Bulletin of the World Health Organization

Changing men’s behaviour can improve women’s health

A new report finds that innovative programmes around the world are helping men to change sexist, risky and violent behaviour that harms the health and well-being of women and the communities in which they live.

The report, Engaging men and boys in changing gender-based inequity in health, found that almost a third of the 58 programmes evaluated were successful in encouraging men to end violence against women, to care for their pregnant wives and children, and to take steps to prevent infecting their partners with HIV or becoming infected themselves.

One shortcoming identified by the report, released in May, was that even successful programmes were limited to a pilot or short timeframe.

Actor Mahlubi Kraai who plays taxi owner Thabo in the seventh series of Soul City. After his violent behaviour towards his wife, Zukiswa, drives her away, Thabo joins ADAPT otherwise known as Agisanang Domestic Abuse Project and Training, a programme that helps men re-examine and change their violent behaviour.
Actor Mahlubi Kraai who plays taxi owner Thabo in the seventh series of Soul City. After his violent behaviour towards his wife, Zukiswa, drives her away, Thabo joins ADAPT otherwise known as Agisanang Domestic Abuse Project and Training, a programme that helps men re-examine and change their violent behaviour.

“Gender [behaviour] transformation allowing women and men to discuss and decide on health, when that may not typically be the case, is the gold standard,” said Dr Peju Olukoya, Integrating Gender into Public Health unit coordinator.

Unequal power relations between the sexes affect women’s health, she said: “In some places women cannot even seek health care unless they get permission from a man.”

The WHO-commissioned report evaluated projects in North America (24), sub-Saharan Africa (9), Latin America and the Caribbean (9), Asia and the Pacific (9), north Africa and the Middle East (5) and Europe (2).

In South Africa, where sexual violence against women is a widely-recognized problem, community programmes and media campaigns have started to address this problem by engaging and involving men.

The Stepping Stones programme in the Eastern Cape, one of the country’s poorest provinces, is one of the report’s success stories. A randomized controlled trial found that the programme brought about behavioural changes that reduced sexually transmitted infections in study participants.

On releasing the findings of the two-year study in May, chief investigator Rachel Jewkes of South Africa’s Medical Research Council hailed Stepping Stones as “the first HIV-prevention behavioural intervention … in South Africa … to have provided evidence of success in reducing sexually transmitted infections in women”.

Gender [behaviour] transformation allowing men and women to discuss and decide on health, when that may not typically be the case, is the gold standard. Dr Peju Olukoya, coordinator of the Integrating Gender into Public Health unit in WHO’s Department of Gender, Women and Health.

How did Stepping Stones bring about such profound change? It recruited about 2801 men and women aged between 15 and 26 years old to test two approaches. Half of them participated in 50 hours of gender behaviour transformation workshops over eight weeks. The other half attended a three-hour course on safe sex.

These workshops and courses – in which men and women were divided into separate groups – encouraged participants to communicate about sexual and reproductive health and to develop relationship skills. Jewkes said: “The men in the programme would decide as a group they should change … these decisions are tremendously powerful.”

The men explored the problem of violence against women and understood it was wrong. One participant told Jewkes: “I saw that [beating women] is not right. When I beat a girl now at my age that means I will beat my wife – so I decided that I must stop it.”

In contrast, participants in the group that did the three-hour safe sex course did not develop such insights or change their behaviour.

Jewkes, who leads the Council’s Gender and Health Research Unit, said that participants had been sexual risk-takers who engaged in casual or transactional sex with multiple partners and who admitted to being violent towards those partners.

“People think we will never get men like that to change, but we did. This is very important for HIV prevention,” Jewkes told the Bulletin.

Freddy Ramokone, 24, a Men as Partners health educator from Soweto, is teaching patients at a South African clinic about how to prevent sexually-transmitted infections. He is holding up a female condom to illustrate his talk.
Freddy Ramokone, 24, a Men as Partners health educator from Soweto, is teaching patients at a South African clinic about how to prevent sexually-transmitted infections. He is holding up a female condom to illustrate his talk.

In addition to the evidence of a reduction in sexually transmitted infections, the study found that more than half of male programme participants (58%) reported less severe violence towards their intimate partners. They also reported less casual and transactional sex, more condom use and less alcohol abuse.

Another community programme, Men as Partners, is run by EngenderHealth South Africa. In April, this nongovernmental organization launched its first national Men as Partners week to encourage men to give up violence against women and prevent spreading HIV.

In South Africa, with a population of 47 million people, 35% of women attending antenatal clinics were HIV positive and an estimated 5.5 million people were living with HIV in 2005, according to the WHO/UNAIDS 2006 AIDS epidemic update.

Cynthia Nhlapo, deputy director of the Gender Focal Point for the department of health, said that the South African government supports such initiatives that work with men. “Men have to be engaged in dialogue and activities that promote gender equality and social justice,” Nhlapo told the Bulletin.

Men as Partners works with men and boys in homeless shelters, clinics, schools and churches. Its stated aim is to help them understand “what it means to be true partners in relationships, families and communities”.

In a sun-filled room in Hillbrow this year about 15 male teenagers from a homeless shelter attended a Men as Partners workshop co-ordinated by Nhlanhla Mabizela, who was assisted by two gender behaviour transformation agents and a counsellor.

Seated in a circle with a flipchart to track their two-hour discussion, they talked about stereotypes of masculinity, HIV and other sexually transmitted diseases.

At the end of the workshops, which use a range of methods including role play and games, as well as simply talking, most participants expressed a deeper understanding of why gender equity was important and why they should practice safe sex.

One of South Africa’s biggest national health promotion campaigns is a popular television soap opera, Soul City, where the production team does research on health and social issues, and uses this to develop a drama. Stereotypes about masculinity and the disclosure and treatment of AIDS were among the themes of the seventh series aired by national broadcaster SABC in 2006.

“It has changed [our] culture. They have removed the perception that a woman should always be in the kitchen [and] be home early,” a female viewer from Gauteng province was quoted as saying in Soul City Series 7 Qualitative Evaluation Report.

“To us, youngsters, it doesn’t mean if you are the head of the family, you are the remote control. You wanted this person to be your partner and in a way you have to support each other,” a young male viewer was quoted as saying in the evaluation.

The WHO-commissioned report found that such community programmes and mass media campaigns were effective approaches to triggering behavioural change in men.

Overall, 29% of the 58 programmes worldwide were assessed as effective, 38% as promising and the remaining 33% as unclear. “This is a positive finding although we had expected more of the programmes to be effective. However, we did set the criteria for categorizing the programmes rather stringently,” Olukoya told the Bulletin.

“Working with men and their role in promoting gender equality is not a zero-sum game. Men and women benefit. We are gaining a lot of ground,” Olukoya said. ■

Claire Keeton, Johannesburg

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