5. Case studies: Gender in health programming

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For the following series of case studies, focus on classifying the project's intended objective and design.

Case Study 1: Condom Social Marketing in Bolivia


Questions for consideration

As you read the case study, consider the following questions:

    • What is the main health concern that this case study is trying to address?
    • What can men and women do to address this health concern?
    • What barriers (e.g., self-confidence, financial resources, role in making decisions) do women and men encounter in addressing this concern? For example, do men and women have equal access to condoms? Can both men and women equally control whether or not a condom is used?
    • Does the intervention remove these barriers?
    • How will this intervention influence men's and women's behaviors?
    • Ultimately and in the long run, is this intervention advancing gender equality?
The goal of a social marketing campaign in Bolivia was to increase condom sales.
The campaign television spot featured a young man who said very proudly that he used a different color condom with each of his several girlfriends.
The intended message
was that he used condoms whenever he had sex, a "safe sex" message.

How would you categorize this case study
according to the IGWG Gender Continuum?
Tap the    button below for the answer.
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Case Study 1: Aware and Exploitative

The case study was aware and exploitative in capitalizing on social and cultural values supporting men's virility, sexual conquest, and control.

The campaign TV spot reinforced the harmful expectation/stereotype that "macho" men have multiple female sexual partners and undercut the notion that joint communication and decision-making, negotiation, and mutual respect are important for safe sex behaviors.

Although condom sales may have increased at the beginning (per the goal of the project), the campaign served to undermine and undercut joint communication, and negotiation that are important for safe sex behaviors, including the correct and consistent use of condoms. 

It also contradicted other health efforts to promote safe sex practices through partner reduction.

A more transformative approach that could have been taken would be to redefine “macho” and what it means to be a man by featuring a young man who demonstrates affection and respect for his partner by engaging her in a discussion related to having sex, what becoming pregnant would mean for them in achieving their immediate goals, and ultimately jointly deciding that using a condom is what they both want to do.

Source

The case studies used in this section were excerpted from the IGWG's Manual for Integrating Gender into Reproductive Health and HIV Programs (2nd ed.), accessible here; and IGWG’s New Evidence report (IGWG, 2009).

Case Study 2: Delaying Child Marriage Among Girls in India


Questions for consideration

As you read the case study, consider the following questions:

  • What is the main health concern that this case study is trying to address?
  • Who can address this concern? What are women’s and men’s roles and responsibilities related to the health concern?
  • What barriers (e.g., self-confidence, financial resources, role in making decisions) do women and men encounter in addressing this concern?
  • How will this intervention influence young girls' and their parents' behaviors?
  • Ultimately and in the long-run, is this case study looking to promote gender equality?
Poverty and violence against women and girls may lead parents to marry their daughters off when they are young.
Parents often think it is in their daughter's best interest to ensure her safety, and in communities in where a “bride price” is given, families may be motivated by the extra income. In most cases, young brides are often physically and emotionally not ready to become wives or get pregnant yet adhere to the societal and cultural norms that they soon become pregnant after marrying.
The objective of a program in India was to delay child marriage among girls.
In order to do so, the program sought to improve the social status of girls by providing life skills training related to gender equality, legal literacy, and team building. The program also involved parents and especially mothers in designing and providing feedback on the intervention and curriculum.

How would you categorize this case study
according to the IGWG Gender Continuum?
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Case Study 2: Aware and Transformative

The project took a women’s empowerment approach in order to reduce the prevalence of a practice harmful to the health of women’s and children’s health. It sought to improve the overall status of girls in the community, ultimately striving for gender equality and improved health.

The involvement of parents was critical to the intervention and contributed to the transformative approach (and results). The intervention did not work exclusively with girls in a vacuum but rather focused on them while understanding the value of engaging the key stakeholders—i.e., their parents—who hold and perpetuate norms and decision making around child marriage.

Case Study 3: HIV/AIDS Prevention in Thailand


Questions for consideration

As you read the case study, consider the following questions:

  • What is the main health concern that this case study is trying to address?
  • Who can address this concern? What are women’s and men’s roles and responsibilities related to the health concern?
  • What barriers (e.g., self-confidence, financial resources, role in making decisions) do women and men encounter in addressing this concern?
  • What support systems or services currently exist to help with the health-related problem?
  • How will this intervention influence female commercial sex workers', their clients', and brothel owners' behaviors?
  • Ultimately and in the long run, is this case study looking to empower female commercial sex workers?
This project provided education, negotiation skills, and free condoms to female commercial sex workers (SW) in Thailand.
Although knowledge and skills among SWs increased, actual condom use remained low.
After further discussions with the SWs, project managers realized that SWs weren't successful in using condoms because they did not have the power to insist on condom use with their clients.
The project then shifted its approach and enlisted brothel owners, who had the power and authority to insist on condom use, as proponents of a "100% condom-use policy."
Since the vast majority of brothels in the project region participated in the project, the project resulted in a significant increase in safe sex practices.

How would you categorize this case study
according to the IGWG Gender Continuum?
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Case Study 3: Aware and Accommodating

This project accommodated the lack of power that female sex workers had over condom use with clients and instead used the power of male brothel owners to demand 100 percent condom use on their premises.

While the approach did not challenge the power differentials between sex workers and brothel owners or between sex workers and clients, it did force more protective health behavior on the male clients.

Also, note that there is sometimes disagreement about whether this is, in fact, exploitative. Some might argue that tapping into the potentially highly exploitative relationship between brothel owners and sex workers is by nature gender-exploitative.

At a minimum, health and development projects should strive to “do no harm” in terms of gender norms and relations. From USAID‘s perspective, there is no viable rationale for designing a project that deliberately exploits gender inequality (gender-exploitative projects).

When a project team fails to look at gender issues in a project design, they are missing an opportunity. In the case of some gender-accommodating examples, project managers have opted to conform to existing gender norms in order to enhance programmatic/health outcomes. Other times, a project may accommodate gender norms as an interim step in response to an identified gender issue. Gender-accommodating strategies can be a reasonable way to “buy time,” while the project figures out how to best address a gender issue in a way that transforms gender relations and promotes gender equity. However, they could also be unintentionally exacerbating an existing gender inequality.

Return to Addressing gender in health programming

Continue to Common approaches to gender-transformative programming​

A note

These materials were adapted from the Global Health eLearning Center, U.S. Agency for International Development.

Image credits

Unless otherwise noted, images are from Adobe Stock.

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