Gender-transformative Programmes: A Framework for Demonstrating Evidence of Social Impact

"A focus on the individual level reflects a more atomised and psychological approach to understanding gender norm change, diverting attention and responsibility from the underlying social structures and systems that contribute to gender inequality."

Evidence has demonstrated that gender inequality and restrictive gender norms wield significant influence over health outcomes. Gender-transformative programmes aim to challenge and change these norms, but many are designed and evaluated with a narrow focus on outcomes in the lives of individual programme beneficiaries and short-term goals. This paper introduces an analytical framework designed to assess the impact of these programmes in terms of achieving broader, lasting norm change. The framework offered here highlights the need for greater ambition in how programmes are designed, implemented and evaluated.

The paper begins by exploring the link between gender norms and health. Research indicates that, combined with other hierarchies like race and class, gender norms are a part of an elaborate system of rewards, punishments, expectations, and constraints that deeply affect the health of individuals and entire communities. For instance, women may engage in potentially harmful body-altering procedures as a consequence of cultural messages about the inadequacy of their bodies and the need to improve themselves to be attractive, and men may engage in risky behaviours like excessive drinking, aggressive behaviour, or even the reluctance to seek medical help, to assert their masculinity and distance themselves from anything perceived as feminine.

The rationale for gender-transformative programming is well established in theory, and data show that these programmes do lead to improved gender-related and health-related outcomes. However, previous research conducted by these authors finds that most gender-transformative programmes are not designed along the dimensions that would be fundamental to achieving lasting gender norm change and gender equality. Among the 85 programmes they examined, nearly all implemented activities focused on the individual and/or interpersonal levels, rather than the system as a whole. Even if community-level activities are undertaken as part of this programming, when done alone, they do not ensure the transformation of structures and policies that enable long-term and large-scale changes in power relations.

In light of this analysis, and as a response, the authors propose that programmes are more likely to transform gender norms and increase gender equality if they demonstrate four key dimensions (see Table 1 in the paper for more detail):

1. Multiplicative effect: emphasises the interconnected nature of societal systems, positing that altering one element can trigger cascading effects throughout the entire system and beyond health outcomes alone.
2. Sustainability: recognises that change within a system is less likely to revert once the structure has shifted. Programmes that facilitate norm change are more likely to sustain the changes brought about by their interventions.
3. Spread: acknowledges the importance of engaging entire networks that share the targeted norms. Successful programmes should demonstrate evidence of gender-related outcomes extending beyond the immediate beneficiaries, progressively diffusing through the broader population.
4. Scalability: highlights the need to bring gender-transformative initiatives to a larger scale to effect broader norm change.

To achieve measured high-quality status (i.e., programmes that are highly likely to transform - and/or have transformed - norms and improve gender equality), a programme must explicitly measure at least one criterion of each dimension in its evaluation. (See box 1 in the paper for a case study describing the measured high-quality programme SASA!, which is a phased community mobilisation intervention that seeks to prevent intimate partner violence (IPV) and reduce women's vulnerability to HIV infection.) Programmes that are designed along the four dimensions of the above framework yet fail to measure all four of the dimensions explicitly would be described as having inferred high-quality status (i.e., programmes that one can only infer are gender transformative). To achieve an inferred high-quality rating, a programme must at least address each of the four dimensions in its design or description of programme implementation, even if the measurement of these dimensions is not reported in its evaluation.

This framework:

• Shifts the focus from the individual to systems-level change.
• Makes the links between well-evaluated programmatic models and social change more explicit.
• Establishes a standard and offers a framework for assessing programmes that aim to change gender norms and improve gender equality.
• Can be used as a tool to analyse existing and completed programmes retrospectively and/or can be used prospectively during programme design and implementation phases. (Table 2 in the paper includes specific considerations for retrospective and prospective operationalisation of the framework.)
• Is relevant not only in the context of gender-transformative health programming but to the assessment of policies as well, which can go beyond their scale as measured by the numbers of people they are reaching to analyse other dimensions of their impact.
• May also be of use within non-health sectors such as education or income generation, which follow similar theories of norm change that drive health-related gender-transformative programming.

In conclusion: "This framework takes the field a step closer to closing the gap between our programmatic aspirations and our ability to know whether we have truly made a difference in shifting the gender norms and inequalities that harm health and well-being."