Gender-related data missingness, imbalance and bias in global health surveys

Abstract

Global surveys have built-in gender-related biases associated with data missingness across the gender dimensions of people's lives, imbalanced or incomplete representation of population groups, and biased ways in which gender information is elicited and used. While increasing focus is being placed on the integration of sex-disaggregated statistics into national programmes and on understanding effects of gender-based disparities on the health of all people, the data necessary for elucidating underlying causes of gender disparities and designing effective intervention programmes continue to be lacking. Approaches exist, however, that can reasonably address some shortcomings, such as separating questions of gender identification from biological sex. Qualitative research can elucidate ways to rephrase questions and translate gendered terms to avoid perpetuating historical gender biases and prompting biased responses. Non-health disciplines may offer lessons in collecting gender-related data. Ultimately, multidisciplinary global collaborations are needed to advance this evolving field and to set standards for how we measure gender in all its forms.

Keywords: epidemiology; health policy; public health.

Figure 1

Topic areas included in the male and female modules of the phase 8 DHS questionnaire. Sex-specific topic areas are depicted by colour (teal for males and tan for females) with the depth of colour indicating the degree to which questions are unique to one sex. Questions were considered matched in both modules if they were identical or nearly identical (eg, the word ‘husband’ in the female module is replaced with the word ‘wife’ in the male module). Topics in light grey are covered equally in both modules. Topics that cross the lines are neither entirely unique nor equally matched by sex. Topics are arranged by total question count, with the largest topic areas at the top of the circles. DHS, Demographic and Health Surveys. IPV, Intimate Partner Violence; STD, Sexually Transmitted Disease.