Health & Medicine
Global health efforts need to catch up with young people
A major study across 40 countries in Asia and the Pacific reveals the stark gender inequalities faced by adolescents, providing a roadmap for effective action
Published 20 October 2020
Adolescence should be a time of opportunities. But for millions of adolescents around the world, early and later adolescence is blighted by emerging gender inequalities.
Most often it is girls who are disadvantaged, but there are aspects of life where gender norms mean boys are more likely to experience harms.
Published in Lancet Global Health, our major study of the state of children and adolescents across 40 low-and middle-income countries in Asia and the Pacific – home to half the world’s population aged 18 and under – has highlighted that gender inequality accelerates from early adolescence.
The data show that, in the region, preference for sons remains – in places like India, Vietnam and China, more boys are born compared to girls than is naturally expected, and more girls die in infancy and very early childhood in some countries in South Asia and the Pacific.
Health & Medicine
Global health efforts need to catch up with young people
But in the majority of countries, there are few gender differences for health, education and other outcomes during childhood. It is during early adolescence that disparities become evident.
Compared to boys, adolescent girls spend more time on household chores, are less likely to have access to the internet and information media, and are more likely to be married and to become a parent. Over 25 per cent of girls in Afghanistan, Bangladesh, Bhutan, India, Nepal and Laos are already married by the time they are 18.
Adolescent girls have poor outcomes in relation to sexual and reproductive health and rights, with very high rates of adolescent fertility in a number of countries, and high rates of adolescent maternal mortality, particularly in Afghanistan, Papua New Guinea and Pakistan.
Many adolescent girls in our region don’t have access to contraception, and have limited autonomy in decision making about their own healthcare. Married adolescent girls have little say in household spending, including on how their own earnings are spent.
Adolescent girls live with high levels of violence. More than one in five girls aged 15-19 who has ever had a partner, report they have experienced intimate partner violence in the last twelve months in Afghanistan, Pakistan and Myanmar – the rate is almost two in five in Timor Leste.
Girls under 18 years are also much more likely to be trafficked than boys (for example, Indonesian girls are 22 times more likely to be trafficked than Indonesian boys).
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Inequalities are also apparent in the area of education. Females aged 15-24 are less likely than males to be in education, employment or training in 17 of 19 countries in the region where data are available.
While in many areas gender inequalities disadvantage girls, there are a number of significant harms more likely to be experienced by boys. In every country in the region where data are available, boys are more likely to experience injury and much more likely to die because of injuries sustained in transport accidents.
The prevalence of health risk behaviours – particularly smoking, binge drinking and use of other drugs – was higher among adolescent boys than girls in almost all countries. Of those in child labour, boys were more likely than girls to be in hazardous work in many countries.
Boys were also at greater risk of suicide in the majority of countries in East and Southeast Asia, Central Asia and the Pacific. For example, the rate of suicide in boys aged 15-19 is at least three times that of girls in Kiribati, Thailand, Myanmar, Malaysia and Indonesia. But this increased vulnerability for boys isn’t uniform – in Bangladesh, India and Pakistan girls aged 15-9 had suicide rates more than twice that of boys.
Our study is the first systematic, multi-country analysis of gender inequality across childhood and adolescence. We mapped population data from 40 countries against a framework of 87 indicators in relation to health, education and employment, protection, and a safe environment. In combination, these data greatly increase our understanding of the inequalities experienced by children and adolescents in Asia and the Pacific.
Many of the differences between the lives of adolescent girls and boys highlighted in our analysis arise because of entrenched inequalities in gender norms and roles – in relation to risk taking behaviours, interpersonal relationships, domestic responsibilities, and access to information and other resources.
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However, most global efforts to measure progress towards gender equality focus on adult women. Across Asia and the Pacific, development programming to challenge harmful gender norms and roles also tends to focus on the empowerment of adult women. Our analysis however suggests that gender norms are well entrenched by late adolescence. Indeed, early adolescent girls and boys can have attitudes that support gender inequality.
It means efforts towards transformative change, to reduce the harms unequal gender norms cause for boys and girls, must begin much earlier.
The other crucial take out from our analysis is that there is enormous variability in rates of specific gender inequalities in adolescence – in some places and for some things the circumstances of adolescents are significantly better than in others. By measuring gender inequality and comparing it across countries we can help to identify what is driving it in particular countries and areas. It can also help us to understand what has worked, and what has not.
These are important questions if we are to develop and apply effective programs and initiatives.
The most fundamental message from the data then is that these inequalities aren’t inevitable. Early adolescence is a window of opportunity to address early inequalities and transform gender norms before they become entrenched and enable young people, girls and boys, to realise a more equal future.
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