Enabling young women and men to live gender-equitable lives free of violence, coerced sex, and unintended pregnancy is a critical global challenge.
Early pregnancy and child marriage are a reality for millions of young women worldwide, curtailing educational and vocational opportunities, leading to poor reproductive health and contributing to the intergenerational cycle of poverty. A focus on individual change is important but insufficient to meet this challenge. Young people’s ability to forge healthy relationships is influenced by social norms enforced by their peers, families and communities.
Social norms shape behaviors related to sexual debut, intimate partner and sexual violence and early marriage, as well as access to education and the services and information they need to protect their health. Research has shown that investing in social norm change at the community as well as the individual level, while ensuring supportive policies and access to good quality services, can bring about significant improvements in reproductive health and well-being.
Passages project is a USAID-funded six-year implementation research project that aims to address a broad range of social norms, at scale, to achieve sustained improvements in family planning, reproductive health, and gender-based violence. Passages seeks to build the evidence base and contribute to the capacity of the global community to strengthen normative environments that support reproductive health and well-being, especially among young people at life course transition points, including very young adolescents, newly married youth, and first-time parents. Passages capitalizes on these formative transition points to test, study, and scale up a suite of interventions in Burundi, Democratic Republic of Congo, Mali, Nepal, Niger, and Senegal, with technical assistance in more countries, that promote collective change and foster an enabling environment for healthy timing and spacing of pregnancies and family planning.
A consortium project that works with both pilot and established innovations, Passages:
- Pilots, replicates and scales up social norm interventions and applies implementation science principles to explain what makes norms-shifting interventions effective and sustainable at scale in real world contexts;
- Strengthens in-country capacity to plan, implement, monitor and evaluate the scale-up of effective norms-shifting pilot initiatives; and
- Distills and shares evidence and fosters dialogue on integration, measurement, and evaluation of norms-shifting interventions.
The community interventions being scaled-up and studied under the Passages project can be explored in depth below.
© Population Services International / Photo by: Benjamin Schilling
Transforming Masculinities | Masculinité, Famille, et Foi
Transforming Masculinities is an evidence-based approach created by Tearfund to promote gender equality and positive masculinities to reduce violence within faith communities. It is based upon the understanding that religious beliefs and faith leaders are part of the structure that shapes social and gender norms, and focuses on prevention and response to sexual and gender-based violence. Under Passages, this innovation has been adapted in Kinshasa, Democratic Republic of Congo (DRC), where it is known as Masculinité, Famille, et Foi. This adaptation includes reflection on normative environments and the acceptability of family planning. It consisted of a series of training, group discussions called ‘community dialogues,’ and diffusion activities that guide faith leaders, young couples, and congregations to identify, create, and embrace positive masculine identities and gender-equitable behaviors for improved health and relationships. In addition, an enabling service environment was provided to form a foundation of high-quality, youth-friendly health services. Currently, the program is being scaled up in Kinshasa, DRC, within the Eglise de Christ au Congo network as well as in Rwanda with two local NGOs.
- Brief: Transforming Masculinities | ENG, FRE
- Report: Transforming Masculinities: Midline Ethnography Report | ENG, FRE
- Brief: Baseline Results | ENG, FRE
- Blog: From My Transformation to Yours: “Gender Champions” share their journeys to transform gender norms in faith communities
- Report: Endline Quantitative Report | ENG
- Report: Masculinite, Famille, et Foi End of Project Report
Growing Up GREAT! | Bien Grandir!
Implemented under Passages, the Growing Up GREAT! innovation adapts elements of two tested models—Gender Roles, Equality, and Transformations (GREAT) from northern Uganda and GrowUp Smart from Rwanda—for an urban DRC setting. A multi-level intervention for very young adolescents (VYAs) aged 10-14 years old and the important people in their lives, Growing Up GREAT! applies an ecological perspective to provide information and address the social and gender norms held at all levels of society that affect reproductive health and well-being among VYAs. Implemented in two low-income localities in Kinshasa, Democratic Republic of Congo, the intervention engages both in-school and out-of-school VYAs, their parents and teachers, health workers and other community members in group discussion and activities to challenge social and gender norms that drive poor reproductive health outcomes. Specifically, it aims to increase:
- VYAs’ knowledge of puberty and reproductive development;
- gender equitable behavior of VYAs and parents; and
- use of family planning and other reproductive health services among VYAs as they age into older adolescence.
The Global Early Adolescent Study evaluates the Growing Up GREAT! intervention using a longitudinal quasi- experimental design to evaluate the relationship between evolving gender norms and a range of key health outcomes across the adolescent period – including reproductive health and gender-based violence. The design includes intervention and control arms, each divided into two subgroups – 1,000 in-school VYAs and 400 out-of-school VYAs 10-14 years-old taking part in the Growing Up GREAT! intervention with matched non-intervention comparison groups.
Husbands’ Schools | Ecoles des Maris
Passages is conducting a Realist Evaluation study of the SongES/UNFPA-implemented Husbands’ Schools innovation. Realist Evaluation (re)opens the possibility for program implementers and evaluators to understand how program activities lead to expected outcomes, how intended beneficiaries receive and interpret activities, and how different contexts may influence results. In particular, studies assessed whether HS operate similarly and with the same effect between pilot and scale-up regions in Niger, and explored the type and extent of gender power-sharing vis-a-vis services acceptability use that results from HS implementation. The Husbands’ Schools intervention is a community-based, social and behavior change intervention designed to engage men in supporting their wives’ use of family planning and reproductive health services, and in the process address gender barriers that contribute to poor health outcomes. It revolves around Husbands Schools, which are comprised of 8-12 men who have met the criteria of a ’model husband.’ A model husband is considered by his community as someone with integrity, who is supportive of his family, strives for peace within his home, demonstrates support for reproductive health care for his wife, and can volunteer his time to improve community health. After training, and with support from implementing NGO coaches, model husbands begin community outreach and sensitization to other men (and indirectly to other women) to facilitate community-level sensitization discussions on reproductive health and women’s and men’s engagement. As community role models, their actions influence a more enabling socio-normative environment that allows men to play new roles in health promotion and engage the larger community to support use of RH services, as well as increased sharing and decision-making within couples.
Girls’ Holistic Development | Développement Holistique des Filles
Under Passages, IRH is conducting a Realist Evaluation study of the Girls’ Holistic Development innovation, implemented by the NGO Grandmother Project: Change Through Culture, in Senegal. Realist Evaluation opens the possibility for program implementers and evaluators to understand how program activities lead to expected outcomes, how intended beneficiaries receive and interpret activities, and how different contexts may influence results. In particular, studies assessed effects (tested causal pathways) of different components of the Girls’ Holistic Development intervention. When the Passages-Grandmother Project collaboration began in 2017, the Grandmother Project was beginning an expansion of the Girls’ Holistic Development innovation into a new district. This presented an opportunity to assess the impact of the Girls’ Holistic Development innovation after 18 months using a mixed method, quasi-experimental design to explore how norms change processes contribute to family and community-wide support for girl-children to remain in school, avoid early marriage and adolescent pregnancy, and abandon female excision.
The innovation adopts a ‘change through culture’ approach that aims to reinforce and expand socially-condoned roles of “grandmothers” (elder women) as family counselors and advocates for girls, and concurrently increase community capacity and cohesion to reflect on and promote the health, education, and well-being of very young adolescent girls. By working across generations, in fora such as “Days of Praise of Grandmothers” involving very young adolescent girls, grandmothers, and communities, and at multiple levels, such as engaging students, teachers, and grandmothers in cultural discussions within school settings, the innovation strengthens cultural values, traditions, and builds community communication and cohesion around norms supportive of positive health and social outcomes for very young adolescent girls.
Responsible, Engaged, and Loving (REAL) Fathers
Piloted, adapted, and scaled up in Uganda by the Institute for Reproductive Health and Save the Children with support from the United States Agency for International Development, the Responsible, Engaged, and Loving (REAL) Fathers initiative is a community-based mentoring program that capitalizes on this key period of transition when young men become fathers. This is a period when fathers are experimenting with new ideas, attitudes and behaviors and programming may transform them to safe and gender equitable practices. Working with fathers (16-25 years old) who are parenting a child one to three years old, REAL Fathers aims to prevent intimate partner violence and harsh discipline of young children, improve fathers’ use of positive parenting and non-violent discipline, increase positive couple communication, increase voluntary family planning use, and foster acceptance of gender equitable roles in parenting in fathers. Pilot and scale-up efforts in Uganda have shown sustained improvements for many of these outcomes. Currently, scale-up efforts include institutionalization of the program in early childhood development centers in Uganda in partnership with the Ugandan government and adaptation of REAL Fathers for communities in West Bengal, India.
The Terikunda Jékulu or TJ approach in Mali uses women’s and men’s social networks to create a positive social dynamic around the demand for and use of voluntary family planning within communities. The TJ approach (then Tékponon Jikuagou) was piloted in Benin between 2012-2017 as a USAID-funded project that aimed to reduce unmet need for family planning through social network interventions. The approach was proven effective and easy to implement in the project’s scale-up phase. As of 2017, Passages provides technical assistance for the introduction, integration into existing health and development projects, and scale-up of TJ as ‘Terikunda Jékulu’ in Mali by Malian NGOs.
The goal of TJ in Mali is to create a social environment that enables men and women who are in union to achieve their fertility desires by fostering single-sex and mixed-sex reflective dialogue and catalyzing discussion about social norms related to fertility desires and family planning. The TJ approach works to diffuse information through formal and informal social groups and influential opinion leaders, all who are socially influential within their social networks and community-at-large. Passages core funding supported the initial introduction of the intervention, stakeholder awareness-raising, and NGO and Ministry engagement, and the John Templeton Foundation supported continued scale-up activities. Following this, Passages has provided several rounds of technical support for NGOs to integrate the TJ approach into their non-FP projects, and to evaluate this scale-up.
Burundi Reproductive Health Norms Study
Passages conducted a qualitative study to explore social norms related to reproductive health (RH) behaviors in unmarried adolescent girls and young women (15-19 years) in Burundi. The study simultaneously aimed to identify relevant individuals and groups who influence and uphold these social norms. This is the first study to document social norms that impact RH behaviors among unmarried adolescent girls and young women in Burundi. The sample consisted of 12 focus group discussions (FGD) with unmarried adolescent girls and young women and 18 FGDs with other influential community members across four provinces of Burundi. The FGDs focused on four domains of inquiry: 1) menstruation and menstrual hygiene management, 2) sexual risk behaviors, 3) sexual violence, and 4) fertility and voluntary family planning use.
Rigorous thematic analysis revealed eight social norms as having the greatest influence on adolescent girls and young women’s RH behaviors and outcomes. Respondents discussed most of these social norms as cutting across several of the domains of inquiry. In terms of key influencers of these social norms, parents, health providers (including community health workers), peers and friends, sexual partners, teachers, religious leaders, neighbors and other family members were the groups most commonly mentioned. All of the social norms were discussed as being influenced by multiple groups of people and as having both social and health consequences for adolescent girls and young women.