Sex and gender in reporting health indicators

I am writing a chapter for a US publication, which has tables of statistics for males and females (which I refer to as “sex”).  The editor contacted me to ask whether I should be calling this “gender”.  This reminded me of a Lancet editorial (December 10, 2016) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32392-3/abstract which referred to sex and gender as basic variables in clinical scientific research and requires the reporting of “reporting of sex, gender or both where appropriate”.

Sex is defined in the policy explicitly as biological sex with three categories (male, female, intersex). Gender is explicitly defined as “Gender is a constellation of sociocultural processes that interact with and have the potential to influence human biology.”  In other words, gender is not a variable with a definable set of categories, but a complex web of interacting processes modifying a huge array of health and other personal and group outcomes.  The policy provides no guidance on how it may be possible for researchers to report results by gender.

Because of this confusion of a complex web of interacting processes with a categorical reporting variable, most researchers wanting to report on gender simply use the label “gender” for the biological sex variable collected in their data.

I am by no means dismissing the importance of sex and gender as key determinants of health progress. But the many voices calling for reporting of research by “gender” need to realize that gender is indeed a complex constellation of sociocultural processes, not a set of categories.

Population growth is a major issue for sustainable development, global climate change, etc.  High fertility levels drive population growth, particularly in Africa. The biggest factors impeding reductions in fertility levels relate to high levels of child mortality, lack of access to modern contraception, and gender inequality. In turn, a major determinant for reductions in child mortality is the education of mothers.

All of this relates back to gender inequality, and the inability of women in many societies to have full autonomy in areas relating to sex and reproduction.  We are used to thinking of this as an issue in Africa and the Middle East, associated with premodern cultural and religious traditions, and the Taliban and IS are extreme manifestations of these attitudes.  But similar attitudes exist and are growing in parts of the developed world.  The US right-wing war on women is the obvious example.  Along with strenuous efforts to block access to safe abortion, there are now growing efforts to block access to contraception.  It is very clear that this is not about moral views on the personhood of embryos, it is really about making sexual behavior highly risky as part of the efforts to control the sexuality of women.

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