Interventions addressing men, masculinities, and gender equality and their implications for preventing violence against women and girls: an evidence and gap map and systematic review of reviews

Background
It is globally recognised that protecting the health and rights of women and girls is central to development and that gender inequality is a key driver of their health. It is also recognized that men and boys can play a role in either supporting and enabling or damaging and denying the health and rights of women and girls especially relating to sexual and reproductive health and rights (SRHR) including prevention of violence against women and girls. Evidence on how to engage men/boys to address harmful masculinities from a gender equality perspective (i.e. gender transformative approach), what works, and for which health outcomes needs to be evaluated. We conducted a systematic review of reviews and established an evidence and gap map (EGM) to evaluate the evidence on the effectiveness of interventions designed to engage men/boys in SRHR, particularly using gender transformative approaches. Here we specifically seek to present the findings with respect to outcomes related to violence against women and girls. Definition of gender transformative approach based on WHO working definition, as an approach to redress the unequal power relations that privilege men and disadvantage women.

Methods
Academic and non-academic databases (CINAHL, Medline, PsycINFO, Social Science Citation Index–expanded, Cochrane, Campbell Collaboration, Embase, Global Health Library, Scopus, Google) were searched using terms related to SRHR, males/masculinities, systematic reviews, and trials between. Reviews of interventions were eligible for inclusion when the review was considered systematic (i.e. utilizing a systematic search, detailing origin of database search, and documenting screening processes), included interventions/programmes that were evaluated using an experimental design (i.e. quasi-experimental or RCT), and was published between 2007-2018. AMSTAR2 was used to assess the quality of included reviews. Records were independently screened, and data extracted by two reviewers.

Results
Following screening of 3,659 non-duplicate records, 462 systematic reviews of rigorous evaluations of interventions engaging men in SRHR were identified for the EGM. Of which, 39 included gender transformative interventions that engaged men/boys in SRHR outcomes.
The EGM provides a visual, interactive summary of the existing systematic reviews of impact evaluations of interventions involving men to improve SRHR and categorised under the identified seven WHO SRHR outcome domains – of which preventing violence against women and girls is one, and whether they were explicitly gender transformative. The EGM illustrates that while the majority of reviews engaging men and boys in SRH are not gender transformative, the reviews of interventions addressing violence against women and girls (VAWG) were almost equally likely to be gender transformative than not gender transformative (ratio of 1:1.2).
From among 39 reviews that focused on or included gender transformative interventions with men, the majority covered outcomes related to prevention of VAWG, providing a robust evidence-base for this area.
The evidence base for outcomes related to intimate partner violence and domestic violence is larger than that for sexual violence more generally. Due to the variety of approaches, it is difficult to draw conclusions on the most effective approaches to preventing VAWG. However, batterer interventions utilising cognitive behavioural approaches were found not to be effective. Interventions engaging both women and men, and involved multiple approaches addressing underlying risk factors related to acceptability of violence, gender and power dynamics were more promising than those that focused on men alone, or individual, or group behaviour change approaches.
Overall, the quality of the evidence is low in relation to effectiveness across studies with the evidence for gender transformative interventions is for the most part limited to norms and attitudes.

Conclusion
Findings highlight that evidence on male involvement and addressing masculinities is emerging and is still in the early stages in terms of demonstrating conclusively effectiveness. The evidence, however, is more promising with respect to VAWG related outcomes The review points to a need for a strong research agenda; one that measures behavioural outcomes that are robust and validated, measured over a longer period of time.
Review findings also highlight the nature of masculinities and male gender norms that require change not only at individual and group level, but at structural and institutional level. In the last two decades, progress has been made in making the case that involving men and addressing masculinities is essential alongside a focus on women and girls’. Promising approaches provide an emerging body of evidence that gender transformative interventions on small scale can work within a reasonable period of time. The next generation of research needs to consolidate this emerging evidence with more robust methods, designs, measures and that can be delivered at scale and sustain changes not only at the individual, but at a population level.