"Gender" refers to the different roles that men and women play in society and also to the rights and responsibilities that come with these roles (39, 53, 202, 283). "Gender" differs from "sex," which refers to the biological and physical differences between men and women (53, 104, 154, 171).

So strong are gender roles that they usually are taken for granted. They are reflected in virtually every social institution, including family structures, household responsibilities, labor markets, schools, health care systems, laws, and public policies. The influence of gender is similar in strength to that of religion, race, social status, and wealth (53, 171, 202).

Worldwide, health care providers, policy-makers, and donors are recognizing the direct connection between men's and women's gender roles and their reproductive health (53, 106, 110, 157, 254, 261, 262). In particular, they are concerned about the effect that inequities in gender roles have on women's well-being. The ICPD Program of Action recognizes the importance of gender in stating: "In all parts of the world, women are facing threats to their lives, health, and well-being as a result of being overburdened with work and of their lack of power and influence" (251).

In many countries traditional male and female gender roles deter couples from discussing sexual matters, condone risky sexual behavior, and ultimately contribute to poor reproductive health among both men and women. Programs can encourage men to adopt positive gender roles, such as being supportive husbands and caring fathers (see Use Communication to Promote Behavior Change).