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**Men and Reproductive Health Programs:**

**Influencing Gender Norms**

**Prepared by**

Victoria White, M.P.H.

Dr. Margaret Greene, Ph.D.

Dr. Elaine Murphy, Ph.D.

**Submitted to**

U.S. Agency for International Development

Office of HIV/AIDS

**Submitted by**

The Synergy Project/Social & Scientific Systems, Inc.

1101 Vermont Avenue, Suite 900

Washington, D.C.

Telephone: (202) 842-2939

Fax: (202) 842-7646

USAID Contract: HRN-C-00-99-0005-00

#   {#section .unnumbered}

# Contents

[Introduction 1](#introduction)

[Conceptual Framework 3](#conceptual-framework)

[Review of Literature 7](#review-of-literature)

> [CANTERA 11](#cantera)
>
> [New Visions Program for Boys and Young Men
> 13](#new-visions-program-for-boys-and-young-men)
>
> [Better Life Options Program for Boys
> 15](#better-life-options-program-for-boys)
>
> [Conscientizing Male Adolescents Program
> 17](#conscientizing-male-adolescents-program)
>
> [Mobilizing Young Men To Care Project
> 19](#mobilizing-young-men-to-care-project)
>
> [Men As Partners Program 21](#men-as-partners-program)
>
> [Talking Man-To-Man 25](#talking-man-to-man)
>
> [Program H 27](#program-h)
>
> [Puntos de Encuentro 29](#puntos-de-encuentro)
>
> [Stepping Stones 31](#stepping-stones)
>
> [Soul City 33](#soul-city)
>
> [The Strength Campaign 35](#the-strength-campaign)
>
> [The Respect Campaign 37](#the-respect-campaign)
>
> [Peer Advocates for Health 39](#peer-advocates-for-health)

[Matrix of Programs 41](#matrix-of-programs)

[Analysis and Discussion 47](#analysis-and-discussion)

[Conclusion 53](#conclusion)

[References 54](#references)

[Annex](#annex): [Annotated Bibliography 56](#annotated-bibliography)

#  {#section-1 .unnumbered}

#   {#section-2 .unnumbered}

# Introduction

In September 2003, program implementers, researchers, evaluators, and
donors came together in a four-day conference in the Washington, D.C.,
area to learn about men and reproductive health programs around the
world that had challenged gender norms. Participants in the conference
were particularly interested in those programs that could show through
evaluations that gender-related attitudes and behaviors had changed in a
direction likely to reduce health risks, specifically, those associated
with violence and unsafe sex. Identifying these programs and the
strategies that made them successful has implications for future
gender-related reproductive health, HIV/AIDS, and maternal and child
health programming because they may serve as models to be adapted,
scaled up, or replicated elsewhere. This review aims to highlight these
good programmatic models, some of which were presented at the September
2003 conference.

Four general themes emerged in the process of conducting this review.
First, initiatives affecting gender norms for the sake of doing so are
still relatively nascent. Only in the past ten years have they become a
significant subset of the wide range of programs in the global health
arena.

Second, substantive evaluations are not common. There simply is not a
large enough sample of thorough and systematic data on the efficacy of
these programs as a whole. Data are typically gathered and analyzed from
the perspectives of participants and facilitators at a level too cursory
to allow an in-depth assessment of their outcomes. Often, these
evaluations do not include comparable data from a control group;
therefore, it is unknown whether or not the results are statistically
significant.

Third, evaluations that specifically report the program's effect on
gender norms---and not only on health outcomes---are rare. Programs may
influence this type of social norm, either directly or indirectly, but
they generally neglect to include their effects on gender norms in an
evaluation.

Fourth, health programs affect social norms related to gender roles even
if they do not aim to address these norms directly. Despite their
inclusion of and near virtual effect on gender roles, few programs
actually separate their work of influencing gender norms from their
efforts to modify or eliminate the behaviors that arise from these
social constructs. For example, programs designed to curb gender-based
violence may include a short module on gender roles and challenging
contemporary definitions of masculinities; similarly, life skills peer
education programs may introduce the concept of alternative and flexible
gender roles to youth and create an enabling environment within the
classroom setting where those alternative roles are reinforced and
encouraged. This is largely due to the historical neglect of
gender-sensitive approaches specifically purposed to alter gender norms
in global health programs.

Programs influence gender norms regardless of whether or not they
incorporate gender-sensitive approaches, because these norms are
inextricably linked to all facets of health behavior. Without proper
consideration of gender as a determinant of health, initiatives can have
haphazard or unintended effects on gender norms. For example, between
1993 and 1994 in Zimbabwe, the Male Motivation and Family Planning
Campaign affected many Zimbabwean men. The planners integrated language
from competitive sports and images of local soccer heroes into some of
the campaign's materials. As intended, the messages appealed to the male
target audience and contraceptive use increased. The action-oriented and
assertive imagery and messages reinforced gender stereotypes, however.
According to surveys, not only did men become more interested and
involved in selecting a family planning method, men tended to dominate
and even assume full responsibility for this decision. Rather than
endorsing shared decision-making between both partners in a couple, the
mass media campaign had the effect of sanctioning and encouraging
male-dominant behavior.[^1]

The relative newness of this interest in changing gender norms and the
lack of long-term, large-scale evaluation efforts means that we cannot
state with much certainty that the attitudinal changes reported by
participants in preliminary and postintervention data are sustainable.
Moreover, whether or not the reported attitudinal changes have been
exhibited as behaviors is left to speculation and confirmation by
forthcoming evaluations.

This review describes programs specifically designed to change social
norms related to gender roles. It explains the methodologies each
employed to achieve this goal and presents findings from evaluations
conducted to assess their efficacy. The information provided herein
attempts to compile information necessary to describe the best-evaluated
approaches to altering entrenched gender norms.

# Conceptual Framework

Over the past ten years, the calls for involving men in reproductive
health issues have emphasized the role of men in improving the health of
their families and themselves, and the importance of addressing the
gender inequities underlying poor reproductive health. In response, many
male involvement programs have been created. Most of these health
interventions have tended to be oriented toward changing behavioral
outcomes (e.g., condom use or the use of health services). Yet, shaping
these outcomes and guiding much of what we do in our everyday lives are
social norms, and central among these are gender norms. Gender norms are
some of the strongest social influences shaping men's and women's lives.
They provide the values that justify different and often discriminatory
treatment of one or the other gender. Widespread social discrimination
against women is visible in lower levels of investment in the
health,[^2] nutrition,[^3] and education of girls and women.[^4]
Institutionalized legal disadvantages for women underpin laws that keep
land, money, and other economic resources out of women's hands,[^5] and
by foreclosing protection and redress, they contribute to violence
against women.[^6]

Sexual and reproductive health is strongly affected by gender norms.
Norms favoring male children and promoting women's economic dependence
on men contribute to high rates of fertility in many settings. Inability
to negotiate sex, condom use, or monogamy on equal terms leaves the
majority of women and girls worldwide at high risk for unwanted
pregnancy, illness and death from pregnancy-related causes, and sexually
transmitted infections. Research has consistently shown that men play
key roles in the spread of sexually transmitted disease, and that women
bear greater reproductive health hazards.[^7]

Addressing gender norms and expectations is key to promoting behavior
change and is essential to instituting equitable relations between all
human beings, regardless of their gender. Clearly, the behavioral
changes that interventions bring about will be relatively limited if
programs do not address the underlying norms that determine them. We
might think of behaviors as being overlaid onto gender and other social
norms. Most programs have yet to address these norms, which cumulatively
direct the entire body of norms.

One widely known example of the relative effectiveness of considering
norms and not just behaviors can be observed in Uganda where efforts to
reduce HIV prevalence in the 1990s encouraged behavior change from many
angles. One such angle encouraged men in particular to reduce the number
of sexual partners they had through "zero grazing," a reference to the
tradition of tethering an animal to a stake and allowing it to graze in
a circle. In the context of gender norms that permit and often encourage
men to have multiple sexual partners, the message about caring for and
respecting their wives and themselves went far beyond a simple behavior
change.

Altering social norms is vital to the equitable distribution of
resources and rights between the sexes. Oftentimes, men act as the
gatekeepers to health care for women. They can either impede or
facilitate women's health service--seeking behavior. Gender roles
adversely affect men as well. Men may engage in high-risk behaviors more
frequently in order to meet the perceived expectations of social norms
related to gender. Men may also repress desires to display effeminate
characteristics due to social prohibitions on homosexuality or social
definitions of masculinity. These realities have been highlighted by the
AIDS epidemic and the combination of men's greater likelihood of having
multiple partners and women's difficulty in negotiating condom use or
the conditions of sexual encounters. Men's involvement in military
campaigns and the myriad risky behaviors associated with warfare
especially contribute to the cycle of infection in areas of Africa
ravaged by military conflict. Altering gender norms will be particularly
imperative in this context, as successive waves of demobilized troops
inculcated to adopt detrimental constructions of masculinity are
reintegrated into society. Furthermore, women's socialized and coerced
dependence on men both financially and emotionally, as well as women's
relative ignorance of the interplay of socioeconomic factors that
increase their vulnerability to infection, further exacerbate the
epidemic. These social, gender-related, and economic issues, among
others, contribute directly to the epidemic and can be addressed through
altering the socialized paradigms of masculinity and gender norms.

The purpose of this review is to present programs that have effectively
altered social norms regarding gender. Norms are perceived shared values
that are often the underlying principles motivating an individual's
outward behavior, which in turn, set the social climate. Debunking the
idea of a single hegemonic masculinity is imperative to addressing the
unhealthy repercussions of socially defined "maleness." This entails the
introduction of multiple and concurrent masculinities that can be
assumed in various contexts to enable men to adapt to social situations
with versatility to increase the probability of positive and
gender-equitable decision-making**.** This review presents a purposive
sample of programs that have affected social norms regarding gender in a
manner that has been captured in an evaluation. Examples were drawn from
regions throughout the world in order to present a balanced and accurate
sense of current efforts to change social norms related to gender.

Most of these programs do not describe their theoretical underpinnings.
However, the process of normative change---as opposed to individual
behavior change---is well captured by the theory of Diffusion of
Innovations (DOI) by Everett Rogers; the programs described follow this
process and are at one or another of its stages. "Diffusion is the
process by which an innovation is communicated through certain channels
over time among the members of a social system... \[leading to\] social
change."[^8] Initially, individuals who are open to (and sometime
seeking) innovation are influenced by the new ideas and practices of
opinion leaders whom they respect. These early adopters of the new
behaviors tend to be leaders within their own peer groups, and therefore
they bring many others to the new way of thinking and acting. When a
critical mass of adopters emerges, the mainstream social group follows.
Some people are late adopters, of course, and some never adopt the
innovation. Successful efforts to combat AIDS have followed this
approach,[^9] as have organized family planning programs.[^10] It should
be noted that theories of individual behavior change are not
incompatible with DOI theory. However, until a *critical mass* of
individuals who have changed attitudes and behaviors emerges, society
itself, and therefore social norms, will not change.

As the DOI theory well articulates, normative change hinges on the
adoption of an innovative idea by individuals until a critical mass of
adopters is achieved. Given this, the programs presented in this review
must be viewed as methods to prompt individuals and societies to
progress through the stages outlined in the DOI theory.

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# Review of Literature

For many years, reproductive health programs simply did not address
men,[^11] in part because women's centrality to reproduction was taken
for granted (an assumption that itself reflects social norms) and in
part because so little was known about men. Recent years have provided
much useful information about men. A 1999 review by the Panos Institute
provided extensive evidence on the special role that men were playing in
spreading HIV and linked men's behaviors to underlying gender
norms.[^12] A comprehensive analysis of men's reproductive health needs
worldwide by the Alan Guttmacher Institute provides much-needed
information about men, though it does not strongly address the ways in
which gender norms constrain reproductive health for both men and
women.[^13]

Over the past decade, numerous programs involving men have been
developed and documented. These programs involve men in safer
motherhood, offer diagnosis and treatment of sexually transmitted
infections, develop men's parenting skills, encourage men's support of
women when they seek services, and provide basic information and
counseling, among the range of their offerings. The wide universe of
programs can be glimpsed in the pages of several important reviews. For
example, a United Nations Population Fund review effectively divides
male involvement efforts into those that promote family planning, serve
men's needs, or attempt to address gender inequity, but does not dwell
on evaluation efforts.[^14] A UNICEF review similarly includes a wide
variety of programs, some of which attempt to change social norms. But
whether these programs have been evaluated is not discussed for the most
part.[^15]

Inspirational, life-changing, informative: these words can describe
nearly the entire myriad of programs designed to change gender norms.
Unfortunately, "evaluated" and "demonstrably effective" are not on that
list of descriptors. Several promising programs that are widely
recognized as being innovative and influential in their work to change
perceptions of gender roles have not been evaluated in ways that would
make their replication possible. For example, Fathers Inc., in Jamaica,
is a training and support program that teaches and encourages men to
nurture their roles as fathers and to assume the position of a
gender-equitable role model for their children and communities. PAPAI
works with adolescent fathers in Brazil, stimulating public discussion
on the importance of young men's participation in sexuality,
reproduction, and parenthood. The organization creates a space for young
fathers, who are an invisible and undervalued group, where they are
appreciated and challenged to assume greater responsibility by
developing their parenting skills and expanding their concepts of
gender, rights, and citizenship.[^16] In Mexico, the Male Collective for
Equitable Relationships (CORAIC) supports creative, emotional, and
respectful constructions of masculinity through programs focused on
nurturing men as fathers and preventing gender-based violence. It also
galvanizes community support to address these issues politically.[^17]
Salud y Género, based in Mexico, sensitizes men to the detriments of
socialized masculinity, especially violence, and how they affect both
men and women. The organization emphasizes working with men facing
social and economic issues in all-male or mixed-gender groups.

The Society for Integrated Development of Himalayas focuses instead on
achieving social justice through educational programs with youth and
network-building between commensurately empowered men and women. In the
Dominican Republic, the Catholic Institute for International Relations
has conducted gender workshops to explore and address the social and
cultural processes that enable gender-based violence. The institute has
also been involved in similar efforts in Haiti, facilitating discussions
analyzing cultural impediments and enablers that affect the power
balance between men and women that in turn influence issues of gender
and development.[^18] The Botswana National Youth Council works with
youth broadly by addressing their needs and anxieties about male
sexuality, including intimate partner relations, through a program
focused on preventing HIV infection. Thandizani, a Zambian
nongovernmental organization, engages communities in meaningful dialogue
on the interconnectedness of gender, sexuality, and vulnerability to HIV
in order to stimulate change in community norms.[^19] The University of
Edinburgh has worked with the Meru ethnic group in Kenya, providing
education on gender issues to men undergoing the initiation rite of
circumcision.[^20] These are just a few of the worthwhile programs
affecting the lives of men of all ages in different contexts.
Unfortunately, it cannot be stated definitively whether the
above-mentioned programs have been effective enough to be expanded or
replicated in other settings.

Influencing deeply entrenched social norms, such as those addressing
gender, is not easy, but clearly, it has already been done. One-hundred
years ago, women in the United States could not vote, and very few went
to college or worked outside the home. Women's emancipation, like all
great social changes, was in part due to organized efforts and in part
due to economic and other forces. Given the worrying state of
reproductive health throughout the world, including HIV/AIDS, we do not
have 100 years to wait. Good programs---given sufficient reach---can
accelerate the pace of progress. The programs described here meet the
criteria of successfully challenging gender norms as well as improving
reproductive health behaviors as outlined in the Framework for Men in
Reproductive Health programs.[^21] Adoption of the highest
criterion---that which changes socially defined male-female roles for
the better---will avoid problems of some male involvement programs that
have unintentionally reduced women's autonomy or increased violence in
their efforts to recruit men to use family planning.[^22]

The following review describes evaluated programs in developing
countries specifically designed to address social norms related to
gender roles. It explains the methods each employed to achieve this goal
and presents findings from various kinds of evaluations conducted to
assess their efficacy.

[]{.mark}

# CANTERA

(Central America)

## Overview

In English the name of this organization is synonymous with "quarry,"
meaning a rich or productive source. The work of CANTERA, which stands
for Population Education and Communication Center, has indeed been a
rich resource for the people it has served. This organization began its
work on masculinity and gender with men in 1994. Since 1989 the
organization has been a leader in popular education. It fuses gender
relations and women's personal experiences in its societal analyses.
Nicaragua, where CANTERA is based, is a predominantly Catholic and
male-dominated society.

## Scope

Two-hundred fifty men in Costa Rica, El Salvador, Guatemala, and
Nicaragua.

## Objectives

Through its workshops, CANTERA seeks to facilitate internal
transformative processes by examining social attitudes, values,
behaviors, and the social construction of masculinity using men's own
life stories as a starting point rather than theoretical frameworks.
Ultimately, through introspection and the recognition of the
contradictions and injustices related to gender roles, the program
encourages men to generate their own proposals for specific change and
to take responsibility for making these changes.

## Audience

Adult men.

## Implementation

Over the span of a year participants attend four 3½-day workshops
centered on the following themes in the order presented: 1) male
identities; 2) gender, power, and violence; 3) unlearning machismo; and
4) forging just relationships. During the first workshop the men engage
in exercises to help them question their own discriminatory practices,
reflect on the social construction of male identities, and consider the
methods men employ to exercise power. The second workshop builds on the
previous analysis of the roots of men's violence, its effects on men and
their families, and its relationship to the current socioeconomic
situation in Nicaragua. Men then brainstorm ways to reduce violence in
their families. In the third workshop, processes that would allow men to
change are identified, strengthened, and outlined in the form of a
methodology that can be employed to train other men. Men and women alike
participate in the last workshop in order to share what they have
learned and to deepen their individual analyses by taking into account
the other's perspectives.

Promoting change in the familial and personal spheres is the highest
priority. The religious nature of the society is integrated into the
workshops; facilitators often quote or elicit passages from religious
texts considered holy by Nicaraguans of Spanish descent and indigenous
peoples. Feature films serve as entry points for discussions to
deconstruct hegemonic definitions of masculinity (e.g., the film *Once
Were Warriors,* a graphic depiction of the negative effects of violent
masculinity on men and women; and *Marta and Raymond*, which inverts
gender roles to enable men to witness the mechanisms used to subjugate,
humiliate, and abuse women).

## Evaluation and Outcomes

One-hundred twelve of the original 250 men who participated in any of
CANTERA's workshops between September 1994 and September 1997 were
surveyed. The men's questionnaire consisted of 312 questions divided
into seven sections. Program evaluators overcame the lack of baseline
data by creating a "subjective approximation" and a "subjective
appreciation" (i.e., a surmised quantification and estimated trend) of
the men's perceived internal changes. They accomplished this by
separating the questions related to the men's pre- and
post-participation behaviors into sections.

When compared with data that had been gathered from surveys of women who
knew the male participants, both groups tended to agree that the men had
changed in the following ways: they reflected less "macho" perceptions
of masculinity, they participated more in domestic chores, their
relationships in the workplace had improved, they had reduced their
discriminatory practices, and they had demonstrated greater solidarity
with women. There was a significant increase in the number of men
actively seeking sexuality education, from 36 percent to 55 percent.

The pool of respondents was not a representative sample of the general
populations in their respective countries, which may explain their high
levels of seeking health education. Like the other 138 participants,
they were generally older, educated, and employed. This could be
explained by the fact that most of the men who took part in the
workshops were referred by their employers, usually nongovernmental
organizations.

In 1999, CANTERA developed and tested "El Significado de Ser Hombre"
(*What it Means to be a Man),* a training manual for former participants
to train others.

## Funding Sources

CANTERA receives the majority of its financial support from European and
U.S. voluntary organizations, development agencies, and religious
congregations. Some major financers include NOVIB and Van Leer
Foundation in The Netherlands; Swedish International Development Agency;
CAFOD, in England; Catholic Women, in Austria; OXFAM America; and
Friends of CANTERA, in the United States. CANTERA also generates revenue
by selling its publications and local goods.

## Contact Information

E-mail: <cantera@nicarao.org.ni>

[www.oneworld.org/cantera](http://www.oneworld.org/cantera)

## Sources

Welsh, Patrick. 2001. *Men aren't from Mars: Unlearning machismo in
Nicaragua.* London: Catholic Institute for International Relations.

CANTERA Web page:
[www.oneworld.org/cantera](http://www.oneworld.org/cantera). Accessed
October 13, 2003.

# New Visions Program for Boys and Young Men

(Egypt)

## Overview

The New Visions Program for Boys and Young Men, located in Upper Egypt,
is an informal educational program of basic life skills and reproductive
health developed in recognition of boys' distinct needs and rights, and
men's and boys' influence on the enabling environment for girls' rights.
A one-year pilot phase of this project, which was sponsored by the
Centre for Development and Population Activities (CEDPA) took place in
2002. The program is currently in its implementation phase, which is
projected to end in 2004. Beni Suef (the evaluation site) is a
relatively poor region of Egypt. Many of its socioeconomic indicators
were substantially lower than those for Egypt as a whole in 2001. For
instance, the female literacy rate was 35 percent, versus the national
average of 54 percent; and 51.2 percent of its residents are poor versus
the national average of 20 percent.

## Scope

While serving 1,900 young men in Beni Suef in 2002, the program is
expected to serve 8,500 participants in eleven governorates by 2004.

## Objectives

To influence gender norms related to reproductive and sexual health,
affecting the rights and needs of girls and boys alike.

## Audience

Literate adolescent boys between the ages of 11 and 20 in Upper Egypt.
The overwhelming majority of the boys in Beni Suef lived with both their
parents at the time of the evaluation.

## Implementation

In 65 educational sessions, facilitators provide participants with
information and discussion issues on a range of topics: gender, gender
roles, interpersonal relationships, and legal rights, among others in a
17 unit schedule. The program is implemented through 180 partnering
Youth Councils and nongovernmental organizations. Facilitators use both
interactive and noninteractive methods. Tapes of drama and poetry,
role-plays, puzzles, posters, and games are among the session aids.

## Evaluation and Outcomes

The evaluation was conducted in three rural villages in Beni Suef. One
of these villages served as a control. Knowledge, attitudes, and
practices surveys were conducted at baseline (T~0~), immediately
following the last educational session (T~1~), and one year after the
sessions (T~2~). Qualitative data were collected in the two intervention
villages through interviews with facilitators and focus groups with
participants. Only preliminary baseline and T~1~ findings are available.
These indicate not only increased awareness of the potential flexibility
of gender roles, gender equity, and gender violence, but also more
positive attitudes toward these issues among boys who underwent the
intervention. Specifically regarding gender equity, there was a
statistically significant decrease in the number of boys who thought
that boys and girls should be treated differently in terms of food,
work, marriage age, and movement outside of the house. There were also
large and significant increases in the proportion of boys who believed
that responsibilities should be shared between husbands and wives in
both society and within the household. More sensitive issues
historically entrenched by cultural and religious values were not as
amenable to change, but results were hopeful. Some evaluation items
indicated that boys displayed significantly more negative attitudes
toward female genital cutting. For example, the percentage of boys who
would prefer to marry an uncircumcised woman increased from 22 percent
to 37 percent. Moreover, those who agreed that the "benefits of female
circumcision outweigh any of the damages" decreased from 70 percent to
55 percent. Equally important, those who remained ambivalent began to
question the utility of the practice. Not all data were available to
contrast these findings with those of the control group.

## Funding Sources

This is a USAID-funded program implemented by CEDPA's Egypt office.

## Contact Information

Centre for Development and Population Activities

53 Manial Street, Suite 500

Manial El Rodah

Cairo 11451, Egypt

Tel: 2-02-365-4567

E-mail: <cedpaegypt@cedpa.org.eg>

[www.cedpa.org/egypt](http://www.cedpa.org/egypt)

## Sources

*Abstracts approved for presentation at the Global Conference on
Reaching Men to Improve Reproductive Health for All September 2003.*
Available at the following Web address:
<http://www.rho.org/reaching_men_09-03/9-03conf_accepted_abstracts.pdf>.
Accessed October 9, 2003.

Selim, Mona. 2003. *Preliminary findings from the New Visions Program
Pilot Evaluation in Egypt* (PowerPoint and oral presentation). Presented
to the Reaching Men to Improve Reproductive Health for All Conference,
Dulles, Virginia.

# Better Life Options Program for Boys

(India)

## Overview

In 2000, the Centre for Development and Population Activities (CEDPA)
began the Better Life Options Program for boys, based on an existing
CEDPA program that works exclusively with girls. Like other similar
programs, it evolved as a response to the need to work with boys, as
identified by girls in the female-specific program. It was developed
using CEDPA's "Better Life Options and Opportunities Model," which
integrates social mobilization with self-efficacy in order to empower
young people. A manual for adolescent boys was developed in 1999 and the
boys' project was planned and executed in a two-year period, between
2000 and 2002.

## Scope

Ten nongovernmental organizations partnered to implement the project
across eleven Indian states affecting 8,397 youth.

## Objectives

To challenge gender inequities and broaden the life options available to
adolescent youth through the use of an empowerment model in the context
of a holistic program.

## Audience

Adolescent boys, 10 to 19 years of age, took part in the program. The
majority of the young men were unmarried students who generally felt
they were not empowered. Preliminary profile data indicated that few
believed they could make an autonomous decision about when to marry (27
percent), whom to marry (36.1 percent), and the number of children to
have (40.7 percent). Moreover, some of the boys stated that peer
pressure, early marriage, and high family expectations were obstacles to
achieving their dreams, which further detracted from their sense of
autonomy.

## Implementation

CEDPA implemented its training module in three settings for differing
lengths of time: intensive camps lasting ten to 14 days; classroom
settings; and various social and educational settings for three to six
months, including vocational and remedial classes, clubs, and gyms. The
training module consisted of the following materials in both English and
Hindi: the "Choose a Future!" training manual, facilitators' handbooks,
posters, videos, and supplementary materials such as anatomy models,
exercises, training aids, and games.

The "Choose a Future!" manual specifically addressed gender issues and
engaged youth in issues surrounding awareness of self and gender,
communication skills, and interpersonal relationships among other
topics. Facilitators included health professionals, educators, and
community members.

## Evaluation and Outcomes

Data were collected systematically before and after the execution of the
project through precoded structured interviews on scheduled intervals.
Participating in the program were 2,379 boys who underwent both
data-collection sessions; however, the participants' input was not
complemented by that of a control group. Almost 12 percent of the
respondents increased their knowledge of nonviolent means of resolving
conflict; about 29 percent knew the definition of sexual harassment; and
at least 7 percent could identify the medical precautions that can
facilitate a healthy pregnancy. Also, there was a 14.8 percent increase
in the proportion of respondents who agreed that boys and girls would be
more equal if both were sent to school. Women and girls close to project
alumni anecdotally reported an increase in the participants' displays of
gender-equitable behaviors as well.

## Funding Sources

The Summit Foundation provided \$100,000, which was used to fund the
entire project.

## Contact Information

Centre for Development and Population Activities

50-M Shantipath

Gate No. 3, Niti Marg

Chanakyapuri

New Delhi, India 110021

Tel: 91-11 2467-2154

Tel: 91-11-2688-6172

E-mail: <bsood@vsnl.net>

## Sources

Mishra, Arundhati. 2003. *Enlightening adolescent boys in India on
gender and reproductive and sexual health* (PowerPoint and oral
presentation). Presented to the Reaching Men to Improve Reproductive
Health for All Conference, Dulles, Virginia.

*Youth Development Project.* Available at the following Web address:
[www.cedpa.org/projects/youth.html](http://www.cedpa.org/projects/youth.html).
Accessed October 28, 2003.

# Conscientizing Male Adolescents Program

(Nigeria)

## Overview

One impetus for the Conscientizing Male Adolescents Program, sponsored
by the International Women's Health Coalition, is the perception that
Nigeria is a country poised on the brink of an extensive HIV/AIDS
epidemic fueled by gender inequity. Its current HIV rate is almost 6
percent among adults aged 15--49. At 130 million, Nigeria is the most
populous country in Africa, and 50 percent of Nigerians are under the
age of 20. As in other countries in Africa, the youth population will be
the hardest hit, and young women will be affected most of all. Cultural
norms support egregious gender inequities, both in the Christian south
and the Muslim north. Economic and social turmoil generally override the
importance of health issues in daily life.

## Scope

Initiated in 1995, the Conscientizing Male Adolescents (CMA) program
began with a pilot project involving 25 boys recruited from three
secondary schools in Calabar, Nigeria. In the first six years of the
program, approximately 2,000 men and boys from Calabar and Uyo, a town
in neighboring Akwa-Ibom State, graduated from the program. In 2002, 600
boys were enrolled.

## Objectives

CMA seeks to foster critical thinking skills and, by so doing, challenge
gender norms and sexist behavior, and increase awareness of gender-based
oppression and equal rights.

## Audience

Boys between the ages of 14 and 20 who demonstrate qualities of
leadership and intelligence in the school setting are recruited into the
program.

## Implementation

CMA employs structured dialogues, a method inspired by Paolo Freire's
pedagogy of the oppressed. CMA is entirely operated by male community
members. Some field officers, who lead the dialogues, are adolescents
and alumni of the CMA program. The curriculum is structured in two
levels. The first level consists of weekly two-hour meetings at
secondary schools and covers the following topics: fundamental concepts
of biological differences between the sexes; gender oppression;
gender-based violence as both a social and personal phenomenon; and
men's responsibility in sexual relationships. Following a graduation
ceremony and promotion to the second level, the following topics are
covered in monthly one-day meetings at a Calabar hotel: communication
skills; logical thinking methods; and critical and anti-sexist
introductions to Nigerian society, world history, and human rights.

Participants are stimulated through dialogue techniques to critique the
world they live in and to brainstorm feasible remedies for
gender-related societal vices. Unlike the traditional rote learning
process, discussions are facilitated by probing questions, and the boys
actively engage in deconstructing their usual way of thinking about
gender issues by considering inherent contradictions. The discussion
groups involve several elements: dialogue, logical argument, information
transfer, role-playing, brainstorming, "true or false" exercises, and
"myths and realities." The boys are not trained as peer educators per
se; rather, their cognitive processes are challenged until they suggest
solutions to the issues they analyze during discussions.

The program has expanded in response to demand to include counseling
services for participants**,** community advocacy work, and a third
section for university youth.

## Evaluation and Outcomes

To date, CMA has yet to conduct a quantitative evaluation of its effect
on participants. Program staff gathered qualitative data using pretests
and posttests in the form of questionnaires with participants and
in-home interviews with participants' families or other caretakers. Data
from the questionnaires have not been analyzed, and the data collected
from the interviews are limited by the lack of adherence to a uniform
methodology. Separate in-depth interviews with CMA staff, community
members, and ten CMA participants, however, provide anecdotal evidence
of positive changes in attitudes and behavior. Unfortunately, a
satisfactory redefinition of masculinity has not yet taken place. For
instance, many boys still blame the victim for rape and do not
understand the concept of marital rape. An evaluation unit was developed
in 2002.

## Funding Sources

International Women's Health Coalition has funded CMA since its
inception in 1995. The MacArthur Foundation has provided support since
2000. The total budget for 2002 was \$100,000.

## Contact Information

Calabar International Institute for Research, Information and
Development/CMA

90B Goldie Street

P.O. Box 915

Calabar, Nigeria

Tel: 087-234704

E-mail: <ciinstrid@hyperia.com>

## Sources

Irvin, Andrea. 2000. *Taking steps of courage: Teaching adolescents
about sexuality and gender in Nigeria and Cameroun.* New York:
International Women's Health Coalition.

Girard, Françoise, and Gary Barker. 2003. *My father didn't think this
way: Nigerian boys contemplate gender equality.* New York: The
Population Council.

Whitaker, Corinne. 2003. *Challenging inequities: The story of an
anti-sexist and rights-based program for Nigerian adolescent males*
(PowerPoint and oral presentation). Presented to the Reaching Men to
Improve Reproductive Health for All Conference, Dulles, Virginia.

# Mobilizing Young Men To Care Project

(South Africa)

## Overview

This project implemented by DramAidE (Drama-in-AIDS Education), a South
African nongovernmental organization operating in KwaZulu-Natal since
1991, has the overarching goal of promoting gender responsibility to
prevent HIV/AIDS among youth in response to school-based violence. The
second phase of this project began in 2001. KwaZulu-Natal is the
epicenter of the HIV/AIDS epidemic in South Africa. The target schools
are disadvantaged ones in rural areas of the eThekwini, uMhlathuze, and
Amahlubi regions in KwaZulu-Natal. Unemployment rates are very high, and
most families sustain themselves through small-scale farming, informal
trading, and factory labor. Traditional Zulu culture dominates the
regions, which are highly stratified and patriarchal. Some more
conservative elements of Christianity also have taken root in these
areas. People typically do not openly discuss high-risk sexual behaviors
with their children. Previous work conducted by DramAidE Youth Clubs,
which had been established by the Act Alive project in the same schools,
facilitated the work of the Mobilizing Young Men to Care (MYMTC)
project.

## Scope

More than 2,000 students and teachers were affected by this program.
Volunteers were accepted from the student bodies of three secondary
schools in KwaZulu-Natal: one in the Matubatuba region, one in the
Hlabisa region, and the other in the Amatikulu region.

## Objectives

The project has four main objectives:

1.  To create an environment in which young men can become more caring
    and socially responsive---which entails changing stereotypes,
    misconceptions, and value systems related to gender norms.

2.  To sensitize young men in order to improve their communication
    skills.

3.  To encourage boys to make healthy lifestyle choices in
    relationships.

4.  To galvanize boys' resolve to be involved in health-related
    projects.

## Audience

Male secondary school students in a poor urban area of South Africa.

## Implementation

MYMTC uses a mixed-gender approach implemented in each school over the
period of one month. A drama technique known as forum theater is used to
facilitate discussions in an intensive series of fifteen workshops. This
technique involves the audience in the outcome of the drama. One of the
exercises involved the production and recording of an improvised
three-scene play, with interchangeable outcomes to each scene, at one of
the schools. This technique is called "stop-start" theater, and in the
video the protagonist is stereotyped as the "typical Zulu male," a
powerful and dominant character, dismissive of any external criticism,
with a number of sexual partners. A professional actor played this
character and the boys and girls complemented his performance as well as
those of other actors in the play. The audience and other actors are
encouraged to challenge the Zulu male's role. In order to achieve a
multiplier effect at relatively low cost, recordings of the production
were featured in other schools accompanied by discussions facilitated by
staff from the University of Natal.

## Evaluation and Outcomes

Three focus groups were held (one male-only, one female-only, and one
mixed-gender) in an informal evaluation of the project, using the Johns
Hopkins University Center for Communication Program's model of behavior
change. Participants provided structured feedback after a period of
introspection and reflection. The evaluation consists of an analysis of
the participants' feedback gathered during the focus groups and the
facilitator's observations. A specific outcome for each focus group is
not given, and it appears that only the observations from the
mixed-gender focus group are reported. This makes it difficult to
understand the transformative processes undergone by the boys, because
the facilitator's perceptions and insights were likely to have been
affected by input from the female participants. However, interviews with
the boys did reveal that they became more open to ideas of gender
equity.

An interesting finding was the facilitator's observation of the
phenomenon of "role reversal" and its effect on group dynamics. Some of
the young girls took on "masculine" attributes as they felt more
empowered, such as being more expressive and performing dances
traditionally reserved for males. In turn, young boys became less open
and vocal during discussions about sexuality in the presence of the
girls. Therefore, despite the focus on boys, the project also had an
effect on the girls.

## Funding Sources

The United Kingdom's Department for International Development funded
this project through the British Council.

## Contact Information

Professor Robert Morrell

Interim Co-Dean

Faculty of Education

University of Natal

Durban 4041, South Africa

Tel: (031) 260 1127

E-mail: <morrell@nu.ac.za>

[www.nu.ac.za/DramAideE](http://www.nu.ac.za/DramAideE)

## Sources

Drafts provided Robert Morrell and Lynn Dalrymple.

*ID21---Communicating development research: Mobilizing men to care?*
Available at the following Web address:
[www.id21.org/education/EgveMorrell.html](http://www.id21.org/education/EgveMorrell.html).
Accessed October 9, 2003.

# Men As Partners Program

## (several countries in Africa and Asia)

## Overview

Outlined in 1996, EngenderHealth's Men As Partners (MAP) program is an
initiative to assist stakeholders in global health to constructively
involve men in reproductive health and family planning. In 1998,
EngenderHealth and the Planned Parenthood Association of South Africa
(PPASA) began a collaborative effort to respond effectively to the
synergistic epidemics of gender-based violence and HIV/AIDS in South
Africa.

South Africa suffers from a number of social and economic woes; in 1999,
for example, it had the highest per capita rape rate in the world.
According to 2001 figures, the national HIV/AIDS prevalence rate for
adults aged 15--49 was greater than 20 percent. South Africans have,
however, proved their mettle when fighting for human rights. The
country's rich history of grassroots activism, which can be harnessed to
galvanize communities around other issues, provides hope for combating
HIV/AIDS and gender inequity.

## Scope

Launched in all but one of South Africa's nine provinces, MAP serves
urban, semi-urban, and rural communities.

## Objectives

MAP has the following aims:

1.  To mobilize men to become actively involved in countering the
    HIV/AIDS epidemic and gender-based violence.

2.  To confront the deep-seated patriarchal beliefs and attitudes that
    place the health and safety of men, women, and children at risk.

## Audience

Older and younger persons of both genders, in male-only and mixed-gender
groups.

## Implementation

Trained PPASA community health educators conduct the workshops in a
variety of settings such as workplaces, trade unions, prisons, and
faith-based organizations. The workshops vary in length from one hour to
seven days. Community health educators are prepared for the workshops
through a training-of-trainers model. After identifying institutions in
which the intervention will take place, master trainers participate in
training-of-trainers workshops, gaining skills in facilitation,
leadership, and conflict resolution. This gender-focused training
complements many of the community health educators' experiences as
activists in the anti-apartheid struggle. Male and female educators
range in age from 20 to 35.

Workshops are based on three core elements of constructive male
involvement:

1)  A recognition that men usually have control or influence over the
    reproductive health choices made by their partners.

2)  An appraisal of how current gender roles negatively affect men by
    promoting risky behaviors as "manly" and health-seeking behaviors as
    indications of frailty.

3)  An appreciation for both the personal investment necessary to
    confront current gender norms and the positive health consequences
    for men and women of a redefinition of gender roles.

Activities incorporated in the workshops include gender boxes, courage
activity, storytelling, role-plays, and discussing the effect of HIV and
gender-based violence on children. The discussions are formed and led in
the context of South Africa's socioeconomic circumstances (i.e., in the
local histories of apartheid, unemployment, rapid urbanization, and
poverty).

[]{.mark}

MAP seeks to sustain its effect through an adaptation of the "Spectrum
of Prevention" approach developed by Larry Cohen[^23] to galvanize
community involvement and approval through marches, education, network
building, mentoring, and the development of theater pieces, as well as
the distribution of condoms.

## Evaluation and Outcomes

EngenderHealth recently conducted a longitudinal evaluation of MAP that
included pre- and post-intervention interviews with 200 male workshop
participants, in addition to a three-month-follow-up inquiry. Fifty
female partners of the male participants were interviewed as well.
Interviews with participants and nonparticipants in a control group
demonstrate the effects of the program:

-   Seventy-one percent of participants believed that women and men
    should have the same rights, versus 25 percent of men in the control
    group.

-   Eighty-two percent of participants thought that it was unacceptable
    to rape sex workers, versus 33 percent of nonparticipants.

-   Eighty-two percent of participants believed that it was not right to
    beat their wives at times, versus 38 percent of the men in the
    control group.

Program implementers reported differences in their work with men of
different ages. Older men tended to respond better to in-depth sessions
of longer duration. On the other hand, adolescent boys were more
amenable to accepting alternate views that challenged traditional
constructions of masculinity.

Monitoring and evaluation are ongoing, and a promising opportunity to
conduct a multiyear study will provide further insights on the
effectiveness of MAP's work.

## Funding Sources

The U.S. Agency for International Development, the MacArthur Foundation,
and other funders financed this program. However, program implementers
cite inconsistent and unpredictable funding as one of the contributors
to their difficulty in providing follow-up for former participants.

## Contact Information

Men as Partners Programme

EngenderHealth

440 Ninth Avenue

New York, NY 10001

Tel: (212) 561-8394

E-mail: <mmehta@engenderhealth.org>

[www.engenderhealth.org](http://www.engenderhealth.org/)

## Sources

Peacock, Dean. 2003. *Taking a stand for gender equity and positive male
involvement in sexual and reproductive health and rights and against
men's violence against women* (PowerPoint and oral presentation).
Presented to the Reaching Men to Improve Reproductive Health for All
Conference, Dulles, Virginia.

EngenderHealth. 2002. *The Men As Partners Program in South Africa:
Reaching men to end gender-based violence and promote HIV/STI
prevention* (a Men As Partners briefing paper). New York:
EngenderHealth.

*Men's work working with men, responding to AIDS: A case study
collection.* London: International HIV/AIDS Alliance. 2003.

*Country by Country: South Africa.* Available at the following Web
address: <http://www.engenderhealth.org/ia/cbc/south_africa.html>.
Accessed October 28, 2003.

#  {#section-3 .unnumbered}

#   {#section-4 .unnumbered}

# Talking Man-To-Man

(Brazil)

## Overview

The Noos Institute for Systematic Research and Development of Social
Networks is a Brazilian nongovernmental organization (a recognized
"federal public utility"). It works with several organizations to
collaborate with the Justice Department to provide an alternative to the
typically lax punishments imposed on male perpetrators of gender-based
and domestic violence. The official name of the Talking Man-to-Man (TMM)
project is "Project for the Application of Alternative Measures and
Punishments for Men Who are Perpetrators of Committing Domestic and
Gender Violence." It is an extension of the Noos Institute's work on
gender-based violence, which began in 1999; the project was carried out
between June 2000 and April 2002.

## Scope

Facilitators were recruited from the Brazilian cities of: São Gonçalo,
Duque de Caxias, and Rio de Janeiro. Sixty-seven men participated in the
intervention.

## Objectives

1.  To create an enabling environment for men to build support networks
    to curtail predatory behaviors in order to end the violence cycle.

2.  To promote the prevention of gender-based violence, including
    domestic violence, through "ownership" of responsibility and
    exploration of nonviolent means of conflict resolution.

## Audience

The Justice Department initially referred young men who were in the
justice system because of violent behavior. Recently, in addition to
these referrals, men from the general population also participate as
self-referrals. The 67 men who participated in the project ranged in age
from 19 to 56; the majority were aged 32 to 45. Thirty-four percent of
the men had completed at least the equivalent of junior high school,
40.3 percent earned an annual income of US\$80 to \$240. Only 16.5
percent of the participants resided with the victim of their violent act
at the time of the interview.

## Implementation

Reflective group methods, developed by the Noos Institute as a result of
its work with men in diverse settings, were used to emphasize male
perpetrators' responsibility for domestic and gender-based violence.

The program has five stages: 1) the purpose of the intervention is
clearly outlined to candidates in a reception group; 2) preliminary
interviews and referrals are provided to other public services; 3) 20
weekly theme-centered meetings take place over a five-month period,
providing a safe place for men to reassess their attitudes toward
gender-based violence in small groups; 4) focus groups are conducted by
persons who have not served as facilitators in order to assess the
effect of the reflective meetings on the participants; and 5) lessons
learned from the reflective groups are identified in follow-up meetings
one year after the meetings end.

## Evaluation and Outcomes

The impact of the program was assessed through focus groups following
the reflexive groups. Discussions with former participants indicated
that the men became more communicative in their interpersonal
relationships, described greater levels of satisfaction in intimate
relationships, questioned the definition of the current construction of
masculinity, perceived the link between the violence they perpetrated
and the violence perpetrated against them as children, and realized that
hegemonic models of masculinity adversely affected them as well as their
victims.

Evaluation data indicate that the program had a noticeable effect on the
men's behavior. Of the men who completed a program at the Noos
Institute, only 5 percent became repeat offenders. This statistic will
be meaningful once a corresponding percentage for a control group is
obtained.

## Funding Sources

## Ministry of Justice and National Center for Alternative Punishments and Measures.

## 

## Contact Information

Instituto Noos

Rua Martins Ferreira

28-Botafogo

Rio de Janeiro, RJ, CEP: 22271-010

Brazil

Tel: 55 21 2579-2357

E-mail: <noos@noos.org.br>

[www.noos.org.br](http://www.noos.org.br/)

## Sources

Bronz, Alan. 2003. *'Talking Man-to-Man' reflexive group methodology
with an approach that emphasizes responsibility for male perpetrators of
domestic and gender based violence* (oral and PowerPoint presentation).
Presented to the Reaching Men to Improve Reproductive Health for All
Conference, Dulles, Virginia.

"Instituto Noos" home page, available at the following Web address:
[www.noos.org.br/projetos/projeto-gen-penasalternativas.html](http://www.noos.org.br/projetos/projeto-gen-penasalternativas.html).
Accessed October 27, 2003.

# Program H

(Latin America and Caribbean)

## Overview

Program H (H is the first letter of *hombre,* the word for man in
Spanish, and *homem* in Portuguese) is a field-tested intervention
involving three components. The project is an international partnership
among ECOS (Estudos e Comunicaçao em Sexualidade e Reproducao
Humana)--Communication in Sexuality, Programa PAPAI, and John Snow
Brasil in Brazil; Salud y Género in Mexico; the Population Council and
the Program for Appropriate Technology in Health (PATH) in United
States; and the Pan American and World Health Organizations, the United
Nations Population Fund, and SSL International plc.

## Scope

The project is active in Bolivia, Brazil, Colombia, Jamaica, Mexico, and
Peru.

## Objectives

To promote reproductive health and gender equity among young men.

## Audience

Young men 15--24 years of age residing in low-income, high-crime areas
in the six countries, recruited by local partnering organizations.

## Implementation

Field-testing integrated three programs developed by Instituto PROMUNDO
in partnership with Programa PAPAI, ECOS and Salud y Genero: Project
Hora H---Life-Style Social Marketing Project and the Project H---Manual
series "Working with Young Men." Male-only group workshops were
structured to promote attitude change. Participants actively engage in
analyzing the health costs and other harmful characteristics of
traditional masculinity; constructing an alternative masculinity; and
rehearsing the newly defined, positive male attitudes through the use of
educational materials. The materials are designed for health
professionals and include five manuals and an animated silent video,
titled *Once Upon a Boy.* The manuals and the video depict various
aspects of a young man's life, such as machismo, violence, homophobia,
loss of virginity, sexually transmitted infections, pregnancy, and
fatherhood.

Second, lifestyle social marketing was implemented with the aim of
creating an environment in which more gender-equitable young men are
identifiable within the community and condom use is associated with a
more gender-equitable lifestyle. Peer promoters reinforced the messages
of the marketing campaign by endorsing respectful treatment of women.
The inexpensive Hora H ("In the Heat of the Moment") condom was made
available for sale throughout low-income communities at strategic
locations. The branding of this product will help to sustain both the
message of the marketing campaign and the campaign itself through income
generation.

The Gender Equity Promotion Evaluation Project, the third component
involved in the field-tested intervention, is using both quantitative
and qualitative data to evaluate the field test's effectiveness. The
evaluation began in May 2002 and will last for two years.

## Evaluation and Outcomes

Initial results are promising and indicate high levels of brand
recognition of the Hora H condom, increased condom use with both stable
and occasional partners, and positive gains on 18 out of 24 items on the
Gender-Equitable Men (GEM) Scale. Improved performance on the GEM Scale
confirms attitudinal changes related to gender-based violence,
fatherhood, and gender equity. This normed scale is a
Leichert-derivative scale comprised of two subscales that measure
traditional and egalitarian norms with 17 and seven items, respectively.
The following are examples of the norms measured by the scale: "There
are times when a woman deserves to be beaten" (traditional) and "It is
important that a father is present in the lives of his children, even if
he is no longer with the mother" (egalitarian).

## Funding Sources

Instituto PROMUNDO receives financial support from the Ford Foundation
for its work in Brazil, from UNFPA for work in Central America, and from
SSL International plc. The Gender Equity Promotion Evaluation Project
receives technical and financial support from The Population
Council/Horizons Project.

## Contact Information

Instituto PROMUNDO

Rua México, 31

Bloco D, Sala 1502---Centro

Rio de Janeiro, RJ, CEP: 20031-144

Brazil

Tel: 55 21 2544-3114/3115

E-mail: <promundo@promundo.org.br>

[www.promundo.org.br](http://www.promundo.org.br/)

## Sources

Instituto PROMUNDO home page available at the following Web address:
[www.promundo.org.br](http://www.promundo.org.br/). Accessed October 13,
2003.

Nascimento, Marcos. 2003. *The Program H: Promoting condom use, health
seeking behavior, and changes in gender norms among young men* (oral and
PowerPoint presentation). Presented at the Reaching Men to Improve
Reproductive Health for All Conference, Dulles, Virginia.

Pulerwitz, Julie. 2003. *Measuring gender-equitable norms: Applications
of the GEM scale* (oral and PowerPoint presentation). Presented at the
Reaching Men to Improve Reproductive Health for All Conference, Dulles,
Virginia.

# Puntos de Encuentro

(Nicaragua)

## Overview

This program was initiated in late July 1999 in response to background
research that indicated that domestic violence increases in the
aftermath of natural disasters. The implementation of Puntos de
Encuentro was hastened by the occurrence of Hurricane Mitch in 2000, and
the subsequent opportunity to ameliorate conjugal relations during the
reconstruction period. The organization strives to foster linkages
between Nicaraguan institutions in order to engender a more
gender-equitable society.

## Scope

Areas of Nicaragua that were affected by Hurricane Mitch in 2000.

## Objectives

Activities guided by the principle of "Violence Against Women: A
Disaster Men Can Avoid" and these two objectives:

1.  Promote the idea that men possess both the responsibility and
    capacity to avoid violence toward their mates.

2.  Recognize domestic violence as an issue with extensive
    repercussions. Not only does it adversely affect the familial unit,
    it also deteriorates the fabric and social reconstruction of the
    nation.

## Audience

Two target audiences, one for each objective above. The first consisted
of men who met the following criteria:

1.  Between the ages of 20 and 39.

2.  Residents of areas affected by Hurricane Mitch.

3.  Ascribe to traditional beliefs about gender norms and a belief that
    violence is an acceptable way to resolve interpersonal conflict with
    their partner.

4.  Attained at least a third-grade education and no more than a high
    school diploma.

Community leaders who influenced pubic opinion in the social contexts of
the first group comprised the second target audience.

## Implementation

A multimedia campaign was carried out in collaboration with local radio
broadcasters, television channels, and print media to disseminate
antiviolent models of gender relations. Mass media on a daily basis were
used to suffuse the target communities with positive and quality
messages that did not approach gender relations in an accusatory manner.
The multimedia campaign included a television program titled "El Sexto
Sentido," articles featured in the *La Boletina* magazine with inserts,
a nationally syndicated radio program, and paraphernalia such as caps
and calendars touting the campaign's themes.

## Evaluation and Outcomes

Pretests were conducted July 1999 and posttests were conducted in
February 2000. A quasi-experimental analysis of the program's effect
using quantitative and qualitative data included both control and target
regions categorized by exposure status, as well as subsampled cultural
profiles. The control and intervention groups were further stratified by
exposure to any violence campaign, Encuentro's or others'. Focus groups
and individual interviews revealed the following:

1.  After the campaign more men in the target regions considered
    conjugal violence and Hurricane Mitch to be commensurate
    disasters/calamities.

2.  Similarly, in both the target and control areas, more men reported
    an increased perceived ability to avoid conjugal violence if they
    were exposed to the campaign (87 percent versus 73 percent in the
    target areas, and 72 percent versus 59 percent in the control
    areas). Generally, the men attributed this to respect for women's
    rights, communication abilities, and their capacity to reason
    through a situation.

3.  The campaign affected men regardless of their perceived degree of
    equitable behavior. Surprisingly, the greatest effect was reported
    among men categorized as "very controlling," given their responses
    to four questions measuring gender equity in intimate relationships,
    but this may be due to underreporting by men grouped in other
    categories.

## Funding Sources

Funding information not available.

## Contact Information

Fundacion Puntos de Encuentro

Apdo Postal RP-39

Managua, Nicaragua

Tel: (505) 268-1227

E-mail: <puntos@puntos.org.ni>

[**[www.puntos.org.ni]{.smallcaps}**](http://www.puntos.org.ni/)

## Sources

Documents provided by Ruben Reyes.

# Stepping Stones

(several African and Asian countries)

## Overview

Stepping Stones is a life-skills, communication, and relationships
training package designed in 1995 for use with communities in
sub-Saharan Africa. Over time, the training package has been adapted and
modified to suit the needs of populations in a variety of settings
throughout the world.

## Scope

This set of workshops has been conducted in Cambodia, The Gambia, Ghana,
Kenya, Philippines, Tanzania, Uganda, and Zambia.

## Objectives

Specifically related to social norms, the workshop series seeks to
transform gender relations; curb gender-based violence; increase
understanding of how stigma and social constraints limit the lives and
health of others with whom participants share their lives; and instill
an appreciation of the effects of individual behavior on others.

## Audience

Stepping Stones broadly focuses on the entire community, not just on
individuals who engage in high-risk behaviors. The project aims at
social change by getting communities to strategize about harmful values
and practices rather than rely on individuals to do the changing by
themselves.

## Implementation

Stepping Stones uses a planned series of community-based focus group
discussions with periodic report back to the wider community. The
facilitators often recruited from the community. It follows these steps:

> 1\. Meetings are organized with community leaders to explain the
> purpose and process of the Stepping Stones program and to obtain their
> support.
>
> 2\. Community members are invited by community leaders to learn about
> the program and are invited to participate.
>
> 3\. A series of workshops ensues for four separate groups: older men,
> older women, younger men, and younger women.

4\. At regular intervals over the course of three to four months, 18
three-hour workshops divided into four theme areas are held with each
group, with report back to all four groups together.

> 5\. The four groups come together and the entire community entertains
> "requests for change" from each group while the groups perform dramas
> reflecting the lessons imparted.
>
> 6\. Each group is encouraged to continue meeting in order to sustain
> the change and serve as a support group.

The program promotes gender equity by getting individuals and
communities to question the inequities that contribute to the spread of
HIV and other problems. Workshops centered around three themes directly
address gender equity and gender-based power dynamics. One thematic
module, "Group Cooperation," engages participants in contemplating their
sentiments about sex, the meaning of love, and blame-shifting. In
another module, "Why We Behave in the Ways We Do," participants are
provided with space to explore the rationale behind their behavior in
sexual situations, the benefits and costs of traditional practices,
issues involving household financial management, and the acceptance of
personal responsibility. In the last module, "Ways in Which We Can
Change," participants learn and rehearse ways to communicate assertively
and tactfully their desires and needs using "I" statements.

## Evaluation and Outcomes

The U.K. Medical Research Council has conducted a formal evaluation of a
Stepping Stones project in The Gambia. In other countries, informal
evaluations through group discussions, structured interviews, and e-mail
correspondence have assessed the outcomes of Stepping Stones activities.
Available findings include enhanced shared decision-making and
communication skills applied to sexual and nonsexual issues and improved
relationships; and changes in behavior such as higher levels of
equitable household income redistribution, reduced gender violence, and
increased prevalence of safer sex.

## Funding Sources

Funding varies by community in which the workshop series has been
implemented. Donors have included the U.K. Department for International
Development and Spanish AID.

## 

## Contact Information

E-mail: <info@steppingstonesfeedback.org>

[www.steppingstonesfeedback.org](http://www.steppingstonesfeedback.org/)

## Sources

*Three case studies: Involving men to address gender inequities.*
Prepared under the auspices of the Interagency Gender Working Group,
Subcommittee on Men and Reproductive Health. July 2003.

Stepping Stones home page, available at the following Web address:
[www.steppingstonesfeedback.org](http://www.steppingstonesfeedback.org/).
Accessed October 13, 2003.

# Soul City

(several African, Asian, Caribbean, and Latin American countries)

## Overview

The Soul City Institute of Health & Development Communication television
and radio series was first broadcast in 1994. Its aim is to create an
enabling environment to overcome structural barriers---including gender
inequity---to good health and social development.

## Scope

Soul City media reaches more than 16 million South Africans. Its
programs have also been broadcast in other African countries as well as
in Latin America, the Caribbean, and Southeast Asia.

## Objectives

Through its broadcasts and materials, the object of Soul City is to
develop a culture in which people can solve health and development
problems through introspection, development of useful skills, and
eventually transformation of societal norms, including gender norms.

## Audience

Priority groups are primary and secondary school students, and adult
learners in educational settings. In addition, Soul City reaches out to
the general public.

## Implementation

Thirteen episodes of the Soul City drama series are broadcast annually
on South Africa's most popular television station over a three-month
period. Sixty radio episodes air annually on nine South Africa regional
radio stations. These electronic media messages are complemented by the
distribution of print media covering a corresponding range of health and
social development topics in partnership with several newspapers. Print
supplements, magazine inserts, and other distributed advertisements are
used to brand the Soul City name and spread the principles and practices
"marketed" by Soul City.

Content is developed through formative research processes and evaluated
on a regular basis. Storylines are nondidactic in nature and structured
around pro-social role modeling. Characters are presented in scenarios
that the average viewer and listener can relate to and empathize with.
Episodes emphasize autonomy and the ability to chose. Each installment
is meant to prompt audience members to reflect on their own attitudes
and actions and to emulate the positive problem-solving and coping
strategies presented.

## Evaluation and Outcomes

Evaluators conducted multivariate analyses of data gathered from rural
and urban sentinel sites (KwaZulu-Natal and Gauteng Provinces,
respectively), as well as data from the national level, and scaled them
whenever possible. About nine months elapsed between the baseline and
postintervention evaluations (i.e., approximately six months after the
completion of the broadcasts).

General findings include: the perception of Soul City as an important
source of information and inspiration, an observed amplification effect
of positive change on the community if a leader responds first to the
messages, and a greater reach of radio than other channels used by the
mass media campaign. Quantitative analyses revealed a statistically
significant dose effect on positive attitudes; persons who were exposed
to greater numbers of Soul City broadcasts and materials changed more.
Qualitative data suggested that more respondents in the
post-intervention period perceived of entrepreneurship as a way of
addressing oppressive gender-based power relations.

National survey data found that exposure to Soul City is associated with
acquiring or increasing gender-equitable attitudes, as measured by
responses to the following items: "girls or women need to depend on
their boyfriends or husbands for \[a\] better life," "boys or men have
the right to have sex with their girlfriend if they buy them gifts," "if
a person really loves his boyfriend or girlfriend, they \[sic\] will
have sex with them," and "a boy who forces his girlfriend to have sex
even though she doesn't want sex is raping her." The same data also
found that exposure to Soul City is associated with increased
interpersonal communication about domestic violence. Soul City plans to
expand its broadcasts and to disseminate its printed resources to eight
additional African countries beyond its current reach.

## Funding Sources

The Soul City series is commercially sponsored by Old Mutual Insurance
Company and British Petroleum, and receives donor funding from the
Department of Health, the U.K. Department for International Development,
European Union, Ireland Aid, and the Royal Netherlands Embassy.

## Contact Information

Soul City Institute of Health & Development Communication

P.O. Box 1290

Houghton 2041

South Africa

Tel: 27 (0) 11 643 5852

E-mail: [soulcity@soulcity.org.za](mailto:soulcity@soulcity.org.za )

[www.soulcity.org.za](http://www.soulcity.org.za/)

## Sources

Kelly, Kevin, Warren Parker, and Salome Oyosi. 2001. *Pathways to action
HIV/AIDS prevention, children and young people in South Africa: A
literature review.* Developed for Save the Children by the Center for
AIDS Development, Research and Evaluation (Cadre).

Scheepers, Esca, et al. 2001. *Soul City 4 evaluation results integrated
summary report.*

*Soul City---Institute for Health and Development Communication---the
Heartbeat.* Available at the following Web address:
[www.soulcity.org.za](http://www.soulcity.org.za/). Accessed October 12,
2003.

# The Strength Campaign

(United States)

## 

## Overview

The Strength Campaign took place in Washington, D.C., where only 50
percent of youth are high school graduates, 36 percent live in poverty,
and the teenage pregnancy rate is nearly twice the national average. Men
Can Stop Rape, a self-described volunteer pro-feminist collective,
launched the campaign in February 2001, fourteen years after the
organization was founded. Formerly known as the Men's Rape Prevention
Project, Men Can Stop Rape was initiated to increase consciousness about
gender-based violence and to build the capacity of men to be strong
without being violent.

## Scope

Approximately 13,000 male youths in the District of Columbia were
affected by the campaign.

## Objectives

The Strength Campaign seeks to challenge constructions of masculinity,
curb gender-based violence (specifically date rape), and empower young
men to partner with young women in order to create equitable and safe
environments.

## Audience

Male youth enrolled in eighteen District of Columbia public high schools
between the ages of 13 and 18, and residents of the ambient communities.

## Implementation

One of five projects in The Strength Training Program, the Strength
Campaign was executed over a one-month period in Washington D.C., public
schools. Organized around the theme line "My Strength is Not for
Hurting," the campaign involves both media and youth education
approaches: posters and bus ads with D.C. United athletes, the *REP*
magazine, "Safe and Strong" workshops with youth, and handbooks for
school staff. Program staff obtained the endorsement of both the
superintendent of schools and the advisory board before launching the
campaign to ensure institutional support and to recruit the school staff
as partners.

The interactive workshops were held only in select schools. During a
series of three sessions, facilitators focused on deconstructing the
definition of masculinity propagated by popular culture, fostering
empathy for survivors of gender-based violence, and instructing young
men on nonviolent strategies to confront attitudes and behaviors that
enable rape.

The campaign redefines the concept of strength as the crux of
masculinity and monopolizes on males' typically action-oriented approach
to problem solving to endorse empathy, compassion, and meekness. A basic
tenet of the campaign is that gender-equitable relationships are
mutually beneficial to both genders, in that displayed appreciation and
affection enhance intimate relationships.

## Evaluation and Outcomes

Surveys conducted before and after the campaign indicate positive
results. More than 80 percent of the respondents became aware of new
ways to have healthy relationships and believed they had received
important information that gave them confidence to play a role in
preventing date violence. This can be attributed to the increased
exposure of the youth to information on dating violence. Before the
campaign only 10 percent of the students recalled being exposed to
information about dating violence. After the campaign this percentage
increased to 59 percent.

In response to demand, the campaign is expanding nationally to all 50
states and internationally to ten countries. Implementers are in the
process of modifying the campaign's materials to effectively portray
images of healthy couples untainted by stereotypes (e.g., that women are
ornaments or status symbols for men and that women are always the
gatekeepers of sexual intimacy).

## Funding Sources

The campaign generated revenue from product sales and received donations
from the Summit Fund and BIL Charitable Trust, and from individual
donors.

## Contact Information

Men Can Stop Rape

P.O. Box 57144

Washington, D.C. 20037

Tel: (202) 265-6530

E-mail: <info@mencanstoprape.org>

[www.mencanstoprape.org](http://www.mencanstoprape.org/)

## Sources

Stillerman, Jonathan. 2003. *Men can stop rape: The Strength Campaign*
(oral and PowerPoint presentation). Presented to Reaching Men to Improve
Reproductive Health for All Conference, Dulles, Virginia.

Men Can Stop Rape home page, available at the following Web address:
[www.mencanstoprape.org](http://www.mencanstoprape.org/). Accessed
November 11, 2003.

# The Respect Campaign

(Western Europe)

## 

## Overview

The Respect Campaign was launched in 1998 by the Zero Tolerance
Charitable Trust in response to the troubling findings of a study of 14-
to 21-year-old youths' perceptions of violence. The campaign was
commissioned by the Trust the same year in three urban areas of the
United Kingdom. The Respect Campaign, a pilot project, is the Trust's
most recent mass media campaign.

## Scope

This independent charity has links with organizations throughout the
world, but operates mainly within the United Kingdom and Europe.

## Audience

All parties potentially affected by gender-based violence in personal
relationships (i.e., everyone).

## Objectives

The campaign highlights issues of consent in personal relationships.
More generally, it aims to promote messages of gender equity and
antidiscrimination. The campaign is geared to promote male
responsibility for ensuring consent in sexual relationships and female
empowerment to assert personal convictions in intimate relationships.
Materials distributed by the campaign are also fashioned to dispel myths
and stereotypes, particularly around the legitimacy of "female-provoked"
violence (i.e., by their chosen attire or flirting).

## Implementation

Distributed materials consisted of postcards, posters, resource guides,
and CD-ROMs. Captions succinctly convey messages of autonomy, female
empowerment to resist abuse, and male responsibility for misuse of power
on simple, yet sophisticated layouts. Although it recognizes violence
perpetrated against males, the Trust focuses on violence perpetrated
against women. The series of four postcards, distributed among youth
networks in venues youth frequent, were specifically designed to
commence a critical appraisal of this issue. Posters focused more on
addressing consent. For instance, one depicted a social situation and
deconstructed it from hypothesized male and female viewpoints, to
demonstrate the different perceptions about consent held by each gender.
More complex messages were presented via "convenience advertising"
(i.e., publicity materials strategically placed in venues frequented by
the intended audience in locales where they were in plain view, such as
on the backs of toilet stalls or on hand dryers in restrooms).

## Evaluation and Outcomes

Quantitative and qualitative evaluations of the "Respect" package's
effect found that 68 percent of respondents believed they had changed
their minds about how people treated each other and 77 percent of
respondents believed they had changed their minds about what girls
should be like and what boys should be like. However, the same research
indicated that a significant need remains for primary prevention work.
Evaluations appear to have been conducted only with persons connected to
the campaign (i.e., Trust employees and their families).

## Funding Sources

The Zero Tolerance Trust is a charitable organization that receives
financial support from donations and proceeds raised through the vending
of its merchandise.

## Contact Information

Zero Tolerance Charitable Trust

25 Rutland St.

Edinburgh, Scotland, United Kingdom EH12AE

Tel: 44 (0)131 221 9505

E-mail: <zerotolerance@dial.pipex.com>

[www.zerotolerance.org.uk](http://www.zerotolerance.org.uk/z_sec08_contacts/contacts.htm)

## Sources

The Zero Tolerance Charitable Trust home page, available at the
following Web address:
[www.zerotolerance.org.uk](http://www.zerotolerance.org.uk/). Accessed
October 15, 2003.

# Peer Advocates for Health

(United States)

## Overview

A five-year demonstration project launched in 1999, Peer Advocates for
Health is a community-based program implemented in partnership with
local health clinics and schools. Scheduled to end in June 2004, this
life skills project advocates abstinence as the best lifestyle.

## Scope

Each year approximately 25 adolescents participate. To date, nearly
3,000 persons have been affected through a multiplier effect as the 75
alumni (representing 15 high schools) disseminate the lessons imparted
through the program.

## Objectives

The program was developed to provide intense training, support, and
follow-up for male participants with the goal of increasing their
reproductive health knowledge and ability to make healthy lifestyle
choices.

## Audience

Male high school students between the ages of 14 and 17 residing in
urban Chicago participate in the program. Initially recruited through
physician referrals, school contacts, and flyers, prospective
participants must pass a drug test after applying for admission.
Virtually no participants are teenage fathers, and the cohort of
participants typically represents a mixture of life experiences.

## Implementation

Program staff screen applications submitted on an annual basis from
prospective participants. Typically, 75 applications are received and a
maximum of 25 youth are chosen to participate in the program. High
attrition rates account for a loss of approximately 50 percent of
participants throughout the year.

Training consists of basic peer advocacy at different intensities
throughout the year. During the summer months, the adolescents meet
three days a week for eight weeks. The intensity decreases to two- to
three-hour sessions once a week, in addition to one or two sessions on
Saturdays each month during the academic year.

Staff conduct community outreach activities (including gender-relations
content) and present creative "Let's Talk About It" sessions to
participants and their parents. Female peer educators who train
participants provide the boys with an opportunity to interact with the
opposite sex in a positive and nonsexual manner. The project
coordinator, a former basketball player, develops a personal
relationship with each participant and describes the particulars of the
program to participants' parents at the outset of the program. After
training, alumni are hired as peer advocates and are compensated on a
graded wage system for attending training sessions and for working in
the field distributing condoms and sharing the lessons they learned from
the program.

## Evaluation and Outcomes

Data for evaluation will be gathered from both participants and their
parents. Intake, three-month, six-month, and year-end data are available
for the first three participant groups. Data are collected according to
curriculum topic and include the following information: demographics,
attitudinal changes, communication abilities, and levels of condom use.
Qualitative data are gathered through interviews with participants and
their families.

## Funding Sources

This demonstration project is supported by an annual budget of \$125,000
provided by the U.S. Department of Health and Human Services/Public
Health Service Region V Office of Family Planning.

## Contact Information

Pat W. Mosena, Ph.D., Project Director

5646 South Kimbark Avenue

Chicago, IL 60637

Tel: (773) 288-1682

E-mail: <mosena@aol.com>

## Sources

Mosena, Pat. 2003. *Peer Advocates for Health: A community-based program
to improve reproductive health and lifestyle choices among adolescent
males in Chicago* (oral and PowerPoint presentation). Presented to
Reaching Men to Improve Reproductive Health for All Conference, Dulles,
Virginia.

Documents provided by Pat Mosena.

# Matrix of Programs

<table>
<colgroup>
<col style="width: 12%" />
<col style="width: 8%" />
<col style="width: 0%" />
<col style="width: 9%" />
<col style="width: 12%" />
<col style="width: 12%" />
<col style="width: 12%" />
<col style="width: 13%" />
<col style="width: 12%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td><strong>Title</strong></td>
<td><strong>Site</strong></td>
<td colspan="2"><strong>Audience &amp; Scale</strong></td>
<td><strong>Objectives</strong></td>
<td><strong>Methods</strong></td>
<td><strong>Evaluation Type &amp; Scale</strong></td>
<td><strong>Main Successes</strong></td>
<td><strong>Main Problems</strong></td>
<td><strong>Dates</strong></td>
</tr>
<tr class="even">
<td><em>CANTERA</em></td>
<td>Costa Rica, El Salvador, Guatemala, Nicaragua</td>
<td colspan="2">250 adult men</td>
<td>Analyze social attitudes, values, behaviors, and masculinity as
social construction</td>
<td>Theme-centered workshops (one with women); empathy exercises; films;
training manual</td>
<td>Quantitative and qualitative data from 112 men; baseline; women's
input</td>
<td>Less “macho” attitudes and sexist discrimination; greater solidarity
with women</td>
<td>Participants not representative of general population; funding
inadequate</td>
<td>1994–1997</td>
</tr>
<tr class="odd">
<td><em>New Visions</em></td>
<td>Egypt</td>
<td colspan="2">1,900 men aged 14–20 years</td>
<td>Change gender norms related to the reproductive health</td>
<td>65 educational sessions implemented through NGOs and youth
councils</td>
<td>KAP<a href="#fn1" class="footnote-ref" id="fnref1"
role="doc-noteref"><sup>1</sup></a> surveys in three rural villages, one
as control; baseline and follow-ups [T<sub>0</sub> and T<sub>0</sub> +
T<sub>1</sub> ]</td>
<td>Increased sense of gender equity, belief in shared responsibilities,
and opposition to genital mutilation</td>
<td>Post-intervention (T<sub>0</sub> + T<sub>2</sub>) data unavailable;
“entrenched norms” little changed.</td>
<td>2002–2004</td>
</tr>
<tr class="even">
<td><em>Better Life Options</em></td>
<td>India</td>
<td colspan="2">Nearly 8,500 boys aged 10–19 in 11 states</td>
<td>Challenge gender inequities and broaden life options</td>
<td>Training module to empower youth in three settings with different
facilitators</td>
<td>Pre-/post-intervention precoded interviews with 2,379 boys;
anecdotal evidence from female peers+F7</td>
<td>Increased knowledge of peaceful conflict resolution, sexual
harassment, and requirements for healthy pregnancy. Increased belief in
appropriateness of education for boys and girls.</td>
<td>Low percentage changes in KAP suggest need to revise project
design</td>
<td>2002–Present</td>
</tr>
<tr class="odd">
<td><em>Conscientizing Male Adolescents</em></td>
<td>Nigeria</td>
<td colspan="2">More than 2,000 adolescents boys in secondary
school</td>
<td>Foster critical thinking and communication skills to ultimately
challenge sexist behavior, gender oppression and norms</td>
<td>Dialogue technique in bilevel curriculum</td>
<td>Systematic evaluation plan developed in 2002; informal in-depth
interviews</td>
<td>Anecdotal reports of positive behavior changes; increased critical
analysis of social problems and mobilization of small advocacy
campaigns</td>
<td>Need to institute evaluation technique with uniform methodology to
conduct to chart impact</td>
<td>1995–Present</td>
</tr>
<tr class="even">
<td>MYMTC</td>
<td>South Africa</td>
<td colspan="2">More than 2,000 adolescent boys in secondary school</td>
<td>Create an enabling environment, improve communication skills,
encourage healthy lifestyle choices</td>
<td>Drama techniques (e.g., stop start and forum theater; performances
and focus groups)</td>
<td>Qualitative data gathered in focus groups with 60 participants (both
male and female)</td>
<td>Increased openness to ideas of gender equity</td>
<td>Most noticeable results among female participants and unclear
evaluation methods</td>
<td>1991 for one month</td>
</tr>
<tr class="odd">
<td><em>Men as Partners</em></td>
<td>South Africa</td>
<td colspan="2">200 men in 8 provinces (and 50 female partners)</td>
<td>Confront patriarchal beliefs and mobilize men to be active in the
fight against GBV<a href="#fn2" class="footnote-ref" id="fnref2"
role="doc-noteref"><sup>2</sup></a> and HIV</td>
<td>Workshops in various settings based on three core elements using
interactive activities to stimulate discussion in context of the
country's history</td>
<td>Longitudinal evaluation with control group comparison</td>
<td>Increased belief in equal rights for men and women; decreased
acceptability of sexual and physical violence against women</td>
<td>Funding issues to sustain support for former participants</td>
<td>1998–Present</td>
</tr>
<tr class="even">
<td><p><em>Talking</em></p>
<p><em>Man-To-Man</em></p></td>
<td>Brazil</td>
<td colspan="2">67 men referred by the Justice Department, mostly 32–45
years of age</td>
<td>Create an enabling environment and prevent GBV<a href="#fn3"
class="footnote-ref" id="fnref3" role="doc-noteref"><sup>3</sup></a>
through male responsibility</td>
<td>Male-only reflexive groups on theme-centered schedule with small
numbers of men</td>
<td>Focus groups conducted after reflexive groups</td>
<td>Improved communication in intimacy; increased empathy for victims of
violence; heightened realization that masculinity norm can adversely
affect men</td>
<td>Lack of data for control group</td>
<td>2000–2002</td>
</tr>
<tr class="odd">
<td><em>Program H</em></td>
<td colspan="2">Bolivia, Brazil, Colombia, Jamaica, Mexico, Peru</td>
<td>Adolescent boys 15–24 years old</td>
<td>Promote reproductive health and gender equity</td>
<td>Male-only group workshops to analyze health costs of traditionally
defined masculinity, redefine this construct, use educational materials
developed by program</td>
<td>Gender Equity Evaluation project will be used to collect and
quantitative data relative to normative change</td>
<td>Responses to 18 out of 24 GEM<a href="#fn4" class="footnote-ref"
id="fnref4" role="doc-noteref"><sup>4</sup></a> Scale items indicate
increased gender equitable attitudes</td>
<td>Lack of availability of detailed evaluation data</td>
<td>Ongoing</td>
</tr>
<tr class="even">
<td><em>Puntos de Encuentro</em></td>
<td colspan="2">Nicaragua</td>
<td>Men 20–39 years old</td>
<td>Promote male responsibility for GBV<a href="#fn5"
class="footnote-ref" id="fnref5" role="doc-noteref"><sup>5</sup></a> and
capacity to avoid it; have men recognize GBV consequences outside the
family</td>
<td>Multimedia campaign with magazine, television, and radio and promote
campaign products</td>
<td>Pre-/post-intervention focus groups and interviews</td>
<td>Acknowledgment that GBV is a disaster tantamount to Hurricane Mitch;
increased perceived ability to avoid GBV</td>
<td></td>
<td>1999</td>
</tr>
<tr class="odd">
<td><em>Stepping Stones</em></td>
<td colspan="2">Various continents</td>
<td>Communities</td>
<td>Transform gender relations, curb GBV,<sup>†</sup> increase
understanding of how stigma and social constraints limit lives and
health</td>
<td>Community-based program with theme-based workshops (male and female
groups combine at end of session series)</td>
<td>Group discussions, structured interviews, and anecdotal
evidence</td>
<td>More equitable distribution of home resources, greater commitment to
healthy marriages, shared decision-making and communication</td>
<td>Lack of uniform evaluation module employed by all projects that use
the materials</td>
<td>Varies by project</td>
</tr>
<tr class="even">
<td>Soul City</td>
<td>South Africa</td>
<td colspan="2">More than 14 million persons</td>
<td>Encourage introspective critical thinking to prompt changes in
social norms</td>
<td>13 television episodes broadcast annually, complemented by print and
radio</td>
<td>Multivariate analyses of national and sentinel site data; rural and
urban; date-scaled and compared to control group, as possible</td>
<td>Demonstrated amplification effect if opinion leader changed;
exposure showed significant dose effect for positive attitudes</td>
<td></td>
<td>1994</td>
</tr>
<tr class="odd">
<td><em>Strength Campaign</em></td>
<td>USA</td>
<td colspan="2">Approximately 13,000 male adolescents in 18 secondary
schools</td>
<td>Challenge constructions of masculinity: decrease incidence of date
rape; foster solidarity among young men and women; create equitable and
safe environments</td>
<td>Mass media and youth education (including workshops) organized
around the theme line “My Strength is Not for Hurting”</td>
<td>Pre- and post-intervention surveys</td>
<td>Increased exposure to information about dating violence and
increased perception of confidence to prevent date rape</td>
<td>Self-reported need to modify materials to more accurately depict
gender equitable relationships</td>
<td>2001 (for one month)</td>
</tr>
<tr class="even">
<td><em>Respect Campaign</em></td>
<td>United Kingdom</td>
<td colspan="2">General population</td>
<td>Highlight issues of consent in personal relationships and promote
gender equity and anti-discrimination</td>
<td>Mass media campaign involving print materials, convenience
advertising, and paraphernalia with campaign’s messages</td>
<td>Qualitative and qualitative data collected from respondents
affiliated with the Trust</td>
<td>Perception that campaign provided useful information and opinion on
gender role changes for the better</td>
<td>Expand scope of evaluation; extend term of campaign</td>
<td>1998</td>
</tr>
<tr class="odd">
<td>Peer Advocates for Health</td>
<td>USA</td>
<td colspan="2">Adolescent boys in secondary school</td>
<td>Increase knowledge of reproductive health and ability to make
healthy lifestyle choices</td>
<td>Intensive peer advocacy training complimented by community outreach
activities</td>
<td>Qualitative data from interviews with participants and their
parents; quantitative data at baseline, three months, six months, and
one year into the program</td>
<td>Currently analyzing the results of the project</td>
<td>High attrition rates and need to expand to other sites; lack of
availability of post-intervention data</td>
<td>1999–2004</td>
</tr>
</tbody>
</table>
<aside id="footnotes" class="footnotes footnotes-end-of-document"
role="doc-endnotes">
<hr />
<ol>
<li id="fn1"><p><sup>*</sup> Knowledge, attitudes, and practices<a
href="#fnref1" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn2"><p><sup>†</sup> Gender-based violence<a href="#fnref2"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn3"><p><sup>†</sup> Gender-based violence<a href="#fnref3"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn4"><p><sup>‡</sup> Gender-Equitable Men<a href="#fnref4"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn5"><p><sup>†</sup> Gender-based violence<a href="#fnref5"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
</ol>
</aside>

#  {#section-9 .unnumbered}

# Analysis and Discussion

## Common Attributes of Featured Programs

These positively evaluated programs were typically structured around a
series of presentations and exercises that progressively build upon one
another. This facilitated the process of men perceiving that axiomatic
principles of gender dynamics are actually social constructions that can
be feasibly altered. Their implementation methodologies usually included
the following components:

1.  A risk-benefit analysis of the pros and cons of current definitions
    of masculinity.

2.  Exercises that prompted the men to consider the differences between
    sex as a biological characteristic and gender as a social construct.

3.  An integration of the men's personal experiences of disempowerment,
    violence, and any subsequent trauma (e.g., Insituto Noos, Soul City,
    and CANTERA).

4.  An empathy exercise with role reversal (e.g., the *Marta and
    Raymond* video used by CANTERA and the dramatic techniques employed
    by Mobilizing Young Men to Care).

5.  A brainstorming activity to generate a list of constructive and
    practical ways to remedy the problem first in individual homes then
    in society at large.

6.  The description and rehearsal of an improved and self-described
    construction of masculinity acceptable to the participants.

7.  The visualization of positive and equitable role models of
    masculinity through actors, television, etc. (e.g., MYMTC and Puntos
    de Encuento).

## Program Highlights and Recommendations

Despite the above-described challenges, the following points emphasize
the strengths of the programs included in this review.

### Institutional Collaboration Makes a Difference

Establish program in partnership with infrastructure pre-existent in the
country that serves the target population. This will partially address
concerns about initial recruitment of participants. As the program
evolves, it can be used to complement and supplement any shortcomings of
the country's infrastructure until the program is institutionalized.

The work performed by Instituto Noos with violent men is a noteworthy
example of the effectiveness of collaborating with departments in a
country's existing infrastructure. Its successful intervention with
referrals from Brazil's Justice Department served as a launch pad for
the program. Program designers solved one difficulty often encountered
during the initiation phase of a program: recruitment of male
participants. After the criminal offenders who completed the program
returned to their respective communities, they generated self-referrals
from the general population, thus making the intervention
self-propagating.

Program H drew from the expertise and client base of multiple
organizations throughout Latin America and the Caribbean to carry out
its field-tested initiative. Drawing upon the technical expertise of
local and international organizations, Instituto PROMUNDO harnessed the
collaborative efforts of organizations from other continents. Its
exemplary efforts address the specific needs of various communities
through partnerships with local organizations sensitized to the concerns
of local populations.

### Sharing Personal Experiences is an Excellent Starting Point

Through interviews with participants, CANTERA discovered that men
typically responded better when their experiences are used as a starting
point for analyzing gender inequities perpetuated by traditional
definitions of masculinity. They also found that when women facilitated
discussions on gender sensitivity in the work setting, many men either
chose not to listen or interpreted the facilitator's speech as
accusatory, causing them to react defensively and to harbor fears that
the women's true motives were to belittle and "turn the tables" on them.

CANTERA also found in its work that externally exhibited change (i.e.,
in society among peers) is more difficult for men to display in
comparison to internally exhibited change (i.e., within the parameters
of the home in intimate relationships). Displaying a genuine behavior
change is not only influenced by men's internal resolve and attitudes,
but also by the perceived and actual reception of and reaction to those
changes by men's peer groups, superiors, and influential members of the
opposite sex. For instance, after participating in CANTERA's program,
some men found it easier to burp their baby in their home than to avoid
engaging in sexist behavior among friends. CANTERA also found that men
may not receive the necessary impetus or support to change from male and
female peers due to their acquiescence with the status quo and a lack of
confidence in men's capacity to change.

### Trained, Gender-Sensitive Facilitators are Necessary

#### The quality of facilitators used when discussing sensitive topics can be a determining factor in the ultimate success of a program. Effective facilitators are empathetic, assertive, patient, objective, and focused negotiators who must be properly trained. MAP in South Africa used the training-of-trainers approach to prepare its facilitators, many of whom were former activists. The project coordinator for Peer Advocates for Youth was a professional basketball player, a profession held in high regard by many adolescent male participants, thereby adding to the coordinator's effectiveness as a role model. Instituto PROMUNDO offers training internationally and nationally to groups interested in using the materials it developed, which are available in English, Portuguese, and Spanish. The Stepping Stones training package has been customized to suit the needs of numerous organizations worldwide.

#### 

### Creatively Integrate Program Outputs into Society 

Networks with other organizations and unions in different settings
should be expanded in order to make the changes long lasting and
sustainable. If the ultimate goal is to fashion a more egalitarian
society, stimuli to this effect must be omnipresent, just as those that
enable the current dichotomies are.

Stepping Stones' innovative approach to promoting collective
responsibility is worth emulation. It endorses approaching behavior
change on the community and individual levels simultaneously, using the
program participants as a medium of communication between the two. By
involving the community from the outset and submitting "requests for
change" to the community, everyone is made aware of the requirements for
establishing a supportive environment. This program also suggests
establishing work-based programs in which men are paid to attend
intervention workshops in order to enroll and retain male participants.
This strategy would require negotiations with employers to convince them
that participation in the program makes practical business sense.

The Conscientizing Male Adolescents Program achieves sustainability
through its recruitment process. The program is an opportunity to
nurture bright young men who may otherwise find their ambitions stifled
in a society with limited career opportunities. Because leaders are the
only participants, the program must expand to a new location once the
pool of willing participants is exhausted. The addition of a project for
university students demonstrates this program's commitment to
sustainability in a practical sense.

The work of Instituto Noos in Brazil highlights the need and utility of
partnerships with the judicial system to provide more effective and
holistic forms of punishment for crimes attributable to negative and
unhealthy characteristics of masculinities. It also draws attention to
the need to bolster the authority of the justice system as well as
citizens' resolve to reform it.

Both of CEDPA's featured programs integrated workshops into the
curricula of educational centers. Although this tactic is difficult to
initiate, it reduces the need to recruit facilitators to sustain the
program's aims. It also ensures the incorporation of modules on gender
equity into the normal curriculum, that is, assuming that the
instructors perceive the information presented as worthwhile and
beneficial to both themselves and their students.

Sustaining changes and networks is a reoccurring difficulty lamented by
all of the programs. Programs using peer education techniques are
particularly prone to this shortcoming. With Stepping Stones, for
instance, the peer educators often failed to maintain relationships with
their peer groups, thereby effectively thwarting the continuance of the
support group. The trust and relationships established during the
project's implementation phase are then severed. Projects that impart
problem-solving and critical-thinking skills avoid this problem to an
extent.

### Conduct Intervention with Males Separate from Females

Often, in order to solidify an innovative way of thinking, individuals
have to be sequestered and allowed time and space to think about the
implications of adopting a new pattern of thinking. The Mobilizing Young
Men to Care project in South Africa can serve as a cautionary tale on
this issue. Its workshops included females in its focus groups in order
to engender genuine change in the male students that would not be
misinterpreted. This strategy proved to be counterproductive in that the
gender dynamics in the focus groups changed as a result of female
participants increasing an exhibition of "masculine" traits in the
mixed-gender focus groups. The female students began to feel more
empowered as the project progressed. It can be inferred that any change
exacted in the young men may not have been captured and may possibly
have been overshadowed by the achievements of the female students. The
environment created by the project did not provide sufficient space for
the males to analyze their behaviors without the input of the opposite
sex.

A possible suggestion to improve the project design could be to conduct
focus groups with males only as a separate phase of the project so that
the self-reconstruction process can solidify into self-actualized
attitudes and behaviors free from the input of the opposite sex. Another
phase can include young women in the focus groups in order to challenge
the strength of the young men's resolve to adopt more gender-equitable
attitudes and behaviors. The young women's sense of empowerment will
then serve the objectives of the project, rather than confound the
results. Or the workshop sequence used by Stepping Stones could be
emulated, whereby males and females participate in separate but
concurrent workshops that are combined for the final workshop session.

### Suffuse Mass Media with Images of Gender-Equitable Relationships

In order to counteract unhealthful messages propagated through the mass
media, equally appealing positive messages have to be disseminated.
Nuances such as the placement of the hands, eye contact, and body
language communicate volumes without words. Keeping this in mind, the
Strength Campaign, for instance, plans to modify its leaflets and
posters to more accurately portray images of couples in which both
partners are mutually valued. The campaign strives to offer an
alternative to the mainstream images of women as ornaments for men and
the sole gatekeepers of sex. Zero Tolerance's Respect Campaign, as well
as Soul City, artfully portray dramatic scenarios to stimulate
discussion of the interconnectedness of different social ills and gender
issues and the necessity of redefining gender roles.

### Integrate Unidirectional and Bidirectional Vehicles of Communication

Essentially, programs involving interactive groups and those using mass
media approaches differ in two ways. First, mass media or marketing
campaigns allow only unidirectional delivery of information, whereas
group-based methods allow bidirectional exchange of information. This is
a strength of the latter program type. Group-based methods provide
participants with an accessible source of information, a soundboard for
comments and feedback, and a reified entity to reinforce intended
messages (at least during the program implementation phase). Marketing
campaigns may, however, possess a greater capacity to create an enabling
environment due to their ability to reach a wider audience.

Second, the messages presented by mass media campaigns must be in the
form of sound bites discretely packaged to deliver simplified
information. Through discussions and dialogue, group-based methodologies
allow participants to delve into and think about the subjects presented.
Group-based methodologies do require the personal commitment of more
individuals rather than corporations in order to sustain the
intervention, however. Both approaches require sensitivity to local
culture and linguistic diversity, in addition to repetition.

Given the limitations of both approaches as channels to induce behavior
change, the most efficacious approach may be a multi-pronged one in
which mass media campaigns simply foster the creation of an enabling
environment for exercising the desired behavior and a group-based
methodology reinforces the messages presented. Program H's field-tested
project in the Caribbean and Latin America would serve as a suitable
model for this type of multipronged approach.

### Quasi-scientific Evaluations are the Most Compelling

Sound evaluations not only provide feedback on the efficiency and
efficacy of a program for internal use, they also provide informative
data on specific methods that can be adapted by posterity to improve and
enrich future programs. Unfortunately, much of the evaluation data
analyzed for this review would have allowed greater latitude for
comparison between programs if the results had been more keenly
scrutinized and systematically collected. Several recommendations
follow.

Stratify results by socioeconomic status, previous exposure to
gender-equity programs, participants' ethnicity or racial group, marital
status, number and gender of children, etc., to allow more in-depth
analyses of data provided. Puntos de Encuentro conducted a thorough and
impressive evaluation of its initiative among men in geographical areas
affected by Hurricane Mitch. It controlled for confounders such as
previous exposure to gender equity campaigns and men's perceived level
of equitable behavior. Soul City has also evaluated its mass media
campaign and has made available on its Website a number of evaluations
of each component of its initiative.

Precisely describe how the respondents in the evaluation differ from the
remaining participants. Also include postulations of whether or not the
pool of participants is a representative sample of the general
population (i.e., accounting for any selection bias). CANTERA
transparently described the limitations of its intervention in Nicaragua
in a CIIR publication. After reviewing the post-intervention surveys
collected from participants, programmers realized that the majority of
the participants were referred to the program by their employers. This,
of course, skews the ability to generalize their results.

Use time-sensitive indicators to chart the progressive impact of the
program from the individuals who participated to society at large.
Short-term and long-term indicators will measure the effect on both
gender equity and health behaviors, as well as the transition from
adoption of an innovative definition of masculinity, to behavioral
change at the individual level, to the creation of an enabling
environment by a *critical mass* adopting the innovative gender norm, to
the establishment of a new social norm. Nearly all the programs featured
in this review adopted this approach; however, not much can be stated to
elaborate on this, because most of these programs have existed for a
short time period due to budgetary constraints or recent implementation.

Involve other community members in the evaluation process. Persons in
the participant's social sphere can serve as informants on the
participant's adoption of gender-equitable behaviors and actual
transformation in daily life. Also, their feedback will facilitate
measurements of the perception of changes in social norms. Evaluators of
the Better Life Options for Boys Program, for instance, interviewed
former participants' spouses and family members in order to corroborate
any behavioral changes self-reported by the participants.

Recruit independent evaluators separate from the facilitators. This may
increase the probability of acquiring accurate feedback from
participants. Instituto Noos took this precaution when evaluating its
intervention among criminal offenders. Practically, this serves to blind
the participant and evaluator to the other's biases.

Adopt uniform evaluation methodologies and indicators, including the
analysis of a control group, to allow standard performance-based
analysis of programs. One of the goals of Program H is to disseminate a
standard evaluation and implementation model after which other programs
can pattern themselves. If adopted universally, standardized evaluation
techniques will facilitate future analyses of program efficacy similar
to the one described here.

## Why Programs Fall Short of Changing Social Norms

Changing social norms is contingent on generating a critical mass of
adopters according to Everett Rogers's Diffusion of Innovations Theory.
The dissemination of normative change and the sustainability of that
change both depend on enough people being actively involved in
reinforcing and legitimating the new and different ideas. Only
individuals change their behaviors, but social norms must change at the
social level. The diffusion of new and lower fertility norms throughout
Europe and the developing world provide a good example of the influence
of norms on private, individual behavior.[^24] But if this sort of
change is to be brought about purposefully, it requires time,
commitment, and basic compatibility between the message of change and
underlying values and ideas. Scarce or inconsistent support often
debilitates many worthwhile programs because not all funders are
committed to supporting a relatively new and diffuse agenda of changing
the social norms that undermine health.

# Conclusion

Despite the difficulty of altering social norms, it is imperative to
try. Gender issues permeate nearly every construct of society and
interaction between human beings. Socialized gender roles especially
affect HIV/AIDS, as well as reproductive, maternal, and child health. In
the wide spectrum of programs in global health, some programs have
intentionally attempted to address both social norms related to gender
and behavioral outcomes in reproductive health. Others have limited
their scope to one of these foci. Of the interventions that exist, few
have been substantively evaluated. But invaluable lessons that can guide
future programs can be gleaned from the findings of those that have
undergone evaluation.

The findings presented in this review highlight the merit and
feasibility of implementing programs to alter social norms related to
gender. More importantly, the findings should impress on implementers
the dire necessity of integrating long-term and short-term evaluation
plans in program designs to capture measurements of efficacy. Proper
evaluation techniques facilitate the identification, replication, and
propagation of best practices to different settings. Although the
evaluations presented differ tremendously in strength and scientific
scrutiny, the described programs herein are exemplary and worth
emulating. The strategies employed by these programs are not only
meritorious, but also feasible. Their experiences have demonstrate the
earnest desire and alacrity of men to participate constructively in
reproductive health, to grapple with the social constructs that fetter
both males and females, to empower themselves as responsible seekers of
healthful solutions in order to empower women as well, and to institute
individual change in order to ameliorate family life and society at
large. This review raises our awareness of the hopeful direction that
HIV/AIDS and reproductive, maternal, and child health programs can take
by addressing not only the behaviors of their audiences, but more
importantly, the normative beliefs that govern behavior.

Drawing from the examples presented, employing a multi-pronged approach
that monopolizes the benefits of unidirectional and bidirectional
vehicles of communication will increase the likelihood of establishing
the link between thought and action, despite the complexities involved
in changing human behavior and the socialized constructs that govern it.
The future of global health programming is hopeful. Prior experience can
engender wise and adroit approaches to health issues spawned by
behavior. With the proper financial, technical, and institutional
support, the ultimate stage of the Diffusion of Innovations Theory can
be actualized in gender-equitable relations that are both sanctioned and
supported by social norms. Similarly, initiatives must expose their
audiences to the interconnected messages of behaviors driven by socially
accepted norms. Programs that harness men's desire to change, focus on
youth as a prevention strategy, incorporate legislative change, optimize
indigenous infrastructure, collaborate with partnering organizations and
opinion leaders, suffuse the media with positive images, and draw upon
local culture to craft appropriate messages are the best-suited to this
endeavor of recreating the social environment to enable positive and
healthful behaviors and beliefs.

# References

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economic analysis and policy in South Asia. *World Development*
22(10):1455--1478.

Alan Guttmacher Institute. 2003. *In Their Own Right: Addressing the
Sexual and Reproductive Health Needs of Men Worldwide*. New York: Alan
Guttmacher Institute.

Catholic Institute for International Relations (CIIR). *News: Crossing
the Sea---Masculinity Work in the Caribbean 1/10/2001.* Available at the
following Web address:
<http://www.ciir.org/ciir.asp?section=news&page=story&id=275>. Accessed
November 13, 2003.

Cohen, Sylvie I., and Michele Burger. 2000. *Partnering: A New Approach
to Sexual and Reproductive Health*. New York: United Nations Population
Fund.

*Colectivo de Hombres por Relaciones Igualitarias A.C.* Home page
available at the following Web address:
[http://www.coriac.org.mx](http://www.coriac.org.mx/). Accessed November
13, 2003.

Das Gupta, Monica. 1987. Selective discrimination against female
children in rural Punjab, India. *Population and Development Review*
13(1):77--100.

Dempsey-Chlam, Justin, and Tom Wilhelm. 2003. *Annotated Bibliography of
Male Involvement* (draft). New York: United Nations Children's Fund
(UNICEF).

Foreman, Martin (Ed.). 1999. *AIDS and Men: Taking Risks or Taking
Responsibility?* London: Panos/Zed Books.

Grant, Elizabeth. 2003. *Seizing the Day---Right Time, Right Place, and
Right Message for Adolescent RSH (Kenya)* (PowerPoint and oral
presentation). Presented at the Reaching Men to Improve Reproductive
Health for All Conference, Dulles, Virginia.

Greene, Margaret E., and Ann E. Biddlecom. 2000. Absent and problematic
men: Demographic accounts of male reproductive roles. *Population and
Development Review* 26(1):81--115.

Greene, Margaret. 2003. *A Framework for Men and Reproductive Health
Programs.* Oral presentation at the Reaching Men to Improve Reproductive
Health for All Conference, Dulles, Virginia.

International HIV/AIDS Alliance. 2003. *Men's Work Working with Men,
Responding to AIDS: A Case Study Collection.* Brighton, England:
International HIV/AIDS Alliance.

Kim, Young Mi, Caroline Marangwanda, and Adrienne Kols. 1996. *Involving
Men in Family Planning. The Zimbabwe Male Motivation and Family Planning
Method Expansion Project, 1993--1994.* Available at the following Web
address:
[www.africa2000.com/PNDX%5CJHU-zimbabwe.html](http://www.africa2000.com/PNDX\JHU-zimbabwe.html).
Accessed October 9, 2003.

Leach, F. 1998. Gender, education and training: An international
perspective. *Gender and Development* 6(2):9‑18.

Leslie, J., E. Ciemins, and S.B. Essama. 1997. Female nutritional status
across the life-span in sub-Saharan Africa: Prevalence patterns. *Food
and Nutrition Bulletin* 18(1):20‑43.

Miller, B.D. 1997. Social class, gender and intrahousehold food
allocations to children in South Asia. *Social Science and Medicine*
44(11):1685‑1695.

Mundigo, Axel I. 1995. *Men's Roles, Sexuality and Reproductive Health.
International Lecture Series on Population Issues.* Chicago, Ill: The
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Murphy, Elaine. Forthcoming. Organized family planning programs: A
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Rogers, Everett M. 1995. *Diffusion of Innovations*. 4th edition. New
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# Annex

# Annotated Bibliography

Bankole, Akinrinola, and Susheela Singh. 2003. *In Their Own Right:
Addressing the Sexual and Reproductive Health Needs of Men Worldwide.*
New York: Alan Guttmacher Institute.

> Few recent works address the sexual and reproductive health needs of
> men independent of their relationships with their female partners. The
> Guttmacher Institute provides an overview of men's sexual and
> reproductive behavior worldwide and highlights health and program
> implications of that information. It identifies needs for health
> information and related services, obstacles that prevent men from
> receiving services, and offers approaches to enhance men's sexual and
> reproductive health and benefits to their partners and children.
> Available at the following Web address:
> <http://www.guttmacher.org/pubs/itor_intl.pdf>

Foreman, Martin, ed. 1998. *AIDS and Men: Taking Risks or Taking
Responsibility?* London: Panos Institute/Zed Books.

> This book examines the relationship between men and HIV/AIDS, arguing
> that the epidemic cannot be contained until men are persuaded to
> change their traditional concepts of masculinity. It suggests one in
> four men worldwide have sexual and drug-taking behavior that places
> them and their partners at risk. Not online; available by order:
> <http://www.panos.org.uk/resources/bookdetails.asp?id=1023>

International HIV/AIDS Alliance. 2003. *Working with men, responding to
AIDS, Gender, sexuality and HIV---A case study collection*.

> Case studies from 13 countries aim to stimulate thinking and
> strategies for reaching men with project interventions to help them to
> change their attitudes and behavior. Lessons from the field offer
> ideas and models for working in a broad range of contexts. Available
> at the following Web address:
> [http://www.aidsalliance.org](http://www.aidsalliance.org/)

United Nations Population Fund. 2000. *Partnering: A New Approach to
Sexual and Reproductive Health*. New York: UNFPA. Technical Paper No. 3.
Available at the following Web address:

> <http://www.unfpa.org/upload/lib_pub_file/170_filename_partnering.pdf>

United Nations Population Fund. 2003. *Enlisting the Armed Forces to
Protect Reproductive Health and Rights: Lessons Learned from Nine
Countries.* New York: UNFPA.

> Taking advantage of the organizational and human resources of military
> institutions to protect reproductive health and rights is emerging as
> a powerful strategy in both peacetime and conflict situations. For
> decades, UNFPA has worked with the military sector to reach men with
> information, education, and services for family life and family
> planning. This experience now is being applied to a wider spectrum of
> reproductive and sexual health concerns, including maternal health,
> HIV/AIDS prevention, and reduction of gender-based violence. This
> digital document offers lessons learned from reproductive health
> projects in nine different military organizations. Available at the
> following Web address:
> <http://www.unfpa.org/rh/armedforces/index.html>

United Nations Population Fund. 2003. *It Takes 2: Partnering With Men
in Sexual and Reproductive Health*. New York: UNFPA.

> "Partnering with men" is emerging as an important strategy for
> improving reproductive health. UNFPA offers guidance on effective
> gender-sensitive ways to engage men in the reproductive and sexual
> health of themselves and their partners, including examples of
> successful strategies and programming and lessons learned. A checklist
> summarizing key points makes this program advisory note useful for
> designing and evaluating projects. Based on *Partnering* (2000),
> below. Available at the following Web address:
>
> <http://www.unfpa.org/upload/lib_pub_file/153_filename_ItTakes2.pdf>

U.S. Agency for International Development, Inter-Agency Gender Working
Group. July 2003. *Involving Men to Address Gender Inequities: Three
Case Studies*. Washington, DC: USAID.

> Profiles of three innovative programs---Salud y Género, Society for
> the Integrated Development of the Himalayas, and Stepping
> Stones---that involve men and youth to improve the reproductive health
> and well-being of both men and women. Available at the following Web
> address:
>
> <http://www.measurecommunication.org/Content/NavigationMenu/Measure_Communication/Gender3/InvolvMenToAddressGendr.pdf>

[^1]: Kim, Young Mi, Caroline Marangwanda, and Adrienne Kols. 1996.
    *Involving Men in Family Planning. The Zimbabwe Male Motivation and
    Family Planning Method Expansion Project, 1993--1994.* Available at
    the following Web address:
    [www.africa2000.com/PNDX%5CJHU-zimbabwe.html](http://www.africa2000.com/PNDX\JHU-zimbabwe.html).
    Accessed October 9, 2003.

[^2]: Miller, B.D. 1997. Social class, gender and intrahousehold food
    allocations to children in South Asia. *Social Science and Medicine*
    44(11):1685‑1695.

    Das Gupta, Monica. 1987. Selective discrimination against female
    children in rural Punjab, India. *Population and Development Review*
    13(1):77--100.

[^3]: Leslie, J., E. Ciemins, and S.B. Essama. 1997. Female nutritional
    status across the life-span in sub-Saharan Africa: Prevalence
    patterns. *Food and Nutrition Bulletin* 18(1):20‑43.

[^4]: Leach, F. 1998. Gender, education and training: An international
    perspective. *Gender and Development* 6(2):9‑18.

[^5]: Agarwal, B. 1994. Gender and command over property: A critical gap
    in economic analysis and policy in South Asia. *World Development*
    22(10):1455--1478.

    Summerfield, G. 1998. Allocation of labor and income in the family.
    In: *Women in the Third World: An Encyclopedia of Contemporary
    Issues*, edited by Nelly P. Stromquist. New York: Garland
    Publishing. (Garland Reference Library of Social Science Vol. 760)
    pp. 218--226.

[^6]: Heise, L.L., J. Pitanguy, and A. Germain. 1994. *Violence against
    women. The hidden health burden*. World Bank Discussion Paper 255.
    Washington, D.C.: The World Bank.

    Heise, Lori L. 1995. Violence, sexuality, and women's lives. In:
    *Conceiving Sexuality: Approaches to Sex Research in a Postmodern
    World*. New York: Routledge.

    Heise, L, M. Ellsberg, and M. Gottemoeller. 1999. Ending violence
    against women. *Population Reports. Series L: Issues In World
    Health.* Dec (11):1--43.

[^7]: Foreman, Martin (Ed.). 1999. *AIDS and Men: Taking Risks or Taking
    Responsibility?* London: Panos/Zed Books.

    Mundigo, Axel I. 1995. *Men's Roles, Sexuality and Reproductive
    Health. International Lecture Series on Population Issues.* Chicago,
    Ill: The John D. & Catherine T. MacArthur Foundation.

[^8]: Rogers, Everett M. 1995. *Diffusion of Innovations*. 4th edition.
    New York: The Free Press.

[^9]: Singhal, Arvind, and Everett M. Rogers. 2003. *Combating AIDS:
    Communication Theories in Action*. Thousand Oaks, Calif: Sage
    Publications.

[^10]: Murphy, Elaine. Forthcoming. Organized family planning programs:
    A diffusion of innovations success story. *Journal of Health
    Communications* Vol. 8(6)*.*

[^11]: Greene, Margaret E., and Ann E. Biddlecom. 2000. Absent and
    problematic men: Demographic accounts of male reproductive roles.
    *Population and Development Review* 26(1):81--115.

[^12]: Foreman, Martin (Ed.). 1999. *AIDS and Men: Taking Risks or
    Taking Responsibility?* London: Panos/Zed Books.

[^13]: Alan Guttmacher Institute. 2003. *In Their Own Right: Addressing
    the Sexual and Reproductive Health Needs of Men Worldwide*. New
    York: Alan Guttmacher Institute.

[^14]: Cohen, Sylvie I., and Michele Burger. 2000. *Partnering: A New
    Approach to Sexual and Reproductive Health*. New York: United
    Nations Population Fund.

[^15]: Dempsey-Chlam, Justin, and Tom Wilhelm. 2003. *Annotated
    Bibliography of Male Involvement* (draft). New York: United Nations
    Children's Fund (UNICEF).

[^16]: *Programa PAPAI: Abstract.* Available at the following Web
    address: <http://www.ufpe.br/papai/Traducao/english.html>. Accessed
    November 13, 2003.

[^17]: *Colectivo de Hombres por Relaciones Igualitarias A.C.* Available
    at the following Web address:
    [http://www.coriac.org.mx](http://www.coriac.org.mx/). Accessed
    November 13, 2003.

[^18]: Catholic Institute for International Relations (CIIR). *News:
    Crossing the Sea---Masculinity Work in the Caribbean 1/10/2001.*
    Available at the following Web address:
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[^19]: International HIV/AIDS Alliance. 2003. *Men's Work Working with
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[^20]: Grant, Elizabeth. 2003. *Seizing the Day---Right time, Right
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[^21]: Greene, Margaret. 2003. *A Framework for Men and Reproductive
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[^22]: Kim, Young Mi, Caroline Marangwanda, and Adrienne Kols. 1996.
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[^23]: *Prevention Institute: The spectrum of prevention: Developing a
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[^24]: Watkins, S.C. *From Provinces into Nations: Demographic
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