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Moalla KT, Darmstadt GL. Legal pluralism and tribalism: Drivers of gender and health inequalities. J Glob Health 2024; 14:03020. [PMID: 38813678 DOI: 10.7189/jogh.14.03020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Affiliation(s)
- Khadija T Moalla
- Senior Development, Human Rights and Gender International Consultant, Tunisia
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Closson K, Zharima C, Kuchena M, Dietrich JJ, Gadermann A, Zulu B, Ogilvie G, Beksinska M, Kaida A. " It's a 50/50 Thing You Know": Exploring the Multileveled Intersections of Gender and Power Within the Relationships of Young South African Men and Women. JOURNAL OF SEX RESEARCH 2024; 61:144-159. [PMID: 36260421 DOI: 10.1080/00224499.2022.2129561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Efforts to advance sexual health globally require greater understandings of youth intimate relationship dynamics. Among 38 South African youth (21 women/17 men aged 21-30 from Durban and Soweto) we conducted qualitative cognitive interviews to explore how gender and power intersect to shape intimate relationship dynamics (October 2019-March 2021). Participants discussed perceptions and relevance of each of 13 items comprising the Sexual Relationship Power (SRP) scale, a widely used measure of gender equity, and the influence of SRP on youth sexual health. Data analysis was guided by constructivist grounded theory. The findings were organized using the socio-ecological model, revealing how gender and power intersected at multiple levels to influence youth intimate relationships. Key influencing factors included individual-level gender attitudes, male partner expectations, and women's resistance to dominance; intimate relationship-level power dynamics, consent, and intimacy; family-level household configurations and parental monitoring of daughters; and societal-level traditional gender norms. At all levels, women discussed resisting power inequities through communication and rejection of inequitable relationships. While men also displayed resistance to inequitable power structures, most upheld traditional gender norms through institutional affiliation (e.g. church) and deep-rooted socialized beliefs and attitudes. Efforts to improve youth sexual health require multileveled approaches that address inequitable power dynamics.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia
| | - Campion Zharima
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand
- Centre for Health Policy, School of Public Health, University of the Witwatersrand
| | - Michelle Kuchena
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand
| | - Janan J Dietrich
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand
| | - Anne Gadermann
- School of Population and Public Health, University of British Columbia
| | - Bongiwe Zulu
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia
| | - Mags Beksinska
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University
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Jochim J, Cluver L, Sidloyi L, Kelly J, Ornellas A, Mangqalaza H, Coakley C, Nogoduka C, Pillay M, Nokama B, George G, Toska E, Eastern Cape TAG. Improving educational and reproductive outcomes for adolescent mothers in South Africa: A cross-sectional analysis towards realising policy goals. Glob Public Health 2023; 18:2206465. [PMID: 37158293 DOI: 10.1080/17441692.2023.2206465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
Adolescent mothers face numerous challenges. This study aimed to address the operationalisation of the new South African national policy for young mothers by testing the associations of potential protective provisions with three policy goals: School return, grade promotion, and pregnancy/HIV prevention. Adolescent mothers aged 12-24 from rural and urban communities of South Africa's Eastern Cape completed study questionnaires between 2017-2019. Using multivariate multi-level analysis, we simultaneously estimated associations between hypothesized provisions and protective variables and all policy-aligned goals. School return was associated with using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Grade promotion was associated with greater exposure to friendly and respectful health staff, using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Pregnancy/HIV prevention (condom use) was moderately associated with greater exposure to friendly and respectful health staff. There was evidence of synergies of provisions whereby a combination of protective characteristics showed larger positive effects than receipt of any single factor alone. This study provides essential evidence for operationalising South Africa's new policy on the Prevention and Management of Learner Pregnancy in Schools, and points to implementation strategies that provide low-cost opportunities to promote educational and health outcomes for adolescent mothers.
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Affiliation(s)
- Janina Jochim
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Lulama Sidloyi
- Oxford Research South Africa, University of Oxford, Oxford, UK
| | - Jane Kelly
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Abigail Ornellas
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Hlokoma Mangqalaza
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Chelsea Coakley
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Coceka Nogoduka
- National Department of Basic Education, Pretoria, South Africa
| | - Managa Pillay
- National Department of Basic Education, Pretoria, South Africa
| | - Busisa Nokama
- National Department of Basic Education, Pretoria, South Africa
| | - Gavin George
- Health Economic and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
- Division of Social Medicine and Global Health, Lund University, Lund, Sweden
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Sociology, University of Cape Town, Cape Town, South Africa
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Burchett HED, Kneale D, Griffin S, de Melo M, Picardo JJ, French RS. Which Structural Interventions for Adolescent Contraceptive Use Have Been Evaluated in Low- and Middle-Income Countries? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11715. [PMID: 36141987 PMCID: PMC9517431 DOI: 10.3390/ijerph191811715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Reducing adolescent childbearing is a global priority, and enabling contraceptive use is one means of achieving this. Upstream factors, e.g., gender inequalities, fertility norms, poverty, empowerment and schooling, can be major factors affecting contraceptive use. We conducted a systematic map to understand which structural adolescent contraception interventions targeting these upstream factors have been evaluated in LMICs. We searched eight academic databases plus relevant websites and a 2016 evidence gap map and screened references based on set inclusion criteria. We screened 6993 references and included 40 unique intervention evaluations, reported in 138 papers. Seventeen evaluations were reported only in grey literature. Poverty reduction/economic empowerment interventions were the most common structural intervention, followed by interventions to increase schooling (e.g., through legislation or cash transfers) and those aiming to change social norms. Half of the evaluations were RCTs. There was variation in the timing of endline outcome data collection and the outcome measures used. A range of structural interventions have been evaluated for their effect on adolescent contraceptive use/pregnancy. These interventions, and their evaluations, are heterogenous in numerous ways. Improved understandings of how structural interventions work, as well as addressing evaluation challenges, are needed to facilitate progress in enabling adolescent contraceptive use in LMICs.
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Affiliation(s)
- Helen Elizabeth Denise Burchett
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London WC1H 0NR, UK
| | - Sally Griffin
- International Center for Reproductive Health: Mozambique, Maputo, Mozambique
| | - Málica de Melo
- International Center for Reproductive Health: Mozambique, Maputo, Mozambique
| | | | - Rebecca S. French
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Cislaghi B, Weber AM, Shakya HB, Abdalla S, Bhatia A, Domingue BW, Mejía-Guevara I, Stark L, Seff I, Richter LM, Baptista Menezes AM, Victora CG, Darmstadt GL. Innovative methods to analyse the impact of gender norms on adolescent health using global health survey data. Soc Sci Med 2021; 293:114652. [PMID: 34915243 PMCID: PMC8819155 DOI: 10.1016/j.socscimed.2021.114652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 12/05/2022]
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. This article presents effective methods to study gender norms in existing global health survey data. We devised conceptual pathways linking gender norms to gender-based health disparities. We identified gender norms proxies and reference groups enforcing the norm. We tested hypotheses linking gender norms to health. These methods can aid policy and programme design to advance gender equality and health.
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Affiliation(s)
- Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK
| | - Ann M Weber
- School of Public Health, University of Nevada, Reno, NV, USA
| | - Holly B Shakya
- Department of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA, USA
| | - Safa Abdalla
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Amiya Bhatia
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK
| | | | - Iván Mejía-Guevara
- 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
| | - Lindsay Stark
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Ilana Seff
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Linda M Richter
- Centre of Excellence in Human Development, University of Witwatersrand, Durban, South Africa
| | - Ana Maria Baptista Menezes
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande de Sul, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande de Sul, Brazil
| | - Gary L Darmstadt
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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Patel SK, Santhya KG, Haberland N. What shapes gender attitudes among adolescent girls and boys? Evidence from the UDAYA Longitudinal Study in India. PLoS One 2021; 16:e0248766. [PMID: 33735285 PMCID: PMC7971892 DOI: 10.1371/journal.pone.0248766] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The role of gender norms in shaping education and work opportunities, distribution of power and resources, and health and wellbeing is well recognised. However, rigorous studies in low- and middle-income countries on when and how norms change over time and what factors shape adolescents’ and young adult’s gender attitudes are limited. This paper explores the factors that determine adolescents’ gender attitudes, as well as patterns in gender attitude shifts over time among younger and older adolescent boys and girls in India. Data and methods Data presented in this paper were drawn from a unique longitudinal study of adolescents aged 10–19 (Understanding the lives of adolescent and young adults–UDAYA study) in the states of Bihar and Uttar Pradesh in India, conducted during 2015–2016 (wave 1) and 2018–2019 (wave 2). The analysis presented in this paper drew on data from 4,428 boys and 7,607 girls who were aged 10–19 and unmarried at wave 1 and interviewed at both rounds of the survey. We used univariate and bivariate analyses to examine changes in adolescents’ gender role attitudes over time and the association between explanatory variables and gender role attitudes. We also used linear fixed effects regression models to identify factors that shape adolescents’ gender role attitudes. Results Gender role attitudes became more egalitarian over time among boys and girls, except among the older cohort of boys in our study. Among both younger and older cohorts, girls/young women held more egalitarian views than boys/young men and this pattern held over time for both cohorts. Factors that influenced gender role attitudes differed for younger and older adolescents, particularly among boys. While some predictors differed for boys and girls, there were substantial similarities as well. Gender attitudes were affected by factors at the individual, family, peer, and societal levels, as well as by community engagement. Conclusions Our findings show that it is possible to shift gender attitudes toward greater equity and, in so doing, contribute to improved health and rights.
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Irwin CE. Centering Gender in Our Clinical, Public Health, and Research Programs. J Adolesc Health 2020; 66:8-9. [PMID: 31866058 DOI: 10.1016/j.jadohealth.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
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Greene ME, Patton G. Adolescence and Gender Equality in Health. J Adolesc Health 2020; 66:S1-S2. [PMID: 31866032 PMCID: PMC6928587 DOI: 10.1016/j.jadohealth.2019.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 11/24/2022]
Affiliation(s)
| | - George Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
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