Gender Equity and Norms in Health Programs: Learnings from a Drowning Reduction Program in Bangladesh
Authors: Gupta Medhavi , Rahman Aminur , Dutta Notan Chandra , Hossain Md. Shafkat , Nambiar Devaki , Parveen Samina , Ivers Rebecca , Jagnoor Jagnoor 
Published: May 2020

Abstract
Background: Community-based health programs implemented in low-and middle-income countries have additional health impacts beyond their targeted outcomes, such as on gender norms, roles and relationships. Programs should measure their effects on gender to respond to any unexpected consequences. Hence, we conducted a gender analysis on a drowning reduction program in rural Bangladesh providing survival swimming classes to children.Methods: A mixed-methods approach was used. Quantitative program monitoring data was analysed to assess gender differences in program participation and engagement. A qualitative approach using interviews, focus group discussions and observations aimed to find explanations for quantitative findings and additional experiences of the program. The analysis was conducted using Family Health International 360’s Gender Integration Framework.Results: Fewer girls participated in the swimming classes than boys due to cultural perceptions on appropriate activities for girls and their greater involvement in domestic work. Women were not hired in leadership roles in the implementing organisation due to constraints on transport access and perceptions on women’s ability to conduct labour-intensive activities. However, the program influenced communities to become more accepting of local women’s mobility and involvement in employed work due to their engagement in the program as swim instructors. Women swim instructors were also more satisfied with the pay and part-time nature of the work as men were able to earn more elsewhere, and so women were recruited in higher numbers by the implementing organisation.Conclusions: Systematised strategies are required to ensure equal participation of girls and boys in swim classes and enable equitable drowning outcomes. Within the implementing organisation, changes to attitudes and the formulation of gender-specific strategies will support women in leadership roles, ensuring that women-specific issues are considered in program delivery. The implementing organisation may also consider strategies to combat perceptions that lower-paying part time work is more suitable for women than men. Addressing these issues would have positive implications for the health and equity of both men and women in these rural communities.Contributions to literature· Community-based health programs have impacts on gender norms, roles and relationships within their context of implementation, which in turn affect individuals’ health outcomes unexpectedly. These effects are rarely analysed.· This study describes a novel application of a gender analysis to a drowning reduction program in Bangladesh, using a mixed-methods approach.· We show that the program had positive impacts on women’s mobility and access to employment, but also identify opportunities for this program to actively transform harmful gender norms for equitable health outcomes.· Implementers of health programs may follow a similar methodology and framework to identify how they are affecting health outcomes through impacts on gendered constraints, norms and relationships.