Monday, October 25, 2010

XY: Men are Changing - An International Look at How Men Live

XY posted this research report from International Planned Parenthood Federation - I haven't had a chance to read the whole thing, but it looks like an interesting study of male experience from around the world.

They tackle the need for changes in how culture and society relates to men - not just here, but around the world. In almost every culture, men are trapped between cultural expectations of masculinity and their own experience - and the conflict between inner and outer leads to stress, anxiety, and depression, as well as unconscious and violent ways of trying to embody the cultural expectations.

We see it here in youth gangs, and we see it around the world in youth soldiers, whether in African nations of the Middle East. The report also lays out ways to change these destructive patterns.

Men are Changing: Case study evidence on work with men and boys to promote gender equality and positive masculinities

'Men are Changing' seeks to strengthen and broaden the evidence base on working with men and boys. It describes and analyzes 12 programmes from around the world that sought to alter the attitudes and behaviours of men in relation to sexuality, sexual and reproductive health, violence and relationships.

The report discusses challenges in this field, provides an overview of emerging good practice, and makes recommendations for improving existing policy work, programmes and services.

Its findings are clear: working with men and boys is effective, men are changing, but greater efforts are still needed to scale up gender-transformative interventions with men and women.

IPPF, Men are Changing 2010.pdf659.47 KB
Here is some of the Executive Summary that highlights the main points in the study and report.
Executive summary

The lives of women and children are intertwined with the lives of men. Without understanding how men’s gendered experiences affect them and those around them it is impossible to promote sexual health and achieve reproductive rights for all.

Interest in understanding masculinities and working with men on gender issues, and especially on gender equity, has increased enormously in recent decades. There has been a great deal of academic, media and community-based activity which is now bearing fruit. For example, masculinities now regularly appear as a topic in social science university courses. What were small-scale local movements – such as the White Ribbon Campaign founded by a group of men in Canada following the brutal murder of 14 women engineering students in Montreal – are now global in scope. There are a burgeoning number of programmes committed to engaging men as partners in achieving gender equality.

Not only is more being understood about different ways to successfully engage with men to challenge harmful expressions of masculinity and promote gender equality, but also more is being understood about men’s ability and desire to change. More and more men are seeing not only the benefits to their wives/partners, mothers, sisters and daughters in working towards gender equality but also the benefits for themselves.

The contribution of this report
This report contributes to the emerging evidence base on working with men to effect change in their lives and the lives of those around them by describing the outcomes of a piece of research that examined the effectiveness of 12 programmes and interventions. The men involved in these programmes are diverse; they reflect activity on all five continents and they cover sexual and reproductive health, violence and healthy relationships.1 The findings of this research are presented as case studies, each of which describes one of these programmes. The use of case studies enables us to outline the methods used and the outcomes achieved, and also describe the processes by which these happened. By presenting the work in this way we are aiming to:
• strengthen the international evidence base on interventions seeking to engage men and boys
• broaden the focus of existing research on working with men and boys through focusing on areas specific to IPPF’s priorities; namely, sexuality and sexual and reproductive health, violence and healthy relationships
• discuss challenges in working with men and boys on sexual and reproductive health and rights and on seeking to address their specific health needs
• provide an overview of emerging good practice when seeking to work with men and boys in the context of programmes focused on sexuality and sexual and reproductive health, violence and healthy relationships
The report concludes with some recommendations for improving existing policy work, programmes and services. Collecting the case studies and producing the evidence The 12 programmes described in this report were drawn from a pool of 26 identified by placing requests for information with organizations and networks that IPPF works with, alongside internet searching. Fourteen of the programmes were excluded from our analysis for three reasons: because they had not been evaluated, because no evaluation report was available or because the evaluation did not report any impact.

Information about each of the 12 programmes was written up into a standard format to allow comparative as well as intra-case study analysis. Using the same criteria as those used in the World Health Organization review of 58 programmes and interventions seeking to engage men and boys,2 programme effectiveness was rated by assessing evaluation design, giving more weight to quasi-experimental and randomized control trial designs; and level of impact, giving more weight to interventions that confirmed behaviour change on the part of men or boys. Combining these two criteria, programmes were rated as effective, promising or unclear. As well as examining effectiveness, we categorized the case studies using the Gupta framework3 to
identify them as one of the following:
• gender-neutral – distinguishing little between the needs of men and women, neither reinforcing nor questioning gender roles
• gender-sensitive – recognizing the specific needs and realities of men and women based on the social construction of gender roles
• gender-transformative – seeking to transform gender roles and promote more gender-equitable relationships between men and women
Main findings
The 12 case studies explored working with men from a range of backgrounds, took place in a variety of settings and addressed a range of issues. They include sexual and reproductive health programmes with men in the military in Namibia, transgender sex workers in Indonesia, men who have sex with men and male sex workers in Indonesia and Bangladesh, and men in the military in Benin; violence prevention programmes with men in the Democratic Republic of the Congo, men in Liberia and young men in Northern Ireland; and healthy relationship programmes with young men in Kenya, Zambia, Tanzania and Uganda, men in India, girls and boys in Canada, and men in Brazil.

The main findings were:
• In all areas – sexuality and sexual and reproductive health, violence and healthy relationships – the interventions led to behaviour change. This further strengthens the existing evidence base showing that interventions with men and boys actually work.
• The majority of programmes were found to be either effective (42 per cent) or promising (50 per cent) in reaching men and boys, addressing their needs and changing their attitudes and behaviours. Only eight per cent of programmes were found to be unclear.
• Seven of the programmes were gender-transformative, four were gender-sensitive and one was gender-neutral.
• Gender-transformative programmes were found to have a higher rate of effectiveness.
• Although the gender-transformative programmes were found to have a higher rate of effectiveness, programmes that adopted a gender-sensitive approach were also effective.
• Those interventions that combined good practice from a range of health issues (for example sexual and reproductive health and violence) were more effective.
• Although there is insufficient data from these case studies to conclude categorically whether some intervention methods are either inherently gender-transformative or more appropriate for gender-transformative work than others, the data does show some recurrent themes that warrant being reflected in future practice. These include:
– using a mix of methods such as training peer leaders, educational workshops, service provision and awareness campaigns
– undertaking extensive baseline work to establish the current situation, priorities for target groups, and to inform the materials and format of the programme
– ensuring that programmes create a context in which men can discuss what it means to be a man without fear of ridicule and where reflection and the exploration of alternatives was actively encouraged
• Few of the programmes had been scaled up from a pilot stage. This highlights the importance of a greater focus on ensuring interventions with men and boys are integrated into existing organizational and government strategies and workplans. Please see the Appendix for a full table of results.
These findings clearly suggest a strong link between programme effectiveness and the utilization of a gender transformation approach. Interventions seeking to engage men and boys should therefore seek to adopt this approach, and move beyond only gender-neutral or gender-sensitive programming.

Good practice and lessons learned
We have also identified a number of factors that underpin good practice when working with boys and young men, as listed here.

• Target women as well as men and boys when working with men. This is because gender norms and the associated inequities are not maintained and produced by men alone but through relations between the genders.
• Some men, but not all, are resistant to change. Equally, some women, but not all, are supporters of change. Programmes should reflect these nuances in their implementation.
• Plan for sustainability of programmes from the outset.
• Programmes benefit if they include both mixed and single sex group work.
• Provide programme staff with training that aims to equip them with skills and confidence in working with men.
• Interventions with men should combine both challenging and supporting them.
• It is important for interventions with men to have goals and outcomes that are concrete, meaningful and useful to men.
• Equip men with skills that allow them to make changes to their behaviour as well as to address knowledge and attitudes.
• It is beneficial to base work on men’s and women’s needs and to involve them in consultation from the beginning of programme development.
• Interventions should ‘go where men are at’; that is, to take interventions to settings where they are to be found rather than expect them to access interventions in settings with which they may be unfamiliar or in which they may feel uncomfortable.
• Consider how programmes can be integrated into existing structures and systems, for example subjects in school curricula, and teaching and professional training.
• Ensure that programmes seek to acknowledge and validate men’s willingness to change and celebrate these changes when they occur.
• Recognize that some men are extremely marginalized – especially men who have sex with men and male sex workers – and that interventions to reach these men need to recognize that their marginalization is in part derived from stigma and homophobia.
• Recognize that the public face of masculinity is often completely at odds with the private face of masculinity and that many men need the tools to negotiate the tension between the interface.
• It is important to set out with a positive message – aiming to correct the ‘faults’ in men does not appeal to them.
• Recognize that many men are struggling to come to terms with social and cultural change that undermines previously-held certainties about male power, authority and roles, and are actively seeking new identities in relation to other men and women and children.
• Accept that men’s engagement with programmes may be inconsistent and irregular. This is often because other activities take priority.
• Be aware of the importance of transitions in men’s lives and the impact that these may have on their willingness and ability to engage with programmes and effect change in their lives.
Furthermore, the case studies suggest some topic-specific factors associated with effectiveness.

With regard to sexual and reproductive health and sexuality
• It is important to use targeted information, education and communication materials and culturally appropriate educational materials to reach men.
• Availability of free condoms and water-based lubricant should be made a priority.
• Peer education is important, especially in reaching the most vulnerable groups of men (and in developing acceptance and trust among such groups).
• Awareness campaigns and advocacy work are necessary to encourage take-up of HIV voluntary counselling and testing, and to dispel myths, stigma and discrimination.
• Safe spaces are essential. These provide a place for men and boys to discuss issues of male sexuality, sexual identity and gender equality.
• It generally does not matter to men whether the service provider is male or female. The key issue is training and support for service providers and counsellors to address male-specific sexual and reproductive health needs.
• Discuss gender and equality issues, and couple communication with men at every opportunity – effective approaches seek to ‘sensitize’ men whenever they use services.
• Provide a broad package of male sexual and reproductive health services including, where possible, information, counselling, testing and treatment for HIV, sexually transmitted infections, male cancers and sexual dysfunctions.
With regard to violence
• Develop effective role models and ensure that leaders use their position to support addressing violence.
• Community outreach is an important strategy for seeking to engage men and boys in addressing violence, and should be scaled up.
• It is important to balance support and a challenging environment for men – interventions must hold them accountable, and recognize their power and privilege while, at the same time, cultivating compassion.
• Deal with perpetrators. It is important to balance values of accountability and compassion, while negotiating safety issues.
• Programmes that linked violence prevention to service provision were found to be more successful in achieving behavioural change.
With regard to healthy relationships
• Local and district governments provide an entry point to work with men and boys on healthy relationships, and activities should be integrated into both district plans and those of implementing partners.
• The integration of comprehensive sexuality education at a national level (in schools) is essential to building better relationships in the future.
• Programmes may work better when they provide sessions for young men only at the outset, and then move into mixed groups.
• Working with community-based organizations and community associations is essential to reaching the most vulnerable young men, particularly those involved in drugs and violence.
• Incentives are an important way to ensure that young men and boys attend and participate in educational sessions.
General conclusions and discussion
As with any new and emerging area, recognition of its benefits does not come quickly or easily. A long process of testing and retesting methods has taken place over the course of a decade with amazing results. Men and boys are, however, not a new area of focus in themselves; rather, the focus on gender is the missing part of existing work with men and boys. Gender is not, and never was, just about women – the time has come for the missing part of the gender equation to be included in the struggle to achieve gender equality in our world.

Men and boys, like women and girls, greatly impact on one another, and their attitudes and behaviour in connection with the role of men and women in a society can have devastating consequences for health, relationships, violence and even war. Ignoring or not seeing men as part of the gender equation and not addressing their needs as well as women’s in policy and programme design is a risk shown to have detrimental results. By including men as part of the gender equation in policy and programme design, we have shown the amazingly positive impact on men’s and women’s lives. This includes opening men’s eyes to how rigid gender norms have constrained their lives, finding ways to achieve more intimacy with their partners and families, understanding the need to support women’s access to health services, supporting women who have been raped, finding alternatives to being involved in violence, and showing greater responsibility through attending voluntary testing and counselling for HIV and other sexually transmitted infections, thereby preventing their spread.

Working with men does not, however, mean isolating women, particularly young women and girls. Interventions and efforts to increase service utilization among men and challenge their behaviour should not be at the cost of essential services for women (both young and older) but should be in addition to these services. The acknowledgement that gender is relational – with a male and female side – means that services and interventions should seek to work with men and women and address both immediate need and underlying behaviours.

For example, policy, programmes and associated budgets to tackle issues such as domestic violence and the spread of HIV need to expand to ensure this wider focus on both needs and behaviours, ensuring services are provided to women and children fleeing domestic violence as well as programmes to challenge the harmful behaviour of male perpetrators of domestic violence. Programmes encouraging women to negotiate safer sex should also include programmes to encourage men to have safer sex, acknowledging unequal power dynamics and challenging harmful gender norms that equate masculinity with multiple sexual partners and risk-taking. In addition, involving females is essential to increasing their support for work with men, and will provide them with the opportunity to explore the ways in which they may reinforce traditional ‘masculinities’, as well as develop their understanding of the wider social benefits of addressing male sexual and reproductive health.

Recommendations for the future
Based on this analysis, a number of specific recommendations can be made regarding how to improve future interventions and programmes seeking to work with men and boys.

Conceptual framework
• A clearer conceptual framework is required for this work. In particular, it is important to:
– clearly define what is meant by gender equality (and that this relates to women and men)
– link with work to empower women and girls – ensure the integration of men without being counter-productive
– understand which methods work best in different settings and subject areas, for example health or violence
• The debate on masculinities and working with men and boys should be broadened from primarily focusing on gender and rights to include a stronger focus on male sexuality.
All health areas
• Interventions must be multi-sectoral.
• More clarity should be provided within programmes on the role that women can play. Women and girls, individually and through women’s organizations and the women’s movement, must be advisors, participants, partners and monitors of this work.
• There should be a clearer articulation of the benefits to men and boys through engaging in this work, and a better understanding of these benefits among men themselves.
• Specific training on gender issues should be provided to men, especially young men and boys.
• The critical role that men can play as partners with women and as agents of social change should be affirmed.
• Teach men to listen better to others, especially their partners and families.
• Take interventions to men – ‘go where they are at’ – as well as try to make services and institutions more appealing to men.
• Staff should be supported with appropriate training to work with men.
• Interventions targeting men and boys should address structural issues, such as laws and policies on gender equality, as well as working at the individual level.
Sexuality and sexual and reproductive health
• There is a need for training and capacity building with service providers and counsellors on the needs (clinical and non-clinical) of vulnerable men and boys, and to ensure confidentiality.
• Develop sexual and reproductive health service packages for different age groups of men following the stages of the lifecycle.
• Devise clinical guidelines for men’s sexual and reproductive health.
• Include a greater focus on social mobilization when working with men and boys on sexual and reproductive health and rights and gender equality.
• Models of male-friendly clinics should be considered, especially for men who have sex with men, male sex workers and transgender people.
• Consideration must be given to the names of health services. Terms such as ‘maternities’ should be renamed to be more gender-neutral, although not in a way that would isolate women and girls. An example would be to use a broad name such as ‘sexual and reproductive health clinic’.
• The distribution of condoms should be central to sexuality and sexual and reproductive health programmes.
• Existing sexual and reproductive health services should, where necessary, include a greater focus on the specific sexual and reproductive health needs of men and boys.
• More efforts are needed to link sexual and reproductive health and HIV interventions that seek to target men and boys, for example linking HIV voluntary counselling and testing with management services for sexually transmitted infections.
• It is important to work with the military and other groups, and support them to integrate sexual and reproductive health and rights into their existing training.
• Validate men’s caring nature and desire for positive masculinity, and understand how violence is caused both by male privilege and men’s feelings of powerlessness.
• Provide specific actions for men to take forward in ending violence, particularly violence against women.
• Develop models for the most effective integration of working with men and boys into existing gender-based violence prevention programmes.
• Promote a greater awareness of how conflict impacts on masculinity and the use of gender-based violence as a weapon of war, making sure that programmes address these specific needs.
• Link violence prevention interventions to comprehensive sexual and reproductive health and HIV prevention services.
• More efforts are needed to integrate a focus on gender issues and couple communication within sexuality education in school curricula.
• It is crucial to create a supportive environment for effective work with men and boys on relationships, and ensure sustained change in attitudes and behaviours.
• More work needs to be done to challenge prevailing masculine norms of detachment and stoicism, which impoverish the ability of men to have intimate relationships with their partners and children.
• There is a need for additional work on homophobia and violence against homosexuals, as many young men are unwilling to challenge the often prevalent societal norm that being gay equates to ‘not being a real man’.
• More efforts are needed to develop a larger cadre of qualified and well-trained facilitators who can train trainers and work with a variety of groups of men and boys.
Campaigns and advocacy
• Ensure the development of well-formulated advocacy strategies to challenge the status quo and encourage policy review that seeks to further engage men and boys in achieving gender equality.
• Train staff in advocacy to enable programmes to have a wider policy impact.
• Campaigns should be designed by representatives of the target community and should use methods appropriate to the country setting to reach that community.
• Organizations and individuals working on engaging men should develop stronger links with those working on sexual diversity and other social movements – work on masculinities should not just be about gender, but also about class, race, etc.
• Put pressure on governments and UN agencies to implement existing commitments on engaging men and boys.
Research is needed to fill the following gaps found throughout the course of this study, on a number of topics.
• Masculinities and sexuality.
• Homosexual men, men with disabilities and men living with HIV.
• Engaging men in safe abortion and post-abortion care.
• Safe motherhood and fathers as caregivers.
• Men and conflict/post-conflict settings.
• Reasons for low condom use among some men.
• The role of men in the prevention of mother-to-child transmission of HIV.
Monitoring and evaluation
Monitoring and evaluation was a key factor in being able to show both effectiveness and behaviour change among the programmes in this analysis. We found great variations across programmes as to what data was collected, and how.

Recommendations to improve monitoring and evaluation in future programmes include:
• Promote effective follow-up after programmes, putting in place evaluation plans with key indicators at the beginning of programmes.
• Longer-term changes need to be monitored to better understand the link between intervention and impact on behaviour over the longer term. With larger-scale programmes, this data should be captured at different intervals to assess when the effect might be lessening, for example at six months, one year, two years.
• Some outcome measures should move away from relying solely on self-reports by participants, to include other more objective measures (for example sexually transmitted infection status for sexual and reproductive health programmes; reports from women and other men about participants for violence programmes; and reports by partners about participants for healthy relationship programmes).
• A common evaluation framework for interventions with men and boys is required, with training for organizational staff on utilizing this framework. This will enable programmes not only to show impact more effectively, but will also allow greater comparison across programmes to better identify good practice and other areas that require more focus.
• More research is required on the costs associated with these programmes, and organizations should be encouraged to record this data to allow such analysis. This will enable funders to make working with men a funding priority with a clearer idea of the costs associated with doing so.
Policy approaches
• Work with men and boys should be incorporated into all gender mainstreaming policies and tools4 to ensure that these resources encourage a gender relational approach (that focuses on both men and women). Without also focusing on men, it will be impossible for gender mainstreaming to truly empower women and girls.
• Organizational policies on sexual and reproductive health, HIV, violence and relationships should be updated, based on the above mainstreaming approach, to include men and women.5
• Policy approaches are central to this work being scaled up, making interventions more systematic and longer term. Governments, non-governmental organizations and funding organizations should urgently review their policies and priorities to include work with men and boys.
• Efforts to update government policies to include a stronger focus on working with men and boys should be undertaken at both national and local levels.
• Promote opportunities for cross-sectoral dialogues on engaging men and boys in gender equality (among men and women).
• Link this work to livelihood support for men and women, addressing poverty, employment and urban/rural differences in the developing world.
• Interventions with men and boys remain local in scale, limited in scope and short-term. It is essential that these programmes are scaled up (in other words, to move beyond a small and limited scope). As such, all new programmes and interventions should incorporate a plan from the outset on how their intervention will be broadened and expanded on completion, including through integration within national health systems.
• Long-term funding is essential for this work, especially when addressing gender issues with men and boys. Activities should be undertaken with donors and funders to encourage them to provide more financial support to this area.
• Scale-up should also look at structured opportunities for men and boys to explore many of the issues they have learned about in interventions, and address their behaviour.
• Working with young people and youth organizations at the optimum time to reach boys is essential to ensure ongoing support for this work.

1 We define healthy in the case of relationships as relationships that are caring, non-violent, non-abusive, open and honest.
2 See Instituto Promundo and World Health Organization (2007) Engaging Men and Boys in Changing Gender-based Inequity in Health.
3 See Gupta GR, Whelan D and Allendorf K (2003) Integrating Gender into HIV/AIDS Programmes: Review Paper for Expert Consultation.
4 See Chant S and Gutmann M (2002) ‘Men-streaming’ gender? Questions for gender and development policy in the twenty-first century. Progress in Development Studies.
5 See International Planned Parenthood Federation (2010) Men-streaming Gender in Sexual and Reproductive Health and HIV/AIDS: A Toolkit for Policy Development and Advocacy. This tool has been designed as part of this project to incorporate men and boys into non-governmental organization and government sexual and reproductive health and HIV policies.

Read the whole 80-page report.

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