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Despite global commitments to achieving gender equality and improving health and well-being for all, quantitative data and methods to precisely estimate the effect of gender norms on health inequities are underdeveloped. Nonetheless, existing global, national, and sub-national data provide key opportunities for testing associations between gender norms and health. Using innovative approaches to analysing proxies for gender norms, we generated evidence that gender norms impact the health of women and men across life stages, health sectors, and world regions. Six case studies demonstrated that: 1) gender norms are complex and may intersect with other social factors to impact health over the life course; 2) early gender-normative influences by parents and peers may have multiple and differing health consequences for girls and boys; 3) non-conformity with, and transgression of, gender norms may be harmful to health, in particular when they trigger negative sanctions; and 4) the impact of gender norms on health can be context-specific, demanding care when designing effective gender-transformative health policies and programs. Limitations of survey-based data are described that resulted in missed opportunities for exploring certain populations and domains. Recommendations for optimising and advancing research on the health impacts of gender norms are made.

Image by DFAT on Flickr Voice and Agency: empowering women and girls for shared prosperity is a major new report by the World Bank that shines a spotlight on the value of empowerment, the patterns of constraints that limit their realization, and the associated costs, not only to individual women but to their families, communities, and societies. It highlights promising policies and interventions, and it identifies priority areas where further research and more and better data and evidence are needed.

ContributorsKH and AR led conceptualisation and drafting of the paper. AD led the study on nurses in Uttar Pradesh, ND the study on accredited social health activists in Uttar Pradesh, HW and JR the study on community health workers and community health worker policy in Sierra Leone, LM, JK, and AR the study on gender parity in the global physician workforce, and KH, YA, and NS the study on selfhelp groups in India. FS and RF-M led development of the case on the nurse from eSwatini. VP, RH, and EBa did the systematic literature review on health systems models. JGS and AR led the systematic review on gender transformative clinical interventions. KH, LM, JK, FS, RF-M, AD, YA, JY, EBl, NB, JGS, and AR did the critical reviews of the literature on gender inequalities and gender norms affecting health and helped draft pieces of those reviews, with consideration of diverse geographic contexts. All authors offered critical inputs and reviews of this work, contributed intellectual and substantive revisions to the writing, and provided final approval of the submitted version.

The Sustainable Development Goals offer the global health community a strategic opportunity to promote human rights, advance gender equality, and achieve health for all. The inability of the health sector to accelerate progress on a range of health outcomes brings into sharp focus the significant impact of gender inequalities and restrictive gender norms on health risks and behaviours. In this paper we draw on evidence from the Series on Gender Equality, Norms and Health to dispel three myths on gender and health and describe persistent barriers to progress. We propose an agenda for action to reduce gender inequality and shift gender norms for improved health outcomes, calling on leaders in national governments, global health institutions, civil society organisations, academia, and the corporate sector to 1) focus on health outcomes and engage actors across sectors to achieve them; 2) reform the workplace and workforce to be more gender equitable; 3) fill gaps in data and eliminate gender bias in research; 4) fund civil society actors and social movements; and 5) strengthen accountability mechanisms. Paper 5 Lancet Series on Gender Equality, Norms and Health Key Messages of the Series • Gender norms and inequalities affect health outcomes for girls and women, boys and men, and gender minorities.

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While central notions around agency are well established in the academic literature, progress on the empirical front has faced major challenges around developing tractable measures and data availability. This has limited our understanding about patterns of agency and empowerment of women across countries. Measuring key dimensions of women's agency and empowerment is complex, but feasible and important. This paper systematically explores what can be learnt from Demographic and Health Survey (DHS) data for 58 countries, representing almost 80 percent of the female population of developing countries. It is the first such empirical investigation. Our findings quantify some important correlations. Completing secondary education and beyond has consistently large positive associations, underlining the importance of going beyond primary schooling. There appear to be positive links with poverty reduction and economic growth, but clearly this alone is not enough. Context specificity and multi-dimensionality mean that interpretation of results is not always straightforward.