(P23-46-26) Perceived Gender Norms and Adverse Birth Outcomes: Secondary Analysis of a Cluster-Randomized Controlled Trial in Rural Bangladesh

Objectives: Inequitable gender norms have been associated with reduced care-seeking but associations with pregnancy outcomes are understudied. Secondary analysis of a pregnancy effectiveness trial in rural Bangladesh was conducted to explore the relationship between gender norms and adverse birth outcomes.

Methods: Pregnant women 15-35 years old were enrolled (n=3390) in a cluster-randomized controlled trial of balanced energy protein vs. multiple micronutrient supplementation to examine impact on birth outcomes. The GNORM scale, developed and validated among women in Odisha, India, measures women’s perceptions of the gender norms in their community. The score, ranging from 0-100 and measured at 1-month postpartum, was categorized into tertiles corresponding to low, moderate, and higher perceived equitable gender norms. Outcomes include birth weight (g), gestational age (GA, weeks), and small vulnerable newborn type (adequate GA (AGA)-Term; AGA-preterm (PTB); small-for-GA (SGA)-Term; SGA-PTB). Birth weight was assessed within 72 hours of delivery and GA was estimated using date of last menstrual period. For missing or delayed measures, multiple imputations were done to estimate birth weight. Associations were assessed using linear and multinomial regression for continuous and categorical outcomes, respectively.

Results: Complete data were available for 2748 mother-infant pairs. At enrollment, the mean (SD) GA was 10.4 (3.9) weeks, and mother’s age was 24.5 (5.5) years. The mean (SD) GNORM score was 51.6 (9.3), with a wide range (18-86) of norms observed. Birth weight in infants born to mothers in the upper two tertiles was 29g (95CI: -5.6, 63.2) and 69g (95CI: 33.7, 103.4) higher, respectively, than those born to mothers in the lowest tertile (mean: 2729, SD: 391). Gender norms were not associated with GA at birth, or risk of AGA-PTB and SGA-PTB. However, those in the highest tertile had a 27% reduced risk of SGA-Term (RR: 0.73, 95CI: 0.60, 0.89), while those in the moderate tertile had a similar risk (RR: 0.90, 95CI: 0.74, 1.10), compared to those in the lowest tertile.

Conclusions: Mothers who perceived more equitable gender norms in their community were more likely to have a higher birth weight and a reduced risk of small-for-gestational age newborns.

Funding Sources: Gates Foundation