Injury Division, George Institute for Global Health, Sydney, New South Wales, Australia.
Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh.
BMJ Open. 2020 Dec 1;10(12):e041065. doi: 10.1136/bmjopen-2020-041065.
Community-based health programmes implemented in low-income and middle-income countries impact community gender norms and roles and relationships, which in turn affect individuals' health outcomes. Programmes should measure their effects on gender norms, roles and relationships in the communities in which they operate to respond to unexpected health consequences. We conducted a gender analysis on a drowning reduction programme in rural Bangladesh to identify its impacts on gendered roles and behaviours in the community.
A mixed-method approach was used. Quantitative programme monitoring data were analysed to assess gender differences in participation and engagement. A qualitative approach using interviews, focus group discussions and observations with purposively selected programme implementing staff and participants aimed at finding explanations for quantitative findings and additional impacts of the programme on gender in the community. The analysis was conducted using Family Health International 360's Gender Integration Framework, which identifies both internal (norms) and external (behaviours) effects.
Fewer girls (n=5030) participated in swimming classes than boys (n=6425) due to cultural restrictions and involvement in domestic work. Women were not hired in leadership roles in the implementing organisation due to lower transportation access and their perceived ability to conduct labour-intensive activities. However, communities become more accepting of local women's mobility and employment due to their engagement as swim instructors. Women swim instructors were more satisfied with the pay and part-time nature of the work as men were able to earn more elsewhere. Menstruation management was ignored as all supervisory staff were men.
Systematised strategies are required to ensure equal participation of girls and enable equitable prevention outcomes. Within the implementing organisation, programmatic changes will support gender transformation, such as ensuring women's mobility and engagement in leadership roles. Strategies to combat perceptions that lower paying part time work is more suitable for women than men may be considered.
在中低收入国家实施的基于社区的卫生项目影响社区的性别规范和角色以及人际关系，进而影响个人的健康结果。为了应对意想不到的健康后果，项目应衡量其对所在社区性别规范、角色和关系的影响。我们对孟加拉国农村地区的一个减少溺水方案进行了性别分析，以确定其对社区中性别角色和行为的影响。
采用混合方法。对定量方案监测数据进行分析，以评估参与和参与程度的性别差异。采用定性方法，对有目的地选择的方案实施人员和参与者进行访谈、焦点小组讨论和观察，旨在为定量发现和方案对社区中性别问题的其他影响找到解释。分析采用家庭健康国际 360 的性别综合框架进行，该框架确定了内部（规范）和外部（行为）的影响。
由于文化限制和参与家务劳动，参加游泳课的女孩（n=5030）比男孩（n=6425）少。由于交通不便和人们认为她们能够从事劳动密集型活动，妇女没有被聘为实施组织的领导角色。但是，由于游泳指导员的参与，社区对当地妇女的流动和就业更加接受。女游泳指导员对薪酬和兼职性质的工作更满意，而男游泳指导员则能够在其他地方获得更多收入。由于所有监督人员都是男性，因此忽略了经期管理。
需要有系统的战略来确保女孩的平等参与，并实现公平的预防结果。在实施组织内，方案的改变将支持性别转变，例如确保妇女的流动性和参与领导角色。可能需要考虑一些策略来应对认为低薪兼职工作更适合女性而不是男性的看法。
