Biological differences and gender inequalities in a health perspective

by Serge Rabier

Serge Rabier, associate researcher at CVV and member of the French High Council on Gender Equality, focuses in his work on the integration of gender in public policies regarding health and sexual rights. Here, he raises questions on the links between biology and gender in a health perspective.

The debates on biological differences and gender inequalities tend to oppose two radical postures: those defending the « natural » course of things and those considering everything as a social construct. However, in the specific perspective of health, it is essential to tackle the interactions rather than oppositions between biological determinants on the one hand and anthropological and sociological factors on the other.

 Therefore, it is appropriate to question how representations, individual and collective gender inequalities and practices, as well as social expectations according to gender have an impact on men’s and women’s health. Here are a few questions among others: how can social expectations and normative attitudes relating to gender induce smoking and other addictive behaviours? How may traditional social practices, like female genital mutilations, have consequences on mental health? How may widely accepted masculinity criteria prevent men from engaging into care pathways or from seeking support and counselling, in particular for mental health? How can inequalities in decision making within couples and households prevent or delay HIV/AIDS prevention and treatment for women specifically? How can the general education level as well as the education level regarding reproductive health and rights have an impact on child mortality and morbidity? How may the absence of comprehensive sexual education, for girls in particular, lead to (however avoidable) harmful consequences like unsafe abortions?

However, it is equally important to consider how biological differences, when not appropriately taken into consideration from a genetic, hormonal and physical perspective, not to mention age, do impact behaviours and negatively affect the quality and the efficiency of both research and health care. Findings show that biological differences play an important role, and have serious health consequences when they are ignored or underestimated. Clinical trials which do not, or insufficiently, include women in their cohorts, loose key pertinent elements for gender analyses. Furthermore, drugs stemming from such trials pose more risks to women than to men to massively experience secondary effects. Likewise, some illnesses do affect more women than men due to the absence of specific hormones after menopause. In the case of heart attacks, symptoms differ substantially between the sexes. As those affecting men are considered the norm, women are often misdiagnosed.

Therefore, it is necessary to take into account the links between biological and social determinants in health research projects, and to call for the development of a research agenda on this issue.