Background

In the context of the Sustainable Development Goals and the shifting global burden of disease, this systematic review analyses the evidence from rigorously evaluated programmes that seek to transform the gendered social norms undermining the health and wellbeing of children, adolescents, and young adults. The aim of this study was threefold: to describe the landscape of gender-transformative programmes that attempt to influence health-related outcomes; to identify mechanisms through which successful programmes work; and to highlight where gaps might exist in implementation and evaluation.

Methods

We systematically reviewed rigorous evaluations published between Jan 1, 2000, and Nov 1, 2018 of programmes that sought to decrease gender inequalities and transform restrictive gender norms to improve the health and wellbeing of 0–24 year olds. We included rigorously evaluated health programmes that met the Interagency Gender Working Group definition of gender-transformative programming, regardless of where in the world they were implemented and what area of health they focused on.

Findings

Among 22 993 articles identified by our search, 61 evaluations of 59 programmes met review criteria. Programmes were concentrated in sub-Saharan Africa (25 [42%]), south Asia (13 [22%]), and North America (13 [22%]) and mainly measured health indicators related to reproductive health (29 [48%]), violence (26 [43%]), or HIV (18 [30%]). Programmes most frequently focused on improving the individual power of the beneficiaries, rather than working on broader systems of inequality. 45 (74%) of the evaluations measured significant improvements in health-related and gender-related indicators; however, only ten (16%) showed evidence of, or potential for, broader norm change. These ten programmes worked with sectors beyond health, included multiple stakeholders, implemented diversified strategies, and fostered critical awareness and participation among affected community members.

Interpretation

This review can accelerate efforts to improve global health by leading to more strategic investment in programmes that promote gender equality and target restrictive gender norms among young people. Such programmes can lead to a lifetime of improved health and wellbeing by challenging not only attitudes and behaviours related to gender at an early age, but also the gendered systems that surround them.

Funding

Bill & Melinda Gates Foundation.

中文翻译：

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针对儿童、青少年和年轻人健康和福祉的性别不平等和限制性性别规范的成功计划的特点：系统回顾。

背景

在可持续发展目标和全球疾病负担不断变化的背景下，本系统综述分析了经过严格评估的项目的证据，这些项目旨在改变损害儿童、青少年和年轻人健康和福祉的性别社会规范。这项研究的目的有三个：描述试图影响健康相关结果的性别变革计划的概况；确定成功计划发挥作用的机制；并强调实施和评估中可能存在的差距。

方法

我们系统地审查了 2000 年 1 月 1 日至 2018 年 11 月 1 日期间发布的对旨在减少性别不平等和改变限制性性别规范以改善 0-24 岁儿童健康和福祉的计划的严格评估。我们纳入了经过严格评估的健康计划，这些计划符合机构间性别工作组对性别变革计划的定义，无论这些计划在世界何处实施，也无论它们关注哪个健康领域。

发现

在我们检索到的 22,993 篇文章中，59 个项目的 61 篇评估符合审查标准。项目集中在撒哈拉以南非洲 (25 [42%])、南亚 (13 [22%]) 和北美 (13 [22%])，主要测量与生殖健康相关的健康指标 (29 [48%]) ]）、暴力（26 [43%]）或艾滋病毒（18 [30%]）。这些计划最常侧重于提高受益人的个人权力，而不是致力于更广泛的不平等制度。45 项（74%）评价显示健康相关和性别相关指标显着改善；然而，只有十人（16%）显示出更广泛的规范变化的证据或潜力。这十个项目与卫生以外的部门合作，包括多个利益相关者，实施多元化战略，并培养受影响社区成员的批判意识和参与。

解释

此次审查可以加速改善全球健康的努力，为促进性别平等和针对年轻人的限制性性别规范的计划提供更多战略投资。此类计划不仅可以挑战幼年时与性别相关的态度和行为，还可以挑战他们周围的性别系统，从而改善一生的健康和福祉。

资金

比尔及梅琳达·盖茨基金会。