Does addressing gender inequalities and empowering women and girls improve health and development programme outcomes?

Abstract

This article presents evidence supporting the hypothesis that promoting gender equality and women's and girls' empowerment (GEWE) leads to better health and development outcomes. We reviewed the literature across six sectors-family planning (FP); maternal, newborn and child health (MNCH); nutrition; agriculture; water, sanitation and hygiene; and financial services for the poor-and found 76 studies from low and middle-income countries that met our inclusion criteria. Across these studies, we identified common GEWE variables that emerged repeatedly as significant predictors of sector outcomes. We grouped these variables into 10 thematic categories, which we termed 'gender-related levers'. These levers were then classified by the strength of evidence into Wedges, Foundations and Facilitators. Wedges are gender-related levers that had strong associations with improved outcomes across multiple sectors. They include: 'control over income/assets/resources', 'decision-making power' and 'education'. Elements of these levers overlap, but combined, they encapsulate agency. Increasing female agency promotes equality and broadly improves health and development for women, their families and their communities. The second classification, Foundations, displayed strong, positive associations across FP, MNCH and nutrition. Foundations have a more proximal relationship with sector outcomes and include: 'equitable interpersonal relationships', 'mobility' and 'personal safety'. Finally, the third group of levers, Facilitators, was associated with improved outcomes in two to three sectors and include: 'access to information', 'community groups', 'paid labour' and 'rights'. These levers make it easier for women and girls to achieve their goals and are more traditional elements of development programmes. Overall, gender-related levers were associated with improvements in a variety of health and development outcomes. Furthermore, these associations were cross-sectoral, suggesting that to fully realize the benefits of promoting GEWE, the development community must collaborate in co-ordinated and integrated ways across multiple sectors. More research is needed to identify the mechanisms by which gendered interventions work and under what circumstances.

Trends in sexual activity and demand for and use of modern contraceptive methods in 74 countries: a retrospective analysis of nationally representative surveys

“…While studies have highlighted problems of access, lack of knowledge, and fear of side-effects as barriers to use, [27][28][29] they have also shown that negative perceptions among people close to potential users can be a barrier to the adoption of modern contraceptive methods. 28,30,31 Societal attitudes to women and their reproductive health could be reflected, via the political process, in the provision, or otherwise, of effective family planning services that are shown to be associated with satisfying contraceptive need. 32 Our finding of an association between contraceptive use and a combination of variables relating to sexual health vindicates recent efforts by WHO to adopt a broader, integrated concept of sexual and reproductive health and to translate it into a framework for policy and practice.…”

The influence of gender on immunisation: using an ecological framework to examine intersecting inequities and pathways to change

“…In low-resourced settings, a mother needs to raise the necessary resources, or mobilise the necessary means of transport to take her child to vaccination 49. Yet, women tend to have poorer access to, and control over resources within households and communities 6 50…”

“…Gender and other structural relationships—eg, family wealth, caste/ethnicity, etc—define membership and participation in formal and informal structures and processes through which people make decisions, establish leadership or organise social and economic activities in their community 35 50 53. As a result, women’s participatory voice and power in community programming—including many health initiatives—is often limited 33…”

The impact of the Adolescent Girls Empowerment Program (AGEP) on short and long term social, economic, education and fertility outcomes: a cluster randomized controlled trial in Zambia

“…For example, data from adolescent girls in South Africa showed that decreases in social isolation and economic vulnerability are linked to decreases in experiences of sexual coercion and transactional sex [6]. Calls have been made to address women's and girls' health issues via improvements in gender equality and empowerment [7,8].…”