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Original research
Gender-transformative programming with men and boys to improve sexual and reproductive health and rights: a systematic review of intervention studies
  1. Eimear Ruane-McAteer1,
  2. Kathryn Gillespie2,
  3. Avni Amin3,
  4. Áine Aventin2,
  5. Martin Robinson2,
  6. Jennifer Hanratty4,
  7. Rajat Khosla3,
  8. Maria Lohan2
  1. 1School of Public Health, University College Cork, Cork, Ireland
  2. 2School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
  3. 3Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
  4. 4Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
  1. Correspondence to Professor Maria Lohan; m.lohan{at}qub.ac.uk

Abstract

Background Global health organisations advocate gender-transformative programming (which challenges gender inequalities) with men and boys to improve sexual and reproductive health and rights (SRHR) for all. We systematically review evidence for this approach.

Methods We previously reported an evidence-and-gap map (http://srhr.org/masculinities/wbincome/) and systematic review of reviews of experimental intervention studies engaging men/boys in SRHR, identified through a Campbell Collaboration published protocol (https://doi.org/10.1002/CL2.203) without language restrictions between January 2007 and July 2018. Records for the current review of intervention studies were retrieved from those systematic reviews containing one or more gender-transformative intervention studies engaging men/boys. Data were extracted for intervention studies relating to each of the World Health Organization (WHO) SRHR outcomes. Promising programming characteristics, as well as underused strategies, were analysed with reference to the WHO definition of gender-transformative programming and an established behaviour change model, the COM-B model. Risk of bias was assessed using Cochrane Risk of Bias tools, RoB V.2.0 and Risk of Bias In Non-randomised Studies of Interventions.

Findings From 509 eligible records, we synthesised 68 studies comprising 36 randomised controlled trials, n=56 417 participants, and 32 quasi-experimental studies, n=25 554 participants. Promising programming characteristics include: multicomponent activities of education, persuasion, modelling and enablement; multilevel programming that mobilises wider communities; targeting both men and women; and programmes of longer duration than three months. Six of the seven interventions evaluated more than once show efficacy. However, we identified a significant risk of bias in the overall available evidence. Important gaps in evidence relate to safe abortion and SRHR during disease outbreaks.

Conclusion It is widely acknowledged by global organisations that the question is no longer whether to include boys and men in SRHR but how to do so in ways that promote gender equality and health for all and are scientifically rigorous. This paper provides an evidence base to take this agenda for programming and research forward.

  • systematic review
  • public health
  • maternal health
  • health services research
  • child health
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2020-002997

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    Footnotes

    • Handling editor Soumyadeep Bhaumik

    • Twitter @EimearRMcA, @AvniNAmin, @QUBSoNM

    • Contributors ER-M, ML, AA, JH and ÁA designed review protocol and procedures. ER-M and KG conducted database search and removed obviously irrelevant records. ER-M and KG screened records for inclusion under guidance from ML. ER-M and KG conducted data extraction, including for quality appraisal under guidance from JH. MR, ML, KG and ÁA conducted initial analysis of the findings. ML, MR, AA, KG and ER-M drafted the manuscript. ÁA, JH and RK provided critical revisions to the manuscript. All authors read and approved the final manuscript.

    • Funding Funded by the Human Reproduction Programme (UNDP/UNFPA/UNICEF/WHO/World Bank collaboration) at WHO.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the 'Methodology' section for further details.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Any further data required are available on request from the corresponding author.