How do social constructions of masculinity affect health equity? What kinds of interventions can produce behavioural change in men and boys? This review assesses the effectiveness of programmes seeking to engage men and boys in achieving gender equality and equity in health. Gender norms influence how men interact with their partners, family and children on a wide range of health issues. Programmes that include gender-transformative elements, and those that are integrated with wider community outreach or mobilisation initiatives, are more effective in producing behavioural change.
The social expectations of what men and boys should and should not do and be directly affect attitudes and behaviour related to a range of health issues. These include HIV prevention, sexual and reproductive health, gender-based violence, parenting and maternal health. The health of both men and women can be placed at risk due to prevailing notions of manhood and masculinity, which stem from patriarchal structures and social norms that are the source of gender inequality and oppression. Consequently, men and boys who adhere to more rigid views of masculinity are more likely to have used violence against a partner, to have had a sexually transmitted infection, to have been arrested and to have used substances.
There are a growing number of health-related programmes targeting men that seek to achieve gender equality and equity in health. However, those most effective at instigating behavioural change include a gender-transformative element – they seek to change the social construction of masculinity and promote more gender-equitable relationships. Further:
- There has been a move from single-issue interventions (such as providing vasectomy or promoting condoms) to programmes working on multiple health areas and with a more integrated perspective.
- Most programmes are small-scale, short in duration and rarely last beyond the pilot stage.
- Few programmes seek to reach men and boys at different stages of their life-course. Rather, most only focus on a specific age group of men or boys during a short project span.
Programmes are more effective at producing behavioural change in men and boys when integrated into community outreach and mass media campaigns. Group sessions combined with community campaigns, mass-media campaigns or individual counselling can provide sustainable changes in attitudes and behaviour. In addition:
- Group education activities should critically reflect on masculinities and gender norms, and themes and discussions should be connected to real life situations.
- Campaigns and community outreach initiatives should be based on initial research that tests campaign messages for effectiveness with the target group.
- High-quality mass media content, including commercials, soap operas and radio dramas are expensive but reach the highest number of men and boys.
- The most effective campaigns last from six months to a year and seek opportunities to present their messages on a weekly or daily basis.
- Health services need to be delivered by professionals who have been sensitised to men’s health issues rather than those who would usually work with women. In addition, physical spaces and educational materials need to be designed specifically for men.
- Home visits are particularly effective: in many cases men are reluctant to visit clinics or are reluctant to take time off. Even a single counselling session can lead to behavioural change, such as increased contraceptive use.
