5. Nutritional status and gender norms

Higher levels of gender inequality are associated with higher levels of acute and chronic undernutrition, with women and girls thought to account for around 60% of the world’s chronically hungry people. Data from more than 140 countries in Africa, Asia and Latin America show that women have a higher prevalence of severe food insecurity.

Evidence tends to focus on adolescent girls, given high rates of early marriage in some regions and links between thinness and risks for both mother and child. South Asia has the highest prevalence of thinness among adolescents:  47% of Indian adolescent girls aged 15-19 are underweight, with a body mass index (BMI) of less than 18.5.

The intersection of gender with wealth, location and ethnicity increases nutritional disadvantage: in Pakistan 40.6% of the poorest rural women from the Sindhi ethnic group are undernourished (with a BMI below 18.5) compared to 2.4% of women from the richest urban households of the Punjabi majority.

At the same time, obesity is a growing global concern. Undernutrition, obesity and micronutrient deficiencies co-exist in many LMICs, with poor access to healthy food contributing to malnutrition. Data from 10 LMICs show that between 20% and 37% of girls aged 15-19 are overweight. There is also a growing focus on adolescent nutrition because the development of healthy eating habits at this time is a foundation for good health and a safeguard against obesity and related NCDs in adulthood.

Norms about access to food

Studies on South Asian settings with strong son preference indicate a pro-male bias in food allocation that starts early in life, with Indian girl infants breastfed for shorter periods. Men make decisions about food allocation in contexts with persistent gender inequality, with more food allocated to those seen as carrying out more important tasks. In some South Asian communities, the tradition that the male head of the household is served first and that women eat last – and often least – can harm their nutritional status. Such bias is heightened when resources are scarce. In Ethiopia, adolescent girls aged 13-17 in households affected by severe food insecurity are more likely than their brothers to report being food insecure (a proxy indicator for insufficient food).

Norms about food preferences and restrictions

Many cultures associate certain foods and eating habits with masculinity and others with femininity. Meat (particularly red meat) is seen as masculine food, while dieting, eating lightly or eating healthier foods are seen as feminine behaviours.

Adolescent girls and young women may also face food restrictions at certain times, such as menstruation, pregnancy or lactation. In parts of rural Nepal, menstruating women and girls are seen as impure, are forbidden to touch food or enter the kitchen, and are even confined to animal sheds with little to eat.

Norms, body image and eating behaviours

Studies on nutrition, gender norms and adolescent girls, often from high-income settings, focus on their dieting habits and weight-control, rather than on healthy nutrition. Evidence shows that adolescent girls may be more concerned than boys about their body image. Their eating behaviours, therefore, aim for a feminine bodily ideal rather than good health.

The 2013/14 HBSC survey found that girls reported being too fat: 43% of those aged 15 were dissatisfied with their body appearance – nearly double the rate for boys – and 26% reported being on a diet although only 13% were overweight. However, such issues are having an increasing impact on adolescent boys, who face their own pressures from family, peers and the mass media to look a certain way.

In some cases, the distorted body image perceived by the individual does not reflect their actual body weight and can lead to unhealthy diets and disorders. Exposure to media may exacerbate such problems. A study of young university students in Pakistan found that those with a high exposure had higher rates of body dissatisfaction than other students. A review noted frequent cyberbullying related to appearance, especially among adolescent girls using social media.