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. Author manuscript; available in PMC: 2015 Aug 1.
Published in final edited form as: Glob Public Health. 2014 Jul 15;9(7):773–786. doi: 10.1080/17441692.2014.928347

Influences of sex, age, and education on attitudes toward gender inequitable norms and practices in South Sudan

Jennifer Scott a,b,c, Michele Hacker a,e, Sarah Averbach a, Anna M Modest a, Sarah Cornish f, Danielle Spencer f, Maureen Murphy f, Parveen Parmar c,d
PMCID: PMC4176771  NIHMSID: NIHMS601910  PMID: 25026024

Abstract

Background

Prolonged conflict in South Sudan exacerbated gender disparities and inequities. This study assessed differences in attitudes toward gender inequitable norms and practices by sex, age, and education to inform programming.

Methods

Applying community-based participatory research methodology, 680 adult respondents, selected by quota sampling, were interviewed in seven South Sudanese communities from 2009 to 2011. The verbally administered survey assessed attitudes using the Gender Equitable Men scale. Data were stratified by sex, age, and education.

Results

Of 680 respondents, 352 were female, 326 were male, and two did not report their sex. The majority of respondents agreed with gender inequitable household roles, but the majority disagreed with gender inequitable practices (i.e. early marriage, forced marriage, and inequitable education of girls). Respondents who reported no education were more likely than those who reported any education to agree with gender inequitable practices (all p<0.03) except for forced marriage (p=0.07), and few significant differences were observed when these responses were stratified by sex and age.

Conclusion

The study reveals agreement with gender inequitable norms in the household, but an overall disagreement with gender inequitable practices in sampled communities. The findings support that education of both women and men may promote gender equitable norms and practices.

Keywords: South Sudan, gender equality, education, early and forced marriage, traditional practices, Gender Equitable Men scale

Background

After decades of conflict, South Sudan gained independence from Sudan in July 2011. Prolonged conflict exacerbated gender disparities and inequities (Abusharaf, 2005; N. Ali, 2011; Elia, 2007; Wright, 2013). Conflict and socio-economic and political marginalisation impacted women and men in gender-specific ways in South Sudan and a clear gendered statebuilding strategy is important post-independence (N. Ali, 2011). As a newly independent nation strengthens gender policies, data can inform policy development and allow for targeted programming to address gender inequitable norms and practices and to promote gender equality and women’s empowerment (Edward, 2011; Government of the Republic of South Sudan Ministry of Gender, Social Welfare and Religious Affairs, 2008; Government of the Republic of South Sudan, 2011).

Gender equality refers to the equal rights, responsibilities, and opportunities of women and men, as well as girls and boys (United Nations Women, 2012). Recognised as a human right and Millennium Development Goal, gender equality is central to the health of individuals and communities, country development, and the eradication of poverty (Organisation for Economic Co-operation Development, 2010; United Nations Statistics Division, 2008; United Nations Women, 2012). Gender discrimination often begins at a young age; therefore, greater equality for girls is necessary to ensure equal rights for women later in life (United Nations Population Fund, 2012). Changes toward equitable gender roles and relations in the household and community are a prerequisite to gender equality (United Nations Women, 2012; International Fund for Agricultural Development of the United Nations [IFAD], 2012). In South Sudan, prolonged conflict and displacement have impacted gender roles and norms (N. Ali, 2011). Gender gaps in education and the persistence of gender inequitable practices, such as early marriage and widow inheritance, remain obstacles to achieving gender equality in South Sudan (Integrated Regional Information Networks [IRIN], 2013).

As of 2009, the gender parity index for primary education in South Sudan was estimated to be 0.7 and for secondary education was estimated to be 0.4, indicative of educational opportunities that favour males (South Sudan National Bureau of Statistics (NBS), 2012; United Nations Statistics Division, 2008). The intake ratio in the first grade is almost equal for girls and boys; however, a gender parity index < 1 for primary education indicates that girls are falling out of the educational system earlier than boys in South Sudan (South Sudan NBS, 2012). The target for Millennium Development Goal 3 (to promote gender equality and empower women) is to eliminate gender disparities in primary and secondary education and achieve a gender parity index of 1 by 2015 (South Sudan NBS, 2012). Education of girls has been purported to be a powerful lever for empowerment, as well as for reducing poverty (Grown, Gupta, & Pande, 2005; United Nations Population Fund, 2012).

Despite efforts to protect girls from early marriage, such as the 2008 Southern Sudan Child Act (Government of the Republic of South Sudan Ministry of Gender, Social Welfare and Religious Affairs, 2008) and the Convention on the Rights of the Child, the practice persists in many South Sudanese communities (United Nations Children's Fund, 2011). A 2009 national household survey found that women marry earlier than men and that 41% of women aged 18 to 19 years are married compared to 8% of men in the same age group (South Sudan NBS, 2012). A 2010 South Sudan Health Survey revealed that 7% of females enter marital unions before their 15th birthday and that 45% have entered a marital union by the age of 18 (Government of the Republic of South Sudan, 2010). Menstruation is often considered the main criteria for marriage by customary courts in South Sudan (IRIN, 2013; United Nations High Commissioner for Refugees, Republic of South Sudan's Ministry of Gender, Child and Social Welfare, Norwegian People's Aid, United Nations Population Fund, & United Nations Entity for Gender Equality and the Empowerment of Women, 2011). From a health and human rights standpoint, early marriage leads to numerous negative health and social consequences, including early pregnancy, high burden of infectious diseases, high maternal mortality, and low educational attainment (IRIN, 2013; Nour, 2006; United Nations Children's Fund, 2011). Furthermore, postponement of marriage for women has been associated with increased literacy rates and higher economic status (United Nations High Commissioner for Refugees et al., 2011). Inequitable practices, such as bride dowry, early and forced marriage, and widow inheritance further impact the rights and future for women in South Sudan (Delistraty, 2013; IRIN, 2013; Sommers & Schwartz, 2011).

The ratified constitution of the Republic of South Sudan calls for the elimination of harmful traditions such as early and forced marriage; prohibits gender discrimination; and specifies gender priorities (i.e. a quota system for women’s parliamentary participation). However, advocates argue that women in South Sudan continue to face obstacles (Edward, 2011; Government of the Republic of South Sudan Ministry of Gender, Social Welfare and Religious Affairs, 2008; Government of the Republic of South Sudan, 2011). One of the Ministry of Gender’s key indicators to measure progress toward gender equality in South Sudan is the change in women’s and men’s attitudes toward women’s roles and potential in society (Government of the Republic of South Sudan Ministry of Gender, Social Welfare and Religious Affairs, 2008).

While there is evidence that gender disparities and gender inequitable practices exist in South Sudan, there are limited data about the attitudes toward these practices and the effects of sex, age, and education on these attitudes. Understanding these attitudes and any differences among sex, age, and education could allow for more effective and targeted programming and support a gendered statebuilding strategy. This assessment of attitudes toward gender inequitable norms and practices was part of a larger study that also evaluated attitudes toward gender-based violence (Scott et al., 2013) and sexual and reproductive health norms (Scott et al., 2013) in South Sudanese communities. Both assessments revealed that the majority of women and men in the sampled communities agreed with inequitable norms regarding violence and sexual and reproductive health and that there were differences in select attitudes when stratified by sex, age, and education.

The study was primarily designed to inform programming for a non-governmental organisation and secondarily to evaluate the influence of sex, age, and education on attitudes toward gender inequitable norms in the household and gender inequitable practices in the sampled communities of South Sudan.

Methods

The methods of this study are described in detail elsewhere (Scott et al., 2013) and are outlined below. The study applied a community-based participatory research model in which a community steering committee participated in the study design, survey development, and data collection with the goal of informing community health (Faridi, Grunbaum, Gray, Franks, & Simoes, 2007). The study was conducted in seven sites within South Sudan from 2009 to 2011, prior to the country’s formal independence in June 2011, in partnership with American Refugee Committee, a non-governmental organisation. The assessment sites (total population sizes) were as follows: Aweil (41,827), Kwajok (243,921), Lainya (89,315), Malakal (126,483), Morobo (103,603), Ronyi (201,443), and Wau (151,320) (Southern Sudan Centre for Census Statistics Evaluation, 2010). We designed the study to sample 100 men and women in each site.

Households, defined as groups who usually live and eat together, were selected at a pre-determined interval and quota sampling was used to attain equal sex and age distribution in each site. Males and females were stratified into two age groups: 18 to 35 years and > 35 years. If the intended individual (i.e. older man or younger woman) was not available, the interviewers proceeded to the next interval household. Verbal consent was obtained, and respondents were informed that their participation was voluntary and they would not receive compensation.

Trained male and female South Sudanese interviewers verbally administered the survey in Arabic or in the regional language, in a private setting in the household. Due to limited resources, interviewers and respondents were not matched by sex. Respondents were asked whether they ‘agree’, ‘partially agree’, or ‘disagree’ with statements regarding gender inequitable norms and practices. Respondents were asked whether women should have ‘more’, ‘the same’, or ‘less’ power within the community compared to their current level of power. Detailed demographic characteristics and attitudes toward norms regarding violence and sexual and reproductive health were previously assessed (Scott et al., 2013).

The statements regarding gender inequitable norms were taken from the original Gender Equitable Men scale (Chronbach’s alpha > 0.80 for the full scale) (Pulerwitz & Barker, 2008) or from adaptations of the scale (Nanda, 2011; Population Council). The Gender Equitable Men scale has been validated and used in several countries (Verma et al., 2006). The original version of the scale included 24 questions with 17 in an ‘inequitable’ gender norms subscale and seven in an ‘equitable’ subscale. Our survey instrument included selected statements from the original ‘inequitable’ gender norms subscale and the community steering committee included additional statements to assess gender inequitable practices (Table 1). The statements are listed in the tables in the verbally administered format. For the purposes of the Gender Equitable Men scale, a gender equitable man is defined as a man who shares responsibility in the household, believes that women and men should have equal rights, is respectful to women, and is opposed to violence against women (Nanda, 2011). Gender inequitable norms were defined as unequal social expectations and roles assigned to women and men (Barker, Ricardo, & Nascimento, 2007). Gender inequitable practices were defined as practices that discriminate by gender (United Nations Women, 2012), including harmful traditional practices affecting women and children such as early marriage, forced marriage, inequitable access to education, and son preference (United Nations, 1979).

Table 1.

Survey instrument

Question Source of survey question1 Subscale (GEM)2
Women should have ___power (more, the same, less) within the community than they currently have Community steering committee Not applicable
A man should have the final word about decisions in his home GEM Scale (original version) Inequitable gender norms
A wife must obey her husband GEM Scale (adapted version) Not in original subscale
A woman’s most important role is to take care of her home and cook for her family GEM Scale (original version) Inequitable gender norms
Changing diapers, giving the kids a bath, and feeding the kids are the mother’s responsibility GEM Scale (original version) Inequitable gender norms
It disgusts me when I see a man acting like a woman GEM Scale (original version) Inequitable gender norms
A couple that has only a female child is unfortunate Community steering committee N/A
Boys deserve to go to school more than girls Community steering committee N/A
It is okay for parents to marry their young daughters (under age 18) to older men Community steering committee N/A
If a woman gets divorced, she should not be allowed to marry again Community steering committee N/A
If a woman’s husband dies, the husband’s family should decide her future Community steering committee N/A
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1

The sources of survey questions include: Gender Equitable Men (GEM) scale (original version) (Pulerwitz & Barker, 2008), GEM scale (adapted version) (Nanda, 2011), and the community steering committee.

2

The original Gender Equitable Men scale (GEM) included an ‘inequitable’ gender norms subscale and an ‘equitable’ gender norms subscale (Pulerwitz & Barker, 2008)

Ethics

American Refugee Committee had permission from the government of the Republic of South Sudan to conduct the assessments. In each site, permission was obtained from the village elder. Ethics approval was granted from Harvard School of Public Health. The community steering committee served as a local ethical advisory board. American Refugee Committee coordinated support services and referral if requested by a respondent or if determined necessary by the interviewer. Data were anonymous and stored securely. Written documentation of verbal consent was not collected.

Statistical analysis

Statistical analysis was performed using SAS® 9.3 statistical software (SAS Institute Inc., Cary, NC). Data are reported as median (interquartile range), proportion, or relative risk (95% confidence interval). Categorical data was compared using the chi-square or Fisher’s exact test. Continuous data was compared using the Wilcoxon rank sum test. The Gender Equitable Men scale can be scored using a three-point scale with agree (1), partially agree (2), and do not agree (3), so that high scores represent high support for gender equitable norms (Nanda et al., 2013). Given our study aimed to inform programming and assess differences in attitudes by sex, age, and education, we decided to combine the responses ‘agree’ and ‘partially agree’. For the question about women’s power in the community, a pairwise comparison for each response was done to determine which response was statistically significant. We used log-binomial regression to control for potential confounders. All tests were two-sided and p-values < 0.05 were considered statistically significant.

Results

A total of 680 adult respondents were included in the analysis. The response rate for Wau was 96% (102/106). Response rates were not recorded in the other sites; however, study supervisors for the other sites reported few refusals and few households without an eligible respondent.

Demographics

Of the 680 respondents, 52% were women, 48% were men, and sex was not reported for 2 individuals. The majority of respondents were married (70%), Christian (62%), and represented the major ethnic groups. The median age was 34.0 years (25.0–45.0) (Scott et al., 2013). Self-reported education and literacy level are described in Table 2. Women were more likely to report no education than men (p=0.002) and a lower literacy level compared to men (p<0.0001).

Table 2.

Age, education, and reported literacy of respondents

Characteristic All Respondents n=680 Male† n=326 Female† n=352 p*
Age 0.22
 ≤ 35 years 367 (54.0) 168 (51.5) 198 (56.3)
 > 35 years 313 (46.0) 158 (48.5) 154 (43.8)
Education 0.002
 No education 159 (23.4) 59 (18.1) 100 (28.4)
 Any education 444 (65.3) 235 (72.1) 209 (59.4)
 Missing 77 (11.3) 32 (9.8) 43 (12.2)
Literacy <0.0001
 Reads easily 228 (33.5) 141 (43.2) 87 (24.7)
 Reads with difficulty 161 (23.7) 75 (23.0) 86 (24.3)
 Not at all 222 (32.6) 80 (24.5) 140 (39.8)
 Unknown 69 (10.1) 30 (9.2) 39 (11.1)
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IQR=Interquartile range

†

2 participants were missing sex data

*

Comparison is between males and females

Attitudes and beliefs

Gender inequitable norms

Gender norms in the household and community are presented in Table 3. When asked about the power of women in the community, men (37%) were more likely than women (27%) to respond that women should have the ‘same’ power within the community compared to what they currently have (p=0.008). More women than men responded that women should have ‘more’ power in the community than they currently have, but that difference did not reach statistical significance (p=0.06). Twenty percent of respondents believed that women should have ‘less’ power within the community. Responses to the question about women’s power in the community did not differ by age or education.

Table 3.

Attitudes toward gender inequitable norms in household and community stratified by sex, age and education

Survey question Male n=326 n (%) Female n=352 n (%) p* Age ≤35 yrs n=367 n (%) Age >35 yrs n=313 n (%) p* No education (n=159) Any education (n=444) p*
Women should have ____power within the community than they currently have More 82 (25.2) 112 (31.8) 0.02 More 90 (24.5) 104 (33.2) 0.14 More 49 (30.8) 107 (24.1) 0.17
The same 120 (36.8) 96 (27.3) The same 120 (32.7) 96 (30.7) The same 50 (31.4) 156 (35.1)
Less 72 (22.1) 82 (23.3) Less 85 (23.2) 71 (22.7) Less 29 (18.2) 100 (22.5)
Missing 52 (16.0) 62 (17.6) Missing 72 (19.6) 42 (13.4) Missing 31 (19.5) 81 (18.2)
A man should have the final word about decisions in his home Agree 251 (77.0) 281 (79.8) 0.26 Agree 279 (76.0) 255 (81.5) 0.03 Agree 128 (80.5) 342 (77.0) 0.44
Disagree 74 (22.7) 67 (19.0) Disagree 88 (24.0) 53 (16.9) Disagree 31 (19.5) 99 (22.3)
Missing 1 (0.3) 4 (1.1) Missing 0 (0.0) 5 (1.6) Missing 0 (0.0) 3 (0.7)
A wife must obey her husband Agree 286 (87.7) 317 (90.1) 0.33 Agree 330 (90.0) 275 (87.9) 0.53 Agree 141 (88.7) 392 (88.3) 0.75
Disagree 39 (12.0) 34 (9.7) Disagree 37 (10.1) 36 (11.5) Disagree 17 (10.7) 52 (11.7)
Missing 1 (0.3) 1 (0.3) Missing 0 (0.0) 2 (0.6) Missing 1 (0.6) 0 (0.0)
A woman’s most important role is to take care of her home and cook for her family Agree 276 (84.7) 314 (81.2) 0.05 Agree 315 (85.8) 277 (88.5) 0.21 Agree 143 (89.9) 382 (86.0) 0.23
Disagree 50 (15.3) 36 (10.2) Disagree 52 (14.2) 34 (10.9) Disagree 16 (10.1) 61 (13.7)
Missing 0 (0.0) 2 (1.0) Missing 0 (0.0) 2 (0.6) Missing 0 (0.0) 1 (0.2)
Changing diapers, giving the kids a bath, and feeding the kids are the mother’s responsibility Agree 277 (85.0) 316 (89.8) 0.03 Agree 319 (86.9) 276 (88.2) 0.44 Agree 150 (94.3) 375 (84.5) 0.003
Disagree 47 (14.7) 32 (9.1) Disagree 46 (12.5) 33 (10.5) Disagree 9 (5.7) 64 (14.4)
Missing 2 (0.6) 4 (1.1) Missing 2 (0.5) 4 (1.3) Missing 0 (0.0) 5 (1.1)
It disgusts me when I see a man acting like a woman Agree 194 (59.5) 204 (58.0) 0.77 Agree 215 (58.6) 185 (59.1) 0.68 Agree 87 (54.7) 259 (58.3) 0.43
Disagree 128 (39.3) 141 (40.1) Disagree 149 (40.6) 120 (38.3) Disagree 70 (44.0) 180 (40.5)
Missing 4 (1.2) 7 (2.0) Missing 3 (0.8) 8 (2.6) Missing 2 (1.3) 5 (1.1)
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Data are presented as n (%)

*

p-values do not include missing category

Regarding the role of women and men in the household and relationships, the majority of respondents agreed that ‘a man should have the final word about decisions in his home’ and those respondents >35 years of age were more likely than those >35 years of age to agree with this statement (p=0.03). The majority of respondents also agreed that ‘a wife must obey her husband’. Regarding domestic family duties, such as bathing and feeding, women were more likely than men (p=0.03) and respondents who reported no education were more likely than those who reported any education (p=0.003) to agree that these duties are the woman’s responsibility. Overall, when stratified by sex, age, or education, the majority agreed that domestic duties are the responsibility of women.

Gender inequitable practices

In contrast to the agreement seen with statements of gender inequitable norms in domestic and daily life, a larger proportion of those surveyed disagreed with statements of gender inequitable practices in the community. Table 4 outlines respondents’ attitudes toward having a female child, girls’ education, early and forced marriage, and widow inheritance. Slightly more than half of respondents disagreed with the statement ‘boys deserve to go to school more than girls’. Respondents >35 years of age (47%) were more likely than those ≤ 35 years of age (40%) to agree that ‘boys deserve to go to school more than girls’ (p=0.05).

Table 4.

Attitudes towards gender inequitable practices stratified by sex, age and education

Survey question Male n=326 n (%) Female n=352 n (%) p* Age ≤35 yrs n=367 n (%) Age >35 yrs n=313 n (%) p* No education (n=159) Any education (n=444) p*
A couple that has only a female child is unfortunate Agree 155 (47.6) 196 (55.7) 0.03 Agree 189 (51.5) 164 (52.4) 0.90 Agree 95 (59.8) 207 (46.6) 0.006
Disagree 169 (51.8) 153 (43.5) Disagree 174 (47.4) 148 (47.3) Disagree 64 (40.3) 234 (52.7)
Missing 2 (0.6) 3 (0.9) Missing 4 (1.1) 1 (0.3) Missing 0 (0.0) 3 (0.7)
Boys deserve to go to school more than girls Agree 137 (42.0) 158 (44.9) 0.45 Agree 147 (40.1) 148 (47.3) 0.05 Agree 80 (50.3) 174 (39.2) 0.01
Disagree 187 (57.4) 192 (54.6) Disagree 219 (59.7) 162 (51.8) Disagree 78 (49.1) 268 (60.4)
Missing 2 (0.6) 2 (0.6) Missing 1 (0.3) 3 (1.0) Missing 1 (0.6) 2 (0.5)
It is okay for parents to marry their young daughters (under age 18) to older men Agree 94 (28.8) 100 (28.4) 0.97 Agree 101 (27.5) 95 0.41 Agree 60 (37.7) 109 (24.6) 0.002
Disagree 230 (70.6) 246 (69.9) Disagree 262 (71.4) (30.4) Disagree 98 (61.6) 331 (74.6)
Missing 2 (0.6) 6 (1.7) Missing 4 (1.1) 214 (68.4) Missing 1 (0.6) 4 (0.9)
It is okay for parents to marry off their daughters without their consent Agree 78 (23.9) 92 (26.1) 0.52 Agree 93 (25.3) 79 (25.2) 1.00 Agree 48 (30.2) 102 (23.0) 0.07
Disagree 246 (75.5) 259 (73.6) Disagree 273 (74.4) 232 (74.1) Disagree 110 (69.2) 341 (76.8)
Missing 2 (0.6) 1 (0.3) Missing 1 (0.3) 2 (0.6) Missing 1 (0.6) 1 (0.2)
If a woman gets divorced, she should not be allowed to marry again Agree 107 (32.8) 134 (38.1) 0.18 Agree 125 (34.1) 117 (37.4) 0.32 Agree 70 (44.0) 144 (32.4) 0.008
Disagree 215 (66.0) 217 (61.7) Disagree 241 (65.7) 192 (61.3) Disagree 88 (55.4) 298 (67.1)
Missing 4 (1.2) 1 (0.3) Missing 1 (0.3) 4 (1.3) Missing 1 (0.6) 2 (0.5)
If a woman’s husband dies, the husband’s family should decide her future Agree 240 (73.6) 253 (71.9) 0.69 Agree 261 (71.1) 234 (74.8) 0.14 Agree 124 (78.0) 305 (68.7) 0.03
Disagree 84 (25.8) 95 (27.0) Disagree 106 (28.9) 73 (23.3) Disagree 34 (21.4) 136 (30.6)
Missing 2 (0.6) 4 (1.1) Missing 0 (0.0) 6 (1.9) Missing 1 (0.6) 3 (0.7)
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Data are presented as n (%)

*

p-values do not include missing category

When asked about early marriage, the majority of respondents disagreed that ‘it is okay for parents to marry their daughters (<18 years of age) off to older men’. Similarly, when asked about forced marriage, the majority of respondents disagreed that ‘it is okay for parents to marry off their daughters without their consent’. In comparison to the disagreement seen with other gender inequitable practices, there was agreement with the statements regarding having a female child and widow inheritance. Women (56%) were more likely than men (48%) to agree that ‘a couple that has only a female child is unfortunate’ (p=0.03). In regard to widow inheritance, the majority of respondents agreed that ‘if a woman’s husband dies, the husband’s family should decide her future’. Respondents who reported no education were more likely than those who reported any education to agree with the following statements: ‘a couple that has only a female child is unfortunate’; ‘boys deserve to go to school more than girls’; ‘it is okay for parents to marry off their young daughters to older men’; ‘if a woman gets divorced, she should not be allowed to marry again’; and ‘if a woman’s husband dies, the husband’s family should decide her future’ (all p<0.03).

Multivariable analyses were performed to assess whether the association between agreement with gender inequitable statements and each of the stratification variables (sex, age, or education) was altered by adjusting for the other two. The associations between education and attitudes and age and attitudes were not appreciably altered with adjustment. While attitudes toward ‘a couple that has only a female child is unfortunate’ and ‘changing diapers, giving the kids a bath, and feeding the kids are the mother’s responsibility’ remained associated with education, they were no longer significantly associated with sex. In addition, after adjusting for education and age, men were less likely than women to agree with the statement ‘a woman’s most important role is to take care of her home and cook for her family’ (p=0.04).

Discussion

Our study provides data on the attitudes of both women and men toward gender inequitable norms and practices at a notable crossroads in South Sudan’s history. Our findings contribute to the dialogue regarding gender equality, women’s empowerment, and development in South Sudan and can inform future policy, programming, and advocacy.

The study aimed to assess differences in attitudes by sex, age, and education. While there were sex differences to select statements about household roles, there were fewer sex differences in attitudes toward gender inequitable practices. The only significant age differences in attitudes were in regard to decision-making in the household and toward inequitable education of girls, with the younger group (≤35 years of age) in agreement with more equitable norms compared to those >35 years of age. Those who reported no education were more likely to agree with inequitable statements about domestic duties in the house and with most gender inequitable practices in the community.

There were differences in agreement toward gender inequitable norms in the household and gender inequitable practices in the community. The majority of respondents agreed with gender inequitable statements in the household. While it is possible that inequitable norms in the household influence or perpetuate inequitable roles for women in the community, we found that the majority of respondents disagreed with statements regarding gender inequitable practices in the community such as early marriage, forced marriage, and inequitable education of girls. This finding could be the result of awareness campaigns, constitutional priorities, or recognition of laws. It may be that programming has been directed more at gender inequitable practices in the community, but that it still has not impacted the more private dimension of people’s lives within the household where gender inequitable norms continue to be perpetuated. A qualitative study of perceptions of gender equality in Uganda found widespread disagreement about the meaning of gender equality and respondents reported challenges in integrating the concepts of gender equality into interpersonal relationships and the community (Mullinax et al., 2013). Future research would be helpful to explore how gender programming can impact both household and community norms.

Among the gender inequitable practices assessed, the statement regarding widow inheritance was the only statement with the majority of both women and men in agreement. This has important implications in a post-conflict community with the rise of female-headed households and widows as a result of conflict-related violence (Abirafeh, 2005). Widows in South Sudan are described as among the most marginalised individuals and reports describe widow inheritance as a common practice that needs to be addressed (N. Ali, 2011; Human Rights Watch, 2011). Studies conducted in neighbouring Kenya and Uganda, for example, have evaluated widow inheritance in the context of HIV/AIDS (Abimanyi-Ochom, 2011; Agot et al., 2010; Rujumba & Kwiringira, 2010), but data on the prevalence of widow inheritance and its social and health consequences in South Sudan are limited. Our finding that the majority of respondents agreed with this practice merits further exploration in South Sudan.

Comparing sex differences in attitudes toward inequitable norms, we found that women were often in greater agreement than men with inequitable statements toward women. In our previously published study, there was an acceptance of violence against women among both women and men surveyed, and in many circumstances, women were in greater agreement than men with gender inequitable statements related to violence against women (Scott et al., 2013). In the current study, half of surveyed women agreed that women should have the ‘same’ or ‘less’ power within the community than they currently have. Women were also more likely than men to agree that having a female child is unfortunate. In other studies examining the relationship of gender attitudes to women’s autonomy (Jejeebhoy, 2002) and reproductive health (Nanda, Schuler, & Lenzi, 2013; Stephenson, Bartel, & Rubardt, 2012), women were more likely than men to report less gender equitable attitudes. It has been proposed that sex differences in attitudes toward gender norms may be due to social conditioning or a social desirability bias. Understanding sex differences and exploring the acceptance of gender inequitable norms among women may allow for more targeted programming.

Stratifying by education, our findings suggest that educating both women and men may be important in influencing attitudes toward gender inequitable practices in the sampled communities. Our analysis showed that those who reported no education were more likely to agree with most gender inequitable practices compared to those who reported any education. Other studies have demonstrated that education can promote gender equitable norms and support that education has an important role in promoting gender equality (Gibbs, Willan, Misselhorn, & Mangoma, 2012; Hallfors et al., 2011). It is unclear what level of education is necessary to achieve a shift toward more gender equitable practices in South Sudan. It is also important to point out that education may be both a conduit for more equitable norms and also a manifestation of more equitable norms within a community. The finding that education led to disagreement with gender inequitable practices merits further discussion and research in South Sudan. New constitutional priorities and policies in South Sudan emphasise the importance of integrating gender programming and education as part of peace building in South Sudan (Kirk, 2005; Government of the Republic of South Sudan, 2011).

While we were able to assess attitudes toward select statements in our study, we were not able to inquire about why women and men agreed or disagreed with the statements. It is also difficult to extrapolate attitudinal data to predict the impact of attitudes on actual practice. Our study included one question on women’s power in the community, but we are not able to hypothesise how ‘power’ was interpreted and whether this interpretation differed by sex, age, or education. While studies have demonstrated a relationship between changing gender norms and the impact on women’s empowerment, the authors also described the challenge of quantifying how a change in gender norms ultimately impacts women’s empowerment and emphasise the need for further research (T. Ali et al., 2012; Ehrhardt, Sawires, McGovern, Peacock, & Weston, 2009; Keleher & Franklin, 2008).

Studies have described the importance of changing attitudes toward harmful traditional practices (Boyden, Parkhurst, & Tafere, 2012; Kamal, 2012), but the authors noted it is challenging to quantify the relationship between attitudes and the change in actual norm or practice. It is also important to highlight that changes in attitudes may not always positively impact actual norms, roles, or practice. As an example, gender equality and shifting gender norms may lead to adverse risks to women such as violence, infidelity, and abandonment and the authors emphasise that the promotion of women’s rights and empowerment must be aligned with community-based efforts toward gender equality (Mullinax et al., 2013).

Limitations

Our study utilised purposive sampling to approximate a representative sample; however, the generalisability of our results may be limited beyond the surveyed communities. The survey included questions about sensitive personal and community issues, and it is possible that responses could be exaggerated or underreported. It is also possible that the sex, age, or education level of the interviewers influenced responses. Education and literacy were self-reported and may not reflect actual educational attainment or literacy. Furthermore, the post-conflict state and political climate surrounding the independence may have also influenced responses. Although the interviewers reported that few declined to be interviewed, response rates could not be calculated for most sites, and it is possible that the attitudes of respondents differed from non-respondents.

Conclusion

Following independence in July 2011, South Sudan has specified gender equality priorities and there are opportunities to address gender inequitable norms and practices and to promote gender equality and women’s empowerment. An understanding of attitudes toward gender inequitable norms and practices can inform policy development and may allow for targeted programming. As part of gender programming, it will be important to directly address the acceptance of inequitable norms toward women by women in communities. Finally, education of both women and men may be important in influencing attitudes and in promoting gender equitable norms and practices.

Acknowledgments

We acknowledge the collaboration between American Refugee Committee and Harvard Humanitarian Initiative and thank the numerous individuals who provided leadership and programmatic support from both organisations. Chelsea Cooper, MHS, of American Refugee Committee, contributed to study design and survey development. We thank the interviewers and staff who assisted with data collection, data entry, security, and logistics. We are especially grateful to the study participants. This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award 8UL1TR000170-05 and financial contributions from Harvard University and its affiliated academic health care centres) and the Harvard Medical School Eleanor and Miles Shore Fellowship Program. The Brigham and Women’s Hospital Global Women’s Health Fellowship supported Dr. Scott’s international travel and professional time. American Refugee Committee supported travel expenses within South Sudan but did not provide salary support. This assessment was funded in part by United Nations Population Fund and United Nations Common Humanitarian Fund.

Footnotes

Competing interests

The co-authors declare no competing interests.

Authors’ contributions

JS contributed to study design, data acquisition, and data entry; directed data analysis; interpreted data; and wrote the initial draft of the manuscript. MH assisted in study design, supervised data analysis, and contributed to data interpretation and writing of the manuscript. SA assisted in data interpretation and writing of the manuscript. AMM conducted the data analysis and contributed to data interpretation and writing of the manuscript. SC and DS contributed to study design, data acquisition, data interpretation, and writing of the manuscript. MM supported the project as monitoring and evaluation officer and provided expertise for data interpretation and manuscript writing. PP assisted with data interpretation and manuscript writing. All authors critiqued drafts of the paper and JS was responsible for final collation of inputs and redrafting. All authors read and approved the final manuscript.

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