Adolescent boys have higher mortality due to unintentional injury, interpersonal violence

Reviewed by Emily Henderson, B.Sc.Nov 9 2020

A new study on gender equality in health and wellbeing in the Asia Pacific region calls for greater attention to be paid to excess mortality and health risks experienced by boys in the first 20 years of life.

According to the study, published last month in The Lancet Global Health, the SDGs have brought justified focus on girls' sexual and reproductive health and elimination of harmful practices; however, there is a need for greater attention to adolescents as well as the effects of harmful gender norms on boys.

The study pointed out that "gender norms vary across sociocultural contexts" in the Asia Pacific. But across the region, patriarchal systems strengthen gender norms "assigning higher status and power to boys over girls", and "reward hegemonic (dominant) constructs of masculinity". These "contribute to boys' risk taking, use of and exposure to violence", resulting in higher incidence of injuries and death.

"Adolescent boys have substantially higher mortality due to unintentional injury, interpersonal violence, and alcohol and other drugs, and higher prevalence of harmful drinking and tobacco smoking," found the study. "In all but some South Asian countries (Bangladesh, India, and Pakistan), boys also had substantially higher rates of suicide than their female counterparts."

Although rates of upper secondary school participation and completion were similar for boys and girls in most countries, boys were more likely to be out of school in several East and South-East Asian and Pacific countries, and were more likely to be engaged in child labour and hazardous work."

The Study

The study further noted that puberty is marked by "intensification of gender socialisation", during which "gender identity, roles, and norms sharply diverge" and are "consolidated during adolescence" with "consequences for health" that extend into adulthood and the next generation.

Son preference — evident in expected male-to-female sex ratios at birth in India, Vietnam, and China, suggesting resort to prenatal sex determination and sex-selective abortion — is suggested as the cause for expected mortality among female children in some South Asian and Pacific nations.

But gains made in child mortality, undernutrition, and primary education are mostly shared by boys and girls in this region.

However, despite educational parity in many countries, girls are not transitioning to further training or employment at the same rate as boys. "Unpaid domestic work, early parenthood, and care-giving responsibilities are likely to be important contributors to girls' unemployment" and keeping them confined to traditional gender roles.

According to the researchers, the disadvantages adolescent girls experience in terms of sexual and reproductive health, particularly in South Asian and Pacific countries, include high rates of child marriage (in Afghanistan, Bangladesh, and Nepal 30 per cent) and more women getting married before 18 years, fertility (65 and more live births per 1,000 girls in Afghanistan Bangladesh, Laos and Nepal), and intimate partner violence (over 20 per cent in Afghanistan, Myanmar, Pakistan and Timor Leste).

Peter Azzopardi, corresponding author of the study and associate professor at the Global Adolescent Health Group, Burnet Institute, Melbourne, Australia, tells SciDev.Net that the analysis also highlights "substantial regional and national variation in the impacts of gender inequality, emphasising the need for context-specific measurement, programming and policy".

For example, explains Azzopardi, "child marriage is comparatively low in Central Asia, but with adolescent girls in this region at excess risk of binge drinking compared to other settings".

"These findings together highlight the need to invest in this developmental window to assure gender equality across the life course," he says.

Deepanjan Mitra, a social health analyst and nuclear medicine physician affiliated to the North City Hospitals, Kolkata, India, tells SciDev.Net that the findings of the study may be used to generate public awareness by governments and non-governmental organisations, targeting families, more specifically the mothers.

The need to make each household [understand gender inequality] should be the fulcrum of all future social endeavours."

Deepanjan Mitra, Social Health Analyst and Nuclear Medicine Physician, North City Hospitals

Anish Ray, a paediatrician at the Cook Children's Medical Center, TX, US, agrees with Mitra. He, however, adds: "I think the biggest impact to address such inequality would be through improving education standards, as it is likely to lead to greater independence especially financially (for women)."

"One must also bear in mind that disparities of this nature and magnitude cannot be overcome overnight but require consistent governmental efforts," he tells SciDev.Net.