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

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. 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). 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. 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. 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 assess these restrictive cultural norms at the national level has proved challenging. This has made it difficult to calculate these indexes for small communities within a nation. This paper proposes a new contextual index to evaluate the restrictive cultural rules that limit women’s health and well-being opportunities within the context of their small communities. The new CGGI index is a composite index at the community level, reflecting the collective attributes of the community regarding women’s position in society and the household. Data for these attributes are regularly available in large-scale data sets conducted in many developing countries, such as the Demographic and Health Surveys. These attributes pertain to early marriage, approval of wife-beating, lack of decision-making power, exposure to violence, and low educational attainment. The index was applied to the 2021 Egyptian Family Health Survey data and successfully identified inequality in reproductive health risks across the index range. It also explained more than half of the community-based variability in having five or more children. These findings show that adopting similar indexes that capture the social and cultural norms in communities can help identify vulnerable communities where women are more exposed to reproductive health risks due to their cultural context, enabling the proper tailoring of interventions and service provision.