Knowledge, attitudes, and behaviours about gender equality: a cross-sectional survey of adolescents from rural India

Introduction

Achieving gender equality and empowering all women and girls is the fifth Sustainable Development Goal (SDG). The SDGs were adopted by all United Nations Member States in 2015 (United Nations, 2021). Gender equality is also vital for other SDGs such as ending poverty; ensuring inclusive and equitable quality education; fostering sustained, inclusive, and sustainable economic growth; and reducing inequality. India, home to one-sixth of the world’s population, has experienced enormous economic and technological developments since the globalisation. Although India has an important role to play in accelerating global progress towards gender equality, improvement in gender equality has been slow. Gender-based discrimination and inequalities in India are widely documented (Sumanjeet, 2016) making it one of the most challenging countries in the world to be female (Landry et al., 2020). The 2019 gender inequality index reports India at 123^rd position (out of 162 nations), suggesting a range of challenges faced by Indian females (United Nations, 2022).

Gender-based discrimination creates an oppressive environment for young girls and women. It is deeply rooted in the country’s culture, society, and practices. One example of this is sex selective abortions (pregnancy termination on identifying female child due to preference to have a male offspring) that have disturbed the natural sex ratio in India (Ahankari et al., 2015a, National Institution for Transforming India (NITI), 2015). Gender-based discrimination manifests from an early age and continues over the life course, e.g. neglect of a female child from birth, poor nutrition provision, lack of education support and child marriages (Brahmapurkar 2017, Davis et al., 2013, UNICEF 2017). Girls often have limited school progression opportunities and high dropout rates compared to boys. Gender discrimination and related practices/behaviours often form part of community and societal culture, and become social and cultural norms (Sumanjeet 2016, Jayachandran 2020, Mukhopadhyay et al., 2019). Such norms are likely to impact on the health of women from early childhood into adulthood, as well as on their family health. Studies report higher mortality in female babies during the postnatal period and also during early childhood compared to boys (Patra 2011, Bobbitt-Zeher 2007). Furthermore, child marriages disproportionately increase the health and emotional burden of early pregnancy and also increase chances of maternal mortality in young females (Fan and Koski, 2022). Lower socioeconomic status, lack of employment/formal earning source, and absence of active role in decision making processes within the family, may disadvantage women in accessing health services, for personal and their children’s needs, especially for a female child (UN Secretary General’s High Level Panel on Women’s Economic Empowerment, 2022). Therefore, gender inequality substantially affects women’s quality of life over time, and places them at a higher risk of physical, emotional, and sexual exploitation (Brahmapurkar 2017, Davis et al., 2013, UNICEF 2017, Jayachandran 2020, Mukhopadhyay et al., 2019). Oppressive gender norms also contribute to violence against women in public and private spheres, and this may explain the fact that a large number of Indian women (30-50%) face intimate partner violence (Kalokhe et al., 2016, Krishnamoorthy et al., 2020). However, prevalence of violence could be much higher because it is often under-reported due to poor governance, victim’s fear, a lack of essential support services, and societal views towards such abuse (Kalokhe et al., 2016, Krishnamoorthy et al., 2020). Economic impacts of gender inequality are also high, affecting India’s gross domestic product and limiting national economic development (Jayachandran 2020, Arora 2012).

The Indian government, non-government organisations, and national and international aid agencies are implementing a range of programmes to address gender inequalities and reduce/prevent violence against women and girls. Recently, such programmes have seen a growing focus on the involvement of men, with an aim to increase awareness of gender equality among them, reduce violence against girls/women, improve family relations and address sustainability of such family and community level interventions (SWISSAID 2021, Ahankari et al., 2015b). Along with the interventions in the adult population, education and training aimed at adolescents are essential for the prevention of gender-based violence and discrimination in future generations. Projects aimed at developing evidence based strategies for adolescents and young men are gaining importance (Freudberg et al., 2018, Jejeebhoy et al., 2017). However, there is limited published research on gender equality about knowledge, attitudes, and behaviours in Indian adolescents especially from rural areas of the country. About 20% of India’s total population consists of adolescents (10-19 years), and approximately 70% of these are in rural areas (Census of India, 2021), often in difficult to access communities. The majority of the existing research on gender equality has focussed on urban settings. There are no published data from the Maharashtra state of India involving adolescents on their outlined gender parameters. Our study is designed to address this gap in the literature by assessing gender equality related knowledge, attitude, and behaviours in adolescent boys and girls in a rural area of Osmanabad district; specifically, one of the difficult to access areas of the Maharashtra state of India. Our study will also provide vital information to plan future development work, where adolescents could be involved in gender equality initiatives/projects.

Methods

Data collection

Four data collection teams under supervision of a senior research co-ordinator (Ms Sandhya Rankhamb) and a project manager (Ms Shilpa Toro) collected the data between April and July 2019 (Figure 1, details on field staff contributions are available in the acknowledgments). Written information about the survey (PIS- Participant Information Sheet) was provided in each village to eligible participants at least two weeks in advance (see Extended data (Ahankari et al., 2019)). The PIS included details about the project background, data collection processes, consent, type of data, and its future application including intention to publish research outputs from this work. These were also verbally explained by field based data collection staff (details on field staff contributions are available in the acknowledgments). Details of data collection day and exact location in each village were informed verbally by members of the data collection team to eligible participants. Two weeks were offered to eligible participants to make an informed decision on whether or not they wished to participate in the study. Due to the nature of the research, subject area, and ethics permissions, no personal details such as name or address, were collected at any time across the project duration from participants. On the day of the data collection, informed verbal consent was explained to participants and those who were willing to participate continued to the next stage. Each participant was then given a survey form prepared in the local language (Marathi) along with an envelope to submit when completed. For those who had questions prior to their participation, these were answered verbally by members of the project team at the data collection site. The data collection sites included a range of location across study villages such as but not limited to schools, health centres, village community halls, or community spaces depending on availability and suitability to conduct village based data collection activities. Once data forms are completed, participants dropped those in a sealed envelope containing the form in a secure box made available at the site. Participants took approximately 30 minutes to complete and return the questionnaire. On submitting a completed form in a sealed envelope, participants received a textbook to take home (reading material in Marathi) on gender equality, thanking them for their contribution to this study. The same reading material was provided to each study participant, and cost of each textbook was 40 Indian rupees (approximately £0.50), which was covered through project funds. Participation was voluntary and there were no monetary benefits to survey respondents. All field based data collection activities were completed between April and July 2019.

Figure 1. Project management structure and survey recruitment.

Results

In total, 1445 adolescents from 60 villages completed the self-reported questionnaire (data forms, of which 139 questionnaires were removed prior to the analysis during quality checks (N=75 boys, N=64 girls). Primary reason for elimination were as follows; multiple answers reported for one or several question(s), re-written or modified answer(s), and incomplete data forms where one or more questions were left unanswered. This elimination was a part of the data quality work which was described in detail in the methods having a systematic process (data entry, error identification, cleaning, quality check and approval by senior staff). All eliminated forms (N=139) were checked by a senior research co-ordinator and project manager who agreed on this elimination, and details of the same were presented to all staff and key collaborators. Complete data from 1306 participants were used in the analysis. Of these, 51% were girls (N=667), and 49% were boys (N=639). The study recorded a high response rate across field area (90% of the distributed forms were returned with full data). About 62% of the total participants were 16 to 17 years old, and the lowest proportion were 19 years old (Table 1). The majority of the adolescents (93%) were in a full-time education (attending school or a college), and about 20% were engaged in a formal/informal paid employment (Table 1).

Reponses pertaining to the KAB scale are detailed in Table 2. The mean gender equality score was 30 [Standard deviation 7.68, Range 0 to 44], suggesting an overall moderate gender equality (GE) scores in rural adolescents in our study area. Less than 4% were in the low GE group (score- 0 to 15), 45% were in the moderate (score- 16 to 30), and over 50% were in the high GE group (score- 31 to 44). The majority of girls (68%) were in the high scoring group, whereas the majority of boys were in the moderate group (60%). Regression analysis reported that responses from boys were associated with lower scores compared to girls by 5 points, when assessed using our KAB scale (adjusted β coefficient -4.99, 95% CI -5.85 to -4.12, p<0.001) (Table 1). Those who were in formal/informal paid employment were also associated with lower scores by 2 to 3 points (adjusted β coefficient -2.57, 95% CI -3.59 to -1.54, p<0.001). Those with a personal mobile phone were likely to have a low score but such effect was minimal (adjusted β coefficient -0.99, 95% CI -1.94 to -0.05, p<0.05). Only 33% of our study participants owned a personal mobile phone and the majority of them were boys. Cronbach’s alpha internal consistency coefficient for the KAB scale was 0.82 indicating sufficiently high reliability of the scale.

Discussion

To the best of our knowledge, this is the first study measuring GE related knowledge, attitudes, and behaviours among adolescents in rural and difficult to access areas of the Maharashtra state of India, where information on gender equality was limited. Although the Gender Equitable Measurement (GEM) Scale and its modifications have been previously applied in urban population in India, GE related knowledge, attitudes, and behaviours among rural adolescents in Maharashtra and also broadly in India were limited. A sufficiently high Cronbach’s alpha coefficient of our survey instrument indicates that our scale offers reliable measurement of gender equality in rural Indian setting.

Our findings demonstrate a statistically significant difference in GE related knowledge, attitudes and behaviours between boys and girls. Adolescent boys scored significantly lower than girls when assessed using our scale, suggesting needs to develop projects to include boys/young men from an adolescent/early stage through education and training initiatives. Our research findings are in agreement with studies conducted elsewhere in India (Syed 2017, Landry et al., 2020). A study from Hyderabad city of India involving 186 adolescents (13 to 16 years) showed similar results (Syed 2017). Girls scored higher than boys in both pre and post intervention assessments. Pre-intervention average score in boys was 21.51 (out of 36), while in girls it was 24.8. Post-intervention gender score difference was significant where girls again scored higher (34.08 out of 36) than boys (24.63 out of 36). Cross-sectional data from 1,691 participants (8 to 18 years) from three Northern Indian states namely Delhi, Punjab, and Rajasthan) showed that boys scored lower compared to girls when assessed for gender-equitable attitudes (Landry et al., 2020). The scores were analysed similar to our study (low, medium, and high categories), but were further assessed by school year/grade and also by geographic region. Findings showed that the overall GE related attitudes improved with age/grade, but boys were likely to be in the lowest scoring categories and girls scored higher over time, which is similar to our research findings. Das and associates examined gender attitudes and violence among urban boys in Mumbai, India (Das et al., 2014). The survey involved 1040 boys aged 10 to 16 years, who were recruited as a part of a larger intervention project. Data on gender related attitudes were collected using a scale similar to our survey tool. The study reported high prevalence of inequitable gender attitudes condoning violence against girls. Only one in five study participants (from 10-12 years age group) reported high levels of condoning violence where the rest suggested some acceptance of such behaviours considering their personal and community exposures/experiences. Those with moderate and equitable attitudes were less likely to engage in violence against girls/women. Such associations remained significant on further subgroup analyses where boys with and without a history of personal violence exposure and also experiences were examined. This suggests that social acceptability of gender based role allocation and male dominant societal structure will lead to inequitable system where girls/women are likely to face discriminatory practices. This may impact on access to resources such as education, health services, financial support, and lifelong opportunities, including impacts on individual health and wellbeing. However, if interventions aimed at adolescents are introduced at appropriate times especially involving boys, then it may deliver substantial benefits for all sectors of the community. Similar findings are published from other countries. Research by De Meyer et al., (2014) involved young adolescents from Bolivia and Ecuador (N= 5,913) to investigate attitudes towards gender equality, sexual behaviour, experiences, and communication. Findings showed several benefits of gender equality such as use of contraception and positive experiences of intimate relations among sexually active adolescents. Importantly, those who were not sexually active also reported positive impacts on communication with their counterparts where sexual relations were deemed less necessary to maintain relationships. Findings were consistent in both boys and girls. Similar findings were recorded from an intervention study conducted in Brazil, where a link was observed between gender equitable norms and higher contraception use during recent sexual activity (Pulerwitz et al., 2010). These wider benefits may help improve adolescent and women’s health as well as sexual and reproductive health outcomes.

Current evidence highlights the importance of developing effective interventions to address issues where adolescents will need to be involved from an early age (Landry et al., 2020, Verma et al., 2006). These research findings including ours especially from male adolescents also indicate a worrying trajectory for their future behaviour towards women – there is substantial evidence that attitudes and behaviour developed in adolescent are carried into adulthood (Blum et al., 2017). This enables these young men to influence a new cohort of adolescents and the cycle begins again (Das et al., 2014). Studies elsewhere have reported some impact through educational programmes with young men (Syed 2017, Jejeebhoy et al., 2017); however, literature also suggests that education is not enough, and thus interventions need to go further and be supported by more structural and legal interventions (Jewkes et al., 2015). Nevertheless, it is important that work within rural communities addresses this issue and recognises that education approach is one of the key parts of interventions to improve gender attitudes of young males (Casey et al., 2017, Jejeebhoy and Santhya 2018, Vyas et al., 2020). Our study also showed positive attitudes towards gender held by female adolescents – not unexpected – but highlights that gender equality work needs to recognise the importance of empowering young women to express their views about inequalities safely as well as effectively (Santhya et al., 2014). It is also imperative that future work includes parents, especially mothers of young girls and fathers of young sons (Dhar et al., 2019, Schroeder et al., 2019), as they can also have a positive effect on gender equality from an early age (Basu et al., 2017, Kågesten et al., 2016).

Our gender equality scores were significantly lower in adolescents involved in some type of employment/paid work, suggesting the need for further development work that combines gender education and welfare programmes for poor and marginalised families to reduce discrimination and improve equality at family and community level. This links to the literature that finds an association between poor gender attitudes and lower educational attainment and development in male adolescents (Gök et al., 2019) and emphasises the importance of early school interventions around gender equality to address such several co-exiting challenges (Chae et al., 2020). It also means that communities themselves have a key role in helping these young boys and men develop more equitable beliefs towards gender, work that is ongoing in India and beyond, and it is showing some positive results (Freudberg et al., 2018). Furthermore, differences seen in our rural population versus studies in urban settings reinforce the need to prioritise work in rural communities by government authorities and NGOs considering gender attitudes and beliefs of young men tend to be worse in poorer rural environments than urban areas (Carter et al., 2016), and our data reinforces this pattern.

Our findings also demonstrate inequitable access to mobile phones in our study population where the majority of the boys owned a personal mobile phone (428 participants had a personal mobile of which 333 [77%] were boys). This is one of the examples of inequitable distribution of finances, resource allocations and preferences at family and community level suggesting parental preference to boys to offer such high value item, and decision-making power often centred around men and for men. We understand that our results are important considering the fifth SDG (Gender Equality) and provides useful research findings for a range of agencies working in India to accelerate progress towards SDGs. Such development work involving adolescents is also likely to generate long lasting impacts on existing and future generations to break the cycle of violence against girls/women and work towards establishing equitable and balanced societies.

Conclusion

Gender inequality is a major issue worldwide. Societal and cultural gender norms impact and shape individual attitudes and behaviours towards girl/women as well as expectations about their role and place in our society. Oppressive gender norms are often reflected in the social status of women and are often associated with violence against women. While oppressive gender norms are widespread globally, their impact on women’s health, development, and well-being is much more noticeable in patriarchal societies such as India. Any efforts to promote gender equality can hardly be effective without the involvement of men and boys from adolescent stages. This study provided important insights into the gender equality related knowledge, attitudes, and behaviours among boys and girls. Our findings suggest a need for community wide education and awareness programmes to promote gender equality especially from adolescence. It is important to note that the majority of the published literature on gender inequality and domestic violence focuses on adults (men and women), who are in intimate relationships. This warrants further research involving young people/adolescents to inform intervention work. Continuous improvements in measurement tools/scale are essential to the process of developing and evaluating interventions to accelerate progress towards gender equality.

Data availability