Innovative methods to analyse the impact of gender norms on adolescent health using global health survey data

Beniamino Cislaghi; Ann M Weber; Holly B Shakya; Safa Abdalla; Amiya Bhatia; Benjamin W Domingue; Iván Mejía-Guevara; Lindsay Stark; Ilana Seff; Linda M Richter; Ana Maria Baptista Menezes; Cesar G Victora; Gary L Darmstadt

doi:10.1016/j.socscimed.2021.114652

Innovative methods to analyse the impact of gender norms on adolescent health using global health survey data

Soc Sci Med. 2022 Jan:293:114652. doi: 10.1016/j.socscimed.2021.114652. Epub 2021 Dec 10.

Authors

Affiliations

¹ London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK.
² School of Public Health, University of Nevada, Reno, NV, USA.
³ Department of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA, USA.
⁴ Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
⁵ Graduate School of Education, Stanford University, Stanford, CA, USA.
⁶ Center for Population Health Sciences, Stanford University School of Medicine, Stanford, CA, USA; Stanford Aging and Ethnogeriatrics (SAGE) Research Center, Stanford University School of Medicine, Stanford, CA, USA.
⁷ Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA.
⁸ Centre of Excellence in Human Development, University of Witwatersrand, Durban, South Africa.
⁹ International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande de Sul, Brazil.
¹⁰ Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: gdarmsta@stanford.edu.

Abstract

Background: Understanding how gender norms affect health is an important entry point into designing programs and policies to change norms and improve gender equality and health. However, it is rare for global health datasets to include questions on gender norms, especially questions that go beyond measuring gender-related attitudes, thus limiting gender analysis.

Methods: We developed five case studies using health survey data from six countries to demonstrate approaches to defining and operationalising proxy measures and analytic approaches to investigating how gender norms can affect health. Key findings, strengths and limitations of our norms proxies and methodological choices are summarised.

Findings: Case studies revealed links between gender norms and multiple adolescent health outcomes. Proxys for norms were derived from data on attitudes, beliefs, and behaviours, as well as differences between attitudes and behaviours. Data were cross-sectional, longitudinal, census- and social network-based. Analytic methods were diverse. We found that gender norms affect: 1) Intimate partner violence in Nigeria; 2) Unhealthy weight control behaviours in Brazil and South Africa; 3) HIV status in Zambia; 4) Health and social mobility in the US; and 5) Childbirth in Honduras.

Interpretation: Researchers can use existing global health survey data to examine pathways through which gender norms affect health by generating proxies for gender norms. While direct measures of gender norms can greatly improve the understanding of how gender affects health, proxy measures for norms can be designed for the specific health-related outcome and normative context, for instance by either aggregating behaviours or attitudes or quantifying the difference (dissonance) between them. These norm proxies enable evaluations of the influence of gender norms on health and insights into possible reference groups and sanctions for non-compliers, thus informing programmes and policies to shape norms and improve health.

Keywords: Attitudes; Behaviours; Gender equality; Gender norms; Global health; Reference group; Sanctions; Survey data.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adolescent Health
Global Health*
Health Surveys
Humans
Intimate Partner Violence*
Social Norms
Surveys and Questionnaires

Grants and funding

K01 HD087551/HD/NICHD NIH HHS/United States