Uneven expectations: Measuring gender norms related to children’s engagement in unpaid work


By: Emma Samman and Lauren Pandolfelli

In homes around the world, girls are performing more caregiving and chores than boys are. Globally, girls between the ages of 5 and 14 spend 160 million more hours every day on unpaid care and domestic work than boys of the same age.[1] Moreover, girls account for more than 60% of children who perform this type of work beyond age-specific thresholds.[2] And as children mature into adolescence, girls’ responsibilities intensify, widening the gender gap.

This unequal gendered distribution of unpaid care and domestic work has profound implications for children’s well-being. It limits girls’ time for learning, personal development, and leisure, stripping them of equal opportunities to thrive. In adulthood, these deprivations are likely to diminish their socioeconomic prospects, choices, and accomplishments – and the well-being of their children. And there are likely to impact on boys, too – e.g., a skewed sense of the value of girls’ versus boys’ time and as adults, limited roles as fathers and caregivers.

The unequal distribution of unpaid work has been documented in time use surveys worldwide. It is also increasingly recognised that gender norms heavily influence girls’ disproportionate engagement in such work. However, measures of these norms are lacking. Indeed, Emerge researchers’ scoping of 102 measures of women’s economic empowerment found that measures of gender norms were largely absent. They identified only nine measures of norms constructs, only three of which related to unpaid care and domestic work.

Building on previous research at UNICEF and beyond, UNICEF is focused on closing this gap by developing a standardized data collection tool to measure gender norms that influence children’s engagement in unpaid work. Our aim is to produce a short module that can be integrated into nationally representative surveys that collect vital data on children and women’s well-being, shedding light on how gender norms contribute to observed outcomes. The module aims to measure a set of common constructs that researchers have agreed to help quantify and capture how gender norms function in society.


Descriptive norm or empirical expectationWhat I think others do
Injunctive norm or normative expectationWhat I think others approve of/expect me to do
Reference groupAny group an individual uses as a standard for evaluating themselves and their own behaviour
Sanction (positive/negative)Beliefs about the perceived benefits and rewards of adhering to a norm, or the perceived consequences of noncompliance
AttitudeWhat I think

We believe that having such information can arm policymakers and practitioners with information to better understand how gender norms affect children and adolescents and their transitions into adulthood and craft policies and programmes aiming to redress girls’ disproportionate engagement in unpaid work.

Our evidence review suggests that having population-level standardized data could be potentially transformative in several respects. First, it could inform the design of policies, interventions, and services aiming to redistribute care and domestic work within households – including labour market interventions (e.g., family-friendly policies such as maternity, paternity, parental leave), social protection, investments in care-related infrastructure (e.g., childcare facilities and support), support for girls’ education and the provision of labor-saving technologies to households. Second, it could enable a richer understanding of how restrictive gender norms predict how girls and boys spend their time and how changes in these norms influence children’s well-being, including outcomes in education and health and transitions to adulthood. Third, it would allow assessment of how norms are distributed within a population, giving insights into how policies, programs, and services can be improved and targeted. Fourth, it could prompt evidence-based shifts in institutional policies, power relations, and media discourse, which powerfully influence gender relations. Finally, it could catalyze changes within communities and households to redress unequal workloads.

Our work to date has focused on an in-depth review of the evidence on gendered norms and a mapping of existing data collection tools. This has enabled us to understand how gender norms related to children’s engagement in unpaid work are conceptualized and measured; and the strengths and methodological limitations of existing measures. Based on this review, we have developed a household survey module and corresponding set of indicators for cognitive and field testing. In collaboration with the Zimbabwe National Statistics Agency, we will conduct the first testing in the Mutare region of Zimbabwe later this year. Following this testing, and with funding from the EMERGE project, we will analyse the validity and reliability of the norms measures and refine the module for testing in other regions before finalizing.

For more information, visit

[1] United Nations Children’s Fund, Harnessing the Power of Data for Girls: Taking stock and looking ahead to 2030, UNICEF, New York, 2016.

[2] International Labour Office and United Nations Children’s Fund, Child Labour: Global estimates 2020, trends and the road forward, ILO and UNICEF, New York, 2021.

About the authors:

Emma Samman is a Research Associate with ODI and an independent consultant, working with UNICEF.  Her research focuses on the analysis of poverty and inequality, particularly gendered inequalities, and household survey design. She has worked extensively on the quantitative measurement of gender norms, and their drivers and impacts.

Lauren Pandolfelli is a Statistics Specialist in the Division of Data, Analytics, Planning and Monitoring (DAPM) at UNICEF, where she leads the division’s technical work to improve the quality, analysis and availability of gender data on women and children. 

Image: “A girl removes laundry from the line at a camp for migrant workers near the city of Adana in Adana Province.” © UNICEF/UNI42696/LeMoyne


Bringing together the family and community to change social and gender norms for newly married women in rural Nepal: findings from the Sumadhur intervention


By: Nadia Diamond-Smith

“…our life becomes imprisoned. We have to live like a prisoner…I mean like a chained animal. When you can’t do whatever your heart wishes, when you can’t go wherever you want to go”

This is a reflection from a young, newly married woman in rural Nepal about her life after getting married. It sums up perfectly observations in the villages in which our team worked for the last five years. Some young, newly married women would not even stand in the doorway of their homes for fear of being seen by someone outside of her home. Starting in 2017, our team collected triadic qualitative interviews with young (<25 years), newly married women, their husbands, and mothers-in-law, followed by a two-year longitudinal observational study with 200 newly married women. We found that in the first four months after marriage, only half of the newly married women had ever left the house. Limited mobility was deeply intertwined with other forms of low status, especially around access to food and order of household eating. In our study, half of the newly married women reported that they ate last always or most of the time and almost all were not meeting minimum dietary diversity standards. In this setting, as in much of South Asia, arranged marriages are still pervasive, and newly married women move into their husband’s family’s home, often living with his parents. This leads young couples to not know each other well in the formative years of marriage, and young women often find themselves in a new household without strong relationships. Women in our study reported low levels of communication with their husbands, with less than half of wives reporting having discussed the number of children they wanted with their husbands and a third feeling comfortable talking to their husbands about sex in the early days of marriage.

Based on these findings, our team, which was comprised of the Center for Research on Environment Health and Population Activities (CREHPA), a research organization in Nepal, the Vijay Development Resource Center (VDRC), a community-based organization in Nawalparasi district of Nepal, and the University of California, San Francisco, worked closely with a community advisory board through a community-engaged process, to develop Sumadhur, meaning “Best Relationship”. The four-month long weekly group intervention engaged newly married women, their husbands, and mothers-in-law, and included education on nutrition, food allocation, prenatal care, pregnancy care, fertility and family planning, household relationship dynamics, and gender inequitable norms, along with interactive games and activities. Through this community-led, co-developed intervention, we hypothesized that strengthening marital bonds and addressing household gender dynamics would improve newly married women’s status, mobility, and access to food.

However, we had many lingering questions—would households allow their newly married brides to attend? Would other household members make time for this? How would they feel engaging in these sensitive topics with other members of their community? Would they play games and activities on these sensitive topics? Would it make a difference?

In early 2021, during the COVID-19 pandemic, we piloted the intervention and were enthused by the eager participation of the community members and households. We found that Sumadhur was acceptable and loved by the participants. Despite initial hesitancy about combined sessions with husbands, mothers-in-law, and newly married women, most women reported that it felt good to attend a session with their in-law. As a result of the intervention, nutritional knowledge and practices improved. There was increased awareness of the need for preconception, pregnant, lactating, or postpartum women and adolescents to eat more. Eating patterns also shifted, with a decline in the number of daughters-in-law reporting that they ate last and an increase in the proportion reporting that the household ate together usually or all the time.

In the interviews, participants reported that they enjoyed the group dynamics and saw the value in bringing people together. Moreover, the intervention addressed social and gender norms and led to changes in household relationships and behaviors:

I felt comfortable to be in a group. There were other members with whom we could interact and know them better. Had it been only my family in the training, it would have been less interactive….. Also, it is very important to give training to community members as well. Here, the community follows traditional practices. I think such training programs will help to change their thought process….. In our community, daughters-in-law cannot come outside freely, woman cannot go outside their house to work, mothers-in-law and daughters-in-law don’t interact much etc. Such things need to be changed. It was somewhat similar in my household as well. But after the training it has changed a little. As I said earlier, we eat together and interact much more than before. My wife and my mother interact more and this makes me feel good. (Husband)

Despite our anxiety that families wouldn’t allow their newly married daughters/wives to leave the home to participate, newly married women described how the intervention gave them the opportunity to leave their homes, and this gave them more voice and confidence.

I had not stepped outside of my home post marriage. I felt very happy to step outside of my home to attend this program. You learn some new things when you step outside of home. Attending program has increased my knowledge, I came to know about many things. I have also developed confidence for speaking. This kind of program raises awareness among people. I am very happy to be a part of this program (Wife)

An unexpected finding was the impact that the program had on mother-in-law’s empowerment, alongside the hoped-for changes in knowledge and strengthening of household relationships.

Going together with my son and daughter-in-law, I came to know many things. It was easier for me to go together with my son and daughter-in-law. I would have been shy to talk too if I had gone alone, but going together with them became easier for me…..I have felt changes even if it’s a little. There are changes in everything regarding behavior of the family members, working environment, eating habit, conflicts. I had always wondered how would my daughter-in-law be. As she was recently married, I had not known her well. I got an opportunity to know her while going to the program. We used to go together, talk on the way and discuss about the things discussed after we would come back. We perform household work together, talk to each other and share our things. I had a negative attitude towards daughter-in-law earlier which has changed now. My daughter-in-law treats me well and so do I. (Mother-in-law)

These are but a handful of quotes and findings from this multi-faceted intervention. Overall, we were overwhelmed by the positive response from the community, and the willingness of young newly married couples and their households to engage with each other and others in their community and challenge long standing restrictive norms such as order of household eating and limited women’s mobility. Social and gender norms are often seen as immovable, or, at least, very hard to shift—however, we found that people were open to, and in many cases ready to embrace change. Subsequently, this relatively short and low-cost intervention that was designed with the community and that addressed individual, household and community level norms, led to changes in behavior, and, perhaps more importantly, brought joy and closeness to newly married women and their families during this formative phase of their lives.

To learn more, check out the full paper related to this blog here.

About the author:

Nadia Diamond-Smith is an Assistant Professor in Epidemiology and Biostatics and The Institute for Global Health Sciences at UCSF. Her research is at the intersection of gender equality/women’s empowerment and reproductive and maternal health, with a focus in South Asia.


Four Tools for Understanding the Nexus of Climate Change and Gender


By: Elettra Baldi, Arnab K Dey, Jennifer Yore and Lauren Bredar

The climate crisis is not gender neutral. The impact of climate change amplifies gender inequalities and continues to pose a disproportionate risk to women and girls, their health, wellbeing, and safety. This year, the theme of the United Nations’ Commission on the Status of Women (CSW) event centered on achieving gender equality in the context of climate change, environmental and disaster risk reduction policies, and programs.

Despite increasing evidence that women and girls disproportionately suffer from climate change and environmental disasters, persistent gender data gaps hinder our understanding of how climate change escalates social, political, and economic tensions through a gender lens.

On March 22nd, the EMERGE project at the Center on Gender Equity and Health (GEH) at UC San Diego joined Data2X and the World Bank at CSW to discuss the challenges of understanding the nexus of gender and the environment and possible tools that individuals can use to close these knowledge gaps.

Below, we discuss four open-access tools shared at the CSW session that stakeholders can use to supplement research, planning, and policy formulation.

Tool 1: Evidence-based Measures of Empowerment for Research on Gender Equality (EMERGE)

The first tool available for understanding this intersection is the Evidence-based Measures of Empowerment for Research on Gender Equality (EMERGE) platform. This tool provides an open access repository of survey measures on gender equality and empowerment compiled by researchers at the GEH. The platform supports researchers and practitioners to assess gender inequities across multiple domains and monitor the achievements of the UN Sustainable Development Goal (SDGs).

Site users can filter their search for survey items and scales by thematic area, including environment and sustainability. Users can further identify the best measures for their context by using filters for country, length, and psychometric strength of measures. These features allow researchers to identify, adapt and develop surveys that consider the gendered effects of climate change in their own setting. For example, the Climate Change Anxiety Scale, assesses the emotional response to climate change. The measure has four sub-scales including cognitive and emotional impairment, functional impairment, personal experience of climate change, and behavioral engagement.

Tool 2: UN Women’s Rapid Gender Assessment on the socioeconomic impacts of COVID-19 (RGA)

Individuals can access the UN Women’s RGA database to explore data on the socioeconomic impacts of COVID-19 in over 50 countries. While these surveys aim to capture the gendered differences in the COVID-19 pandemic, they also reveal essential information on the intersection of gender and the environment. For example, the RGA in Asia and the Pacific found that women are less likely to access the internet, a key source for early warning information for environmental disasters. The RGA also provides employment insights on climate-sensitive sectors such as agriculture and tourism, which can be helpful for discussions on climate action and planning.

Tool 3: Gender Data Solutions Inventory

Data2X and Open Data Watch’s new Gender Data Solutions Inventory, released in tandem with the Solutions to Close Gender Data Gaps report, presents over 140 practical, replicable solutions to fill gaps in existing evidence across development domains, including the environment. These examples cover opportunities and tools that readers can reference when considering means of tackling environmental gender data gaps. A few environmental tools listed in the inventory include:

  • CARE’s Rapid Gender Analysis (RGA): CARE’s RGA is a survey tool to understand the gendered impacts of climate disasters and has been used to evaluate climate crisis and food security in Malawi, Mozambique, and Zimbabwe.
  • 50×2030 Guide on Survey Tools: This survey guide outlines two modules for measuring gender parity in ownership and tenure rights over agricultural land (SDG 5.a.1).
  • The Gender Climate Tracker App: This app gives decision-makers regularly updated information on policies, mandates, research, decisions, and actions related to gender and climate change. This tracker also serves as an accountability tool for citizens and civil society groups to hold governments accountable.

Tool 4: *New* World Bank Gender Data Portal

The fourth tool, the new World Bank Gender Data Portal, gathers over 900 gender indicators in an easily accessible and usable format. This initiative has made the available sex-disaggregated data easier to analyze and visualize. The portal provides valuable resources such as the Gender and Information Communication Technology (ICT) survey toolkit that practitioners can use to develop data collection instruments. It also includes country-level information on gender data availability in the form of a dashboard that can be useful for funders to inform funding strategies to fill gaps.

The portal’s particular section on the environment highlights important indicators for understanding the nexus of gender and climate change. They have data available on the differential effects of unsafe water, sanitation, and ambient air pollution on mortality – by gender. Making this crucial data accessible to multiple audiences will facilitate its use in policymaking, advocacy, and research efforts.

To tackle the climate crisis, it is necessary to rapidly develop our understanding of the relationship between climate change and gender. Understanding this relationship would require us to find answers to essential questions such as: how does climate change impact women differently? How can policies adapt a gendered lens to mitigate such differences? What role can women play in addressing this crisis?

While the existing data gap hinders our ability to answer these and other important questions, these new emerging tools give changemakers resources they can use to address gaps in measurement related to gender and environment. However, access to tools like these is only the first step. We need to work on mechanisms that support data democratization and its use to build and support evidence for program development and policymaking related to addressing the effects of climate change globally.

Finally, changemakers must understand those gender vulnerabilities to climate change are not because of characteristics salient to women but result from inequities in multiple gender dimensions ranging from women’s economic empowerment, time use, reproductive rights, and agency. Therefore, the use of these tools should be seen in this light to address the multiple dimensions of gender inequities in climate change.


Unpacking Reproductive Autonomy: Why do women switch or discontinue contraception??


By Chhavi Sodhi

Recently released findings from National Family Health Survey-5 (NFHS-5), 2019-’21 illustrate that the national contraceptive prevalence rate among married couples (15-49 years) has increased from 53.5 percent in 2015-16 to 66.7 percent in 2019, while the total fertility rate (TFR) has declined to  2.0,  below the replacement level. This is a positive development,  but the work on Family Planning (FP) in India is not done yet. It is imperative to reflect on whether and how these increases are related to greater reproductive autonomy and decision-making for women on the ground. Looking at the data deeper revealed that a whopping 43.6 percent of women in India (15-49 years) using a modern contraceptive for spacing discontinued their chosen method within 12 months of commencement and 5.7 per cent switched over to a newer method of choice (as per NFHS-4, 2015-’16).

Over the last two decades, increases in the variety and reach of contraceptive methods available within the family planning (FP) basket of choice in India have enabled more women and couples to gain access to different contraceptive methods catering to their specific fertility and health needs. Increasing the types of contraception available also increases the likelihood of choice to switch to and fro different methods. The concept of contraceptive switching is central to upholding the right to reproductive choice by women and enabling them to use contraceptives effectively. However, it is important to understand the basis of such decision-making and the experiences of women who orchestrate a sideways shift across methods.

Contraceptive switching, as the name implies, refers to the process of discontinuing a contraceptive method and adopting an alternate method (either permanent or temporary) within two months. Switching, here can be direct, wherein a woman shifts from one method to another sequentially or can be an uneven process. In the latter scenario, post-discontinuation, there can be a period of no use or the use of an intermediate method, before the woman settles on a particular destination method. There may also be an overlapping of methods before the final switch is made. In numerous instances, it has also been observed that women may come to accept contraceptive discontinuation, particularly if the period of no use becomes prolonged, thereby, switching from an earlier method of choice to no method.


Contraceptive discontinuation and switching rates  in India

The use of a contraceptive method is not just mediated by its popularity and availability, but also by a series of decision-making events about adoption, discontinuation and rejection of other methods. Social, medical, systemic and personal factors can act, either in tandem or independently, to catalyze change. Due to a variety of these personal or social reasons, there may be a general dissatisfaction with the current method or there may even be a simple desire to try out an alternative method.


Source: National Family and Health Survey-4 (NFHS-4), 2015-’16: India


As per NFHS-4, 2015-’16, discontinuation rates were higher among women using injectables (50.6%), condoms (47.2%) and pills (41.9%), as compared to those using an intrauterine contraceptive device or IUD (26.4%). While 18.1 percent of all women using a modern spacing contraceptive stated that the reason they discontinued their earlier method of choice was due to fertility-related reasons, 17.1 percent claimed that they orchestrated this change due to method-related reasons, including failure of origin method (2.5%), experiencing side-effects from use of origin method (5.5%) and the desire to use a more effective method (2.3%). The data shows that 20 percent of women discontinued their earlier method of choice and switched to no method use, despite no explicit desire to beget children immediately.  Given the situation, it becomes important to understand the method-specific barriers towards usage that constrain women and couples from exercising their reproductive rights and autonomy vis-à-vis contraceptive usage.

Well known reasons of discontinuation are spousal, familial and social pressures and lack of agency among women who wish to use contraceptives but face accessibility constraints;  the role played by the health service system in supporting and responding to the concerns of women using or wanting to use contraceptives needs to be examined in greater depth.

How can the health system enable more informed contraceptive choices among women? 

Findings from NFHS-4, 2015-’16 reveal that among users of female sterilization, oral pills and IUD, a total of 46.5 percent had been informed about the possible side effects of their method, while only 39.3 percent had been informed about ways in which these side-effects could be managed and 54.0 percent had received information about alternative methods available. Rana et al (2021) state that users with knowledge of alternate methods demonstrated a greater likelihood of switching, as the information enabled them to make a more informed contraceptive choice, in keeping with their contraceptive requirements. Similarly, information about side-effects and their management enabled women to make better choices about their destination method and continuing with the same. The latter was also associated with a shift towards the more efficacious long-acting reversible methods, including IUCD and injectables. In the absence of comprehensive knowledge about a new method of choice, including possible side-effects and their management, the authors mention probability of discarding the destination method and reusing or switching back to the original method remained considerably higher.

The health system, and in particular, contraceptive counseling, can play an important role in enabling a relatively smoother and desirable transition between contraceptive methods. In particular, women need additional support during the intermediate period of a transition, since the likelihood of an unintended pregnancy is particularly high during this period. Similarly, soon after the transition is made, they may need greater support and reassurance as they learn how to adapt to the mechanisms of a new method.

Evidence from NFHS is also pointing to a rise in the number of women who may be switching from modern to traditional methods, the use of which increased from 5.7 per cent in NFHS-4, 2015-’16 to 10.2 per cent in NFHS-5, 2019-’21. We need to understand whether this transition represents a way for women to exercise greater control over their bodies or has been an outcome of factors, both household or health-system related, that impeded their access to modern contraception. Understanding choice and agency in the context of contraceptive switching can be critical for ensuring that the FP services provided by the healthcare system addresses their needs.

How do we reframe the narrative on contraceptive switching?

The COVID-19 pandemic provides a more urgent reason to re-examine patterns of contraception use and switching that can be central to women’s reproductive autonomy. In the past two years,  healthcare delivery in India has been severely compromised. During the numerous lockdowns and stay-at-home orders, people faced various restrictions not only on their movement but healthcare practitioners, including frontline workers (FLWs), too experienced a considerable increase in their daily work responsibilities, as they dealt with the aftermath of the disease. These factors have led to a de-prioritization of women’s health and FP needs. There was a decline in in-clinic consultations as well as a reduction in the availability of facility-based methods (female sterilization and intra-uterine contraceptive devices), which limited the basket of choices available and hindered the possibility of switching, while increasing the likelihood of discontinuation.

We need to better unpack reproductive autonomy in the context of India, particularly given contraceptive switching and discontinuation rates in India. The next phase of work for FP in India must include answering the questions below:

  • Why do women switch or discontinue contraception, and how do the reasons vary across social groups?
  • How does women’s access to contraception method specific information lead to a consciousness of choice?
  • Who are the enablers of informed contraceptive choice among women, in the family and the health system, and how can enablers be influenced?
  • What interventions and services by family planning programs can support the information and decision-making processes for making choice for a new method
  • How can family planning counseling improve women’s choice and agency around switching and discontinuation

About the author:

Dr. Chhavi Sodhi, PhD (Social Medicine), is a trained public health professional with over five years of experience in monitoring and evaluation. She has worked in the field of RMNCH+A, nutrition, health system and environmental health research.


Youth Empowerment through Collective Action: What we are learning from the Uganda Wellbeing Club


By Rebecca S. Levine, Zaharah Namanda, Amy V. Bintliff & Anita Raj


Depression and anxiety among children and adolescents has been increasing steadily for more than 20 years1, and evidence shows that the COVID-19 pandemic has exacerbated this trend worldwide, particularly for adolescent girls2. Many youth are experiencing severe pandemic-related trauma, including financial and food insecurity3, sickness and death of loved ones4, and increased domestic violence5. Meanwhile, supports that might typically buffer youth against hardship, such as the school structure, social services, extracurricular activities, and time with friends, have drastically changed or disappeared6. Without social connection, youth are isolated and lonely7 during a time when peers typically play a critical role in healthy identity and social-emotional development8.

The Wellbeing Club

Despite the challenges associated with COVID-19, there are remarkable examples of youth empowerment9 as youth take action to make positive change in their communities. This past year, our partnership between UC San Diego and Africa Education & Leadership Initiative (Africa ELI), a Ugandan non-governmental organization dedicated to the education, health, and wellbeing of youth, implemented The Wellbeing Club with 25 youth in Uganda. The Wellbeing Club builds upon the evidence-based Gender, Wellbeing, and Ecological Common Framework10. Through regular leadership meetings, we worked together to adapt the curriculum to meet the cultural and contextual needs of the facilitators and participating youth11, 12, 13.

Curriculum. The Ugandan youth in The Wellbeing Club pilot, majority girls, attended two multi-day retreats, one in February 2021 and one in September 2021, to participate in the curriculum, facilitated by Africa ELI leadership and local college mentors. Youth learned about a multi-dimensional framework of wellbeing through art projects, hands-on activities, and talking circles14.

These conversations helped youth identify the many influences on their day-to-day wellbeing, while simultaneously developing trust and connection as a group. Importantly, youth realized that they were not alone–many of their experiences were shared by their peers–and that others listen and care. These collective conversations also contributed to an increase in critical consciousness, as youth recognized inequalities and oppressions, as well as sources of strength, on multiple levels.

These conversations led into the culminating project. Facilitators created the space for youth to identify a community need, set goals for an activism project, generate a plan, and carry out an activism project that was important to them in their community.

Youth Activism through Wellbeing Clubs. For their activism project, youth in The Wellbeing Club decided to address a pressing issue related to gender inequality in their community: the association between school dropout and teen pregnancy. During the lockdowns of COVID-19, youth noticed the increasing numbers of Ugandan adolescent girls who were dropping out of school, “selling their bodies” to earn a living, and becoming pregnant. For their project, the youth prepared skits to raise awareness about this issue in their community. Survey and interview findings with the youth and facilitators suggest that youth improved in their self-confidence, their ability to use their voice and expression, and their engagement: key constructs that contribute to empowerment.

What have we learned? 

Youth value and effectively use spaces to connect with peers in a meaningful way. As youth begin to connect, it is important that opportunities are available for safe, supportive, and genuine connection. Ground rules and conversation structures contribute to social-emotional safety, while conversation starters related to youth’s lived experiences can open the door for peer-to-peer sharing and validation. When adults are part of these conversations, they can provide additional support and resources.

Youth have the power to organize and effect change in their communities. We found that youth were highly aware of and concerned about issues related to their community’s wellbeing. Find out what issues youth care about within your community; or, if they are unaware or indecisive, design opportunities for them to encounter community organizations and activists so they can see what others are working on. This often spurs ideas.

Community-based research-practice partnerships can work with youth-led program models to create change. Throughout our partnership, UC San Diego and Africa ELI collaboratively developed the project with the goal of supporting Ugandan youth empowerment at the forefront. Universities and other research institutions can similarly partner with community-based organizations to develop and evaluate youth-focused programming that fits unique contextual needs.

What’s next?

We are currently synthesizing feedback from our pilot to finalize The Wellbeing Club curriculum. When complete, the curriculum will be freely available via the UNESCO Chair on Gender, Wellbeing, and a Culture of Peace. Meanwhile, Africa ELI plans to roll-out training on Wellbeing Clubs to Ugandan teachers and will host 18 additional clubs over the next three to five years.

Moving forward, we must prioritize local and global solutions that support youth mental health. We recommend a focus on youth empowerment and connection to remind youth that they are important, capable, and loved, and that they can make a difference.


The Changemaker Faculty Fellowship

The Friends of the International Center Fellowship

Africa ELI partners/facilitators: Patrick Bacokorana Kanyeihamba, Norah Nalutaaya, and Dr. Beinomugisha Peninah

About the author:

Rebecca S. Levine, LICSW is a PhD student in Education Studies at the University of California, San Diego. A licensed social worker in the state of Massachusetts, she has worked with youth in clinical, school-based, and academic research settings. Her research centers youth well-being, with specific interests in trauma-informed approaches and community-engaged research. 


1CDC. (2021). Children’s Mental Health. Retrieved from

 2Benton, T. D., Boyd, R. C., & Njoroge, W. F. M. (2021). Addressing the global crisis of child and adolescent mental health. JAMA Pediatrics, 175(11), 1108-1110.

3OCED. (2021). Young people’s concerns during COVID-19: Results from risks that matter 2020. OECD Policy Responses to Coronavirus (COVID-19). Retrieved from

4Absher, L., Maze, J., and Brymer, M. (2021). The traumatic impact of COVID-19 on children and families: Current perspectives from the NCTSN. Los Angeles, CA, and Durham, NC: National Center for Child Traumatic Stress. 

5CALVEX-UCSD. (2021). Survey: Violence increased in California during COVID-19. Center on Gender Equity and Health. 

6Hussong, A. M., Benner, A. D., Erdem, G., Lansford, J. E., Makila, L. M., & Petrie, R. C. (2021). Adolescence amid a pandemic: Short- and long-term implications. Journal of Research on Adolescence, 31(3), 820–835. 

7Sabato, H., Abraham, Y., & Kogut, T. (2021). Too lonely to help: Early adolescents’ social connections and willingness to help during COVID-19 lockdown. Journal of Research on Adolescence, 31(3), 764–779. 

8Erikson, E. H. (1968). Identity: Youth and Crisis. Norton & Co.

9UNICEF. (2021). Youth and COVID-19: Stories of creativity and resilience. UNICEF South Asia. Retrieved from

10Bintliff, A. V. (2020). Multidimensional aspects of adolescent well-being. Psychology Today. 

11International Federation for Human Rights. (2012). Women’s rights in Uganda: Gaps between policy and practice. Retrieved from

12Plan-UK. (n.d.) The impacts of COVID-19 on girls in crisis. Plan International.

13Ojulu, E. (2021). Pandemic leads to surge of child mothers in Uganda. New African Magazine.

14Living Justice Press. (n.d.) What do we mean by “Circle?” Retrieved from


Politics and Social Media: Misogyny and Online Violence Against Women in Politics


By Nabamallika Dehingia1, Lucina Di Meco2, Anita Raj1

1 Center on Gender Equity and Health, University of California San Diego

2 #ShePersisted

To mark the 30th anniversary of the annual international campaign, 16 Days Of Activism Against Gender-Based Violence (25 November to 10 December 2020), we place the spotlight on online violence against women in politics (OVAW-P)- an emerging and pervasive form of violence deserving of priority global attention.

On November 17, 2021 in the US, Republican Party Rep. Paul Gosar of Arizona was censured by the House of Representatives, for posting a photoshopped anime video online. The video showed him appearing to kill Democratic Rep. Alexandria Ocasio-Cortez and attacking President Joe Biden. While the censure resolution indicates a strong condemnation of violence and misogyny by Congress, this is not the first case of OVAW-P in the country. It is yet another addition to a grim and growing roster of cases in the US, as well as globally.

Delivering her remarks on this incident at the House debate on the censure, Rep. Ocasio-Cortez noted that “these depictions are part of a larger trend of misogyny, and racial misogyny “. Incidentally, this is not the first time she has had to call out the blatant misogyny in US politics. In July 2020, she gave a powerful speech emphasizing the culture of violence against women, in response to being called a “f***ing b***h” by her male colleague Rep. Ted Yoho on the steps of the US Capitol.

While misogynist attitudes and regressive gender norms deriding women’s political participation are at the heart of the issue of OVAW-P, the critical role of social media platforms in exacerbating this culture of misogyny must not be underestimated. Instances of gendered disinformation campaigns on Facebook, Twitter, and other platforms, are many. Often, these disinformation campaigns are sexually charged, or they try to discredit the professional achievements of women by spreading fake stories about their personal lives. In August of last year, US House Chair Nancy Pelosi, along with many other female leaders from the US and other countries, sent a letter to Facebook CEO Mark Zuckerberg; the letter called for action to protect the ability of women to engage in democratic discourse on its platform. This letter was sent after Facebook refused to take down a fake video of Speaker Pelosi that depicted her as being intoxicated.

OVAW-P is made worse by the intersections of gendered disinformation campaigns with the violent extremism that exists and thrives on social media platforms. For example, the kidnapping plot against Governor of Michigan, Gov. Gretchen Whitman in 2020, was preceded by days of online campaigns spreading disinformation and conspiracy theories about her. In recent years, policymakers and activists have expressed concerns over the role of social media websites, more specifically, the role of their recommendation algorithms, in artificially amplifying such harmful narratives. Disinformation and extremism get more engagement, and thus bring in more profit for the social media giants. The recent Facebook Files from the Wall Street Journal, whistle-blower Frances Haugen’s testimony, and whistle-blower Sophie Zhang’s account demonstrate the ways in which Facebook prioritises profit over protecting both users on their platforms and democratic systems.

Online political violence against women can push them out of politics, as well as have direct impacts on their electoral outcomes in certain cases.

In Germany during the September 2021 elections, top-runner Annalena Baerbock received much more harassment online than her two competitors, both men. According to experts, this harassment might have undermined her campaign. Similar results have been noted for many other countries, most recently in Uganda in the run up to their January 2021 general elections. In the US, during the 2020 presidential campaign, abusive tweets were far more likely to be directed toward women candidates, making up more than 15% of the messages directed at these women. Furthermore, these online attacks and harassment on Facebook and Twitter often disproportionately target women of color and younger women.

We need better policies to protect women, and democracy

For years, women’s rights organizations have asked social media companies to do better. Earlier this month, they issued a series of policy recommendations, focused on user policy and hate speech; disinformation, defamation, and promotion of extremism; enforcement and transparency for survivors of harassment and hate; and internal platform policy and culture. We discuss a few recommendations here.

Social media companies need to be transparent about their guidelines on what constitutes violence/hate speech/harassment as well as disinformation. The companies also do not share information on implementation of these guidelines, and research has shown that on social media, false news reaches more people than the truth.

Social media companies should include misogyny, misogynoir, and transmisogyny in their hate speech rules, given its well-documented connections to gun violence and other extremist acts. In many instances, disinformation campaigns targeting women politicians might not include blatantly abusive content. They might instead cover sexist information, or fake stories targeting them based on their gender, race, religion etc., which would not necessarily flag the current hateful content identification protocols. To that end, social media companies should include gendered, racialized, and religiously bigoted disinformation in their hate speech rules, and such content should be removed or banned.

From a global perspective, one important task for social media companies is to establish hate speech and disinformation removal protocols for content in all languages, and not just for English. Moderators and algorithms should be trained for different languages, taking into account the different cultural nuances associated with each language.

And political actors must be held accountable for what they do 

In many instances, gendered disinformation campaigns or violent content directed at the women politicians originate from their political competitors. In the case of Rep. Ocasio-Cortez, it was her Republican colleague who posted the photoshopped video. In her speech, Rep. Ocasio-Cortez calls out her colleagues for refusing to condemn the incident, and advancing the argument that “this was just a joke“. Political parties, and the government, definitely have the responsibility to hold political actors accountable in such situations where the perpetrators are within their institutions. We need legislations that can tackle online violence and gendered disinformation campaigns against women and girls.

The setting up of The National Task Force on Online Harassment and Abuse, proposed by President Biden during his campaign, could prove to be an important step towards addressing OVAW-P from a policy and legislative perspective. This task force is expected to provide recommendations for preventing and improving the response to technology-facilitated gender-based violence, and the use of the internet as a tool of abuse to intimidate and silence women, including women politicians, journalists, and activists.


Social media platforms represent an essential space for democracy, political campaigning, and civic engagement. As they are currently structured, however, they are facilitating the proliferation of OVAW-P, gendered disinformation and hate, with the potential to push women out of politics.  In this 16 Days of Activism against Gender Based Violence 2021, we must prioritize ending of OVAW-P, gendered disinformation, ending misogyny, and holding social media accountable for change.

About the authors:

Nabamallika Dehingia is a PhD Candidate in Public Health at San Diego State University and University of California San Diego. Her research is on gender-based violence, with a focus on online misogyny.

Lucina Di Meco is a gender equality expert and women’s rights advocate, recognized by Apolitical as one of the 100 Most Influential People in Gender Policy for her work on gendered disinformation. She is the co-founder of #ShePersisted, a cross-national, feminist initiative to tackle gendered disinformation and online attacks against women in politics.

 Anita Raj is a Tata Chancellor Professor of Society and Health at UC San Diego. She is a Professor in both the Departments of Medicine and Education Studies, and the Director of the Center on Gender Equity and Health (GEH).


COVID, HIV, and the Impact on Women who use drugs: One City’s Experience


By Miriam Harris

The novel coronavirus 2019 pandemic (COVID-19) and public health responses to it have exacerbated inequities among socially structurally marginalized populations in the US. In Boston, this has been particularly true for unhoused people who use drugs where this population has experienced an increase in segregation, policing, and barriers to addiction, harm reduction, and HIV prevention services. This environment has operated to exacerbate an existing HIV outbreak in the city of Boston.

COVID-19 has also worsened structural challenges to HIV prevention among women who use drugs, a population that was already lacking HIV services pre-pandemic.1 These include worsening gender inequity, male domination in the street drug culture, sex work criminalization, and a lack of safe centers for harm reduction and addiction treatment access. While the impact of COVID-19 on HIV among women who use drugs remains unknown, this article draws on experiences caring for this population during the COVID-19 pandemic in Boston to reflect on challenges and launch calls for action.

Women who inject drugs before COVID-19 faced greater HIV risk. Though women comprised roughly one-third of all people who inject drugs, closer two-thirds of injection-related HIV infections occurred in women.2 In the US in 2018, women accounted for 62% of the 11,770 new HIV cases attributable to either heterosexual sex or injection drug use.3 HIV transmission during sex work and injection drug use were identified as primary drivers of the 2015-2018 HIV outbreak in Massachusetts4,5 and are believed to be responsible for the worsening HIV spread during the pandemic, however, data are lacking.

On March 15, 2021, a year into the pandemic and well into Massachusetts’s second COVID-19 wave, the Massachusetts state and city of Boston departments’ of public health released an alert declaring they were investigating a worsening HIV cluster among unhoused or vulnerably housed, people who inject drugs in Boston (Figure 1).6 The public health alert reported that 13 new HIV cases were identified between January 1, 2021, and February 28, 2021, alone. These new cases were a part of an ongoing HIV outbreak that had started in 2019, responsible for at least 113 new HIV infections in Massachusetts. Gender data is not yet available but based on provider experience most of the new HIV cases diagnosed during the COVID-19 have been among men rather than women, out of step with national trends.

Figure 1. New HIV Cases in Boston, Massachusetts from 2018-2021.[6]

However, local experts fear the 13 new HIV cases reported in the alert are only the tip iceberg,7 and women are likely being underdiagnosed. Research has shown that women who use drugs are less likely to access street outreach, harm reduction, and addiction treatment where HIV testing and prevention occur because of stigma and safety concerns.8,9 Data from the state showed HIV testing dropped dramatically following COVID-19 stay-at-home advisories and while they have gradually increased testing has not yet returned to pre-pandemic levels (Figure 2). Harm reduction staff report testing access among women in particular decreased because harm-reduction drop-in spaces closed and pivoted to active street outreach to reduce COVID-19 spread. Women need safety, warmth, and time for HIV testing, elements active street outreach could not offer.

Figure 2. Massachusetts Department of Public Health HIV testing data, 2020[6]

Additionally, the same barriers preventing women equally benefiting from street outreach efforts, namely the male-dominated street culture and a lack of safety,10,11 have worsened in Boston since the pandemic. From 2020 through 2021 unhoused people who inject drugs have been increasingly segregated in a small geographic area in the city of Boston where they experience heighted police scrutiny and stigmatization. In tandem, the pandemic has significantly curtailed economic opportunities such as work in the service or restaurant industry, exotic dancing or sex work in clubs or massage parlors, panhandling, and income generated through shoplifting. These economic changes have disproportionately impacted women and may be related to reported increases in sex work and related physical and sexual violence against women in the area where the new HIV cases have been identified. Outreach staff fear women are benefiting less from the aggressive sterile syringe, condom, and HIV pre-and post-exposure prophylaxis outreach efforts as they are more difficult to reach and stay connected with.

Furthermore, injection use behaviors have changed in response to changes in the drug supply and street culture in Boston during the pandemic. Fentanyl and other toxic synthetic opioids replaced heroin predating COVID-19 and have been associated with more frequent injections related to its shorter duration of action.12,13 People who use drugs in Boston report the opioid supply became even more unstable during the pandemic changing injection practices. Methamphetamine use, which was rising pre-pandemic,14,15 continued to do so during the pandemic. The combination of the unstable opioid supply and increasing methamphetamine use resulted in people having to inject more frequently. Women have reported increased injection use to also stay awake and safe at night and during sex work. These changes have made accessing sterile syringes more difficult increasing HIV risks.

The COVID-19 pandemic severed to exacerbate drivers of HIV risk among women who use drugs and increased barriers to HIV prevention services in Boston. There is an immediate need to increase access to harm reduction and substance use treatment services to support HIV prevention among women who use drugs. Developing or scaling programs that are gender-specific, i.e., are designed for women, have long been called for and are needed now more than ever. Women-only, sex work-specific programs, and services that include violence prevention and other wrap-around sexual health services have been shown to increase engagement with addiction and HIV prevention services,16,17 and offer a road map to increasing HIV prevention for women who use drugs.

Policies that seek to reduce the root drivers of HIV are also urgently needed. The US must move to sanction safe consumption spaces which could significantly reduce HIV among people who use drugs. Access to low barrier housing, that is not contingent on abstinence from drug use, would interrupt HIV spread among unhoused people who use drugs. Low barrier housing for women experiencing intimate partner violence, violence during sex work, or sex work coercion is urgently needed. Such housing has historically been segregated from addiction and harm reduction services, rendering many women’s or family shelters inaccessible to women who actively use drugs. Without bold and immediate action, we risk worsening HIV outbreaks like the one occurring in Boston across the US. Women who use drugs must be prioritized in HIV responses if we wish to avoid further HIV risk inequity, morbidity, and mortality.

About the author:
Dr. Harris is an Assistant Professor of Medicine at Boston University School of Medicine and an addiction expert at Boston Medical Center. Her research is focused on the intersection of women’s health and addiction. She is a primary-care and addiction physician and attends on the General Medicine units and the Addiction Consult Service in the hospital.


1. Metsch L, Philbin MM, Parish C, Shiu K, Frimpong JA, Giang LM. HIV testing, care, and treatment among women who use drugs from a global perspective: progress and challenges. J Acquir Immune Defic Syndr. 2015;69(0 2):S162-S168. doi:10.1097/QAI.0000000000000660
2. El-Bassel N, Strathdee SA. Women who use or inject drugs: an action agenda for women-specific, multilevel and combination HIV prevention and research. J Acquir Immune Defic Syndr. 2015;69(Suppl 2):S182-S190. doi:10.1097/QAI.0000000000000628
3. Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2018 (Updated). HIV Surveillance Report. 2020;31:1-119.
4. Alpren C, Dawson EL, John B, et al. Opioid Use Fueling HIV Transmission in an Urban Setting: An Outbreak of HIV Infection Among People Who Inject Drugs—Massachusetts, 2015–2018. Am J Public Health. 2019;110(1):37-44. doi:10.2105/AJPH.2019.305366
5. Cranston K, Alpren C, John B, et al. Notes from the field: HIV diagnoses among persons who inject drugs—Northeastern Massachusetts, 2015–2018. Morbidity and Mortality Weekly Report. 2019;68(10):253.
6. Madoff L, Brown C, Lo JJ, Sánchez S. Public Health Alert to Boston Area Healthcare Providers: Increase in newly diagnosed HIV infections among persons who inject drugs in Boston. Published online March 15, 2021.
7. Taylor JL, Ruiz-Mercado G, Sperring H, Bazzi AR. A collision of crises: Addressing an HIV outbreak among people who inject drugs in the midst of COVID-19. Journal of Substance Abuse Treatment. 2021;124:108280. doi:10.1016/j.jsat.2021.108280
8. Ayon S, Ndimbii J, Jeneby F, et al. Barriers and facilitators of access to HIV, harm reduction and sexual and reproductive health services by women who inject drugs: role of community-based outreach and drop-in centers. AIDS Care. 2018;30(4):480-487. doi:10.1080/09540121.2017.1394965
9. Boyd J, Collins AB, Mayer S, Maher L, Kerr T, McNeil R. Gendered violence & overdose prevention sites: A rapid ethnographic study during an overdose epidemic in Vancouver, Canada. Addiction. 2018;113(12):2261-2270. doi:10.1111/add.14417
10. Harris MTH, Bagley SM, Maschke A, et al. Competing risks of women and men who use fentanyl: “The number one thing I worry about would be my safety and number two would be overdose.” Journal of Substance Abuse Treatment. Published online January 27, 2021:108313. doi:10.1016/j.jsat.2021.108313
11. Collins AB, Bardwell G, McNeil R, Boyd J. Gender and the overdose crisis in North America: Moving past gender-neutral approaches in the public health response. International Journal of Drug Policy. 2019;69:43-45. doi:10.1016/j.drugpo.2019.05.002
12. Ciccarone D. Fentanyl in the US heroin supply: A rapidly changing risk environment. International Journal of Drug Policy. 2017;46:107-111. doi:10.1016/j.drugpo.2017.06.010
13. Talu A, Rajaleid K, Abel-Ollo K, et al. HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: implications for intervention. Int J Drug Policy. 2010;21(1):56-63. doi:10.1016/j.drugpo.2009.02.007
14. Wakeman S, Flood J, Ciccarone D. Rise in presence of methamphetamine in oral fluid toxicology tests among outpatients in a large healthcare setting in the northeast. Journal of Addiction Medicine. 2021;15(1):85-87.
15. Ciccarone D. The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Current Opinion in Psychiatry. 2021;34(4):344-350.
16. Deering KN, Kerr T, Tyndall MW, et al. A peer-led mobile outreach program and increased utilization of detoxification and residential drug treatment among female sex workers who use drugs in a Canadian setting. Drug Alcohol Depend. 2011;113(1):46-54. doi:10.1016/j.drugalcdep.2010.07.007
17. Wechsberg WM, Deren S, Myers B, et al. Gender-specific HIV prevention interventions for women who use alcohol and other drugs: The evolution of the science and future directions. J Acquir Immune Defic Syndr. 2015;69(0 1):S128-S139. doi:10.1097/QAI.0000000000000627


COVID-19 made Mental Wellbeing a Focus Area


By Divya Bhardwaj

The lived experiences of COVID-19 over the past 18-months have exhibited its many socio-economic implications. With governments oscillating between instituting travel bans and lockdowns while fighting recurring waves of COVID-19 cases–lives and livelihoods across the world continue to be gravely impacted.

Months into this pandemic, we observed an increased articulation of constant stress and anxiety due to a sudden loss of control over sustenance, life and future. Vihara conducted longitudinal, design-led qualitative research studies, with remote and in-person data collection in India, specifically in Bihar, Uttar Pradesh, Delhi, and Maharashtra. These studies were conducted with women, men, adolescent girls and frontline workers. The research unpacked COVID-19’s impact on lived experiences, mental stressors, coping mechanisms, as well as potential interventions to address these concerns.

The Second Wave Amplifying the Severity of our Challenge
Our research reveals that what may have been a ubiquitous problem of stress and anxiety, has now led to a pervasive sense of loss, severe grief and trauma, especially since India’s second wave in April-June 2021. In this wave, many experienced the trauma of witnessing near-death experiences themselves or of a loved one, in a time of acute scarcity and an unequivocal breakdown of the health system. Much worse is the guilt, grief and trauma of families who have experienced the loss of one/both parents, a partner, provider or a loved one, with the inability to offer last rites respectfully. Coping with such severe mental health conditions is foremost about acknowledging them, finding support or an appropriate release, and learning to live through it without suppressing the emotions. This could not be further from the reality for women like Radha*, in rural Darbhanga, Bihar, who lost her partner, the provider to her family to COVID-19. With the sudden loss of her husband to an unknown fever with no local doctors willing to touch, let alone cure him – her grief and despair are unparalleled. There is a strong sense of abandonment from both her deceased husband and the system, but what takes precedence is the fear and uncertainty about life and sustenance of her three children. Radha finds odd jobs to put food on the table, with little time to mourn or focus on coping with everything she is feeling. Much like Radha, women in rural India don’t have the privilege to take time off to acknowledge or process their mental health as household and child care responsibilities are solely theirs.

With the added burden of providing for their families due to the dire economic stress that many women face today – there is little opportunity to heal. Vihara’s research also brought to fore the discomfort women feel when pushed into a provider role as it conflicts with their gender role of a caregiver and hinders their capability to perform it.

Correspondingly, our research identified that men experience a constant internal conflict as they are unable to fulfill their gender roles of provider and protector of their families, due to the loss of subsistence or loved ones during this economic and health crisis. Men’s discomfort around acknowledgement and expression of their emotions more often manifests in anger leading to violence and increased dependence on substance abuse. We find that women and girls are at the receiving end of such maladaptive coping. Women and girls are more likely to turn to passivity, self-imposed isolation, and non-communicative behaviours3 thereby impacting their efficacy and capacity to fulfill their responsibilities. This further results in stigmatisation from the unit and the community creating a vicious cycle that disproportionately impacts their mental health and reinforces gender inequalities.

Reassessing Psychosocial Interventions Design
Diverse experiences of grief and trauma exist across gender, age, economic strata, or occupations. Traditional clinical approaches to mental health are proving to be inadequate to these widespread needs, not just due to systemic and digital access challenges, but also due to deficient colloquial vocabulary and stigma around mental wellbeing, especially in low-income resource constraint communities.

Mental health interventions need to be community-led and sensitive to contextualities that may often be triggers or exacerbate stressors. Vihara is keen to build such interventions that focus on enabling individual coping strategies through cognitive behavioural reflections, techniques to navigate triggers, especially for men, where we also need to de-stigmatise expressions of distress and vulnerability.

Given the challenges of articulation of mental health, gamified and narrative tools can greatly encourage sharing and become a way to build emotional support and collaborative familial or couple dynamics. There is a lack of direct channels to adolescents, especially with schools shut and curtailed peer networks. We, therefore, need to leverage available entry points and influencers to provide support and develop escalation pathways where necessary. Interventions that focus on adolescents need to also focus on skill-building, both commercial and life skills, to navigate the social stressors impacting their mental wellbeing.

In addition, the sharp increase in access to mobile internet for women in India is an opportunity for digital innovations if designed with a focus on contextual and behavioural insights. In urban and peri-urban areas, digital solutions must be envisioned to normalize a dialogue around mental wellbeing, equip communities to recognise the symptoms of poor mental health and ways to build healthy active coping behaviours by providing sustained support without fear of judgement.

The COVID-19 pandemic has amplified the need for mental wellbeing interventions that equip men, women, and adolescents to navigate various stressors within and outside of homes. Vihara is committed to designing interventions that consider regional variance around digital access-literacy to develop in tailored offline-online models that are more culturally embedded, contextually rooted and are built on human-centred design approaches for them to be effective and transformative in a meaningful way.

About the author:
Divya Bhardwaj leads the work in gender, social vulnerability, and psychosocial health at Vihara Innovation Network. She brings expertise on social and environmental factors that perpetuate vulnerability, and their impact on behaviours, mental models and decision-making patterns. She directs human-centred design and research projects in RMNCH+A, Covid-19, and has worked across India and Kenya.

Vihara Innovation Network is an impact and innovation firm that uses anthropological research, human-centred design and systems thinking to unpack barriers and design interventions that are inclusive and equitable. We have been working in the development sector for the past 17 years across Asia and Africa.


Measuring Women’s Political Empowerment: the Women’s Empowerment as Political Citizens Index


By Nivedita Narain, Soledad Artiz Prillaman, and Natalya Rahman

Gendered imbalances in political spaces are widespread. While women may have attained universal suffrage, women are less present than men in most political institutions (World Bank 2012). Even when women are present, they often hold less political authority and are less likely to be heard than men (Karpowitz and Mendelberg 2014).

Empowering women in political spaces is not only critical for inclusive governance but also bears the promise of improved and responsive policy-making. Despite the need for and benefits from women’s political empowerment, few frameworks exist to assess and diagnose the extent of prevailing political power imbalances, particularly at the individual level. Further, unlike economic empowerment, political empowerment — the ability to choose when and how one interacts with political institutions — has received less scholarly attention. We propose a theoretical framework to conceptualize the process of political empowerment at an individual level and then introduce a new index of political empowerment measured through surveys conducted with individual women.

Conceptualizing Political Empowerment

Drawing on Kabeer (1999), we define political empowerment as the process by which those who have been denied the ability and agency to express their voice in the political system acquire such an ability. By political we refer to actions and beliefs that pertain to government institutions or are in service of engaging government institutions and policies (Burns et al. 2001).

Kabeer (1999) suggests that the ability to exercise strategic life choices, or the process of empowerment, can be thought of in terms of three domains of social change: resources, agency, and achievements. We apply this framework to the domain of political action and argue that it is the accumulation of political resources, agency, and achievements that yields true political empowerment:

  1. Resources or the various material, human, and social resources that enhance the ability to exercise choice and act in the political domain, including knowledge about political systems, interest in political action, networks to facilitate political action, and norms that determine for whom political action is socially acceptable.
  2. Agency or the process related to an individual’s ability to define one’s goals and act upon them with respect to interactions with political institutions, includes both the autonomy to choose to act on one’s own interest and belief that such actions are socially acceptable and likely to achieve their aims.
  3. Achievements or the meaningful improvements in life outcomes that result from increased political agency, including all of the varied ways that individuals engage state institutions, such as through electoral participation, claims-making, public discourse, and resistance against the state.

Figure 1 below maps this conceptual framework for political empowerment and highlights key components of each domain of political empowerment.

Figure 1: Conceptual framework for political empowerment

The Women’s Empowerment as Political Citizens Index

Drawing on this conceptual framework, we develop a set of survey questions to construct a single measure of an individual woman’s political empowerment, which we call the Women’s Empowerment as Political Citizens Index (WEP Citizens Index). The index comprises 30 questions, [1] designed for the context of rural India, which are aggregated and weighted such that each of the three main domains receives equal weight. The final measure for each individual is an empowerment score that ranges from zero to one.

To test and evaluate the WEP Citizens Index, we conducted two surveys in 2019 in Betul district of Madhya Pradesh, India. Both surveys included all component measures of the index and were conducted with a random sample of adult women from rural villages. The first survey was conducted as per usual academic surveying practices with a team of external surveyors and included 540 women from 12 villages. The second survey was conducted as per a common practice of practitioner organizations and employed community-based data collectors (CDC) to survey 756 women from 16 villages, overlapping the 12 villages from the first survey.

Women’s Political Empowerment in Rural India

What can we learn from a measure of women’s political empowerment? Figure 2 shows the distribution of empowerment scores  among women in our external enumerator and CDC survey respectively. Three key facts emerge:

  1. The average political empowerment score was 0.4 in the external enumerator survey and 0.35 in the CDC survey. This implies that, on average, women are not entirely disempowered as many measures of political participation alone would suggest, but that there is still quite a way to go to achieve complete empowerment.
  2. There is a large spread of political empowerment across women; women’s political empowerment varies from 0.03 to 0.90. Roughly 13% of women score below 0.2, where they have only a few components of just one domain of political empowerment but lack empowerment in the other two domains. For example, a woman at this score could have knowledge of and interest in politics, but no agency to make choices about political participationOn the other hand, 14% of women score above 0.5, where they would have several components of multiple domains of political empowerment. For example, a woman at this score could have all of the resources needed to participate, some agency over their participation, and may vote, but may still be unlikely to participate in politics outside of voting. About 70% of our respondents are somewhere in the middle of these two kinds of people.
  3. The distributions for the two surveys are similar in shape and spread, as shown in the third panel of the figure. This implies that the WEP Citizens Index is a reliable measure.

Figure 2: Distribution of political empowerment for women across surveys

What drives political empowerment?

One test of the validity of our measure is how it correlates with previously theorized determinants of political participation. We examine whether higher income, increased labor force participation, higher levels of education, and self-help group membership positively correlate with political empowerment, all of which have been hypothesized to increase women’s political activity (Prillaman Forthcoming, Chibber 2002, Burns et al 2001).

Table 1 below reports the correlation between these indicators and our index of political empowerment using a basic OLS regression. Each of these conventional predictors of political participation is positively and significantly correlated with political empowerment. The effect of these predictors is also substantial; for example, SHG members in the external enumerator survey have a higher empowerment score by 0.04 on average. This might translate to one additional act of political participation. Similarly, women in the labor force in the CDC survey have a higher empowerment score by 0.08, which could translate to having one additional resource, for example, political interest. These strong and sizable predictions suggest that the WEP Citizens Index has construct validity.

Table 1: Predicting political empowerment with conventional correlates

What next?
Despite women’s political inclusion being a key goal of the SDGs, we have not had a framework for conceptualizing the holistic process of women’s political empowerment at an individual-level until now. Such a framework is critical for academics as they develop insights into the root causes and consequences of women’s political empowerment and for practitioners as they evaluate whether programs and policies have increased women’s political empowerment. While much more research is needed into the validity of this framework in different contexts and countries, we believe the WEP Citizens Index takes a step forward in conceptualizing the importance of women’s agency in political decision-making and demonstrating how such a conceptual framework can be deployed in realtime to understand progress at achieving this goal.

About the authors:
Nivedita Narain has worked with PRADAN for over three decades in a variety of leadership roles. She currently leads the research portfolio. 

Soledad is an Assistant Professor of Political Science at Stanford University. Her research focuses on gender, political representation, and development, with a focus in South Asia. She received a Ph.D. in Government at Harvard University.

Natalya is a Ph.D. Candidate in Political Science at Stanford University. She studies political behavior and development in South Asia.


Burns, Nancy, Kay Lehman Schlozman, and Sidney Verba. The Private Roots of Public Action. Harvard University Press, 2001.

Chibber, Pradeep. “Why are some women politically active? The household, public space, and political participation in India.” International Journal of Comparative Sociology 43.3-5 (2002): 409-429.

Kabeer, Naila. “Resources, agency, achievements: Reflections on the measurement of women’s empowerment.” Development and change 30.3 (1999): 435-464.

Karpowitz, Christopher F., and Tali Mendelberg. The silent sex. Princeton University Press, 2014.

Prillaman, Soledad Artiz. “Strength in numbers: How women’s groups close India’s political gender gap.” American Journal of Political Science (Forthcoming).

World Bank. 2012. World Development Report: Gender Equality and Development.

[1] The full list of questions can be provided on request.


Adolescents’ Sexual Behaviors and Needs in India: Barriers to Effective Evidence


By Swetha Sridhar

With the largest adolescent population in the world at 253 million adolescents, one in every five people in India is between the ages of 10 to 19 [i]. It is broadly agreed that this is a critical transitional stage, with major physiological changes such as the attainment of puberty and emotional changes such as the development and exploration of gender and sexual identities and orientations manifesting themselves in the lives of young people.  For many adolescents, these changes mark the beginning of a series of complex developmental events. In some contexts, adolescents drop out of school to support domestic responsibilities, join the workforce or marry. Girls who marry early experience a break with their natal families and familiar social networks. Further, they may be subject to the pressures of early fertility, with lifelong consequences. During this phase, adolescent girls are especially exposed to multiple layers of vulnerability due to gendered social norms that impact the way they live their lives, affects their mobility, and limits their decision-making ability.  Further, these transitions are embedded within larger structural challenges such as poverty, statelessness, issues of safety and violence and so on.

Support for adolescents during this transition is imperative. However, within global health and social policy, the needs of adolescents are often overlooked [i],[ii]. This neglect has resulted in minimal investments in adolescent-centered programming, lack of social safety support interventions for adolescents compared to other age groups and most importantly, limited robust and credible evidence on adolescents. [iii]

Why must we talk about adolescents?

The adolescent evidence gap has significant implications for health and social programs designed and implemented for adolescents. Studies suggest that adolescents, especially those with the most pressing sexual and reproductive health (SRH) needs may not be reached by interventions as intended by policy-makers and program planners [iv]. For instance, a review of India’s flagship adolescent health program, the Rashtriya Kishor Swasthya Karyakram (RKSK) found that despite efforts being made to encourage adolescents to visit the Adolescent Friendly Health Clinics, unmarried adolescents were reluctant to visit these clinics. This gap in implementation was not identified early on due to a lack of disaggregated data and evidence within adolescent health programming. [v]

Such oversight has significant impacts on India’s development trajectory. Effective and evidence-based adolescent programming has not only the ability to yield a “triple dividend of benefits” [vi], but it also has a cascading impact on education, livelihoods, and an individual’s overall ability to lead full, empowered lives.

In the recent past, India has seen some research attention being paid to adolescents – for instance, the UDAYA study, which is a pioneering study on adolescents in the states of Uttar Pradesh and Bihar and the Performance Monitoring for Action (PMA) project in Rajasthan, which recently expanded its ambit to collect data on adolescent girls. However, despite these gains, there are social, legal and policy barriers that hinder the collection of data, particularly related to unmarried adolescents and their SRH health needs, leaving these needs unaddressed.

Challenges to Evidence Building on Adolescents

The first and perhaps foremost challenge is the lack of universal acceptance of adolescence as a demographic category within India. While, globally, the WHO and UNICEF define adolescents as those between 10 and 19 years of age [vii],[viii], within India, different ministries, departments, and agencies categorize individuals in differing and sometimes overlapping ways [ix]. For instance, even though the Ministry of Health and Family Welfare has adopted the WHO definition, other ministries variously use the categories of children (ages 5 -18) or youth (ages 15 -29). Consequently, even where data are collected and analyzed, comparison is hindered by these differing definitions.

Secondly, collecting evidence on sexual activity amongst adolescents is complicated by the fact that many of the adolescents who are voluntarily sexually active and or have pre-marital sexual activity are below the legal age of consent in India. Under the Protection of Children from Sexual Offences (POCSO) Act, 2012, which is meant to protect children and adolescents below 18 from harm and abuse, any sexual encounter (even if it is consensual) is defined as violence [x]. This criminalization of all sexual expression discourages adolescents from talking about their sexual experiences and needs.

These policy and legal challenges are further reinforced by the far “stickier” challenge of  sociocultural dimensions that influence interactions and conversations between researchers and communities as they seek to understand adolescent sexual activity. In general, the social norms that govern adolescent SRH behavior condemn dating and pre-marital sexual activity amongst adolescents. While there is some laxity with regard to men’s sexual behavior [xi],[xii],  women’s sexual activity is greatly policed because of the perception of “purity” linked to adolescents, and its association with family honor. Consequently, there is a tendency to deny the occurrence of sexual experiences amongst unmarried adolescent girls – leading to misreporting [xiii], especially amongst adolescent girls, or outright denial [xiv]. On the other hand, given the relative freedom that adolescent boys enjoy, they have been reported to exaggerate sexual encounters, as a result of peer pressure and cultural attitudes around masculinity and sexual activity [xv].  Consequently, it is hard to accurately estimate the actual extent of sexual activity amongst unmarried adolescents.

These norms also influence the ways in which gatekeepers – parents, teachers, and community leaders – who are the first points of contact for researchers on adolescent issues, respond to requests to discuss these “taboo” topics with their adolescent charges. As a result, research on adolescents face unique challenges when it comes to obtaining informed consent [xvi].


Despite the heightened awareness that ensuring sexual and reproductive health and well-being in adolescence plays an essential part in reproductive health and wellbeing in later life, we currently lack the data required to design and implement successful programs. There is a need to expand our understanding of adolescent health and behaviors beyond those of married adolescents. We also urgently need to include adolescents, particularly unmarried adolescents within national and sub-national studies, and ensure the disaggregation of data by age, gender, and socio-economic status. This evidence would enable us to work towards including better inclusion of disadvantaged or marginalized young people in SRH research, particularly those who are out-of-school, economically disadvantaged, migrants, living with disability, and young key populations.

“Swetha Sridhar is a development practitioner committed to ensuring adolescent girls transition into adulthood successfully. Her work focuses on issues of SRHR and adolescence, and it’s linkages to social sector policy in India.”


[i] UNICEF. (n.d.). Adolescent development and participation. UNICEF India. Retrieved July 17, 2021, from

[ii] Molyneux, M. (2020, January 15). Adolescence: policy opportunities and challenges. UNICEF.

[iii] Patton, G. C., Sawyer, S. M., Santelli, J. S., Ross, D. A., Afifi, R., Allen, N. B., Arora, M., Azzopardi, P., Baldwin, W., Bonell, C., Kakuma, R., Kennedy, E., Mahon, J., McGovern, T., Mokdad, A. H., Patel, V., Petroni, S., Reavley, N., Taiwo, K., . . . Viner, R. M. (2016). Our future: a Lancet commission on adolescent health and wellbeing. The Lancet, 387(10036), 2423–2478.

[iv] Chandra-Mouli, V., Lane, C., & Wong, S. (2015). What Does Not Work in Adolescent Sexual and Reproductive Health: A Review of Evidence on Interventions Commonly Accepted as Best Practices. Global Health, Science and Practice, 10(3), 333–340.

[v] Barua, A., Watson, K., Plesons, M., Chandra-Mouli, V., & Sharma, K. (2020). Adolescent health programming in India: a rapid review. Reproductive Health, 17(1).

[vi] Sheehan, P., Sweeny, K., Rasmussen, B., Wils, A., Friedman, H. S., Mahon, J., Patton, G. C., Sawyer, S. M., Howard, E., Symons, J., Stenberg, K., Chalasani, S., Maharaj, N., Reavley, N., Shi, H., Fridman, M., Welsh, A., Nsofor, E., & Laski, L. (2017). Building the foundations for sustainable development: a case for global investment in the capabilities of adolescents. The Lancet, 390(10104), 1792–1806.

[vii] WHO. (2014). Health for the World’s Adolescents: A Second Chance in the Second Decade. World Health Organisation.

[viii] UNICEF. (2019, October). Adolescents overview.

[ix] Ministry of Youth and Sports Affairs. (2014). National Youth Policy. Government of India.

[x] PLD. (2017). National Consultation on Adolescent Sexuality, Health, and the Law: Mapping Interventions Related Challenges and Strategies. Partners for Law in Development.

[xi] Santhya, K., Acharya, R., Jejeebhoy, S. J., & Ram, U. (2011). Timing of first sex before marriage and its correlates: evidence from India. Culture, Health & Sexuality, 13(3), 327–341.

[xii] Ghule, M., Balaiah, D., & Joshi, B. (2007). Attitude Towards Premarital Sex among Rural College Youth in Maharashtra, India. Sexuality & Culture, 11(4), 1–17.

[xiii] Subaiya, L. (2008). Premarital Sex in India: Issues of Class and Gender. Economic and Political Weekly, 43(48), 54–59.

[xiv] Joshi, B., & Chauhan, S. (2011). Determinants of youth sexual behaviour: program implications for India. Eastern Journal of Medicine, 16, 113–121.

[xv] Jaya, & Hindin, M. J. (2009). Premarital Romantic Partnerships: Attitudes and Sexual Experiences of Youth in Delhi, India. International Perspectives on Sexual and Reproductive Health, 35(2), 97–104.

[xvi] Mehta, S. D., & Seeley, J. (2020). Grand Challenges in Adolescent Sexual and Reproductive Health. Frontiers in Reproductive Health, 2.

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