Evaluation of a male engagement intervention to transform gender norms and improve family planning and HIV service uptake in Kabale, Uganda

ABSTRACT

Men’s limited understanding of family planning (FP) and harmful cultural gender norms pose obstacles to women’s FP use. Thirty-two model men called ‘Emanzis’ were recruited from the community in Kabale, Uganda to lead men from their peer group through a 10-session curriculum designed to transform gender norms and motivate men to engage in FP and HIV services. Cross-sectional surveys were conducted before (n = 1251) and after (n = 1122) implementation. The Gender Equitable Men (GEM) Scale was used to assess the effect on gender attitudes. The intervention achieved negligible changes in responses to GEM items. Improvements in some gender-influenced health-seeking behaviours and practices in men were noted, specifically in visiting health facilities, HIV testing, and condom use. For future application, the intervention should be adapted to require higher peer educator qualifications, longer intervention duration, and more frequent supervision. Practical guidance is needed on where to direct investments in gender-transformative approaches for maximum impact.

KEYWORDS:

• Gender
• male engagement
• HIV
• family planning
• community

Acknowledgements

The authors express gratitude to Rebecca Neriima (Interventions Coordinator, Elizabeth Glaser Pediatric AIDS Foundation), Edward Bitarakwate (Country Director, Elizabeth Glaser Pediatric AIDS Foundation), Joy Angulo (Senior Community Linkages Officer, Elizabeth Glaser Pediatric AIDS Foundation), the Emanzi and participating communities, the Kabale District Health Office and health facilities that participated in the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. The WHO defines gender as society’s collective ideas about the appropriate roles, rights, duties, responsibilities, accepted behaviours, opportunities and the status of women and men in relation to one another that can vary within and between cultures and can change over time (WHO, 2009).

2. WHO defines IPV as intimate partner or ex-partner behaviour that produces ‘physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviors’ (WHO, 2013b).

3. Omitted items include, ‘I would never have a gay friend’, due to the sensitive nature of homosexuality in Uganda; and ‘If a woman cheats on a man, it is okay for him to hit her’, deemed locally to be covered by the item, ‘There are times when a woman deserves to be beaten’.

Additional information

Funding

This work is made possible by the generous support of the American people through the U.S. Agency for International Development (USAID). Financial assistance was provided by USAID to FHI360 under the terms of the Preventive Technologies Agreement No. GHO-A-00-09-00016-00. The contents do not necessarily reflect the views of USAID or the US Government.