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

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

What is Gender?

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

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

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.

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”

“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

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.)

“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

“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)

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.”

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

Lessons Learned Gender Transformative Approach Gender Synchronized Approach

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

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

Exploitative

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

Gender Neutral

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

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

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.)

Transformative

Transformative

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

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

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

Video Statements from Gender Matters Participants

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.

Examples of Gender Integration

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

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

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

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

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

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

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

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

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

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

Questions