‘I took a loan to rent out a piece of land where I could farm and sell the produce. The farm flooded with all my crops. I had already invested a lot, so I took a second loan from the group [savings group] to try a second time. Again I experienced another flood. Now I work here at the reception during the day and I am a seamstress in the evenings and weekends to try and pay off my debts.’ – Jane Doe, Homa Bay town.
Jane is not alone. With the climate shifting under the weight of our emissions and disappearing ecosystems, she will likely be one among many. Often, individuals, especially women, lose their savings or mount debt due to sudden shocks that they could have been insured against. It is easy to say that had Jane had some type of insurance, she would not have had to take a second loan and would not be facing a mountain of debt. However, the reality is that, despite insurance being a valuable and crucial tool for risk management, it remains heavily inaccessible and underutilized in the global south, especially by women. In order to understand why, we need to go beyond financial and structural barriers and address interventions design, delivery and communication.
Designing studies or interventions for women necessitates more than including a ‘gender’ checkbox in the outlines. A gendered lens requires intentionality, accessibility, and a clear commitment to making sure women are both present and involved in shaping the outcomes of research. In the several projects we have done across different countries, it is clear how the lack of intentionality directly contributes to the low uptake of behavioral interventions among the population and, in particular, women.
We explore how being intentional in designing for women can ensure that we have effective interventions drawing from the work that Busara has done.
Intentionality
Promoting impactful behavioral change among women needs to start by acknowledging that women are central stakeholders in our communities. Yet in practice, women are often seen as an afterthought, a sidenote or a checkbox in research and intervention design, included as a diversity pool, usually for funding requirements. Intentionality requires acknowledging that women are not only beneficiaries of interventions like insurance, but also key decision-makers in communities.
In Kenya, we have witnessed many interventions rolled out with an emphasis on increasing awareness and promoting financial literacy for women, as an assured way of bringing about uptake of insurance. While both are crucial, we find the reality is that women often have obligations that get prioritized over insurance – school fees, healthcare, and food, for instance even when participants absolutely understand the importance of insurance. Therefore, designing any intervention that does not ask, ‘What do we need to understand about women in this particular context’ leads to designing unimpactful interventions that fail to address key underlying issues.
Something else that is often overlooked is the fact that women are not homogenous. A young, single woman in an urban location will experience risk, economic instability and household dynamics very differently from a middle-aged, married woman in a rural location. Despite this, solutions are often marketed as a one-size-fits-all output. Insurance products for women or agricultural insurance for female farmers. However, which women are being addressed? What type of farmers are being addressed? Approaches which ignore the intersectionality of gender, age, marital status, education, economic standing, environmental aspects, cultural norms and other factors will miss out on understanding issues that heavily impact behaviors.
Finally, it is important to emphasize that women do not exist in a vacuum. We often find that at the very least, women make monetary decisions in partnership with their spouses and in many cases, defer monetary decisions to their spouses or male figures in their lives. For example, in a Busara study regarding savings groups in Kenya, we find that even with personal savings, at least 44% of married women budget for their savings with their spouses and an additional 14% save on their own with occasional support from their spouses. In a different study with households, we observed that when making household budgeting decisions, including for insurance, women work in tandem with their spouses or, in some cases, leave the decision-making to the spouse.
Accessibility
One of the biggest challenges we face during field work and intervention uptake is securing sustainable participation from women. Socio-cultural roles like caregiving, household responsibilities and economic responsibilities make it harder to secure continuous or long-term female participation. To overcome this, and avoid creating stressful, restless environments for female participants, we have to ensure that we design our research according to and around these realities rather than enforcing inflexible and demanding timelines and parameters.
With women’s savings groups, Busara found that participants are much more receptive when scheduling discussions around the time they already planned to meet. It was easier to coordinate and plan around their schedules rather than extending field days in hopes of getting a larger sample.
In a different project promoting HPV vaccinations, the intervention involved hairdressers as community vaccine champions; we had trainers sit in with them as they were working and catering to their clientele, thus making it convenient for them. Apart from courtesy and effective research design, both methods created a rapport that made the respondents open to understanding what is being discussed rather than restlessly waiting for the session to conclude so they may get back to more pressing matters. Leveraging existing social structures and social time slots provides an effective accessibility strategy for intervention uptake.
Furthermore, it is important to design around the lived realities of women respondents and participants. Often, we find that our respondents are mothers who would attend sessions with their children. And catering to needs that make the environment more accommodating is crucial to good research feedback.
For instance, lengthy sessions could cater to meals and refreshments that reduce fatigue., Having simple toys or activities can help keep children engaged. When we were conducting a card sorting exercise with women, we carried extra boards and cards which children could ‘sort’ alongside their mothers which helped reduce fussiness and wailing.These small design choices signal respect for women’s time, responsibilities, and realities, conditions that make genuine participation possible.
Designing interventions
When designing efficient interventions that align with women’s lived realities, they can further be customized to context, and here is a guideline on the best practice methods for designing research interventions for women.
- Simplicity and time sensitivity
Insurance and risk management products and protocols are often complex (or overcomplicated) and require in-depth explanations and paperwork. Women who are already stretched for time are very unlikely to immerse themselves in such a complicated-sounding process. Simplifying interventions not only makes it easier for participants but also increases trust; people are more likely to trust what they understand and can comprehend. Some of the ways this can be done is by ensuring that the tools cater to local languages, education levels and even tech-literacy.
- Social acceptability and safety
Something that bears reiterating is that context matters. Socio-cultural norms often set certain expectations and restrictions on what may be appropriate or inappropriate for women. It is crucial that interventions avoid placing women in situations that may appear culturally questionable or unsafe. For instance, there are some communities where women cannot attend mix-gender trainings or briefs. Any intervention that does not take this into consideration is bound to fail. Behavioral interventions should be mindful of socio-cultural norms to avoid isolation and stigmatization of female participation.
- Leveraging social networks
Our previous work with savings groups and hairdressers highlight how crucial social support networks can be for women’s comfort and safety in giving genuine opinions or experiences. Even in settings with strangers, women are likely to engage in personal, private conversations as long as they occur in informal, trusted social circles. Positive word of mouth on insurance products and risk management methods from trusted peers rather than agents would have a bigger impact on intervention efficiency. Designing around methodologies that include snowballing and leverage social proof can help in uptake of interventions.
- Transparency and trust
Women have been a marginalized community in most decision making interventions. They are more risk averse and distrusting because of this. In our previously mentioned work with savings groups, an agent informed us that whenever they introduce something new, it has to work flawlessly otherwise they risk losing the entire group. Slip ups and intervention failures are likely to deepen mistrust and further marginalize women in implementation uptake. To that end, the most important part of study and intervention design is to ensure transparency in every aspect, including possible effects or limitations.
Effective interventions for women require more than inclusion, they demand design grounded in women’s actual contexts. When we account for responsibilities, decision-making dynamics, social networks, and trust, participation becomes possible and meaningful. By building around these realities, interventions stop being theoretical solutions and become tools women can genuinely use.
Low uptake of behavioral intervention of risk management mechanisms for women cannot solely be linked to affordability or accessibility. At the center of it all is deliberate study and intervention design. Women need to be prioritized as key stakeholders and decision makers in a context specific lens. This helps us move beyond arbitrary designs in order to cater to core issues and develop relevant interventions to mitigate risk in communities.
Fostering long-term trust among women
In many studies, researchers extract information from communities without disseminating findings of the research. This has shown to create a transactional relationship between researchers and participants, eroding trust over time. This particularly happens when we do not have structured community exit strategies, in short, disappear after data collection without communicating findings to the community. Closing the loop on a study helps to foster trust not only in organizations but in effective interventions too.
In A better how, the research process is well summarized in the following steps:
- Hire local enumerators for better contextualization of research tools.
- Identify and include community focal points such as village heads that would assist with conducting research and identifying any potential conflicts and resolutions.
- Involve the larger community by informing them on the study objectives and reaching a mutual understanding.
- Ensure an open line of communication throughout the process and stress on informed consent at all stages.
- Close the loop on the study by addressing initial expectations, study achievements and learnings on future research.
- Finally, share findings with community members to uphold ethical guidelines and avoid a transactional nature of research.
