Chapter 2: Enabling children, girls and women to live their lives to the fullest

Early childhood is an important stage of development. It's when our mental, social, and emotional skills are developed and these skills influence our lifelong educational achievements, our health and our wellbeing.

When children play, they learn. Learning through play reaps immense benefits and enables children to develop their resilience, social skills, and creativity. However, it can also be when children adopt ideas around gender which shape the path of their lives.
(UNICEF. (2022). How to remove gender stereotypes from playtime. Inclusive play for all children.)

It's essential we know and understand that girls can do well at activities that people usually associate with boys. It's important for boys to have the freedom to follow their interests too, which may include activities that society usually associates with girls.

To prevent children from developing gender stereotypes and create more gender equalities, we can:
(UNICEF. (2022). How to remove gender stereotypes from playtime. Inclusive play for all children.)

• Give girls and boys a wide range of toys to play with, such as trucks, dolls, action figures and blocks
• Praise both boys and girls for the same behaviour, such as if they are neat, courageous, kind or physically active
• Let children see adults doing a variety of tasks that may not be considered 'typical' of their gender, such as the male person in the household doing the laundry
• Allow children to choose the sports or activities that interest them, such as dance, rugby, maths, arts
• Encourage children to make friends with both boys and girls
• Use gender neutral terms such as 'firefighter' rather than 'fireman'

Enabling both girls and boys to expand their opportunities throughout childhood creates equal opportunities into adulthood. We all have a role to support children to have these equal chances and to create healthy environments for them to flourish. Here, we look at the impact of body weight and physical activity, as well as educational outcomes and emotional health and wellbeing throughout childhood and into adulthood.

In England, children take part in the National Child Measurement Programme (NCMP).
(Knight M, Bunch K, Patel R, et al. (2022). Saving lives, improving mothers' care. MBRRACE-UK)

The information from this programme is useful as it helps us to find out if children are growing as expected, lets us see trends over time, and enables us to provide better health services for children.

All children in Reception (ages four and five) and in Year 6 (ages 10 and 11) are measured once a year. Trained staff measure the height and weight of children while they are in their clothes at school. Measurements are done sensitively and in private. The results are not shared with teachers or other children.

Once measured, children are categorised as:

In 2021/22 in the North East, over 70% of children in Reception year are of a healthy weight. We have more boys than girls in this age group who are underweight. However, the percentage of children in the North East who are at a healthy weight reduces to around 58% by Year 6, with more girls being a healthy weight. (Office for Health Improvement and Disparities. (2023) Public health profiles)

The differences in overweight and obesity prevalence between boys and girls may be driven, in part, by social and cultural factors. Research shows that girls tend to eat smaller portions and prefer healthier options to maintain their appearance. Girls also report higher levels of weight-related concerns, including their desire to lose weight, feelings of guilt for overeating and lower self-esteem. In contrast, research finds that boys eat until they 'feel full' and focus on optimising their physical performance.

These cultural ideals for children are often strengthened in the home, where differences in parental nurturing, feeding practices and attitudes occur. Studies have shown that parents tend to be more concerned about weight status in their daughters than their sons, with their sons often encouraged to eat more. There are also sex-related influences, such as body composition and hormones.
(Shah B, Tombeau Cost K, Fuller A et al. (2020). Sex and gender differences in childhood obesity: contributing to the research agenda. BMJ Nutrition and Preventative Health. 3(2): 387-290.)

Women are less active than men. (Sport England. (2022) Gender. Encouraging more women to find their way into sport and physical activity is vital if we're to close the gender gap that exists. So how can we do this?) 

This gender gap has been shown to start in childhood and before adolescence, with girls being less active from a very young age. (Farooq MA, Parkinson KN, Adamson AJ et al. Timing of the decline in physical activity in childhood and adolescence: Gateshead Millennium Cohort Study. British Journal of Sports Medicine 2018;52:1002-1006.) By the time children reach seven years of age, their level of physical activity starts to reduce. It's important to reach children before their teenage years to keep them interested in physical activity.

The most recent 'Active Lives Children and Young People Survey' 2020-21 highlighted that activity levels have started to fall among boys. In contrast, activity levels have started to increase slightly among girls. As a result, boys and girls were equally likely to be active across the 2020-21 academic year, with 45% of both boys and girls taking part in physical activity.
(Sport England. (2021). Active lives children and young people survey. Academic year 2020-21.)

The decrease over time in activity levels for boys was initially driven by the younger age groups slowly reducing physical activity levels. But over the last 12 months, the decrease has been seen more among older boys. The recent increases for girls have come from the younger age groups, while rates remain flat among secondary age girls.
(Sport England. (2021). Active lives children and young people survey. Academic year 2020-21.)

Another contribution to the changes in physical activity levels, with girls increasing slightly and boys reducing, is because of the gender impact from the effects of the Covid-19 pandemic restrictions. Organised sports, which are a major contribution to boys' activity levels and disruption, haven't fully recovered. Other forms of activity, such as dance, Zumba and exercise classes carried on via online courses, enabling more girls to participate.
(Sport England. (2022). Gender. Encouraging more women to find their way into sport and physical activity is vital if we're to close the gender gap that exists. So how can we do this?)

Nationally, Sport England's 'This Girl Can' campaign aims to close the gender gap by addressing the practical and emotional pressures that stop many girls and women from being as active as they would like. These include a lack of confidence and fear of being judged, as well as time restrictions.

Locally, we're also working to tackle those barriers. We want to adapt our physical activity offer to meet the needs of our people, providing more support along with our partners. By providing more affordable, inclusive and accessible ways to get active, incorporating new or emerging activities and targeting activities to specific groups, we are able to provide more opportunities for girls and women across Gateshead.

Active through football

With support from the National Lottery, Gateshead Council is delivering the Active Through Football programme together with Sport England, the Football Foundation, RISE, and local partners including Gateshead Older People's Assembly and Edberts House.

Over the next five years, the programme aims to increase activity levels particularly amongst females aged 16+, males aged 50+, refugees and individuals experiencing mental health issues. Its purpose is to make football more accessible to these groups, with sessions tailored to all levels of fitness, ability and confidence.

Active mums

Active Mums is a fun way to meet for new mums (after their eight week health check or 12 weeks if they've had a Caesarean) to meet new people and get active outdoors with their baby. 

With babies safe and snug in their pushchairs, mums work on improving fitness and toning up by performing a range of enjoyable cardio and bodyweight exercises, overseen by a qualified instructor. 

As well as supporting mums to become more physically active, the scheme helps reduce social isolation and builds confidence.

By the time a young person reaches 15 years of age, approximately three in five boys in the UK think that they're the right size, whereas only two in five girls think that they are.
(NHS Digital (2015). Health and Wellbeing of 15-year-olds in England - Main findings from What About YOUth? Survey 2014.)

Body dissatisfaction, defined as 'a person's negative thoughts and feelings about their own body' is a leading cause of eating disorders, low self esteem, and poor mental wellbeing. Nearly one in two (48%) of teenage girls are dissatisfied with their bodies, compared with one in three boys (31%).
(Mahon C and Hevey D (2021). Processing body image on social media: gender differences in adolescent boys' and girls' agency and active coping. Front. Psychol.)

Girls' bodies are constantly scrutinised and stigmatised. Many girls say that they stop doing things because they are worried about being criticised over their bodies. From the images girls see in the media to harmful comments at school, girls feel pressured to conform to unrealistic beauty and body standards. This pressure is increased by the growing number of images girls are exposed to today, both online and offline. This all becomes a major source of anxiety in girls' lives.
(Mahon C and Hevey D (2021). Processing body image on social media: gender differences in adolescent boys' and girls' agency and active coping. Front. Psychol.)

Plan International UK's survey of over 1,000 girls aged 14-21 found that 72% of girls have seen photos of themselves that have made them feel bad about the way they look. It takes, on average, 10 photo attempts before young girls are happy to post a photo on social media. (Plan International (2020). The state of girls' rights in the UK 2019-2020)

In a 2021 NHS survey on children and young people's mental health during the pandemic, there were indications that the proportion of children and young people with possible eating problems increased between 2017 and 2021. In 11 to 16 year olds, this rose from 6.7% to 13.0%, and in 17 to 19 year olds from 44.6% to 58.2%.
(NHS Digital. (2022). Mental health of children and young people in England, 2021. Wave 2 follow up of the 2017 survey.)

To support their mental health, young people have said that the most important topics they would like to be addressed in school were depression and anxiety, body image and identity. Young girls consider eating disorders and body image to be important issues in relation to their mental health and wellbeing.
(Cortina M, Linehan T, Sheppard K. (2021). Working towards mentally healthy schools and FE colleges: the voice of students. Anna Freud National Centre for Children and Families.)

For all stages across education, females outperform boys. 'School readiness' is a term used to describe how ready children are socially, physically and intellectually to start formal schooling in the UK.
(Nursery Resources (2019). School readiness - a definition and how early years key workers can help)

More girls have achieved a good level of development by the end of Reception year compared to boys. Gateshead's figures are similar to England's. 

By the time children reach 16 years of age, 'Attainment 8' score is used to compare differences across population groups and across areas. Attainment 8 measures pupils' results in eight GCSE-level qualifications.
(Department for Education. (2022). Education, skills and training)

In Gateshead, girls have outperformed boys in their GCSE results, achieving scores that were on average 5% higher than boys over the past three years. 

This is the same pattern for England; where for every ethnic group, girls had higher average score than boys.

On average in Gateshead, girls and boys are just as likely to have the same level of authorised absences (2020/21). The percentage of 'persistent absences' is also the same for girls and boys, whether they have been persistently absent for 50% of the time (1.2%) or 10% of the time (13%).
(Department for Education. (2022) Pupil absence in schools in England: 2020 to 2021)

However, when we look at the reasons why young people are absent from schools, gender differences start to be seen. Boys are twice as likely to be excluded compared with girls, mirroring national trends. Girls are more likely to be absent from school due to illness or religious reasons. 
(Department for Education. (2022) Pupil absence in schools in England: 2020 to 2021)

Periods are one of the main 'illness' absences, where 49% of girls have missed an entire day of school because of their periods. Also, 59% of girls have made up a lie or have given an alternative excuse rather than tell their school that they have period pain. This is because they are too embarrassed. Poor knowledge and management of menstruation can impact on girls' school attendance and academic performance. It's important that our schools and colleges talk about periods with both boys and girls and that policies clearly explain the impact and what adjustments can be made for girls.
(Plan International. (2017). Almost half of girls aged 14-21 are embarrassed by their periods.)

Between July to September 2022, there has been an increase in young people (14-25 years) who are not in education, employment or training (NEET) across England, with the total estimated to be 724,000. There are more males than females who are classed as NEET, however, the recent increase was entirely affected by women, where an increase of 14,000 was seen.
ONS. (2022). Young people not in education, employment or training (NEET), UK: November 2022)

Local data suggests that the percentage of females aged 16 to 24 in the North East of England who are NEET has reduced from 10% in 2020 to 9.1% in 2021. This is a decrease of 25,517 females. The number of males who are NEET has also decreased, from 13.5% in 2020 to 11.8% in 2021. This is a reduction of 56,695 males.
(Department for Education. (2021) Education and training statistics for the UK: 2021 - NEET and NET estimates from the LFS for 16-24 year old Male and Females)

For Gateshead, in 2020, 7.3% of 16-17-year-old boys aren't in employment or training compared to just 4.3% of girls.
(Office for Health Improvement and Disparities. (2023) Public health profiles)

When we look at the latest data (July-September 2021) for young people accepting an apprenticeship in Gateshead, males (59%) are more likely to be taking up these opportunities than females (41%).
(Department for Education. (2021/22) Apprenticeships and traineeships - Interactive data visualisation tool)

It's interesting to see that for each academic milestone, girls are proven to outperform boys. However, this academic achievement isn't converted into high employment rates and high employment wages for women. Chapter 3: Create fair employment and work for all looks into fair employment and the reasons why this may be the case.

As children transition into their adolescent years (also known as teenage years), and then into adulthood, each developmental stage has its own levels of stress and anxiety. Change is rapid alongside exposures to new risk factors including physical changes, peer pressure, educational stress, and sexual exploration. (Campbell OLK, Bann D and Patalay P (2021). The gender gap in adolescent mental health: A cross-national investigation of 566,829 adolescents across 73 countries. SSM Popul Health. 13:100742)

Adolescence is a time when emotional disorders emerge, and 1 in 5 adolescents may experience a mental health problem in any given year. It is also a time when the gender gap in mental health happens. (World Health Organization. (2020). Adolescent mental health)

Whilst mental illness is often diagnosed in adulthood, it usually begins in adolescent years: (World Health Organization. (2020). Adolescent mental health.)

• Half of all mental health problems are established by age 14 years 
• Three-quarters of all mental health problems are established by age 24 years
• 1 in 10 children and young people aged 5 to16 years have a clinically diagnosable mental health problem

The Adult Psychiatric Morbidity Survey, the biggest survey of mental health disorder and treatment in England, has found that women are more likely to have mental health problems than men, with young women at particularly high risk. (Gulland A. (2016). Women have higher rates of mental disorders than men, NHS survey finds. BMJ. 354:i5320)

In 2014, 19.7% of 16- to 24-year-old girls reported self-harming compared with 6.5% in 2000. Women and girls in the overall population continue to be more at risk of self-harm, although rates tripled in both male and female populations between 2000 and 2014, from 1.4% to 4% in men and boys, and from 2.1% to 6.8% in women and girls. (McManus S, Gunnell D, Cooper C et al. (2019). Prevalence of non-suicidal self-harm and service contact in England, 2000-14: repeated cross-sectional surveys of the general population. The Lancet Psychiatry. 6:7 p573-581.)

Nationally, the rate of young people being admitted to hospital as a result of self-harm is increasing. This is not the case in Gateshead, where there is no significant trend. The admission rate is also similar to the England average. Nationally and in Gateshead, levels of self-harm are higher among young women than young men.
(Office for Health Improvement and Disparities. (2023) Public health profiles)

Alcohol and mental health are closely linked. Drinking too much can affect your wellbeing and some people may drink to try to relieve the symptoms of mental ill-health.
(Mental Health Foundation. (2022). Alcohol and Mental Health.)

In Gateshead, there are more hospital admissions for alcohol specific conditions for young women aged under 18 than young men, with the total number of admissions falling since 2008/9.

Similar to alcohol, hospital admission rates due to substance misuse (15-24 years) has changed dramatically over time. Adolescent males saw an increase in the rates between 2010/11-12/13, peaking in 2013/14- 15/16. For substance misuse, hospital admission rates for males have now reduced to below those of females (since 2016/17-18/19).
(Office for Health Improvement and Disparities. (2023) Public health profiles)

Whilst hospital admissions rates for substance misuse is higher in females than males, drug related deaths are greater in males in Gateshead.
(Office for Health Improvement and Disparities. (2023) Public health profiles)

• There were 15 drug related female deaths in Gateshead between 2018 and 2020, which is 5.1 deaths per 100,000 persons. 
• There were 51 drug related male deaths in Gateshead between 2018 and 2020, which is 17.6 deaths per 100,000 persons. 

Life is full of decisions. Effective decision-making has the potential to influence positive thinking and enhance our mental health and wellbeing. For those living with mental health problems of any level, including anxiety or depression, decision-making can become more challenging. People end up having lower motivation to engage in activities that positively contribute to their wellbeing. This could include less motivation to go to school, do homework, or even get out of bed. Furthermore, women are more likely to feel unhappy, depressed and unable to overcome problems and a loss of self-confidence. 

All of this impacts on their life decisions, life chances and life outcomes. Public mental health and wellbeing is well supported in Gateshead through strong partnerships and by taking a life-course approach. This support covers many activities, from brief interventions delivered by community organisations trained through the Making Every Contact Count programme, through to acute care provided by the NHS trusts.

'The Young Women's Outreach Project was established in 1992 and is based on Gladstone Terrace in central Gateshead. We recognise that society is fundamentally unequal for young women; our service was set up to address the unmet needs of young women and young mothers. Existing underlying health, social and economic inequalities disproportionately impact young women and are a significant barrier to them fulfilling their potential to live a good life.' 

'We support young women aged 11 to 19 years through single or complex issues occurring in their lives. Most young women are referred to us by schools, Children & Young People Services, Midwives and Social Services. However, anyone can refer to the Young Women's Project, even young women themselves. Over a year, we have contact with approximately 250 young women. Attendance at the Young Women's Project is voluntary, embedding our values of personal choice and control.'

When asked about inequalities women who access the project face, Liz explained:

'Young women and young mothers who attend the Young Women's Outreach Project are experiencing health, social and economic inequalities which are having a hugely detrimental impact on their mental health, their hopes for the future and the opportunities available to them.

austerity measures since 2010 has led to huge service cuts and has resulted in massive closures of local services for young people. Where services can be offered, there are often waiting lists of months, if not years.

A report by the End Child Poverty Coalition in 2020 shows that the percentage of children and young people living in poverty in the North East of England has risen from 26% in 2014-2015 to 36.9% in 2019-2020, the highest rise in the UK. The North East of England also had the highest unemployment rate in the United Kingdom in the first three months of 2022, standing at 5.4%.'

'On top of these inequalities, local and national lockdowns from the Covid-19 pandemic have led to young women being isolated from their friends, peers and trusted adults. They have lived with a lack of socialisation and fun, have lost many opportunities, including formal education, and had increased caring responsibilities. Many young women we meet are incredibly stressed and anxious over missing so much face-to-face schooling; they feel they are behind in their studies and somehow believe this is their fault. This is putting a huge strain on their mental health; they feel lonely and unsure of whom they can turn to, which is leading them to crisis point.' 

We asked Liz how the work at The Young Women's Outreach Project strives to tackle these inequalities:

'Our working methods are person-centred, trauma-informed and individually tailored, focussing on strengths, potential and aspiration. We listen to young women and provide practical and emotional support through small group work and one-to-one and specialist service provisions. Our work is mainly delivered from our building, a home-from-home, a safe space for young women to share openly without judgement.'

'Our highly skilled, specialist Youth Workers see each young woman as a unique individual with incredible potential. All our group sessions will be focused on building knowledge, skills and capabilities, reinforcing coping mechanisms and resilient behaviours, which leads to individual growth in self-worth and confidence. Young women then start to make positive choices and move forward with their lives with the confidence and belief that they can do great things. Many re-engage with formal education and training, which is particularly important for this age group, not only for their futures but also to reduce the risks of them experiencing further exploitation and harm.'

Finally, in regard to what more needs to be done in this area to address these inequalities, Liz states:

'As an organisation, we are receiving a higher number of referrals than ever before, particularly for young women who need support with their mental health. To address this, we have successfully applied for funding from the Pilgrim Trust for two Mental Health Support Workers. We have also started a new Early Intervention programme called Rise Up, funded by the Kavli Trust. We believe that young women across Gateshead and the surrounding areas need access to more services, particularly specialist and open-access youth work provision, mental health support and counselling. Waiting lists need to be brought down and support in place for young women while they are on waiting lists.' 

'There are also a huge number of young people across Gateshead who are now Electively Home Educated which increases isolation, risk of exploitation, and is adding to their already high stress levels regarding formal education. We believe that providing safe, accessible, alternative education, including courses such as construction, engineering and sports programmes that are led by women, would go a long way to addressing inequalities experienced by young women.'

'We also believe that more work needs to be done with young men and boys around healthy relationships, coercive control and sexualisation of young women. Without this, young women will continue to feel that it is their responsibility and they are at fault if they become a victim of men's behaviour. '

'Finally, we believe that families need better financial stability and employment opportunities. The cost of living crisis is impacting on all generations; children and young people are going to school cold, hungry and worried about their parents and family members which is having a detrimental impact on their ability to concentrate, their friendships and their hopes for a better future'.

Chapter 3: Create fair employment and work for all