Improving health with programmatic, legal, and policy approaches to reducing gender inequality and changing restrictive gender norms

Evidence that gender inequalities and restrictive norms adversely affect health is extensive, yet far less research has focused on testing solutions. We examined approaches that can be taken at community and national scale. 

First, we systematically reviewed the peer-reviewed literature and comprehensively reviewed the grey literature for rigorously evaluated programmes. Nearly all (98%) of the 85 programmes meeting our inclusion criteria implemented interactive awareness-building/educational activities that actively sought to examine, question, and change restrictive gender norms and/or power imbalances, as means of improving health and achieving gender equality objectives; and 87% included activities to engage one’s community or improve one’s social support system. Across programmes demonstrating the greatest health and gender impacts and promise for scalability and sustainability, we identified four mutually reinforcing factors underpinning change: (1) multisectoral action, (2) multilevel, multi-stakeholder involvement, (3) diversified programming, and (4) social participation and empowerment.

Second, because little research has investigated the impacts of national-level law and policy reforms, we conducted original quasi-experimental studies on laws/policies related to education, work, and income, all social determinants of health in which deep gender inequalities exist. We examined whether the laws/policies significantly affected health outcomes and gender norms, and whether law-/policy-induced changes in gender norms mediated the health effects, in areas for which longitudinal data existed. Laws/policies that made primary education tuition-free (13 intervention countries with the law/policy, ten control countries without) and that provided paid maternity and parental leave (seven intervention and 15 control countries) significantly improved women’s and their children’s health (odds ratios: 1·2–2·1, depending on health outcome) and gender equality in household decision making (odds ratios: 1·5) as a proxy indicator of gender norms. Increased equality partially mediated the positive effects on health outcomes.