We know that risks and outcomes in famine are gendered. Men tend to have higher mortality rates during famine, though women surviving famine tend to have worse well-being outcomes in the longer-term than the male survivors of the same famine.
While some of this is biological, much of this appears to be due to gender roles that are typical in a society experiencing famine, but also common across many societies. Gender roles can be considered those expectations of behavior, responsibility and duty associated with a particular sex. When we speak of gendered roles, there is a risk of viewing people as passive agents upon whom these roles are forced. Likewise, in famine, there is a risk of viewing people as passive agents enduring great hardships. In both cases, such views do not do justice to people’s ownership in many of these values and their agency in trying to survive and keep their loved ones alive.
To many women – certainly not all – their gendered roles reflect their own values and they work hard within these roles, sometimes choosing to make sacrifices to promote and protect what they cherish. In famine, people are thrust into terrible situations of deprivation that are very rarely of their own making, but they are anything but passive. They are constantly trying new strategies to adapt to a deteriorating situation, navigating a changing economic, political, social and even security landscape.
Societies function on the basis of norms, more than legal systems, governing our day-to-day lives and interactions. They are the expectations we have on what behaviors are expected, avoided or completely sanctioned. Norms arise from living together over generations, helping us to survive and avoid conflict, big and small, between individuals and as a society. One of the characteristics of famine in the more severe stages is societal collapse, indicated by violations of normally sanctioned behaviors.
We see a small set of similar gendered norms across the globe – “special norms” if you will – which persist after social collapse and abandonment of other norms, and which likely have a profound impact on the gendered mortality patterns that we see in many famines. Though the female mortality advantage is widely recognized and its nature debated, it’s important to recognize that gendered suffering is not always associated with physical violence or coercion, nor is it limited to risk of death in famine. A wider view of suffering needs to be brought into our thinking, and it needs to include the values and agency of those being forced to make terrible choices and who suffer because of the paths they choose.
Famine is a collapse of systems. Most obviously, it is the collapse of the systems people depend on for their livelihoods and well-being. For much of the population purchasing power, access to food, and access to basic services all deteriorate. Food security, nutrition and health suffer to the point of increasing all-cause mortality. These things we can see and measure.
Much more difficult to see or measure from the outside, social systems weaken and can eventually even collapse – including social safety nets and many traditions that protect the most vulnerable through sharing and other forms of solidarity. The collapse of societal norms or “social disorder” is one of the later, more severe signs we may see in a famine – when my survival means your death. In some societies or situations, social systems are more robust. For example, up until the fall of El Fasher, Sudan in October 2025, the constant need to work together to fight against besieging forces for more than 500 days appears to have encouraged a continuation of social support systems and a willingness to sacrifice for the survival of others.
More commonly though, famine histories and memoirs are full of accounts of social collapse, filled with guilt or accusations when people took for themselves what they needed to survive at another’s expense – norms violated. These stories are told by the survivors, potentially a biased view of this willingness in an extreme situation to cast aside societal norms to ensure one’s own survival at the expense of others. We don’t get many first-hand stories of those who died because they maintained societal norms to their own detriment.
Some describe two types of social norms. Regulatory and value norms. Regulatory norms say what you can or can’t do in specific circumstances. They “regulate” or enforce social behavior through reprisals or punishment when they are not followed. People who are tempted to break a norm may follow them only out of fear of reprisals.
In contrast, people hold value norms for internal reasons, because of common values they hold within themselves. Because they are value-based and not action-based, they can seem a bit nebulous. But when we don’t or can’t follow a value norm, rather than fearing punishment from others, we know and accuse ourselves of violating our own values. We feel guilt and shame rather than fear.
In Seattle, pedestrians will wait at the corner for the light, regardless of whether or not a car is coming and people who jaywalk may be openly chastised, even when there are no cars nearby, because they hold a value norm about following rules. This is not a norm held in Boston, even though, technically it is illegal in Boston, too. A Bostonian in Seattle may wait pointlessly at an empty corner to avoid chastisement; for the Bostonian, this becomes a regulatory norm.
In other words, it would be wrong to assume that people respond in accordance with a norm only to avoid sanctions. Many hold values behind that norm which may compel them to act against their own interests to preserve something they value more than what they risk losing. Seattleites value calm, order and politeness more than losing three minutes at a street corner. A mother may value her child’s health over her own.
Sometimes, following these norms can come at one’s own expense and for that reason there is more understanding and fewer reprisals when these particular norms are not followed. This distinction in types of norms or parts of a “social system” is actually important and pertinent to how people react to terrible situations during a famine.
Imposing a prescriptive gendered norm on women – or men – that risks their survival during famine could be considered a form of gender-based violence. But it is different for someone to risk their lives to follow their own internal values. I propose that many gendered norms that disadvantage women or men differently during famine may not be imposed upon them externally by prescriptive norms, but often may just be people having to make terrible decisions under terrible circumstances, trying to do their best to follow their own values, even if it is to their own detriment – because they value something or someone else more than their own survival. These are the ultimate expressions of love. The reasons why a person takes on a gendered role and makes these choices in accordance with those roles even at the height of famine is not always clear (is it prescriptive or willingly taken up?) While we want to protect people from harmful gender-based norms, we need to be careful. To assume all are forced on them by prescriptive norms is to dishonor the sacrificial choices of many.
True protection may come less by targeting norms, or protecting people from norms we deem harmful, but by preventing circumstances in which people are forced to make terrible, no-win choices as they struggle to protect those things or people they value most. Sacrificial love is precious and laudable, but it would be better if that love could be expressed without the need to sacrifice so dearly.
In any society, men and women both have common gendered roles– each creating different patterns of risk in famine, but which persist even after social collapse and abandonment of other norms. These contribute to the gendered famine mortality patterns that we see.
Famine has always had a strong association with conflict. Across centuries and multiple contexts, men (especially young men) are far more likely to die of violence during conflict, in large part because most combatants are men. In famine, men have a higher relative risk of death that increases by age, some of that due to conflict and being targeted by forces of oppression, but it doesn’t appear that is the whole story. Where the data is disaggregated by age and sex, a greater proportion of the women who die in famine, die of malnutrition-related causes while men are more likely to die of other causes. Let’s look at some specific examples.
Tigray, Ethiopia (2021-23) – Males had higher overall mortality. Over 70% of all deaths were among the young (<5) and old (>50). Within this more vulnerable population more deaths were from hunger than not, and more males than females died of hunger-related causes. In the middle age range (5-49yo), only 37% of deaths were hunger-related, but more females than males died of hunger. So, among the more physically fragile populations, males were more likely to die, and more likely to die of hunger. But among more physically robust populations where overall death rates were much lower, females were more likely to die of hunger and males were far more likely to die of non-hunger-related causes. This is a pattern we have seen elsewhere, like the Dutch Hunger Winter of 1945, or whenever the data are disaggregated by age and sex.
Gaza (2023-2025)– Of all reported fatalities in Gaza between October 2023 and May 2025, 49% were adult men and 19.5% women. Even by IDF calculations, only 17% of deaths have been combatants. If all combatants are counted as adult males, then 32% of all deaths would still be non-combatant adult men, half again as many as women. Men, often younger, stronger men, are the ones to take physical risks in going out to seek food where they may be exposed to violent causes of death or accidents. They also often express shame at not being able to fulfill their gendered role to provide what their families need for survival. In interviews, men who took great risks trying to get food from the GHF sites but came away with nothing and finally refuse to return to GHF sites, and who are met with understanding by their families, still expressed shame and guilt for not returning to try again.
In Gaza as is common elsewhere, women are responsible for the day to day, hour to hour care of their children. Malnutrition among young children did not rise as rapidly as the poor food security and sanitation indicators might have predicted. They only spiked once more than 40% of women of child-bearing age, including a very high proportion of pregnant and breastfeeding women (PBW), were malnourished. Malnutrition among PBW in Gaza tripled between March and July. Then in late July and early August, malnutrition among children suddenly climbed exponentially. In Gaza, we see and hear, time and again, about mothers spontaneously giving their own food, or the more nutritious foods to their young children even though medical staff treating their children encourage mothers to prioritize themselves.
Men and women in these cases face different risks according to their gendered roles. While the gendered roles may have been imposed on them by society, these sacrifices don’t appear to be forced on them, rather they reflect choices people have made according to their own values. When they are unable to fulfill these gendered roles, they feel shame and guilt from within, even when offered understanding from others around them. These sacrifices appear to stem from values held in common by so many men and women, valuing the lives of their loved ones over their own.
Suffering in war and famine is gendered, that is clear. We often think of GBV almost as a euphemism or code for the specific targeting of women for physical violence and control, but the patterns of gendered suffering go far beyond this one example. Investigating these patterns wherever possible can reveal the best and the worst in us as humans. They also shed light on so many horrific, no-win choices that people face in these terrible situations. To ignore that there are those who choose to take on gender-based burdens, or to assume that certain choices are forced on them discredits their sacrifice. At the same time, to simply give them credit for their sacrifice without preventing others from having to make the same terrible choices doesn’t really honor those sacrifices. Focusing on changing gender roles may be less effective than preventing people from having to make these terrible choices.
This article was made possible in part by a grant from Carnegie Corporation of New York. The statements made and views expressed are solely the responsibility of the author.
