Gendered cultural context as a structural determinant of sexual and reproductive health.

backgroundThe impact of cultural norms on women’s health, particularly their reproductive health, has long been acknowledged. However, due to extensive data requirements, creating an index to capture these cultural norms at the national level has proved challenging, making it difficult to calculate these indices for small communities within a nation. This paper proposes a new contextual index, which uses data from regularly fielded large-scale surveys, to evaluate the restrictive cultural rules that limit women’s health and well-being opportunities within the context of their small communities.

methodsThe GCCI is a compositional index that combines the prevalence of five culturally restrictive women’s attributes at the community level using factor analysis. Egypt was adopted as a case study using data from the Egyptian Family Health Survey 2021. The Wagstaff concentration index assessed the GCCI’s validity in reflecting the inequalities in reproductive health risks. Multilevel logistic analysis was used to determine the index’s ability to explain the community-level variability in multiparity (having 5 + children).

resultsThe five indicators showed high internal consistency, with a Cronbach’s alpha of 0.72. The factor combining the five indicators accounted for 72.7% of the total variances. The index was effective in capturing the inequality in reproductive health risks among the 47 communities in Egypt, with a positive Wagstaff concentration index that exceeded 10% for the move from the least to the most restrictive communities in Egypt. The multilevel analysis showed that the community level captured 11% of the variability in multiparity, of which the GCCI index explained 51%. This suggests that the GCCI index can account for a significant portion of the community-specific factors that contribute to reproductive health disparities.

conclusionThe GCCI index, with its simple structure and reliance on regularly available large-scale data, offers strong evidence of the significant effect of the gendered cultural context in explaining inequality in women’s reproductive health risks. It has successfully pinpointed communities that limit women’s health and well-being opportunities. Adopting a similar approach to capture the cultural context could provide substantial support for the development of culturally sensitive and tailored interventions that address the cumulative effects of restrictive cultural norms across different communities.