluation.
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Affiliation(s)
- Marjorie Pichon
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Daniel J Carter
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lottie Howard-Merrill
- Department of Education, Practice and Society, Institute of Education, University College London, London, United Kingdom
| | - Revocatus Sono
- Adolescent Girls and Young Women Department, Amani Girls Home, Mwanza, United Republic of Tanzania
| | - Veronicah Gimunta
- Adolescent Girls and Young Women Department, Amani Girls Home, Mwanza, United Republic of Tanzania
| | - Oscar Rutenge
- Tanganyika Christian Refugee Service, Shinyanga Unit, United Republic of Tanzania
| | - Yandé Thiaw
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kirsten Stoebenau
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States
| | - Nancy Perrin
- Department of Behavioral and Community Health, Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Ana Maria Buller
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Hill AL, Miller E, Switzer GE, Abebe KZ, Chang JC, Pulerwitz J, Brush LD, Hill AV. Gender Equitable Attitudes Among Adolescents: A Validation Study and Associations with Sexual Health Behaviors. ADOLESCENT RESEARCH REVIEW 2022; 7:523-536. [PMID: 38895164 PMCID: PMC11185410 DOI: 10.1007/s40894-021-00171-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/27/2021] [Indexed: 06/21/2024]
Abstract
Gender inequitable attitudes are associated with violence perpetration and poor sexual health. There is limited diversity in U.S. samples used to validate gender attitudes measurements. This study assessed a 13-item gender equitable attitudes scale's validity among a sample of predominantly Black adolescent boys (n = 866; mean age = 15.5, range = 13-19 years) and examined associations with sexual health behaviors. Exploratory and confirmatory factor analyses tested construct validity. Logistic mixed-effects models were used to explore associations between gender equitable attitudes, adolescent relationship abuse, pornography use, and condom use behaviors; linear mixed-effects models explored associations between gender equitable attitudes and condom negotiation self-efficacy. By pooling data from two other gender transformative programs, Sisterhood 2.0 (n = 246, 13-19-year-old females (mean age = 15.2), 73.6% Black/African American) and Coaching Boys into Men Middle School (n = 958, 11-14-year-old males-6th grade: 10.4%, 7th grade: 36.5%, 8th grade: 53.1-56.6% white), measurement invariance was assessed across Black (n = 400) and white (n = 298) race and male (n = 429) and female (n = 246) gender. A three-factor 11-item scale showed construct validity among a sample of Black adolescent boys, weak factorial invariance across Black and white race, and configural invariance across male and female gender. Gender equitable attitudes were associated with less adolescent relationship abuse, higher condom negotiation self-efficacy, and less pornography use. These findings demonstrate some variability in measurements of gender equitable attitudes by race and gender. Targeting harmful gender norms may help prevent adolescent relationship abuse and improve sexual health behaviors.
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Affiliation(s)
- Amber L. Hill
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA 15213, USA
- Department of Pediatrics, Michigan Medicine, 1522 Simpson Road East, Ann Arbor, MI 48109, USA
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA 15213, USA
| | - Galen E. Switzer
- Department of Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA 15213, USA
- Center for Health Equity Research and Promotion (CHERP), Veterans Affairs Pittsburgh Healthcare System, 151C University Drive, Pittsburgh, PA 15240, USA
| | - Kaleab Z. Abebe
- Department of Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA 15213, USA
| | - Judy C. Chang
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA
- Department of Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA 15213, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, 300 Halket St, Pittsburgh, PA 15213, USA
| | - Julie Pulerwitz
- Population Council, 4301 Connecticut Ave NW #280, Washington, DC 20008, USA
| | - Lisa D. Brush
- Department of Sociology, University of Pittsburgh, 230 S Bouquet St, Pittsburgh, PA 15213, USA
| | - Ashley V. Hill
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA 15213, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA 15261, USA
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Lowe H, Dobbin J, Kiss L, Mak J, Mannell J, Watson D, Devakumar D. Mechanisms for the prevention of adolescent intimate partner violence: A realist review of interventions in low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001230. [PMID: 36962608 PMCID: PMC10022317 DOI: 10.1371/journal.pgph.0001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/09/2022] [Indexed: 03/26/2023]
Abstract
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.
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Affiliation(s)
- Hattie Lowe
- Institute for Global Health, University College London, London, United Kingdom
| | - Joanna Dobbin
- Primary Care and Population Health, University College London, London, United Kingdom
| | - Ligia Kiss
- Institute for Global Health, University College London, London, United Kingdom
| | - Joelle Mak
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jenevieve Mannell
- Institute for Global Health, University College London, London, United Kingdom
| | - Daniella Watson
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Gender-transformative approaches in international development: A brief history and five uniting principles. WOMENS STUDIES INTERNATIONAL FORUM 2022. [DOI: 10.1016/j.wsif.2022.102635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Emezue CN, Dougherty DS, Enriquez M, Bullock L, Bloom TL. Perceptions of Risk for Dating Violence Among Rural Adolescent Males: An Interpretive Analysis. Am J Mens Health 2022; 16:15579883221126884. [PMID: 36305641 PMCID: PMC9619278 DOI: 10.1177/15579883221126884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
About one in eight U.S. high school students in Grades 9 to 12 report experiencing teen dating violence (TDV) in the form of physical, sexual, or psychological dating violence in the past year in person, on school grounds, and online. Compared with their urban counterparts, rural teens face nearly double the rate of physical dating abuse and an elevated risk of experiencing multiple forms of violence. Rural young males are exposed to regional masculinities and gender norms that may simultaneously promote female subordination (a prelude to dating violence) while impeding help-seeking intentions. We used an interpretive and dialectical approach grounded in Relational Dialectics Theory to explore how rural young males perceive and describe their own risk of experiencing and perpetrating dating violence and the factors contributing to their help-seeking intentions and behaviors. Data from three focus groups and individual interviews with 27 rural young males (ages 15-24) were collated. We identified two central dialectical themes described as (a) Social Tension Dialectics (subthemes include: Abusive vs. Unhealthy Relationships: A Dialectic of Language; #MeToo vs. #WeToo: A Dialectic of Victimhood; "It's All Country Boys": A Dialectic of Masculinity) and (b) Help-Seeking Dialectics demonstrating the dual roles Religion, School Guidance Counselors, Peer Mentors, and Social Cohesion play in promoting or preventing dating violence. Overall, we found dialectic tensions in rural youth risk perceptions about dating violence. These findings bear implications for advocates and practitioners working with rural youth in planning developmentally and culturally appropriate TDV prevention programs, offering policy and research-relevant insight.
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Affiliation(s)
- Chuka Nestor Emezue
- Department of Women, Children and Family Nursing, College of Nursing, Rush University, Chicago, IL, USA,Chuka Nestor Emezue, Assistant Professor, Department of Women, Children and Family Nursing, College of Nursing, Rush University, 600 S. Paulina Street, Chicago, IL 60612-3801, USA.
| | - Debbie S. Dougherty
- College of Arts and Science Communication, University of Missouri, Columbia, MO, USA
| | - Maithe Enriquez
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Linda Bullock
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA,School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Tina L. Bloom
- Women’s and Children’s Health, School of Nursing, Notre Dame of Maryland University, Baltimore, MD, USA
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Raghavan A, Satyanarayana VA, Fisher J, Ganjekar S, Shrivastav M, Anand S, Sethi V, Chandra PS. Gender Transformative Interventions for Perinatal Mental Health in Low and Middle Income Countries-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12357. [PMID: 36231655 PMCID: PMC9564578 DOI: 10.3390/ijerph191912357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. In the context of Low and Middle Income Countries (LMIC), a leading risk factor is gender disparity. Addressing gender disparity, by involving fathers, mothers in law and other family members can significantly improve perinatal and maternal healthcare, including risk factors for poor perinatal mental health such as domestic violence and poor social support. This highlights the need to develop and implement gender-transformative (GT) interventions that seek to engage with men and reduce or overcome gender-based constraints. This scoping review aimed to highlight existing gender transformative interventions from LMIC that specifically aimed to address perinatal mental health (partner violence, anxiety or depression and partner support) and identify components of the intervention that were found to be useful and acceptable. This review follows the five-stage Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Six papers that met the inclusion criteria were included in the review (four from Africa and two from Asia). Common components of gender transformative interventions across studies included couple-based interventions and discussion groups. Gender inequity and related factors are a strong risk for poor perinatal mental health and the dearth of studies highlights the strong need for better evidence of GT interventions in this area.
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Affiliation(s)
- Archana Raghavan
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 530068, India
| | - Veena A. Satyanarayana
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 530068, India
| | - Jane Fisher
- School of Public Health and Preventive Medicine, University of Monash, Melbourne 3800, Australia
| | - Sundarnag Ganjekar
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 530068, India
| | - Monica Shrivastav
- ROSHNI-Centre of Women Collectives led Social Action, Lady Irwin College, New Delhi 110001, India
| | - Sarita Anand
- ROSHNI-Centre of Women Collectives led Social Action, Lady Irwin College, New Delhi 110001, India
| | - Vani Sethi
- United Nations Children’s Fund (UNICEF) Regional Office for South Asia, Kathmandu 44600, Nepal
| | - Prabha S. Chandra
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 530068, India
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Willie TC, Katague M, Halim N, Gupta J. Latent classes of men’s intimate partner violence perpetration and attitudes towards gender norms: A UN multi-country, cross-sectional study in Asia and the Pacific. PLoS One 2022; 17:e0264156. [PMID: 36155974 PMCID: PMC9512213 DOI: 10.1371/journal.pone.0264156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To examine distinct patterns of IPV perpetration and examined gender equitable attitudes as a correlate of these patterns among men from six countries in Asia and the Pacific. Design 2011–12 UN Multi-country Study on Men and Violence cross-sectional study. Setting Households in Bangladesh, Cambodia, China, Indonesia, Sri Lanka and Papua New Guinea. Participants 10,178 men aged 18–49 years residing in Bangladesh, Cambodia, China, Indonesia, Sri Lanka and Papua New Guinea. Primary outcomes measure Our primary outcome was distinct patterns of IPV perpetration which were derived from multilevel latent class analyses. Results The odds of being assigned to the Low All Forms of IPV Perpetration class than the High All Forms of IPV Perpetration class was lower for men in the middle tertile group than men in the high tertile group for gender equitable attitudes. The odds of being assigned to the High Emotional IPV Perpetration class than the High All Forms of IPV Perpetration class was greater for men in the low tertile group than men in the high tertile group for gender equitable attitudes. The odds of being assigned to the High Physical/Emotional/Economic IPV Perpetration class than the High All Forms of IPV Perpetration class was lower for men in the low tertile group than men in the high tertile group for gender equitable attitudes. Conclusions Gender transformative interventions that use an adaptive, personalized approach to men’s typology of IPV perpetration may be beneficial to reduce violence against for women in the Asia-Pacific region.
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Affiliation(s)
- Tiara C. Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
| | - Marina Katague
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
| | - Nafisa Halim
- Department of Global Health, Boston University, Boston, MA, United States of America
| | - Jhumka Gupta
- Department of Global and Community Health, George Mason University, Fairfax, VA, United States of America
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Bartel D, Coile A, Zou A, Martinez Valle A, Nyasulu HM, Brenzel L, Orobaton N, Saxena S, Addy P, Strother S, Ogundimu M, Banerjee B, Kasungami D. Exploring system drivers of gender inequity in development assistance for health and opportunities for action. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13639.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Deep-rooted and widespread gender-based bias and discrimination threaten achievement of the Sustainable Development Goals. Despite evidence that addressing gender inequities contributes to better health and development outcomes, the resources for, and effectiveness of, such efforts in development assistance for health (DAH) have been insufficient. This paper explores systemic challenges in DAH that perpetuate or contribute to gender inequities, with a particular focus on the role of external donors and funders. Methods: We applied a co-creation system design process to map and analyze interactions between donors and recipient countries, and articulate drivers of gender inequities within the landscape of DAH. We conducted qualitative primary data collection and analysis in 2021 via virtual facilitated discussions and visual mapping exercises among a diverse set of 41 stakeholders, including representatives from donor institutions, country governments, academia, and civil society. Results: Six systemic challenges emerged as perpetuating or contributing to gender inequities in DAH: 1) insufficient input and leadership from groups affected by gender bias and discrimination; 2) decision-maker blind spots inhibit capacity to address gender inequities; 3) imbalanced power dynamics contribute to insufficient resources and attention to gender priorities; 4) donor funding structures limit efforts to effectively address gender inequities; 5) fragmented programming impedes coordinated attention to the root causes of gender inequities; and 6) data bias contributes to insufficient understanding of and attention to gender inequities. Conclusions: Many of the drivers impeding progress on gender equity in DAH are embedded in power dynamics that distance and disempower people affected by gender inequities. Overcoming these dynamics will require more than technical solutions. Groups affected by gender inequities must be centered in leadership and decision-making at micro and macro levels, with practices and structures that enable co-creation and mutual accountability in the design, implementation, and evaluation of health programs.
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Skovdal M, Clausen CL, Magoge-Mandizvidza P, Dzamatira F, Maswera R, Nyamwanza RP, Nyamukapa C, Thomas R, Gregson S. How gender norms and 'good girl' notions prevent adolescent girls and young women from engaging with PrEP: qualitative insights from Zimbabwe. BMC Womens Health 2022; 22:344. [PMID: 35974360 PMCID: PMC9379870 DOI: 10.1186/s12905-022-01928-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis, or PrEP, has been hailed for its promise to provide women with user-control. However, gender-specific challenges undermining PrEP use are beginning to emerge. We explore the role of gender norms in shaping adolescent girls and young women's (AGYW) engagement with PrEP. METHODS We draw on qualitative data from 12 individual interviews and three focus group discussions with AGYW from eastern Zimbabwe. Interviews were transcribed and thematically coded in NVivo 12. Emerging themes were further investigated using Connell's notion of 'emphasised femininity'. RESULTS Participants alluded to the patriarchal society they are part of, with 'good girl' notions subjecting them to direct and indirect social control. These controls manifest themselves through the anticipation of intersecting sexuality- and PrEP-related stigmas, discouraging AGYW from engaging with PrEP. AGYW recounted the need for permission to engage with PrEP, forcing them to consider engaging with PrEP in secrecy. In addition, limited privacy at home, and fear of disclosure of their health clinic visits, further heightened their fear of engaging with PrEP. PrEP is not simply a user-controlled HIV prevention method, but deeply entrenched within public gender orders. CONCLUSION AGYW face significant limitations in their autonomy to initiate and engage with PrEP. Those considering PrEP face the dilemma of Scylla and Charybdis: The social risks of stigmatisation or risks of HIV acquisition. Efforts to make PrEP available must form part of a combination of social and structural interventions that challenge harmful gender norms.
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Affiliation(s)
- Morten Skovdal
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Camilla Lysemose Clausen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Phyllis Magoge-Mandizvidza
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Freedom Dzamatira
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rufurwokuda Maswera
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Constance Nyamukapa
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Ranjeeta Thomas
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Simon Gregson
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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McCook S. ‘So, What is a Good Masculinity?’: Navigating Normativity in Violence Prevention with Men and Boys. AUSTRALIAN FEMINIST STUDIES 2022. [DOI: 10.1080/08164649.2022.2095612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sarah McCook
- Criminology and Justice Studies, School of Global, Urban and Social Studies, RMIT University, Melbourne, Australia
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Morgan R, Garrison-Desany H, Hobbs AJ, Wilson E. Strengthening effectiveness evaluations through gender integration to improve programs for women, newborn, child, and adolescent health. Glob Health Action 2022; 15:2006420. [PMID: 36098954 PMCID: PMC9481075 DOI: 10.1080/16549716.2021.2006420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Over the past decade, there has been substantial progress towards integrating our understanding of social determinants of reproductive, maternal, newborn, child, and adolescent health (RMNCAH) into health planning and programs. For these programs, gender inequity remains one of the most harmful factors for women’s access to healthcare. Designing RMNCAH programs to be gender-responsive through active engagement with and overcoming of gender-related barriers remains paramount to increasing women’s access to and use of health programs. However, the integration of gender within RMNCAH programs and their evaluation is often non-existent or is limited in scope. Building on a prior framework for comprehensive gender analysis in RMNCAH, we discuss key steps used to incorporate a gender lens and analytical approach in the Real Accountability: Data Analysis for Results (RADAR) evaluation framework. In order to effectively address these key areas, gender must be integrated into all stages of the evaluation, including tool development and programmatic activities that are associated with each question. Our paper includes practical activities and tools that evaluators may use to integrate gender into their evaluation tools.
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Affiliation(s)
- Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Henri Garrison-Desany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy J Hobbs
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily Wilson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ncube J, Adom T, Nkonki L. Protocol for a systematic review of economic evaluations conducted on gender-transformative interventions aimed at preventing unintended pregnancy and promoting sexual health in adolescents. BMJ Open 2022; 12:e056553. [PMID: 35613786 PMCID: PMC9174771 DOI: 10.1136/bmjopen-2021-056553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In the context of family planning and reproductive health, a gender-transformative approach involves helping communities understand and challenge the social norms that perpetuate inequalities between men and women, and improving women's access to key services.The purpose of this systematic review is to synthesise the best available evidence on economic evaluations of gender transformative interventions targeted at preventing unintended pregnancy and promoting sexual health in adolescents, assess the methodological quality of the economic evaluation studies and identify gaps in the evidence. METHODS AND ANALYSIS We will search the following bibliographic databases for economic evaluations that meet our selection criteria; PubMed, Cochrane, National Health Service EE database, SCOPUS, CINHAL, Web of Science and Paediatric EE Database. We will additionally conduct a grey literature search. The search will be conducted for the period 1 January 1990 to 31 December 2021. Two independent reviewers will conduct the screening, data extraction and quality assessment. We will consider the following outcomes from economic evaluations; relative resource use, cost and incremental cost-effectiveness ratio, incremental net benefit ratio or net present value, quality-adjusted life-years and disability-adjusted life-years. Quality assessment will be conducted using the Consolidated Health Economic Evaluation Reporting Standards statement and the Consensus on Health Economic Criteria checklist. Results will be reported using summary tables and narratively. Attempts will be made to use the Joanna Briggs Institute three-by-three dominance ranking matrix tool to compare relevant cost-effectiveness studies. ETHICS AND DISSEMINATION Ethics approval is not required because the review will not use individual patient data, instead publicly available economic evaluation research studies will be used. However, an ethics exemption was obtained from the Stellenbosch University Health Research Ethics Committee, Reference No: X21/05/012. The results of the systematic review will be published in a peer-reviewed journal and presented at a relevant scientific conference. PROSPERO REGISTRATION NUMBER CRD42021264698.
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Affiliation(s)
- Janet Ncube
- Health Systems and Public Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Theodosia Adom
- Health Systems and Public Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Nutrition Research Centre, Ghana Atomic Energy Commission, Legon, Ghana
| | - Lungiswa Nkonki
- Health Systems and Public Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
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Koris A, Steven S, Akika V, Puls C, Okoro C, Bitrus D, Seff I, Deitch J, Stark L. Opportunities and challenges in preventing violence against adolescent girls through gender transformative, whole-family support programming in Northeast Nigeria. Confl Health 2022; 16:26. [PMID: 35550180 PMCID: PMC9096748 DOI: 10.1186/s13031-022-00458-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Household violence is one of the most prevalent forms of gender-based violence faced by adolescent girls in humanitarian settings. A growing evidence base demonstrates the extent to which multiple forms of familial violence, including intimate partner violence, violence against children, and sibling violence overlap in the same households. However, existing evidence of family support programming that effectively reduces violence against girls by addressing intersecting forms of household violence are limited, particularly in the Global South. Through a qualitative implementation evaluation informed by a grounded theoretical approach, we explored the perceived impact of a gender transformative, whole-family support intervention aimed at building adolescent girls’ protective assets against violence, among program participants in two communities of internally displaced people Maiduguri, Borno State, Northeast Nigeria. Methods We conducted six in-depth interviews and six focus group discussions with adult caregivers; six participatory activities and four paired interviews with adolescent girls and boys; and 12 key informant interviews with program staff. Criterion sampling was used to recruit 21 male caregivers, 21 female caregivers, 23 adolescent boys, and 21 adolescent girls; purposive sampling was used to recruit 12 program staff to participate in qualitative research activities. We audio recorded, translated, and transcribed all interviews. In a collaborative coding process, a multi-stakeholder team used applied thematic analysis in Dedoose to identify emergent themes in the data. Results Participants reported a decreased tolerance for and perpetration of violence against girls at the household level, and endorsed their right to protection from violence at the community level. However, alongside these self-reported changes in attitude and behavior, aspects of normative, patriarchal norms governing the treatment of adolescent girls were maintained by participants. Conclusions This study builds the evidence base for gender transformative, whole-family support programming and its impact on preventing violence against adolescent girls in humanitarian emergencies. Situating our findings in a feminist analysis of violence, this study calls attention to the complexity of gender norms change programming amongst families in conflict-affected settings, and highlights the need for programming which holistically addresses the relational, community, and structural drivers of violence against girls in emergencies.
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Affiliation(s)
- Andrea Koris
- Women's Refugee Commission, 15 W. 37th St, New York, NY, 10018, USA
| | - Shadrack Steven
- Mercy Corps Nigeria, 35 Patrick Bokkor Crescent, Jabi, Utako District, Abuja, Nigeria
| | - Veronica Akika
- Mercy Corps Nigeria, 35 Patrick Bokkor Crescent, Jabi, Utako District, Abuja, Nigeria
| | - Cassondra Puls
- Women's Refugee Commission, 15 W. 37th St, New York, NY, 10018, USA
| | - Charles Okoro
- Mercy Corps Nigeria, 35 Patrick Bokkor Crescent, Jabi, Utako District, Abuja, Nigeria
| | - David Bitrus
- Mercy Corps Nigeria, 35 Patrick Bokkor Crescent, Jabi, Utako District, Abuja, Nigeria
| | - Ilana Seff
- Brown School at Washington University in St. Louis, Campus Box 1196, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Julianne Deitch
- Women's Refugee Commission, 15 W. 37th St, New York, NY, 10018, USA
| | - Lindsay Stark
- Brown School at Washington University in St. Louis, Campus Box 1196, 1 Brookings Drive, St. Louis, MO, 63130, USA.
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Abstract
Gender is an important determinant of health, but explicit attention to gender is often missing in health promotion. We build on Pederson and colleagues' gender-transformative framework for health promotion to propose four guiding principles for gender-transformative health promotion. First, health promotion must address gender norms directly if it is to improve health outcomes. Second, it should move beyond individual change to engage explicitly with structural and social determinants of health. Third, it should address underlying gender-related determinants in order to influence health outcomes. And fourth, it requires complexity-informed design, implementation, and evaluation. We provide background on key concepts that are essential for designing, implementing, and evaluating gender-transformative health promotion: gender norms, socioecological approaches, and the gender system. We give examples of the four principles in practice, using the case of postnatal mental health promotion in Australia and sexuality education in Mexico. These four principles can be applied to health promotion efforts across contexts and outcomes to address the harmful gender norms that contribute to poor health as a part of broader efforts to improve health and well-being.
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Affiliation(s)
- Jane Fisher
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; ,
| | - Shelly Makleff
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; ,
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Santhya KG, Francis Zavier AJ. Long-Term Impact of Exposure to a Gender-Transformative Program Among Young Men: Findings From a Longitudinal Study in Bihar, India. J Adolesc Health 2022; 70:634-642. [PMID: 34952780 DOI: 10.1016/j.jadohealth.2021.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Gender-transformative programs with men and boys are recognized as a promising strategy for reducing violence against women and girls (VAWG). Reviews of such programs have underscored the need for investments in high-quality studies that measure effects on bio-behavioral outcomes and downstream effects. This article extends the limited evidence on long-term effects of gender-transformative programs with men and boys in India. METHODS We used data from a cluster randomized trial of a gender-transformative life-skills education cum sports coaching program that sought to promote gender egalitarian attitudes and rejection of VAWG among boys and men aged 13-21 and a follow-up study. Young men were interviewed thrice-before the launch, after the completion, and 5 years after the completion of the trial (N = 853). We used generalized estimating equations models to estimate the short- and long-term effects of the intervention and effect modification by participation level and intervention exposure in early/late adolescence. RESULTS The intervention succeeded in promoting gender equitable attitudes and notions of positive masculinity (β = 0.319; p = .012), and attitudes rejecting men's controlling behaviors (β = 0.428; p = .068) and VAWG (β = 0.673; p = .051) among young men in the long- erm. It reduced their perpetration of intimate partner violence (odds ratio 0.639; p = .062). The long-term positive effects were observed for regular participants only, and greater effects were observed among those exposed to the intervention in early than late adolescence. DISCUSSION Exposing boys to gender-transformative programs early on and ensuring their regular intervention participation can have sustained impact on promoting gender egalitarian attitudes and reducing their perpetration of VAWG.
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Affiliation(s)
- K G Santhya
- Population Council, Poverty, Gender and Youth, New Delhi, India.
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Sennott C, Kane D. Rights vs. Lived Realities: Women's Views of Gender Equality in Relationships in Rural South Africa. SOCIAL PROBLEMS 2022; 2022:spac015. [PMID: 37426294 PMCID: PMC7614733 DOI: 10.1093/socpro/spac015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
South Africa's Constitution is among the world's most ambitious in promoting gender equality, but the country continues to be marked by inequality and gender-based violence. Given this context, we analyze 43 interviews with Black women aged 18-55 in rural South Africa to explore how the constitutional ideal of gender equality-or "50/50"-has been interpreted and applied in women's intimate relationships. Overall, we found that inequality and gender hierarchy were common in relationships. Women relied on two logics to explain the persistence of inequality in their relationships. First, women offered ideological support for gender norms supporting hierarchy by linking 50/50 to the abandonment of culture, tradition, and respect. Second, women viewed reaffirmation of gender inequality within relationships as a pragmatic way to avoid men's violence and infidelity, thus protecting women from abandonment and HIV. Women's views about equality in relationships were shaped by dominant gender norms, precarity in the local political economy, and the risks of violence and HIV/AIDS. Our findings expand theories of social change by highlighting how not only longstanding social norms, but also local political-economic and health conditions can influence views of equality and ultimately the local adoption or dismissal of international standards of rights and equality.
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Affiliation(s)
- Christie Sennott
- Corresponding Author: Department of Sociology,
Purdue University, 700 W. State St., West Lafayette, IN 47906, USA.
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King K, Schlichthorst M, Chondros P, Rice S, Clark A, Le LKD, Mihalopoulos C, Pirkis J. Protocol for a cluster randomized control trial of the impact of the Breaking the Man Code workshops on adolescent boys' intentions to seek help. Trials 2022; 23:110. [PMID: 35115023 PMCID: PMC8811738 DOI: 10.1186/s13063-022-06034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Males in Australia and many other countries account for three-quarters of all deaths by suicide. School-based programs to support young men's wellbeing have become increasingly common in recent years and show much promise to tackle the issue of male suicide by fostering protective factors and mitigating harmful factors. However, only a few of these programs have been evaluated. This trial seeks to address the lack of knowledge about the potential for school-based gender-transformative programs to have a positive impact on boys. Breaking the Man Code workshops, delivered by Tomorrow Man in Australia, challenge and transform harmful masculinities with young men with a view to ultimately reducing their suicide risk. The trial aims to examine whether adolescent boys who participate in the Breaking the Man Code workshop demonstrate an increase in their likelihood of seeking help for personal or emotional problems compared to boys waiting to take part in the workshop. METHODS A stratified cluster randomized controlled superiority trial with two parallel groups will be conducted. Schools will be randomly allocated 1:1, stratified by location of the schools (rural or urban), state (Victoria, NSW, or WA), and mode of workshop delivery (face-to-face or online), to the intervention group and waitlist control group. DISCUSSION The Breaking the Man Code workshops show great promise as a school-based prevention intervention. The trial will fill a gap in knowledge that is critically needed to inform future interventions with boys and men. Some methodological challenges have been identified related to the COVID-19 pandemic in Australia, such as delays in ethics approvals and the need for Tomorrow Man to introduce an online delivery option for the workshop. The trial protocol has been designed to mitigate these challenges. The findings from the trial will be used to improve the workshops and will assist others who are designing and implementing suicide prevention interventions for boys and men. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ( ACTRN12620001134910 ). Registered on 30 October 2020.
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Affiliation(s)
- Kylie King
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.
| | - Marisa Schlichthorst
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Patty Chondros
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Simon Rice
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Anna Clark
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Long Khanh-Dao Le
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Howard-Merrill L, Wamoyi J, Nyato D, Kyegombe N, Heise L, Buller AM. 'I trap her with a CD, then tomorrow find her with a big old man who bought her a smart phone'. Constructions of masculinities and transactional sex: a qualitative study from North-Western Tanzania. CULTURE, HEALTH & SEXUALITY 2022; 24:254-267. [PMID: 33118865 DOI: 10.1080/13691058.2020.1832259] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
Men's role in transactional sex is relatively unexplored, limiting initiatives to prevent exploitative transactional sex and its negative health implications for girls and women. We addressed this literature gap by conducting eight focus group discussions and twenty in-depth-interviews with boys and men aged 14 - 49 years in 2015 in Tanzania. We employed a novel combination of theoretical perspectives - gender and masculinities, and social norms - to understand how transactional sex participation contributes to perpetuating gendered hierarchies, and how reference groups influence men's behaviour. Findings signal two gender norms that men display within transactional sex: the expectation of men's provision in sexual relationships, and the expectation that men should exhibit heightened sexuality and sexual prowess. Adherence to these expectations in transactional sex relationships varied between older and younger men and created hierarchies among men and between men and women and girls. We found that approval of transactional sex was contested. Although young men were likely to object to transactional sex, they occupied a structurally weaker position than older men. Findings suggest that interventions should employ gender synchronised and gender transformative approaches and should prioritise the promotion of alternative positive norms over preventing the exchange of gifts or money in relationships.
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Affiliation(s)
- Lottie Howard-Merrill
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Joyce Wamoyi
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Daniel Nyato
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Nambusi Kyegombe
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Lori Heise
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana Maria Buller
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Varela JJ, Sánchez PA, Aguayo F, González C, Alfaro J, De Tezanos-Pinto P. Gender attitudes, school violence and well-being among Chilean adolescents. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02637-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gittings L, Colvin CJ, Hodes R. Blood and Blood: Anti-retroviral Therapy, Masculinity, and Redemption among Adolescent Boys in the Eastern Cape Province of South Africa. Med Anthropol Q 2022; 36:367-390. [PMID: 35029315 PMCID: PMC9279516 DOI: 10.1111/maq.12686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
Adolescents living with perinatally acquired HIV are among the first generation in South Africa to grow up with anti‐retroviral therapy and democratic freedoms. In this article, we explore the biosocial lives of adolescent boys and young men living with HIV in the Eastern Cape Province of South Africa. We conducted qualitative research with 36 adolescent boys and young men in 2016‒2018, including life history narratives, semi‐structured interviews, and analysis of health facility files. [masculinity, South Africa, HIV, adolescence]
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Affiliation(s)
- Lesley Gittings
- Centre for Social Science Research, University of Cape Town.,Factor-Inwentash Faculty of Social Work, University of Toronto
| | - Christopher J Colvin
- Department of Public Health Sciences, University of Virginia.,Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town.,Department of Epidemiology, Brown University
| | - Rebecca Hodes
- Centre for Sexualities, AIDS & Gender, University of Pretoria.,Department of Historical and Heritage Studies, University of Pretoria
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Schamp J, Vanderplasschen W, Meulewaeter F. Treatment providers' perspectives on a gender-responsive approach in alcohol and drug treatment for women in Belgium. Front Psychiatry 2022; 13:941384. [PMID: 36111302 PMCID: PMC9468262 DOI: 10.3389/fpsyt.2022.941384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Gender inequity is a pervasive challenge to health equity on a global scale, and research shows the impact of sex and gender on substance use regarding for example epidemiology, treatment needs, treatment admission and treatment outcomes. The gender-transformative approach to action and health indicates that health interventions may maintain, exacerbate or reduce gender-related health inequalities, depending on the degree and quality of gender-responsiveness within the programme or policy. However, research shows a lack of gender-responsive initiatives in the alcohol and drug addiction field. AIMS The purpose of this study is to explore in depth how alcohol and drug treatment can be made more sensitive to female users' treatment needs from the perspective of service providers. Consequently, study findings can inform the development of gender-responsive treatment options and aid to a deeper understanding of how these trends are designated on the continuum of approaches to action and health in the alcohol and drug field. METHODS Four focus groups were organized across different regions in Belgium with a total of 43 participants, including service providers, policy makers and women who use(d) drugs. RESULTS The perspective of the participants on substance use prevention and treatment for female users incorporates some crucial gender-specific and gender-transformative features. Next to implementing mother-child options, a holistic approach, experts by experience and empowering women in treatment, professionals report the relevance of awareness raising campaigns targeting all levels and sectors in society. Also, recurring attention was given to the role of men in the narratives of female users. CONCLUSION Study findings show that the field of alcohol and drug prevention and treatment is being looked at through the lens of gender-responsiveness. However, to achieve improvement in the lives of both women and men, and hence creating more equal chances and opportunities in substance abuse treatment, the gender-transformative approach in addiction care needs to be further explored, criticized and established in practice and future research.
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Affiliation(s)
- Julie Schamp
- Department of Social Educational Care Work, University of Applied Sciences and Arts, Ghent, Belgium
| | - Wouter Vanderplasschen
- Department of Special Needs Education, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Florien Meulewaeter
- Department of Special Needs Education, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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Harris-Fry H, Saville NM, Paudel P, Manandhar DS, Cortina-Borja M, Skordis J. Relative power: Explaining the effects of food and cash transfers on allocative behaviour in rural Nepalese households. JOURNAL OF DEVELOPMENT ECONOMICS 2022; 154:102784. [PMID: 34824488 PMCID: PMC7612026 DOI: 10.1016/j.jdeveco.2021.102784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We estimate the effects of antenatal food and cash transfers with women's groups on household allocative behaviour and explore whether these effects are explained by intergenerational bargaining among women. Interventions were tested in randomised-controlled trial in rural Nepal, in a food-insecure context where pregnant women are allocated the least adequate diets. We show households enrolled in a cash transfer intervention allocated pregnant women with 2-3 pp larger shares of multiple foods (versus their mothers-in-law and male household heads) than households in a control group. Households in a food transfer intervention only increased pregnant women's allocation of staple foods (by 2 pp). Intergenerational bargaining power may partly mediate the effects of the cash transfers but not food transfers, whereas household food budget and nutrition knowledge do not mediate any effects. Our findings highlight the role of intergenerational bargaining in determining the effectiveness of interventions aiming to reach and/or empower junior women.
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Affiliation(s)
- Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Corresponding author. London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Naomi M. Saville
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Puskar Paudel
- Mother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal
| | - Dharma S. Manandhar
- Mother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jolene Skordis
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
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