Efforts to decrease gender inequality, such as tuition-free primary education and paid parental leave, transform norms and improve health for women and their children, according to a new study.

“These policies had both direct positive health effects as well as a positive impact on health mediated by more gender equality in decision making,” says coauthor Jessica Levy, associate professor of practice at the Brown School at Washington University in St. Louis.

“We know that the health consequences of gender inequality fall most heavily on girls, women, and gender minorities,” Levy says, “but restrictive gender norms harm everyone’s health.

“Gender norms are the often unspoken ‘rules’ that govern what is valued and considered acceptable for being masculine/male and feminine/female. They’re deeply embedded in our community culture and institutions, and can intersect with other social factors to impact health over the life course,” she says. “Knowing how to decrease gender inequality and change restrictive gender norms are key to seeing long-term, equitable improvements in health.”

3 paths to less gender inequality

In the paper, Levy and her coauthors ask what has been done and what can be done to decrease gender inequalities and loosen restrictive gender norms in order to improve the health and well-being of communities.

They looked at three key ways of accomplishing this goal: gender transformative health programming (which are programs that actively seek to transform norms and improve health); large-scale laws and policies; and actions related to governance.

First, in their systematic review of gender transformative programs, they found that most interventions were in Sub-Saharan Africa (46 percent), South Asia (24 percent), and North America (16 percent).

“One the one hand, we were encouraged to find that 85 programs met our study’s inclusion criteria and worked in some way to address gender norms and improve health; however only 16 of those programs actually showed evidence of larger norm change,” Levy says.

What's working?

Levy says that among those 16 programs, researchers found four key similarities:

  • they involved multiple stakeholders across multiple levels were involved;
  • they used multi-sectoral action, recognizing that interventions that reach beyond the health sector can better improve health outcomes;
  • they used diversified programming, strategically combining activities that reinforce one another and address issues from multiple perspectives; and
  • they fostered critical awareness and participation among affected community members, encouraging people to become active agents in shaping their own health.

Using conceptual and statistical models, they also studied laws and policies with the potential to affect gender equality and health. Analysis of data from more than 20 countries showed that increased equal opportunities in work and education improved gender equality in decision making.

Access to tuition-free education throughout primary school, as well as a 10-week increase in paid maternity or parental leave, increased the odds that women had sole or joint household decision making power with spouses/partners by about 45 percent, respectively. The same laws and policies also significantly improved women’s and their children’s health, the researchers found.

“These findings are innovative because they demonstrate that these policies improve health, in part by improving gender norms,” Levy says.

The researchers also found that across 97 countries, a 10 percent increase in the gender parity index, an index reflecting gender equality, is associated with an increase in life expectancy for women of about one to two years and of men of approximately one year.

“Increasing gender equality in political representation by, for example, having more women and gender minorities at the table, makes all of this possible,” Levy says.

The research appears in The Lancet.