Adaptation of the G-NORM (Gender norms scale) in Uganda: An examination of how gender norms are associated with reproductive health decision-making
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Gender norms are multifaceted, context-specific social norms that shape women’s reproductive health decision-making, and must be measured as distinct but related constructs—particularly descriptive norms (what people do) and injunctive norms (what people believe should be done). The discussion highlights that injunctive norms may shift more quickly than descriptive norms and are more strongly associated with reproductive agency, suggesting that interventions may benefit from first targeting perceived expectations before attempting to change behaviors. Additionally, accurately measuring norms—including social sanctions and reference groups—is critical for understanding and shifting gender inequality at scale.
Objectives The study aimed to adapt and validate the G-NORM (Gender Norms) scale for use in Uganda and to examine how gender norms are associated with reproductive health decision-making among women of reproductive age.
Methods The study used a mixed-methods approach combining qualitative and quantitative data. Qualitative in-depth interviews informed the development and adaptation of scale items to the Ugandan context. Cognitive interviewing was used to refine items. A cross-sectional survey of 2,422 sexually active women aged 15–45 was conducted, and psychometric analyses—including exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and regression models—were used to validate the scale and assess associations with reproductive health decision-making outcomes. Social norms were measured using paired items capturing descriptive and injunctive norms, including perceptions of community behaviors, expectations, and social sanctions.
Results The adapted G-NORM scale demonstrated a strong two-factor structure distinguishing descriptive and injunctive norms, with high internal consistency (Cronbach’s alpha .80 and .92). Injunctive norms were more equitable than descriptive norms, suggesting differences between perceived expectations and actual behaviors. Importantly, more equitable injunctive norms were significantly associated with improved reproductive health decision-making outcomes, including lower likelihood of partner-dominated contraceptive decisions and reduced perceived conflict around contraceptive use, while descriptive norms were not significantly associated with these outcomes.
Conclusions The study concludes that gender norms are a critical determinant of health and require robust, contextually adapted measurement tools. The validated G-NORM scale provides a reliable way to assess gender norms in sub-Saharan Africa and can support both research and interventions aimed at reducing health inequalities. Distinguishing between types of norms enables more targeted and effective strategies to shift gender norms and improve women’s reproductive autonomy and well-being.
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