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Try out PMC Labs and tell us what you think. Learn More. Fleming originated the study and led the writing. Fleming and J. Lee contributed equally to developing ideas and writing initial drafts. Dworkin contributed original ideas and writing to subsequent drafts.
All authors reviewed and edited each draft. We critically assess the deployment of hegemonic male norms in the Man Up Monday campaign. We draw on ethical paradigms in public health to challenge programs that reinforce harmful aspects of gender norms and suggest the use of gender-transformative interventions that challenge constraining masculine norms and have been shown to have a positive effect on health behaviors. Unintended and harmful consequences can lurk behind even the most promising and innovative public health interventions.
At first glance, the campaign has used public health best practices. It also deploys language that is relevant to young men 6 and uses savvy advertising to appeal to the target population by conveying the image that STI testing is hip. However, interventions using approaches that leverage gender norms require careful consideration as researchers have documented the detrimental effects of narrowly defined gender norms and gender inequality on the health of men, women, and children.
Even though the Man Up Monday campaign leverages best practices, it is crucial to thoughtfully and constructively critique messaging strategies used in programs such as this one to advance and refine the development of future gender-related health interventions.
Even well-intentioned, carefully deed programs can have unintended consequences and may need improvement. We start by reviewing the recent history of efforts to address gender norms in the name of improved health for both women and men; we then define some of the pitfalls and ethical implications of current approaches that deploy reinforcing instead of gender-transformative notions of manhood; we end by offering a path forward for public health interventions that seek to intervene on masculinities in the name of improved health.
Too often, deviation from masculine ideals le to violence against gay men and heterosexual men who are perceived to not neatly conform to the social definitions of maleness. We examine and describe the continuum of gender-related approaches in the box on the next . Initially, efforts were considered gender-neutral because they failed to for the existence of differing gender norms and failed to address the differential social context of men and women.
As a result, gender-sensitive HIV prevention interventions were deed to recognize these gender-related constraints. As with most ideals, very few individuals feel they measure up, which opens up possibilities for marketing and behavior change interventions. Acknowledgment of the power and sway of normative gender roles that are put forward by industry and marketing does little to change the existing system of gender norms and in fact works to reinforce it. In the case of public health interventions, many scholars have argued that gender-neutral and even gender-sensitive approaches are insufficient to permanently improve health outcomes associated with gender norms.
The field of public health has arrived at a point where gender norms are routinely acknowledged and sometimes intervened upon to improve health outcomes. However, the field has been less critical about the specific approaches used in gender-related public health programs. Although numerous cultural and social factors influence prevailing gender norms e. Additionally, they are more likely to maintain high degrees of control over their female partners, 70 engage in more sexual risk taking, 20 avoid health care clinics, 71 and enact more physical and sexual violence with their partners.
The intervention then seeks to redefine the health behavior of interest STI testing as a positive, masculine behavior. Using the continuum of health interventions established by Gupta, this type of effort can be considered a gender-damaging approach because it specifically exploits the rigidity of male gender norms. Consider the well-documented disparity in suicidal ideation among adolescent boys deemed gay by their peers.
On the basis of the current state of evidence that gender inequality and norms of masculinity are drivers of negative health outcomes, approaches that purposefully reinforce hegemonic norms may be considered unethical. Additionally, calls for public health as social justice require practitioners and researchers to examine and address existing structures of power, including gender inequalities.
Although reinforcement of gender norms is pervasive throughout US society e. If public health interventions had no alternative approaches, 74 gender-reinforcing approaches could be considered ethical to achieve a specific health outcome. However, there are alternatives: gender-transformative approaches. Because gender-transformative approaches do not rely on adherence to harmful gender norms and instead aim to challenge the inequitable system of gender norms, their implementation would minimize harms and burdens while producing similar desired health outcomes. Even more importantly, gender-transformative interventions address the gender and power structures at the root of a host of harmful behaviors and therefore can effect positive changes beyond the stated program goals.
Programs can rarely eliminate all potential harms. However, within the evidence base, gender-transformative programs have been found to reduce inequitable attitudes toward women, rework the norms of masculinity that harm health, and promote positive health changes for both women and men.
In the next section, we discuss how gender-transformative public health interventions have achieved much success by attempting to de-emphasize hegemonic ideals and transforming narrow conceptions of what it means to be a man, thus shifting gender relations in the direction of more equality between women and men.
Campaigns such as Man Up Monday could adopt various gender-transformative strategies to move away from the reinforcement of hegemonic masculinity and toward the promotion of a more gender-equitable masculinity. First, such campaigns could modify messaging strategy to focus less on manning up and more on questioning the characteristics of contemporary masculinity that prevent men from seeking health care services.
Campaigns could use places where men congregate e. By adopting these gender-transformative strategies, the campaign would provide a safe space in which men can actively recognize, challenge, and reconfigure gender norms in the presence of other men to improve health. As a result, men would not only potentially feel more comfortable seeking health care services—including STI testing—in the future, but also take preventive action to decrease the likelihood of contracting an STI.
Intervention developers aiming to adopt gender-transformative strategies can look to the emerging literature on evidence-based gender-transformative programs that have been implemented within the past decade. Stepping Stones, a cluster randomized control trial implemented in South Africa, demonstrated the effectiveness of a gender-transformative approach at changing sexual and violent behaviors in men.
One program, Program H, developed by Instituto Promundo in Brazil, uses a group educational format with young men to challenge male norms of violence and multiple partners within a safe environment facilitated by a male role model. research has shown that young men perceive their peers as less supportive of gender equality and nonviolent masculinities than they actually are. The program moves men toward greater support for gender equality to reduce the spread and impact of HIV and to reduce violence against both women and men. Gender-transformative intervention content can be delivered through a variety of strategies e.
Although still underused globally, efforts in developing countries have far outpaced public health programming in the United States and most other high-income countries with regard to gender-transformative programming. For a recent review of gender-transformative interventions domestically and globally, see Dworkin et al. Any gains achieved by such efforts in the short-term are unlikely to be sustainable. Public health has an ethical obligation to carry out a careful assessment of the risks and benefits of existing programs according to the established evidence base. The currently available evidence on the harmful effects of adhering to hegemonic gender norms is too well established to ignore.
The contents of this article do not necessarily represent the views of the funders or institutions. This research did not involve any primary data collection or contact with human participants. National Center for Biotechnology Information , U. Am J Public Health. Published online June. Paul J. Dworkin , PhD, MS. Author information Article notes Copyright and information Disclaimer. Fleming and Joseph G. Shari L. Corresponding author. Correspondence should be sent to Paul J. Contributors P. Accepted November 25, This article has been cited by other articles in PMC.
Open in a separate window. Print marketing material for the Man Up Monday campaign. Continuum of gender-related approaches to public health interventions. Acknowledgments P. We are grateful to the anonymous reviewers at the Journal. Human Participant Protection This research did not involve any primary data collection or contact with human participants. References 1. An injury prevention program in an urban African-American community.
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