London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK.
School of Public Health, University of Nevada, Reno, NV, USA.
Soc Sci Med. 2022 Jan;293:114652. doi: 10.1016/j.socscimed.2021.114652. Epub 2021 Dec 10.
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.
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.
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.
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.
了解性别规范如何影响健康是设计方案和政策以改变规范、提高性别平等和健康水平的重要切入点。然而，全球卫生数据集很少包含关于性别规范的问题，特别是那些超出衡量与性别相关态度的问题，从而限制了对性别问题的分析。
我们使用来自六个国家的健康调查数据开展了五个案例研究，旨在展示定义和操作代理指标的方法，以及调查性别规范如何影响健康的分析方法。总结了我们的规范代理指标和方法选择的主要发现、优势和局限性。
案例研究揭示了性别规范与多种青少年健康结果之间的联系。规范代理指标来源于态度、信念和行为数据，以及态度和行为之间的差异。数据来源包括横断面数据、纵向数据、普查数据和社会网络数据。分析方法多种多样。我们发现，性别规范影响着：1）尼日利亚的亲密伴侣暴力；2）巴西和南非的不健康体重控制行为；3）赞比亚的艾滋病毒状况；4）美国的健康和社会流动；5）洪都拉斯的分娩。
研究人员可以利用现有的全球健康调查数据，通过生成性别规范代理指标，来研究性别规范影响健康的途径。虽然性别规范的直接衡量方法可以极大地提高对性别如何影响健康的理解，但规范代理指标可以针对特定的与健康相关的结果和规范背景进行设计，例如通过汇总行为或态度，或者量化它们之间的差异（不和谐）。这些规范代理指标可以评估性别规范对健康的影响，并深入了解可能的参照群体和不遵守者的制裁，从而为塑造规范和改善健康的方案和政策提供信息。
