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Aligning Gender Strategies to Foster a Better Balance of Male-Female Responsibility with an Emphasis on the Situation of Adolescent Girls Presented by:

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1 Aligning Gender Strategies to Foster a Better Balance of Male-Female Responsibility with an Emphasis on the Situation of Adolescent Girls Presented by: Judith Bruce Senior Associate and Policy Analyst, Population Council A version of this was presented at: Tuesday, March 3rd 2009 UN Commission on the Status of Women discussion: The shared responsibilities between women and men in advancing sexual and reproductive health, Dag Hammarskjold Library Auditorium (UN Secretariat), New York This will be made available at the Rio Conference entitled Global Symposium on Engaging Men and Boys in Gender Equality, Rio de Janeiro, March 30 – April 3, 2009 Special thanks to Nina Lopatina for her help in preparation © 2008 The Population Council, Inc.

2 Why Girls? The poorest girls in the poorest communities bear special focus for work to foster gender equity. What is proposed here is a strategy that seeks as a first priority to build up the health, social, and economic assets of girls at high risk: Girls at risk of forced sex, especially those under the age of 15. Girls living in HIV-affected communities, under the double threat of poverty from HIV and forced or economically driven exchanges of sex for gifts and money Girls at risk of child marriage. Adolescent girls in “marriages.” Girls living apart from both parents and not in school.

3 Considerations in Setting Priorities
Gender equity is an elusive and important concept. Its achievement is important to all females and males. However, driving this emphasis on specific populations of girls are a set of considerations: That girls’ puberty comes two years earlier than boys’, potentially intensifying their exposure to negative outcomes arising from gender norms. Gender norms generally restrict options, choices, and protections for girls while keeping them at least stable and opening a door for boys. That abuses that take place early in life are more consequential than those later in life in forming a self-image, a sense of agency. There are settings in which high proportions of girls suffer violent, unchosen, health-threatening outcomes as a result of gender norms – they may be appropriate for an “ecological approach.” That such abuse, though rising also in boys, is particularly prevalent in girls. For that reason, the point of view expressed here is that though work to establish gender equity and safety is important for all, we must give a priority to the poorest girls (10-19) in the poorest communities at the highest risk

4 Facts to Consider The majority of sexual activity of adolescent girls (10-19) in developing countries takes place in the context of marriages that are often illegal (under legal age) and unchosen. A significant proportion of adolescent girls in many settings report that their first sexual experience was forced or tricked. Girls that are classified as sexually active frequently do not identify themselves as being in a relationship. Girls can often identify specific times in the day, month, or year or specific types of family crises or tasks (such as water and wood fetching) that increase the risk of sexual violence or economically driven exchanges of sex for gifts and money.

5 Facts to Consider V. The males most problematic to adolescent girls are not necessarily (chosen) partners, nor adolescent male peers, but: Fathers (with the complicity of mothers forcing unwanted sexual initiation in marriage). Older males predating on younger girls. The age gap between “partners” at sexual initiation is often greater than at any other point in the sexual lifecycle. Clusters of men in specific public locations which create risks and often confine girls’ movements, thereby limiting their ability to build health, social, and economic assets. Employers of girls in domestic service, girls who are in exploitative and often illegal underage work. Brothers : Who by not carrying their fair share of family labor limit girls. May actively discourage their sisters from participating in new opportunities under the guise of “protecting” their reputations.

6 Let’s consider the situation of girls in or at risk of child marriage

7 If present patterns continue, over the next ten years 100 million girls will be married as children. Some hot spots: % of year old girls married by 151 % of year old girls married by 181 Estimated % of year old girls living with HIV, national2 Country [DHS Year] (Regional hotspot) National Regional hotspot Ethiopia [2005] (Amhara) 17.6 36.7 44.7 69.1 5.7-10 Mozambique [2003] (Niassa) 16.1 32.9 56 77.3 10.7 Malawi [2004] (Southern) 8.7 11.4 47.9 54.3 9.6 Tanzania [2004] (Arusha/Tabora) 5.5 13.1* 39.8 60.6** Uganda [2000/01] (Eastern) 10.8 15.6 51.2 61 5 Zambia [2001/02] (Eastern) 6.3 9.9 39.7 51.8 12.7 *Arusha **Tabora Source: 1Demographic and Health Surveys (DHS) 2UNAIDS and UNFPA/PRB Tabulations: Adam Weiner, Population Council

8 Child brides, married adolescents: A world apart
Unmarried sexually active girls Married adolescents Older married women

9 Social isolation of married girls
Married adolescent girls are typified by: - Highly limited or even absent peer networks - Restricted social mobility/freedom of movement - Low educational attainment and virtually no schooling options - Very limited access to modern media (TV, radio, newspapers) and health messages - Very low participation in clubs or organizations - Almost entirely absent from current youth serving initiatives Source: Haberland, N., Chong, E., and Bracken, H. “Married Adolescents: An Overview.” Paper prepared for the Technical Consultation on Married Adolescents, WHO, Geneva, Dec 9-12, 2003.

10 Social Isolation of Married Girls
Case study: Amhara, Ethiopia All boys (n = 925) All girls (n = 937) Never married girls (n = 663) Ever married girls (n = 274) Social participation in the last week Socialized with friends  80.1*** 70.3 71.9~ 66.4 Gone outside your home to meet same-sex friends 36.1*** 21.2  24.0** 14.6 Gone to a church or mosque 17.2 25.0*** 21.9 32.8** Participated in a coffee ceremony 81.6*** 76.7 75.0 80.7~ Media exposure in the last week Listened to the radio  37.2*** 24.4 27.0** 17.9 Watched TV 9.1 7.8 9.5** 3.6 Differences between groups significant at ~p<0.10; *p<0.05; **p<0.01; ***p<0.001 Source: Erulkar et al. 2004a

11 Child marriage and HIV: Risk without guidance
Older partners Higher sexual frequency Intense pressure for pregnancy Greater social isolation Difficulty benefiting from any of the conventional HIV protection messages: Abstinence Reduce sexual frequency Reduce number of partners Use condoms Know one’s own and one’s partner’s HIV status, Observe mutually monogamous relations with an uninfected partner

12 Emerging evidence of high rates of HIV infection in married girls
Unmarried, sexually active Kisumu, Kenya 32.9% 22.3% Ndola, Zambia 27.3% 16.5% Sources: Glynn, J.R., Caraël, M., Auvert, B., Kahindo, M., Chege, J., Musonda, R., Kaona, F., and Buvé, A., for the Study Group on Heterogeneity of HIV Epidemics in African Cities. “Why do young women have a much higher prevalence of HIV than young men?” A study in Kisumu, Kenya and Ndola, Zambia. AIDS 15(suppl 4), S51-60, 2001; Bruce, J. and Clark, S. “Including Married Adolescents in Adolescent Reproductive Health and HIV Policy,” Prepared for for the Technical Consultation on Married Adolescents, WHO, Geneva, December 9-12, Under review for publication; Clark, S. “Early Marriage and HIV Risks in Sub-Saharan Africa,” Studies in Family Planning, 35(3), 2004; Clark, S., Bruce, J., and Dude, A. “Protecting Young Women from HIV/AIDS: The Case Against Child and Adolescent Marriage.” International Family Planning Perspectives,32(2), June 2006.

13 Let’s consider specific populations of younger, socially isolated girls at high risk

14 In some countries, especially those in sub-Saharan Africa, the majority of girls are living in urban areas are living with only one or no parent; in some settings 10% or more are living with neither parent and not in school Country % living with one parent % living with neither parent % living with neither parent and not in school Estimated number of girls living with neither parent and not in school* Nigeria (2003) 21 19 5 402,800 Malawi (2004) 23 31 45,100 Mozambique (2003) 27 25 9 125,247 Ethiopia (2005) 15 8 391,400 Haiti (2000) 30 13 70,600 Peru (2000) 11 2 30,000 Bolivia (2003) 22 4 21,000 Dominican Republic (2002) 32 9,600 Indonesia (2002/03) 7 1 109,100 Source: Demographic and Health Surveys (DHS) Tabulations: Adam Weiner, Population Council * Calculations based on DHS and individual country census data

15 Linkages between social connectedness and adolescent girls’ vulnerability
Girls are less likely to have many friends than boys, and low wealth is associated with girls having fewer friends Socially-isolated girls are 6 times more likely to have been physically forced to have sex than socially-connected girls Ever forced to have sex: Females age 14-16 “I have many friends at my school” Females age 14-16 Source: Hallman, K., and Judith Diers. “Social Isolation and Economic Vulnerability: Adolescent HIV and Pregnancy Risk Factors in South Africa,” presentation at the Annual Meeting of the Population Association of America, Boston, MA.; Hallman and Onabanjo 2005

16 Linkages between poverty and forced sexual relations
First sex was not willing: sexually experienced girls aged 14-19; Durban, South Africa Source: Hallman 2006

17 Linkages between family situation and poverty-driven sexual relations
Orphaned girls are three times more likely to have ever traded sex for money, goods, or favors than non-orphaned girls (6% vs. 15%) Economically-motivated sexual encounters Ever traded sex: Debuted females age 14-16 Source: Hallman, K. Socioeconomic Disadvantage and Unsafe Sexual Behaviors of Young Women and Men in South Africa. Population Council Working Paper 190, 2004.

18 What is the state of the art of gender-sensitive programming?
These data are drawn from an analysis, provisionally entitled “Aligning Gender Strategies to Benefit Both Males and Females: An Examination of Illustrative HIV and Gender Programs” by Nicole Haberland, Amy Joyce, Tobey Nelson, and Eva Roca. There will be a forthcoming paper.

19 Profile of Participating* Programs
Location: 70% SSA, 22% India, 3% N.Af, 2% Brazil, 2% Vietnam Size: 54% > 5,000 22% < 1,000 24% 1,000-5,000 Funding sources: 37% US gov’t; 37% private; 11% multilateral; 8% national/local gov’t; 5% other bilateral Implementing organizations: 50% single NGOs; 35% multiple NGOs; 15% research organizations * 61 programs overall, of which 58 dealt with heterosexual sexual relations

20 Who is reached in “HIV and Gender” programs directed at heterosexual populations?
36% of programs reach either males or females exclusively. Of those: 64% of programs work with both males and females. Of those: (36% of all programs work with couples). 68% work exclusively with females (of the 15 that do, 4 work with girls and 8 work with women and girls. 32% work exclusively with males (2 boys only, 5 men & boys). 80% primarily reach women (more than 50%). 20% primarily reach men (more than 50%). Primarily = more than half

21 Characteristics of male-focused, female-focused, and couple-centered programs
Female-focused programs are more likely to engage gatekeepers than are male-focused programs. 50% of female-only programs aim to build girls’/women’s economic skills/capital, whereas no male-only programs do this for men/boys. Couple-centered programs stress mediation, negotiation, gender norms, and direct services. FIRST bullet: Among female focused programs about one-quarter (23% ) are adult only. Only 12.5% of male-focused programs are adult only THIRD BULLET: 31% of female prog’s vs. 3% of male prog’s

22 Of the 64% of programs that engage men, few consult their female participants in identifying male targets

23 Confirming behavioral change
Only 35% of programs that include men even report they confirmed changes with females they had identified. When probed, only 13% of all programs which engaged males “only” or males and females tried to directly seek women’s/girls’ own opinions about changes in their partners’ (or male peers’) behavior and/or attitudes.

24 Prospects for change

25 Over one-third (37%) reported that their problem statement changed over the life of the project
“When we started out, working with different communities, we focused on young men and other support groups, such as TBAs and boys’ parents. Over time, we learned that male involvement alone wasn’t addressing key SRH problems in these communities. Young women also [were] a key component within these rural communities. If you work only with young men, the difference you make is not as large as if you work with young women too.” (reported by a Sub-Saharan African youth-serving organization) BUT THERE IS IMPROVEMENT --This wasn’t even part of mainstream discourse, now we’re

26 What do we mean by “gender alignment” anyway?
A gender aligned program: in program design, implementation and evaluation. Explicitly identifies specific goals in terms of asset-building, attitude change, and behavior change by age and gender, possibly partnership status. Is conscious of and addresses the dynamic between male-female attitudes and behaviors.

27 What could programs do with respect to priority females?
Select females deliberately with specific criteria based on, for example, the extensiveness of the abuse or risk. Use data to identify geographic areas in which there are concentrations of especially vulnerable females, e.g. districts in which girls in domestic service live/work. Ask the “index” females which males are problematic to them. Rank in sequence the males & plan the programs to address the men presenting the most severe problems in sequence.

28 What could programs do with respect to priority females?
Consult with affected females to devise a plan to change male behavior. Provide realistic/private/safe means to assess change. Tailor program content for adolescent girls, mindful of their safety, the possibility of coerced or tricked sex, a potentially skewed power imbalance, and the economic implications, short term and long term, of many adolescent relationships.

29 What could programs do with respect to male participation?
Select male participants deliberately in consultation with female stakeholders, e.g. men who have a history of violence, are “baby fathers”, partners of pregnant women, employers, brothers, fathers. Extend the effectiveness of current male-focused programs by building the protective assets of the affected females’ social support, livelihood skills, safety nets, knowledge, access to services, and safe channels of expression. Overall, work bilaterally: build the protective assets of specific females as well as address the men in their environment that they identify as bringing the greatest challenge to their well-being.

30 Some considerations in evaluating programs
Measure programs’ ability to reduce structural violence, such as child marriage or FGM. Define distinctive goals by gender and age for males and females in terms of gains and changes sought in attitudes, knowledge of rights, and behaviors. Track these gender/age inputs to a primary client, e.g. a female who knows her rights, a male who knows how to practice safe sex. Hypothesize and track potential synergies among inputs to different clients, for example, the potential trade-ons of programs that simultaneously build the protective assets of females and work with appropriately selected men on a parallel set of benchmarks for them.

31 Some considerations in evaluating programs
When the couple paradigm is appropriate, confirm with both partners --do not rely on one-sided self-reports in program evaluation, for example: Assess changes in females’ autonomy and agency by also asking their partners. Assess changes in men’s use of the threat of violence to control their intimate partner by not only asking men, but also asking their partners/wives. Assess male willingness to carry a fair share of the work burden by asking mother of child/wife whether there is a changed participation in child care.

32 Some considerations in evaluating programs
Change takes time and relationships transmute. Ideally, programs would be evaluated over a 5-year rather than a 3-year period to capture sustained change, at the individual as well as couple level. Assess male willingness to carry a fair share of the work burden by asking mother of child/wife whether there is a changed participation in child care. If we begin to see the violence and abuse that can result from negative gender norms as a disinvestment in the whole community. We may be able to mount and measure ameliorative programs within specific catchment areas. Programs could address important and linked subsets of males and females in parallel to measure individual level and community change in attitudes, levels of violence, reported safety on the streets, and so forth.

33 Thank you!!!

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