Observations About Gender Norms and Health - Part 1

By Lori A. Rolleri, MSW, MPH | October 11, 2017
Principal, Lori Rolleri Consulting

Are you one of those people who likes to sit in a park and people-watch? Me too. I like to think about why people do what they do. I’m fortunate that I have a career that actually pays me to do this—although not just by sitting on a park bench!

My people-watching is the type that involves talking with people, reading professional journals and researching the reasons why people do or don’t engage in certain health behaviors.

Why Do You Do What You Do?

Several of these “reasons why” questions have been floating around in my thoughts lately, related to some of my current work. For example:

• Why do some men use violence to resolve conflict in their relationships, while others do not? Why do some women shy away from conflict?
• Why do some fathers engage with their young children, while others don’t? Why do some mothers object to fathers becoming “too” involved with caregiving?
• Why are boys and men more likely to use illicit drugs than girls and women? Why are girls and women more likely to ask for help than men?

I’d suggest that one answer, based on the type of people watching I do, is that some people adhere more firmly to conventional gender norms about masculinity and femininity—norms that can be rigid, inequitable and harmful.

My Gender Journal

As I thought about these matters, I decided it would be interesting to do some focused people-watching of friends and acquaintances over a two-week period. I brought particular attention to the ways I saw gender norms being played out, which is why I called this “My Gender Journal.” Here are some of the things I saw and heard.

• Smart girls: A friend of mine told me about her 11-year-old daughter’s experience at an all-girls summer camp. At the end of camp, campers could anonymously give compliments to other girls. My friend’s daughter received a lot of comments about “being smart.” I know this girl, and she is indeed remarkably articulate and creative.

My friend was concerned that other girls were seeing her daughter as a know-it-all, and that this would somehow affect her daughter’s ability to relate to others and make friends.

• Birthday lunch: I invited a much younger male friend out to lunch for his birthday (my treat). Our server brought us the check and placed it front of my friend. The server clearly assumed my friend would pay the bill.
• The pleasant banker: I went to my bank to manage a few things on my accounts. A very nice banker introduced himself and shook my hand. We made small talk. He asked me what I do for a living, and then asked what my husband does. I told him I wasn’t married. His body language immediately changed, expressing a sort of sorrowful regret. He then asked repeatedly why I wasn’t married given how “beautiful” I was.
• The empathetic son: A friend told me about her hectic morning. Her three-year-old son fell and cut his knee just as they were leaving for school. He was crying inconsolably. As her husband cleaned the wound, the boy cried even more. Her nine-year-old son then started crying as well, asking why Dad kept doing something that clearly upset his brother. This added to the chaos.

My friend said she should at least feel lucky that her older son is empathetic, because so many boys and men are not.

What Does This Reveal?

So what are your thoughts about the people-watching I shared here? Do any of these situations sound familiar?

What do these observations say about the pressures people face when confronted by conventional or traditional gender norms and gender roles? What are the costs to men, women and families when they abide by these norms and roles?

What would happen if the people in these scenarios broke away from conventional norms? How might a breakaway affect how boys and men, girls and women behave in school? The workplace? The family? Romantic relationships?

For example, will my friend’s daughter feel pressure from others to not look or sound “too smart?” Will she be conditioned to believe that girls and women who look too smart might be considered intimidating, aggressive, bossy or unlikable? Will she tone it down to better fit in with her peers, and will this affect her opportunities to express her opinions, maintain her boundaries and be a leader?

What about my young male friend? Is there a message for him that men should be the providers? Be in charge? Have more resources than women? Is he being told that women need to be taken care of? How could this affect communication and decision-making in his romantic relationships?

The effects of adhering to traditional gender norms are sometimes subtle, but they do influence our thinking and behavior. This can negatively affect our health and wellbeing and has the potential to fracture equality and presence in our relationships as well.

Changing Inequitable Gender Norms

As much as I enjoy people-watching, I also have to think about creating interventions to change inequitable gender norms that can lead to unhealthy behavior. Based on my experience in doing this work, I’d like to share a couple of observations on the ways we communicate about and seek to transform gender norms.

1. Many people confuse “sex” and “gender,” or believe the words are synonymous. They are not. Sex refers to biological characteristics (physical characteristics, internal organs, chromosomes and hormones). Gender is the set of expectations, set by the society in which we live, about how boys/men and girls/women should or should not behave. We are not born with gender. It is not fixed and it is not innate. Our gender-conditioning usually starts at birth and is reinforced throughout the life span.
2. Many of my colleagues in the U.S. don’t think gender norms are all that important. I’ve heard practitioners and researchers say things such as, “I just don’t think gender is an issue anymore.” Or, “Girls know by now not to let boys take advantage of them.” Or, “Gender is not so critical an issue in developed, first world nations such as the U.S.” And my personal favorite, “Boys will be boys and girls will be girls. There’s nothing we can do about that.”

I strongly disagree with both of these perspectives. There are multiple studies from the U.S. and other countries (see here, here and here, for example) that demonstrate the association between adherence to inequitable gender norms and adverse health outcomes such as unintended pregnancy, STIs, suicide, incarceration, vehicle collisions, violence, the misuse of substances and others.

Below, I’ve listed some examples of gender norms that are relevant to the work I do. Of course, not all men and women abide by all of these norms. But the negative consequences of inequitable norms such as these can be considerable. What examples would you add to this list?

What’s the Problem?

I don’t want to give the impression that all the characteristics we associate with masculinity and femininity are undesirable. Being strong, a leader, a caretaker and a peacemaker are all great qualities, for both men and women. What makes some of these characteristics problematic is when women and men are taught they must:

• Behave in accordance with these characteristics at all times and in all situations. It is difficult and stressful for men to always be tough, strong and brave; or for women to always be peacekeepers and nurturers.
• Prove their manhood or womanhood by interpreting expected gender characteristics to an extreme. It is one thing to show strength by running a marathon or chopping firewood (positive). It’s quite another to show strength by hitting someone to prevail in a conflict, or using intimidation to force someone to have sex (negative).
• Limit themselves to only the characteristics assigned to their sex. All human beings have the right to be their true selves. They deserve to experience a range of characteristics associated with being human. For example, women can be strong and tough just as men can. Women can run marathons and chop firewood. Men can be nurturing and expressive. They can be peacemakers and caregivers.
• Value the characteristics associated with one gender more than those associated with the other gender. Many people believe, for example, that being the primary breadwinner of the family is more important than caring for children.

We Need More Up-to-Date Data

While there is quite a bit of research from the developing world showing the associations between inequitable gender norms and health outcomes, there is less in the U.S., and some of it is out-of-date. This may partially be the consequence of so many U.S. researchers who don’t believe gender plays a significant role in health behavior or outcomes. I wish nationally representative surveys like the Youth Risk Behavior Surveillance System (YRBSS), National Longitudinal Study of Adolescent to Adult Health (AddHealth), National Survey of Family Growth (NSFG) and others would include questions about gender norms to better explore the association with health outcomes. New data from the Global Early Adolescent Study (GEAS) is going to be very helpful.

We Need the Know-How

Even when practitioners and educators want to transform gender norms, they often don’t know how. In Part 2 of this post, I’ll outline a list of evidence-informed strategies I’ve used to incorporate gender into curricula designed to prevent adolescent pregnancy and STIs.

I hope you’ll join me and share some of your insights and perspectives. In the meantime, you may want to take a week or two to do a Gender Journal of your own. Here are some questions you can think about as you do your people-watching and thinking:

• Notice how adults speak to children. Does their voice differ when talking to girls compared to boys? What about their language and words?
• How do parent or family activities differ between sons and daughters?
• Who do you notice in leadership positions at work? Who speaks first at meetings? Are there differences in the ways men and women express themselves at meetings?
• What do you experience as a member of the “general public”? Do you notice being treated differently because of your gender by waiters, bankers, grocery store checkers, street musicians, car mechanics, dentists or people attending the same movie or concert as you?

Lori Rolleri, MSW, MPH, is principal of Lori Rolleri Consulting, an independent public health consulting practice. Her work focuses on program assessment and planning, development and testing of behavior change interventions, training and technical assistance, technical writing and business development. Her primary areas of practice are sexual and reproductive health, adolescent development, gender equality, intimate partner violence prevention and parenting. She can be contacted at lorirolleri@gmail.com.