Women in Tanzania who buy fish to feed their families or sell in the market must often have sex with local fishermen before they are allowed to make their purchases. According to Elin Torell, a coastal management specialist with the University of Rhode Island's Coastal Resources Center, this "entry to buy fish" is one example of gender norms' influence over diverse aspects of life. Torell, along with Karen Hardee, a social demographer and senior adviser at John Snow, Inc., advocated greater integration of gender into reproductive health and sustainable livelihood programs at an event sponsored by the Environmental Change and Security Program on June 19, 2007.

Positive Reproductive Health Outcomes

According to the Interagency Gender Working Group's (IGWG) 2004 ‘The So What? Report,' reproductive health programs that attempt to transform harmful gender norms have reported consistently positive outcomes. The report evaluated 25 reproductive health interventions that sought to alter gender relations, finding that 10 interventions reported increased knowledge of HIV/AIDS transmission and prevention, six reported an increase in family planning use, and three reported reductions in sexually transmitted infections.

‘The So What? Report,' to which Hardee contributed, identified several gender norms that pose challenges for reproductive health initiatives. One of the primary obstacles is the gendered division of labor, along with the devaluation of work that is traditionally performed by women. "Women's labor, usually domestic chores, could…in some cultures not be valued as work, but rather as a natural part of being a woman," she said. Another obstacle for reproductive health initiatives is social pressure that drives women to have more children than they want—or can easily care for. Furthermore, it is important for health initiatives to consider the effect gender has on an individual's access to and control over financial resources. For example, women may have access to income but no power to decide to spend the money on family planning.

One intervention that the report found highly successful addressed husbands' role in post-abortion care in Egypt. One in five patients admitted to public ob-gyn hospitals in Egypt is seeking post-abortion care. Hardee explained that after returning home, many women quickly resume domestic duties and face pressure from husbands and in-laws to become pregnant again before they have fully recovered. In the intervention, physicians counseled husbands privately about dangers such as obstetrical complications that are more likely to occur when women are not given adequate time to recover. Thirty days after their release from the hospital, women whose husbands had been counseled reported receiving 1.5 times more instrumental support, 1.3 times more emotional support, and 1.6 times more family planning support than did women whose husbands had not been counseled. However, the study also found that regardless of whether or not they had been counseled, husbands tended to provide lower levels of instrumental support than emotional support. Hardee speculated that this phenomenon might be the result of an Egyptian norm that ridicules men who attend to domestic tasks.

Gender in Tanzanian Coastal Communities

Gender can also play a significant role in sustainable livelihood programs, which often confront deeply embedded social inequalities. Torell noted that most Tanzanian women have little access to income and lack decision-making power, so many of the Coastal Resources Center's (CRC) programs have attempted to increase women's participation in and control over income-generating activities. In one such program in Fumba, Tanzania, the CRC showed women how to harvest "half-pearls" by placing a small grain of sand in an oyster in deep coastal waters. After a few months, the grain turns into a half-pearl that the women can sell. In coastal Tanzania, women are responsible for collecting muscles and oysters from intertidal areas, a practice that is ecologically unsustainable; the half-pearl project proved a relatively easy and more sustainable way for women to earn money. But the CRC encountered a major barrier: Tanzanian women are not taught to swim. To overcome this obstacle, Torell and her colleagues had to break down this traditional gender norm and teach the women the necessary skill.

The CRC's programs were not always able to overcome traditional gender norms, however. For example, in the Mkuranga district, multiple villages were exhausting the resources in a common coral reef. The CRC convened leaders from different communities to establish voluntary fisheries monitoring and restrictions, but only 20 percent of those involved in planning and negotiations were women. To correct gender imbalances in future projects, Torell suggested that programs incorporate occupations in which women routinely work: "If we had made the planning exercise broader, to somehow involve the people who buy fish, maybe more women would have been involved."

More Integration, More Evaluation, More Funding

While IGWG reviewed 400 reproductive health programs, only 25 programs examined the effects of gender integration thoroughly enough to be included in ‘The So What? Report.' "Isolating the effect of the gender perspective is difficult because a lot of these interventions are sort of multi-sectoral, multi-component," Hardee said. "It is hard to tease out what the impact of just one component is on the programs." Also, the short-term nature of most interventions makes changes in long-term behavior difficult to gauge. To correct for these problems, she advocated greater integration of gender into interventions, more and better data on the effectiveness of those integrations, and—crucially—longer-term initiatives. Additionally, she promoted an inclusive definition of gender as a way to dispel the "idea that if you're working on gender then you're just working to improve the lot of women."

Despite their proven effectiveness, programs that strive to integrate gender suffer from a lack of funding, said Torell. In Tanzania, for instance, she noted that gender-focused programs are passed over for more conventional ones: "You always have to go at it from either the environment group or the health group or some other group." Although incorporating gender into reproductive health and sustainable livelihood programs requires creativity and persistence, Hardee and Torell agreed that the results justify the effort.

Drafted by Karima Tawfik.