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

Studies have shown that harmful gender norms that promote male dominance over women prevent women from practicing safer sex, limit their use of contraceptives, and increase their risk of sexually transmitted infections (STIs), including HIV. Similarly, research has shown a relationship between violation and neglect of human rights and negative health outcomes and emphasises the need to better integrate human rights approaches into interventions, particularly with attention to provider training, service delivery, raising awareness, and capacity building. A systematic literature review of reviews was conducted to examine the questions: What do we know about how research in the context of sexual and reproductive health (SRH) programmes and policies has addressed gender equality and human rights, and what are the current gaps in research?

The researchers searched 3 databases for reviews that addressed the research questions, were published between 1994 and 2014, and met certain methodological standards. Of the 3,073 abstracts identified, 56 articles were reviewed in full, and 23 were included along with 10 from the grey literature. Results are broken down by key themes, such as research topic, location, target population, outcomes, and other methodological issues. The majority focused on interventions addressing gender inequalities; very few reviews explicitly included human-rights-based interventions. The gender equality interventions focused on male involvement, women's empowerment, and addressing gender roles - such as those relating to communication and decision-making, and biomedical interventions addressing gender-based barriers to SRH (e.g., female-controlled HIV prevention methods). Several reviews examined whether strategies reinforced (i.e., perpetuated unequal gender relations), accommodated (i.e., took into account men and women's unequal roles and power but did not change them), or were transformative (i.e., attempted to change unequal gender power relations and norms). Reviews also indicated that gender equality interventions in this area have ranged from those that focused on structural factors such as community gender norms to others that focused on interpersonal gender power relations reflected in couple's communication. Gender-related measures often included gender norms, partner communication, male involvement levels, decision-making, or power dynamics, but also measurement of harmful outcomes, such as incidence of female genital mutilation (FGM), violence, or early marriage. Across both topics (gender and human rights), weak study designs and use of intermediate outcome measures limited evidence quality. Further, there was limited evidence on interventions that addressed marginalised groups.

For example, while interventions have clearly targeted gender equality for women from multiple levels ranging from the interpersonal to the structural, understanding and measuring change from both women and men's perspectives is still inadequately done. There is a need to better understand whether and what types of interventions lead to resistance to prevailing inequitable gender norms among men and how resistance to norms impacts men for the sake of their own SRH (as partners, fathers, and community members). The latter is of particular importance given both the challenge of engaging men in these issues and the need to engage them to address their contribution to maintaining existing gender inequalities that inhibit women's health. While much remains to be learned on effective male engagement, motivating men based on the contributions they can make is one approach that has been highlighted; reliable and valid measurement of these outcomes needs to be incorporated into future research. "Finally, several gaps identified by this review, including the short timeframes of research studies, the limited geographical spread of research, the minimal inclusion of a wider variety of populations, and the missing focus on policy research and on cost, replicability and scale of interventions hinder the field's ability to progress in integrating gender equality and equal human rights in SRH programmes and policies."

In conclusion, the researchers note: "Further investment, documentation, research and development of methodologies is needed in order to capture a) the pathways by which gender equality and human rights interventions can improve SRH outcomes; and b) how we address intersecting forms of inequalities and discrimination along with gender and human rights concerns faced by specific sub-populations and marginalized groups in relation to their SRH. Increased coordination between gender and human rights focused actors could improve their ability to more holistically incorporate human rights and gender into intervention design, implementation, and evaluation thereby strengthening the evidence base."