The lost boys

Abstract

The gravity of gender inequality seems to have, at last, reached all sectors of society. A watershed on dangerously permissive attitudes to sexual assaults, outrage at gender-oriented discrimination, and a refusal to accept socially constructed gender roles are aired daily on social media and in the mainstream press. Living in an affluent city in the northern hemisphere, one might think that we are making good progress in tackling gender inequality. But in reality, in a global sense, much remains to be done. First, we must understand gender and its role in society. Women and girls have experienced disadvantages compared with men since time began, but this entrenched hardship is not rooted in differences in sex (a person's biological status as either male, female, or intersex) but in inequalities because of gender (the culturally assigned attributes associated with being male or female). Gender norms traditionally endorse masculinity over femininity, undermining the rights of women and girls and promoting authority and privilege among men. This historical legacy of inequity means that women and girls have suffered enormously through the effects of early marriage and motherhood, stigma surrounding menstruation, and denied education and autonomy, and more. However, rigid gender systems also disadvantage men and boys, through promotion of toxic forms of masculinity that encourage risk taking (75% of traffic accident deaths occur in males) and stifled emotions (suicide rates in men in high-income countries are 3·5 times higher than in women). Gender expression and gendered behaviours are typically established during adolescence. In a paper published on May 30, Holly Shakya and colleagues use data from 12 000 adolescents in the USA to show that gender expression is stable from adolescence (ages 11–18 years) into adulthood (24–32 years), and that adolescent gender-specific behaviours were associated with adult health outcomes (independent of biological sex). Masculinity was seen to be linked with an unhealthy diet, increased alcohol intake, and smoking, whereas femininity reduced the risk of substance abuse but was associated with depression. In Gender equality, norms and health, a Series published by The Lancet on May 30, Gary Darmstadt and colleagues explain that as gender is a socially constructed concept, it is in our power to change the status quo. To do so, we must bring gender equality into mainstream public health discussions, establish evidence for power as a health determinant, and enlist a multisectoral commitment to prioritise gender equality in the health sphere. Adolescents are vital for such positive disruption. The plasticity of the adolescent brain offers a prime opportunity not only to shape self-perception and behaviour but also to manipulate social constructs. Inequitable gender stereotypes that are harmful to both girls and boys must be tackled before discriminatory norms become entrenched. By 15–16 years old, gender stereotypes have solidified, thus early adolescence (up to 10 years) offers a critical window for influence. A report from GAGE (Gender and Adolescence: Global Evidence), released in December, 2018, assessed the evidence for promotion of gender-equitable masculinities among adolescent boys and found that outside of sexual-health programmes, very few adolescent interventions in low-income and middle-income countries offered components targeted at boys. Engagement and retention of adolescent boys in such programmes is notoriously difficult, but in neglecting their needs, we miss a vital opportunity to teach boys an alternative masculinity, with better life skills and more gender-equitable attitudes. Interventions should address key concerns for boys within their communities (eg, violence-avoidance strategies and upskilling for improved employment prospects) and use of aspirational messaging (avoiding historical blame). This policy gap is echoed in a report by the Bellagio Working Group, Achieving Gender Equality by 2030: Putting Adolescents at the Centre of the Agenda, released on May 20. As well as advocating for early interventions, the report stresses that if the fifth Sustainable Development Goal (achieving gender equality by 2030) is to be met, then greater attention needs to be given to boys and men: “We cannot achieve a gender equitable world by ignoring half of its occupants”. Investing in adolescent boys offers the potential for a brighter future for both girls and boys. Raising the next generation of men to be committed to gender equality offers limitless opportunities for improved global health and social benefits. The gains to be made through effective gender-equality programming aimed at adolescent boys are simply too immense to give up on. Adolescent gender norms and adult health outcomes in the USA: a prospective cohort studyWe found compelling evidence that adolescent gender expression is correlated with health in adulthood independently of gender expression as an adult. Although more research is needed to identify causal mechanisms, our results suggest that those designing health behaviour interventions should carefully consider integrating gender transformative components into interventions. Full-Text PDF Open Access