Peer-reviewed article
Gendered cultural context as a structural determinant of sexual and reproductive health.
Khadr Z, Rashad H, Shawky S ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This research develops a new index to measure how restrictive cultural norms affect women's reproductive health and well-being at the community level in Egypt. Using data from the 2021 Egyptian Family Health Survey, the index combines five culturally restrictive attributes affecting women using statistical analysis. The index successfully identified communities with the most restrictive cultural rules and explained more than half of the community-level differences in women having multiple children, suggesting cultural context is a major driver of reproductive health disparities.
Key points
- The Gendered Cultural Context Index (GCCI) combines five culturally restrictive women's attributes at community level with a Cronbach's alpha of 0.72, showing high internal consistency
- The index explained 51% of the 11% community-level variability in multiparity (having 5+ children)
- Inequality in reproductive health risks between the least and most restrictive communities exceeded 10% using the Wagstaff concentration index
- The approach uses regularly available large-scale survey data, making it feasible to calculate for small communities within nations
- The authors propose this method could support development of culturally sensitive interventions targeting restrictive community norms
Limitations
This is a methodological paper that develops an index rather than evaluating an intervention; it demonstrates associations between cultural context and reproductive outcomes but cannot establish causation or directly inform what interventions would be effective. The study is limited to Egypt and may not be generalizable to other contexts with different cultural and social structures.
Abstract
BACKGROUND: The 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. METHODS: The 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). RESULTS: The 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. CONCLUSION: The 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.