C-Change Picks - Focus on Gender Norms

C-Change Picks #10 - Focus on Gender Norms
Information about Social and Behaviour Change Communication, sponsored by C-Change
November 11 2009

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.

C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on social and behaviour change communication (SBCC) in the health sector - in particular HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health - and in the environmental sector. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

C-Change Picks #10 focuses on gender norms and highlights programme efforts that address gender norms to improve health outcomes by addressing gender norms. Included in this issue are programmatic examples and evaluations of integration of gender strategies into programming from several HIV prevention projects and a couple of family planning projects.

C-Change has just published two new resources focused on gender norms and family planning. "Gender Norms and Family Planning Decision-making in Tanzania: A Qualitative Study" based on research carried out in Tanzania, examines the role of gender norms in decision making among young married women and men on issues of family planning and contraceptive use. "Incorporating Male Gender Norms into Family Planning and Reproductive Health Programs: Program Guidance Brief," provides evidence-based recommendations to guide family planning programmers in the design, implementation, and evaluation of family planning programmes that have a male gender norms component. Both reports are summarised and available below.

In this Issue...

GENDER NORMS AND HEALTH PROGRAMMING

1.Incorporating Male Gender Norms into Family Planning and Reproductive Health Programs: Program Guidance Brief
2.Gender Norms and Family Planning in Tanzania
3.Addressing Gender-Based Violence through Health Programming
4.Research Related to Gender Norms and Family Planning in Jamaica and Uganda

GENDER AND HIV IN AFRICA

5.Integrating Multiple Gender Strategies to Improve HIV and AIDS Interventions
6.Developing Men as a Means of HIV/AIDS Prevention in sub-Saharan Africa
7.Integrating HIV Prevention and Gender Norms and Rights in Kenya and Indonesia
8.Gender Norms and HIV Risk in Kenya
9.Letting Girls Call the Shots in Madagascar
10.Changing Behaviours on Gender Norms to Prevent HIV in Malawi
11.Building the Capacity of South African Leaders Involve Men and Boys in Achieving Gender Equality and Responding to HIV/AIDS
12.Gender, HIV, and the Church

RESOURCES FOR THE FIELD

13.Using Interactive Drama for Sexual and Reproductive Health
14.Effective Sexuality Education through Use of Youth Language

GENDER NORMS AND HEALTH PROGRAMMING

1.Incorporating Male Gender Norms into Family Planning and Reproductive Health Programs

Drawn from a March 2009 C-Change Expert's Meeting, this brief is intended to provide family planning and reproductive health programme planners and implementers with suggestions for how to incorporate activities that address male gender norms. It builds on the recommendations of the 2007 World Health Organization (WHO) report on evaluated health interventions that engage men and boys.

Male gender norms - defined as "socially constructed expectations about how men and boys should behave" - are factors influencing a range of family planning and reproductive health behaviours. These include informed use of family planning methods, condom use for disease prevention, and actions to prevent violence against women. Evidence suggests that gender-transformative interventions deliberately trying to examine, question, and change male gender norms are more effective in improving outcomes than those that merely acknowledge or mention gender roles. The following are strategies reviewed in the study:

1. Encouraging equitable communication, joint decision-making, and shared responsibility for family planning through couple counselling.
2. Encouraging men to critically reflect on gender norms and their impact on family planning behaviours and outcomes through participatory group education or other participatory community activities.
3. Addressing notions of gender in family planning through community channels of communication such as participatory theatre or community dialogue.
4. Portraying gender-equitable role models through mass media.
5. Promoting the norm that 'real men' are no longer obstacles to family planning through role models, such as model couples.
6. Engaging men's involvement in the health and well-being of the family through fatherhood programmes.

Those interventions that accommodated male gender norms, such as approaching men as gatekeepers and encouraging them to endorse contraceptive use, have not, according to the study, challenged the inequitable power dynamic between couples that often favour men and can limit women's decision-making abilities.

Based on reviewed programmes, this brief identifies evidence-based recommendations to guide family planning/reproductive health programmers as they design, implement, and evaluate programmes with a male gender norms component.

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2.Gender Norms and Family Planning Decision-making in Tanzania: A Qualitative Study

This paper examines a qualitative study undertaken by researchers from C-Change in order to explore the role of gender norms in reproductive decision-making and contraceptive use among young married men and women in Tanzania. The purpose of the research was to understand the role of gender norms in supporting high fertility, unplanned pregnancies, and unhealthy timing and spacing of births in Tanzania - with the ultimate goal of incorporating this understanding into social and behaviour change communication (SBCC) in specific social contexts.

According to the paper, gender norms - such as men's dominance in decision-making - often support high fertility, influencing the timing of marriage and childbearing, and aspirations regarding family size and sex composition. Family planning programs and services have often selectively accommodated rather than challenged prevailing gender norms by targeting family planning toward women, reinforcing the idea that reproduction and family welfare are women's responsibilities.

The findings showed near universal agreement among women and men users and non-users of contraceptives about the norms related to men's and women's roles in the family and society. In short, men were characterised as being the head of the household, the provider for the family, able to have sex and satisfy a woman, able to have children, and able to participate in society. A woman in Tanzanian society was characterised as the supporter of the husband, a caretaker of the family, and a bearer of children. It was considered disrespectful for a woman to disagree with and disobey her husband.

This paper details findings and concludes that "...despite ample evidence of gender inequality and gender norms that were potential barriers to the use of contraception, fears and misconceptions about side effects appeared to be more powerful deterrents to contraceptive use than non-egalitarian gender norms...." Family planning "messages and interventions should engage both men and women and encourage equitable decision-making. Men should be encouraged both to seek information about modern contraceptive methods from reliable sources and to encourage their wives or partners to do so. In addition, the capacity of clinics and other sources of contraception to provide accurate information might need to be strengthened."

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3.Addressing Gender-Based Violence through Health Programming

According to this September 2008 document from USAID entitled "Addressing Gender-Based Violence Through USAID's Health Programs: A Guide for Health Sector Program Officers", research demonstrates that gender-based violence has implications for almost every aspect of health policy and programming, from primary care to reproductive health programmes, because it not only results in injury and death of its victims, but also it can contribute to the spread of HIV. Reducing violence and coercion is among five high-priority gender strategies of the President’s Emergency Plan for AIDS Relief (PEPFAR).

Findings show that violence against women may increase in communities where women break from traditional norms. Crime and armed conflict are causally linked to gender violence. The document suggests that: "From a public health perspective, community-level risk factors may be the most helpful for identifying promising ways to reduce violence against women. Focusing too much on individual risk factors may obscure the fact that violence against women tends to occur throughout society and across all demographic and socio-economic groups and appears to be heavily influenced by community norms and responses."

Examples of factors associated with high levels of violence against women at the community level include:

• Traditional gender norms that support male superiority and entitlement
• Gender norms that tolerate or even justify violence against women
• Weak community sanctions against perpetrators
• Poverty
• High levels of crime and conflict in society more generally

This document presents strategies - by programme type - suggesting what programmes should and should not do. For example, Communication for Social and Behaviour Change (CSBC) programmes should support long-term efforts to link communication activities with other types of GBV activities, such as combining mass media communication strategies to include helping their audiences find services in the community and build support for policy change. They should integrate GBV messages into existing public health communication programmes, ensuring that images and messages are empowering and that they do not reinforce stereotypes, such as women as "victims" and men as "aggressors." They can also support programmes that use many different types of media channels and formats, including "edutainment", and focus not only on men and women, adolescents and adults, but also on teachers, the police, and the justice system.

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4. Research Related to Gender Norms and Family Planning in Jamaica and Uganda

Published in 2008 from the Youth Research Working Paper Series of Family Health International (FHI), "Early Sexual Debut, Sexual Violence, and Sexual Risk-Taking among Pregnant Adolescents and Their Peers in Jamaica and Uganda" focuses on early sexual début and experiences of sexual coercion/violence as they are related to each other and to unintended adolescent pregnancy.

A selection of the key findings from this research include the following:

• In Uganda, most of the pregnant girls married early and childbearing was an expected consequence of being married at an early age.
• Sexual violence was a common experience for girls in both countries. Verbal harassment was common. Many girls described having been coerced to have sex at one time or another by their boyfriends or someone they had a relationship with; sometimes this meant actual force or threat of force and sometimes this meant feeling verbally pressured.
• Jamaican girls were more likely to describe resistance to sexual violence than the girls in Uganda, who were more likely to keep sexual violence a secret. Results from the study in Jamaica found an association between pregnancy and early sexual debut but not between pregnancy and sexual violence. Though this lack of statistical association was a surprise, the prevalence of sexual violence among both pregnant and never pregnant girls indicates that it is an issue that cannot be ignored in programmes for and with adolescent girls.

Based on the study's findings, the following are strategies and goals for programmes to reduce unintended pregnancy:

• build adolescents' self-esteem and future orientation
• address norms that encourage early marriage and enforce marriage-age laws
• discourage older partners
• encourage stronger connections with parents and community groups
• teach girls and boys about contraception and make it accessible
• teach the community about the benefits of delayed childbearing among married and unmarried adolescents
• teach boys to respect that girls have the right to refuse sex
• teach refusal skills to girls
• provide girls with good reasons to delay sexual début
• reach girls and boys at young ages (before age 14).

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GENDER AND HIV IN AFRICA

5.Integrating Multiple Gender Strategies to Improve HIV and AIDS Interventions

Published in May 2009 by USAID, this compendium of HIV/AIDS programmes in sub-Saharan Africa is designed to illustrate the many programmatic approaches to integrating multiple gender strategies to mitigate women's and men's vulnerability to infection. Its premise is that gender strongly influences how HIV spreads and how people respond to the epidemic and that using multiple approaches in HIV/AIDS programming is more effective than single strategies. Featured programmes address at least two of the following gender strategies: reducing violence and sexual coercion; addressing male norms and behaviours; increasing women’s legal protection; and increasing women’s access to income and productive resources.

The compendium describes each of the 31 selected programmes, and synthesises trends and findings to provide initial insights on using multiple gender strategies in HIV programming, including how strategies are employed together, where gaps exist, and what lessons and experiences are common across programmes.

The findings include:

• Community involvement is vital to programmes that address multiple gender strategies because these approaches often require changing interconnected and sensitive gender norms. National policy and government involvement also are important to sustaining and scaling up combined approaches.
• Of the four gender strategies:
  - Reducing gender-based violence was the most common.
  - Increasing women's legal protection was the least common.
  - Programmes often addressed male norms and behaviours in combination with gender-based violence efforts, successfully engaging men with innovative approaches.
  - Strategies to increase women's income were combined with other strategies to sustain women's capacity to address a range of issues in their lives, including violence and HIV.
• Most programmes lack rigorous data collection and evaluation, often because implementers do not have sufficient resources or technical capacity.
• Few featured programmes collect findings related to gender outcomes.

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6.Developing Men as a Means of HIV/AIDS Prevention in sub-Saharan Africa

Published in January 2008 in the journal Political Perspectives, "As a Man This is How You Should Behave! A Critical Look into Methods of 'Developing Men' as a Means of HIV/AIDS Prevention in sub-Saharan Africa" looks at two HIV/AIDS prevention programmes in Uganda that both focus on changing men's attitudes and behaviour. According to the author, both programmes, Operation Gideon and the "Be a Man" campaign, tend to reinforce the same "truth" about Ugandan men, namely that they are the ones in control of their families or society. However, the author states that because the programmes use different methods and techniques, their effects are very different.

The "Be a Man" campaign combines health awareness techniques with specific gender perspectives to enable Ugandan men to reflect on how certain dominant notions of masculinity in Uganda make them behave in ways which are unhealthy to themselves and others. It aims to change male gender norms rather than changing men.

Operation Gideon primarily relies on strengthening Christian techniques of self-government to enable men in Mbuya to resist the dangers of the Ugandan culture's negative influences. Operation Gideon organises facilitated discussion groups in different drinking establishments.

The key concern in Operation Gideon is not so much to redefine the cultural and social expectations of men, as it is to change how men in Mbuya relate to these expectations. Facilitators attempt to enable men to resist "negative" cultural influences through messages combining AIDS prevention and Christian morality.

The author argues that within their various strategies and methods, neither programme actually attempts to change the balance of power between men and women - men's role as decision-maker and head of the household is not questioned - rather the programme simply encourages men to use the power they have differently.

The conclusion is that there is a need to further study the consequences and effects of HIV/AIDS prevention initiatives in sub-Saharan Africa that are specifically geared toward men, paying attention to how these overall ideas are translated on the ground into specific practices.

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7.Integrating HIV Prevention and Gender Norms and Rights in Kenya and Indonesia

The initial sections of "Gender Development Project Review Report: Kenya and Indonesia" from Stop AIDS Now! (SAN!) in November 2008 explore the design and development of the Gender Development Project (GDP), which seeks to add value to the HIV/AIDS and gender policies of SAN! partners - community-based and non-governmental organisations (NGOs) - by identifying promising local-level strategies and interventions for HIV prevention that integrate promotion of egalitarian gender-based attitudes, behaviours, and norms, and women's rights. In keeping with other SAN! development projects, the GDP takes place in two countries, one with a generalised epidemic and another with a nascent or concentrated epidemic. This particular two-country choice is designed to allow for comparisons and to provide opportunities for actors in the AIDS response in the low-prevalence country to learn from the experiences of their counterparts in the high-prevalence country.

Some of the key lessons from the review are the following:

• Use of tangentially relevant entry points for dialogue with communities helps lead into discussions on HIV/AIDS. Such entry points currently used by counterparts include such issues as economic empowerment, education, and religion. The use of such entry points also help get men and boys become involved in discussions.
• It is important to involve men and boys from the start of an activity. This helps create greater acceptance of the activity, and to ensure their overall greater participation as well as that of women and girls.
• It is important to integrate activities that address the economic well-being of beneficiaries. The struggle for day-to-day survival still hampers the involvement of women (and men) in awareness raising activities around HIV/AIDS. This point is especially relevant in relation to women living with HIV.
• It is helpful to create or link beneficiaries living with HIV to existing people living with HIV/AIDS (PLWHA) support groups. This helps increase the confidence and knowledge of beneficiaries to take action to live positively and better manage their lives with HIV.
• The involvement of community leaders such as teachers, cultural custodians, and government officials in projects is key to the greater impact and sustainability of the changes the GDP is seeking to achieve. Such leaders have the influence to promote and/or implement change and the legitimacy and respect of communities to influence their thinking and behaviour.

For more information on the Gender Development Project (GDP), please click here.

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8.Gender Norms and HIV Risk in Kenya

The Silent Partner: HIV in Marriage is a 12-minute documentary that was filmed and produced in Kenya by Population Action International (PAI). The film explores some of the complex realities of married women, and how the challenges of HIV prevention in this group defy simple solutions. According to the producers, the film urges a broader, integrated approach to preventing HIV, which includes confronting damaging social norms that put all people - men and women alike – at risk. It is designed to raise awareness of the risk of HIV transmission within marriage and illustrate the particular challenges facing married women. It also shows that traditional approaches to HIV prevention do not meet the needs of married women, because practicing abstinence is unrealistic, wives cannot control the faithfulness of their husbands, and because they find it difficult to negotiate condom use.

This film is intended to be used as an advocacy tool to inform, provoke discussion, and mobilise political and financial support for evidence-based HIV prevention, sexual and reproductive health and rights programmes, and broader social and economic policies to improve the lives of women and their families. The film is accompanied by fact sheets that can be downloaded from the website and used at organised screenings.

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9.Letting Girls Call the Shots in Madagascar

Red Card is a component of a health communication campaign led by C-Change in Madagascar that was designed to prevent the spread of HIV/AIDS and to curb associated risky behaviours by "letting girls call the shots" and sparking conversation between parents and adolescents. The campaign appropriated the signal soccer referees use to kick aggressive players out of a game; paper Red Cards were distributed to 1.5 million young women across Madagascar. These girls use the Red Cards as ice breakers to start conversations on sensitive topics and to stop risky and inappropriate behaviours at school, parties, their homes, and on dates.

To kick off the initiative, 4 television spots were broadcast showing teenage girls in common, but difficult, situations. For example, one spot features a boyfriend who won't listen to a girl's polite, but insistent, refusals to drink alcohol at a party. Not knowing what else to say, she draws a Red Card from her pocket, shakes her head with confident disapproval, says, "I told you three times I just want a soda; why won't you listen to me?" and leaves.

As the initial series of spots was airing, dozens of two-hour training sessions were held in schools and clubs and with sports teams so that girls could practice using Red Cards. Trainers asked the girls to explain Red Card to their parents once they got home. The intention was that this conversation might open the door to discussing sexual harassment, alcohol use, and other risky behaviours.

During the project's second phase, trainings took place throughout the country, directly reaching 30,000 teenage girls and sparking an exponential increase in the number of phone calls made to the national HIV/AIDS hotline - most of them asking for packs of 100 Red Cards. In addition, more than 2,000 Red Card clubs were formed, providing an opportunity for girls to talk about their experiences using the tool. In the words of organisers, "Red Cards...clearly give young women a way to be heard, even if they can't find the right words."

Note: currently all USAID funding for programmes in Madagascar, including those implemented through C-Change, has been suspended.

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10.Changing Behaviours on Gender Norms to Prevent HIV in Malawi

This report from 2008 details an evaluation of the Enhanced HIV/AIDS Prevention and Improved Family Health Program (EHAP-IFH), which was launched in Malawi in July 2005 by Population Services International (PSI)/Malawi in an effort to contribute to the overall USAID Malawi Strategic Objective (SO) 8: Improved Health Status of Malawians. Malawians face many barriers to access to health services: At least 14% of the total population of 12-13 million Malawians is estimated to be HIV-positive, with 90,000 infected every year. Young women aged 15 to 24 are nearly 4 times more likely to be infected than young men. One in every 8 children dies before age 5, and malaria is endemic in all parts of the country.

There are a number of programmatic elements, including various behaviour change communication (BCC) and social marketing interventions, detailed here. Those that specifically address gender norms include:

• As enhancement to the YA! Mix radio programme, YA! Listener Club Open Days are held occasionally in order to sensitise community members, reinforce messages, and address problems such as adverse societal pressures. This is part of an effort to embed the YA! approach and activities within traditional structures, to engage gatekeepers without whose permission such activities could not occur, and to move forward on BC issues.
• The pilot Faith Communities Program (FCP) works primarily through training of traditional and religious gatekeepers. A dedicated manual aids in leadership training. The FCP manuals have a detailed and culturally aware focus on gender issues such as incest and gender-based and sexual violence, their links to both HIV transmission and human rights, and the need for the community to address such matters equitably.

Key recommendations from this evaluation related to gender include:

• Future PSI/Malawi behaviour change and behaviour maintenance (BC/BM) interventions should further strengthen girls' capacity to communicate and negotiate.
• Gender should be more systematically mainstreamed throughout PSI/Malawi programmes and activities.
• Gender analysis should be incorporated into all qualitative and quantitative research activities and inform all BC/BM message development.

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11.Building the Capacity of South African Leaders Involve Men and Boys in Achieving Gender Equality and Responding to HIV/AIDS

"Sonke Gender Justice Network's Report to the Ford Foundation" evaluates the One Man Can (OMC) campaign, which the South African NGO Sonke Gender Justice (Sonke) launched in November 2006 to promote attitudinal change among men in their interactions with women. The report, published in August 2008, describes the range of activities carried out by Sonke with Ford Foundation support during the period July 1 2007 to June 30 2008.

As detailed in this report, the OMC campaign encourages men to become actively involved in advocating for gender equality, preventing gender-based violence (GBV), and responding to HIV and AIDS. The organisation holds trainings with other community-based organisations and groups that focus on gender norms and traditional roles and are intended to catalyse change. For example, Sonke held a 4-day workshop to train 15 AIDS Consortium participants in the OMC approach and methods. When asked before the training whether men have the right to choose when to have sex with their partner, 67% of the participants agreed; post-training, none of them agreed. When asked beforehand if they felt that people with sexually transmitted infections (STIs) are at a higher risk for contracting HIV, 100% of the participants disagreed; post-training, 60% agreed that this statement was actually true. As a culmination of the training, a memorandum was presented to the South African Police Services (SAPS) station in Hillbrow urging efficient implementation of the Domestic Violence Act and offering OMC training to SAPS staff. The memorandum and walk to the SAPS offices was designed to forge a link between the OMC training and the importance of community mobilisation.

Having been trained by Sonke, another organisation, Munna Ndinnyi, has conducted community activities focusing on voluntary counselling and testing (VCT) and teen pregnancy, and has hosted HIV talks at Tshilidzini Hospital. The group has developed posters challenging stereotypes and the cultural beliefs regarding gender issues and HIV/AIDS. Munna Ndinnyi has conducted training workshops, working with traditional leaders through the relationship they have with the male circumcision schools. Two hundred students were reached with messages about gender and HIV and AIDS through school debates. Munna Ndinnyi staff trained Thsilidzini Hospital staff on the OMC initiative and formed 2 community action teams which have developed early drafts of posters they will finalise and disseminate widely.

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12.Gender, HIV, and the Church

Describing a two-year pilot project to engage local churches in Zimbabwe and Burkina Faso, this March 2009 Tearfund case study looks at the church's ability to work with communities to address culturally sensitive issues such as gender and HIV, by focusing on the relationships between men and women.

Research in both countries found that many attitudes and behaviours prevalent among Christians were based on underlying traditional cultural values rather than biblical values, and that in many cases the church was not challenging harmful traditional views about gender; indeed, it was often reinforcing them through selective use of Bible passages.

Over the 2-year pilot project, the churches involved held a variety of interventions including workshops for couples to develop relationship and parenting skills; camps for young people focusing on life skills, goal setting, and making positive choices; teaching in churches; and training for church leaders. A significant part of the project involved addressing key Bible passages often used to justify gender inequalities.

According to Tearfund, the programme did have a significant impact on the communities involved. During a review of the project, focus group participants were asked to discuss the most significant change in their communities. People reported increased HIV testing, reduction in multiple or concurrent partners, and increased discussion within relationships about love and sexuality. Some also reported increased condom use, and young people said they no longer saw HIV as a death sentence. However, the case study notes that tackling deep-rooted traditions is a long-term process, as some women still felt as though they had no choice in negotiating sex with their partners.

The report concludes that working with local churches is key to addressing gender inequality, and that by taking a biblical and relationships-based approach to gender, pastors and congregations can openly discuss and debate cultural traditions and norms that have previously restricted both men and women from reaching their full potential in life.

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RESOURCES FOR THE FIELD

13.Using Interactive Drama for Sexual and Reproductive Health

"Feel! Think! Act! A Guide to Interactive Drama for Sexual and Reproductive Health With Young People", a toolkit published by the International HIV/AIDS Alliance Secretariat in March 2008, looks at how interactive drama can be used in work with young people to encourage them to think about and take action to improve their sexual and reproductive health (SRH). It is based on the experience of the International HIV/AIDS Alliance, its partners, and drama practitioners working in Zimbabwe, Malawi, and Zambia.

The toolkit is designed to:

• encourage practitioners in drama and in SRH to share their knowledge and skills, and work together to improve lives through interactive drama;
• increase the use of drama as a creative and participatory process to address SRH issues as opposed to using a one-way message delivery tool;
• equip practitioners with the knowledge, skills, and attitudes that they need to use interactive drama effectively in SRH programmes and other areas; and
• enable practitioners to use drama in a positive way, which reduces stigma and discrimination towards vulnerable groups.

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14.Effective Sexuality Education through Use of Youth Language

This article explains that language shapes the way people think about life and, therefore, influences actions. It proposes that analysing the metaphors young people use while talking about sex can provide valuable insights into the ways in which youth understand sex, sexual behaviour, and sexual relationships. These insights may have untapped potential for enhancing the effectiveness of sexuality education interventions.

"Talking About Sex: Using Youth Language in Sexuality Education" discusses how interventions to raise knowledge and awareness and to influence attitudes and behaviour need to be well-designed and accessible for young people. The authors suggest that an important way of tailoring interventions to the sociocultural context is through incorporating young people's own language into curricula and teaching approaches.

Research conducted by the African Population and Health Research Center (APHRC) found that young people conceptualise sex in three main ways. Young people’s expressions focused largely on the mechanics of sexual actions and the utility of sexual organs, the gratifying nature of sex, and the passionate aspects of sexual activity. Recurrent metaphors could serve as a starting point for tailoring educational messages; for example, discussing phrases related to having sex - such as, "putting Colgate toothpaste on a toothbrush" or "opening a girl" - or related to multiple sexual partnerships - such as, "It is good to have a spare tire; if one gets flat, you just fix the other", or "Girls say, you don’t need to have one cloth outfit only".

The report concludes that given the importance of sexuality education, there is value in continued development of innovative ways of addressing these challenges. A reflective discussion of metaphors not only provides an opportunity for instructors to understand the concepts and constructs in the sexual worlds of young people in their own right, but it could also help teachers and trainers to identify and address their own biases and assumptions.

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Communication for Change (C-Change) implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of social and behaviour change communication programmes, activities, and tools. C-Change works with global, regional, and local partners to incorporate knowledge about the social determinants and underlying causes of individual behaviours and takes into account research and lessons learned from implementing and evaluating activities. Employing innovative and tested methods, C-Change works to meet the continuing challenges posed by evolving health issues that require a social and behaviour change communication approach. C-Change also works to strengthen the capacity of local organisations to plan, implement, and evaluate programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email: cchange@aed.org.

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please visit The CI website.

This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.