1. Andrew Levack and Lori Rolleri
Gender Matters:
Working with Youth to Explore Views of Masculinity and Femininity and Their Impact on Health Outcomes
Andrew Levack and Lori Rolleri

2. Session Objectives
Describe how rigid norms about gender influence health outcomes
List three key steps in gender transformative programming
Describe the Gender Matters teen pregnancy prevention intervention
Identify at least two ways that gender norms can be integrated into existing science-based ARH curricula

3. What is Gender?

4. What is Gender?
Socially constructed roles, behaviors and attributes that a given society considers appropriate for men and women.

5. What is Gender?
Socially constructed roles, behaviors and attributes that a given society considers appropriate for men and women.

6. Sex or Gender? Women give birth to babies, men don’t.
Girls should be gentle, boys should be tough.
Women can breastfeed babies, men cannot.
Four-fifths of all the world’s injecting drug users are men.
Women get paid less than men for doing the same work.
The number of women with HIV infection and AIDS has increased steadily worldwide.

7. Assignment Turn to a person sitting next to you
Take one minute each to share some of the messages you received growing up about how you were expected to behave as a male or female.
If it helps, think about the times you were told to:
“Act Like a Man” or
“Act Like A Lady”

8. “Act Like A Man” Be tough Be strong Don’t cry or show emotion
Be dominant over women
Have many sexual partners
Take risks
Drink / do drugs and handle it
Be in control
Don’t ask for help
Violence as a means to address problems 8

9. US-Specific Data on Male Gender Norms
Adolescent males who held traditional attitudes towards masculinity indicate having:
More sexual partners in the last year
Less intimate relationship at last intercourse with current partner,
Greater belief that relationships between women & men are adversarial.
Less consistent use of condoms
Specific attitudes about condoms associated with low condom use
Less belief in male responsibility to prevent pregnancy
Greater belief that pregnancy validates masculinity
(Pleck J. et al, Masculinity ideology: Its impact on adolescent males heterosexual relationships, Journal of Social Issues, 1993, 49 (3:)11-29.)

10. “Act Like a Lady” Be seen, not heard Look pretty
Defer to men to make decisions
Don’t get angry
Do not have sex until marriage
Don’t talk about sex
Be the caretaker and homemaker
Keep your man – provide for him
Have children

11. “Act Like a Lady” “Acquiescent femininity” (Jewkes et al 2010):
Traditional constructions of femininity are characterized by accommodating the interests and desires of men.
Encourages resonance, rather than dissonance with harmful male norms
Young women whose gender ideology was relatively traditional have a lower age at first motherhood than those whose gender ideology is less traditional. (Stewart, 2003)

12. Different Constructions of Femininity
“Assertive communication isn’t what works. Aggressive communication is what works.”
“We do it (treat badly) to guys because guys do it to us.”

13. Since 1996, EngenderHealth’s gender work…
…has reached thousands of people in 26 countries with the goal of promoting healthy gender norms and positive SRH outcomes through:
group education
community engagement
clinical services with the goal of promoting healthy gender norms and SRH outcomes

14. Lessons Learned Gender Transformative Approach
Gender Synchronized Approach

15. Adapted from – Geeta Rao Gupta, SIECUS Report, Vol. 26, No. 5, 2001
Program Continuum
Gender transformative
Gender-sensitive/accommodating
Gender-neutral/blind
Gender exploitative
Adapted from – Geeta Rao Gupta, SIECUS Report, Vol. 26, No. 5, 2001

16. Gender Exploitive
Takes advantage of rigid gender norms and existing imbalances of power
Can result in harmful consequences and undermine a program’s intended objective

17. Exploitative

18. Gender Blind
Little or no recognition of the influence of gender norms on behavior
Not harmful programming, but a missed opportunity

19. Gender Neutral

20. Gender Accommodating Acknowledge the role of gender norms & inequities
Develop activities to adjust to and/or compensate for them
Do not actively aim to change norms, but strive to limit the impact of harmful gender norms
Can provide a sensible first step toward gender transformative programming

21. Accommodating Young Men’s Clinic Designed specifically for young men
Comprehensive SRH services (STIs, physical exams, FP, RH counseling)
Informational materials, slideshows and videos
Hours designed to best serve male clients
Few opportunities to build awareness, question and redefine harmful norms regarding masculinity

22. Three Tasks (GT Programming)
A program that allows participants to develop awareness, question and redefine the socially constructed roles, behaviors and attributes that a given community considers appropriate for men and women.
Gender Transformative programs generally address multiple forces in an individual's environment (e.g., peers, health facilities, workplaces, media, government, etc.)

23. Transformative

24. Transformative

25. Gender Synchronized
Engage both sexes in challenging harmful constructions of masculinity and femininity
Equalize the balance of power between men and women in order to ensure gender equality and transform social norms that lead to gender-related vulnerabilities
View all actors in society in relation to each other

26. Gender Matters Intervention
Three-component teen pregnancy prevention intervention:
20-hour youth curriculum
Social media
Community-based events

27. Gender Matters Curriculum
Delivered over five days (four hours per day)
Two facilitators (one male, one female)
Workshop Sessions:
Day One: Understanding Gender
Day Two: Healthy Relationships
Day Three: Are You Ready to Become a Teen Parent?
Day Four: Skills to Prevent Teen Pregnancy
Day Five: Taking Action

28. Video Statements from Gender Matters Participants

29. Gender Matters Declaration of Independence
I am the boss of me.
I decide what being a man or a woman means to me.
I treat others in the way I want to be treated.
I decide when and if I am ready for sex.
I use protection every time I have sex.
I go to the clinic to get tested and protected.

30. Examples of Gender Integration

32. Specific Gender Attitudes and Norms Addressed in Gender Matters
(See Handout)

33. Integrating Gender During All Phases of Program Planning:
Relationship/Commitment Building
Assessment
Goal Setting
Program Design and Adaptation
Organizational/Staff Capacity Building
Program Implementation
Program Evaluation
Quality Improvement

34. Logic Models Interventions Determinants Behaviors Delay onset of sex
Health Goal
Design intervention
activities that are
directly linked to
these determinants
and will
change them.
Knowledge
Attitudes
Skills/Self Efficacy
Intentions
Parent-Child Communication
Gender Norms
Delay onset of sex
Increase use of contra-ceptives including condoms
Reduce adolescent pregnancy in Pittsburg, PA 34

35. Adaptation is …
making changes (e.g., additions, changes, deletions, substitutions, etc.) to an evidence-based program in order to make it more suitable for a particular population and/or an organization’s capacity without compromising or deleting its core components. 35

36. Three Tasks (GT Programming)
Create Awareness about Gender Norms
Using examples from media
Sex disaggregated data
Personal reflections
Question Gender Norms
Why are there differences?
What are the costs of rigid norms?
What are the benefits gender equality?
Redefine Gender Norms
Promote alternative/positive models of masculinity
Build skills and self-efficacy to model new norms
Advocacy

37. Becoming a Responsible Teen (BART)
Session 2: Making Sexual Decisions & Understanding Your Values
Major Activities
Review of definitions and how HIV is transmitted
AIDS and African Americans
HIV Feud (game)
Personalizing HIV Risks
Exploring drug risks for HIV
Support systems

38. BART Adaptation
Review of definitions and how HIV is transmitted: Incorporate “gender” into list of definitions
AIDS and African Americans: Include information about how HIV affects men and women differently, discuss reasons why
Personalizing HIV Risks & Exploring drug risks for HIV: Explore how gender norms affect sexual decision making and risk taking; Ask youth to redefine gender norms to support healthy behavior

39. Reducing the Risk Classes 3 & 4: Refusals and Using Refusal Skills
Major Activities
Talk to Your Parents Homework
Introduce Refusals
Demonstrate Role Plays
Role Plays in Small Groups

40. Reducing the Risk Adaptation
Talk to Your Parents Homework: Include interview question about the role gender plays in sexual decision making for parents
Introduce Refusals: Integrate discussion about the types of gender norms that may make it difficult for a girl or a boy to refuse sex
Demonstrate Role Plays & Role Plays in Small Groups: Integrate debrief discussion that helps to redefine these norms

41. For More Information… Andrew Levack, MPH Lori A. Rolleri, MSW, MPH
Director, Director Gender Matters
Gender and Men as Partners, EngenderHealth
Lori A. Rolleri, MSW, MPH
Senior Technical Advisor, Team Lead

42. Questions