Beyond ‘working with men and boys’: (re)defining, challenging and transforming masculinities in sexuality and health programmes and policy

In the 21 years since the 1994 Cairo International Conference on Population and Development, those working in the fields of health and sexuality have seen changing ‘men and masculinities’ as central to struggles to improve the health of women and men (Cornwall, Edstrom, and Greig 2011; Peacock and Barker 2014). Efforts to respond to men’s violence and HIV, in particular, have focused on understanding the links between masculinities and men’s health-related behaviour, and increasingly on engaging men and boys as a pathway to transforming masculinities (Jewkes, Flood, and Lang 2015; Mane and Aggleton 2001; Peacock and Barker 2014).

Perhaps as a consequence of these efforts, the phrase ‘We need to work with men and boys’ has become something of a mantra dominating health and sexuality programmes. In the past few years, there have been a number of reviews of interventions that have sought to work specifically with men and boys to promote health-enhancing behaviours. These reviews have highlighted the important role that interventions engaging men and boys can have in reducing men’s use of violence against women (Dworkin, Treves-Kagan, and Lippman 2013; Jewkes, Flood, and Lang 2015), increasing access to HIV-testing (Hensen et al. 2014), reducing HIV-risk behaviours (Barker, Ricardo, and Nascimento 2007; Dworkin, Treves-Kagan, and Lippman 2013) and, more widely, enabling men to become more engaged in supporting partners and children (Levtov et al. 2015). However, these reviews also highlight that working with men and boys does not always translate to changes in their behaviour, that changing attitudes about gender does not always lead to behaviours that support gender equality and that intervention effectiveness is dependent on the approaches used and the process and context of implementation (Barker, Ricardo, and Nascimento 2007; Dworkin, Treves-Kagan, and Lippman 2013; Jewkes, Flood, and Lang 2015). Given the growth in the number of programmes and interventions working with men and boys globally, research exploring the processes involved, the challenges, problems, limitations and politics of this kind of work is surprisingly limited. The ways in which women are and could be involved in this work, so as to support and not hinder efforts at changing masculinities, has also received limited attention.

It was against this backdrop that this special issue of Culture, Health & Sexuality was conceptualised. A call for papers led to 55 abstracts being submitted for consideration; reflecting on these submissions provides us with an insight into some of the wider contemporary dynamics of the field of masculinities and how this special issue could contribute, potentially stimulating new conversations, reflections and debates. First, the geographical spread of research on this topic was highly skewed towards Africa and in particular, South Africa. In total, 21 abstracts were received based on research conducted in South Africa, and a further 19 were about Africa more widely. Beyond that, 5 abstracts were submitted drawing on work undertaken in Australia, 5 more from Asia, 2 from Europe, and 1 each from Canada, Mexico and the Caribbean. What does this suggest to us? First, it would be correct to acknowledge that this partly reflects existing networks and communities of research, which are reflected in our specific geographic locations as editors in South Africa and Australia, and that English is the primary language of the journal. Second, those writing on a country are not necessarily based there (although this was only the case in the minority of submissions). However the geographical focus of submissions does reflect something wider about the global production of knowledge on masculinities at this moment in the field of health and sexuality. It highlights that much of the recent research on masculinities has emerged in the context of the immediate needs and challenges faced in the global South, particularly those associated with violence and HIV (Shefer et al. this issue).

In the early years of the HIV epidemic, the global response focused on communities’ urgent, practical needs and on advocacy and activism for structural and political change (Mbali 2013). Practitioners responding to the epidemic were often informed by debates in relation to Women in Development and then Gender and Development, but less space was allocated to reflection on how gender transformation efforts could contribute to this work (Jewkes et al. this issue). However, over the last 20 years, the often hard lessons of the epidemic have seen HIV researchers and practitioners in southern Africa shift their gaze towards gendered power, masculinities and men’s violence against women. Across the Atlantic, frustration at prevailing discourses about gender equality and the limited attention paid to the struggles of young Brazilian men gave rise to the highly influential work of Program H and subsequently the work of Promundo. In a very important sense, therefore, the global South has been central to the production of knowledge in the field of masculinities, even if the process has often been mediated by the agenda of academic and development partners in the global North (Epstein and Morrell 2012).

Collectively, the papers of this special issue significantly upscale existing dialogue around the processes of engaging men and boys in gender transformative work. In the rest of this overview, we highlight a number of key themes we see emerging through the papers.

Changing men and men changing

Masculinities are changing continually. Connell’s (2005) central work and her evolving concept of hegemonic masculinity have been critical in shaping the field of masculinities and the understanding of processes of change within it. Indeed, the majority of articles in this special issue draw on Connell’s concept of hegemonic masculinity and the notion of subordinated masculinities to understand men’s behaviours in relation to health and sexuality. Researchers have used Connell’s overall theoretical framework to describe the continuing contestation of masculinities and to document how masculinities can change over time, allowing new kinds of practice to emerge as hegemonic (Connell and Messerschmidt 2005; Morrell, Jewkes, and Lindegger 2012). There is now a substantive body of literature on how masculinities change in relation to exogenous processes of social, economic and political change. Hunter’s (2010) work in South Africa clearly traces how economic processes associated with apartheid and then globalisation, alongside the political regimes of colonialism, apartheid and democracy, intersect to construct and shape the potential for specific forms of masculinity to emerge at particular moments. Work in other parts of the world has also traced the impact of wider social change on masculinities (Segal 2007; Seidler 2005).

While the impact of social and structural forces on how masculinities evolve over time has been relatively well documented, less is known about whether and how programmes may be able to change or reformulate masculinities. Researchers have attributed change in men’s attitudes, and sometimes behaviours, to particular actions and interventions (Jewkes, Flood, and Lang 2015), but, as highlighted by Dworkin et al. (this issue), it is less clear whether such interventions can contribute to sustained change in hegemonic or subordinated masculinities over time.

There have been few efforts to articulate a theory of change by which an intervention translates to a change in masculinities, and limited description of the practical steps involved in such an undertaking. Indeed, as Jewkes et al. (this issue) suggest, the concept of hegemonic masculinities is not itself a theory of change, although it can be, and has been, incorporated into theories of change. This lack of an explicit theory of change within interventions working with men and boys means it is sometimes unclear as to what change is sought, whether is it a change in health-related behaviours (for instance a reduction in perpetration of violence) or a wider change in the dominant form of masculinity in the group being addressed. Theorisation of how the desired change can be supported to occur is also infrequent. Encouragingly, the papers comprising this special issue present a number of ideas that can inform future efforts when working with men and boys.

A number of the papers here make reference to Paulo Freire’s (1973) conceptualisation of conscientização, or critical consciousness raising (e.g. Jewkes et al. this issue; Stern et al. this issue). Freire theorised social change as being underpinned by the relationship between conscientização and collective action, and his theory of social change has informed discussions of changing masculinities in other work (Campbell 2003; Gibbs, Jewkes, et al. 2014). More widely, social psychologists have sought to operationalise Freire’s theory of social change through the development of safe social spaces from which collective action can emerge (Campbell and Cornish 2010; Gibbs, Campbell et al. 2015; Vaughan 2011). This body of work has articulated a number of components central to how safe social spaces can enable change. These components include building participants’ confidence and skills in self-reflection and communication; facilitating the dialogue necessary for the development of new critical social understandings; and expanding the social networks and ‘social capital’ of participants (Campbell 2003; Vaughan 2014). Throughout the special issue, whether implicitly or explicitly, authors use the notion of safe social spaces to examine how men may be supported to change attitudes and behaviours and to contest hegemonic masculinities.

Namy et al. (this issue), for example, describe the theory of change underpinning the Young Men’s Initiative in the Balkans, outlining the theorised role of safe social spaces. Their analysis notes that safe social spaces enabled participants to question dominant masculinities, to think more critically about ‘what it means to be a man’ and to reflect on the consequences of dominant masculine ideals. Further, they emphasise that much of the dialogue and change work occurred in informal interactions outside the formal safe social spaces that the Young Men's Initiative fostered through workshops and structured activities. This resonates with others who have highlighted the importance of what happens on the peripheries of formal interventions, in ‘in-between spaces’, expanding our understanding of what a ‘safe social space’ actually is (Jones and SPEECH 2001; Vaughan 2014).

In her analysis of group work with young, economically marginalised men in London, UK, McGeeney (this issue) reflects on how safe social spaces can also provide opportunities for collusion so as to reinforce the forms of masculinity that an intervention might be trying to challenge. Through her close reading of the interactions of these young men, who were from a deprived inner-city borough and out of formal education and employment, McGeeney highlights the ways a social environment functioned to maintain certain forms of power through the very logic of a safe discursive space. The group setting enabled a type of hypermasculinity (Herek 1986) to be performed and limited participants’ ability to engage in critical discussion. McGeeney’s reflections on her limited ability to challenge oppressive talk in this setting point towards the challenges for practitioners in encountering resistance (see also Dworkin et al. this issue; Jewkes et al. this issue; Ratele this issue).

In other contexts, researchers have noted that safe social spaces may be necessary for facilitating collective action towards social change, but are not in and of themselves sufficient (Campbell 2003; Campbell and Cornish 2010; Vaughan 2014). Men and boys may be supported to reflect on the costs of hegemonic masculinity and the benefits of gender-equitable attitudes and behaviours, and to practise behaviours associated with the democratising of gender relations in the safe social spaces developed by an intervention (such as workshops, group meetings, retreats or sports camps). However, whether and how men can be supported to sustain new attitudes and behaviours in the ‘unsafe’ environments to which they return is much less clear. The subordinated men who are most often engaged in interventions seeking to promote gender transformation live in particularly ‘unsafe’ environments, settings where performance of hegemonic masculinity may be protective in interactions with peers and local structures. This reinforces the belief that theories of social change underpinning interventions with men and boys need to consider the wider structural impediments to change.

Another set of research in this special edition draws on more post-structuralist approaches to change. Specifically Shefer et al. (this issue) use Butler’s idea of precariousness to suggest that only through men acknowledging their vulnerability may they start a process of change. In some papers, there is acknowledgement that other theories of masculinity, including discursive psychology (Wetherell and Edley 1999) and psychoanalytic theory (Frosh 1994), provide alternative perspectives and understandings of how change can happen. Yet, while these are fruitful approaches for thinking through the micro-politics and processes of change at an individual, group or discursive level, there remains the overarching question of whether these approaches can enable more structural shifts in the form of hegemonic masculinity or whether they leave this unruffled (Jewkes et al. this issue).

What are we seeking to achieve?

There is an assumption that gender transformative interventions with men and boys are good for men and good for women – but there is often not much agreement about what the overarching aim of interventions should be. This special issue highlights what one author describes as an ‘ambiguity of intention in male involvement interventions’ in the case of interventions working to increase male involvement in mother, newborn and child health programmes (Comrie-Thompson this issue). Indeed this ambiguity concerning the intention of interventions can be extended to the field of working with men and boys for gender equality more widely. A scan of the papers contained here highlights how this ambiguity can give rise to tension in relation to the long-term aims of interventions. For some, the aim is to introduce ‘positive masculinities’ or, as described by Ratele (this issue), ‘progressive masculinities and gender justice’. Ratele also uses the term ‘pro-femininist masculinities’ to describe the desired outcome of interventions with men and boys. Similarly, Jewkes et al. (this issue) comment that the aim of many ‘interventions that seek to build gender equity is not the dissolution of the idea of a numerically dominant and legitimated masculinity that is accorded power through consensus among men and women of its “ideal” status, but rather a change in the content of such a masculinity so that it is non-violent and accords with an emancipatory model of gender relations.’ The assumption underpinning many interventions that aim to change masculinities, therefore, is that a hegemonic masculinity can emerge that is gender equitable and progressive, enabling the realisation of women’s rights and gender justice.

Yet, as Flood (this issue) and others (Jewkes et al. this issue) point out, for some the idea of developing new progressive forms of masculinity is inherently problematic. Two major elements of critique are raised. First, interventions aiming to encourage men to adopt particular behaviours that do not align with hegemonic norms have sometimes attempted to engage men using language and imagery that appeals to stereotypical ideas of manhood. As Fleming, Lee and Dworkin (2014) describe in their analysis of Man Up Monday, an intervention that sought to encourage STI testing among men, deploying hegemonic male norms in an attempt to appeal to men may serve to reinforce dominant and harmful forms of masculinity rather than challenge them.

A second critique of interventions based on the notion of promoting progressive masculinities is that any retention of gender binaries is problematic, with Jewkes et al. (this issue) suggesting that ‘as long as a gender dichotomy is maintained, men will maintain hegemony.’ This analysis suggests that the aim of gender transformative programming with men (and women) should be to overthrow the gender categoies/boundaries suggested by masculinities and femininities and create an entirely new lexicon.

In addition to debate about whether it is possible to achieve a progressive masculinity or whether masculinity itself needs to be erased (and whether this is in fact possible either), there is a separate but linked argument about whether and how this can be done through discrete, short-term interventions. The case study of the Young Men's Initiative described by Sophie Namy and colleagues (this issue), explicitly deployed an aspirational model of masculinity through the intervention tag line ‘Be a Man! Change the Rules!’ Deployment of such language may raise concerns, but the authors describe how it opened up a space for men to become engaged in an intervention that had a positive impact on participant attitudes and intentions. Jewkes and colleagues (this issue) try to resolve this tension by suggesting that the long-term aim of gender transformative interventions must be the removal of gender binaries, but that the short-term objectives of discrete interventions may be much more limited. They highlight that a ‘cautious analysis of the types of change that are secured by such interventions suggests that, even when IPV [intimate partner violence] perpetration is reduced, men’s strides towards gender equity are at best incremental’. Similarly, Comrie-Thomson et al. (this issue) question what constitutes success for interventions with men and boys: changing behaviours or changing identities? Their review found that securing greater male involvement in maternal and child health is often seen as a positive outcome of interventions in and of itself, but note that this is a very instrumental view of male involvement that says nothing about whether relationships between men and women have been transformed.

Whether it is possible to introduce gender-equitable forms of masculinity or whether gender-binaries need removing, and whether either of these outcomes is achievable, or rather an ideal to strive towards, remains a central theoretical question in this work. A review of the contributions to this special issue highlights how researchers and practitioners in diverse settings are struggling with the pragmatic translation of this theoretical question into time-bound, measurable interventions, under pressure to demonstrate ‘success’.

Intersectionality, structure and agency

In their reflections on how men and boys may be engaged to support change, authors in this special issue inevitably consider how men and boys also resist change. Many of the papers in this issue describe interventions working with subordinated men, who experience intersecting disadvantage on the basis of age, ethnicity or colour, socio-economic status or class. Ratele (this issue) notes that marginalised men may resist efforts to change dominant masculinities, when adherence to a hegemonic masculinity is a symbolic resource in the context of few others. As Dworkin et al. (this issue), Flood (this issue) and others have highlighted, democratising the gender order will mean that men will lose access to the patriarchal dividend (Connell 2009), undermining men’s willingness to be involved in progressive gender justice work.

In reflecting on resistance to change, and the resources available to marginalised men, the papers highlight the role of economic marginalisation in the construction of masculinities (Gibbs, Sikweyiya, and Jewkes 2014; Silberschmidt 2001). Indeed, Ratele (this issue) comments, ‘Getting boys and young men to listen to why gender justice is needed might mean working through issues of poverty, unemployment and income inequality’. Dworkin et al. (this issue) suggest the need for interventions that ‘attempt to shift the structural context in which masculinities and health are constituted’. Very few interventions working with men have really engaged with how efforts towards changing masculinities can also address economic marginalisation (Gibbs et al. 2012; Greig 2009; Raj et al. 2014).

The crucial questions raised by an intersectional approach to masculinities lead to another set of questions about the extent to which we can conceptualise men’s agency in relation to social structures (Dworkin et al. this issue; Shefer et al. this issue). On the one hand all men are, through structural positioning, powerful vis-à-vis women, and the global understanding is of male power and female subordination; yet on the other hand many men are also oppressed by structural forces and other men, as the research on subordinated masculinities has shown (Ratele this issue; Shefer et al. this issue). Conceptualising men’s simultaneous position of being powerful – through the overarching logic of patriarchy – yet also potentially vulnerable is at the heart of many of the special issue papers. As Shefer et al. (this issue) point out, this ongoing tension in many men’s lives may also be productive to enable change to occur.

Men and boys who face a range of intersecting disadvantages may be particularly harmed by hegemonic masculine norms, as may be the women and girls in their lives. It is therefore understandable why so many interventions seeking to engage men and boys towards gender transformation ‘target’ marginalised men. As Dworkin et al. (this issue) point out, this may risk asking subordinated men to ‘carry the burden of increasing gender equality’. Consistent with the current focus of efforts to engage men and boys in gender transformation in a range of settings, there is a focus in this issue on the harms associated with hegemonic masculinity and those most harmed by it. This reflects the inadequate focus in the field on those who most benefit. An intersectional approach highlights the particular vulnerabilities of some men, but it should also highlight the particular power and privilege of others (Shefer et al. this issue). Little has been said in these papers about targeting privileged men as agents of change. We should be concerned about the impact of constant ‘intervention’ in the lives of the poor and marginalised, without concomitant scrutiny of and interventions to change the hegemonic masculinities enacted by transnational corporations, donor governments and politicians (Connell 2011).

How ‘best’ to work with men and boys

There is lively debate in this special issue about how best to work with men and boys for gender transformation. What becomes clear from the papers is that ‘It’s generally not possible to reach and retain men in participatory processes without engagement with men’s vulnerability and positive aspects of masculinity’ (Jewkes et al. this issue), see also (Dworkin et al. this issue; McGeeney this issue; Namy et al. this issue; Stern et al. this issue). Using this as an entry point enables the wider objective of transforming gender relationships (or removing them altogether) to be introduced. Yet, as highlighted earlier, appealing to aspirational models of masculinity risks reinforcing gender binaries and promoting the assumption that there can be positive masculinities. The tension between the practical needs of programmatic work and the wider political battles being fought needs continual questioning.

Another question is raised around who is best to facilitate interventions with men and boys. As Flood (this issue) highlights, should the facilitators be male, female, dominant men or marginalised men? Flood suggests that there is no evidence on what is working best and sets out both practical and political reasons for the different combinations. Yet the two papers drawing on practical intervention experiences potentially suggest that closely matching facilitators and participants may be critical. McGeeney (this issue) describes the way the young working-class men played up against her middle-class sensibilities and those of the facilitators, resisting their interactions. While Namy et al. (this issue) emphasise that facilitators who were similar to the young men they were working with enabled participants to build an easy relationship of trust and openness to change. As Flood (this issue) concludes in his discussion, there is an ongoing tension ‘between meeting men “where they are”, on the one hand, and seeking to transform the gendered identities and relations among men which sustain men’s violence against women.’

How to intersect with women’s rights work

Finally there is a growing body of work about how working with men and boys intersects with, builds and challenges feminist and/or women’s rights work (e.g. Casey et al. 2013; Jewkes, Flood, and Lang 2015). Somewhat unsurprisingly, the papers included here, written as they are by many people working with men and boys from a progressive agenda, highlight the overlaps and the ways in which a progressive approach to working with men and boys works to improve the lives of women and girls and men and boys themselves (Flood this issue; Jewkes et al. this issue). Papers also highlighted the importance of women in the constitution of masculinities and shaping the possibilities for change (Comrie-Thompson et al. this issue; Flood this issue; Ratele this issue; Shefer et al. this issue; Stern et al. this issue). Despite the ongoing debates around whether working with men and boys diverts from working with women and girls and can truly advance women’s rights, only Flood (this issue) directly engages with these debates. Flood argues that there is very little evidence that the men and boys agenda has taken away funding from working with women and girls. Yet he also suggests that the turn to men and boys has at some level ignored the fact that there remains a substantial body of research that shows that working only with women and girls can lead to changes in the gender order and to women resisting male power (Ellsberg et al. 2015). The perception remains in many settings that work with men and boys has led to a disinvestment in more ‘traditional’ approaches to improving women’s health and wellbeing, such as direct work with women and girls to empower them socially and economically.

Many papers discuss how the wider political contexts that efforts to engage men and boys are situated in, particularly those of racism (Dworkin et al. this issue; Ratele this issue; Shefer et al. this issue) and unemployment/economic marginalisation (Dworkin et al. this issue; Flood this issue; Jewkes et al. this issue; Ratele this issue; Stern et al. this issue), hinder gender justice work. However, there is little further interrogation of the politics of current hegemonic masculinities. Indeed, one strong argument in feminist research on the emergence of gender inequality in Africa suggests that it only developed in its current form at the same time as capitalism was forced on Africa through colonialism (Amadiume 1987). If this is indeed the case, then the parallel argument must be that gender justice cannot readily be obtained without transforming the global capitalist system (Greig 2009). These wider questions of how we theorise the global transformation of gender relationships need to be at the heart of future thinking around gender justice.

In conclusion

Given the relatively limited in-depth research on interventions working with men and boys, it is perhaps unsurprising that many of the papers are reflections and overviews of the topic, rather than in-depth empirical analyses of interventions. Dworkin et al. (this issue) provide an overview of the development of gender transformative health programming, including evidence of its success, through reflections on their work in South Africa. The same authors also highlight four key challenges in the field: a focus on harmful individualised masculinities, a privileging of a gender lens over an intersectional approach, male resistance to change and sustaining change. Ratele (this issue) develops many of these ideas through his analysis of men and boy’s resistance to change. He emphasises the need for an intersectional approach to understanding men, particularly the role of class and race in men’s lives and how this can function to limit change. Jewkes et al.’s (this issue) paper includes a detailed discussion of how hegemonic masculinity has been used in thinking about men, men’s behaviours and the ‘target’ of interventions theoretically. Through this approach, they highlight many of the debates in the field of masculinities, which they then use to explore in the development of a Swedish intervention, The Macho Factory, showing how theory can be put to use. Flood (this issue), in his paper, questions a number of taken-for-granted assumptions around how to work with men and boys. Importantly, he suggests there are no easy answers to the questions he raises, but that they need to continually be reflected on. Comrie-Thomson and colleagues’ (this issue) review of how engaging men is conceptualised in maternal and newborn child health emphasises that men are narrowly constructed as barriers to resources for women and there is little engagement with a more transformative approach to working with men and boys.

Importantly, this special issue provides an opportunity to build further examples of practice and reflect on the challenges, successes and theorisation behind interventions. Namy et al.’s (this issue) and Stern et al.’s (this issue) papers provide two concrete examples from large ‘gender’ non-governmental organisations that have actively worked to promote gender equality through working with men. In Namy et al.’s (this issue) case, they reflect on lessons learned through the implementation of the Young Men Initiative in the Balkans, highlighting the need continually to refine programmes and strategies for engaging young men. Similarly, Stern et al.’s (this issue) work around engaging men as clients, partners and advocates for sexual and reproductive health in Uganda also analyses the successes and challenges of a well-known model for working with men. From a quite a different theoretical position, McGeeney’s (this issue) reflection of one session working with young, economically margainlised men in the UK questions the extent to which group-based interventions have the potential to engender change in dominant discourses, or whether they simply end up reinforcing these. Potentially Shefer et al.’s (this issue) analysis of young men’s talk has a more positive take: while recognising the dominance of certain discourses, they also highlight how young men’s vulnerability is also evident in talk and how this establishes a precariousness that may be the basis for change.

Significantly, this special issue does not seek to provide simple solutions to the challenges and issues raised around working with men and boys. Rather, it provides an entry point to new discussions that are emerging around how to work with men and boys practically, as well as to the theoretical debates that this is engendering. We have sought to draw together some of the main themes that emerge from this and other work, and point towards other research and theoretical approaches that may provide additional insights into the approach of working with men and boys.

In conclusion, we would like to thank the reviewers of the papers submitted to this special issue for providing engaging reviews and encouraging greater reflection and debate. We also thank the authors who responded so well to the call for papers by providing a range of intellectually stimulating yet policy- and practice-relevant contributions. We hope you enjoy engaging with them. Finally, we would like to thank the funders of this special issue, the Swedish International Development Agency (Sida) and the Norwegian Agency for Development Cooperation (Norad).