Addressing the Role of Gender in the Demand for RMNCH Commodities: A Programming Guide

"Demand generation increases awareness of and demand for health products or services among a particular intended audience through social and behavior change communication (SBCC) and social marketing techniques."

This guide is a resource for increasing demand for the 13 reproductive, maternal, newborn, and child health (RMNCH) commodities identified as underutilised by the UN [United Nations] Commission on Life-Saving Commodities (UNCoLSC) for Women's and Children's Health. It provides information and practical tools to help programme managers determine how gender norms and roles may limit demand for these commodities, exploring how to address these norms and roles by making health messages more effective, stimulating awareness of the need for equity in gender roles, and improving equitable behaviours with respect to RMNCH. The ultimate goal is to increase the demand for and utilisation of the commodities, which include:

• In the category of reproductive health: (1) female condom, (2) contraceptive implants, and (3) emergency contraception.
• In the category of maternal health: (4) oxytocin, (5) misoprostol, (6) magnesium sulfate.
• In the category of child health: (7) amoxicillin, (8) oral rehydration salts (ORS), (9) zinc.
• In the category of newborn health: (10) injectable antibiotics, (11) antenatal corticosteroids, (12) chlorhexidine, (13) resuscitation.

(For additional background information on the Commission, please click here.)

Having outlined the commodities, the resource begins with an overview of demand generation, which draws on SBCC and social marketing techniques in order to:

• Convince members of the intended audience to adopt new behaviours, products, or services;
• Convince current users to increase or sustain the practice of the promoted behaviour and/or to increase or sustain the use of promoted products and services; and
• Take market share from competing behaviours (e.g., convince caregivers to seek health care immediately, instead of not seeking care until their health situation has severely deteriorated or has been compromised) and products or services (e.g., convince caregivers to use ORS and zinc instead of other anti-diarrhoeal medicines).

It is noted that coordination and collaboration with appropriate partners is important when forming demand generation communication strategies and programmes because they should be matched with efforts to improve logistics and expand services, increase access to commodities, and train and equip providers in order to meet increased demand for products and/or services.

Next, the report outlines key concepts and definitions in demand generation, describing what is involved in SBCC campaigns and interventions as well as in social marketing. Specifically, channels and approaches defined here include: advocacy, community mobilisation, entertainment-education (EE), information and communication technologies (ICTs), interpersonal communication (IPC), and mass and traditional media.

Key concepts and definitions in gender outlined in the following section include: female empowerment, gender, gender norms, gender equality, gender equity, gender-based violence (GBV), gender integration, and gender transformation.

Two key frameworks/models for gender programming in RMNCH presented and utilised in this guide are:

1. The Gender Equality Continuum (GEC) Framework, which can be used as a planning framework or as a diagnostic tool. Please see Figure 3 on page 11 in order to understand how the GEC works. In brief, it shows a process of analysis that begins with determining whether interventions are gender blind or gender aware. The process then considers whether gender aware interventions are exploitative, accommodating, or transformative. Programmes should ultimately work toward transforming gender roles, norms, and dynamics for positive and sustainable change. An example provided here is of a programme that, while trying to encourage a community to abandon the practice of female genital mutilation/cutting (FGM/C), focused on engaging women, men, girls, boys, and community leaders to examine the existing gender norms and beliefs leading to the practice of FGM/C. The process helped the community identify a healthy and empowering coming of age ritual for young girls to replace FGM/C.
2. The Social Ecological Model (SEM), which recognises that social networks, communities, and society affect a person's decisions and behaviours. "For example, demand for RMNCH services is determined not only by individual attributes such as knowledge and attitudes, but also by household members and peers, community support, access to resources, and broader social and structural policies and norms". (See Figure 4 on page 13.)

The next section explores the process of conducting a situational analysis, which, according to the resource, programmes should carry out prior to designing and implementing a programme to increase utilisation of underutilised commodities. The purpose is to identify the gender-related social and behavioural determinants that impact demand for RMNCH commodities and services. These determinants can include, but are not limited to, gender roles, partner communication, GBV, access to and control over resources, women's empowerment, and male engagement in RMNCH. (See also Checklist 1 on page 16.)

A series of checklists are provided with specific questions to help guide programme managers as they seek to increase demand for the commodities. References to the SEM are incorporated within the tools to emphasise the importance of the model during situation analysis, design, and implementation:

• Checklist 1: Including Gender in Situation Analysis
• Checklist 2: Integrating Gender into Program Design and Implementation
• Checklist 3: Using the Gender Equality Continuum to Assess Integration of Gender in Programming
• Checklist 4: Is Gender Integrated into Monitoring and Evaluation?

The report concludes with a list of additional resources divided into the categories of: demand generation; gender; RMNCH; and monitoring and evaluation.

The Demand Generation for Reproductive, Maternal, Newborn, and Child Health Commodities activities are implemented by the Health Communication Capacity Collaborative (HC3) at Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (JHU-CCP), with support from the RMNCH Trust Fund and the United States Agency for International Development (USAID), in partnership with Demand Generation sub-group of the UNCoLSC Demand, Access and Performance Technical Resource Team, including Population Services International (PSI), International Consortium on Emergency Contraception (ICEC), Jhpiego, and other partners.