Towards gender-transformative SRHR: a statement in reply to EUPHA and offer of a working definition.

We welcome EUPHA’s statement on sexual and reproductive health and rights (SRHR) and support their call to more gender-responsive social and public health infrastructure; in Europe and beyond. Drawing on UNDP’s definition, gender-responsive may be understood as policies and programmes that respond to existing gender inequities by promoting equal participation and share of health benefits. We agree with and support efforts to improve health services for women, girls, gender diverse and transgender individuals and join in their call to governments in Europe and beyond ensuring gender-justice in SRHR provision. In addition to EUPHA’s statement and call to action that argues for structural and regulatory reform from a global human rights perspectives, we suggest that a gender-responsive answer to the identified gap in SRHR could be helpfully complimented through a greater focus on and definitional clarity of gender-transformative approaches that takes a more ecological approach towards identifying levels on where and how social change happens.

Broadly speaking, a gender-transformative framework addresses the structures and causes of gender inequality and points towards ways to transform unequal power relations and harmful gender norms beyond individual interventions. In the literature, there are varied understandings of what social structures and gender norms are actually being transformed by gender-transformative programmes and how far-reaching, radical or fast that change actually is. It remains unclear which gender-transformative approaches and pathways would enable various forms of transformative change and which theoretical perspectives may both, articulate as well as performatively enact that change.

Seeking to address this definitional gap and bringing together our practical, academic, theoretical and methodological expertise, we offer here a working definition of ‘gender-transformative’ in the context of SRHR, with the aim to contextualize, specify and frame future SRHR research and practice:

Gender-transformative SRHR is a multi-level approach towards gender equity that engages with and strategically synergises theoretical, operational, individual, relational, structural, and community perspectives.

Our definition proposes that strategic bridge-building between (gender) theory, research, policy and practice is key to advancing gender equity in European SRHR provision and Public Health more generally (see e.g. Refs.,). The definition also acknowledges that successful Public Health interventions operate across multiple social and structural strata and on an ecological level in a transversal manner. This aligns with Connell’s argument that gender is a multidimensional and relational embodied process in a network of institutions and actors, going beyond short-term and mid-term gender-specific interventions.

To push SRHR in Europe and beyond, we propose to dismantle the root causes of unequal and unjust SRHR through a transformative approach on six critical levels:

Theoretical level: advocate for interdisciplinary and intersectional perspectives on gender and gender norms, e.g. masculinities, building greater awareness of power dynamics, sexuality and identity.

Operational level: incorporate gender theories into SRHR research method design, e.g. ensuring qualitative, quantitative and mixed methods tools incorporate gender, rather than just sex, and find ways to measure change in gender norms and attitudes and improvement in SRHR, for instance, through tools like the International Men and Gender Equality Survey (IMAGES).

Individual level: ensure a person-centred approach to research that incorporates people who are marginalized due to intersecting structures of oppression such as ethnicity, sexuality, gender, ability, language, class; as well as incorporate reflexive research practices on the power, ethics and assumptions of research and researchers.

Relational level: critically reflect how gender dynamics operate interpersonally on an everyday basis and throughout the life course, how this shapes our understanding, and what this means for gender-transformative co-operations; build relations with existing stakeholders, like LGBTQI+ groups and engage men and boys helping them become allies.

Structural level: examine the interconnection between SRHR and political, social, economic, cultural and legal systems and structures and the ways in which these are institutionalized, all of which require a gender-transformative approach to address social injustices and advance reproductive rights.

Community level: learn from, amplify and multiply gender-transformative messages that are already spreading on social media, in education systems, and other forms of formal and informal engagements, not limited to formal academic or clinical settings.

We acknowledge that actions towards change on these levels may unfold or reveal themselves unevenly over time and depend on institutional path dependencies, material conditions, and other local and global forces. Gender-transformative interventions and research in the Global South, however, are showing that unjust systems can be changed. Furthermore, successful gender-transformative interventions do not just require action from government bodies, as the EUPHA statement remarks. Instead, it takes sustained action and strategic co-operation between governments, activists, health providers, civic society associations and research institutions that hold themselves and each other accountable in mobilizing their forces within and across their respective levels.

Europe is a long way off gender equity, as EUPHA’s statement clearly shows. As a conceptual tool, the six levels presented here may help to embed ongoing efforts from EUPHA scholars, other SRHR researchers, policymakers and practitioners into a wider movement of gender transformation.

Funding

This study was funded by German Ministry of Health, grant number 2520FSB509: Manfokus Project: ‘Masculinities in focus: towards gender-equitable care’.

Conflicts of interest: None declared.