Assessing progress in gender-transformative sexual and reproductive health interventions: how does practice-based knowledge compare with published evidence in sub-Saharan Africa?

BACKGROUND: Discriminatory gender norms and unequal power relations shape sexual and reproductive health (SRH) outcomes in sub-Saharan Africa. Yet, approaches to assessing progress in gender-transformative interventions remain underdeveloped. OBJECTIVE: This paper compares measures and approaches to gender-transformative SRH interventions in the published evidence with practitioners' perspectives in sub-Saharan Africa. METHODS: The study draws on two data sources from a broader research initiative: in-depth interviews with 19 African practitioners and researchers engaged in gender-transformative health programming, and 44 published evaluations of 20 gender-transformative SRH interventions implemented between 2012 and 2025. We examine what is assessed, how assessments are designed and implemented, and when they are conducted. RESULTS: Practitioners emphasised assessments that capture multi-level, context-specific changes; participatory processes; longitudinal, qualitative methods; and documentation of change pathways and sustainability. In contrast, published studies predominantly measured short-term, individual-level attitudinal and behavioural change - especially among men - using standardised, externally defined instruments reliant on self-reports, with limited attention to women's empowerment, intersectional inequalities, institutional or health-system change, or long-term sustainability. CONCLUSIONS: Findings reveal significant misalignments between practice-based knowledge, feminist and gender-responsive evaluation principles, and published evaluation studies. To strengthen investment and learning, we propose advancing assessment frameworks that: engage with communities in the design, implementation, and assessment of gender-transformative SRH interventions; use gendered health outcome indicators; use participatory approaches; document processes and unintended effects; validate men's self-reports with other perspectives; and extend evaluation beyond project cycles. Aligning evidence generation with grounded African practice is essential for more effective and sustainable gender-transformative SRH programming in sub-Saharan Africa.