How Are Gender Equality and Human Rights Interventions Included in Sexual and Reproductive Health Programmes and Policies: A Systematic Review of Existing Research Foci and Gaps

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Abstract

The importance of promoting gender equality and human rights in sexual and reproductive health (SRH) programmes and policies has been affirmed in numerous international and regional agreements, most recently the 2030 Agenda for Sustainable Development. Given the critical role of research to determine what works, we aimed to identify research gaps as part of a broader priority setting exercise on integrating gender equality and human rights approaches in SRH programmes and policies. A systematic literature review of reviews was conducted to examine the question: what do we know about how research in the context of SRH programmes and policies has addressed gender equality and human rights and what are the current gaps in research. We searched three databases for reviews that addressed the research question, were published between 1994–2014, and met methodological standards for systematic reviews, qualitative meta-syntheses and other reviews of relevance to the research question. Additional grey literature was identified based on expert input. Articles were appraised by the primary author and examined by an expert panel. An abstraction and thematic analysis process was used to synthesize findings. Of the 3,073 abstracts identified, 56 articles were reviewed in full and 23 were included along with 10 from the grey literature. The majority focused on interventions addressing gender inequalities; very few reviews explicitly included human rights based interventions. Across both topics, weak study designs and use of intermediate outcome measures limited evidence quality. Further, there was limited evidence on interventions that addressed marginalized groups. Better quality studies, longer-term indicators, and measurement of unintended consequences are needed to better understand the impact of these types of interventions on SRH outcomes. Further efforts are needed to cover research on gender equality and human rights issues as they pertain to a broader set of SRH topics and populations.

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Most cited references 12

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Evaluating men's involvement as a strategy in sexual and reproductive health promotion.

Peter Sternberg, John Hubley (2004)

Nearly 10 years has passed since the 1994 International Conference on Population and Development recognized men as legitimate targets for sexual and reproductive health promotion. This recognition was born of the experience of many health promoting agencies in the 1980s and 1990s who realized that without working with men, change would be very difficult or impossible. It was proposed that men should be involved because their active participation was crucial to the success of programs and to the empowerment of women. However, the idea that men should play an active role in health promotion has not been without its critics, who have posed serious questions about the efficacy of involving men and the effects their involvement would have on women and children. In an effort to examine the lessons learned from men's involvement, this paper reviews published evaluations of interventions that have targeted heterosexual men. Twenty-four studies that met the criteria for inclusion (reported on interventions in areas of sexual and reproductive health that targeted heterosexual men and contained evaluation data) were found. From their review of these studies, the authors suggest that there is some evidence that the use of media approaches may be a successful strategy and that there may be some problems with the application of some cognitive behavior change approaches. However, the fact that few interventions have targeted heterosexual men and have been the subject for detailed evaluation suggests that there is a need for more interventions and better evaluations, which would examine not only the process of men's involvement, but also their impact on the lives of both the men themselves and their families. The reality is that although perhaps no longer regarded as part of the problem, men have yet to be seen as part of the solution.

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An Evidence Review of Gender-Integrated Interventions in Reproductive and Maternal-Child Health

Joan Marie Kraft, Karin Wilkins, Guiliana Morales … (2014)

Evidence-based behavior change interventions addressing gender dynamics must be identified and disseminated to improve child health outcomes. Interventions were identified from systematic searches of the published literature and a web-based search (Google and implementer's websites). Studies were eligible if an intervention addressed gender dynamics (i.e., norms, unequal access to resources), measured relevant behavioral outcomes (e.g., family planning, antenatal care, nutrition), used at least a moderate evaluation design, and were implemented in low- or middle-income countries. Of the 23 interventions identified, 22 addressed reproductive and maternal-child health behaviors (e.g., birth spacing, antenatal care, breastfeeding) that improve child health. Eight interventions were accommodating (i.e., acknowledged, but did not seek to change gender dynamics), and 15 were transformative (i.e., sought to change gender dynamics). The majority of evaluations (n = 12), including interventions that engaged men and women to modify gender norms, had mixed effects. Evidence was most compelling for empowerment approaches (i.e., participatory action for maternal-child health; increase educational and economic resources, and modify norms to reduce child marriage). Two empowerment approaches had sufficient evidence to warrant scaling-up. Research is needed to assess promising approaches, particularly those that engage men and women to modify gender norms around communication and decision making between spouses.

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A systematic review of income generation interventions, including microfinance and vocational skills training, for HIV prevention.

E. Kennedy, Virginia Fonner, M Sweat … (2013)

Income generation interventions, such as microfinance or vocational skills training, address structural factors associated with HIV risk. However, the effectiveness of these interventions on HIV-related outcomes in low- and middle-income countries has not been synthesized. The authors conducted a systematic review by searching electronic databases from 1990 to 2012, examining secondary references, and hand-searching key journals. Peer-reviewed studies were included in the analysis if they evaluated income generation interventions in low- or middle-income countries and provided pre-post or multi-arm measures on behavioral, psychological, social, care, or biological outcomes related to HIV prevention. Standardized forms were used to abstract study data in duplicate and study rigor was assessed. Of the 5218 unique citations identified, 12 studies met criteria for inclusion. Studies were geographically diverse, with six conducted in sub-Saharan Africa, three in South or Southeast Asia, and three in Latin America and the Caribbean. Target populations included adult women (N = 6), female sex workers/bar workers (N = 3), and youth/orphans (N = 3). All studies targeted females except two among youth/orphans. Study rigor was moderate, with two group-randomized trials and two individual-randomized trials. All interventions except three included some form of microfinance. Only a minority of studies found significant intervention effects on condom use, number of sexual partners, or other HIV-related behavioral outcomes; most studies showed no significant change, although some may have had inadequate statistical power. One trial showed a 55% reduction in intimate partner violence (adjusted risk ratio 0.45, 95% confidence interval 0.23-0.91). No studies measured incidence/prevalence of HIV or sexually transmitted infections among intervention recipients. The evidence that income generation interventions influence HIV-related behaviors and outcomes is inconclusive. However, these interventions may have important effects on outcomes beyond HIV prevention. Further studies examining not only HIV-related outcomes but also causal pathways and intermediate variables, are needed. Additional studies among men are also needed.

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Author and article information

Contributors

Benjamin Mason Meier: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 21 December 2016

Publication date Collection: 2016

Volume: 11

Issue: 12

Electronic Location Identifier: e0167542

Affiliations

[1 ]Women’s Global Health Imperative, RTI International, San Francisco, CA, United States of America

[2 ]World Health Organization, Geneva, Switzerland

[3 ]Research Triangle Institute Global India Private Limited, New Delhi, India

[4 ]School of Public Health, University of the Western Cape, Cape Town, South Africa

[5 ]Program on Global Health and Human Rights, University of Southern California, Los Angeles, CA, United States of America

University of North Carolina at Chapel Hill, UNITED STATES

Author notes

Competing Interests: The authors declare that they have no competing interests.

Conceptualization: RK AA SK.
Data curation: MH.
Formal analysis: MH SK.
Funding acquisition: RK AA.
Investigation: MH.
Methodology: MH SK RK AA SG AG.
Project administration: RK.
Visualization: MH RK.
Writing – original draft: MH RK.
Writing – review & editing: MH SK RK AA SG AG.

‡ These authors are joint first authors on this work.

* E-mail: mhartmann@ 123456rti.org

Author information

Miriam Hartmann http://orcid.org/0000-0001-8109-9679

Article

Publisher ID: PONE-D-16-36128

DOI: 10.1371/journal.pone.0167542

PMC ID: 5176262

PubMed ID: 28002440

SO-VID: 0804f511-fdf5-4c8d-8b6c-3c958b7daaa3

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 8 September 2016

Date accepted : 15 November 2016

Page count

Figures: 1, Tables: 1, Pages: 14

Funding

Funded by: funder-id http://dx.doi.org/10.13039/100004423, World Health Organization;

Award Recipient :

ORCID: http://orcid.org/0000-0001-8109-9679

Miriam Hartmann

This review was supported by the Human Reproduction Programme, World Health Organization. The content is solely the responsibility of the authors and does not necessarily represent the official views of the authors’ employers or funders. Asha George is supported by the South African Research Chair's Initiative of the Department of Science and Technology and National Research Foundation of South Africa (Grant No 82769). Any opinion, finding and conclusion or recommendation expressed in this material is that of the author and the NRF does not accept any liability in this regard.

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How Are Gender Equality and Human Rights Interventions Included in Sexual and Reproductive Health Programmes and Policies: A Systematic Review of Existing Research Foci and Gaps

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Most cited references 12

Evaluating men's involvement as a strategy in sexual and reproductive health promotion.

An Evidence Review of Gender-Integrated Interventions in Reproductive and Maternal-Child Health

A systematic review of income generation interventions, including microfinance and vocational skills training, for HIV prevention.

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