Gender norms and the wellbeing of girls and boys – Author's reply
Authors: Peter S Azzopardi, Cathy Vaughan, George C Patton, Karen Humphries-Waa, Gerda Binder, Liz Comrie-Thomson, Elissa Kennedy
Journal: The Lancet Global Health (2021)

We are pleased our Article1Kennedy E Binder G Humphries-Waa K et al.Gender inequalities in health and wellbeing across the first two decades of life: an analysis of 40 low-income and middle-income countries in the Asia-Pacific region.Lancet Glob Health. 2020; 8: e1473-e1488Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar has generated interest and discussion, including around the need to include boys in gender policy, programming, and research. Severi Luoto and colleagues suggest that we should expect differences in outcome between females and males, and that these differences are driven by biological sex. We agree that biological sex differences might explain some gender disparities in health; however, if observed differences were driven predominantly by biological sex, we would not observe the wide variation in health across boys—or between boys and girls—or across countries or over time. Nor would we expect to see adolescent girls to be at increased risk of suicide as we observed in India, Pakistan, and Bangladesh. It is also difficult to conceive of a biological basis for our observed gender differences in the domains of education, protection, or safety. Biology needs to be considered in a context of socially constructed gender systems. Gender inequality becomes evident in adolescence—a time of great biological and neurocognitive change driven by puberty. These biological changes bring a sensitivity to the social environment and drive identity formation, including what it is to be a given gender (male, female, or non-binary).2Blum RW Gender norm transformative programing: where are we now? Where do we need to be?.J Adolesc Health. 2020; 66: 135-136Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar The gender norms and values embedded in the individual during childhood and adolescence persist into later adult life and, through parenthood, are generally passed on to the next generation. In summary, although we agree that biology contributes to this process, much of the variation in health outcomes observed can be attributed to socially constructed gender systems, and these are amenable to transformative intervention.3Heymann J Levy JK Bose B et al.Improving health with programmatic, legal, and policy approaches to reduce gender inequality and change restrictive gender norms.Lancet. 2019; 393: 2522-2534Summary Full Text Full Text PDF PubMed Scopus (51) Google Scholar Our Article did not systematically explore the drivers of gender inequalities or what the responses should be. We speculate that, in addition to driving the disadvantage and discrimination experienced by girls, patriarchal systems also reinforce rigid, restrictive norms around masculinity that contribute to boys' risk-taking and use of and exposure to violence. As such, we support Kylie King and colleagues' call to include boys in programming to address gender inequality. Further to Gwyther's review that King and colleagues cite, we note a 2020 review4Ruane-McAteer E Gillespie K Amin A et al.Gender-transformative programming with men and boys to improve sexual and reproductive health and rights: a systematic review of intervention studies.BMJ Glob Health. 2020; 5e002997Crossref PubMed Scopus (10) Google Scholar that identified 36 randomised trials of gender-transformative programming with men and boys to improve sexual and reproductive health and rights, as well as a synthesis of programmes targeting gender inequality and restrictive norms to improve outcomes for children and adolescents.5Levy JK Darmstadt GL Ashby C et al.Characteristics of successful programmes targeting gender inequality and restrictive gender norms for the health and wellbeing of children, adolescents, and young adults: a systematic review.Lancet Glob Health. 2020; 8: e225-e236Summary Full Text Full Text PDF PubMed Scopus (39) Google Scholar We hope that this growing body of evidence informs effective responses to the gender disparities identified in our study. We declare no competing interests. Gender inequalities in health and wellbeing across the first two decades of life: an analysis of 40 low-income and middle-income countries in the Asia-Pacific regionThese findings call for a focus on gender policy and programming in later childhood and early adolescence before gender inequalities become embedded. Full-Text PDF Open AccessGender norms and the wellbeing of girls and boysElissa Kennedy and colleagues (December, 2020)1 described the emergence of gender disparities in health and wellbeing across the first two decades of life, arguing that they are caused by harmful gender norms. The gender inequalities framework1 implicitly presupposes that, in a just society, males and females would show equal outcomes on every metric considered. This expectation is at odds with a vast body of research on sex differences in psychobehavioural traits and life outcomes in humans and other species. Full-Text PDF Open AccessGender norms and the wellbeing of girls and boysGender and health has become an area of major research and policy focus.1 Elissa Kennedy and colleagues' meticulous study2 on the health-based gender inequalities experienced by young people in the Asia-Pacific region offers timely insights. Underscoring the burden shouldered by adolescent girls and young women, their study also shines a light on boys and young men. We support their urgent call for a focus on adolescent males to address gender-related disparities. Full-Text PDF Open Access