2.4.3 Gender Inequalities

Facts/messages: Historically, gender relationships have usually been based on the subordination of women in various social spheres. Some of the mechanisms that tend to perpetuate poverty are connected with gender inequalities. For cultural and institutional reasons, often reinforced by public policies that lack a gender focus, the child-rearing burden is not distributed equally in the family and tends to fall disproportionally on women. This bias is one of the factors that reinforce the subordinate role of women and, consequently, gender inequality. According to much recent empirical research, one of the factors that most protects two-parent families against poverty is that the two members of the couple work. The greater and largely unwanted fertility of the poor is one of the obstacles of a gender system that tends to perpetuate the traditional roles of women and, at the same time, inhibits one of the main mechanisms for fighting poverty—the participation of women in the workforce.

These inequalities, as well as those relating to sexuality or questions of autonomy, citizenship, and power, must become visible in the PSA. Moreover, violence towards women should be highlighted and its root causes identified. It is not sufficient to denounce the treatment of women. If the final goal is gender equity, the effective involvement of men is also necessary. For example, the so-called “conciliatory” policies between motherhood and employment can be far removed from actual gender equity if they are based on the assumption that women alone should be concerned with raising children. On the other hand, it is important to recognize progress with regard to gender equity: some indicators that have traditionally been used to measure such inequity (for example, enrolment ratios under the MDGs) no longer apply in some parts of the world, such as Latin America, the Caribbean, parts of Asia and even some Arab countries, while they still apply in much of Africa and in South Asia. This makes it necessary for the PSAs to go beyond the standard MDGs indicators if they are to accurately capture gender inequalities. The notion that female-headed households are poorer than male-headed households has not been uniformly confirmed. The situation varies from country to country, according to the criterion of poverty (general or extreme), the method of calculation (income or consumption), by age of the head of household, household composition, and migratory status of the family members.

Methodology: Among indicators that continue to show clear gender inequities in every region one finds: labour participation, labour income, time dedicated to domestic activities, child-rearing and care of the sick and elderly, etc. With regard to the analysis of poverty of households according to whether these are male or female-headed, it is advisable to go beyond simple dichotomies, disaggregating the situation by the age of the household head and other characteristics of the household structure, such as the dependency ratio or the number of active or inactive people in the home, marital status of the head of household and whether missing spouses are living abroad, and particularly the number of children of dependent age. For example, one can analyze the economic activity or average income of women in a specific age group (e.g. 30-39 years old) as a function of the number of children of dependent age and the presence or absence of other adults, apart from the spouse, in the household. The variation of this indicator by different population groups can provide invaluable clues for targeting conciliatory policies. The Demographic Module for Population Analysis and Projection (DMPAP), which will be referred to in greater detail in Chapter V, also analyzes poverty in a disaggregated way, by sex of the head of household and other household characteristics. In cases where information is available, it is important to cite studies that document inequality in the patterns of individual remuneration between men and women, not in the aggregate, but in comparable occupations and by hours worked.

Primary Sources:

  • Censuses;
  • Surveys of the Living Standards Measurement Study (LSMS) type or income and expenditure surveys of another kind are the best option for indicators of gender equity connected with work, income and education;
  • Specialized surveys for indicators of the use of time.

Secondary Sources:


  • Interagency Working Group (IAWG, 2009) Manual on integration of gender in SRH services. Includes topics on assessment, strategic planning, design, monitoring, and evaluation;
  • WHO. Gender Analysis in Health, available at: www.who.int/gender/documents/en/Gender.analysis.pdf. Tools for addressing Situation Analysis are listed in a Table on page 7;
  • UNSD (1997). Handbook for producing national statistical reports on women and men;
  • UNFPA (2007). Demographic Model for Poverty Analysis and Projections (DMPAP);
  • Lamlenn B. Samson (2008). Guidance note for the in-depth analysis of data from a Population and Housing Census. Dakar, CST: section on the Situation of Women.

3.1. The Gender Gaps

Facts/messages: Gender inequality affects the spheres of culture, religion, home, work, income groups, politics, sexuality, power, and violence. Yet there are differences in the way gender disparities manifest themselves and how they have evolved over time. The magnitude of these disparities must be captured in order to design effective measures for reducing them.
Economic discrimination with respect to wages can be attributed, inter alia, to occupational segregation/segmentation, which means that people are distributed across occupations based on their characteristics, in this case, their sex. In order to understand gender inequalities in labour markets, the distinction between horizontal and vertical modes of occupational sex segregation needs to be recognized. Horizontal segregation exists when an individual is valued on the basis of the perceived average characteristics of his or her group and not on the basis of his or her own characteristics. For example, horizontal segregation limits career choices of women and keeps them in low-paid occupational sectors due to gender stereotypes that determine the sectors in which they can work. Women tend to be employed in the health and education sector and are generally excluded from sectors considered as being male, including mining and construction. To measure horizontal segregation, indicators such as educational achievements, skills and distribution of women and men across occupations should be used. Vertical segregation is associated with stratification according to the power, authority, income, and prestige of the occupation. For instance, vertical segregation limits the participation of women in economic policy– and decision-making in the public sector and in reaching managerial and decision-making positions in the private sector. The absence of policies, such as parental leave and flexible work schedules, limits labour force opportunities for women and makes them carry a maternal burden.

Methodology: Four measures of gender-based inequality will be described here:

  1. The Gender-Related Development Index (GDI) calculates female and male results separately for the following variables, i) Life expectancy at birth, to capture health; ii) Adult literacy and combined primary, secondary and tertiary enrolment rates, to capture education; and iii) Estimated earned income, to capture income (note that these are the same as in the Human Development Index). For the final score these indices are combined. The GDI goes up either as the three components improve for both men and women or as disparities between men and women decrease.
  2. The Gender Empowerment Measure (GEM) is based on three concepts to measure the relative empowerment of men and women. These three concepts include i) Women’s participation in political decision-making (e.g. women’s share of parliamentary seats); ii) Women’s access to professional opportunities (e.g. weighted average of women’s share among legislators, senior officials and managers and their proportion among professional and technical workers); and iii) Women’s relative earning power (e.g. women’s share of estimated earned income).
  3. The OECD Database on Gender, Institutions and Development (GID) combines information on social and legal institutions, usually ignored in traditional quantitative data. The GID provides information on norms, laws, customs and traditions, which exercise a relevant impact on gender disparities. The Social Institutions Indicator (SID) comprises four categories, including i) Family code; ii) Physical integrity; iii) Civil liberties; and iv) Property rights. These categories include a wide range of factors, such as early marriage, polygamy, parental authority, inheritance, freedom of movement and the existence of legislation punishing acts of violence against women.
  4. With the Gender Gap Index (GGI), the magnitude of the gap between women and men can be captured in four areas: i) Economic participation and opportunity; ii) Political empowerment; iii) Educational attainment; and iv) Health and survival. With visible skill shortages in the labour markets, it is becoming more and more important to close the gaps between gender and leverage the skills of both women and men. The GGI ranks countries on how well resources and opportunities are divided among the male and female population, regardless of the overall level of resources and opportunities. It can be used as a tool to mainstream dialogue and partnerships in order to address the global gender gap. Data and messages contained in the Global Gender Gap Report serve as a comprehensible framework for assessing and comparing global gender gaps and by revealing countries that can serve with best practices in dividing resources equitably between women and men.

Primary Sources:

  • Population censuses;
  • DHS, Labour Force Survey and Income, poverty, time use and other specialized surveys;
  • IPUMS International.

Secondary Sources:

  • International Labour Organization. Key Indicators of the Labour Market;
  • World Economic Forum. Executive Opinion Survey;
  • World Economic Forum. Global Gender Gap Report 2007;
  • World Economic Forum. Country Highlights and Profiles;
  • UNDP. Human Development Report;
  • ILO. LABORSTA Internet, online database;
  • ILO. Occupational data;
  • UNECE: Gender Statistics Database: Available at: http://w3.unece.org/pxweb/DATABASE/STAT/Gender.stat.asp
  • UNESCO Statistics Division. Education Indicators;
  • CIA. World Factbook estimates;
  • World Bank. World Development Indicators Online;
  • WHO. World Health Statistics and The World Health Report;
  • US Bureau of the Census. International Data Base (IDB).

3.2. Gender-Based Violence

Facts/messages: Gender-based violence (GBV) is the most extreme manifestation of gender inequality, defined as any act of violence based on gender that results from or in physical, sexual or psychological damage or suffering for women. This kind of violence is mainly perpetrated against women precisely because they are women by domestic and intimate partners; by non-partners such as teachers, relatives, other acquaintances or strangers; in harmful traditional practices; in conflict situations; or for commercial purposes, such as in trafficking.

The high levels of GBV in most societies and its serious health and socio-economic consequences make it a priority problem on the human rights and public health agendas. Highlight the extent of GBV, physical, psychological and sexual, broken down by the relationship with the aggressor. Of particular interest are the various manifestations of sexual violence, such as forced sexual initiation, sexual harassment in the workplace, sexual abuse of female migrants, sexual abuse against sex workers, and forced prostitution. Women who experience violence are at higher risk for HIV infection. However, violence may also follow HIV infection, as women are blamed for bringing HIV into the relationship. Domestic violence can also affect men, taking the form of physical and emotional abuse.

Violence during pregnancy and its consequences are important issues to address. Older women are vulnerable to discrimination, exploitation, violence and abuse. Little data exist, however, on the extent of abuse against older persons. In some countries, older women are victims of street crime, disrespectful treatment, family violence, social discrimination or intergenerational conflicts. Elderly women may also be victims of witchcraft accusations which can lead to physical attacks and killings.

One should highlight the most important demographic and social determinants related to violence against women, as well as the consequences, especially with regard to SRH. Violence against women in armed conflicts should be underscored if the context warrants it.

Sexual violation and torture of civilian women and girls during armed conflicts and conflict situations is largely based on traditional views of women as property and sexual objects. Deliberately impregnating women is a further assault on cultural mores and family integrity. For these reasons, sexual violence is a potent weapon of war and terror. The victims of modern armed conflict are far more likely to be civilians than soldiers, especially women and children. Women and girls fleeing conflict zones risk sexual violence from combatants, bandits, border guards, traffickers and other refugees, who may demand sex in return for safety or food. Displaced women and girls living in refugee camps risk sexual violence from other refugees, guards and peacekeepers, or when they leave the camp for necessities such as food, fuel and water.

Methodology: Due to the diversity of gender-based violence, a broad definition of violence against women should be applied, incorporating both a criminal justice and public health perspective. Ideally, it should also adopt a human rights perspective. It is important to include indicators such as the prevalence of physical, psychological and/or sexual violence. If possible, it is important to disaggregate information by frequency and severity of the violence exercised, as well as by possible injury to women, mainly in the field of SRH. In addition, obtain indicators that reflect the consequences of this kind of violence. For example, in the field of health it is crucial to focus on the nutritional status of women who have suffered violence, gynecological problems and to assess the relationship between violence and sexually transmitted infections (STIs) and HIV/AIDS.

It is also important to highlight other kinds of costs, e.g. economic costs. There are several studies that point out the annual medical cost of treating victims of violence. Indicators on whether the woman looked for help and whether she received medical attention can also be included. If possible, obtain data on all types of perpetrators. Women and men often suffer a significant proportion of their victimization through their partners. However, they also become victims to other types of offenders, including family members, acquaintances, and strangers.

Primary Sources:

  • Specialized surveys for example, the Multi-Country Study carried out by WHO;
  • Specialized national surveys on violence against women at home;
  • DHS and Center for Disease Control (CDC) surveys;
  • MICS;
  • WHO. Multi-country Study on Women’s Health and Domestic Violence Against Women.

Secondary Sources:

  • UNFPA. 2000 State of the World Population. Chapter 3: “Ending Violence against Women”;
  • UNIFEM. Fact and Figures on Violence against Women.


  • Interagency Standing Committee (IASC). Women, Girls, Boys and Men Different Needs – Equal Opportunities. Part of the Guidelines for Gender-based Violence Interventions in Humanitarian Settings. Resources for assessment are on pages 78-82;
  • Sexual Violence Research Initiative (SVRI). How to Conduct a Situation Analysis of Health Services for Survivors or Sexual Assault, available at: http://www.svri.org/analysis.htm. Includes two questionnaires for Situation Analysis of Health Services for Survivors of sexual assault. One is for health care providers: http://www.svri.org/healthcare.pdf;
  • The second is a facility checklist: http://www.svri.org/facility.pdf.

3.3. Harmful Cultural Practices

Certain forms of sexual violence have been perpetrated against women in some places for so long that they are accepted cultural norms. They lead to death, disability, physical and psychological harm for millions of women every year. Female genital mutilation/cutting (FGM/C) has been inflicted as a coming-of-age ritual on girls and women, mainly in Africa and the Middle East. Child marriage forces girls in many countries into sexual relations before their bodies are mature, jeopardizing their health and raising their risk for obstetric fistula, HIV infection, and dropping out of school. ‘Bride money’ may induce poor families to marry off their daughters as young as six or seven.

3.3.1. Honour Crimes

Facts/messages: Honour crimes are a form of gender-based violence and exact a heavy toll on women’s mental and physical health. Human Rights Watch defines honour crimes as “acts of violence, usually murder, committed by male family members against female family members, who are held to have brought dishonour upon the family clan, or community”. Such crimes single out women for engaging in what their families regard as immoral behaviour, which could entail anything from extra-marital sex, mixing with men from outside the family circle, to merely utilizing dress codes unacceptable to the family or community. Honour crimes are prevalent mostly in Muslim societies, but also common in South Asian countries. Punishment for women could be as severe as death, especially if the prohibited act results in pregnancy. It even encompasses punishing the woman for being a victim of rape.

Methodology: Honour crimes are often included within the category of gender-based violence, or even as an indicator of gender-based violence. Little methodology exists on honour crimes as such. People perceive honour as affected by age, background, education, residence (rural or urban) and social relations, women’s status and sexuality. Obtain data that will provide information on these crimes, including age, marital status, socio-economic status, education level, etc for both the victim and the perpetrator. The characterization of the victims can display the level of economic and educational empowerment of the women. Their marital status indicates their dependency on relatives for their livelihood. This lack of empowerment is a strong indicator of vulnerability. It would also be useful to have information on the motive of crime, as well as laws in place.

Primary Sources:

  • Security Department Records;
  • National Crime Victimization Survey;
  • DHS surveys;
  • Surveys on violence against women, youth, and women;
  • MICS surveys.

Secondary Sources:

  • UNFPA. 2000 State of the World Population. Chapter 3: Ending Violence against Women;
  • UNDP. Human Development Report;
  • UNDP. Regional Human Development Reports;
  • UNDP. Arab Human Development Report.


  • IPPF (2004): Improving the Health Sector Response to Gender-Based Violence. A resource manual for health care professionals in developing countries, available at: http://www.ippfwhr.org/files/GBV_Guide_EN.pdf. This manual includes a management checklist on pages 43-47, for comprehensive planning for the integration of GBV into SRH services. There are also several assessment tools in the annexes, including a provider survey, a clinic observation guide, and a record review protocol.

3.3.2. Female Genital Mutilation/Cutting (FGM/C)

Facts/messages: Female genital mutilation/cutting (FGM/C) is defined as “the partial or total removal of the female external genitalia or other injury to the female genital organs for cultural or other non-therapeutic reasons”. Today, it is estimated that more than 130 million girls and women have undergone FGM/C, primarily in Africa and, to a lesser extent, in countries in the Middle East. In-depth analysis is important to improve the understanding of issues relating to FGM/C in the wider framework of gender equality and social change, because FGM/C is an expression of structural inequity and violates human-rights principles of non-discrimination.

Methodology: Analysis of FGM/C can be conducted based on household survey data from DHS and MICS. They provide data on the occurrence of FGM/C practice at national and regional levels. Focus will be on women aged 15–49 years. Determine the distribution of FGM/C within countries and the circumstances surrounding the practice. Attitudes towards female genital mutilation and support for the discontinuation of FGM/C can give insight into the possible space for programmatic intervention.

Surveys should be used to correlate prevalence with ethnicity, religion or other background variables; to indicate how the practice is distributed; to help identify girls at risk; and enable monitoring trends over time. Two types of prevalence indicators are collected through DHS and MICS: 1) Proportion of women aged 15–49 years who have undergone FGM/C; and 2) Proportion of women aged 15–49 years with at least one daughter who has undergone genital mutilation or cutting. By comparing the two prevalence rates, one can estimate the generational change in FGM/C prevalence. The FGM/C distribution by age cohorts reflects changes in practice.

Further variables that should be considered are: 1) Education; 2) Residence; 3) Religion; 4) Ethnicity; and 5) the DHS Household Wealth Index. DHS and MICS data allow the presentation of FGM/C prevalence among women according to their educational attainment. However, FGM/C can take place before education is completed or before it begins. Therefore, the relationship between a woman’s FGM/C status and her educational level can be misleading. Mothers’ level of educational attainment can be used to classify the FGM/C status of daughters.

An analysis of the type of FGM/C practitioner provides important insights into the context and circumstances surrounding the practice. Important insights into FGM/C and the medical complications can be obtained by focusing on the type of FGM/C practiced. Data on the type of FGM/C performed on daughters tend to be most accurate because the information is obtained directly from the mother. However, it is often difficult to construct estimates on the type of circumcision in different places, as classifications may not correspond to local concepts or terminology. Moreover, since FGM/C occurs primarily during the first years of childhood, young girls may not remember details on the procedure.

Primary Sources:

  • Household survey data from DHS and MICS;
  • Pan Arab Project for Family Health (PAPFAM).

Secondary Sources:

  • Center for Reproductive Rights: Female Genital Mutilation (FGM);
  • Population Reference Bureau: Female genital Mutilation/Cutting: Data and Trends;
  • UNICEF: Female Genital Mutilation/Cutting: a statistical exploration;
  • Women’s United Nations Report Network: FGM Legislation for 25 African Countries—Female Genital Mutilation;
  • WHO: Female Genital Mutilation, Fact Sheet No. 241.

3.3.3. Sex Selection

Facts/messages: Sex Selection is a major issue for UNFPA in several Asian countries, especially in South Asia, China and Vietnam. Pre-natal sex selection refers to deliberate and consistent actions with the intention of eliminating one sex, in particular of girls and women, through abortion, infanticide and neglect, resulting in long-lasting and major demographic imbalances. The number of missing women in some parts of the world is high and, in the case of South Asia, further aggravated by the fact that, until about 1990, female mortality was higher than male mortality. The ICPD discussed sex selection as a problem of son preference and discrimination of girls since the early stages of their lives and which has been compounded by new technologies that assist in the determination of fetal sex and abortion of female fetuses.

Pre-natal sex selection results in skewed sex ratios already at birth, reaching levels of 115 or more (compared to a ‘normal’ level of around 105) in a growing number of countries. In addition, the sex ratio normally does not vary markedly according to birth order (first, second, third child). Any variation from this is therefore particularly indicative of sex selection. Sex selection and skewed sex ratios are seen both as symptoms of gender inequality and as leading to further aggravation of inequality. The demographic imbalance between men and women in any society has far-reaching social and economic impacts, some of them even to the disadvantage of men.

Sex selection is due to a combination of three factors, including i) Son preference; ii) Rapidly declining fertility, i.e. families have to accommodate their wish for sons within a smaller family size; and iii) Accessibility of sex determination technology, especially since 1980. The concept of son preference needs to be broken down since some preference for sons may exist in many cultures without manifesting itself in prenatal or post-natal elimination of females. Son preference can have an economic component, such as the perception of parents that they can only remain on their land after retirement if they have a son who can inherit the land, or the practice of providing dowry for daughters. This results in girls being seen as an economic burden. Other components of son preference may be related to the tradition of sons performing funeral rites, for carrying on the family name, or for taking care of ageing parents, and therefore fulfilling filial piety roles.

However, imbalanced sex ratios of a population can also be the result of other factors. One such factor is the gendered nature of migration. For example, in some countries in the Gulf Region, 60-80% of all migrant workers are male. A second factor is violent conflict and natural disaster, affecting usually the sex ratio through higher mortality rates of males or females. In addition, there are a number of biological factors that have an impact on the sex ratio through differential mortality – such as malnutrition, stress, hormone levels or prevalence of Hepatitis B. For mortality differentials by sex, read the next section.

Methodology: Data quality to measure prenatal sex selection is a problematic issue. For instance, in some countries children are born at home and may not be registered or parents may not register all children to avoid fees. However, sex selection patterns and trends can be established, and are based combining data from censuses, surveys and civil registration sources. Look at sex disaggregated data on sex ratios at birth (SRB) and infant mortality. The SRB is usually expressed as the number of boys born per 100 girls and in most populations the ratio is in the range of 104-106. The sex ratio should not vary markedly according to birth order. Look out for any variation from this range.

Primary Sources:

  • Population census;
  • Civil registration data;
  • DHS;
  • Stand-alone qualitative and quantitative studies.

Secondary Sources:

  • UN Population Division. World Population Prospects;
  • UNFPA. Guidance Note on Prenatal Sex Selection;
  • UNFPA. Recent change in the sex ratio at birth in Vietnam: A review of evidence.

3.4. Mortality Differentials by Sex

Facts/messages: The issue of mortality differentials by sex is rather different from the preceding ones, not in least because by and large mortality differentials between men and women tend to be favourable to women. Generally speaking, female life expectancies at birth tend to be 4 to 5 years higher than male life expectancies: less so in high mortality populations and more so in low mortality populations. This difference cannot be explained away simply as a biological regularity, especially because it can vary considerably between social contexts. In India, Pakistan, Nepal and – to a slightly lesser extent – Bangladesh, life expectancies for women until about 1990 were lower than male life expectancies. This difference has been reversed since then, but the gap continues to be much smaller than in other countries with the same overall mortality level. Explanations have generally focused on the particularly low status of women and the relative neglect of young girls in these countries. The other extreme is that of the countries that made up the former Soviet Union. Male mortality in these countries had been particularly high since the 1970s and in the wake of the collapse of socialism it increased even further, to the point where the sex differential in life expectancy in Russia in the early 1990s widened to more than 10 years. Chronic alcoholism, suicide and stress related to economic difficulties have been cited as problems that affected (older) men more strongly than women during these years.

Methodology: In countries with reliable vital registration data, obtaining the base information is relatively easy and involves the same sources listed under Section 3 of Chapter III. In countries that do not have reliable vital statistics, adult mortality is normally not measured very precisely. Therefore, it is often imputed on the basis of models which may not accurately reflect sex differentials in the country. In such cases it is better not to use the life expectancy as a criterion, but rather to focus on sex differentials in infant and child mortality, which are measured more reliably from census or survey data. Using the sex ratio as an analytical instrument for mortality differentials by sex is not recommended because the sex ratio is also affected by other factors and at higher ages it reflects the accumulated effects of a long time period that may no longer accurately represent the current situation. To the extent that mortality differentials by sex in the country are unusual, it is recommended to try to locate specific studies to explain them.

Primary Source:

  • National Population Censuses;
  • Vital registration data, if available.

Secondary Sources:


  • Lamlenn B. Samson (2008). Guidance note for the in-depth analysis of data from a Population and Housing Census. Dakar, CST: section on Analysis of Mortality Levels and Differentials.

76   UNDP (2008). Innovative Approaches to promoting Women’s Economic Empowerment.
77   World Economic Forum: (2007). Global Gender Gap Report 2007.
78   For more information on the construction of the various indicators, see the World Economic Forum (2007). Global Gender Gap Report 2007, Measuring the Global Gender Gap.
79   WHO, UNICEF and UNFPA (1997). Female Genital Mutilation. A joint WHO/UNICEF/UNFPA Statement.
80   UNFPA (2009): Recent Change in the Sex Ratio at Birth in Vietnam: A review of evidence.
Guilmoto, Christophe (2007): Sex Ratio Imbalance in Asia: Trends, Consequences and Policy responses, 4th Asia Pacific Conference on Reproductive and Sexual Health and Rights.
81   For example, the fact that many men in China are unable to form families and will age in a situation of social isolation and likely poverty.