ArticleGlobal health action2026
Assessing progress in gender-transformative sexual and reproductive health interventions: how does practice-based knowledge compare with published evidence in sub-Saharan Africa?
Article in Global health action, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDiscriminatory gender norms and unequal power relations shape sexual and reproductive health (SRH) outcomes in sub-Saharan Africa. Yet, approaches to assessing progress in gender-transformative interventions remain underdeveloped.
objectiveThis paper compares measures and approaches to gender-transformative SRH interventions in the published evidence with practitioners' perspectives in sub-Saharan Africa.
methodsThe study draws on two data sources from a broader research initiative: in-depth interviews with 19 African practitioners and researchers engaged in gender-transformative health programming, and 44 published evaluations of 20 gender-transformative SRH interventions implemented between 2012 and 2025. We examine what is assessed, how assessments are designed and implemented, and when they are conducted.
resultsPractitioners emphasised assessments that capture multi-level, context-specific changes; participatory processes; longitudinal, qualitative methods; and documentation of change pathways and sustainability. In contrast, published studies predominantly measured short-term, individual-level attitudinal and behavioural change - especially among men - using standardised, externally defined instruments reliant on self-reports, with limited attention to women's empowerment, intersectional inequalities, institutional or health-system change, or long-term sustainability.
conclusionsFindings reveal significant misalignments between practice-based knowledge, feminist and gender-responsive evaluation principles, and published evaluation studies. To strengthen investment and learning, we propose advancing assessment frameworks that: engage with communities in the design, implementation, and assessment of gender-transformative SRH interventions; use gendered health outcome indicators; use participatory approaches; document processes and unintended effects; validate men's self-reports with other perspectives; and extend evaluation beyond project cycles. Aligning evidence generation with grounded African practice is essential for more effective and sustainable gender-transformative SRH programming in sub-Saharan Africa.
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