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A review of gender-transformative approaches and promising practices in health, nutrition and HIV programming in Africa: from theory to practice

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UNICEF
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Author | Mary Picard

Laying the Groundwork

The growing emphasis on gender-transformative approaches (GTA) in UNICEF’s programming comes at a crucial time; in the wake of the COVID-19 pandemic, the multiplier effect of deep-seated gender inequalities hit hard with increases in gender-based violence (GBV), intimate partner violence, and unpaid care work. Disruption in services and lockdowns reduced women and girls’ access to services, resources and income. UNICEF Country Offices (COs) in the East and Southern Africa Region (ESAR) and the West and Central Africa Region (WCAR) noted the dire impacts of school closures on adolescent girls and children and the rise in adolescent pregnancies. Moreover, the intersection of gender with key population groups, persons with disabilities and other groups at risk “of being left behind” increased inequalities for many groups over the course of the pandemic.

UNICEF’s commitment to gender-transformative programming is formalized in its most recent Gender Action Plan 2022-25 (GAP). In the past few years, UNICEF has laid the conceptual and policy foundation for moving this agenda forward. This study contributes to a broader set of efforts to take stock of where COs are situated on the Gender Integration Continuum, how their understanding of gender-transformative approaches is taking shape, and what lessons can be learned. The study is focused on health, including nutrition and HIV, within the relevant Goal Areas of the GAP that encompass interventions targeting adolescents and adolescent girls in particular. Interventions in these thematic areas face the notable risk of reinforcing gender stereotypes (e.g., women’s reproductive and caretaking roles), by virtue of their target population. However, as will be seen in the findings, the increasing awareness of this risk and the opportunities that go with prioritizing the Second Decade of life bode well for UNICEF’s intention to position women and girls in their primary role as rightsholders.

A gender-transformative approach is concerned with redressing gender inequalities, removing structural barriers, such as unequal roles and rights and empowering disadvantaged populations. In practice, this means working for change in: laws and policies, systems and services; distribution of resources; norms, beliefs and stereotypes; and behaviour and practices.
Background Paper Series: Gender Transformative Programming

The Conceptual Framework for Assessing Gender-Transformative Approaches

The model in the PDF summarizes the combination of interactive components of gender-transformative programming:

  • The targeted dimensions of change with the transformation of unequal gender power relations at the core
  • Strategies in use that contribute to the changes
  • The phases of the programme cycle showing the actions and the results

This conceptual model served as the principal tool for assessing the programme initiatives under this study.

All elements of this model are derived from UNICEF’s foundational understanding of the key elements of a gender-transformative approach and are confirmed by similar theoretical work on gender transformation. For a full explanation of the strategies in use, refer to UNICEF’s background papers on gender transformation.

The Study: Scope, Objectives and Methodology

The aim of the study is to promote learning around gender-transformative programming by identifying examples with empirical evidence that meet the dimensions of the Model for Assessing Gender Transformative Approaches. It is hoped the outcomes of the study will support UNICEF in its broader objective to develop gender-transformative theories of change in health, nutrition, and HIV programming and to scale up models that address gender barriers in both the short-term and long-term.

The methodology for this study consisted of an intensive document review, using an assessment criteria template based on the model, supplemented by interviews and follow-up questions with some UNICEF COs in West and Central Africa (WCA) and Eastern and Southern Africa (ESA).

The review assessed country initiatives/programmes against the four dimensions of change of the Model for Assessing Gender Transformative Approaches and against the eight different implementation strategies contributing to those dimensions – socio-ecological, multisectoral, engaging men and boys, positive masculinities, gender socialisation, women’s empowerment, intersectional/inclusive, and life cycle. The review also considered whether any type of diagnosis of gender barriers had been conducted and classified the progress of the programme initiatives as early (still in the diagnostic or planning stage), emerging (implementation phase with evidence of actions and strategies) or demonstrating some degree of results (output or outcome level). These characteristics in combination were the basis for ascertaining whether an initiative qualified as gender-transformative either in its approach or as a promising practice. Four gender-transformative initiatives were identified and selected for more in-depth review. These case studies – carried out for Côte d’Ivoire, Ghana, Tanzania and South Africa - included interviews with CO staff and, for Côte d’Ivoire and Tanzania, focus group discussions with beneficiaries. Readers are referred to the full report, “Case Studies in Gender-Transformative Approaches: UNICEF Tanzania, Côte d’Ivoire, South Africa and Ghana.”

Promising practices are those initiatives evolving in the right direction, but which do not yet meet all the necessary conditions for being gender-transformative. Many are still at a nascent stage of development. These are featured as sidebars under each thematic area with illustrative actions to be taken and recommendations for improving gender-transformative aspects.