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American Journal of Community Psychology

, Volume 56, Issue 1–2, pp 57–68 | Cite as

Community Gender Norms Change as a Part of a Multilevel Approach to Sexual Health Among Married Women in Mumbai, India

  • Stephen L. SchensulEmail author
  • Rajendra Singh
  • Jean J. Schensul
  • Ravi K. Verma
  • Joseph A. Burleson
  • Bonnie K. Nastasi
Original Article

Abstract

Inequitable gender norms in societies and communities negatively contribute to women’s sexual and reproductive health. While the need for change in gender norms is well recognized, the task is highly challenging in terms of intervention design, implementation and assessment of impact. This paper describes a methodology for identification of gender norms, the design of community level intervention, community participation and the assessment of intervention impact in a low income, predominately Muslim community of 600,000 people in Mumbai, India. Formative research focused on in-depth interviews with women, men and couples yielding gender normative statements and assessment of community resources to facilitate change. A Gender Equity Scale (GES) based on this formative research was developed and administered annually for a three-year period to random, cross-sectional samples in the intervention and control communities, and to community based, non-governmental organizations (NGO) staff and Imams (religious leaders) in the intervention community. NGO staff disseminated gender oriented messages to their female constituency through their regular outreach activities and through special events and festivals in the community. Imams disseminated gender messages through lectures on social issues for men attending Friday prayers. The results showed that the NGO staff and Imams, assumed more gender equitable attitudes across time. The intervention was associated with a significant improvement in attitudes towards gender equity in the intervention relative to the control community. Men showed a dramatic change in more positive gender attitudes, while women lagged behind in their GES scores. The meaning of these results are explored and the implications assessed for the generalizability of the methodology for other countries, cultures and communities.

Keywords

Gender Norms Community intervention India Impact 

Notes

Acknowledgements

The data on which this paper is based is drawn from the Grant, “The Prevention of HIV/STI among Married Women in Urban India” funded from 2007 to 2013 by the US National Institute of Mental Health of the US National Institutes of Health (R01MH075678, S. Schensul PI, R. Verma, Co-I). The authors would like to thank the dedicated RISHTA research team, the cooperation of the respondents to the GES and for the collaboration of the NGOs and the Muslim religious sector for their facilitation of the intervention.

Supplementary material

10464_2015_9731_MOESM1_ESM.docx (14 kb)
Supplementary material 1. The Gender Equity Scale (GES) (DOCX 14 kb)

References

  1. Abramsky, T., Devries, K., Kiss, L., Francisco, L., Nakuti, J., Musuya, T., & Watts, C. (2012). A community mobilisation intervention to prevent violence against women and reduce HIV/AIDS risk in Kampala, Uganda (the SASA! Study): Study protocol for a cluster randomised controlled trial. Trials, 13(1), 96.PubMedCentralPubMedCrossRefGoogle Scholar
  2. Altaf, A., Shah, S. A., Shaikh, K., Constable, F. M., & Khamassi, S. (2013). Lessons learned from a community based intervention to improve injection safety in Pakistan. BMC Research Notes, 6(1), 159.PubMedCentralPubMedCrossRefGoogle Scholar
  3. Amaro, H., & Raj, A. (2000). On the margin: Power and women’s HIV risk reduction strategies. Sex Roles, 42(7–8), 723–749.CrossRefGoogle Scholar
  4. Arora, M., Tewari, A., Tripathy, V., Nazar, G. P., Juneja, N. S., Ramakrishnan, L., & Reddy, K. S. (2010). Community-based model for preventing tobacco use among disadvantaged adolescents in urban slums of India. Health Promotion International, 25(2), 143–152.PubMedCrossRefGoogle Scholar
  5. Atkin, C., & Freimuth, V. (1989). Formative evaluation research in campaign design. In R. E. Rice & C. K. Atkin (Eds.), Public communication campaigns (2nd ed., pp. 131–150). Newbury Park, CA: Sage.Google Scholar
  6. Baker, E. A., & Brownson, C. A. (1998). Defining characteristics of community-based health promotion programs. Journal of Public Health Management and Practice, 4(2), 1–9.PubMedCrossRefGoogle Scholar
  7. Gittelsohn, J., Harris, S. B., Whitehead, S., Wolever, T. M. S., Hanley, A. J., Barnie, A., & Zinman, B. (1995). Developing diabetes interventions in an Ojibwa-Cree community in northern Ontario: Linking qualitative and quantitative data. Chronic Diseases in Canada, 16(4), 157–164.Google Scholar
  8. Gómez, C. A., & Marin, B. V. (1996). Gender, culture, and power: Barriers to HIV-prevention strategies for women. Journal of Sex Research, 33(4), 355–362.CrossRefGoogle Scholar
  9. Kegeles, S. M., Hays, R. B., & Coates, T. J. (1996). The Mpowerment Project: A community-level HIV prevention intervention for young gay men. American Journal of Public Health, 86(8_Pt_1), 1129–1136.PubMedCentralPubMedCrossRefGoogle Scholar
  10. Keleher, H., & Franklin, L. (2008). Changing gendered norms about women and girls at the level of household and community: A review of the evidence. Global Public Health, 3(S1), 42–57.PubMedCrossRefGoogle Scholar
  11. Klassen, T. P., MacKay, J. M., Moher, D., Walker, A., & Jones, A. L. (2000). Community-based injury prevention interventions. The Future of Children, 10(1), 83–110.Google Scholar
  12. Kostick, K. M., Schensul, S. L., Singh, R., Pelto, P., & Saggurti, N. (2011). A methodology for building culture and gender norms into intervention: An example from Mumbai, India. Social Science & Medicine, 72(10), 1630–1638.CrossRefGoogle Scholar
  13. Krishnan, A., Ekowati, R., Baridalyne, N., Kusumawardani, N., Kapoor, S. K., & Leowski, J. (2011). Evaluation of community-based interventions for non-communicable diseases: experiences from India and Indonesia. Health Promotion International, 26(3), 276–289.PubMedCrossRefGoogle Scholar
  14. Macaulay, A. C., Paradis, G., Potvin, L., Cross, E. J., Saad-Haddad, C., McComber, A., & Rivard, M. (1997). The Kahnawake Schools Diabetes Prevention Project: intervention, evaluation, and baseline results of a diabetes primary prevention program with a native community in Canada. Preventive Medicine, 26(6), 779–790.PubMedCrossRefGoogle Scholar
  15. Merzel, C., & D’Afflitti, J. (2003). Reconsidering community-based health promotion: promise, performance, and potential. American Journal of Public Health, 93(4), 557–574.PubMedCentralPubMedCrossRefGoogle Scholar
  16. Mittelmark, M. B., Luepker, R. V., Jacobs, D. R., Bracht, N. F., Carlaw, R. W., Crow, R. S., & Blackburn, H. (1986). Community-wide prevention of cardiovascular disease: Education strategies of the Minnesota Heart Health Program. Preventive Medicine, 15(1), 1–17.PubMedCrossRefGoogle Scholar
  17. Moonzwe Davis, L., Schensul, S. L., Schensul, J. J., Verma, R. K., Nastasi, B. K., & Singh, R. (2014). Women’s empowerment and its differential impact on health in low-income communities in Mumbai, India. Global Public Health: An International Journal for Research, 9(5), 484–494.CrossRefGoogle Scholar
  18. Muhr, T. (2010). User’s Manual for ATLAS.ti 6.0, ATLAS.ti Scientific Software Development, GmbH, Berlin.Google Scholar
  19. Pulerwitz, J., Barker, G., Segundo, M., & Nascimento, M. (2006). Promoting more gender-equitable norms and behaviors among young men as an HIV/AIDS prevention strategy. New York: Population Council.Google Scholar
  20. Raudenbush, S. W., Bryk, A. S., Cheong, Y. F., Congdon, R. T., & du Toit, M. (2011). HLM 7: Hierarchical linear and nonlinear modeling. Chicago: Scientific Software International.Google Scholar
  21. Rocca, C. H., Rathod, S., Falle, T., Pande, R. P., & Krishnan, S. (2009). Challenging assumptopms about women’s empowerment: social and economic resources and domestic violence among young married women in urban south India. International Journal of Epidemiology, 38, 577–585.PubMedCentralPubMedCrossRefGoogle Scholar
  22. Rosal, M. C., Goins, K. V., Carbone, E. T., & Cortes, D. E. (2004). Views and preferences of low-literate Hispanics regarding diabetes education: results of formative research. Health Education & Behavior, 31(3), 388–405.CrossRefGoogle Scholar
  23. Sarrafzadegan, N., Kelishadi, R., Esmaillzadeh, A., Mohammadifard, N., Rabiei, K., Roohafza, H., & Malekafzali, H. (2009). Do lifestyle interventions work in developing countries? Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran. Bulletin of the World Health Organization, 87(1), 39–50.PubMedCentralPubMedCrossRefGoogle Scholar
  24. Schensul, S. L., Mekki-Berrada, A., Nastasi, B., Saggurti, N., & Verma, R. K. (2006a). Healing traditions and men's sexual health in Mumbai, India: The realities of practiced medicine in urban poor communities. Social Science & Medicine, 62(11), 2774–2785.CrossRefGoogle Scholar
  25. Schensul, S. L., Nastasi, B. K., & Verma, R. K. (2006b). Community-based research in India: A case example of international and transdisciplinary collaboration. American Journal of Community Psychology, 38(1–2), 95–111.PubMedCrossRefGoogle Scholar
  26. Schensul, S. L., Saggurti, N., Singh, R., Verma, R. K., Nastasi, B. K., & Mazumder, P. G. (2009). Multilevel perspectives on community intervention: an example from an Indo-US HIV prevention project in Mumbai, India. American Journal of Community Psychology, 43(3–4), 277–291.PubMedCrossRefGoogle Scholar
  27. Tuladhar, S., Khanal, K. R., Lila, K. C., Ghimire, P. K., & Onta, K. (2013). Women’s empowerment and spousal violence in relation to health outcomes in Nepal. Calverton, MD: Nepal Ministry of Health and Population, New ERA and ICF International.Google Scholar
  28. Vastine, A., Gittelsohn, J., Ethelbah, B., Anliker, J., & Caballero, B. (2005). Formative research and stakeholder participation in intervention development. American Journal of Health Behavior, 29(1), 57–69.PubMedCrossRefGoogle Scholar
  29. Wingood, G. M., & DiClemente, R. J. (2000). Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education & Behavior, 27(5), 539–565.CrossRefGoogle Scholar
  30. Young, D. R., Johnson, C. C., Steckler, A., Gittelsohn, J., Saunders, R. P., Saksvig, B. I., & McKenzie, T. L. (2006). Data to action: using formative research to develop intervention programs to increase physical activity in adolescent girls. Health Education & Behavior, 33(1), 97–111.CrossRefGoogle Scholar

Copyright information

© Society for Community Research and Action 2015

Authors and Affiliations

  • Stephen L. Schensul
    • 1
    Email author
  • Rajendra Singh
    • 2
  • Jean J. Schensul
    • 3
  • Ravi K. Verma
    • 4
  • Joseph A. Burleson
    • 1
  • Bonnie K. Nastasi
    • 5
  1. 1.Department of Community Medicine and Health CareUniversity of Connecticut School of MedicineFarmingtonUSA
  2. 2.International Center for Research on Women, MumbaiMumbaiIndia
  3. 3.Institute for Community ResearchHartfordUSA
  4. 4.International Center for Research on Women, DelhiNew DelhiIndia
  5. 5.Tulane UniversityNew OrleansUSA

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