“What about boys? A literature review on the health and development of adolescent boys” (WHO) 2000


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This literature review sheds new light on how adolescent boys and girls differ in their health and development needs and what implications these differences have for health interventions. The document takes a gender approach and while assessing the gender specific needs of adolescent males, it provides ideas into how to improve the health and development of adolescent boys and girls.

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“What about boys? A literature review on the health and development of adolescent boys” (WHO) 2000

  1. 1. WHO/FCH/CAH/00.7 WHAT Original: English ABOUT BOYS? Distribution: General 1WHAT ABOUT BOYS? A Literature Reviewon the Health and Development of Adolescent Boys Department of Child and Adolescent Health and Development World Health Organization
  2. 2. 2 WHAT ABOUT BOYS? WHO/FCH/CAH/00.7 Copyright World Health Organization, 2000 This document is not a formal publication of the World Health Organization (WHO) and all rights are reserved by the organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale nor for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. Editor: Mandy Mikulencak Cover Photo: Straight Talk Foundation, Uganda Designed by: Ita McCobb Printed in Switzerland
  3. 3. WHAT ABOUT BOYS? 3 table of contentsACKNOWLEDGMENTS 5INTRODUCTION 7CHAPTER 1 Adolescent Boys, Socialisation and Overall Health and Development 11CHAPTER 2 Mental Health, Suicide and Substance Use 23CHAPTER 3 Sexuality, Reproductive Health and Fatherhood 29CHAPTER 4 Accidents, Injuries and Violence 41CHAPTER 5 Final Considerations 49REFERENCES 53
  4. 4. 4 WHAT ABOUT BOYS?
  5. 5. WHAT ABOUT BOYS? 5 acknowledgements The author of this review is Gary Barker, Director of Instituto PROMUNDO, Rio deJaneiro, Brazil. The helpful suggestions and contributions to the document by the following people are gratefullyacknowledged: Paul Bloem, Jane Ferguson, Claudia Garcia-Moreno, Adepeju Olukoya and ShireenJejeebhoy (WHO); John Howard (Macquarie University, Australia); Josi Salem-Pickartz (Family HealthGroup, Jordan); Wali Diop (Centre de Coopération Internationale en Santé et Développement, BurkinaFaso); Malika Ladjali (UNESCO); Matilde Maddaleno and Martine de Schutter (PAHO); Judith Helzner(IPPF/WHR, USA); Benno de Keijzer (Salud y Genero, Mexico) Neide Cassaniga (Brazil); Robert Halpern(Erikson Institute, USA); Jorge Lyra (PAPAI, Brazil); Lindsay Stewart (FOCUS, USA); Bruce Dick (UNICEF);Mary Nell Wegner (AVSC International, USA) Margareth Arilha (ECOS, Brazil) and Margaret Greene(Center for Health and Gender Equity, USA). Thanks are also due to the Chapin Hall Center for Children at the University of Chicago; theInstituto PROMUNDO, Brasilia and Rio de Janeiro, Brazil; and the Open Society Institute, New York,U.S., for general support to the author during work on this document. Gratitude is due for the financial support of UNAIDS and the Government of Norway.
  6. 6. 6 WHAT ABOUT BOYS?
  7. 7. WHAT ABOUT BOYS? 7 introduction Assumptions are often made about the New research and perspectives call for a health and development of adolescent boys: that more careful and thorough understanding of how they are faring well, and supposedly have fewer adolescent boys are socialised, what they need in health needs and developmental risks compared terms of healthy development, and what health to adolescent girls; and that adolescent boys are systems can do to assist them in more appropriate disruptive, aggressive and “hard to work with.” ways, and how we can engage boys to promote This second assumption focuses on specific greater gender equity for adolescent girls. aspects of boys’ behaviour and development – such as violence and delinquency – criticising and The purpose of this document is to review sometimes criminalising their behaviour without existing and available literature on adolescent boys adequately understanding its context. and their health and development; analyse this research for programme and policy implications; These generalisations do not take into and highlight areas where additional research is account the fact that adolescent boys – like needed. This document also seeks to describe adolescent girls – are a heterogeneous population. what is special about adolescent boys and their Many boys are in school, but too many are out of developmental and health needs, and to make school; others work; some are fathers; some are the case for focusing special attention on meeting partners or husbands of adolescent girls; others the needs of boys and on working with boys to are bi- or homosexual; some are involved in armed promote greater gender equity for adolescent girls. conflicts as combatants and/or victims; some are sexually or physically abused in their homes; some Finally, this document is limited by sexually abuse young women or other young men; information that was available. Some of the some are living or working on the streets; others research and information on programmes working are involved in survival sex. with adolescent boys is not in print; in many cases, programme experiences are new and have not yet been evaluated or documented. In many partsAdolescent boys – like adolescent girls – of the world, studies on adolescent health focus primarily on adolescent girls (Majali and Salem-are a heterogeneous population. Some are Pickartz, 1999).faring well in their health and development.Other boys face risks and have needs that Applying a Gender Perspective tomay not have been considered, or are Adolescent Boyssocialised in ways that lead to violence anddiscrimination against women. The “why” of focusing on adolescent boys emerges from a gender perspective. The review of research used a gender perspective from two The majority of adolescent boys are, in fact, approaches – gender equity and gender faring well in their health and development. They specificity. represent positive forces in their societies and are respectful in their relationships with young women Gender equity refers to the relational aspects of and with other young men. However, some young gender and the concept of gender as a power men face risks and have health and developmental structure that often affords or limits opportunities needs that may not have been considered, or are based on one’s sex. Gender equity applied to socialised in ways that lead to violence and adolescent boys implies, among other things, discrimination against women, violence against working with young men to improve young other young men, and health risks to themselves women’s health and well-being, and their relative and their communities. disadvantage in most societies, taking into consideration the power differentials that exist in
  8. 8. 8 WHAT ABOUT BOYS? many societies between men and women. A Research on adolescent and adult men has common refrain from programmes working in suggested that while men were often women’s and young women’s health in many considered the default gender, they have not parts of the world is that girls and women are been adequately studied or understood. asking for greater involvement of men and adolescent boys in themes that were once defined as “female” – particularly, reproductive health and Emerging research on adolescent and adult maternal and child health. Many advocates argue men has suggested that while men were often that unless adult and young men are engaged in considered the default gender, they have not been these issues in appropriate ways, gender equity adequately studied or understood. Some authors will not be achieved. Thus, a gender equity argue that much social science research assumes perspective for working with adolescent boys that men are genderless (Thompson and Pleck, suggests that we examine how social constructions 1995). A review of literature on delinquency and of masculinity affect young women and how we crime – which is overwhelmingly perpetrated by can engage adolescent boys in improving the adolescent and young men – concludes that well-being and status of women and girls. masculinity has been seen as inherently violent and that the impact of gender socialisation on men has Gender specificity refers to examining specific largely been ignored in the study of violence health risks to women and men because of: 1.) (Messerschmidt, 1993). Numerous researchers health problems that are specific to each sex for have argued that men have been treated as absent biological reasons (such as testicular cancer or in the reproductive process, whether in research gynecomastia for young men); and 2.) the way on fertility or in programme development that gender norms influence the health of men (Figueroa, 1995; Greene and Biddlecom, 1998). and women in different ways. The typical Thus, one of the compelling rationales for applying approach to gender specificity in health a gender-specific perspective to adolescent boys promotion has been to show how each sex faces is that while we sometimes had statistics on their particular risks or morbidities and then to develop health conditions and health-related behaviours, programmes that take into account these specific we did not have an adequate understanding of needs. Applying gender specificity to adolescent their realities, their socialisation and their males suggests that we focus our attention on psychosocial development. those areas where young men have high rates of mortality and morbidity and on those areas in In the last 15 years, a growing body of which gender socialisation influences young research on men and masculinities has contributed men’s health behaviour and health status (NSW greatly to our understanding and offered new Health, 1998). insights on men’s health-related behaviours and their development. Connell’s work (1994 and A gender equity perspective has long been 1996) has been important in introducing the notion considered in women’s health, examining how of multiple versions of masculinity or manhood, unequal power differentials between women and recognising that manhood is not a singular entity. men adversely affect the health and well-being Connell suggests that most cultural contexts have of women. In recent years, however, a number a “hegemonic masculinity,” or a prevailing model of researchers, theorists and advocates have of masculinity against which males compare asked us to reconsider some of our traditional themselves, and alternative versions of masculinity. notions about gender power differentials and This theoretical framework is useful in identifying male dominance. Other researchers have men who find ways to be different than the questioned some of our assumptions about men, prevailing norms — an important point if we seek and how much we really know about the to promote more gender-equitable versions of socialisation of boys and men. masculinity.
  9. 9. WHAT ABOUT BOYS? 9New perspectives suggest that male consequences for their health and development. Of course, we should be careful not to portrayprivilege is not a monolithic structure that boys as mere puppets to social norms, and todistributes an equal slice of advantage to recognise the contextual nature of their behaviour.each man. Low-income men, young men, Nonetheless, it is clear that the versions ofmen outside the traditional power masculinity or manhood that young men adherestructure, men who hold alternative views, to or are socialised into have importanthomosexual and bisexual men, and other implications for their health and well-being and that of other young men and women aroundspecific groups of men are at times subject them.to discrimination. Finally, however, we should remember that gender is only one variable affecting development While we must keep in mind that men and and health. Social class, ethnicity, local context boys as a group have privileges and benefits over and country settings are all important variables women and girls, new perspectives suggest that that interact with gender to influence health and male privilege is not a monolithic structure that well-being. By focusing on gender, and specifically distributes an equal slice of advantage to each masculinity, as the variable, we have to be careful man. Furthermore, in other cases, it may be that not to lose sight of these other important variables. the “costs” of masculinity exceed the benefits and Some searchers and advocates have questioned privileges. Low-income men, young men, men whether paying too much attention to gender may outside the traditional power structure, young men draw our attention away from the fundamental in some settings, men who hold alternative views, social class and income inequalities related to homosexual and bisexual men, and other specific adolescent health and development. groups of men are at times subject to discrimination. Connell’s work and that of other It is also important to keep in mind that authors (for example, Archer, 1994) have called looking at what is unique about boys often requires us to examine not only how men and women comparing them to girls. In this document, interact, and the power differentials in such “making the case” for focusing on boys often interactions, but also how men interact with other means highlighting areas where boys have higher men and the power dynamics and violence that rates of morbidities or mortality compared to sometimes emerge in such interactions. While we young women. However, these comparisons are should not portray young men as “victims” , this problematic for several reasons. First, comparing new field of research on men has also relative levels of disease burden by sex is not bias- demonstrated that while men and boys may have free. Issues such as women’s victimisation by aggregate privileges over women and girls, violence, women’s depression, and chronic pelvic manhood generally brings with it a mix of privilege pain related to sexual tract infections (STIs) are as well as personal costs - costs that are reflected sometimes excluded from health statistics. Second, in the mental and other health needs of men. simply comparing relative levels of risk by sex can Being socialised not to express emotions, not to lead to a polarising and simplistic debate about have close relationships with one’s children, to who “suffers” more or which sex faces greater use violence to resolve conflicts and maintain health risks. Third, by emphasising differences, we “honour,” and to work outside the home at early may downplay the important similarities between ages are among the costs of being a man. adolescent women and men. Furthermore, by calling attention to the needs and realities of Applied to the health and developmental adolescent boys we should not imply that girls’ needs of adolescent boys, the field of masculinities needs have been adequately considered and is helping us understand how boys are socialised included – indeed, in most cases they have not. into prevailing norms about what is socially Finally, we could lose sight of the fact that acceptable “masculine” behaviour in a given relationships between boys and girls are important setting and how boys’ adherence to these to their development and well-being. prevailing norms can sometimes have negative
  10. 10. 10 WHAT ABOUT BOYS? With these caveats, this document While a certain amount of comparison approaches the health and developmental needs of adolescent boys via three questions: between adolescent males and females and their respective health needs is inevitable, p How do adolescent men and women differ the challenge is to examine the specific needs in their health needs, strengths or potentials and realities of adolescent boys in a way that and risks? allows us both to understand their legitimate needs and to work with boys to promote p What are the implications of gender-specific health needs for health interventions for greater gender equity. adolescent boys? concern that calling attention to the health needs p Based on what we know about adolescent of boys and men may draw resources and attention boys, how can we work with them to away from women’s health concerns – concerns promote greater gender equity? that in some countries have only recently begun to be addressed. However, if we use this dual While a certain amount of comparison perspective of gender specificity and gender equity, between the health needs of adolescent males we can potentially avoid a debilitating debate over and females is inevitable, the challenge is to whose needs are more urgent and instead focus examine the specific realities of adolescent boys on gender equity for women and young men, and in a way that allows us both to understand their underline this and at the same time incorporating legitimate needs and to work with boys to a concept of gender specificity when it is useful to promote greater gender equity. From a women’s understand the gender-specific health and rights perspective, some advocates, researchers developmental needs of boys. and health practitioners have voiced a thoughtful
  11. 11. chapter 1 WHAT ABOUT BOYS? 11 adolescent boys, socialization and overall health and development General Health Status and Health Trends General Morbidity and Mortality Like adolescent girls, adolescent boys are In every region of the world except for India generally “healthy,” that is, they show low levels and China (which combined represent about one- of morbidity and mortality compared to children third of the world’s population), WHO data shows and adults. However, some adolescent boys face that Disability Adjusted Life Years (DALYs) lost, specific morbidities and, on the whole, show which take into account mortality and disability higher rates of mortality than adolescent girls. due to morbidity, are higher for men than for According to international health data, the major women (see Table 1). As we present DALY figures, difference between adolescent boys and girls is however, it is important to keep in mind that such that boys generally show higher rates of mortality, broad gender comparisons sometimes downplay in some places several times higher, while girls in other health issues. While there are fewer deaths most regions show higher rates of morbidity. among adolescent women world-wide, women Furthermore, there are significant differences in may suffer from domestic violence, sexual violence the causes of mortality and morbidity that boys and other morbidities that are reflected poorly or and girls face. Boys world-wide show higher rates not at all in DALY figures. of mortality and morbidity from violence, accidents and suicide, while adolescent girls In most regions of the world, adult men have generally have higher rates of morbidity and higher mortality rates from causes not specific to mortality related to reproductive tract and either sex. Men die of heart disease and cancer pregnancy-related causes. more frequently than women at all ages, and until old age, men have higher rates of accidents and injuries. Women in most industrialised and manyBoys world-wide show higher rates of developing countries suffer from a highermortality and morbidity from violence, incidence of non-fatal conditions and in some settings are more likely to pay attention to theiraccidents and suicide, while adolescent girls health needs. Overall, in most regions of the world,have higher rates of morbidity and mortality men have higher rates of fatal conditions, whilerelated to reproductive tract and women have higher rates of acute illness and non-pregnancy-related causes. fatal chronic conditions. According to these DALY figures, gender This chapter reviews general health differences are highest in industrialised countries, concerns of adolescent boys and the gender- in Latin America and the Caribbean, and in the specific challenges that boys may face as they former socialist economies of Europe. One transition to adulthood. Health and possible explanation for this gender difference in developmental concerns of boys affect their well- DALYs is that in countries and regions that have being during adolescence and have important made substantial advances in maternal and child implications for their future health and well-being health, the morbidities and mortalities of men as adults. WHO estimates that 70 percent of represent a growing proportion of the public health premature deaths among adults are due to burden. Overall, in Latin America and the behavioural patterns that emerge in adolescence, Caribbean, for example, the health burden for including smoking, violence, and sexual men is 26 percent higher than it is for women behaviour. (World Bank, 1993). Examining regional and country-level statistics on men’s health finds that much of this disease burden is due to health problems associated with the gender socialisation:
  12. 12. 12 WHAT ABOUT BOYS? Graph 1 Sex differences in adolescent burden of disease (DALYs for all causes in 10-19 yr olds, 1990) boys girls 300 250 DALY per 1000 adolescents 200 150 100 50 0 World Established China Former Latin Middle East Other India Subsaharan Market Socialist America & Crescent Asian & Africa Economies Economies Caribbean Islands traffic accidents (where bravado and alcohol use health complications during childhood, some of come into play), injuries (associated with the which may carry over into adolescence (Gissler et workplace and with intra-gender violence), al., 1999; NSW Health, 1998). homicides (the vast majority as a result of intra- gender violence) and cardiovascular diseases, Infectious Disease Burden associated in part with stress and lifestyles. Reviewing data from Mexico, Keijzer (1995) The limited data on sex differences in found that mortality rates for males and females communicable and infectious diseases provides are about equal until they reach age 14. At that little evidence for sex differences. A national study time, male mortality begins to increase and is of adolescent health in Egypt found that the twice as high overall for males among young prevalence of parasitic diseases was 57.4 percent people ages 15-24. The top three causes of death for girls and 55.5 percent for boys, representing for young men in Mexico – accidents, homicide no statistical difference (Population Council, 1999). and cirrhosis – are related to the societal norms In terms of schistosomiasis, WHO data indicates on masculinity. These trends are repeated that in affected regions, infection rates peak throughout Latin America and in other parts of between the ages of 10-20 because of the degree the world, from the Middle East, to Western of water contact and age-related immunity. Some Europe, to North America and Australia (Yunes gender differences are found in rates of and Rajs, 1994; Commonwealth Department of schistosomiasis infection in specific contexts, Health and Family Services, 1997). depending on whether boys or girls are more likely to come in contact with infested rivers and lakes Limited studies using official health statistics (Personal correspondence, Dirk Engels, 1999). The from some industrialised countries suggest that epidemiology of tuberculosis shows a different from birth to age 7, boys have higher rates of pattern. Recent WHO data indicates higher TB health problems than girls. After the perinatal incidence and death in girls than in boys up to the period, boys in Finland had a 64 percent higher age of 14. Between 15 and 19 that the pattern is cumulative incidence of asthma, a 43 percent inversed and boys show higher levels. However, higher cumulative incidence of intellectual for most infectious diseases, large sex differences disability, and 22 percent higher level of mortality. are unlikely, except when differences in gender Similar trends have been reported in Australia. socialisation affect boys’ or girls’ exposure to Some researchers suggest that there may be some infectious agents. biological propensity for boys’ greater rates of
  13. 13. WHAT ABOUT BOYS? 13Self-Reported Health Status In developing countries for which data is available, the nutritional status of boys and From existing data on self-reported health girls is about equal, or boys are faring worse.status, it is difficult to arrive at any conclusions The exception is India, where girls’about whether boys or girls have better general nutritional status is markedly worse thanhealth. Furthermore, when adolescents are asked boys.to report their health status, their responses arelikely to be influenced in part by gender norms. conclude that, overall, girls in the countries studiedIn most countries, girls are more likely to be seem less likely to be undernourished than boys.attuned to health problems, whereas boys may Of the 34 developing countries included, thebe more likely to ignore them, to diminish their authors did not find any country where girls hadimportance, not to report them and not to seek a consistent nutritional disadvantage comparedhealth services when they need them. For with boys (United Nations, 1998). Otherexample, Thai girls were more likely than boys to researchers have hypothesised that differentialreport a current health problem: 25.2 percent for treatment for boys and girls, favouring boys infemales compared to 14.9 percent for males. terms of food allocation, should result in lowerHowever, nearly equal numbers of males and nutritional status for girls during later childhoodfemales reported having purchased medication for and adolescence. However, data has either beenthemselves in the past month, suggesting that boys inconclusive or has not confirmed this hypothesis,and girls face virtually equal rates of health with the important exception of India, notedproblems, but that girls are more likely to report earlier.these problems (Podhisita and Pattaravanich,1998). A national study on adolescent health in With some exceptions, data on sexEgypt found that 20.7 percent of adolescents differences in stunting during adolescence arereported having had an illness in the previous similarly inconclusive. Between 27-65 percent ofmonth, the most common complaints being adolescents showed stunting according to datacommon cough and cold followed by from 11 studies representing nine developinggastrointestinal problems. There was virtually no countries. In Benin and Cameroon, boys showeddifference in reported rates of illness by gender more stunting than girls. The authors suggest that(Population Council, 1999). in these two countries, boys may be encouraged to be independent earlier than girls and are thusNutrition, Growth, Puberty and more likely to have diarrhoeal diseases. In India,Spermarche stunting was far more prevalent among girls than boys – 45 percent compared to 20 percent –Nutrition which is consistent with the presumed effects of gender bias in parts of South Asia (Kurz and An analysis of existing data questions the Johnson-Welch, 1995). In the national adolescentlong-standing assumption that boys’ nutritional health study in Egypt, boys were more likely tostatus is better than that of girls. In developing be stunted: 18 percent for boys versus 14 percentcountries for which data is available, the nutritional for girls (Population Council, 1998). In seven ofstatus of boys and girls is about equal, or boys are eight studies presenting data, at least twice asfaring worse. The exception is India, where girls’ many adolescent boys as girls werenutritional status is markedly worse than boys. undernourished (Kurz and Johnson-Welch, 1995). A note of caution is needed in regard to In a review of 41 Demographic and Health anthropometric measures underlying stunting andSurveys for 34 countries examining children from wasting in adolescents. Recent work in this areabirth to 5 years, 24 surveys show that boys have by WHO shows that both the indicators to identifyhigher levels of wasting than girls; 19 surveys show wasting and stunting in adolescents, as well as thethat stunting levels are higher for boys, while only cut-off points for different degrees of thesefive surveys show more stunting among girls. The conditions, need more research. It has not beendifferences in nutritional status between boys and established whether sex differences play any rolegirls ages 0-5 were relatively small, but the authors in the anthropometry of nutritional status in adolescents.
  14. 14. 14 WHAT ABOUT BOYS? Similarly, a review of data on the nutritional shorter but more intense. Most boys reach status of adolescents in developing countries spermarche by age 14, and are about two years found that prevalence of anaemia was 27 percent older than girls at the height of their maximum for adolescents overall, with similar rates among growth spurt. The amount of height attained during boys and girls (United Nations, 1998). In Egypt, the growth spurt, however, is about equal for boys the overall prevalence rate of anaemia was 47 and girls. percent, with little difference by gender. Boys had a slightly higher rate of anaemia until age 19, The social meaning of menarche and when anaemia for girls increased (Population spermarche are often quite different. Typically, boys Council, 1999). Adolescent girls were often are not encouraged to talk about pubertal changes presumed to have higher rates of anaemia nor offered spaces to ask questions or seek because of iron lost during menstruation, but boys information about these changes(Pollack, 1998). also have high iron requirements because they In contrast, menarche sometimes implies enhanced are developing muscle mass during the adolescent social status while also bringing with it increased growth spurt. social controls over young women and their movements and activities outside the home. The implications of a possible nutritional Societies seem to have developed more structures disadvantage for boys are unclear. Some authors to discuss and prepare girls for menarche than they have suggested that the issue is related to boys’ do boys for spermarche. However, these delayed and longer growth spurt. In terms of “structures” in some settings can be repressive for stunting, boys may later catch up with girls. In young women, including forced seclusion of girls any case, the existing data suggests paying closer of reproductive age and even female genital attention to boys’ nutritional status and re- mutilation. Boys on the other hand, may be given examining the longstanding presumption of girls’ more information and guidance related to sexual nutritional disadvantages. activity, but not necessarily information about puberty and its procreative implications. In some Puberty and Spermarche cases, boys have more information about menarche than ejaculation, given the societal Puberty is generally recognised as the importance attached to female reproduction. beginning of adolescence. With biological Reasonable conclusions are that puberty means changes and sexual maturation, adolescents must intense social pressure for both boys and girls to incorporate their new body images, reproductive ascribe to gender norms; that girls generally have capacity and emerging sexual energies into their their movements and activities restricted to a identity and learn to cope with their own and greater degree than boys after puberty; and that others’ reactions to their maturing bodies. There boys in some settings may have less guidance are biologically-based differences for boys and about their reproductive potential. girls in the timing of puberty and socially- constructed gender differences in the meaning of and reactions to puberty for boys and girls. Puberty means intense social pressure for both boys and girls to ascribe to gender In terms of biologically-based differences, norms. sexual development among girls generally starts at age 8 with the first stages of breast development. Menarche usually occurs between While there are some studies about 10.5 and 15.5 years with the female adolescent adolescent girls and their reactions to puberty and growth spurt between 9.5 and 14.5 years. Males physical changes during adolescence, research is are slower to mature sexually, with testicular lacking on how adolescent boys feel about their enlargement generally occurring between 10.5 bodies and their ability to procreate. Among and 13.5 years and the growth spurt and Brazilian university students, 50 percent of young spermarche about one year later (Population men had positive feelings toward their body Council, 1999). Compared to growth during development and sexuality, 23 percent were childhood, the growth during adolescence is indifferent and 17 percent reported being anxious
  15. 15. WHAT ABOUT BOYS? 15and uncertain about physical changes during Socialisation and Psychosocialpuberty (Lundgren, 1999). Limited research in the DevelopmentU.S. has examined young men’s awareness ofthemselves as procreative beings. Among young Gender-Specific Theories of Adolescentmen ages 16-30 in the U.S., this awareness is not Developmenta major event. In fact, in their desire for sex, someyoung men even seem to repress notions or While biologically-based differences andconcepts of themselves as procreative. This limited overall growth and nutritional differences betweenresearch suggests the need to help young men adolescent boys and girls exist, probably the mostthink about themselves as procreative and to offer significant differences, with the greatestthem spaces where they can discuss what it means implications for programme and policy, are thoseto be capable of procreation (Marsiglio, related to the gender-specific socialisation of youngHutchinson and Cohan, 1999). people and the ensuing differences in their psychosocial development before and duringBiological Differences in Development adolescence. Some research has also examined hormonal There is a growing body of research anddifferences in boys and girls, particularly the theory on the psychosocial development of boys,possible role of testosterone both in early mainly from industrialised countries, that serveschildhood and adolescence. This limited research as an important complement to previous work onsuggests that there may be significant hormonal the psychosocial development of adolescent girls.differences between boys/girls and men/women While there is considerable individual, local andthat are still only partially understood. There may cultural variation, there are similarities acrossbe biologically-based differences in early brain cultures that allow us to begin to construct gender-development for boys and girls which affects boys’ specific theories of the psychosocial developmentand girls’ styles of communication. Research of adolescent males.suggests that early exposure to testosterone ininfant boys is associated with boys’ greater level It is important to keep in mind culturalof aggression and agitation, a lower attention span variations in the concept of adolescence. Therethan in infant girls, and less visual acuity at early are major cultural and urban-rural differences inages (Manstead, 1998). The meaning and extent terms of whether the passage from childhood toof these biological differences are ambiguous. adulthood is fairly short and direct, or whether itFurthermore, existing research suggests that overall is prolonged (as in many modern, Westerndifferences within sexes are often greater than societies) and frequently marked by extendedaggregate differences between the sexes. In any formal schooling and conflicting role expectations,case, it is important to keep in mind that these among other common characteristics. In spite ofbiologically-based differences such as the cultural and contextual differences, there is abiological tendency toward greater agitation in general consensus that adolescence implies, inboys interacts with gendered-patterns of addition to new reproductive capacities: 1.) ansocialisation described below (Manstead, 1998; increase in cognitive abilities, and as aPollack, 1998). consequence, concern over future roles and identity; 2.) greater social expectations that the young person contribute to household income, maintenance and production; and 3.) social expectations of greater economic independence from the family of origin and/or the formation of a new family unit.
  16. 16. 16 WHAT ABOUT BOYS? Keeping in mind these cultural variations researcher in the U.S. suggests that both in their in the concept of adolescence, emerging research introduction to school and in early adolescence, on boys’ psychosocial development concludes boys are pressured to achieve autonomy and that boys have different potential crisis points separation from familial support before they are during their psychosocial development and their necessarily ready (Pollack, 1998). own specific vulnerabilities, even though they sometimes appear and are assumed to be less In adolescence, boys often face continuing psychologically vulnerable than girls in pressure from the male peer group, where sexual adolescence. New, more targeted research on experiences may be viewed as achieving or adolescent boys finds that once we get beyond demonstrating competence, rather than achieving boys’ customary silences, their “clowning” and intimacy and connection (Marsiglio, 1988). In late their feigned indifference, boys face their share adolescence, boys are often encouraged to further of challenges during adolescence that have often distance themselves from their parents. They may, been ignored or sometimes misdiagnosed. in fact, desire greater connection with their parents Another common refrain in research on boys’ or other adults but find themselves unable to psychosocial development is that men’s express this desire because of social sanctions discussions of identity and roles continue to be against boys’ expression of emotional need and limited while 20 years of research and policy vulnerability (Paterson, Field and Pryor, 1994; development expanded women’s options and Pollack, 1998). roles in some areas of the world. Boys world-wide report experiencing the dual pressures to act like Boys and Gender Identity Formation “real men” as traditionally defined and to be more respectful and caring in their relationships with These new perspectives on adolescent males young women. build on previous research and theories on gender identity development and gender socialisation during early childhood. Many developmental Emerging research on boys’ psychosocial psychologists argue that fundamental aspects of gender identity are linked to the earliest development concludes that boys have experiences of being cared for and to the person different potential crisis points during their giving that care. According to these theories, the psychosocial development and their own fundamental task of early gender identity specific vulnerabilities, even though they development for boys is to develop a separate sometimes appear and are assumed to be gender identity than the mother’s and thus achieve less psychologically vulnerable than girls a greater normative separation from the mother than girls generally do. At the stage of separation in adolescence. from the primary attachment figure (generally the mother), a boy must achieve separation and In looking at the normative pattern of boys’ individuation, and publicly define his gender development in Western settings, various identity (Gilmore, 1990; Chodorow, 1978). researchers argue that boys experience difficult moments at ages 5-7 when they enter the formal According to this theoretical perspective, primary school and have to learn how to sit still, boys become non-affective. To create an identity stay on task and operate in educational systems that is different from their mother’s – in essence, that in some ways seem more attuned to girls’ anti- or not-mother – they frequently reject overall patterns of socialisation (Pollack, 1998; feminine characteristics, namely emotional displays Figueroa, 1997). At the same time, entering the and affection (Chodorow, 1978; Gilmore, 1990). formal school system frequently means greater Furthermore, with the pressure they face to define exposure to male peer groups and the “culture themselves as masculine in the public arena and of cruelty” that they can perpetuate. Certain acts because their male role models are often distant, and behaviours considered “feminine” can elicit boys may exaggerate their masculinity to make it harsh criticisms from the social group, including clear in their social world that they are in fact “real using stereotypes of homosexuality. One boys” (Pollack, 1995; Chodorow, 1978). In sum,
  17. 17. WHAT ABOUT BOYS? 17numerous researchers and theorists argue that girls of masculinities and lead to more rigid conceptionsdefine themselves more in relationship to others of gender roles, and even to domestic violence.because girls’ intense attachment to their mother Thus, some men may over the lifespan becomelasts longer (Gilligan, 1982; Chodorow, 1978). more flexible in gender roles, while for others, theirSeveral researchers assert that the clinical views about gender roles may be situational.ramifications for men emerging from these early Additional research from a lifespan perspective ispatterns are problems achieving intimacy and needed to offer insights on the tendencies andexpressing emotions (other than anger), and possible changes in men’s views of their roles.hidden depression resulting from early unmetemotional needs. This depression may be Is it possible to change how boys aremanifested in alcoholism, abuse and anger socialised? First, it is important to affirm that not(Levant and Pollack, 1995; Real, 1997). all traditional forms of raising boys, and views about manhood, are negative, nor are all boys Almost universally, cultures and parents socialised in the stereotypical ways presented inpromote an achievement- and outward-oriented some research. Research suggests the importantmasculinity for boys and men (Gilmore,1990). role of fathers and other male family members inThis achievement-oriented manhood is specifically raising boys who are more flexible in their viewsconstructed so that boys reach the societal goals of masculinity. But all family members have anof being providers and protectors. Many cultures important role in socialising boys. Mothers andsocialise young boys to be aggressive and other female family members may inadvertentlycompetitive – skills useful for being providers and reinforce traditional views about masculinity byprotectors – while socialising girls to be non-violent not involving boys in domestic tasks, orand sometimes accepting of male violence (Archer, encouraging them to repress emotions or not to1984). Boys are also sometimes brought up to complain about health needs. Mothers, fathers,adhere to rigid codes of “honour” and “bravado,” other family members, teachers and other adultsor feigned courage, that obligate them to compete, who interact with young people may worry morefight and use violence, sometimes over minor about girls during puberty, believing that boys canaltercations, all in the name of proving themselves manage without guidance. Research finds thatas “real men” (Archer, 1994). when boys interact with adults and peers who reinforce alternative views about gender – for During late childhood and adolescence, example, men involved in caring for children orboys may be more likely to accept traditional in domestic tasks, or women involved in leadershipversions of manhood, displaying “machismo,” or positions – boys are more likely to be flexible inan exaggerated sense of masculinity. Girls, their views about gender roles (Pollack, 1998;however, are more likely to question traditional Barker and Loewenstein, 1997).gender norms (Erulkar et al., 1998). Thus, thenormative challenges in gender identity for girls Socialisation Outside the Home and themay be to question the limits that they perceive Male Peer Groupare placed on them upon reaching puberty, whilefor boys, the challenge may be to prove oneselfas a “man” in the social setting, while searching Studies from many parts of the worldfor ways to create intimacy and connection in conclude that boys generally spend moreprivate settings. Some researchers suggest a unsupervised time on the street or outsidenormative pattern of gender identity development the home than do girls. This time outsidein which adolescent boys pass through a periodof exaggerated manhood, but then become more the home represents both benefits and risksprogressive or flexible in terms of their gender for adolescent boys.identities later in adulthood (Archer, 1984).However, other research from a lifespanperspective suggests that unemployment or social Studies from many parts of the worldchanges (for example, women’s new roles in many conclude that from an early age, boys generallysocieties) may threaten some men’s conceptions spend more unsupervised time on the street or
  18. 18. 18 WHAT ABOUT BOYS? outside the home than do girls, and participate homophobic, callous in their attitudes toward in more economic activities outside the home women, and supportive of violence as a way to (Evans, 1997; Bursik and Grasmick, 1995; Emler prove one’s manhood and resolve conflicts. and Reicher, 1995). During adolescence, the amount of time adolescent boys spend outside While the male peer group is not the cause the home increases further. In Latin America, for of males’ aggressive attitudes or of macho attitudes, example, an important share of the economically greater association with an oppositional, street- active population is between ages 15-19. While based peer group is correlated with academic labour force participation is increasing among difficulties, substance abuse, risk-taking behaviour females and decreasing for males, it continues to in general, delinquency and violence (Archer, be substantially higher for males. In Ecuador, for 1994; Earls, 1991; Elliott, 1994). Furthermore, example, 44 percent of boys and 19 percent of while the male peer group is often studied for its girls from low-income families studied were negative influences on boys, there are also engaged in wage-earning activities. In five examples of male peer groups that have positive, developing country studies reviewed, girls were prosocial influences on boys. A positive male peer more likely to do work in the home while boys group can serve several important functions: 1.) it were far more likely to work outside the home provides a sense of belonging as boys seek or are (Kurz and Johnson-Welch, 1995). In Egypt, one- encouraged to seek independence, 2.) it provides third of adolescents work, with one out of every a buffer against a sense of failure that some low- two boys involved in economic activities outside income boys may experience in the school setting, the home compared to one in every six girls. Also, and 3.) it provides boys with models for male 48 percent of boys went out with friends the day identity, which may be missing in some homes. prior to the interview compared to 12 percent of girls (Population Council, 1999). It is interesting to note that some research suggests that this differential socialisation – girls This time spent outside the home represents closer to home and female role models, and boys both benefits and risks for adolescent boys. While outside the home – also leads to different kinds of freedom of movement is generally a benefit, and cognitive development or “intelligences” for boys provides boys with opportunities to learn social and girls. Consistently, women have a greater and vocational skills useful for their development, ability to read emotions and a greater ability to it also brings risks and costs. The primary risk is decode non-verbal messages (Manstead, 1998). related to the kinds of behaviour and socialisation Some researchers suggest that girls develop more promoted by the male peer group. These peers “emotional empathy” – the ability to “read” and may encourage health-compromising behaviours understand human emotions – while boys develop such as substance use or may promote traditional, “action empathy” – the ability to “read” and restrictive male behaviours such as the repression interpret action and movement (Pollack, 1998). of emotions. Boys and School Performance Because of the time they spend outside the home, in many cultural settings, girls’ role models Emerging data on school performance and (mothers, sisters, aunts, other adult women) are enrolment suggest that boys face special challenges physically closer and perhaps more apparent for in completing their formal education. In a 1994 girls, while boys’ same-sex role models may be UNICEF meeting, researchers from the Caribbean, physically and emotionally distant. Accordingly, North America, parts of South Asia and some some researchers have suggested that the male urban areas in Latin America reported that in peer group is the place where young men “try secondary schools in several countries in the out and rehearse macho roles,” and that the male region, young men currently comprise fewer than street-based peer group judges which acts and 50 percent of students in secondary schools (Engle, behaviours are worthy of being called “manly” 1994). While female disadvantage in the education (Mosher and Tomkins, 1988). However, the sector is still prevalent in many regions – versions of manhood that are sometimes particularly South Asia, Africa and some rural parts promoted by the male peer group can be of Latin America – in other areas, girls’
  19. 19. WHAT ABOUT BOYS? 19disadvantage has diminished substantially and higher rates of school drop-out were related toeducational inequality based on socio-economic gender issues within the school environment,status is more prevalent than gender imbalances namely that girls’ behaviour patterns were morein education enrolment and attainment (Knodel in tune with school norms (Kurz and Johnson-and Jones, 1996). Where the structural barriers Welch, 1995). It is important to note that boysto girls’ access to formal education have been dropping out of school in order to work is notovercome, there is increasing evidence that boys always perceived as negative. In certain parts offace gender-specific educational challenges. Nigeria, cultural practice requires boys to end their schooling around age 13 to become highly valued apprentices with trading masters. Women, therefore, are the majority at universities.Data on school performance in WesternEurope, Australia, North America, parts Researchers in parts of North America, theof Latin America and the Caribbean Caribbean, Australia and Western Europe aresuggests that where the structural barriers beginning to ask what specific factors impedeto girls’ access to formal education have boys’ – and particularly low-income boys’–been overcome, boys face gender-specific academic achievement. This research has focused on several issues, including the possibility thateducational challenges. socialisation in the home for girls encourages positive study habits, and that the school environment is more conducive to “female” ways Throughout Western Europe (with the of thinking and interacting. In Jamaica, where girlsexceptions of Austria and Switzerland) girls are outperforming boys at the secondary andcurrently outperform boys on standardised tests, tertiary levels, boys are generally socialised to rungraduate from secondary school in higher free while girls are confined to the home. As anumbers and are more likely to attend university result, girls may learn to concentrate on tasks, sit(Economist, 1996; Pedersen, 1996). In the U.S., still for longer periods of time and interact withnational figures show that boys score higher on greater ease with female authority figures.standardised tests in math and science, but girls Research from North America and the Caribbeanscore higher on writing and reading, arguably the on low-income boys suggests that teachers (themost important skills for academic success majority of whom are women at the primary level)(Ravitch, 1996). In low-income, urban areas in sometimes possess stereotypical images of boys,many industrialised countries, the differences creating self-fulfilling prophecies – i.e. they thinkbetween girls’ and boys’ academic performance that boys will act out and, in turn, boys act outare even more accentuated. In Brazil, as of 1995, (Figueroa, 1997; Taylor, 1991). Qualitative95.3 percent of young women ages 15-24 were research is also examining the dynamics of genderliterate compared to 90.6 percent of boys. In relations in low-income, urban settings where maleaddition, 42.8 percent of girls in this age range peer groups may be ambivalent to schoolwere enrolled in school compared to 38.9 percent completion, and where school systems expel thoseof boys. Boys are also more likely to repeat a grade children and youth who do not conform to its(Saboia, 1998). The most frequent explanation modes of authority and interaction – in mostfor boys’ lower school enrolment and achievement instances, these are more likely to be boys.is that boys begin working outside the home atearlier ages and their work outside the home may In Western Europe, Australia, Northinterfere with school. America, Caribbean and parts of Latin America, researchers are also examining learning disabilities Similarly, by age 19, girls in the Philippines that may impede boys’ academic performance,had on average 10 years of education compared including attention deficit hypertensive disorderto 8 years for boys. Girls also spend more time (ADHD) – also known as hyperactivity or attentioneach week in school. As in Brazil, researchers deficit disorder – which is more prevalent amonghypothesised that boys were being taken out of boys that girls (Pollack, 1998). Boys also haveschool to work, but respondents felt that boys’ higher reported rates of conduct disorder in school,
  20. 20. 20 WHAT ABOUT BOYS? a factor associated with lower educational Boys and Health-Seeking and Help-Seeking performance (Stormont-Spurgin and Zentall, Behaviour 1995; Pollack, 1998). Boys who rated high on stereotypical “masculine” behaviours had the The pressure to adhere to traditional and highest rates of externalising behaviour and stereotypical norms of masculinity has direct conduct disorder, which in turn are associated consequences for men’s mental and other health, with higher rates of school difficulties (Silvern and and for their health-seeking, help-seeking and risk- Katz, 1986). related behaviour. A national survey of adolescent males ages 15-19 in the U.S. found that beliefs While this research on boys’ experiences about manhood emerged as the strongest predictor in the school system is far from definitive, a of risk-taking behaviours; young men who adhered number of compelling questions arise. One is the to traditional views of manhood were more likely cost of boys’ oppositional and aggressive to report substance use, violence and delinquency, behaviour in terms of their early educational and unsafe sexual practices (Courtenay, 1998). achievement. At the primary school level, the Pleck (1995) asserts that violating gender norms control mechanisms that educational systems has significant mental health consequences for men have over disobedient, troublesome or aggressive – ridicule, family pressure and social sanctions – boys or those who are not performing at academic and that a significant proportion of males feel stress levels are various: placing boys in slower track as a result of not being able to live up to the norms groups, retention, or labelling them as having of “true manhood.” O’Neill, Good and Holmes some specific problem, the most common being (1995) suggest that the version of manhood ADHD. While some boys have a neurological promoted in many societies leads to six predisposition that warrants both the term and characteristics frequently found in men: restrictive treatment associated with ADHD, some emotionality; socialised control, power and researchers and commentators have questioned competition; homophobia; restrictive sexual and the sometimes overzealous tendency to use this affectionate behaviour; obsession with diagnosis in some Western settings (Mariani, achievement and success; and health problems. 1995; Pollack, 1998). Researchers have In settings where they feel comfortable expressing confirmed a connection between early conduct such emotions – generally outside of the traditional disorder and ADHD and later involvement in male peer group – some young men are able to delinquency and problems in the school setting express frustration at these rigid gender (Moffitt, 1990; Cairns and Cairns, 1994). What socialisation patterns just as girls have expressed is not clear is whether these boys have frustration about their gender normative patterns biologically-based temperamental traits that (Pollack, 1998; Barker and Loewenstein, 1997; predispose them to ADHD and aggressive Gilligan, 1982). behaviour, or whether being labelled as “troublesome” or delinquent leads boys to Research confirms that boys are less likely become delinquent and have difficulties in school. than girls to seek health services when they need them and less likely to be attuned to their health Boys’ school performance has important needs. A study in Thailand found that adolescent implications in terms of individual development girls in urban areas were more likely than boys to and health. Research from North America has report having sought medical attention in the last found that school performance as well as the month. However, nearly equal numbers of degree of “connection” to the school are adolescents reported having purchased protective factors against health–risk behaviours. medications for themselves in the past month, Youth who do better academically and who feel suggesting nearly equal rates of illnesses for boys connected to their school display fewer risk and girls (Podhisita and Pattaravanich, 1998). In behaviours, including substance use, early and a Kenyan study, girls were slightly more likely than unprotected sexual activity, and suicidal thoughts. boys to have used health facilities (52 percent (Resnick et al., 1997). versus 47 percent) (Erulkar et al., 1998). In Jamaica, a national survey of young people ages 15-24 found that young women were more than
  21. 21. WHAT ABOUT BOYS? 21twice as likely (29.8 percent versus 13 percent) to brought on by the frustrations of living in a low-talk to health personnel about family life education income and violent setting (Nightingale, 1993).topics than were young men (National Family Researchers have concluded that the ability toPlanning Board, 1999). A nation-wide survey of process and express emotional stress in non-violentboys ages 11-18 in the U.S. found that by the ways protects against a number of developmentaltime they entered high school, more than one in and health problems. Thus, boys are at afive boys said there had been at least one occasion disadvantage if they have fewer opportunities andwhen they did not seek needed health care. The feel constrained to express emotions associatedprimary reason cited was not wanting to tell with adverse circumstances and stressful life eventsanyone about their problem (28 percent), followed (Cohler, 1987; Barker, 1998).by cost and lack of health insurance (25 percent)(Schoen et al., 1998). Other anecdotal Boys’ difficulties in seeking help andinformation finds that young men sometimes expressing emotions have importantencounter hostile attitudes in clinics, that they consequences for their mental health andperceive maternal and child health clinics and development. Where boys are working in largereproductive health clinics as “female” spaces, and numbers or spend their time outside the homethat they are even turned away from clinics and school settings, boys may also be less likely(Armstrong, 1998; Green, 1997). Young men in than girls to be connected to informal and formala Ghana study said they were sometimes turned support networks. While male kinship and peeraway from reproductive health clinics because of groups may provide a space for socialisation andtheir age; others said they were uncomfortable companionship, they may provide limitedwith female staff (Koster, 1998). Indeed, while opportunities for discussions of personal needsthere are health professionals who specialise in and health concerns.working with girls and women, such as agynaecologist, there is no such professional foradolescent and adult men. The literature suggests that the biological differences that clearly exist between boys How might boys be encouraged to make and girls affect their health and developmentgreater use of existing health services? When in a more limited way than differences dueasked, boys often say that they want many of the to gender socialisation.same things in health services that young womenwant: high quality service at an accessible price;privacy; staff who are open to their needs; Implicationsconfidentiality; the ability to ask questions; and ashort waiting time (Webb, 1997; Site visit to Summing up, the literature suggests that theCISTAC, Santa Cruz, Bolivia, 1998). biological differences that exist between boys and girls affect their health and development in a more Research also suggests that gender limited way than differences due to gendersocialisation is related to boys’ limited help-seeking socialisation. The literature identifies two keybehaviour. Boys are generally socialised to be trends in the socialisation of adolescent boys withself-reliant and independent, not to show direct implications for their health and well-being:emotions, not to be concerned with or complain 1.) a too-early push toward autonomy and aabout their physical health, and not to seek repression of desires for emotional connection;assistance during times of stress. Research in and 2.) social pressure to achieve rigidly definedGermany with boys ages 14-16 found that in times male roles. In some low-income areas – whereof trouble, 36 percent would prefer to be alone access to other sources of masculine identity, suchand 11 percent said they needed no comfort; 50 as school success or stable employment, are harderpercent of boys turned to their mothers, and fewer to achieve – young men may be more inclined tothan 2 percent said they turned to their fathers adopt exaggerated masculine postures that involve(Lindau-Bank, 1996). Among low-income youth risk-taking behaviour, violence or sexist attitudesin the U.S., girls more frequently learn how to toward women, and violence against other menand are allowed to process pain and emotions as a way to prove their manhood.
  22. 22. 22 WHAT ABOUT BOYS? The implications of this research include: Research Implications Programme Implications p There is a need for additional information on young men’s attitudes toward existing p The need to sensitise health personnel and health services to find ways to confront others who work with young people on the challenges to access and encourage young realities and perspectives of boys, and how men to utilise existing health services. to encourage boys to seek health services and help when they need it. This may also p There is a need for additional research on include engaging health personnel and gender socialisation and boys’ school other youth-serving staff in discussions performance, and the implications of boys’ about their own possible stereotypes about apparent school difficulties and mental boys. health and well-being. p There is a need for health educators and p The need for additional research on how other youth-serving staff consider boys are socialised in various settings, and alternative spaces for boys to discuss additional qualitative explorations that normative developmental milestones such incorporate boys’ voices and their as spermarche and puberty, and other interpretations of gender, equity, issues. masculinity, roles and responsibilities. p There is a need to sensitise teachers and p There is a need for additional research on education personnel on the possible the changing nature of masculinities and gender-specific challenges that boys, gender roles and boys’ perceptions of these particularly low income boys, may changes. More must be understood about encounter in school . how boys are responding to changes in women’s roles and changes in gender roles p There is need for creative approaches in generally. health service delivery for adolescent boys, taking into account their expressed desires p There is a need for additional research on for confidentiality, staff who are sensitive where boys “hang out,” the meaning of their to their needs, waiting areas that are time use in different settings, their social welcoming, and accessible hours. networks and implications for their development and socialisation. These p There is a need to engage boys, parents, studies should also examine more communities, health and educational adequately the meaning and impact of boys’ personnel and youth-serving personnel in greater socialisation outside the home. open discussions about longstanding ideas about manhood, recognising both the positive and negative aspects of traditional aspects of gender socialisation.
  23. 23. chapter 2 WHAT ABOUT BOYS? 23 mental health, coping, suicide and substance use The previous chapter highlights a number even suggest that young men’s greater denial of of mental health issues related to gender stress and problems, and their propensity not to socialisation, particularly the lack of perceived and talk about problems, may be related to men’s real opportunities for young men to seek assistance greater rates of substance use (Frydenberg, 1997). during stressful moments; boys’ tendencies not to talk about emotions and personal problems; On the other hand, adolescent girls more difficulties admitting mental health needs; and frequently turn to friends and pay attention to rigid pressures to adhere to traditional gender roles health needs resulting from stress. Boys are less and norms. Substance use should be added to likely to admit that they could not cope during this constellation of young men’s common stressful moments, while girls are more likely to reactions to stressful situations, and viewed as a be able to express their difficulties in coping, risk-taking behaviour sometimes used as a way probably because they are more willing to express to prove one’s “manhood” or fit in with the peer helplessness and fear (Frydenberg, 1997). group. Similarly, there are gender-related patterns However, it is important to point out that while in suicide that emerge from patterns of male girls may sometimes be more likely than boys to socialisation. verbally express their stress, they may also internalize such feelings in the form of eating There are clear gender patterns in the way disorders and general aches and pains – issues that young people respond to stressful and seldom reported by or observed in boys. Thus, traumatic life events. Some researchers argue that in suggesting that boys and girls show different men typically respond less well, face greater risks patterns in responding to stress, we should not and are less likely than women to seek social imply which sex actually is subject to greater stress. support during stressful life events, such as a death in the family or divorce (Manstead, 1998). While Suicide women’s external expressions of emotion and grief during traumatic life events were traditionally These gendered patterns of coping with considered a sign of mental weakness or even stress can also be seen in gender differences in precursors of mental health disorders, the mental suicide. Suicide is among the three leading causes health field has come to see these outward of death for adolescents, and suicide rates among expressions of emotion as a sign of positive mental adolescents are rising faster than among any other health (Manstead, 1998). age group. World-wide, between 100,000 and 200,000 young people commit suicide annually, while possibly 40 times as many attempt suicideIn times of stress or trauma, boys are more (WHO Adolescent Health and Developmentlikely to respond to stress with aggression Programme, 1998). In terms of sex-(either against others or against disaggregation, three times more women thanthemselves), to use physical exertion or men attempt suicide but three times as many men commit suicide (WHO, 1998). (There are somerecreation strategies, and to deny or ignore exceptions, such as China and India, where suicidestress and problems. rates among women are higher. It should also be mentioned that suicide rates world-wide are underreported because suicides are often classified Various studies have found that in times of as accidents or simply not classified.) stress or trauma, boys are more likely than girls to respond to stress with aggression (either against In the U.S., where suicide is currently the others or against themselves), to use physical third leading cause of death among young people exertion or recreation strategies, and to deny or ages 15-24, boys are four times as likely to commit ignore stress and problems. Some researchers suicide as girls, although girls try more often
  24. 24. 24 WHAT ABOUT BOYS? (Goldberg, 1998; National Center for Injury Although it is difficult to assess whether such Prevention and Control, 1998). In addition, surveys are truly representative, evidence indicates suicide rates for girls and boys, until age 9, are that youth who identify themselves as homosexual identical. From ages 10-14, boys commit suicide probably engage in higher rates of suicidal at twice the rate of girls; from ages 15-19 at rates behaviour but may not necessarily complete four times as high; and from age 20-24, at rates suicide. Comparison studies with hetero- and six times as high as girls (U.S. Bureau of Health homosexual youth in Australia found no significant and Human Services, 1991). differences in rates of depression, but homosexual youth more frequently reported suicidal thoughts. A quarter of homosexual youth who had attempted Suicide is among the three leading causes suicide identified sexual orientation as at least part of death for adolescents, and suicide rates of the reason they had attempted. Overall, 28.1 percent of homosexual youth had attempted among adolescents are rising faster than suicide compared to 7.4 percent of heterosexual among any other age group. World-wide, youth (Nicholas and Howard, 1998). Similarly, 30 three times more women than men percent of all homosexual and bisexual males attempt suicide but three times as many interviewed in the U.S. report having attempted men commit suicide. suicide at least once (American Academy of Pediatrics, 1993). Girls are more likely to attempt suicide but It is also important to note that in Australia, less likely to complete the act. Because suicide the U.S. and New Zealand, suicide was once more attempts for some women are sometimes used common among adolescent males of European to get attention, women may choose methods descent, but is becoming equally or more prevalent that are deliberately ineffective (Personal among minority and indigenous populations correspondence, Benno de Keijzer, 1999). Men, (African-Americans and Native Americans in the on the other hand, may choose effective and U.S., Aboriginal and Torres Straight Islanders in terminal suicide because prevailing gender norms Australia and Maori, and Pacific Islanders in New do not allow them to seek help for personal stress. Zealand). There is evidence of an increasing For young men, therefore, suicide may not be a number of older adolescent males in the South call for help, but an effective and final end to Pacific committing suicides by hanging, jumping, suffering. or using firearms (Personal correspondence, John Howard, 1998). However, the issue of suicide and gender must be considered with caution. Research on Substance Use suicide is insufficiently clear to determine whether girls’ suicide attempts and the methods they Gender also influences rates of substance choose generally are not intended to be final. It use. While statistics often are not disaggregated may be that both adolescent boys and girls want by sex, boys are more likely than girls to smoke, to end pain when they attempt suicide, but that drink and use drugs. Currently, about 300 million boys have greater access to effective and youth are smokers and 150 million will die of immediate means such as firearms, or that boys smoking-related causes later in life. In most have a greater propensity for aggression and risk- developing countries, boys smoke at higher rates taking, and can more directly act out their suicidal than girls, although rates in girls are increasing thoughts. faster (WHO Adolescent Health and Development Programme, 1998). In some countries, bisexual or homosexual youth – both male and female – constitute a Similar trends are seen with other significant risk group for suicidal behaviour. substances. In Ecuador, 80 percent of narcotics Studies have found that between 20-42 percent users are men, the majority are in the late teen of homosexual youth attempt suicide, with most years to early 20s (UNDCP and CONSEP 1996). , attempts occurring between 15-17 years of age. In Jamaica, lifetime and current use of marijuana
  25. 25. WHAT ABOUT BOYS? 25for young and adult men is two to three times said they “are always or sometimes high ongreater than usage rates for young women alcohol or drugs during sex”(Brindis et al., 1998).(Wallace and Reid, 1994). In Jordan, 17 percent In the U.K., one in three 15-year-old boysof adolescent males ages 15-19 smoke regularly, compared to one-in-five 15-year-old girls reported16 percent occasionally use tranquillisers and 3 being involved in fights or arguments after drinkingpercent occasionally use stimulants (UNICEF, (Gulbenkian Foundation, 1995).1998). A national survey of adolescents in the U.S.found that 20.1 percent of males compared to 15.6 World-wide, substance use is correlated withpercent of females report using alcohol two days a range of problems that are more frequentlyor more per month (Blum and Rinehart, 1997). associated with adolescent boys: violence,Upon reaching high school age, boys and girls accidents and injuries (Senderowitz, 1995).were smoking, drinking and using drugs at similar Various studies suggest that substance use isrates, but younger boys (ages 11-14) were twice related to lack of parental support, unconventionalas likely as girls to drink (6 percent of boys versus goals, negative peer group influences, exposure3 percent of girls) and more likely to use illegal to violence in the home, personal frustration, lackdrugs (9 percent of younger boys versus 6 percent of future orientation, and having been victims ofof girls in the same age range). Boys are also more abuse or violence at home. Reporting substancelikely than girls to say that they use drugs to be use rates by sex is an important first step toward“cool” (Schoen et al., 1998). Surveys in the U.S. understanding how substance abuse differs infind that boys and girls around age 13 engaged rates, meaning, context and sequelae for boys andin nearly equal rates of “binge” drinking (defined girls.in the study as five or more drinks in a row). Byage 18, 40 percent of boys are engaging in such Mental Health Problems and Needsbehaviour compared to fewer than 25 percent ofgirls (Kantrowitz and Kalb, 1998). Similarly, in Do boys and girls or men and women haveKenya, boys are more likely to have tried different rates of mental health disorders orcigarettes, alcohol and marijuana than girls (38 different mental health needs? Evidence for sexpercent versus 6 percent for cigarettes; 38 percent differences in rates of mental disorders are limited,versus 14 percent for alcohol; and 7 percent versus and those studies that do exist must be interpreted1 percent for marijuana) (Erulkar, et al., 1998). In with caution. Women are more likely to beEgypt, 11.2 percent of boys smoke compared to diagnosed for psychoneuroses and depression, but0.3 percent for girls (Population Council, 1999). these higher rates may not reflect true sex differences. Instead, they may reflect the willingness of women to admit that they areIn many parts of the world, boys are more experiencing these problems. Other studies havelikely than girls to smoke, drink and use confirmed biases by mental health professionalsdrugs. Substance use, particularly alcohol in terms of diagnosing psychological disorders;use, is frequently part of a constellation that is, mental health professionals may be more likely to label the externalising behaviour ofof male risk-taking behaviours, including women, rather than the internalising behaviourviolence and unprotected sexual activity. of men, as a mental disorder (Manstead, 1998). Adolescent boys, on the other hand, are more likely than adolescent girls to be diagnosed with Substance use, particularly alcohol use, is conduct disorders and aggressive disorders. Againfrequently part of a constellation of male risk- these differences may reflect biologically-based sextaking behaviours, including violence and differences, or may reflect gender biases in theunprotected sexual activity. In Brazil, substance diagnoses of mental health professionals.abuse among young men was associated withhaving the “courage” to propose sexual relations, The timing of mental health disorders andand was likely to impair sexual decision-making the possible underdiagnosis of young men’s(Childhope, 1997). In a study of adolescent males mental health problems may be the mostusing family planning clinics in the U.S., 31 percent important issues regarding adolescent boys and