One Health for Humans, Environment, Animals and Livelihood Operationalizing One Health in pastoralist settings Module 2: Gender, culture, and One Health PARTICIPANT MANUAL Acknowledgments This training material was prepared by Mamusha Lemma (ILRI) together with Siobhan Mor (University of Liverpool/ILRI) and Micol Fascendini (Amref Health Africa). The HEAL project is funded in part by the Swiss Agency for Development and Cooperation (SDC). About HEAL The Arid and Semi-arid areas of the Greater Horn of Africa are among the areas in Eastern Africa frequently affected by natural and man-made disasters. These areas are therefore vulnerable to recurrent drought and other emergencies such as outbreaks of infectious diseases. They are characterized by inadequate access to basic services, inadequate infrastructure, and increased competition for resources. The HEAL project is based on the assertion that, despite the huge challenges that have hit the Horn of Africa in recent years, its people, livestock, and natural resource base provide a firm foundation upon which to improve livelihoods and increase resilience. Pastoralist communities depend on the close interlinkages between rangeland, livestock, and human health. This insight and understanding provide an ideal basis to apply a One Health approach to tackle one of the key bottlenecks for pastoralists which is access to necessary services and inputs. The HEAL project is building on this foundation by supporting a bottom-up approach that is participatory, context-specific, coordinated and integrated to reshape service delivery in the form of One Health Units (OHUs). These units will facilitate a combination of services from different disciplines in a meaningful way and will thus facilitate interactions and coordination between governmental departments, private service providers and communities. Their aim is to sustainably strengthen human, livestock and rangeland health services and support communities to develop sustainable strategies to cope with changing environments and threats related to climate change. The HEAL project focuses on selected pastoral areas of Ethiopia, Somalia, and Kenya, which share some common characteristics in terms of climate, culture, population dynamics and challenges related to these. These countries have strong cross-border dynamics and are also linked in their historical context. Consortium partners: • Vétérinaires Sans Frontières Suisse (VSF-Suisse; Lead) • Amref Health Africa • International Livestock Research Institute (ILRI) Implementation sites: VSF-Suisse managed sites: • Moyale woreda of the Somali region (Ethiopia) • Miyo and Moyale woredas of Oromia region (Ethiopia) • Beled Xaawo and Dollow districts of Gedo Region (Somalia) Amref Health Africa managed sites: • Filtu woreda of the Somali region (Ethiopia) • Marsabit and Isiolo counties (Kenya) ILRI: working in all project sites i Table of contents Page Acknowledgments i About HEAL i Table of contents ii Acronyms iii 1. Introduction 1 1.1. Module description 1 1.2. Intended learning outcomes 1 1.3. Module content 2 1.4. Target audience 2 1.5. How to use this manual 2 2. Understanding and applying concepts of culture to One Health 3 2.1. Intended learning outcomes 3 2.2. Key concepts and definitions 3 2.3. Practical application of culture concepts to One Health in pastoralist settings 7 2.4. Self-assessment questions 9 3. Understanding and applying gender concepts to One Health 10 3.1. Intended learning outcomes 10 3.2. Why does gender matter in One Health? 10 3.3. Key concepts and definitions 11 3.4. Gender analysis 15 3.5. Gender integration 18 3.6. Practical application of gender concepts to One Health in pastoralist settings 21 3.7. Putting it together: learning integration and reinforcement 24 3.8. Self-assessment questions 24 4. References and further reading 25 ii Acronyms AMREF African Medical and Research Foundation HEAL (One Health for) Humans, Environment, Animals and Livelihoods ILRI International Livestock Research Institute MSIP Multi-Stakeholder Innovative Platform OH4HEAL One Health for Humans, Environment, Animals and Livelihoods OHU One Health Unit iii 1. Introduction 1.1. Module description Welcome to Module 2: Gender, culture, and One Health of the HEAL training package. One Health emphasizes the interdependent health of humans, animals, and the environment. It employs an integrated, collaborative, and equitable approach to address common health issues such as zoonotic diseases, antimicrobial resistance, food safety, and environmental pollution and degradation. In this Module, basic concepts and practical applications of culture and gender in One Health will be discussed in pastoralist settings. Sociocultural and gender issues can influence One Health outcomes in many ways. Both women, men, boys, and girls play a role in One Health. However, different sociocultural factors influence how women and men participate in and benefit from One Health interventions. Gender norms, roles, unequal power relations, and social structures can limit the aspirations and opportunities of women and men in One Health. Pastoralist women are often excluded from community decision-making processes, resulting in disempowerment and their needs not being considered. Previous efforts to formulate One Health competencies (Frankson et al. 2016) have not explicitly included sociocultural and gender analysis or addressed the intersection of gender, culture, and One Health (Friedson-Ridenour et al. 2019). Understanding gender and culture and how this influences health outcomes for humans, animals and the environment is a core One Health competence. The Module is organized in chapters. In each chapter, the learning activities cover conceptual and application aspects. First, basic concepts and terminologies of culture and gender are presented to give learners the conceptual foundation and analytical tools for the practical applications of the concepts in One Health. Then, framing concepts are further contextualized and explained with examples and cases to enable learners to understand the contributions and practical applications of the concepts in the analysis and integration of sociocultural and gender issues in One Health in pastoralist settings. 1.2. Intended learning outcomes By the end of the Module, you will be able to: • appreciate the values of cultural diversity, relativism, and responsivity in a One Health context; • apply concepts of cultural diversity and relativism as analytical tools in One Health practices; • strive for cultural diversity as a source of exchange, innovation, and creativity in One Health practices; • frame concepts of culture and One Health within the veterinary and human healthcare context in pastoralist settings; • demonstrate ability to assess and integrate culture and gender issues in One Health practices focusing on pastoralist settings; and • demonstrate culturally competent knowledge, skills, and attitudes in working across disciplinary, organizational, and cultural boundaries in a One Health context. 1 1.3. Module content • Culture, values, norms, beliefs • Socialization and agents of socialization • Ethnocentrism, cultural diversity, relativism, responsivity, competence • Gender roles, norms, relations • Gender stereotypes and inequalities • Gender integration approaches and methodologies in One Health 1.4. Target audience The Module primarily targets One Health supervisors and service providers in the HEAL project. The Module aims to strengthen the capacity of supervisors and service providers in understanding and exploring sociocultural and gender issues in One Health and consider these aspects in One Health interventions. As One Health is a collaborative and transdisciplinary approach to designing and implementing integrated human, animal, and environmental health interventions, One Health supervisors and service providers should appreciate the contributions of social sciences and must ensure proper analysis of sociocultural and gender issues in the planning, implementation, and evaluation of One Health initiatives. 1.5. How to use this manual This manual is intended as a resource for self-study. Some tips for self-study are provided below. Define goals. Before you read this training material, try to identify your learning goals and how you will apply the lessons learnt in a One Health context. Create questions. After you read each section of the learning topics, write questions that you want other people to answer. After you finish reading the topics, try to answer the questions yourself. Find main ideas. As you read each paragraph of the learning topics, make note of the main ideas, and reflect on their practical implications in the context of One Health. Review your notes after you finish reading each learning topic. Reflect on key lessons and insights. After you finish reading the topics, ask yourself what it means to you in the context of One Health. Write down your key take-home messages or lessons and explain how you would apply these lessons in a One Health context. 2 2. Understanding and applying concepts of culture to One Health Human behavior is influenced by cultural values and belief systems. In this chapter, basic sociocultural concepts will be discussed as analytical tools in the context of One Health. Cultural and belief systems of pastoralist communities will be examined from the perspectives of human, animals, and environmental health. The practical implications of the basic sociocultural concepts for communication, collaboration, power dynamics and partnerships will be explored in the context of One Health in pastoralist settings. 2.1. Intended learning outcomes By the end of this topic, you will be able to: • explore your own attitudes, values, beliefs, and biases and explain how this can affect your ability to work in multicultural and transdisciplinary teams in a One Health context; • explore the relationship between the individual and society drawing on the concepts of socialization, culture, and social identity; • develop a culturally competent approach in understanding the interconnectedness between animal, human and environmental health; and • demonstrate self-reflective practices for continual learning by assessing and recognizing your own values, beliefs, attitudes, and experiences in One Health. 2.2. Key concepts and definitions Pre-reading refection: When you think of the word ‘culture’, what words come to mind? Do you think of any personal experiences, like your own family traditions or practices from places you have traveled to that were new to you? Can you define culture by any one thing (element)? Culture is a multifaceted, intersectional concept that each of us will understand, define, and experience differently. It is the system of shared beliefs, values, customs, behaviors, and artifacts that members of society use to interact with their world and with one another (Figure 1). Culture is the beliefs, behaviors, objects, and other characteristics shared by groups of people. It can be based on shared ethnicity, gender, customs, values, or even objects. Culture can also demonstrate the way a group thinks, their practices, or behavioral patterns, or their views of the world. Culture encompasses many things and influences our choices as individuals, households, and groups in many ways. Belief is a conviction or a firmly held opinion about the nature of reality that an individual or group accepts as true. Beliefs may be based on tradition, faith, myths, values, ideologies, experience, or some combination of these. A collection of beliefs forms a belief system. 3 Figure 1. The culture wheel. Source: theculturewheel.org/ Norm refers to something that is usual, typical, standard, or expected. Norms are rules or expectations that are socially enforced. Norms that you are used to are neither right nor wrong, just different. Norms may be prescriptive (encouraging positive behavior) or proscriptive (discouraging negative behavior). Human behavior can be strongly influenced by actual and perceived social norms. Social norms can greatly influence health-related choices and behaviors of individuals and groups. Subjective norms are the belief that an important person or group of people will approve and support a particular behavior. Subjective norms are determined by the perceived social pressure from others for an individual to behave in a certain manner and their motivation to comply with those people’s views. A value is an ideal or principle that determines what is correct, desirable, or morally proper. Social values are beliefs or strongly held ideas of individuals and groups about what is good and what is bad or what is right or what is wrong. The culture of a society is shaped by social values which provide guidelines for behavior. A collection of values forms a value system. Socialization is the lifelong process through which people learn the values and norms of a given society. It involves the development of personality, attitudes, and expected social roles. People learn to conform to their society’s norms, values, and roles through the process of socialization. It is also an adaptive lifelong learning experience because society is constantly changing. Agents of socialization are social institutions (e.g., family, school, the media) that are responsible for the process of socialization. For example, gender norms and roles are learned and maintained through the process of gender socialization. Ethnocentrism means using one’s own culture or discipline as the center and evaluating other cultures or disciplines based on it. For example, judging or making assumptions about the food of other cultures based on one’s own norms, values, or beliefs. Ethnocentrism can lead to negative judgments of the behaviors of groups or societies. It can also lead to discrimination against people who are different. Ethnocentrism can limit the ability of One Health practitioners to work across different cultures and disciplines at different levels. 4 Cultural relativism is the ability to understand a culture in its own context and not to make judgments using the standards of one’s own culture. There are no universal truths in ethics. Morality is culture-bound. When we think about different cultures and societies, we should think about their customs in a way that helps us make sense of how their cultural practices fit within their overall cultural context. This promotes understanding and appreciation of cultural practices that are not typically part of one’s own culture. Cultural diversity (multiculturalism) can be defined as a system of beliefs and behaviors that recognizes and respects the presence of all diverse groups (age, gender, religion, ethnicity, education, etc.) in an organization or society, acknowledges and values their socio-cultural differences, and encourages and enables their continued contribution within an inclusive cultural context which empowers all within the organization or society. Important actions in cultural diversity: • Recognizing that different cultures exist. • Respecting each other’s differences. • Acknowledging the validity of different cultural expressions and contributions. • Valuing what other cultures offer. • Encouraging the contribution of diverse groups. • Empowering diverse groups to contribute. • Celebrating differences, not just tolerating them. Cultural responsivity is an ability to learn from and relate respectfully to people from your own and other cultures. It includes adjusting your behaviors based on things that you learn about other cultures. It requires openness to experiencing and thinking about things from other points of view. It is about cultivating an open attitude and acquiring new interpersonal skills, and it involves exploring and honoring your own culture while learning about and honoring other people’s cultures. Cultural competence is an ability to interact and work effectively with people of different socio- cultural and disciplinary backgrounds at different levels (individual, organizational and system). It is a set of attitudes and behaviors that enables individuals and groups to work effectively in cross- cultural and interdisciplinary situations. It is portrayed along a continuum that indicates the various levels of cultural awareness, knowledge, and skills of individuals, organizations, or systems. Cultural competence is a developmental process (Figure 2; Table 1). Developing cultural competence is a dynamic and complex process that evolves over time and requires: • Ongoing education of self and others • Awareness of one’s cultural worldview • Attitude towards cultural differences • Knowledge of different cultural practices and worldviews. • Cross-cultural skills • Support, modeling, and risk-taking behaviors • A vision that reflects multi-culturalism, values diversity, and views it as an asset • Careful attention to the dynamics of difference, realizing that equal access is not equal treatment • Cultural empathy, emotional stability • Self-efficacy, open-mindedness, flexibility, and social initiative 5 Figure 2. Continuum of cultural competence. Adapted from www.ecald.com Table 1. Level of cultural competence Level of cultural Description competence Cultural Genocide or ethnocide; exclusion laws; cultural/racial oppression; forced destructiveness assimilation Cultural Disproportionate allocation of resources to certain groups; lowered incapacity expectations; discriminatory practices, unchallenged stereotypical beliefs Cultural blindness Discomfort in noting difference; beliefs/actions that assume the world is fair and achievement is based on merit; treat everyone the same: ignores cultural differences. The belief that methods used by the dominant culture are universally applicable and can lead to implicit or explicit exclusion of ethnic minority communities. Cultural pre- Delegate diversity work to others, e.g., cultural programs asked to be led by competence those of that background; quick fix, packaged short-term programs; inconsistent policies and practices; practitioners are sensitive to minority issues, but these are not an organizational priority. Cultural On-going education of self and others; support, modeling, and risk-taking competence behaviors; a vision that reflects multi-culturalism, values diversity, and views it as an asset: evidence of continuing attempts to accommodate cultural change; careful attention to the dynamics of difference, realizing that equal access is not equal treatment Cultural Interdependence; personal change and transformation; alliance for groups proficiency other than one’s own; follow-through social responsibility to fight social discrimination and advocate for social diversity Credit: www.ecald.com 6 2.3. Practical application of culture concepts to One Health in pastoralist settings Pre-reading reflection: Can you think of a way that culture plays a role in human, animal, and environmental health? Cultural beliefs, traditions and practices can affect behaviors of individuals and groups in human, animal, and environmental health. People may have different beliefs about human and animal illness and may seek different treatment options and resort patterns. For example, misperceptions about zoonotic diseases, such as rabies and Brucellosis, can influence prevention and treatment options of pastoralist communities. People’s beliefs about animals also play a significant role in animal health and welfare. Cultural traditions may also influence how male health providers interact with female patients or community members, or how female livestock keepers use animal health services. One Health practitioners must understand the role of culture and beliefs in their practices. Such understanding of how culture influences and informs individuals’ perceptions of health, their health behaviors, health needs, and health outcomes is a core competence for One Health practitioners at all levels. As One Health practitioner, understanding culture helps you know yourself and relate with others. It can help you recognize the variety of ways in which people solve the same problems. Understanding cultural diversity has practical implications for how different disciplines work together in One Health by transcending disciplinary culture, boundaries, and biases. Working across disciplinary, organizational, and cultural boundaries is a core competence for One Health practitioners. It is important for One Health practitioners to develop competencies in systems thinking, collaboration, and partnership management. This again requires open-mindedness and learning culture to understand and appreciate the perspectives, views, cultural values, and beliefs of others and explore together to co-create a shared understanding and joint actions that optimize health outcomes for animals, humans, and the environment. The iceberg model of culture can help appreciate the influence of deep culture. The surface culture is what is observable (behavior, artifacts, practices – the way we do things). The deep culture is the invisible (underlying beliefs, attitudes, values patterns – why we do the things we do). Our thinking and feelings about something (such as health) are reflected in the deep culture (Figure 3). Perceptions and behavior of pastoralist communities about human, animal, and environmental health issues are often influenced by their cultural values and how they perceive other people (e.g., health professionals) would think about their behaviors (subjective norms). For example, encouraging individuals and groups to take up integrated human, animal, and environmental health measures often requires effective communication and social support of people (such as experts, opinion leaders) whom they regard important. It is essential that One Health practitioners understand why pastoralist communities do what they do within the context of their own culture. One Health practitioners also need to reflect on their perceptions of others’ beliefs and assumptions which may influence their thoughts on others’ behaviors and beliefs which are different from their own. 7 Figure 3. The iceberg model of culture. Source: www.trainerslibrary.org/the-iceberg-model/ C ulture may determine the roles women, men, boys, and girls play in human, animal, and environmental health management in pastoralist settings. For example, in the Borana culture, women are predominantly responsible for human health while men are responsible for livestock health, but it may differ by livestock species. However, men are largely in control of the resources, which can impact on women’s access to veterinary and human healthcare, making it difficult for women to obtain prevention and treatment services (Eba 2020). Throughout the Horn of Africa, women’s rights to and ownership over livestock are often embedded in traditions and customary practices. One Health practitioners should not do harm by reinforcing cultural norms (such as gender norms and practices) that discriminate against women and girls. It is important that One Health practitioners consider the influence of socio-cultural factors in human, animal, and environmental health service delivery. For an effective community engagement in One Health, it is essential to understand cultural values, norms, perceptions, attitudes, social structures, and power dynamics and consider how these constrain or enable women and men’s participation in One Health interventions. For example, social and institutional systems can influence the role of women and men in resource use and governance (such as rangelands and watering points) and in decisions about treating/vaccinating animals and children in pastoralist communities. Exploring concepts and practices of cooperation, mutualism, and collective action in pastoralist cultural settings can provide useful insights into mechanisms for engaging cross-sectional community groups in One Health practices. 2.3.1. How do One Health practitioners become culturally competent? Develop cultural self-awareness. Think about the different factors that have influenced your own cultural identity development. How have these factors influenced your beliefs and values? Have your beliefs and values changed over time? Why and how? Be aware of cultural values that you hold and understand that others may hold different values. 8 Appreciate the value of diverse views. Think about friends or acquaintances that have different values than yours. Can you understand their point of view? Can you accept that their values are different from yours without judging them to be wrong? Think of a specific belief that you hold, then list what other perspectives of that belief might be. Can you identify advantages to holding the other perspective? Avoid imposing your own values. As you become familiar with the values that you hold, and identify the differences in values that others hold, think about how the choice you make are based in your values and beliefs. When observing or interacting with others, and something makes you uncomfortable, resist the urge to make a judgment about the person or behavior. Make a conscious effort to understand the perspective they may be coming from. Resist stereotyping. List as many stereotypes as you can think of, including both positive and negative examples. Think about people you know who fall into these groups. Consider the accuracy of these statements. Identify groups that you belong to. Do the stereotypes accurately reflect the way you see yourself? 2.4. Self-assessment questions First, review your notes and pre-reading reflections. Then, try to answer the following questions to deepen and reinforce your learning experience. 1. Describe how socialization and cultural values influence your personality and interpersonal qualities and discuss practical implications of this for fostering or inhibiting collaboration and partnership in a One Health context. 2. Explain how cultural values and beliefs influence human behaviour in One Health practices. Give examples and make reflections on your own culture. 3. Explain how your own beliefs, practices, norms, and experiences inform how you understand and work with others across disciplines and cultures in One Health context at different levels. 9 3. Understanding and applying gender concepts to One Health Gender identities and relations are important aspects of culture because they shape the daily life in the household and community. Women, men, boys, and girls have different health risks, opportunities, and challenges due to their different gender roles, decision-making power, access to and control over resources, and exposure mechanisms to animals and the environment. 3.1. Intended learning outcomes By the end of the Session, you will be able to: • identify and address gender issues related to human, animal, and environmental health in pastoralist settings. • develop and apply critical analytical skills as you explore how gender and One Health intersect. • conduct gender analysis to identify and address gender-based constraints of women and men in One Health interventions • design and implement One Health interventions that promote equality and empowerment for women, men, boys, and girls • analyze how the risks of infection and the response capacity differ between women and men due to their gender roles in human, animal, and environmental health management. 3.2. Why does gender matter in One Health? Pre-reading reflection: Why does gender matter in One Health? What are the arguments for gender integration into One Health? There are justice and efficiency arguments for gender integration into One Health (Figure 4). The social justice argument has an intrinsic value (i.e., realizing gender equality as a right). It strives to address gender inequalities and empower women and girls. On the contrary, the efficiency argument has an instrumental value (i.e., realizing gender equality to achieving outcomes related to societal development and well-being). Gender-integration in One Health is the right and smart thing to do and can enhance the relevance, acceptance, and effectiveness of integrated human, animal, and environmental health interventions. Pastoralist women play key roles in livestock production, public health, and environmental protection. They have valuable experiences and knowledge of livestock diseases, human health and ecological systems which can be explored and strengthened through a One Health approach. 10 Figure 4. Arguments for gender integration into One Health. Adapted from Bagnol, Alders and McConchie (2015). Gender relations in pastoralist communities can affect One Health interventions and outcomes. If both women and men do not participate or have access to information, health outcomes at the household and community level can be affected. Studies show that husbands rarely share information from training programs or community meetings with female members of households (Lemma et al. 2020). The participation of both women and men (including couples) in One Health interventions can increase collaborative learning and action within the household and can lead to better adoption of integrated human, animal, and environmental health practices. It is, therefore, important to conduct a proper gender analysis to identify gender-based constraints of women and men and devise strategies to address these barriers and inequalities in One Health interventions. Ensuring that One Health interventions are gender responsive can have a positive impact on gender equality and health outcomes. 3.3. Key concepts and definitions Below you will learn about concepts of gender and related terms to better understand what gender integration in One Health means conceptually and in practice. As you study each gender concept, pause, and reflect on your own gender perspectives or attitudes and think critically how that plays out in your work and relationship with others. Sex and gender. While the terms sex and gender are sometimes used interchangeably, they have different meanings. Sex is biological and physiological difference between women, men, boys, and girls. For example, women give birth and breastfeed, and men produce sperm. Gender is socially given attributes, roles, activities, behavior, and responsibilities considered culturally appropriate for women, men, boys, and girls in society. For example, women are caregivers, while men are providers. People are born male or female but learn how to behave as men, women, boys, and girls from their society through the process of gender socialization. 11 Gender roles and division of labor. Gender roles are tasks, activities and responsibilities culturally assigned to women, men, boys, and girls in a society. For example, in pastoralist communities, men often diagnose and treat sick animals and women are responsible for collecting and preparing various herbs used in traditional remedies. As women also do the milking of animals, they are often the first to notice behavioral changes and other signs of disease. Women also care for young stock and have a good understanding of their disease issues. Gender roles in looking after livestock can affect the way zoonotic diseases are passed between animals and different members of a household. Women’s roles in most societies fall into three categories: productive (relating to production of goods for consumption or income through work in or outside the home), reproductive (relating to domestic or household tasks associated with creating and sustaining children and the family), and community management (relating to tasks and responsibilities carried out for the benefit of the community). Women need to balance the demands of these different roles and should be recognized for their contributions. The tasks women usually perform in carrying out their different roles do not generally earn them an income. Women are often defined exclusively in terms of their reproductive roles, which largely concern activities associated with their reproductive functions. These reproductive roles, together with their community management roles, are perceived as natural. But because these roles do not earn income, they are not recognized and valued as economically productive despite their importance to communities and society at large. Women’s contributions to national economic development are often not quantified and are invisible (CEDPA 1996). For example, livestock development initiatives tended to neglect donkeys which largely relieve women's workload. Gender roles and responsibilities vary among cultures and can also change over time. It is important to analyze gender roles since the gender division of labor can shape women’s freedom of movement, the allocation of time and ability to participate, autonomy, access to information and opportunities, how women and men engage in development activities, and whom they contact and consult (Figure 5). Figure 5. Importance of gender role analysis. Source: Drucza et al. (2018). 12 Gendered roles, because they are culturally constructed, are frequently context- and location- specific, but they are also dynamic, changing across the lifespan of women, men, boys, and girls in response to shifting sociocultural norms and in relation to wider political and economic climates. For example, climate change can influence the roles of women and men and affect them differently in pastoralist communities. Gender needs and interests. Practical gender needs are the immediate necessities of women and men due to their gender roles, for example water, health, firewood, technologies, and information. Strategic gender interests are related to structural changes in society regarding women’s position and equity, for example, decision-making power, ownership, and representation in community governance structures. Condition and position. Condition refers to the material state in which women and men live and relates to their gender responsibilities and work. Improvements in conditions of women and men can be made by providing, for example, safe water, firewood, credit, and health services (practical gender needs). Position refers to social, economic, and political standing of women and men in society relative to men, for example, gender disparities in access to resources and services, unequal representation in decision-making process, and unequal ownership of livestock (strategic gender needs/interests). Gender norms are socially defined acceptable attributes, characteristics, actions and behaviors for women, men, boys, and girls in society. They are the accepted ideas of how women and men should be, and how they should act, within a specific society or community. As social constructs, gender norms vary from culture to culture, and evolve throughout time. Gender norms are learned early in life through the process of gender socialization – social institutions (such as families, and schools), social interactions (such as between family members), and wider cultural products (such as textbooks, literature, film, and video games) – which sets common standards and expectations to which girls and boys, and, later, women and men, should conform. These expectations are reinforced in various ways, for example, through different play environments, toys, and clothing. Gender norms often reflect and reinforce unequal gender relations, usually to the disadvantage of women and girls. Changing gender norms is not just about changing individual mindsets. It is also about considering broader social, economic, and political processes and trends. Gender identities refer to how individuals or groups perceive and present themselves in relation to gender norms. Gender identities may be context-specific and interact with other identities, such as ethnicity, class, or cultural heritage. Gender relations define how women, girls, men, and boys interact with others and how others relate to them, depending on their gender identity, for example, how a male healthcare provider interacts with a female Muslim patient. Gender relations should be analyzed within the sociocultural context in which they develop. Gender relations can define how power and access to and control over resources, including human and animal health care, and benefits are distributed between women, men, boys, and girls. Gender relations intersect with all other influences on social relations – age, ethnicity, race, religion – to determine the position and identity of people in social groups, amplifying barriers to health-seeking for specific groups in specific contexts. Since gender relations are a social construct, they can be changed. 13 Access to and control over resources and benefits. Access refers to the opportunity to use a resource or benefit; whereas control is being able to define and decide on its use. Gender equity and equality. Gender equality means women, men, boys, and girls are treated equally regardless of their gender differences and inequalities. Gender equity means being fair to women, men, boys, and girls to redress historical gender inequalities and differences (Figure 6). For example, gender differences and inequalities may be manifested in access and control over resources (human, natural, physical, financial, and social), wellbeing (health, freedom from domestic violence, mobility), decision-making (household, group, community), workloads (gender division of labor, reproductive versus productive tasks, multi-tasking, length of working day), and access and control over benefits (monetary, non-monetary, food and nutrition security). We must ensure gender equity before we can achieve gender equality. Figure 6. Gender equality and equity. Credit: Angus Maguire/Interaction Institute for Social Change Gender differences and inequalities are produced and maintained through social norms and institutions: rules (how things get done), resources (what is used and/or produced), people (who is in/out, who does what), activities (what is done), and power (who decides, and whose interests are served). Gender stereotypes and biases. Gender stereotypes are beliefs, assumptions and generalizations of characteristics, differences and attributes of women, men, boys, and girls based on their sex. They are beliefs and images of women and men that are popularly depicted in the mass media, folklore, and general conversation. For example, women are emotional, or men are poor at housework. Gender bias is behavior that shows favoritism toward one gender over another. Using male words is a gender bias, for example, he or him. Intersectionality of multiple social identities. Social identities describe the socially constructed groups that are present in specific environments. Our multiple social identities are connected in ways that uniquely shape our experience, perceptions, interactions, and choice (Figure 7). The concept of intersectionality describes the ways in which systems of inequality based on age, gender, race, ethnicity, disability, class, and other forms of discrimination intersect to create unique dynamics and effects (i.e., overlapping social identities and related systems of privilege, domination, or discrimination). All forms of inequality are mutually reinforcing and must be analyzed and 14 addressed simultaneously to prevent one form of inequality from reinforcing another. Gender differences should be analyzed in an intersectional manner to better understand differential health opportunities and risks of women and men in One Health context. For example, an old woman who is also divorced and poor may experience discrimination differently than a married woman in health care settings. Figure 7. Gender and intersectionality. Source: Intersectionality in Today’s Society – SOCI 410 Blog (wordpress.com) 3.4. Gender analysis Gender analysis aims to identify sociocultural constructs that might enhance or inhibit gender equality and women’s empowerment. It explores the relationships of women, men, boys and girls and the inequalities in those relationships, by asking: • Who does what? • Who has what? • Who decides? • Who gains? • Who loses? Effective gender analysis can identify: • Social relations (normative roles, duties, and responsibilities) • Activities (a division of labour within the household and community) • Access and control over resources, services and decision making • Gender needs both practical (current, immediate), and strategic (what needs to change) Through a gender analysis it is possible to obtain qualitative information for understanding the different roles of women, men, boys, and girls, to identify what resources they have, or they control, to understand what their priorities are, and to uncover the reasons for any gender differences. A gender analysis can also help identify where adverse gender issues are impacting gender equality and women’s empowerment. Sex-disaggregation is a first step in gender analysis, which also goes to include gender- disaggregation, gender-sensitive indicators, and participatory research that gives voice to women 15 and men about gender roles and disparities. By so doing, gender analysis can provide explanatory insights as well as generate innovations to achieve gender equality. The practice of gender analysis has evolved into an important disciplinary expertise with a broad range of methods and tools. Gender analysis frameworks range from role-based models like the Harvard framework (Overholt et al. 1985), to models that emphasize planning (Moser 1993), and models that focus on power relations and empowerment (Kabeer 2005). The key features of gender analysis include role definition and relations, understanding of discrimination, attention to both equality and equity, gender mainstreaming efforts, and gender impact assessment. Gender analysis is deeply associated with power relations and empowerment. Kabeer (2005) defines empowerment as the expansion in people’s ability to make strategic life choices in a context where this ability was previously denied to them. Empowerment is not just about expanding choice, it is more fundamentally about the interrelationship of resources (conditions), agency (process), and achievements (outcomes), which are inextricably linked to power and together constitute the potential to convert choice into transformational change. 3.4.1. Gender analysis frameworks and tools Many gender analysis frameworks and tools exist that can be adapted to specific contexts. Gender analysis is often conducted by means of key informant interviews, focus group discussions as well as desk reviews, using a wide range of participatory tools. a) Sex- and gender-disaggregation Sex-disaggregated data are collected and analyzed separately on males and females. For example, 30 training participants (13 women and 17 men). Gender-disaggregated data analyse gender differences, allowing a more accurate understanding of the situation of women, men, boys, and girls. For example, of the 13 women, about 60% are female-headed households. b) Activity profile The tool answers “who does what?” – what women and men (adults, children, elders) do, and where and when these activities take place. Gender roles Women/girls Men/boys Productive activities Activity 1 Activity 2 Reproductive activities Activity 1 Activity 2 Community management activities Activity 1 Activity 2 16 c) Daily activity clock The daily activity clock is a useful tool to compare workload of women, men, boys and girls, differences in contact with people outside the home, identify similarities and differences in the activities performed, and differences in exposure to infections. Time Men Boys Women Girls 05:00 am 06:00 am … d) Access and control profile The tool answers “who has what?” – who has access to and control of resources and services and decision-making – and lists what resources people use to carry out the tasks identified in the activity profile. It indicates whether women or men have access to resources, who controls their use, and who controls the benefits of these resources. Access Control Assets and resources Women Men Women Men Grazing land Watering points Livestock Veterinary drugs Livestock information Income from livestock sales Human healthcare facilities Community leadership e) Context analysis The tool answers “what is the socioeconomic and cultural context?” – how activity, access and control patterns are shaped by structural factors (demographic, economic, legal, and institutional), and by cultural, religious, attitudinal factors – and helps chart factors that influence the differences in gender division of labor, access, and control. Influencing factors Constraints Opportunities Community norms and practices Demographic factors Institutional structures Economic factors Political factors Access to information and training 17 3.5. Gender integration Gender integration is the process of identifying and addressing gender norms, gender relations, and the differences and inequalities between males and females in program planning, implementation, and monitoring and evaluation. Gender integration continuum is a conceptual framework that illustrates the different approaches to gender integration and their potential consequences (Figure 8). It categorizes development approaches by how they treat gender norms and inequalities in the planning, implementation and monitoring and evaluation of programs. Figure 8: Gender integration continuum. Source: Tannenbaum et al. (2016). Gender blind approach lacks information on women and men’s roles, participation, access and control to resources, power relations between them, and other gender aspects. It does not consider how gender norms and unequal power relations will affect the achievement of objectives, or how program or policy will affect gender norms and relations. Gender exploitative approach intentionally or unintentionally reinforces gender inequalities and stereotypes in pursuit of economic outcomes. For example, increasing women’s workload by involving them in time-intensive activities without direct benefit to themselves, income controlled by husbands, etc. Gender accommodating approach recognizes and responds to the specific needs and realities of women and men based on their existing roles and responsibilities; works around existing gender differences and inequalities; integrates women into the existing social and economic context, but do not question the barriers put up by that context. For example, improving women’s access to information, resources, technologies, training, etc. Gender transformative approach explicitly engages both women and men to examine, question and change institutions and norms that reinforce gender inequalities and, through that process, achieve both economic growth and gender equality objectives. The approach sees the sociocultural and economic context as not just something to understand and work within, but as something to act on. For example, women’s empowerment; promoting women’s rights; improving women’s access 18 and control over resources and technologies; organizing women and creating awareness of their rights; increasing women’s ownership of livestock and their ability to market livestock on their own terms; interventions at household level that improve intra-household decision-making on livestock management, including sales and distribution of income from sales (Mulema et al. 2021). 3.5.1. Gender transformative approaches Gender transformative approaches enable women, men, boys and girls to understand how gender inequalities constrain equitable development and to create a household or community vision to improve their lives. Gender transformation can happen at three levels: personal, social, and institutional. Transformational gender tools help challenge the ideological, socio-cultural, economic, political, and institutional frameworks and structures that create, recreate, and maintain gender inequalities. Gender transformation does not simply entail a ‘how to’ but rather a sustained effort to change attitudes that result in the socialization of gender equity norms. A state of change to aim for (visioning) can be identified through such as scenario planning. Women and men’s community groups define the future/desired state they would like to see and then discuss constraints, what needs to change (solutions), what steps are needed to get there (actions), and how to know progress (indicators). Household methodologies (such as household mentoring, household visioning and action planning, Gender Action Learning System, etc.) seek to change the persistent pattern of gender inequality within the household. Women in male-headed households often lack a voice in determining household priorities and spending patterns, and in addressing their own wellbeing. Household methodologies shift the focus from the individual to the household level, and from things such as assets, resources, and infrastructure to people, whom they aspire to be, and what they aspire to do. They enable household members to work together to improve relationships and decision-making and achieve more equitable workloads by tackling underlying social norms, attitudes, behaviors, and systems. Collaborative tools are used to facilitate behavior change and planning within the household. One such tool is the vision road journey which helps household members to shape their idea of a better life. It analyses the present situation and the past and identifies opportunities and challenges. Another tool is the Gender Balance Tree (Figure 9) which illustrates the distribution of productive and reproductive roles, assets, decisions, and responsibilities between household members and the benefits they each accrue. The objectives/uses of the Gender Balance Tree are to: • identify who contributes most work to the household: women or men • identify who spends most for the household: women or men • identify who benefits most from household income: women or men • identify inequalities in ownership and decision-making • decide whether the household tree is balanced • decide priority areas for improving the gender balance of the tree so it can stand up straight and bear richer fruit equally for women and men • see which household members ‘challenge and break the gender norms’ as a basis for change 19 Figure 9. The gender balance tree. Adapted from McCarthy (2018). Households are like trees. They need to be properly balanced if they are to bear rich fruit. If the roots are not equally strong on both sides, then the tree will fall over in the first storm. If the fruits on one side are heavier than on the other, then the tree will fall over and there will be no harvest next year. Inequalities between women and men in households are a key cause of imbalances and inefficiencies in the household tree which make them fail. Often women and men do not work equally, leading to inefficient division of labor inputs to the tree. Women and men may not benefit equally in the fruits and unproductive expenditures may cause the tree to fall over. The household trunk is often made to bend one way or the other because of inequalities in ownership and decision- making. This means everyone goes their own way without caring about the other and the whole tree becomes weak. It is important that the forces acting on each side of the trunk are equal to help it grow straight and help the flow of goodness from roots to branches. Even if fertilizer is given to the roots, if this is done on one side only e.g., training or inputs only for the men, or if the forces acting on the tree are not made equal e.g., asset ownership, then the tree will just grow faster on one side and may fall over even faster. The gender balance tree aims to address these imbalances, so everyone contributes equally, and everyone benefits. Then, the household tree can grow straight and strong with strong roots and big fruits and is sustainable (Mayoux 2014). Community methodologies (for example, community conversations) enable collaborative exploration and analysis of underlying gender norms and practices, challenge community gender perceptions and lead to actions toward equitable gender relations and role sharing within the household (Lemma et al. 2021). 20 3.6. Practical application of gender concepts to One Health in pastoralist settings Pastoralist women play key roles in livestock and rangeland management such as managing livestock, water points, grazing land management, and herding and grazing livestock in nearby rangelands. They have access to and responsibility for livestock care but not necessarily ownership or control over decision-making in relation to livestock acquisition, disposal, and exchange. Women are usually responsible for the management of child health; they are the ones going to the clinic, ensuring children get vaccinated and receive treatment when needed. But they normally need to ask for money to their husband/partner to access healthcare. 3.6.1. Gender issues in pastoralist communities Pastoralist women face many challenges, including: • limited access to animal healthcare services • personal safety in accessing water and grazing • limited mobility due to heavy workload and cultural norms and customary practices • climate change (women have greater exposure to climate hazards, greater susceptibility to damages caused by climate change, and less ability to cope with and recover from these damages) • limited decision-making powers on their and their children health (both preventive and curative care) • limited access to funds to access health facilities (for direct and indirect costs) • limited decision-making power in an emergency. For example, it is quite common that women cannot decide on where and when to access care at the time of childbirth. In case of emergency, when complications arise and a timely transfer to the hospital is required, the man must be there to give his approval. Late arrival at the hospital is often a cause of stillbirth and maternal mortality. • poor cultural knowledge and attitude of health workers are also affecting access to care among pastoralist women who do not feel comfortable, especially at the time of delivery. They are not allowed to choose their preferred delivery position and feel uncomfortable in being assisted by male midwives and doctors. • limited access to natural resources (grazing and water for livestock) • limited accessibility to and utilization of healthcare services • limited participation and voice in community decision-making processes • limited recognition of inheritance rights • limited access, ownership, and control of incomes from livestock sales • limited access to services (information, advice, health facilities). What this means for One Health is that access, ownership, and management of livestock and access to natural resources and healthcare services as well as trends related to these need to be properly understood to inform gender-sensitive interventions. This helps not only understand the socio-cultural context to guide interventions but also ensures that the interventions do not negatively impact women’s rights, undermine, or override them. 21 a) Gender dimension of mobility Mobility is a key strategy for pastoralist communities to access resources. It is important to analyse the gender dimension of mobility to understand the differential opportunities and constraints of women and men. Exploring questions such as ‘who is moving to where, for what reasons and for how long?’ and ‘who takes livestock to markets, who controls income from livestock sales?’ inform gender differences and power dynamics within the household. Mobility influences women and men in pastoral communities as they undertake different roles. For example: • men often migrate seasonally with the main herd. • women are often left with pregnant, sick, weak, or young animals, responsible for caring for the rest of the household as well as farm plots. • women also undertake seasonal herding in nearby locations. • men often migrate for non-pastoralist-related work, meaning women are taking over traditional men’s tasks. • customary rules and traditions can limit women’s mobility and freedom which results in women facing challenges in participating in extension meetings or training activities on subjects such as husbandry and veterinary practices. b) Access and control over resources Natural resources such as rangelands and watering points are communally accessed and managed in pastoral communities. Women also have less access to financial resources and markets. Gender norms and relations can influence the differential access and use of these resources and decisions over their use, leading to non-equitable resource distribution and utilization between women and men. Further, gender intersects with other identities of women to influence their access to and control over resources such as livestock, rangelands, water, information, and services. Failure to properly analyze gender differences, identify constraints, and design strategies can negatively impact One Health outcomes. c) Status and position of pastoralist women Understanding how women are viewed in pastoralist communities and how the clan provides protection of women’s traditional rights (gender-based social justice), and what cultural systems magnify the role of women in conflict management can give valuable insights into socio-cultural factors to consider in One health practices. d) Changes in production systems Changes in pastoralist production systems due to climate change can have a differential impact on women and men such as changes in their gender roles, access to resources, decision-making, and income-earning opportunities. For example, the decline of income from livestock products particularly affects women where they traditionally are engaged in selling milk products to use for household expenditure. The practical implication of this is that a good understanding of gender issues and influencing factors is key for One Health interventions to ensure both gender equality and health outcomes. 22 e) Social structures and institutions Gender inequality is embedded in institutions, including human and animal health institutions. Institutions determine who has access to what, who does what, who controls what, who decides on what, or who has what opportunities and benefits. It is important to understand the differential opportunities and constraints of women and men for accessing and using health services in the One Health approach. Pastoralist women are less involved in decision-making processes both at the community and household levels. They often have limited decision power concerning their and their children’s health. They may also have less control over household assets including financial resources. Although decisions over livestock can be jointly taken, women may have less ability to negotiate and influence decisions. It is important to better understand household gender dynamics and identify the roles and constraints of household members. There may be capacity differences among household members (husband and wife) to participate in decisions on household activities (such as selling and buying animals, and mobility decisions). This may be pronounced for women in male- headed households where they have lower household and community level decision-making power. Strengthening the decision-making power of women in male-headed households over household assets and income can contribute to household food security, wellbeing, and health of household members. f) Differential exposure to disease risks Women, men, boys, and girls impact the environment differently and are also impacted differently by it (Bagnol, Alders and McConchie, 2015). Pastoralist women play key roles in livestock health management and processing of animal source foods. Despite differences in access to information and knowledge on livestock management, women are as knowledgeable as men in identifying and prioritizing animal diseases. Women and men are differently affected by and vulnerable to health risks. Due to their role in livestock management, women and men can be exposed differently to infectious diseases such as zoonotic diseases (Annet et al. 2020). For example, women are more likely exposed to pathogens in milk, birthing products, and manure. Men are more likely exposed to pathogens in blood during the slaughtering process. Hunting wildlife can also expose communities to different health risks. This can be significant for women given their roles in caring for sick or newborn animals, milking animals, cleaning barns, or assisting births. Handling and consumption of raw animal source foods can also expose women, men, boys and girls to zoonotic diseases (Lemma et al. 2019). Women are traditionally responsible for handling food for both family consumption and sale (milking animals, processing the milk, and preparing meals. Consequently, women tend to be exposed to a higher risk of zoonotic diseases than men (Eba 2020). Such gender-related issues should be adequately considered when designing and implementing One Health interventions. This way, women and men can be effectively supported in increasing the productivity and welfare of their livestock and improving their livelihoods and health. 23 3.7. Putting it together: learning integration and reinforcement For One Health to achieve its purpose of building sustainable livelihoods, especially in areas highly predisposed to zoonotic diseases and rapid environmental change, the planning and implementation of its programs must capture the culture, gender relations, factors to disease occurrence and the knowledge, attitudes, and practices of both genders on prevention and control. As One Health is a collaborative, transdisciplinary approach to achieving optimal health outcomes for humans, animals, and the environment, it requires going beyond the control of diseases. Biomedical and environmental specializations have historically been well represented within the One Health work (Friedson-Ridenour et al. 2019). It is critical to recognize the role of social scientists in One Health to ensure proper analysis and integration of social, cultural and gender issues. However, disciplinary culture and biases may be barriers to collaborative and intradisciplinary practices in One Health, and this requires understanding and appreciating the limitations of own disciplines and developing shared language and conceptual and analytical frameworks. Understanding the interaction between culture, gender and One Health can lead to important insights into disease transmission patterns, strategies for prevention and control and the use of a multidisciplinary approach to inform policy and practice. One Health professionals work in a manner that considers everyone’s cultural characteristics and unique values so that the most effective services can be provided. Pastoralist women often face obstacles in accessing and thriving in training, advisory opportunities, and community engagement. One Health practitioners need to ensure that gender- and culture- specific communications, information, and training reach women in animal, human and environmental health services. Gender-responsive community engagement approaches, such as Community Conversations, can be effective ways to challenge and transform gender norms towards equitable role sharing and valuing of women’s contributions. Embedding gender and sociocultural issues in One Health platforms such as multistakeholder innovation platforms (MSIPs) can increase participation and empowerment of women and men and measure gender integration progress and outcomes. Such community engagement approaches can facilitate discussions about the intersection of gender, culture, and health, and encourage men to act in solidarity with women in the quest for women’s empowerment and gender equality in health and well-being. 3.8. Self-assessment questions First, review your notes and pre-reading reflections. Then, try to answer the following questions to deepen and reinforce your learning experience. 1. Explain with examples how gender interacts with other social identities to shape bias and discuss the implications of this in One Health context in pastoralist settings. 2. Explain with examples how gender norms and relations can affect participation and women’s empowerment in One Health context in pastoralist settings. 3. Explain with examples how gender norms and relations can affect collaboration and partnership both at the organizational, community and household levels and discuss how this can be challenged and transformed. 24 4. References and further reading Amoki, O.T., Bikaako, W., Muchunguzi, C., Gatongi, P., Oduma, J., Kisaka, J.K., Amuguni, H. 2019. Culture and Ethical Values in One Health and Infectious Disease Management. Facilitator guide. Kampala, Uganda: OHCEA. Amuguni, H., Mugisha, A., Bagnol, B., Kyewalabye, E., Talmage, R. and Shah, N. 2019. Gender, One Health, and Infectious Disease. Facilitator Guide. Kampala, Uganda: OHCEA. Amuguni, H., Mugisha, A., Kyewalabye, E., Bagnol, B., Talmage, R., Bikaako, W., & Naigaga, I. 2018. EnGENDERing One Health and addressing gender gaps in Infectious disease control and response: Developing a Gender, One Health and Emerging Pandemics threat short course for the public health workforce in Africa. Advances in Social Sciences Research Journal, 5(5) 467-479. Bagnol, B., Alders, R. and McConchie, R. 2015. Gender Issues in Human, Animal and Plant Health using an Ecohealth Perspective. Environment and Natural Resources Research 5(1):62-76. Barker G, Ricardo C, Nascimento M. 2007. Engaging men and boys in changing gender-based inequality in health: evidence from programme intervention. World Health Organization. CEDPA (The Centre for Development and Population Activities). 1996. Gender and Development. The CEDPA Training Manual Series. Drucza, K. and Abebe, W. 2017. Gender transformative methodologies in Ethiopia’s agricultural sector: A review. Addis Ababa, Ethiopia: CIMMYT. Drucza, K., Lemma, M., Mulema, A., Kinati, W. 2018. Gender responsive research: Training facilitation manual for EIAR gender focal persons. CIMMYT-Ethiopia: Addis Ababa. Eba, E., Wieland, B., Flintan, F., Njiru, N. and Baltenweck, I. 2020. Gender and One Health context analysis for HEAL. Nairobi, Kenya: ILRI. Eliyas, A. and Jose, D. 2019. The Dynamics of Gender Relations under Recurrent Drought Conditions: A Study of Borana Pastoralists in Southern Ethiopia, Human Ecology, 47(3): 435-447. DOI:10.1007/s10745- 019-00082-y FAO (Food and Agriculture Organization of the United Nations). 2013. Understanding and integrating gender issues into livestock projects and programs: A checklist for practitioners. Rome, Italy: FAO Farnworth, C.R., Stirlinga, C.M., Chinyophiroc, A., Namakhomac, A. and Morahand, R. 2018. Exploring the potential of household methodologies to strengthen gender equality and improve smallholder livelihoods: Research in Malawi in maize-based systems. Journal of Arid Environments 149: 53–61. Frankson R, Hueston W, Christian K, Olson D, Lee M, Valeri L et al. 2016. One Health core competency domains. Frontiers in Public Health 4:192. doi: 10.3389/fpubh.2016.00192 Friedson-Ridenour S., Tracey V. Dutcher, Claudia Calderon, Lori DiPrete Brown, and Christopher W. Olsen. 2019. Gender Analysis for One Health: Theoretical Perspectives and Recommendations for Practice, EcoHealth https://doi.org/10.1007/s10393-019-01410-w Kabeer, N. 2005. Gender Equality and Women’s Empowerment: A Critical Analysis of the Third Millennium Development Goal. Gender and Development, 13, 13-24. https://doi.org/10.1080/13552070512331332273 Kristjanson P, Waters-Bayer A, Johnson N, Tipilda A, Njuki J, Baltenweck I, et al. 2010. Livestock and women’s livelihoods: A review of the recent evidence. International Livestock Research Institute, Discussion Paper No. 20. Lemma, M. and Tesema, E. 2016. New Approaches and Methods for Addressing Gender Gaps in Extension Services: Experiences and Lessons from LIVES Project in Ethiopia. Journal of Agricultural Economics, Extension and Rural Development 4(4): 429-435. Lemma, M., Mulema, A., Gizaw, S., Mekonnen, M., Tigabie, A. and Wieland, B. 2021. Master training course on community conversation approach in animal health management. Nairobi, Kenya: ILRI. https://hdl.handle.net/10568/114137 25 Mayoux, L. 2014. Rocky Road to Diamond Dreams: GALS Phase 1 Process Catalyst Manual. Oxfam Novib. McCarthy, L. 2018. There is no time for rest: Gendered CSR, sustainable development, and the unpaid care work governance gap. Business Ethics: A Eur Rev. 27:337–349. https://doi.org/10.1111/beer.12190 Moser C. 1993. Gender Planning and Development: Theory, Practice and Training, New York: Routledge. Mulema, A.A., Kinati, W., Lemma, M., Galiè, A., Ouma, E., Baltenweck, I., Kangogo, D., Barasa, V., Rischkowsky, B., Mora Benard, A.M., Godek, W., Tavenner, K., van Lidth de Jeude, M. and Rijke, E. 2021. Gender capacity development guidelines for trainers. ILRI Manual 43. Nairobi, Kenya: ILRI https://hdl.handle.net/10568/113767 Mulema, A.A., Kinati, W., Lemma, M., Galiè, A., Ouma, E., Baltenweck, I., Kangogo, D., Barasa, V., Rischkowsky, B., Mora Benard, A.M., Godek, W., Tavenner, K., van Lidth de Jeude, M. and Rijke, E. 2021. Gender capacity development participants’ pack. ILRI Manual 44. Nairobi, Kenya: ILRI. https://hdl.handle.net/10568/113762 Njuki, J., Waithanji, E., Bagalwa, N. and Kariuki, J. 2013. Guidelines on integrating gender in livestock projects and programs. Nairobi, Kenya: ILRI. https://hdl.handle.net/10568/33425 Public Health and Global Societies: A survey course in Global Health. https://pubh110.digital.uic.edu/ Tannenbaum, C., Greaves, L. and Graham. I.D. Why sex and gender matter in implementation research. BMC Medical Research Methodology 16:145. DOI 10.1186/s12874-016-0247-7 World Bank. 2014. Levelling the Field: Improving Opportunities for Women Farmers in Africa. World Bank Group. 26