Adolescence, defined as the period between 10 and 19 years old, is a time of rapid social, emotional, physical and neurological changes that have a lasting impact well into adulthood; it is a time of opportunity and vulnerability (United Nations Children's Fund, 2011; Davies, 2012). The socialisation of masculine ideals begins at a young age, defining ideal masculinity as related to toughness, stoicism, heterosexuality, self-sufficiency, attitude and a lack of emotional sensitivity and being connected to others (Wall and Kristjanson, 2005). Boys can learn to be men from men in their lives, from their own experiences as they work through social norms, and from the large social and cultural context. Boys are living under increased demands to express gender-appropriate behaviours.
Boys and men are diverse with regards to their race, ethnicity, culture, migration status, age, socioeconomic status, ability status, sexual orientation, gender identity, and religious affiliation; they are unique beings. Each of these social identities according to the American Psychological Association (APA, 2018) will contribute in intersecting ways to shape how men experience and perform their masculinities, which in turn contributes to relational, psychological and behavioural health outcomes, positively and negatively.
Men's health problems are related to multifaceted interactions between biology and environment, including sociopolitical factors, for example, race or socioeconomic status, along with variables that are related to power and privilege. There are many gender health disparity patterns that can be associated with increased risk behaviours for men that start in early adolescence (Mahalik et al, 2005).
Perpetuating rigid gender roles results in gender health disparity patterns that can be associated with increased risk behaviours for men, beginning in adolescence.
Gender role conflict
O'Neil (2008) considered gender role conflict as problems that result from adherence to ‘rigid, sexist, or restrictive gender roles, learned during socialisation, that result in personal restriction, devaluation, or violation of others or self’. Gender role conflict has negative results for individuals; it is the most extensively studied feature of masculine gender role strain, with men experiencing conflict associated with four domains of the male gender role (Table 1).
Table 1. Four domains of the male gender role (O'Neil, 2008; 2013; 2015)
| Domain | Discussion |
|---|---|
| Success, power and competition | A disproportionate emphasis on personal achievement and control, or being in a position of power |
| Restrictive emotionality | Discomfort expressing and experiencing vulnerable emotions |
| Restrictive affectionate behaviour between men | Discomfort expressing care and affectionate touching of other men |
| Conflict between work and family relations | Distress due to balancing school or work with the demands of raising a family |
The ultimate outcome of this type of conflict are constraints of human potential of either the individual who is experiencing it or of those who are around that person.
Masculinity
When societies fail to sensitise or socialise boys and men to gender-equitable relationships, this will only perpetuate the historical divisions of labour and responsibilities that have resulted in premature deaths of men on a global scale. If boys are sensitised with regards to relationships that are gender equal, then the predominant (often known as toxic) notion of masculinity that has, and is, causing so much harm may be eliminated or significantly reduced.
There is much to be gained by men and boys from increased gender equality. Males pay a significant price with regards to their quality of life that is associated with fixed and rigid gender relations and how these are defined and played out. Where there is less rigidity of masculinity and less stereotyping, the real potential is to increase options for men, bringing benefits to their mental health as well as their physiological wellbeing. A concerted effort to embrace and make gender equality a reality is destined to enhance overall social inclusion, benefitting men and boys, as well as women and girls. As men and women are not independent of each other, it is essential that boys and men be included in efforts to promote gender equality and empowerment. There has to be active engagement of girls and boys at the onset of adolescence to enhance total social inclusion and engender generational change.
There are many contexts where men can feel pressured and harassed as they strive to conform to being competitive, driven and determined, to avoid talking about their feelings and to spend time away from the home as their children are growing up. Achieving gender equality should be seen as a societal responsibility that concerns and should fully engage men as well as women, and requires partnerships between women and men. The school nurse is ideally placed to see through these responsibilities and promote gender equality, making every contact count with children as they grow up to be men and women.
‘School nurses have to account for the way in which their own cultural assumptions regarding masculinity can influence their clinical practice, acknowledging that gender is not exclusively a biological issue.’
Socialisation
For effective policies to be developed, implemented, sustained and evaluated, it is essential that all those involved in gender equality have a better understanding of:
- Gender stereotypes
- Expectations about men's roles and responsibilities
- How expectations influence male attitudes and behaviours
- How boys are socialised to become men.
Wentzell and Nangia (2018) make the very important point that healthcare providers must also take into account and be aware of their own gender expectations. School nurses have to account for the way in which their own cultural assumptions regarding masculinity can influence their clinical practice, acknowledging that gender is not exclusively a biological issue. The way that masculinity or femininity contrasts are acted out across individual and cultural situations and is very often context dependent. Therefore, school nurses and other health and social care providers, and the boys and their parents may well all have different beliefs about how a man should feel and behave. The ways in which boys are socialised will determine how they will relate as young men and adults to women and others.
Socialisation processes begin at an early age, this is when values and attitudes that shape identities as women and men are formed. In the earliest years of childhood, children's brains form neural connections at a speed that is never repeated in later life (Dahl and Suleiman, 2017). This period is the first window of opportunity that can influence a child's mental development. It is widely acknowledged that child development is complex and there are a number of forces at play.
Adolescence is a significant period to build on early investments, providing, perhaps, a second chance for those who did not do well in their early childhood. Making the most out of an adolescent's potential during this period of opportunity and galvanising positive change could offer answers concerning critical intervention opportunities and approaches during adolescence (United Nations Children's Fund, 2017).
Adolescent development encompasses the positive and negative ‘spirals’ beginning and continuing through this period of rapid change (Dahl and Suleiman, 2017), bringing with them challenges and opportunities. Early adolescence provides a timely window of opportunity for prevention as well as early intervention. It is during adolescence that negative physical and mental health outcomes first begin to become apparent (Dahl and Suleiman, 2017).
There are several influences on a child's perception regarding the ways of being a man, including close relatives, friends and peers, schools, youth clubs, sports groups, the media (in its many forms), the police, the armed forces and the school nurse.
Throughout life, friends and peer groups have an important part to play in determining what it is that makes a ‘real’ man. In various contexts, masculinity can be determined as being long-suffering, self-reliant, tough, courageous, energetic, risk taking and aggressive (Omar, 2011). Some men are taught that to be driven and aggressive is akin to being ‘manly’ (Omar, 2011). When boys show an interest in caring for their younger siblings, cooking or other domestic tasks, if they have close friendships with girls or exhibit their emotions, then they can be mocked, bullied and ostracised (United Nations, 2007). However, there are many men, shaped by local contexts and cultures, who act in responsible and caring ways. Men have attitudes and capacities that can be used to positively influence gender relations and promote alternative, gender-equitable attitudes and behaviours.
Education
Education is a basic human right and gender equality is central to its full realisation. Education must ensure that girls and boys, women and men are treated equally and have equal access to learning opportunities. By benefiting from education equally, students can develop their potential, feel empowered to realise their aspirations and contribute to and benefit from social, cultural, political and economic development as equals (Gomendio, 2017).
‘There is an urgent need for guidelines to be provided for school nurses who offer services to boys, to help these nurses develop their own understanding and to apply their learning to their practice.’
The education system is a powerful force for change that can influence gender equality in both positive and negative ways. Schools are important locations for positive learning regarding gender equality and can create a move toward a culture that is based on gender equality. There are several key elements to encouraging a greater contribution of men and boys to gender equality, including curricula that are gender sensitive and emotionally engaging, classroom discussions that focus on gender equality, teacher education that encourages positive role models, and the sensitisation of school staff and parents. However, the school environment also has the ability to contribute to propagating gender stereotypes through biases in school curricula and materials, as well as attitudes and behaviour.
School nurses
The provision of a high-quality education that includes a safe and supportive learning environment, a curriculum that is challenging, and counselling that is integrated has the potential to enhance the intellectual, emotional and social development of individuals, helping them as they prepare for their future roles in the community and workforce (Foxx et al, 2017).
There is an urgent need for guidelines to be provided for school nurses who offer services to boys, to help these nurses develop their own understanding and to apply their learning to their practice. To provide services to boys, school nurses must recognise and challenge socialisation pressures on boys to be hypercompetitive and hyperaggressive with one another, to help boys develop healthy same-sex friendships. Interactive all-male groups, self-help books and educational videos are some approaches suggested by the APA (2018) that may be helpful. The school nurse can discuss with boys, parents and others about withholding affection from other males, to help them understand how aspects of traditional masculinity, for example, emotional stoicism, homophobia, not showing vulnerability, self-reliance and competitiveness could deter them from forming close relationships with others (Smiler, 2016). In this respect, school nurses will be striving to develop a greater understanding of the varied and healthy ways that boys can demonstrate their masculinities in a variety of relationships with a variety of people.
School nurses play an important role in supporting young people with health problems. Few studies have considered how the nurse's own gender norms may influence their discussions with pupils. Rosvall and Nilsson (2016) reported that when school nurses discussed students who are difficult to reach, boys in particular were mentioned, and some of the school nurses reported that it was more difficult to initiate a health dialogue with boys.
School nurses can enhance their practice by acknowledging that neither their own expectations about masculinity nor those that are presumed in nursing and medical guidance are accepted universally. For example, when the school nurse, teacher, or physician recognise and accept that their assumptions concerning gender may be different from the adolescent, then they may realise that their understanding is only their own and not that of the adolescent; only then can they address and meet the actual needs of the adolescent and not their presumed needs.
Conclusions
There is a need to increase the efforts currently being used to work with men and boys to promote gender equality. Having said this, it is important to note that the increased endeavours and resources being used by school nurses and others to support men and boys must not mean that there will be a reduction in effort to support women and girls.
Gender equality must be promoted in schools as a critical educational goal and outcome and this should be done alongside other important subject matter, such as literacy and numeracy. School curricula should be subjected to ongoing critical reviews and impact evaluations to eliminate gender stereotypes and strengthen ways of promoting gender equality that engage boys as well as girls.
Programmes have to be developed and resources made available for school nurses, teachers, administrative staff and other groups dealing with children and young people, to encourage engagement of boys and young men in promoting gender equality.
All of us have a stake in and a part to play in helping adolescents reach their full potential. Failure to do this undermines the health and wellbeing of everyone, women and girls, boys and men, and gender minorities. Today's adolescent is tomorrow's nurse, leader, scientist; they are the future.