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

Figures & data

Table 1. Key gender definitions

Gender refers to a culturally defined set of economic, social, and political roles, responsibilities, rights, entitlements and obligations associated with being female and male, as well as the power relations between and among women and men, boys and girls. The definition and expectations of what it means to be a woman or girl and a man or boy (i.e., norms), and sanctions for not adhering to those expectations, vary across cultures and change over time, and often intersect with other factors such as race, class, age, and sexual orientation.

Gender equality is the state or condition that affords women and men equal enjoyment of human rights, socially valued goods, opportunities, and resources.

Note. Gender equality definition from Interagency Gender Working Group (2013), adapted from the USAID Gender Equality and Female Empowerment Policy (USAID, 2013).

Figure 1 Gender-equality continuum.

Figure 2 Conceptual model: Gender-integrated interventions to improve child health.

Table 2. Abbreviated findings on the positive behavioral and health effects of gender-integrated interventions for child health and development

Source	Intervention and target population	Statistically significant improvements
		Gender behaviors	Family planning, antenatal care, maternal and child health behaviors and outcomes	Child health status
Accommodating: Adult men or couples
Abdel-Tawab et al., 1999	Separate counseling, improved medical careWomen seeking abortions and husband, Egypt	Perceived husband's instrumental (e.g., cook) and family planning support (e.g., family planning acceptable)
Terefe & Larson, 1993	In-home couples family planning counseling and provision/referralMarried couples, Ethiopia		Family planning initiation within follow-up periodFamily planning use at 2- and 12-month follow-up
Amatya et al., 1994	Individual education and counselingWomen enrolled in Norplant clinical trial and husbands, Bangladesh		Continuation at 36 months, if want no more children at baseline
Becker et al., 2010	Couples HIV counseling and testingPregnant women and husbands/live-in partner, Tanzania
Kuene et al., 2004	Individual or same-sex group education, couples counselingPregnant women and husbands/live-in partner, South Africa	CommunicationMen assist with pregnancy emergencies
Varkey et al., 2004	Individual or same-sex group education, couples counselingPregnant women and husbands/live-in partner, India	CommunicationJoint decision makingHusband attend clinic	Family planning useSupplement baby's diet
Midhet & Becker, 2010	Women's group sessions, distribute information, education, and communication materials to husbandsPregnant women and husbands, Pakistan		Routine prenatal careDiet during pregnancy
Mullany et al., 2006	Couples education, print materialsPregnant women and husbands/live-in partners, Nepal		More birth preparationsAttendance at postpartum visit
Susin & Giugliani, 2008	Couples education, videoImmediate postpartum women and husbands/live-partners, Brazil		Increased breastfeeding, effects stronger if father has more education
Transformative: Female and male adolescents
Erulkar & Muthengi, 2009	Community mobilization (norms); informal group education; livelihood programs; incentives10–14 and 15–19-year-old girls, Ethiopia	10–14-year-olds only: marriage after 18 years of ageSchool enrollment	Family planning use
Daniel et al., 2008	Group meetings, workshops, infotainment, couples counseling (if married)15–24-year-old married and unmarried youth, India		Family planning use
Daniel & Nanda, 2012	Group meetings, workshops, livelihood, infotainment, couples counseling (if married)15–24-year-old married and unmarried youth, India	5 years postintervention: increased age of marriage (if not married at training)	5 years postintervention: increased age at first birth, family planning use
Centre for Development and Population Activities, 2001	Literacy, education, vocational training, health education, social mobilization, access to services12–20-year-old girls, India	“Empowerment” (e.g., joint decision making, ability to move outside house)	Increased in marriage after 18 years of ageAntenatal care visits Postnatal care visits
Sebastian et al., 2012	Information, education, and communication for women, mother-in-law, husband15–24-year-old pregnant women, mother-in-law and husband, India	Discuss birth spacing with husband	Postpartum family planning use
Santhya et al., 2008	Information, education, and communication (home visit) for women, mother-in-law, husband; women's support groups (include gender issues such as financial literacy), provider trainingYoung pregnant women, mother-in-law, husband, India	Household decision makingDiscuss family planning with husbandGender role attitudes	Number of birth preparationsFed colostrumPostpartum check upPostpartum family planning useBreastfeeding
Transformative: Adults, women only
Prost et al., 2013	Meta-analysis of 7 intervention trials with adult women in 6 Asian and 1 African country4-phase action cycle: identify problem, plan action, implement action, assess action		Reduced maternal mortality, stronger effects if at least 30% women in group were pregnant	Reduced infant mortality, stronger effects if at least 30% of women in group were pregnant
Colbourn et al., 2013	4-phase action cycle: identify problem, plan action, implement action, assess action; quality improvement (facility)Pregnant and nonpregnant women, Malawi		Reduced maternal mortality	Reduced perinatal and infant mortality
Smith et al., 2011	Multicomponent intervention: nutrition (e.g., food, education), sanitation, women's empowerment (similar to participatory action), poverty alleviationMothers, Bangladesh		Food security (e.g., sufficient food)Caring for baby (e.g., immunization, vitamin A) and mother (e.g., 3 antenatal visits, diet)Access to safe water and latrines	Decreased stunting, overall and for combination of nutrition and empowerment components
Transformative: Adults, men only or couples
Shattuck et al., 2011	Individual education, counseling, and learning activitiesYoung men in union, not yet using contraception, Malawi		Family planning use
Exner et al., 2009	Intensive workshops (education, adult learning activities)18–73-year-old men, Nigeria		Condom use, for dual protection (main partner)
Schuler et al., 2012	Group sessions for men, women, and couplesCouples, Tanzania	Gender-equitable attitudes held by men and women
Schuler & Ramirez, 2012	Group sessions for men, women, and couplesCouples, Guatemala	Gender-equitable attitudes held by men
Lundgren et al., 2005	Family planning education included in safe water activities, 2 in-home visitsCouples, El Salvador	More positive attitudes toward discussing family planning
Transformative: Adults, community
Blake & Babalola, 2002	Radio, print, community mobilizationMen and community, Guinea	Discussion about family planning with spouse and friends	Family planning use among women not initially using contraception
Kim & Marangwanda, 1997	Radio, print, community mobilizationMen and community, Zimbabwe	Communication with spouse about family planningPerceived family planning approval by spouse
Philips et al., 2012	Community health centers, social mobilization to diffuse messages and to increase women's participation in communication networks, peer volunteers			Fertility decline in short run, effects diminish over 10-year period
Pence et al., 2007	Community leaders and community members, Ghana			Improvements in child mortality, in communities with community health centers

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