Distinguishing between sex and gender in health research
This week is SGBA awareness week. We thought we would take this opportunity to look at the role of sex and gender in health.
Sex and gender. These are two concepts that often get confused and conflated in research and used interchangeably. However, they are different and it is important to distinguish between the two.
Typically, we think of sex as being biological; a multidimensional construct that includes physical features, anatomy, physiology, gene expression, and hormone levels. [1]
Gender, on the other hand, is a social construction based on the norms and expectations we have around one’s behaviours and their role in society because of their sex. Gender is culturally and historically specific, intricately linked to the political context, as well as social and economic status. [1]
It used to be that sex was divided into males and females depending on whether an individual has two X chromosomes or one X, one Y. We now have a better understanding that this is a less rigid; where some individuals may be intersex, with a mix of characteristics that may be male or female.
Similarly, gender is no longer being represented as binary categories of man/woman or girl/boy. Gender is a spectrum and individuals may identify as fully male, fully female, somewhere in between the two, neither or other. For a good resource on sex/gender and other definitions check out this site.
The notion of gender and sex being distinct is still fairly new, but it is now better understood that each can influence health in different ways. There are discrete sex differences in the body and these physiological and hormonal differences may have potential effects on different risk factors, progression/signs of disease, or effectiveness of treatments. Gender can also affect health in numerous ways including one’s association with risk factors, how they perceive their own health and how they receive care.
As researchers we should always try to include an analysis on sex and gender in our own research to try and identify where there are differences and similarities.
Lumping everyone together you may miss important factors, which can compromise the validity and generalizability of findings. Including a sex-and-gender-based-analysis (SGBA) typically makes research more equitable but can also lead to more effective policies, and potentially save money for the health care system. An SGBA is required by CIHR and it is internationally as well by the WHO, UN and PAHO.
If you want to learn more, there are many resources that can help you with incorporating a SGBA in your own research (Rising to the Challenge, CIHR, Cochrane Collaboration, CWHN).
You can think about these concepts in your own research, for example when designing questionnaires — do you want to know about sex differences? Or gender and roles in society? Are you providing participants with only two binary options to choose from? Or are there more?
Considerations about sex and gender are also necessary when it comes to patient and public engagement in health research. There will be different challenges or barriers that will come with trying to engage men, women and people who are gender diverse. Similarly, once involved in research, there may be differences in ways they will require support to continue being engaged in a meaningful way. More importantly though, are the benefits that will come from engaging a diverse group as they will be able to share different experiences based on their sex and gender; adding value and meaning to your research.
The Awesome Model incorporates a “gender lens” which encourages researchers to be gender sensitive in their planning; reflecting on gender differences and how they will affect patient engagement in research.
Reference:
1. Johnson, J.L., Greaves, L., & Repta, R. (2007). Better Science with Sex and Gender: A Primer for Health Research. Vancouver: Women’s Health Research Network. Available at: http://bccewh.bc.ca/wp-content/uploads/2012/05/2007_BetterSciencewithSexandGenderPrimerforHealthResearch.pdf
