Gender equality, health improve through paid leave, tuition-free school

Brown School study offers specific solutions to loosening restrictive gender norms

Policy approaches such as tuition-free primary education and paid parental leave both transform norms and improve health for women and their children, finds a new study co-authored by Jessica Levy, associate professor of practice at the Brown School at Washington University in St. Louis.

“These policies had both direct positive health effects as well as a positive impact on health mediated by more gender equality in decision making,” said Levy, second author of the study, “Improving Health With Programmatic, Legal, and Policy Approaches to Reduce Gender Inequality and Change Restrictive Gender Norms,” recently published in The Lancet.

The paper is the third in the five-part “Lancet Series on Gender Equality, Norms, and Health.” Another study in the series was co-authored by Lindsay Stark, associate professor at the Brown School.


“We know that the health consequences of gender inequality fall most heavily on girls, women and gender minorities,” Levy said, “but restrictive gender norms harm everyone’s health.

“Gender norms are the often unspoken ‘rules’ that govern what is valued and considered acceptable for being masculine/male and feminine/female. They’re deeply embedded in our community culture and institutions, and can intersect with other social factors to impact health over the life course,” she said. “Knowing how to decrease gender inequality and change restrictive gender norms are key to seeing long-term, equitable improvements in health.”

In the paper, Levy and her co-authors asked what has been done and what can be done to decrease gender inequalities and loosen restrictive gender norms in order to improve the health and well-being of communities.

They looked at three key ways of accomplishing this goal: gender transformative health programming (which are programs that actively seek to transform norms and improve health); large-scale laws and policies; and actions related to governance.

First, in their systematic review of gender transformative programs, they found that most interventions were located in Sub-Saharan Africa (46%), South Asia (24%) and North America (16%).

“One the one hand, we were encouraged to find that 85 programs met our study’s inclusion criteria and worked in some way to address gender norms and improve health; however only 16 of those programs actually showed evidence of larger norm change,” Levy said.

Levy said that among those 16 programs, four key similarities were found:

  • Multiple stakeholders across multiple levels were involved;
  • multi-sectoral action was used, recognizing that health outcomes can be better improved by interventions that reach beyond the health sector;
  • diversified programming was used, strategically combining activities that reinforce one another and address issues from multiple perspectives; and
  • critical awareness and participation among affected community members was fostered, encouraging people to become active agents in shaping their own health.

Using conceptual and statistical models, they also studied laws and policies with the potential to affect gender equality and health. Analysis of data from more than 20 countries showed that increased equal opportunities in work and education improved gender equality in decision making.

Access to tuition-free education throughout primary school, as well as a 10-week increase in paid maternity or parental leave, increased the odds that women had sole or joint household decision making power with spouses/partners by about 45%, respectively.The same laws and policies also significantly improved women’s and their children’s health, the researchers found.

“These findings are innovative because they demonstrate that these policies improve health, in part by improving gender norms,” Levy said.

The researchers also found that across 97 countries, a 10% increase in the gender parity index, an index reflecting gender equality, is associated with an increase in life expectancy for women of about one to two years and of men of approximately one year.

“Increasing gender equality in political representation by, for example, having more women and gender minorities at the table, makes all of this possible,” Levy said.