The standards and expectations to which men and woman generally conform impact health across life stages, health sectors and world regions, finds a new study from the Brown School at Washington University in St. Louis.

By analyzing a series of six case studies, gender norms expert Lindsay Stark, associate professor at the Brown School, and co-authors show that such norms are complex and their impact on health can be context-specific.

The study, “Gender Norms and Health: Insights From Global Survey Data,” was published in the British journal The Lancet as part of a series on gender norms and health.

Also among the researchers in the series was Jessica Levy, associate professor of practice at the Brown School, who was second author on a study titled “Improving Health With Programmatic, Legal, and Policy Approaches to Reduce Gender Inequality and Change Restrictive Gender Norms.”

The Lancet series aims to inform the global health community of the critical need and effective actions that must be taken to recognize and transform restrictive gender norms and gender inequalities. The research looked at their intersections with other social inequalities — including those related to age, race and ethnicity, religion and socio-economic status — in all they do.

“Gender norms are the spoken and unspoken rules of societies about the acceptable behaviors of girls and boys, women and men — how they should act, look and even think or feel,” Stark and co-authors wrote in their paper.

“Gender norms are perpetuated and challenged in families, communities, schools, workplaces, institutions and the media. These expectations start early and powerfully shape individuals’ attitudes, opportunities, experiences, and behaviors, with important health consequences throughout the life course.”

“Gender norms are complex in how they interact with social factors to influence health behaviors,” Stark said. “We have seen cases where individuals make poor health decisions based on how they believe others in their community expect them to act. We have also seen cases where individuals’ health may be harmed if they transgress communal norms and are forced to suffer the repercussions.”

From more than a dozen case studies involving secondary analyses of existing global, national and subnational datasets, the researchers selected six to discuss in the Stark paper, on the basis of conceptual and practical considerations.

“Our analyses were informed by feminist sociological theories on how gender norms contribute to shaping an unequal gender system that can be harmful to both women and men, boys and girls,” the authors wrote. “We sought to include pathways across the life course, from different geographical settings, and for diverse mental and physical health-related outcomes, despite challenges in data quality and operationalizing gender norms.”

The case study led by Stark and co-author Ilana Seff, PhD candidate at the Brown School, compared Nigerian communities where working outside of the home was, and was not, a norm.

Women who defied communal norms by working outside of the home faced higher rates of intimate partner violence than women workers in less restrictive communities.

“This finding has important implications for processes of empowerment,” Stark said. “Women who are trailblazers in shifting inequitable norms to improve their economic standing may be at increased risk for violence. Acknowledging the complexity of the relationships between individual behavior and social norms, and understanding how discordance between the two might give rise to unintended negative outcomes for women and girls, is critical for developing truly gender-equitable policies and programs.”

The case studies focused on childhood illness in Ethiopia; adolescent weight control and mental health in South Africa and Brazil; school peer influences on adolescent health in the United States; premarital sex and HIV status in Zambia; and women working outside the home and intimate partner violence in Nigeria.

Journal Link: The Lancet