Reproductive & Sexual Health

Research More than two decades of research--often originating in US colleges and universities--have crystallized the strongest possible links between internalizing narrow norms of traditional masculinity and femininity and lower reproductive health outcomes for at-risk youth, because gender "scripts” for how boys and girls are supposed to act are what drive behavior in sexual situations, especially during the "gender intensification” years of late adolescence and early teens when young people are most likely to buy in to primitive gender codes and most vulnerable to peer pressure to live up to them. 

At-Risk Youth The impact of narrow gender norms can be most harmful in disinvested and under-resourced communities, where codes for masculinity and femininity are apt to be particularly narrow, and penalties for transgressing them especially harsh ("Why We Can't Wait," Ford Foundation, 2005)

Young Men For instance, research shows that young men who internalize ideals of traditional masculinity as defined by strength, toughness, sexual prowess, and aggression have earlier sex, more sexual partners, and lower condom use. They are more likely to believe in sex as adversarial, that women are responsible for preventing conception, and that pregnancy validates manhood (Pleck, et al., 1993). 

Intimate Partner Violence In addition, they are more likely to view violence against an insubordinate female partner as justified, and to engage in sexual coercion either through physical or psychological abuse. 

Taken together, this collection of behaviors and beliefs is almost a perfect prescription for lower reproductive health outcomes.

MSM The effects are not limited to heterosexuals -- young gay men internalize many of the same masculine norms, and may strive all the harder to emulate them. For instance, studies show that narrow codes of masculinity among young men who have sex with men (MSM) are connected to  avoiding HIV testing, "bare-backing” (not using protection), valorizing promiscuity, and eschewing safer sex behaviors (like caressing and touching) that do not prioritize penetration but do entail emotional vulnerability.

Young Women Women are affected as well. For years researchers have known that internalizing narrow codes of femininity which place a premium on passivity, obedience, docility, conflict avoidance, and physical beauty is strongly linked to lower sexual self-efficacy, condom use and safer sex negotiation among young women as well as higher rates of body objectification, acceptance of male infidelity, and tolerance for sexual coercion or violence (Tolman & Porche, 2000; Tolman, et al., 2003).

At-Risk Women Gender codes can be especially harmful for women in at-risk communities. For instance, machista codes of femininity that prioritize passivity, obedience, purity, motherhood, and deference discourage young Latinas from learning about or discussing sex, and from carrying or using condoms while simultaneously encouraging them to become mothers early, tolerate sexual coercion or violence, and defer to male sexual prerogatives (Gomez and Marin, 1996). Combined with male codes of machismo, such traditional norms can decrease gender equity and disempower young Latinas.

Gender Transformative Findings like these have created an increased focus on and commitment to what leading authority Geeta Gupta called "gender transformative" programs and policies. Approaches, which are gender transformative, highlight, challenge and ultimately change belief in harmful norms of femininity and masculinity.  

International Agencies like UNAIDS, UNFPA, PEPFAR and WHO have already implemented gender transformative approaches that are more effective at increasing gender equity and improving life outcomes for young women. 

USAID no longer funds new programs that lack a strong gender analysis–including gender norms–and it launched a website ( just to coordinate information on gender sensitive initiatives. WHO developed an in-depth report to document the increased effectiveness of gender transformative work with women and girls ("The 'So What' Report: A Look at Whether Integrating a Gender Focus in Programmes Make a Difference in Outcomes.”).

The U.S.  Yet the US still lags behind. In 1995 Hortensia Amaro, a leading expert on young women of color, wrote in one of the most often-cited reproductive health papers ever that the US still pursues improved reproductive health outcomes and gender equity for at-risk women "in a gender vacuum." That remains true today ("Love, Sex, Power: Considering Women's Realities in Preventing HIV," 1995).

Disconnect There is a wide and growing disconnect between research and actual practice. For instance, the CDC's two dozen Evidence-Based Programs lack a strong, specific focus on gender norms, and Emerging Answers, the bible of teen pregnancy policy, mentions gender norms specifically only in a footnote.

Coming Change But that is all starting to change. Gender transformative approaches are quietly gaining wider domestic acceptance. 

    For instance, our recent convening at the Ford Foundation to explore launching a National Council on Gender drew affirmative replies from 47 researchers, funders, policy-makers and NGOs. 

    A growing roster of international-facing US groups like Population Council, EngenderHealth, and International Planned Parenthood are launching gender transformative efforts of their own. 

    And the White House recently invited us to brief them on gender transformative approaches to improving reproductive health outcomes for at-risk youth.   

 Our Work  This is what a new discourse starting to catch looks like. Research shows that addressing gender norms is a key to improving reproductive health outcomes for young women and men. TrueChild is dedicated to leading and partnering in that effort. 



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