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• Published: 07 April 2023

Barriers and interventions on the way to empower women through financial inclusion: a 2 decades systematic review (2000–2020)

• Omika Bhalla Saluja   ORCID: orcid.org/0000-0001-9831-1947 1 ,
• Priyanka Singh 1 &
• Harit Kumar 1  

Humanities and Social Sciences Communications volume  10 , Article number:  148 ( 2023 ) Cite this article

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• Development studies

This study aims to reduce ambiguity in theoretical and empirical underpinning by synthesizing various knowledge concepts through a systematic review of barriers and interventions to promote the financial inclusion of women. The surrounding literature is vast, complex, and difficult to comprehend, necessitating frequent reviews. However, due to the sheer size of the literature, such reviews are generally fragmented focusing only on the factors causing the financial exclusion of women while ignoring the interventions that have been discussed all along. Filling up this gap, this study attempts to provide a bird’s-view to systematically connect all the factors as well as mediations found in past studies with the present and future. PRISMA approach has been used to explain various inclusions and exclusions extracted from Scopus & WOS databases with the backward and forward searches of important studies. Collaborative peer review selection with a qualitative synthesis of results is used to explain various barriers and interventions in financial inclusion that affected women’s empowerment in the period 2000–2020. Out of 1740 records identified, 67 studies are found eligible based on systematic screening for detailed investigation. This study has identified patriarchy structures, psychological factors, low income/wages, low financial literacy, low financial accessibility and ethnicity as six prominent barriers and government & corporate programs/policies, microfinance, formal saving accounts & services, cash & asset transfer, self-help groups, and digital inclusion as six leading interventions to summarize the literature and highlight its gaps.

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Introduction.

All over the world, women bear an inadequate load of poverty because of social and structural hurdles. A long-dated body of literature (Klasen, 1999 ; Dollar and Gatti, 1999 ; Klasen and Lamanna, 2009 ; Seguino, 2010 ) emphasizes the effect of numerous facets of gender inequality and economic growth. Females are found to be less educated, less paid, less on ownership and able to exercise much less economic control than their male counterparts. This discrimination, especially in education, hampers their financial development, leading to income inequality (Gonzales et al., 2015 ). Consequently, women suffer from lack of health, education, work opportunities and control over their own lives and selections (Kabeer, 1999 )

Nevertheless, we are observing a critical drive to achieve gender equality, with 193 United Nations member countries committing to achieving the sustainable development goal (SDG 5) of ending gender inequality issues by 2030. Realizing that women’s empowerment benefits not only women but also the sustainable development of the community (Vithanagama, 2016 ), numerous banks all over the world, such as Westpac in Australia, ICICI and SBI in India, Natwest in the UK, and UNITAR in Kenya, have developed products and services designed especially for women, keeping in mind their security, accessibility and affordability. To make the most of this, we need more extensive literature exploration to enable conceptually strong evidence-based solutions catalyzing women’s mobility from poverty and exploitation. Considering the vastness of literature, this can only be addressed by a scientific approach to review, which has been followed in the present study. However, due to the sheer size of the related literature, previous reviews (Holloway et al., 2017 , Kalaitzi et al., 2017 , Roy and Patro, 2022 ) are found to be fragmented as their results focused only on the factors causing the financial exclusion of women while ignoring the interventions that have been discussed all along.

Therefore, filling up this gap our review paper aims to scientifically identifying and amalgamating the related studies between 2000 and 2020 with the objective of (a) identifying the nature of major barriers, (b) exploring the most useful mediations/interventions and trends in research on the financial inclusion (FI) of women to enable the community to design thoughtful interventions for them.

The economic empowerment of women was explored in various dimensions at a much greater pace after 2000 (Priya et al., 2021 ). This inspired us to focus on the research work and other initiatives taken in the following 2 decades, defining our study period 2000–2020. Many influential articles have been published in journals dedicated to women and general development, such as World Development Footnote 1 , Feminist Economics Footnote 2 , Journal of Development Economics Footnote 3 and Gender & Development Footnote 4 . However, despite tremendous progress in the global state of FI, the gap in gender has not changed much since 2011, as a 6% difference still exists in access to Bank accounts among men and women in developing countries (Demirguc-Kunt et al., 2022 ), raising the need for considerate customized mediation.

Early studies on financial empowerment of women

Professor Irene Tinker’s work in women studies in the 1960s and 70s is the foundation for research on women development studies. Her work was instrumental in bringing about the first United Nations International conference on Women in 1975, which is also marked as International women’s year. She also founded the International Centre for Research on Women in 1976, which promotes empirical research to advocate evidence-based ways to empower women and promote gender equality.

Research in the 1970s was characterized by pioneer studies that highlighted the role of women in economic development (Boserup, 1970 ; Tinker, 1976 ), while the 1980s captured the role of females in family structures (Acharya and Bennett, 1981 ), the hardships faced by women in agriculture, which was identified as the single most important employment-generating sector for women (Staudt and Jaquette, 1982 ), and the advancement of land rights for women (Agarwal, 1988 ).

In the 1990s, research gathered pace with numerous studies about the persisting gender inequalities (Tinker, 1990 , 1999 ; Sen, 1990 ; Buvinić and Gupta, 1994 ; Mehra, 1997 , Mayoux, 1998 ; Pande, 1999 ) in cooperatives (Sen, 1990 ), financial services and microlevel entrepreneurship (Mehra and Gammage, 1999 ), and discriminations in agriculture and land rights of women to bring about sustainable development and suggest inclusive policies and practices (Mehra, 1995 ). Providing a much need direction and empirical advancement, Kabeer, 1999 proposed the measurement of women’s empowerment with the identification of the ‘resources’ they own, the ‘agency’ or commanding role they have and their ‘achievement’, which can be understood as the outcome in terms of well-being as the basic constructs to be observed. This is one of the most cited articles in the context of studies about the economic empowerment of women. By the end of the decade, the World Bank’s research report presented a cross-country comparison of the impact of gender inequalities on growth and development (Klasen, 1999 ), thus introducing crucial insights into the geographical diversity of the issue.

Thus, the literature around the financial empowerment of women began with recognizing the crucial role of women in the commercial progress at macro level then; it started to realize their critical role at family level and nature of their contribution at social level, which highlighted gender inequalities. Various dimensions in which such discrimination existed were identified giving scope to future researchers to explore various barriers in the way of women development and to develop suitable policy interventions.

Research methodology

Systematic reviews must follow the preset protocol, which is an advance plan of action specifying the methods to be used in the study and is generally accepted as a research design in social science studies. These rules are crucial to avoid researcher bias in data selection and analysis and increase the reliability of reviews (Xiao and Watson, 2019 ).

In this section, we have described systematic steps undertaken to extract data using specific channels, keywords, inclusion & exclusion criteria and expert selection explained through the PRISMA framework (Fig. 1 ).

Our initial result of 1734 documents (results as on 30 January 2022) was filtered by including only peer reviewed open access, full text English articles on Financial inclusion and women empowerment, resulting in 67 eligible documents. (author created).

Further, the studies thus extracted have been classified and synthesized qualitatively for deeper insights.

Channel used for literature search

Literature for this review has been found using the two sources suggested by Xio and Watson in 2019. These sources are:

Electronic database —Web of Science (WOS) and Scopus. WOS has the longest indexing coverage from 1900 to the present (Li et al., ( 2010 ) while Scopus has an extensive coverage of good quality academic work (Gavel and Iselid, 2008 ). A literature search using both databases despite the overlapping articles is still recommended to avoid missing out high-impact documents (Vieira and Gomes, 2009 ). Extractions from Scopus and WOS for this study were made on January 30, 22.

Backwards and forward search —Articles cited in important studies (highly cited) were traced to identify the inspiration and key background variables, likewise the articles that cited important studies were explored to determine the direction of the flow of research. (Webster and Watson, 2002 ; Haddaway et al., 2022 ). Also, publications by key authors (highly cited) who contributed to the pool of knowledge were identified to ensure that all their important studies were included.

Concepts from the search statement were extended by synonyms, abbreviations, verb forms and related terms to select keywords (Rowley and Slack, 2004 ), as shown in the Table 1 below:

To capture the essence of the study’s research objectives, a dive was made into the Web of Science and Scopus data extracting 751 and 983 records, respectively, based on identified keywords.

PRISMA approach

Data pulled out were filtered using Preferred Reporting Items for Systematic Reviews and Meta-Analyses—PRISMA (Fig. 1 ), that explains initial screening, determining parameters for inclusion and exclusion and outlining work limitations (Stovold et al., 2014 ; Selçuk, 2019 ).

Inclusion parameters

Publications from 2000–2020.

Open access articles.

Research areas: “Business management, social science, economics, econometrics, accounting and finance”

Exclusion parameters

Incomplete and non-English language publications.

Conference reviews, books, chapters, book reviews, conference papers, and surveys were excluded.

Articles in press.

Collaborative peer review-based exclusion

Expert selection and evaluation

After the electronic screening of records, a double screening was performed by all three authors, where all 89 studies were reviewed by each author individually. Later, 48 studies were screened out as they were not found to be measuring the population (vulnerable women) or outcomes (barriers and interventions) of interest, and 41 studies were finally selected. Additionally, 26 important and relevant studies, including 8 working papers, were identified through backwards and forward searches while reviewing the studies. The included working papers are listed in the Table 2 for reference. After the screening of the literature, a total of 67 articles were documented individually and classified and amalgamated in tables followed by a qualitative synthesis of these studies.

To achieve our research objectives, the selected articles were classified as barrier-related studies, experimental studies and studies evaluating interventions, with a few studies covering more than one dimension (Fig. 2 ).

Venn grouping of the selected studies on the basis of their evaluation of barriers or interventions and the nature of study being experimental or otherwise (author created).

Tabular synthesis

In Table 3 below, we have classified and connected 67 eligible articles based on their contribution to developing different perspectives about barriers and interventions in FI-based women empowerment.

Additionally, twenty-four experimental studies during 2000–2020 are presented in a tabular form (Table 4 ) for review. For the purpose of our study, only the gender-based findings are listed for each study. Owing to the high level of heterogeneity of quantitative data, we could not conduct a meta-analysis; instead, we summarized studies based on their characteristics, factors, mediations and results (Bohren et al., 2015 ).

Qualitative synthesis

The ideas forwarded through the tabular classifications in the studies of FI and WE have been knit to arrive at a thematic discussion about barriers, intervention-based studies and intervention types, which are the three main dimensions of our study.

Barriers to financial empowerment of women

Women have been suppressed and exploited physically, socially, mentally and economically for a long time. Developing countries particularly have a patriarchal set up where women are seen second to men (Nagindrappa and Radhika, 2013 ). While there is a section of society that encourages women empowerment, numerous barriers continue to restrict their advances.

Through our set of identified studies, we have presented below a discussion about various barriers that have been found through the discussion to be interlinked and often cyclical in nature. Figure 3 highlights the scope of our further discussion about the barriers to FI in women.

Six cyclic and interconnected barriers to the FI of women identified through an expert evaluation of selected studies (author created).

Patriarchy structures

Patriarchy is a socio-ideological concept in which men in the family (father, brother, husband, son, etc.) are considered to be superior to women. It is also described as a social arrangement in which men (patriarchs) dominate, oppress and exploit women (Walby, 1989 ).

Delving into the subject of patriarchy, noted author, Naila Kabeer, 2015 pointed to two types of inequities against women. First, gender mediated social class-based violence, rape and other sexual exploitation that women get subject to, and second, domestic violence due to scarcity or poverty and related helplessness of males within the household.

The abuse of women does not stem from scarcity or poverty; even affluent families exploit their daughters by denying them their land and property rights. The Indian government introduced a gender-progressive inheritance law to combat this injustice; despite the reforms, parents continued to deprive their daughters of their rights based on emotions and compensation in the form of higher education and higher dowries (Roy et al., 2015 ). This ill treatment of woman, which starts from her parental abode, continues in her husband’s house, where the ordered unequal power relations developed out of patriarchy further diminish her position. Her production, reproduction and sexuality are controlled by men. This biased treatment of women in the household adversely affects all levels of her social interactions, depriving her of access to resources and opportunities (Manta, 2019 ; Ghosh and Günther, 2018 ) and financial independence (Schaner, 2017 ).

Psychological factors

For obvious reasons, as discussed under the previous heading, many women lose self-confidence and self-esteem and perceive opportunities with fear of failure (Koellinger et al., 2008 ). An experimental study found that females in the lower income group tend to be more risk averse than their male counterparts and think about the negative consequences of not being able to pay back loans. (Manta, 2019 ) Thus, psychological factors must be carefully studied as crucial drivers of the FI of women (Kavita and Suman, 2019 ).

It was found that investment pattern, group experience and age impacted women’s perception about barriers to FI (Lombe et al., 2012 ), and attitude could be explained by personality traits, ability to cope-up, resource utilization, entrepreneurial abilities, organizational control, financial inclusion and economic betterment (Patil and Kokate, 2017 ).

Low income/wages

Although the concepts of income inequality and gender have been discussed separately in the literature, they cannot be compartmentalized, as they keep interacting by the way of inequality in outcomes and opportunities, which are a bye-product of inequalities mainly in education, financial access, social structures and individual perspectives.

With the biasness of patriarchy and her own fallen self-esteem, a woman’s low negotiation and bargaining power leads her to enter into the social contracts where she is able to earn a low level of income and wages compared to men for the same work. This discrimination is popularly referred to as the “glass ceiling” and is experienced by women at all levels of hierarchy. This reminds us of the much-discussed US presidential elections in 2016, where former U.S. Senator and Secretary of State Hillary Clinton was subject to misogynistic attacks indicating to her being too weak to serve the nation’s highest office. (Marie et al., 2017 ). Hence, women being exploited at work in terms of work treatment and low wages are no exception. At lower levels of education and power, gendered wage gaps are even more pronounced (Gonzales Martínez et al., 2020 ) and are found to further contribute to financial exclusion (Ghosh and Vinod, 2017 ) and further impede the economic growth of women.

Low financial literacy

With cyclical interconnections with all other barriers to the financial empowerment of women, financial literacy has been much discussed by researchers. Hung, A. et al, 2009 combined all previous definitions of financial literacy to express it as “knowledge of basic economic and financial concepts, as well as the ability to use that knowledge and other financial skills to manage financial resources effectively for a lifetime of financial well-being.” Successive studies have recognized financial awareness, financial knowledge, financial skills, financial attitude and financial behavior as key factors in determining financial literacy (Kumari and Azam, 2019 )

Financial literacy has been supported as one of the critical factors to bring about FI and has greater importance for increasing economic empowerment among women, especially the rural poor (Gonzales et al., 2015 ; Montanari and Bergh, 2019 ; Kumari and Azam, 2019 ; Kaur and Kapuria, 2020 ), who in the lack of it make wrong choices and become vulnerable to high financial risks (Manta, 2019 ). With a lack of financial knowledge and skills, women cannot access financial services and the benefits of the formal financial system, making them economically dependent on men and confined to the vicious circle of low investments, low income and low profits (Manta, 2019 ). Montanari and Bergh, 2019 found that the participation of women in the earnings and decision-making activities of rural cooperatives was almost nonexistent. It insisted that women’s roles in such institutions were restricted to low-cost or free physical labor, while those who benefited were literate and generally educated people.

Spatial diversity and related factors play an important role in the effective communication of financial literacy. Gendered gaps in education were found to be greatly related to the general variation in educational achievement across countries, signifying a shortage of access to education. (Gonzales et al., 2015 ).

A cross-regional comparison showed high-level gendered discrimination based on education level and economic participation in South Asia. Observations in Asian countries indicate lessening of the gendered employment gap with the rise in gendered education levels, while in the Middle East and North Africa (MENA), gender gaps in education have decreased, yet women have not obtained opportunities in employment (Klassen and Lamanna, 2009 ). This result hints at the presence of interwoven barriers that are passed on locally.

Overall, a high level of financial literacy is expected to result in greater economic participation of women, where she has an opportunity to express her thoughts and receive suggestions about investment avenues and updates about new profitable products and services, encouraging her towards group effort and informed financial behavior (Ingale and Paluri, 2020 ), which in turn improves her relative wealth (Doss et al., 2020 ) and empowers her.

Low financial accessibility

Access to bank accounts, savings instruments, and other financial amenities may result in women’s better control of their earnings, personal consumption and commercial expenditure (Bernasek, 2003 ), and lack of it pushes her back to obscurity. This was exemplified in an experimental study in Kenya that found that credit constraint prevented women from starting a business and savings constraint further barred them from sustaining it (Brudevold et al., 2017 ).

While trying to develop within the male dominant society, a woman is subject to biases that pull down her self-confidence hurling her into the loop of less education, low employment and low wages, denying her the benefits of access to formal finance such as credit, deposits, insurance, payments and other risk management services (Demirguc-Kunt et al., 2022 ). Findings in an Africa-based study indicate that access to formal finance is mainly driven by individual characteristics such as education, age, income, residence area, employment status, marital status, household size and degree of trust in financial institutions (Soumare et al., 2016 ). Most of the above factors have been identified as obstacles for the FI of women, thus emphasizing women’s overall lack of opportunity to access finance.

Women’s lack of access to financial products and services may also happen because of the absence of a bank branch in rural areas that are not commercially viable for banking. Marginalized women living in underdeveloped far-flung areas with poor infrastructure and roads find it hard to regularly visit bank branches in other areas (Manta, 2019 ), so they avoid banking altogether. This problem was addressed by Mueller et al. in 2020, who worked to develop a travel time model to indicate market accessibility, which is the summary travel time to the nearest state capital city in hours. Such indicators may help in planning inclusion strategies.

Another major reason for women’s lack of access to finance is the lack of commercial interest of banks in disbursing small credit to poor women with no credit history or collateral. Such lending may lead to the building up of non-performing assets and eventually high losses for banks. Therefore, they avoid giving loans to underprivileged women depriving them of economic opportunities. Moreover, the absence of collateral with women is further enhanced by biased traditional property rights (Manta, 2019 ), which denies her resources to build upon a better future.

Looking at the brighter side, ambitious efforts are being made through pathways such as microfinance (Kemp and Berkovitch, 2020 ) and digital inclusion to pull women out of these never-ending and self-building barriers.

In recent studies, ethnicity has emerged as an important factor to be considered while promoting FI in women. Gonzales Martínez et al. ( 2020 ) conducted a controlled laboratory experiment in Bolivia to evaluate whether credit officers in microfinance institutions rejected loan applications on the basis of the interaction of gender and ethnicity of potential buyers. Although the study supported that women were benefitting from microcredit, it indicated discrimination based on ethnicity, as nonindigenous women had twice the probability of getting loan approved, whereas indigenous women had only 1.5 times the probability of getting loan approved compared to men. This idea was supported by another contemporary study (Kaur and Kapuria, 2020 ), suggesting that households headed by females belonging to socially underprivileged backgrounds had a poorer likelihood of obtaining finance from institutions. This suggests that important insights for FI for women can be derived from ethnic studies.

Experimental studies on women’s financial empowerment

As the researchers identified various variables related to the financial empowerment of women through exploratory and descriptive studies, a number of empirical and experimental studies were undertaken to understand the relationship between them. The three main types of interventions identified during our analysis were as follows:

Economic interventions —Involving cash/asset transfer, free bank accounts, free services, subsidies

Social interventions —Comprising family counseling, life skill training, vocational training, awareness programs

Bundled Economic and Social Interventions

Mostly, field experiments measuring the long-term impact of interventions on women’s financial empowerment were conducted. Overall, economic interventions were found to be highly effective in reducing the economic vulnerability of women (Stark et al., 2018 ; Brudevold et al., 2017 ). However, Ismayilova et al., 2018 and Buehren et al., 2015 ) suggested that bundling up economic, social and psychological interventions could make them more constructive.

Interventions implemented for financial empowerment of women

Intervention studies have guided various programs and policies of governments that are essential to support, promote and scale up the literacy, access and growth of financial products and services for women’s empowerment. Realizing the fact that women’s empowerment benefits not only women but also the sustainable development of the community (Vithanagama, 2016 ), numerous banks all over the world, such as Westpac in Australia, ICICI and SBI in India, Natwest in the UK, and UNITAR in Kenya, have developed products and services designed especially for women, keeping in mind their security, accessibility and affordability. Figure 4 defines the scope of our further discussion about six successful interventions in the way of FI of women.

Six most important interventions in empowering women through FI identified through an expert evaluation of selected studies (author created).

Government/corporates programs and policies

The insights developed from the conclusive studies provided governments and public and private enterprises around the world to design suitable inclusive programs, schemes and policies to address the gender gap in finance. Interventions such as government-to-people transfers and the inclusion of post office financial services were evaluated by researchers to comprehend their success or failure in bringing about fairness for women. Swamy ( 2014 ) evaluated the Indian government’s inclusive plans, policies and programs by observing changes in income level, food security, living standards, production levels and asset creation to find that the FI initiatives had a much higher impact on women than on men. These results were cited in many successive studies and laid the groundwork for more intensive inclusive efforts in India.

While acknowledging the imperative need for women’s empowerment for nation building, governments and related organizations all over the world launched ambitious programs to support women. Strategies of the Green Morocco Plan (GMP) were explored by Montanari and Bergh ( 2019 ) to conclude towards the persisting miserable circumstances of women despite planned efforts.

Similar to the actions taken by the states, many private sector companies design schemes, products and programs to promote gender equality for the benefit of their women staff. A Turkish study (Gülsoy and Ustaba, 2019 ) investigated diversity management strategies of companies and found that company leadership played an important role in bringing about equality programs in the workplace. However, they also pointed to the profiteering motive of corporations, which could be served by associating with image building activities, higher productivity and innovation capability, which could result from greater employee satisfaction.

However, some studies claim that many such initiatives had failed because they did not fully anticipate the importance and influence of social institutions such as age, gender, ethnicity, literacy, race, background and religion towards building an enabling environment for inclusion (Gonzales Martínez et al., 2020 ; Kaur and Kapuria, 2020 ).

Microcredit/microfinance

Microfinance helps to bring about the financial independence of poor or exploited women by enabling them to participate in economic activities, improving their status in households and society and reinforcing their power to make decisions (Zhang and Posso, 2017 ; Lall et al., 2017 ). A strong correlation was found between the level of outreach of microfinance institutions and women’s empowerment (Laha and Kuri, 2014 ).

Zhang and Posso ( 2017 ) used case studies to support the constructive role of microfinance to reduce gender inequality. This idea was strengthened by the empirical diary data-based study (Elu et al., 2019 ) in Mozambique, Sub-Saharan Africa, which revealed that being a woman had a positive treatment effect on procuring microcredit. A longitudinal panel study (Khandker and Samad, 2014 ) comparing the effects of microcredit programs in Bangladesh showed that a 10% increase in borrowing by women lowered extreme poverty by 5% and increased the willingness to work of women by 0.46%.

The usefulness of microfinance, microcredit, and microenterprises to promote the empowerment of women has been widely studied (Karlan et al., 2007 ; Swamy, 2014 ; Laha and Kuri, 2014 ; Zhang and Posso, 2017 ), along with the impact of bundling them up with vocational trainings, education or counseling (Kim et al., 2007 ; Buehren et al., 2015 ; Karlan et al., 2007 ). It has been found that both economic and social empowerment programs together were effective in reducing IPV (Kim et al., 2007 ). One such intervention affirms that lifeskills and livelihood training along with microfinance resulted in the likelihood of higher earnings and consumption along with a reduction in teen pregnancy and early marriage (Buehren et al., 2015 ). Likewise, it was found that health knowledge along with microcredit could help in reducing health risks (Karlan et al., 2007 ).

On the other hand, the success of microfinance policy based on outreach was challenged with an argument that institutions and their policies had engaged in a residual rather than the relational understanding of poverty (Johnson, 2013 ). Similarly, it was also questioned by Gonzales et al. in 2020 by highlighting the regressive attitude and biasness of credit officers against indigenous women.

Formal accounts/services

Formal account ownership and its use have been established as an important indicator of FI, and with the support of several research experiments, it has been adopted as an important policy intervention in many countries. Worldwide, 55% of males have a formal account at a financial institution, whereas only 47% of women own or co-own such an account with a gloomier picture in developing countries where women are 28% less likely to have an account at a formal financial institution. (Demirguc-Kunt et al., 2022 ).

Bank accounts result in savings that lead to wealth creation, which is an identified determinant of FI. A study in Kenya found that women made use of savings account far more than men. It observed that there was a 45% increase in savings on business investments among women when commitment-saving bank accounts were opened along with a high fee on withdrawal (Dupas and Robinsion, 2013 ). However, in their successive study (Dupas et al., 2014 ), where instead of a compulsive intervention, the mediation was only to facilitate account opening, it was found that men saved more than women and were more frequent in making transactions.

Hence, the mere opening of bank accounts in the names of women will not ensure their inclusion in the financial mainstream, and their usage of the same over the long run is crucial development. An experimental study found that 22% of such mediated accounts were active in the short run, and only 7% were used in the third year. Many women claim that they use the formal account of someone else in their family so they do not need an account in their own name. In many cases, husbands hold access to the ATM card of their wife, hinting towards the family structures that deprive women of a sense of ownership, making her dependent on other family members in financial matters. (Schaner, 2017 ; Demirguc-Kunt et al., 2022 ).

On the brighter side, it was found that with the sense of ownership of wealth, women tend to appreciate themselves by spending on their personal needs, elevating their sense of self-worth. There was a 40% increase in women’s personal expenditure (Dupas and Robinsion, 2013 ) and an increase in education and health after the account opening (Prina, 2015 ). Additionally, the ATM cards issued along with bank accounts were found to be quite popular among married couples, as transactions increased up to 62% in the short run and 68% in the long run. It was found to enable wives to participate in joint financial decisions along with their husbands (Schaner, 2017 ). These results reflect the positive impact of free account opening and subsidized or free financial services on inclusion but also emphasize the need to ensure that the benefits reach out to the targeted vulnerable women and have long-term effects.

Cash/asset transfer program

CTs benefit women through financial well-being, economic security and emotional well-being, leading to a reduction in intimate partner violence and significant improvement in women’s status and relationships in the family. (Ismayilova et al., 2018 ; Buller et al., 2018 )

Studies have supported adding cognitive and emotive features such as training, counseling and coaching with economic strategies in policy interventions to empower women (Ismayilova et al., 2018 ; Brudevold et al., 2017 ). When CT intervention was compared with the one coupled with life skill training, it was found that sole cash transfers were more useful in increasing the income of women in the short run only, whereas the likelihood of employment could be increased with life skill training and CT bundled together (Brudevold et al., 2017 ). An interesting study to find the real beneficiaries of CT in the long run found that benefits were largely retained by women, as they had less pressure to share their income with their relatives on the pretext that their earning options were limited (Squires, 2018 ).

The impact of productive asset transfer (livestock) in the name of women was explored in an experimental setting in Bangladesh. It revealed that although women’s asset ownership increased significantly, the real beneficiaries were men instead of women (“fly paper effect”), male sole ownership in agriculture and land increased significantly after the intervention (Roy et al., 2015 ). This reaffirms the earlier made point about the way dowry benefits are reaped by the male members.

The usefulness of CT or asset transfer cannot be denied in the short run, where lack of cash or assets averts women from starting a business, but their limitation to save prevents them from sustaining the benefits in the long run (Brudevold et al., 2017 ).

Self-help groups (SHG), philanthropy, NGOs

SHGs are informal groups of rural women formed to socially and economically support each other with a sense of belongingness and responsibility among themselves. These groups foster FI along with the social empowerment of women. Members join the SHG mainly to obtain financial support to meet basic needs, especially in the case of emergency (Nagaraj and Sundaram, 2017 ).

Most SHG members are young in age, are less educated, have less income and lack any kind of previous experience in handling money. After their SHG experience, women have been found to be managing cash (Kabeer, 2011 ; Maclean, 2012 ; Ramachandar and Pelto, 2009 ), although some studies have found that even after SHG training, there was no impact on asset formation or income of participants (Deininger and Liu, 2013 ), women remained unsure and pressurized about their financial decisions, especially in the presence of a community member (Maclean, 2012 ; Ramachandar and Pelto, 2009 ).

It was found that when the members become old in the group, they start realizing their social responsibilities, which transforms their social participation and builds up their confidence in making decisions (Mehta et al., 2011 ), enabling them to fight against exploitation at the family or societal level.

Many philanthropists and NGOs have dedicated themselves to the cause of women’s empowerment. The BOMA project in Kenya, which works to achieve the UN sustainable development goals of poverty reduction, reducing gender inequality and mitigating the effects of climate change, has been instrumental in increasing income and savings (Tiwari et al., 2019 ). In 2019, Hendriks studied the logic and strategy of the functioning of one such philanthropic Bill & Melinda Gates foundation that aims to reduce the gender gap through FI, while in 2020, Kemp and Berkovitch worked to study feminist NGOs in Israel.

Digital inclusion

Gender was identified as a key variable in consumer readiness in adopting mobile payment services and strategizing market segmentation (Humbani and Wiese, 2018 ). Digital financial services have been discussed in papers as one of the most effective FI models (Arnold and Gammage, 2019 , Natile, 2019 ), promising greater privacy, confidentiality and control of women over their finances (Duflo, 2012 ). An influential African study by Efobi et al. in 2018 found a strong positive relationship between progressions in information technology through mobile & internet penetration and the participation of women in the economy.

With the advent of mobile banking, many women who cannot reach out to financial institutions have been linked to financial services and are more likely to save than men, even with limited amounts (Ouma et al., 2017 ), gaining greater flexibility to spend on household expenditures and child welfare measures (Duflo, 2012 ). In 2016, Suri and Jack found that Kenyan mobile money system M-PESA was able to lift 194,000 households, which was 2% of the total households, out of poverty, with a significant positive impact in female households driven by higher savings and better employment of women. Acknowledging its phenomenal reach, the drawbacks and efficiencies of mobile banking were discussed further to promote FI (Humbani and Wiese, 2018 ; Arnold and Gammage, 2019 ). Prospects of digitizing G2P payments were evaluated (Klapper and Singer, 2017 ) to find that with the backing of government, there could be a dramatic reduction in costs, higher efficiencies, transparency and greater acceptance of technology.

Deliberating imperfections, on the one hand, complex financial products and services are being launched every other day; on the other hand, almost 80% of women in low-income economies still earn their wages in cash (Klapper and Dutt, 2015 ). Inherent inequalities in financial access (Klapper and Dutt, 2015 ), innumeracy, illiteracy and unfamiliarity with technology (Tiwari et al., 2019 ) are barriers to women’s digital FI. Reiterating the above idea, the exploration of inclusionary arrangements found the exploitation of the M-PESA program to identify market opportunities causing its failure to adopt the redistributive measures necessary for the benefit of society (Natile, 2019 ). This suggests that there is a need for a very well-planned, systematic digital intervention with higher transparency, sensitivity and awareness.

Our systematic study seeks to explore its research objectives through three dimensions viz. barriers, intervention types and intervention/experimental studies (Fig. 2 ). The results obtained with regards to each dimension have been further discussed to present the contribution of our work.

Out of 67 related studies 24 studies provided us insights about the barriers in the way to financial Inclusion of women. A tabular synthesis of these studies resulted in the identification of six barriers, which were further qualitatively synthesized to find that they were interlinked and often cyclical in nature. We found that the study conducted for understanding one barrier led the way to explore other barrier. The long-term ill treatment of women due to patriarchy structures induce low self-esteem and other psychological barriers, which in turn reduce their negotiation power and more often than not they have to settle for low income and wages coupled with low literacy levels than their male counterparts. Low finances, economic power and low literacy directly affect their decision-making, leadership and opportunities. With fewer opportunities to grow, females get lesser access to finance and the women who have been underprivileged on account of their ethnicity face greater challenges in accessing finance their development. Lack of financial strength and literacy keeps pushing women into the patriarchy structures and hence the viscous cycle of disempowering women continues.

The results obtained from the tabular synthesis of 34 intervention studies, identified Government/Corporates programs and policies, Microcredit/Microfinance, Formal accounts/services, Cash/asset transfer program, Self-Help Groups (SHG), Philanthropy, NGOs and Digital Inclusion as the main interventions. These interventions have been individually documented to get insights about the related studies. The qualitative results suggest that there is a significant role of public and social institutions, related experiences, economic nature of intervention and technical advancement in financial services in fostering financial empowerment of women.

Also, we have presented a tabular synthesis of 24 intervention or experimental studies, which give an insight about the kind of intervention, the key findings and the research methodology that has been adopted in previous studies (Table 4 ). The findings from intervention studies suggest that economic interventions alone or bundled with social interventions were useful in financially empowering women.

Previous studies such as Holloway et al. ( 2017 ) and Kalaitzi et al. ( 2017 ) have used thematic mapping and traditional review methods to approach similar problem. Holloway et al. ( 2017 ) studied the impact of various saving, credit, payments and insurance products on women empowerment and found that there are numerous demand and supply-side barriers, some of which could be overcome by product design features. The study suggested that a greater degree of control and privacy surrounding women’s income and expenditure decision could boost their inclusion in the financial system. Our study results supports this finding especially while planning financial inclusion of women through digital ways where transparency, sensitivity and awareness must be considered as important variables.

Kalaitzi et al. ( 2017 ) identified 26 barriers to women leadership in Healthcare, Academia and Business, some of which were common while some were found to be starkly different across sectors. A systematic review by Roy and Patro ( 2022) synthesized evidence from 73 studies to find out that demand side factors were the main cause of gender-based exclusion. Unlike these studies, we have not only identified the different types of barriers, but also have attempted to understand the nature of these barriers, which has led to physical, social, mental, economic exploitation and overall suppression of women since a very long time. The focus of previous studies was only on the factors and the importance of the FI of women, giving us the opportunity to discuss the subject at a comprehensive level by including related interventions. Also, our findings about the experimental studies have not been presented in former studies making our contribution significant in women studies.

Thus, filling up the gaps, we have discussed the nature of six main barriers, summarized 24 key experimental studies and have clearly identified six major interventions that have been applied in the first 2 decades of the twenty-first century to provide a bird’s-view to systematically connect the factors as well as mediations found in past studies with the present and future.

However, as mentioned earlier in the result section of this paper, the presence of heterogeneity of the quantitative studies prevented us from conducting a meta-analysis, which we have tried to compensate with a rigorous synthesis of results from various studies. Sincere efforts have been made to include all the major contributors to the research topic, but due to the vastness of the subject and the limitation of our research design, some insightful studies may have been omitted from the discussion. Nevertheless, we believe that the current work covers inputs from many imminent studies, such as Kabeer ( 2011 ), Kabeer and Sweetman ( 2015 ), Beck et al. ( 2007 ), Brudevold et al. ( 2017 ), Swamy ( 2014 ), Efobi et al. ( 2018 ), Klapper and Dutt, ( 2015 ), and Dupas and Robinsion ( 2013 ) is able to provide the readers with a comprehensive, yet quick overview of the literature and its gaps while contributing to the development of useful interventions to achieve the sustainability goal of gender equality by 2030.

Practical implications

Considering the vastness of the subject and the need for urgent attention as the fifth sustainability goal, a quick understanding to formulate useful policies, programs and other interventions is much needed. Therefore, the findings of our study can provide useful insights to policy makers.

The barriers to financial Inclusion of women have been found to be inter-related and cyclical. This implies that a constant endeavor to eradicate even one such hurdle will have a multifold effect and will be useful in removing others. On the flip side, if attention is not paid to remove even one of these hurdles, they will keep occurring and obstructing the way of women’s development. Therefore, long-term policy interventions with continuous monitoring of efforts are required to bring about inclusive financial growth of women.

We have found through our exploration of intervention studies (Table 3 ) that though Government-to-people transfers (G2P), such as pensions, conditional cash transfers, financial literacy programs, microfinance, other socioeconomic transfers and products & services of public facility institutions such as post-offices, have resulted in the growth of savings and thereby higher entrepreneurship among women, but the related experiences of poor women determine their likelihood of connecting with the system in the long run. Hence, merely designing the intervention is not enough, and careful monitoring of such interventions must be done to achieve the objectives.

We have also found that SHGs, NGOs and other local communities enable women to become a part of the value chain and the familiarity and trust of vulnerable women in such organizations gives them a comparative advantage over other formal institutions. Therefore, as these formal or informal setups help women to get past the psychological hurdles, they must be included in all programs devised for including women in the financial system.

Moreover, we have found digital inclusion to be the most promising intervention with the widest range and prospects to connect with left-behind poor women. This calls for a sensitive customized approach keeping in mind the convenience of vulnerable and less educated women in adapting to the digital ways.

Furthermore, through our exploration of experimental studies (Table 4 ) we have found that economic interventions are more useful than social interventions in promoting entrepreneurship, savings, consumption and general betterment of the lifestyle of women. However, the most effective programs are those in which both economic and social components are incorporated. This insight can be utilized towards designing valuable mediations to support entrepreneurship among women, keeping in view that such intervention should not just be on papers, but must actually reach to the beneficiary and be utilized towards the identified cause only.

Future scope for research

The 67 studies discussed in this work have exposed many gaps in the related literature. As we have found that all the barriers are inter-related and cyclical, there is a need to break the cycle. Our findings can help future researchers to develop deeper insights about each of the highlighted barrier. A few future areas for research have been identified as:

Meaningful and important insights can be derived from ethnic studies to measure the impact of cultural institutions such as women’s dress codes and their expected public behavior on the level of their economic participation.

Exploration of behavioral irrationality of rural women towards financial products and services.

Biasness at the workplace in terms of income, authority and leadership should be explored further to devise suitable interventions.

The perception, attitude, and behavior of women towards finance have been evaluated in many studies, but not much has been discussed to understand the supply-side psychological hurdles at the individual level in disbursal of finance.

Likewise, our results suggest and discuss the evaluation of most effective interventions, which can help researchers to understand the way these mediations have developed so far and the way in which they can be improvised. Some future areas, which may be explored in theory may be:

The usefulness of online education to promote financial literacy and awareness in the remote corners of countries and across countries.

The lack of discussion about insurance products to mitigate risk and encourage investments among women can be addressed.

There is a need to discuss security, transparency and awareness in digital financial services along with thoughtfully designing simpler digital interfaces, tools and devices customized for women.

Moreover, as the problem of the FI of women has evidently been discussed primarily in developing nations, there is a need for exploration studies about poor or indigenous women in developed countries.

Thus, offering a deeper insight to the subject of Women empowerment through Financial Inclusion, we have identified six prominent barriers to FI of women: patriarchy structures, psychological factors, low income/wages, low financial literacy, low financial accessibility and ethnicity and have uniquely found that these barriers are interconnected with cyclical impact, resulting in redistribution effects that further widen the gaps between the privileged and the underprivileged, which must be considered while designing interventions in future.

Similarly, we have recognized six main interventions that have been introduced thus far: government and corporate programs/policies, microfinance, formal saving accounts/services, cash or asset transfer, self-help groups and digital inclusion and have presented various methods and findings of related experimental researches to provide direction for future inquiry. The consequences, appreciation and criticism of various interventions have been documented in the results and discussion to provide useful vision for future policy or theoretic implementation. Overall, this study has exclusively presented a summary of the barriers and interventions, which have been inquired into during 2000–2020 thereby contributing to achieving sustainable development goal (SDG 5) of ending gender inequality issues by 2030.

Data availability

All data generated or analyzed during this study are included in this published article and its supplementary information file.

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Saluja, O.B., Singh, P. & Kumar, H. Barriers and interventions on the way to empower women through financial inclusion: a 2 decades systematic review (2000–2020). Humanit Soc Sci Commun 10 , 148 (2023). https://doi.org/10.1057/s41599-023-01640-y

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An International Perspective on the Human Rights of Women

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• Volume 8 , pages 253–261, ( 2023 )

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• Abraham Tetteh Teye   ORCID: orcid.org/0000-0002-9989-6075 1  

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The welfare and well-being of women worldwide continues to depend on the respect for basic human rights. Research on the rights of the vulnerable highlights the necessity to defend the rights of women in local and global contexts. This article aims to add to the body of existing knowledge by examining women’s rights from a global perspective and the role social workers play in advancing these rights. The methodology of this article was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Based on the literature reviewed, this paper explores the advancement of women’s rights through a social work approach, specifically addressing the issues of violence and abuse against women, access to sexual and reproductive healthcare, and fair employment and reasonable working conditions. The paper proceeds with a critical analysis of the aforementioned issues concerning women’s rights and makes recommendations that would help promote the rights of women within the local and international setting. This article further suggests that improving health services, taking preventive measures, and advocating for equal pay and working conditions for women will go a long way to aid in the defence of the fundamental rights of women.

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Acknowledgements

The author would like to thank Katerina Nolan from the School of Health and Social Care at the University of Lincoln, for her assistance. The language of this article includes her suggestions and criticism from her evaluation feedback.

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Teye, A.T. An International Perspective on the Human Rights of Women. J. Hum. Rights Soc. Work 8 , 253–261 (2023). https://doi.org/10.1007/s41134-023-00253-4

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Accepted : 28 April 2023

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DOI : https://doi.org/10.1007/s41134-023-00253-4

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Gender equality in research: papers and projects by Highly Cited Researchers

Strategic Alliances and Engagement Manager

Empowering women and girls is a critical target of the United Nations Sustainable Development Goals (SDGs). In this installment of our blog series about Highly Cited Researchers contributing to the UN SDGs, we focus on SDG 5: Gender Equality. We discuss the research that Highly Cited Researchers have published and the trends we’re seeing emerge.

Gender equality is a fundamental human right and yet women have just three quarters of the legal rights of men today. While the speed of progress differs across regions, laws, policies, budgets and institutions must all be strengthened on an international scale to grant women equal rights as men.

The socioeconomic impact of the COVID-19 pandemic and high-profile policy changes like the overturning of Roe v. Wade have shown how much work needs to be done. The COVID-19 pandemic caused many women to leave the workforce and amplified challenges related to child and elder care, with women shouldering much of the burden. This can disproportionately affect girls’ educational prospects and, as is often the case in stressful environments and during times of crisis, puts women at increased risk of domestic violence .

While some high-profile issues related to women’s rights and safety make the news cycle, gender inequalities are firmly entrenched in every society, impacting the daily lives of women and girls in ways that are rarely reported on. As Kamala Harris, Vice President of the United States, once said , “from the economy to climate change to criminal justice reform to national security, all issues are women’s issues.”

Women’s issues are interconnected with all the SDGs, as we touched on in our recent post in this series, which explored the research centered around SDG 16: Peaceful, just and strong institutions . In that post we found that sexual, domestic and intimate partner abuse and violence against women are the most published topics related to SDG 16.

In this post, we look at Highly Cited Researchers who focus specifically on SDG 5 and issues of equality and gender .

What is SDG 5: Gender equality?

SDG 5: Gender Equality is intended to address the serious inequalities and threats faced by women around the globe. The targets related to this goal include:

• End all forms of discrimination against all women and girls everywhere.
• Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation.
• Ensure women’s full and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic and public life.

There has been an increase in articles and reviews related to this SDG since the establishment of the SDGs in 2015. This trend graph from InCites Benchmarking & Analytics ™, using Web of Science Core Collection ™ data, shows growth from 86,000 papers in 2015 to 152,000 in 2021. That’s a 77% increase in six years.

Growth in academic papers related to SDG 5: Gender Equality

Source: Incites Benchmarking & Analytics. Dataset: articles and reviews related to SDG 5: Gender Equality published between 2015-2021.

The top ten countries publishing on SDG 5: Gender Equality during this period are shown below, with the U.S. producing roughly one third of all papers.

Countries producing the most papers related to SDG 5: Gender Equality

We explore these angles from research published between 2010 and 2020 in more detail, below.

Inequalities in the treatment of women during childbirth

Özge Tunçalp , a Highly Cited Researcher from the World Health Organization (WHO), wrote a systematic review in 2015 about the mistreatment of women globally during childbirth. This paper, coauthored with Johns Hopkins University, McGill University, University of Sao Paulo and PSI (a global nonprofit working in healthcare), has been cited more than 590 times to date in the Web of Science Core Collection. Tunçalp’s paper provides further information about the type and degree of mistreatment in childbirth, which supports the development of measurement tools, programs and interventions in this area.

Tunçalp authored another open access paper on this topic in 2019 , which followed women in four low-income and middle-income countries to study their experiences during childbirth. Unfortunately, more than one third of the women in the study experienced mistreatment during childbirth, a critical time in their lives, with younger and less educated women found to be most at risk. Beyond showing that mistreatment during childbirth exists, this study demonstrates the inequalities in how some women are treated in comparison to others, which informs the interventions needed.

“Our research showed that mistreatment during childbirth occurs across low-, middle- and high-income countries and good quality of care needs to be respectful as well as safe, no matter where you are in the world.” Dr Özge Tunçalp, World Health Organization

According to Dr. Tunçalp, “Women and families have a right to positive pregnancy, childbirth and postnatal experiences, supported by empowered health workers, majority of whom are women. Improving the experience of care throughout pregnancy and childbirth is essential to help increase the trust in facility-based care – as well as ensuring access to quality postnatal care following birth. Our research showed that mistreatment during childbirth occurs across low-, middle- and high-income countries and good quality of care needs to be respectful as well as safe, no matter where you are in the world. It was critical to ensure that these findings were translated into WHO global recommendations to inform country policy and programmes .”

Autism spectrum disorder and the gender bias in diagnosis

William Mandy, a Highly Cited Researcher in Psychiatry and Psychology, looks at gender differences related to autism spectrum disorder (ASD). Mandy, from University College London, and his co-authors found that the male-to-female ratio of children with ASD is closer to 3:1, not the often assumed 4:1 . With an apparent gender bias in diagnosis, girls who meet the criteria for ASD are at risk of being misdiagnosed or not diagnosed at all. This can cause confusion and challenges with social interactions growing up, and can put women and girls at greater risk of traumatic experiences. Mandy et al’s paper has been cited more than 830 times to date.

“The reason for this diagnostic bias is that sex and gender influence how autism presents, such that the presentations of autistic girls and women often do not fit well with current conceptualisations of the condition, which were largely based on mainly male samples.” Dr William Mandy, University College London

When asked about the relevance of his research to the clinical community, Dr. Mandy said: “Clinicians have long held the suspicion that there is a diagnostic bias against autistic girls and women – that they are more likely to fly under the diagnostic radar. Our work (Loomes et al., 2017) has helped to provide systematic, empirical evidence that this bias does indeed exist, and to quantify its impact, in terms of how many autistic girls go undiagnosed.

The reason for this diagnostic bias is that sex and gender influence how autism presents, such that the presentations of autistic girls and women often do not fit well with current conceptualisations of the condition, which were largely based on mainly male samples. Therefore, to address the gender bias in autism diagnosis, we need an evidence-based understanding of the characteristics of autistic girls and women. Our study (Bargiela et al, 2016), in which we interviewed late-diagnosed autistic women about their lives, helps do this, revealing distinctive features of autistic women and of their experiences. This knowledge is shaping research and clinical practice.”

Going forward

The above papers are just a few examples of Highly Cited Researchers contributing to SDG 5-Gender Equality. Others focus on depression, Alzheimer’s Disease, cardiovascular disease and ovarian cancer. The fact that biomedical research featured so prominently in these results should not be a surprise. Gender bias has been identified in many areas of healthcare, including patient diagnosis , discrimination against health care workers , and low rates of women in clinical studies to name a few.

The Highly Cited Researchers working on gender equality within their respective fields, which also include social sciences, economics and other areas in addition to medicine, are helping to address the complex issues related to SDG 5. And what’s worthy of note is that many of the researchers mentioned here were named as Highly Cited Researchers in the cross-field category, which identifies researchers who have contributed to Highly Cited Papers across several different fields. This shows that a multifaceted and integrated approach to gender equality research may be playing a significant role in addressing this global issue.

Stay up to date

We discussed the SDG Publishers Compact in the first post in our series and then celebrated the Highly Cited Researchers in SDG 1: No Poverty and SDG 2: Zero Hunger. We then covered SDG 3: Good Health and Well-Being and SDG 4: Quality Education , and then jumped ahead to cover SDG 16: Peace, Justice and Strong Institutions . Alongside this, we also looked at Ukrainian research contributions to the UN Sustainable Development Goals, here , and published an Institute for Scientific Information (ISI)™Insights paper called, Climate change collaboration: Why we need an international approach to research .

In our next post, we will identify Highly Cited Researchers who are working to address SDG 6: Clean Water and Sanitation.

At Clarivate, sustainability is at the heart of everything we do, and this includes support of human rights, diversity and inclusion, and social justice. Read more about our commitment to driving sustainability worldwide, and see highlights from our 2021 Clarivate Sustainability Report .

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Open Access

Peer-reviewed

Research Article

Twenty years of gender equality research: A scoping review based on a new semantic indicator

Contributed equally to this work with: Paola Belingheri, Filippo Chiarello, Andrea Fronzetti Colladon, Paola Rovelli

Roles Conceptualization, Formal analysis, Funding acquisition, Visualization, Writing – original draft, Writing – review & editing

Affiliation Dipartimento di Ingegneria dell’Energia, dei Sistemi, del Territorio e delle Costruzioni, Università degli Studi di Pisa, Largo L. Lazzarino, Pisa, Italy

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Visualization, Writing – original draft, Writing – review & editing

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Software, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations Department of Engineering, University of Perugia, Perugia, Italy, Department of Management, Kozminski University, Warsaw, Poland

Roles Conceptualization, Formal analysis, Funding acquisition, Writing – original draft, Writing – review & editing

Affiliation Faculty of Economics and Management, Centre for Family Business Management, Free University of Bozen-Bolzano, Bozen-Bolzano, Italy

• Paola Belingheri, 
• Filippo Chiarello, 
• Andrea Fronzetti Colladon, 
• Paola Rovelli

• Published: September 21, 2021
• https://doi.org/10.1371/journal.pone.0256474
• Reader Comments

9 Nov 2021: The PLOS ONE Staff (2021) Correction: Twenty years of gender equality research: A scoping review based on a new semantic indicator. PLOS ONE 16(11): e0259930. https://doi.org/10.1371/journal.pone.0259930 View correction

Gender equality is a major problem that places women at a disadvantage thereby stymieing economic growth and societal advancement. In the last two decades, extensive research has been conducted on gender related issues, studying both their antecedents and consequences. However, existing literature reviews fail to provide a comprehensive and clear picture of what has been studied so far, which could guide scholars in their future research. Our paper offers a scoping review of a large portion of the research that has been published over the last 22 years, on gender equality and related issues, with a specific focus on business and economics studies. Combining innovative methods drawn from both network analysis and text mining, we provide a synthesis of 15,465 scientific articles. We identify 27 main research topics, we measure their relevance from a semantic point of view and the relationships among them, highlighting the importance of each topic in the overall gender discourse. We find that prominent research topics mostly relate to women in the workforce–e.g., concerning compensation, role, education, decision-making and career progression. However, some of them are losing momentum, and some other research trends–for example related to female entrepreneurship, leadership and participation in the board of directors–are on the rise. Besides introducing a novel methodology to review broad literature streams, our paper offers a map of the main gender-research trends and presents the most popular and the emerging themes, as well as their intersections, outlining important avenues for future research.

Citation: Belingheri P, Chiarello F, Fronzetti Colladon A, Rovelli P (2021) Twenty years of gender equality research: A scoping review based on a new semantic indicator. PLoS ONE 16(9): e0256474. https://doi.org/10.1371/journal.pone.0256474

Editor: Elisa Ughetto, Politecnico di Torino, ITALY

Received: June 25, 2021; Accepted: August 6, 2021; Published: September 21, 2021

Copyright: © 2021 Belingheri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its supporting information files. The only exception is the text of the abstracts (over 15,000) that we have downloaded from Scopus. These abstracts can be retrieved from Scopus, but we do not have permission to redistribute them.

Funding: P.B and F.C.: Grant of the Department of Energy, Systems, Territory and Construction of the University of Pisa (DESTEC) for the project “Measuring Gender Bias with Semantic Analysis: The Development of an Assessment Tool and its Application in the European Space Industry. P.B., F.C., A.F.C., P.R.: Grant of the Italian Association of Management Engineering (AiIG), “Misure di sostegno ai soci giovani AiIG” 2020, for the project “Gender Equality Through Data Intelligence (GEDI)”. F.C.: EU project ASSETs+ Project (Alliance for Strategic Skills addressing Emerging Technologies in Defence) EAC/A03/2018 - Erasmus+ programme, Sector Skills Alliances, Lot 3: Sector Skills Alliance for implementing a new strategic approach (Blueprint) to sectoral cooperation on skills G.A. NUMBER: 612678-EPP-1-2019-1-IT-EPPKA2-SSA-B.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The persistent gender inequalities that currently exist across the developed and developing world are receiving increasing attention from economists, policymakers, and the general public [e.g., 1 – 3 ]. Economic studies have indicated that women’s education and entry into the workforce contributes to social and economic well-being [e.g., 4 , 5 ], while their exclusion from the labor market and from managerial positions has an impact on overall labor productivity and income per capita [ 6 , 7 ]. The United Nations selected gender equality, with an emphasis on female education, as part of the Millennium Development Goals [ 8 ], and gender equality at-large as one of the 17 Sustainable Development Goals (SDGs) to be achieved by 2030 [ 9 ]. These latter objectives involve not only developing nations, but rather all countries, to achieve economic, social and environmental well-being.

As is the case with many SDGs, gender equality is still far from being achieved and persists across education, access to opportunities, or presence in decision-making positions [ 7 , 10 , 11 ]. As we enter the last decade for the SDGs’ implementation, and while we are battling a global health pandemic, effective and efficient action becomes paramount to reach this ambitious goal.

Scholars have dedicated a massive effort towards understanding gender equality, its determinants, its consequences for women and society, and the appropriate actions and policies to advance women’s equality. Many topics have been covered, ranging from women’s education and human capital [ 12 , 13 ] and their role in society [e.g., 14 , 15 ], to their appointment in firms’ top ranked positions [e.g., 16 , 17 ] and performance implications [e.g., 18 , 19 ]. Despite some attempts, extant literature reviews provide a narrow view on these issues, restricted to specific topics–e.g., female students’ presence in STEM fields [ 20 ], educational gender inequality [ 5 ], the gender pay gap [ 21 ], the glass ceiling effect [ 22 ], leadership [ 23 ], entrepreneurship [ 24 ], women’s presence on the board of directors [ 25 , 26 ], diversity management [ 27 ], gender stereotypes in advertisement [ 28 ], or specific professions [ 29 ]. A comprehensive view on gender-related research, taking stock of key findings and under-studied topics is thus lacking.

Extant literature has also highlighted that gender issues, and their economic and social ramifications, are complex topics that involve a large number of possible antecedents and outcomes [ 7 ]. Indeed, gender equality actions are most effective when implemented in unison with other SDGs (e.g., with SDG 8, see [ 30 ]) in a synergetic perspective [ 10 ]. Many bodies of literature (e.g., business, economics, development studies, sociology and psychology) approach the problem of achieving gender equality from different perspectives–often addressing specific and narrow aspects. This sometimes leads to a lack of clarity about how different issues, circumstances, and solutions may be related in precipitating or mitigating gender inequality or its effects. As the number of papers grows at an increasing pace, this issue is exacerbated and there is a need to step back and survey the body of gender equality literature as a whole. There is also a need to examine synergies between different topics and approaches, as well as gaps in our understanding of how different problems and solutions work together. Considering the important topic of women’s economic and social empowerment, this paper aims to fill this gap by answering the following research question: what are the most relevant findings in the literature on gender equality and how do they relate to each other ?

To do so, we conduct a scoping review [ 31 ], providing a synthesis of 15,465 articles dealing with gender equity related issues published in the last twenty-two years, covering both the periods of the MDGs and the SDGs (i.e., 2000 to mid 2021) in all the journals indexed in the Academic Journal Guide’s 2018 ranking of business and economics journals. Given the huge amount of research conducted on the topic, we adopt an innovative methodology, which relies on social network analysis and text mining. These techniques are increasingly adopted when surveying large bodies of text. Recently, they were applied to perform analysis of online gender communication differences [ 32 ] and gender behaviors in online technology communities [ 33 ], to identify and classify sexual harassment instances in academia [ 34 ], and to evaluate the gender inclusivity of disaster management policies [ 35 ].

Applied to the title, abstracts and keywords of the articles in our sample, this methodology allows us to identify a set of 27 recurrent topics within which we automatically classify the papers. Introducing additional novelty, by means of the Semantic Brand Score (SBS) indicator [ 36 ] and the SBS BI app [ 37 ], we assess the importance of each topic in the overall gender equality discourse and its relationships with the other topics, as well as trends over time, with a more accurate description than that offered by traditional literature reviews relying solely on the number of papers presented in each topic.

This methodology, applied to gender equality research spanning the past twenty-two years, enables two key contributions. First, we extract the main message that each document is conveying and how this is connected to other themes in literature, providing a rich picture of the topics that are at the center of the discourse, as well as of the emerging topics. Second, by examining the semantic relationship between topics and how tightly their discourses are linked, we can identify the key relationships and connections between different topics. This semi-automatic methodology is also highly reproducible with minimum effort.

This literature review is organized as follows. In the next section, we present how we selected relevant papers and how we analyzed them through text mining and social network analysis. We then illustrate the importance of 27 selected research topics, measured by means of the SBS indicator. In the results section, we present an overview of the literature based on the SBS results–followed by an in-depth narrative analysis of the top 10 topics (i.e., those with the highest SBS) and their connections. Subsequently, we highlight a series of under-studied connections between the topics where there is potential for future research. Through this analysis, we build a map of the main gender-research trends in the last twenty-two years–presenting the most popular themes. We conclude by highlighting key areas on which research should focused in the future.

Our aim is to map a broad topic, gender equality research, that has been approached through a host of different angles and through different disciplines. Scoping reviews are the most appropriate as they provide the freedom to map different themes and identify literature gaps, thereby guiding the recommendation of new research agendas [ 38 ].

Several practical approaches have been proposed to identify and assess the underlying topics of a specific field using big data [ 39 – 41 ], but many of them fail without proper paper retrieval and text preprocessing. This is specifically true for a research field such as the gender-related one, which comprises the work of scholars from different backgrounds. In this section, we illustrate a novel approach for the analysis of scientific (gender-related) papers that relies on methods and tools of social network analysis and text mining. Our procedure has four main steps: (1) data collection, (2) text preprocessing, (3) keywords extraction and classification, and (4) evaluation of semantic importance and image.

Data collection

In this study, we analyze 22 years of literature on gender-related research. Following established practice for scoping reviews [ 42 ], our data collection consisted of two main steps, which we summarize here below.

Firstly, we retrieved from the Scopus database all the articles written in English that contained the term “gender” in their title, abstract or keywords and were published in a journal listed in the Academic Journal Guide 2018 ranking of the Chartered Association of Business Schools (CABS) ( https://charteredabs.org/wp-content/uploads/2018/03/AJG2018-Methodology.pdf ), considering the time period from Jan 2000 to May 2021. We used this information considering that abstracts, titles and keywords represent the most informative part of a paper, while using the full-text would increase the signal-to-noise ratio for information extraction. Indeed, these textual elements already demonstrated to be reliable sources of information for the task of domain lexicon extraction [ 43 , 44 ]. We chose Scopus as source of literature because of its popularity, its update rate, and because it offers an API to ease the querying process. Indeed, while it does not allow to retrieve the full text of scientific articles, the Scopus API offers access to titles, abstracts, citation information and metadata for all its indexed scholarly journals. Moreover, we decided to focus on the journals listed in the AJG 2018 ranking because we were interested in reviewing business and economics related gender studies only. The AJG is indeed widely used by universities and business schools as a reference point for journal and research rigor and quality. This first step, executed in June 2021, returned more than 55,000 papers.

In the second step–because a look at the papers showed very sparse results, many of which were not in line with the topic of this literature review (e.g., papers dealing with health care or medical issues, where the word gender indicates the gender of the patients)–we applied further inclusion criteria to make the sample more focused on the topic of this literature review (i.e., women’s gender equality issues). Specifically, we only retained those papers mentioning, in their title and/or abstract, both gender-related keywords (e.g., daughter, female, mother) and keywords referring to bias and equality issues (e.g., equality, bias, diversity, inclusion). After text pre-processing (see next section), keywords were first identified from a frequency-weighted list of words found in the titles, abstracts and keywords in the initial list of papers, extracted through text mining (following the same approach as [ 43 ]). They were selected by two of the co-authors independently, following respectively a bottom up and a top-down approach. The bottom-up approach consisted of examining the words found in the frequency-weighted list and classifying those related to gender and equality. The top-down approach consisted in searching in the word list for notable gender and equality-related words. Table 1 reports the sets of keywords we considered, together with some examples of words that were used to search for their presence in the dataset (a full list is provided in the S1 Text ). At end of this second step, we obtained a final sample of 15,465 relevant papers.

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https://doi.org/10.1371/journal.pone.0256474.t001

Text processing and keyword extraction

Text preprocessing aims at structuring text into a form that can be analyzed by statistical models. In the present section, we describe the preprocessing steps we applied to paper titles and abstracts, which, as explained below, partially follow a standard text preprocessing pipeline [ 45 ]. These activities have been performed using the R package udpipe [ 46 ].

The first step is n-gram extraction (i.e., a sequence of words from a given text sample) to identify which n-grams are important in the analysis, since domain-specific lexicons are often composed by bi-grams and tri-grams [ 47 ]. Multi-word extraction is usually implemented with statistics and linguistic rules, thus using the statistical properties of n-grams or machine learning approaches [ 48 ]. However, for the present paper, we used Scopus metadata in order to have a more effective and efficient n-grams collection approach [ 49 ]. We used the keywords of each paper in order to tag n-grams with their associated keywords automatically. Using this greedy approach, it was possible to collect all the keywords listed by the authors of the papers. From this list, we extracted only keywords composed by two, three and four words, we removed all the acronyms and rare keywords (i.e., appearing in less than 1% of papers), and we clustered keywords showing a high orthographic similarity–measured using a Levenshtein distance [ 50 ] lower than 2, considering these groups of keywords as representing same concepts, but expressed with different spelling. After tagging the n-grams in the abstracts, we followed a common data preparation pipeline that consists of the following steps: (i) tokenization, that splits the text into tokens (i.e., single words and previously tagged multi-words); (ii) removal of stop-words (i.e. those words that add little meaning to the text, usually being very common and short functional words–such as “and”, “or”, or “of”); (iii) parts-of-speech tagging, that is providing information concerning the morphological role of a word and its morphosyntactic context (e.g., if the token is a determiner, the next token is a noun or an adjective with very high confidence, [ 51 ]); and (iv) lemmatization, which consists in substituting each word with its dictionary form (or lemma). The output of the latter step allows grouping together the inflected forms of a word. For example, the verbs “am”, “are”, and “is” have the shared lemma “be”, or the nouns “cat” and “cats” both share the lemma “cat”. We preferred lemmatization over stemming [ 52 ] in order to obtain more interpretable results.

In addition, we identified a further set of keywords (with respect to those listed in the “keywords” field) by applying a series of automatic words unification and removal steps, as suggested in past research [ 53 , 54 ]. We removed: sparse terms (i.e., occurring in less than 0.1% of all documents), common terms (i.e., occurring in more than 10% of all documents) and retained only nouns and adjectives. It is relevant to notice that no document was lost due to these steps. We then used the TF-IDF function [ 55 ] to produce a new list of keywords. We additionally tested other approaches for the identification and clustering of keywords–such as TextRank [ 56 ] or Latent Dirichlet Allocation [ 57 ]–without obtaining more informative results.

Classification of research topics

To guide the literature analysis, two experts met regularly to examine the sample of collected papers and to identify the main topics and trends in gender research. Initially, they conducted brainstorming sessions on the topics they expected to find, due to their knowledge of the literature. This led to an initial list of topics. Subsequently, the experts worked independently, also supported by the keywords in paper titles and abstracts extracted with the procedure described above.

Considering all this information, each expert identified and clustered relevant keywords into topics. At the end of the process, the two assignments were compared and exhibited a 92% agreement. Another meeting was held to discuss discordant cases and reach a consensus. This resulted in a list of 27 topics, briefly introduced in Table 2 and subsequently detailed in the following sections.

https://doi.org/10.1371/journal.pone.0256474.t002

Evaluation of semantic importance

Working on the lemmatized corpus of the 15,465 papers included in our sample, we proceeded with the evaluation of semantic importance trends for each topic and with the analysis of their connections and prevalent textual associations. To this aim, we used the Semantic Brand Score indicator [ 36 ], calculated through the SBS BI webapp [ 37 ] that also produced a brand image report for each topic. For this study we relied on the computing resources of the ENEA/CRESCO infrastructure [ 58 ].

The Semantic Brand Score (SBS) is a measure of semantic importance that combines methods of social network analysis and text mining. It is usually applied for the analysis of (big) textual data to evaluate the importance of one or more brands, names, words, or sets of keywords [ 36 ]. Indeed, the concept of “brand” is intended in a flexible way and goes beyond products or commercial brands. In this study, we evaluate the SBS time-trends of the keywords defining the research topics discussed in the previous section. Semantic importance comprises the three dimensions of topic prevalence, diversity and connectivity. Prevalence measures how frequently a research topic is used in the discourse. The more a topic is mentioned by scientific articles, the more the research community will be aware of it, with possible increase of future studies; this construct is partly related to that of brand awareness [ 59 ]. This effect is even stronger, considering that we are analyzing the title, abstract and keywords of the papers, i.e. the parts that have the highest visibility. A very important characteristic of the SBS is that it considers the relationships among words in a text. Topic importance is not just a matter of how frequently a topic is mentioned, but also of the associations a topic has in the text. Specifically, texts are transformed into networks of co-occurring words, and relationships are studied through social network analysis [ 60 ]. This step is necessary to calculate the other two dimensions of our semantic importance indicator. Accordingly, a social network of words is generated for each time period considered in the analysis–i.e., a graph made of n nodes (words) and E edges weighted by co-occurrence frequency, with W being the set of edge weights. The keywords representing each topic were clustered into single nodes.

The construct of diversity relates to that of brand image [ 59 ], in the sense that it considers the richness and distinctiveness of textual (topic) associations. Considering the above-mentioned networks, we calculated diversity using the distinctiveness centrality metric–as in the formula presented by Fronzetti Colladon and Naldi [ 61 ].

Lastly, connectivity was measured as the weighted betweenness centrality [ 62 , 63 ] of each research topic node. We used the formula presented by Wasserman and Faust [ 60 ]. The dimension of connectivity represents the “brokerage power” of each research topic–i.e., how much it can serve as a bridge to connect other terms (and ultimately topics) in the discourse [ 36 ].

The SBS is the final composite indicator obtained by summing the standardized scores of prevalence, diversity and connectivity. Standardization was carried out considering all the words in the corpus, for each specific timeframe.

This methodology, applied to a large and heterogeneous body of text, enables to automatically identify two important sets of information that add value to the literature review. Firstly, the relevance of each topic in literature is measured through a composite indicator of semantic importance, rather than simply looking at word frequencies. This provides a much richer picture of the topics that are at the center of the discourse, as well as of the topics that are emerging in the literature. Secondly, it enables to examine the extent of the semantic relationship between topics, looking at how tightly their discourses are linked. In a field such as gender equality, where many topics are closely linked to each other and present overlaps in issues and solutions, this methodology offers a novel perspective with respect to traditional literature reviews. In addition, it ensures reproducibility over time and the possibility to semi-automatically update the analysis, as new papers become available.

Overview of main topics

In terms of descriptive textual statistics, our corpus is made of 15,465 text documents, consisting of a total of 2,685,893 lemmatized tokens (words) and 32,279 types. As a result, the type-token ratio is 1.2%. The number of hapaxes is 12,141, with a hapax-token ratio of 37.61%.

Fig 1 shows the list of 27 topics by decreasing SBS. The most researched topic is compensation , exceeding all others in prevalence, diversity, and connectivity. This means it is not only mentioned more often than other topics, but it is also connected to a greater number of other topics and is central to the discourse on gender equality. The next four topics are, in order of SBS, role , education , decision-making , and career progression . These topics, except for education , all concern women in the workforce. Between these first five topics and the following ones there is a clear drop in SBS scores. In particular, the topics that follow have a lower connectivity than the first five. They are hiring , performance , behavior , organization , and human capital . Again, except for behavior and human capital , the other three topics are purely related to women in the workforce. After another drop-off, the following topics deal prevalently with women in society. This trend highlights that research on gender in business journals has so far mainly paid attention to the conditions that women experience in business contexts, while also devoting some attention to women in society.

https://doi.org/10.1371/journal.pone.0256474.g001

Fig 2 shows the SBS time series of the top 10 topics. While there has been a general increase in the number of Scopus-indexed publications in the last decade, we notice that some SBS trends remain steady, or even decrease. In particular, we observe that the main topic of the last twenty-two years, compensation , is losing momentum. Since 2016, it has been surpassed by decision-making , education and role , which may indicate that literature is increasingly attempting to identify root causes of compensation inequalities. Moreover, in the last two years, the topics of hiring , performance , and organization are experiencing the largest importance increase.

https://doi.org/10.1371/journal.pone.0256474.g002

Fig 3 shows the SBS time trends of the remaining 17 topics (i.e., those not in the top 10). As we can see from the graph, there are some that maintain a steady trend–such as reputation , management , networks and governance , which also seem to have little importance. More relevant topics with average stationary trends (except for the last two years) are culture , family , and parenting . The feminine topic is among the most important here, and one of those that exhibit the larger variations over time (similarly to leadership ). On the other hand, the are some topics that, even if not among the most important, show increasing SBS trends; therefore, they could be considered as emerging topics and could become popular in the near future. These are entrepreneurship , leadership , board of directors , and sustainability . These emerging topics are also interesting to anticipate future trends in gender equality research that are conducive to overall equality in society.

https://doi.org/10.1371/journal.pone.0256474.g003

In addition to the SBS score of the different topics, the network of terms they are associated to enables to gauge the extent to which their images (textual associations) overlap or differ ( Fig 4 ).

https://doi.org/10.1371/journal.pone.0256474.g004

There is a central cluster of topics with high similarity, which are all connected with women in the workforce. The cluster includes topics such as organization , decision-making , performance , hiring , human capital , education and compensation . In addition, the topic of well-being is found within this cluster, suggesting that women’s equality in the workforce is associated to well-being considerations. The emerging topics of entrepreneurship and leadership are also closely connected with each other, possibly implying that leadership is a much-researched quality in female entrepreneurship. Topics that are relatively more distant include personality , politics , feminine , empowerment , management , board of directors , reputation , governance , parenting , masculine and network .

The following sections describe the top 10 topics and their main associations in literature (see Table 3 ), while providing a brief overview of the emerging topics.

https://doi.org/10.1371/journal.pone.0256474.t003

Compensation.

The topic of compensation is related to the topics of role , hiring , education and career progression , however, also sees a very high association with the words gap and inequality . Indeed, a well-known debate in degrowth economics centers around whether and how to adequately compensate women for their childbearing, childrearing, caregiver and household work [e.g., 30 ].

Even in paid work, women continue being offered lower compensations than their male counterparts who have the same job or cover the same role [ 64 – 67 ]. This severe inequality has been widely studied by scholars over the last twenty-two years. Dealing with this topic, some specific roles have been addressed. Specifically, research highlighted differences in compensation between female and male CEOs [e.g., 68 ], top executives [e.g., 69 ], and boards’ directors [e.g., 70 ]. Scholars investigated the determinants of these gaps, such as the gender composition of the board [e.g., 71 – 73 ] or women’s individual characteristics [e.g., 71 , 74 ].

Among these individual characteristics, education plays a relevant role [ 75 ]. Education is indeed presented as the solution for women, not only to achieve top executive roles, but also to reduce wage inequality [e.g., 76 , 77 ]. Past research has highlighted education influences on gender wage gaps, specifically referring to gender differences in skills [e.g., 78 ], college majors [e.g., 79 ], and college selectivity [e.g., 80 ].

Finally, the wage gap issue is strictly interrelated with hiring –e.g., looking at whether being a mother affects hiring and compensation [e.g., 65 , 81 ] or relating compensation to unemployment [e.g., 82 ]–and career progression –for instance looking at meritocracy [ 83 , 84 ] or the characteristics of the boss for whom women work [e.g., 85 ].

The roles covered by women have been deeply investigated. Scholars have focused on the role of women in their families and the society as a whole [e.g., 14 , 15 ], and, more widely, in business contexts [e.g., 18 , 81 ]. Indeed, despite still lagging behind their male counterparts [e.g., 86 , 87 ], in the last decade there has been an increase in top ranked positions achieved by women [e.g., 88 , 89 ]. Following this phenomenon, scholars have posed greater attention towards the presence of women in the board of directors [e.g., 16 , 18 , 90 , 91 ], given the increasing pressure to appoint female directors that firms, especially listed ones, have experienced. Other scholars have focused on the presence of women covering the role of CEO [e.g., 17 , 92 ] or being part of the top management team [e.g., 93 ]. Irrespectively of the level of analysis, all these studies tried to uncover the antecedents of women’s presence among top managers [e.g., 92 , 94 ] and the consequences of having a them involved in the firm’s decision-making –e.g., on performance [e.g., 19 , 95 , 96 ], risk [e.g., 97 , 98 ], and corporate social responsibility [e.g., 99 , 100 ].

Besides studying the difficulties and discriminations faced by women in getting a job [ 81 , 101 ], and, more specifically in the hiring , appointment, or career progression to these apical roles [e.g., 70 , 83 ], the majority of research of women’s roles dealt with compensation issues. Specifically, scholars highlight the pay-gap that still exists between women and men, both in general [e.g., 64 , 65 ], as well as referring to boards’ directors [e.g., 70 , 102 ], CEOs and executives [e.g., 69 , 103 , 104 ].

Finally, other scholars focused on the behavior of women when dealing with business. In this sense, particular attention has been paid to leadership and entrepreneurial behaviors. The former quite overlaps with dealing with the roles mentioned above, but also includes aspects such as leaders being stereotyped as masculine [e.g., 105 ], the need for greater exposure to female leaders to reduce biases [e.g., 106 ], or female leaders acting as queen bees [e.g., 107 ]. Regarding entrepreneurship , scholars mainly investigated women’s entrepreneurial entry [e.g., 108 , 109 ], differences between female and male entrepreneurs in the evaluations and funding received from investors [e.g., 110 , 111 ], and their performance gap [e.g., 112 , 113 ].

Education has long been recognized as key to social advancement and economic stability [ 114 ], for job progression and also a barrier to gender equality, especially in STEM-related fields. Research on education and gender equality is mostly linked with the topics of compensation , human capital , career progression , hiring , parenting and decision-making .

Education contributes to a higher human capital [ 115 ] and constitutes an investment on the part of women towards their future. In this context, literature points to the gender gap in educational attainment, and the consequences for women from a social, economic, personal and professional standpoint. Women are found to have less access to formal education and information, especially in emerging countries, which in turn may cause them to lose social and economic opportunities [e.g., 12 , 116 – 119 ]. Education in local and rural communities is also paramount to communicate the benefits of female empowerment , contributing to overall societal well-being [e.g., 120 ].

Once women access education, the image they have of the world and their place in society (i.e., habitus) affects their education performance [ 13 ] and is passed on to their children. These situations reinforce gender stereotypes, which become self-fulfilling prophecies that may negatively affect female students’ performance by lowering their confidence and heightening their anxiety [ 121 , 122 ]. Besides formal education, also the information that women are exposed to on a daily basis contributes to their human capital . Digital inequalities, for instance, stems from men spending more time online and acquiring higher digital skills than women [ 123 ].

Education is also a factor that should boost employability of candidates and thus hiring , career progression and compensation , however the relationship between these factors is not straightforward [ 115 ]. First, educational choices ( decision-making ) are influenced by variables such as self-efficacy and the presence of barriers, irrespectively of the career opportunities they offer, especially in STEM [ 124 ]. This brings additional difficulties to women’s enrollment and persistence in scientific and technical fields of study due to stereotypes and biases [ 125 , 126 ]. Moreover, access to education does not automatically translate into job opportunities for women and minority groups [ 127 , 128 ] or into female access to managerial positions [ 129 ].

Finally, parenting is reported as an antecedent of education [e.g., 130 ], with much of the literature focusing on the role of parents’ education on the opportunities afforded to children to enroll in education [ 131 – 134 ] and the role of parenting in their offspring’s perception of study fields and attitudes towards learning [ 135 – 138 ]. Parental education is also a predictor of the other related topics, namely human capital and compensation [ 139 ].

Decision-making.

This literature mainly points to the fact that women are thought to make decisions differently than men. Women have indeed different priorities, such as they care more about people’s well-being, working with people or helping others, rather than maximizing their personal (or their firm’s) gain [ 140 ]. In other words, women typically present more communal than agentic behaviors, which are instead more frequent among men [ 141 ]. These different attitude, behavior and preferences in turn affect the decisions they make [e.g., 142 ] and the decision-making of the firm in which they work [e.g., 143 ].

At the individual level, gender affects, for instance, career aspirations [e.g., 144 ] and choices [e.g., 142 , 145 ], or the decision of creating a venture [e.g., 108 , 109 , 146 ]. Moreover, in everyday life, women and men make different decisions regarding partners [e.g., 147 ], childcare [e.g., 148 ], education [e.g., 149 ], attention to the environment [e.g., 150 ] and politics [e.g., 151 ].

At the firm level, scholars highlighted, for example, how the presence of women in the board affects corporate decisions [e.g., 152 , 153 ], that female CEOs are more conservative in accounting decisions [e.g., 154 ], or that female CFOs tend to make more conservative decisions regarding the firm’s financial reporting [e.g., 155 ]. Nevertheless, firm level research also investigated decisions that, influenced by gender bias, affect women, such as those pertaining hiring [e.g., 156 , 157 ], compensation [e.g., 73 , 158 ], or the empowerment of women once appointed [ 159 ].

Career progression.

Once women have entered the workforce, the key aspect to achieve gender equality becomes career progression , including efforts toward overcoming the glass ceiling. Indeed, according to the SBS analysis, career progression is highly related to words such as work, social issues and equality. The topic with which it has the highest semantic overlap is role , followed by decision-making , hiring , education , compensation , leadership , human capital , and family .

Career progression implies an advancement in the hierarchical ladder of the firm, assigning managerial roles to women. Coherently, much of the literature has focused on identifying rationales for a greater female participation in the top management team and board of directors [e.g., 95 ] as well as the best criteria to ensure that the decision-makers promote the most valuable employees irrespectively of their individual characteristics, such as gender [e.g., 84 ]. The link between career progression , role and compensation is often provided in practice by performance appraisal exercises, frequently rooted in a culture of meritocracy that guides bonuses, salary increases and promotions. However, performance appraisals can actually mask gender-biased decisions where women are held to higher standards than their male colleagues [e.g., 83 , 84 , 95 , 160 , 161 ]. Women often have less opportunities to gain leadership experience and are less visible than their male colleagues, which constitute barriers to career advancement [e.g., 162 ]. Therefore, transparency and accountability, together with procedures that discourage discretionary choices, are paramount to achieve a fair career progression [e.g., 84 ], together with the relaxation of strict job boundaries in favor of cross-functional and self-directed tasks [e.g., 163 ].

In addition, a series of stereotypes about the type of leadership characteristics that are required for top management positions, which fit better with typical male and agentic attributes, are another key barrier to career advancement for women [e.g., 92 , 160 ].

Hiring is the entrance gateway for women into the workforce. Therefore, it is related to other workforce topics such as compensation , role , career progression , decision-making , human capital , performance , organization and education .

A first stream of literature focuses on the process leading up to candidates’ job applications, demonstrating that bias exists before positions are even opened, and it is perpetuated both by men and women through networking and gatekeeping practices [e.g., 164 , 165 ].

The hiring process itself is also subject to biases [ 166 ], for example gender-congruity bias that leads to men being preferred candidates in male-dominated sectors [e.g., 167 ], women being hired in positions with higher risk of failure [e.g., 168 ] and limited transparency and accountability afforded by written processes and procedures [e.g., 164 ] that all contribute to ascriptive inequality. In addition, providing incentives for evaluators to hire women may actually work to this end; however, this is not the case when supporting female candidates endangers higher-ranking male ones [ 169 ].

Another interesting perspective, instead, looks at top management teams’ composition and the effects on hiring practices, indicating that firms with more women in top management are less likely to lay off staff [e.g., 152 ].

Performance.

Several scholars posed their attention towards women’s performance, its consequences [e.g., 170 , 171 ] and the implications of having women in decision-making positions [e.g., 18 , 19 ].

At the individual level, research focused on differences in educational and academic performance between women and men, especially referring to the gender gap in STEM fields [e.g., 171 ]. The presence of stereotype threats–that is the expectation that the members of a social group (e.g., women) “must deal with the possibility of being judged or treated stereotypically, or of doing something that would confirm the stereotype” [ 172 ]–affects women’s interested in STEM [e.g., 173 ], as well as their cognitive ability tests, penalizing them [e.g., 174 ]. A stronger gender identification enhances this gap [e.g., 175 ], whereas mentoring and role models can be used as solutions to this problem [e.g., 121 ]. Despite the negative effect of stereotype threats on girls’ performance [ 176 ], female and male students perform equally in mathematics and related subjects [e.g., 177 ]. Moreover, while individuals’ performance at school and university generally affects their achievements and the field in which they end up working, evidence reveals that performance in math or other scientific subjects does not explain why fewer women enter STEM working fields; rather this gap depends on other aspects, such as culture, past working experiences, or self-efficacy [e.g., 170 ]. Finally, scholars have highlighted the penalization that women face for their positive performance, for instance when they succeed in traditionally male areas [e.g., 178 ]. This penalization is explained by the violation of gender-stereotypic prescriptions [e.g., 179 , 180 ], that is having women well performing in agentic areas, which are typical associated to men. Performance penalization can thus be overcome by clearly conveying communal characteristics and behaviors [ 178 ].

Evidence has been provided on how the involvement of women in boards of directors and decision-making positions affects firms’ performance. Nevertheless, results are mixed, with some studies showing positive effects on financial [ 19 , 181 , 182 ] and corporate social performance [ 99 , 182 , 183 ]. Other studies maintain a negative association [e.g., 18 ], and other again mixed [e.g., 184 ] or non-significant association [e.g., 185 ]. Also with respect to the presence of a female CEO, mixed results emerged so far, with some researches demonstrating a positive effect on firm’s performance [e.g., 96 , 186 ], while other obtaining only a limited evidence of this relationship [e.g., 103 ] or a negative one [e.g., 187 ].

Finally, some studies have investigated whether and how women’s performance affects their hiring [e.g., 101 ] and career progression [e.g., 83 , 160 ]. For instance, academic performance leads to different returns in hiring for women and men. Specifically, high-achieving men are called back significantly more often than high-achieving women, which are penalized when they have a major in mathematics; this result depends on employers’ gendered standards for applicants [e.g., 101 ]. Once appointed, performance ratings are more strongly related to promotions for women than men, and promoted women typically show higher past performance ratings than those of promoted men. This suggesting that women are subject to stricter standards for promotion [e.g., 160 ].

Behavioral aspects related to gender follow two main streams of literature. The first examines female personality and behavior in the workplace, and their alignment with cultural expectations or stereotypes [e.g., 188 ] as well as their impacts on equality. There is a common bias that depicts women as less agentic than males. Certain characteristics, such as those more congruent with male behaviors–e.g., self-promotion [e.g., 189 ], negotiation skills [e.g., 190 ] and general agentic behavior [e.g., 191 ]–, are less accepted in women. However, characteristics such as individualism in women have been found to promote greater gender equality in society [ 192 ]. In addition, behaviors such as display of emotions [e.g., 193 ], which are stereotypically female, work against women’s acceptance in the workplace, requiring women to carefully moderate their behavior to avoid exclusion. A counter-intuitive result is that women and minorities, which are more marginalized in the workplace, tend to be better problem-solvers in innovation competitions due to their different knowledge bases [ 194 ].

The other side of the coin is examined in a parallel literature stream on behavior towards women in the workplace. As a result of biases, prejudices and stereotypes, women may experience adverse behavior from their colleagues, such as incivility and harassment, which undermine their well-being [e.g., 195 , 196 ]. Biases that go beyond gender, such as for overweight people, are also more strongly applied to women [ 197 ].

Organization.

The role of women and gender bias in organizations has been studied from different perspectives, which mirror those presented in detail in the following sections. Specifically, most research highlighted the stereotypical view of leaders [e.g., 105 ] and the roles played by women within firms, for instance referring to presence in the board of directors [e.g., 18 , 90 , 91 ], appointment as CEOs [e.g., 16 ], or top executives [e.g., 93 ].

Scholars have investigated antecedents and consequences of the presence of women in these apical roles. On the one side they looked at hiring and career progression [e.g., 83 , 92 , 160 , 168 , 198 ], finding women typically disadvantaged with respect to their male counterparts. On the other side, they studied women’s leadership styles and influence on the firm’s decision-making [e.g., 152 , 154 , 155 , 199 ], with implications for performance [e.g., 18 , 19 , 96 ].

Human capital.

Human capital is a transverse topic that touches upon many different aspects of female gender equality. As such, it has the most associations with other topics, starting with education as mentioned above, with career-related topics such as role , decision-making , hiring , career progression , performance , compensation , leadership and organization . Another topic with which there is a close connection is behavior . In general, human capital is approached both from the education standpoint but also from the perspective of social capital.

The behavioral aspect in human capital comprises research related to gender differences for example in cultural and religious beliefs that influence women’s attitudes and perceptions towards STEM subjects [ 142 , 200 – 202 ], towards employment [ 203 ] or towards environmental issues [ 150 , 204 ]. These cultural differences also emerge in the context of globalization which may accelerate gender equality in the workforce [ 205 , 206 ]. Gender differences also appear in behaviors such as motivation [ 207 ], and in negotiation [ 190 ], and have repercussions on women’s decision-making related to their careers. The so-called gender equality paradox sees women in countries with lower gender equality more likely to pursue studies and careers in STEM fields, whereas the gap in STEM enrollment widens as countries achieve greater equality in society [ 171 ].

Career progression is modeled by literature as a choice-process where personal preferences, culture and decision-making affect the chosen path and the outcomes. Some literature highlights how women tend to self-select into different professions than men, often due to stereotypes rather than actual ability to perform in these professions [ 142 , 144 ]. These stereotypes also affect the perceptions of female performance or the amount of human capital required to equal male performance [ 110 , 193 , 208 ], particularly for mothers [ 81 ]. It is therefore often assumed that women are better suited to less visible and less leadership -oriented roles [ 209 ]. Women also express differing preferences towards work-family balance, which affect whether and how they pursue human capital gains [ 210 ], and ultimately their career progression and salary .

On the other hand, men are often unaware of gendered processes and behaviors that they carry forward in their interactions and decision-making [ 211 , 212 ]. Therefore, initiatives aimed at increasing managers’ human capital –by raising awareness of gender disparities in their organizations and engaging them in diversity promotion–are essential steps to counter gender bias and segregation [ 213 ].

Emerging topics: Leadership and entrepreneurship

Among the emerging topics, the most pervasive one is women reaching leadership positions in the workforce and in society. This is still a rare occurrence for two main types of factors, on the one hand, bias and discrimination make it harder for women to access leadership positions [e.g., 214 – 216 ], on the other hand, the competitive nature and high pressure associated with leadership positions, coupled with the lack of women currently represented, reduce women’s desire to achieve them [e.g., 209 , 217 ]. Women are more effective leaders when they have access to education, resources and a diverse environment with representation [e.g., 218 , 219 ].

One sector where there is potential for women to carve out a leadership role is entrepreneurship . Although at the start of the millennium the discourse on entrepreneurship was found to be “discriminatory, gender-biased, ethnocentrically determined and ideologically controlled” [ 220 ], an increasing body of literature is studying how to stimulate female entrepreneurship as an alternative pathway to wealth, leadership and empowerment [e.g., 221 ]. Many barriers exist for women to access entrepreneurship, including the institutional and legal environment, social and cultural factors, access to knowledge and resources, and individual behavior [e.g., 222 , 223 ]. Education has been found to raise women’s entrepreneurial intentions [e.g., 224 ], although this effect is smaller than for men [e.g., 109 ]. In addition, increasing self-efficacy and risk-taking behavior constitute important success factors [e.g., 225 ].

Finally, the topic of sustainability is worth mentioning, as it is the primary objective of the SDGs and is closely associated with societal well-being. As society grapples with the effects of climate change and increasing depletion of natural resources, a narrative has emerged on women and their greater link to the environment [ 226 ]. Studies in developed countries have found some support for women leaders’ attention to sustainability issues in firms [e.g., 227 – 229 ], and smaller resource consumption by women [ 230 ]. At the same time, women will likely be more affected by the consequences of climate change [e.g., 230 ] but often lack the decision-making power to influence local decision-making on resource management and environmental policies [e.g., 231 ].

Research gaps and conclusions

Research on gender equality has advanced rapidly in the past decades, with a steady increase in publications, both in mainstream topics related to women in education and the workforce, and in emerging topics. Through a novel approach combining methods of text mining and social network analysis, we examined a comprehensive body of literature comprising 15,465 papers published between 2000 and mid 2021 on topics related to gender equality. We identified a set of 27 topics addressed by the literature and examined their connections.

At the highest level of abstraction, it is worth noting that papers abound on the identification of issues related to gender inequalities and imbalances in the workforce and in society. Literature has thoroughly examined the (unconscious) biases, barriers, stereotypes, and discriminatory behaviors that women are facing as a result of their gender. Instead, there are much fewer papers that discuss or demonstrate effective solutions to overcome gender bias [e.g., 121 , 143 , 145 , 163 , 194 , 213 , 232 ]. This is partly due to the relative ease in studying the status quo, as opposed to studying changes in the status quo. However, we observed a shift in the more recent years towards solution seeking in this domain, which we strongly encourage future researchers to focus on. In the future, we may focus on collecting and mapping pro-active contributions to gender studies, using additional Natural Language Processing techniques, able to measure the sentiment of scientific papers [ 43 ].

All of the mainstream topics identified in our literature review are closely related, and there is a wealth of insights looking at the intersection between issues such as education and career progression or human capital and role . However, emerging topics are worthy of being furtherly explored. It would be interesting to see more work on the topic of female entrepreneurship , exploring aspects such as education , personality , governance , management and leadership . For instance, how can education support female entrepreneurship? How can self-efficacy and risk-taking behaviors be taught or enhanced? What are the differences in managerial and governance styles of female entrepreneurs? Which personality traits are associated with successful entrepreneurs? Which traits are preferred by venture capitalists and funding bodies?

The emerging topic of sustainability also deserves further attention, as our society struggles with climate change and its consequences. It would be interesting to see more research on the intersection between sustainability and entrepreneurship , looking at how female entrepreneurs are tackling sustainability issues, examining both their business models and their company governance . In addition, scholars are suggested to dig deeper into the relationship between family values and behaviors.

Moreover, it would be relevant to understand how women’s networks (social capital), or the composition and structure of social networks involving both women and men, enable them to increase their remuneration and reach top corporate positions, participate in key decision-making bodies, and have a voice in communities. Furthermore, the achievement of gender equality might significantly change firm networks and ecosystems, with important implications for their performance and survival.

Similarly, research at the nexus of (corporate) governance , career progression , compensation and female empowerment could yield useful insights–for example discussing how enterprises, institutions and countries are managed and the impact for women and other minorities. Are there specific governance structures that favor diversity and inclusion?

Lastly, we foresee an emerging stream of research pertaining how the spread of the COVID-19 pandemic challenged women, especially in the workforce, by making gender biases more evident.

For our analysis, we considered a set of 15,465 articles downloaded from the Scopus database (which is the largest abstract and citation database of peer-reviewed literature). As we were interested in reviewing business and economics related gender studies, we only considered those papers published in journals listed in the Academic Journal Guide (AJG) 2018 ranking of the Chartered Association of Business Schools (CABS). All the journals listed in this ranking are also indexed by Scopus. Therefore, looking at a single database (i.e., Scopus) should not be considered a limitation of our study. However, future research could consider different databases and inclusion criteria.

With our literature review, we offer researchers a comprehensive map of major gender-related research trends over the past twenty-two years. This can serve as a lens to look to the future, contributing to the achievement of SDG5. Researchers may use our study as a starting point to identify key themes addressed in the literature. In addition, our methodological approach–based on the use of the Semantic Brand Score and its webapp–could support scholars interested in reviewing other areas of research.

Supporting information

S1 text. keywords used for paper selection..

https://doi.org/10.1371/journal.pone.0256474.s001

Acknowledgments

The computing resources and the related technical support used for this work have been provided by CRESCO/ENEAGRID High Performance Computing infrastructure and its staff. CRESCO/ENEAGRID High Performance Computing infrastructure is funded by ENEA, the Italian National Agency for New Technologies, Energy and Sustainable Economic Development and by Italian and European research programmes (see http://www.cresco.enea.it/english for information).

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• v.1(3); 2016

Women's health: a new global agenda

Sanne a e peters.

1 The George Institute for Global Health, University of Oxford, Oxford, UK

Mark Woodward

2 The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia

3 Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA

Vivekanand Jha

4 The George Institute for Global Health, New Delhi, India

Stephen Kennedy

5 Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK

Robyn Norton

Associated data.

bmjgh-2016-000080supp_appendix.pdf

Global efforts to improve the health of women largely focus on improving sexual and reproductive health. However, the global burden of disease has changed significantly over the past decades. Currently, the greatest burden of death and disability among women is attributable to non-communicable diseases (NCDs), most notably cardiovascular diseases, cancers, respiratory diseases, diabetes, dementia, depression and musculoskeletal disorders. Hence, to improve the health of women most efficiently, adequate resources need to be allocated to the prevention, management and treatment of NCDs in women. Such an approach could reduce the burden of NCDs among women and also has the potential to improve women's sexual and reproductive health, which commonly shares similar behavioural, biological, social and cultural risk factors. Historically, most medical research was conducted in men and the findings from such studies were assumed to be equally applicable to women. Sex differences and gender disparities in health and disease have therefore long been unknown and/or ignored. Since the number of women in studies is increasing, evidence for clinically meaningful differences between men and women across all areas of health and disease has emerged. Systematic evaluation of such differences between men and women could improve the understanding of diseases, as well as inform health practitioners and policymakers in optimising preventive strategies to reduce the global burden of disease more efficiently in women and men.

Key messages

• Increase awareness, promote research, and implement policies and interventions to prevent, treat and optimise outcomes for NCDs among women;
• Promote a life-course approach to addressing sexual and reproductive health issues, recognising that such an approach has the potential to lead to reductions in sexual and reproductive health conditions and NCDs.
• Appropriate numbers of women should be included in scientific studies;
• A systematic approach to the sex-disaggregated collection, analyses and dissemination of healthcare data is needed, as well as sex-disaggregated implementation of results.
• The sex-specific impact of biological, behavioural, social, cultural and economic factors in risk and outcomes for NCDs needs to be further examined;
• Pathways and quality of healthcare for women for the prevention and treatment of NCDs need to be addressed; whether these pathways differ for men and women needs to be examined; and strategies to ensure that women (and men) receive the best available healthcare need to be developed, evaluated and implemented.

Introduction

The global burden of disease among women has changed significantly over the past decades. Non-communicable diseases (NCDs) are now the leading causes of death and disability for women in almost all countries of the world. Nearly 80% of NCDs occur in low-income and middle-income countries (LMICs), and it is particularly in these parts of the world where NCDs are rapidly replacing infectious diseases, maternal and child conditions, and nutritional deficiencies as the leading causes of death and disability.

Despite their obvious and growing significance, NCDs continue to be sidelined as a major concern to the health of women globally. Instead, global efforts to improve the health of women have largely focused on improving women's sexual and reproductive health. Partly owing to these efforts, particularly after the introduction of the Millennium Development Goals (MDGs) in 2000 and subsequent actions, the number of maternal deaths has dropped by 44% from 385 in 1990 to 216 per 100 000 live births in 2015. 1 While the women's sexual and reproductive health agenda remains unfinished and sustained effort and commitment are needed, more women now die annually from NCDs than from any other cause ( figure 1 ). In 2012, an estimated 18.1 million women died from NCDs, of which ∼8.8 million were due to cardiovascular disease (CVD), 3.5 million to cancers and 1.8 million to respiratory diseases ( figure 2 ). 2 The global agenda for women's health must, therefore, encompass women's sexual and reproductive health, as well as the leading causes of death and disability for women, especially NCDs.

Deaths from non-communicable diseases, communicable diseases and injuries among women in 2012, by the World Bank income category and the WHO region. Data were obtained from the Global Health Estimates 2014 Summary Tables. 2 List of World Bank income categories and WHO regions: high-income countries : Andorra, Antigua and Barbuda, Australia, Austria, Bahamas, Bahrain, Barbados, Belgium, Brunei Darussalam, Canada, Chile, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, Equatorial Guinea, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Latvia, Lithuania, Luxembourg, Malta, Monaco, the Netherlands, New Zealand, Norway, Oman, Poland, Portugal, Qatar, Russian Federation, Saint Kitts and Nevis, San Marino, Saudi Arabia, Singapore, Slovakia, Slovenia, South Korea, Spain, Sweden, Switzerland, Trinidad and Tobago, the United Arab Emirates, the UK, the USA , Uruguay; African region : Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cabo Verde, Cameroon, Central African Republic, Chad, Comoros, Congo, Côte d'Ivoire, Democratic Republic of the Congo, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, South Africa, Swaziland, Tanzania, Togo, Uganda, Zambia, Zimbabwe; region of the Americas : Argentina, Belize, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Venezuela; South-East Asia region : Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, North Korea, Sri Lanka, Thailand, Timor-Leste; European region : Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Georgia, Hungary, Kazakhstan, Kyrgyzstan, Montenegro, Moldova, Romania, Serbia, Tajikistan, Macedonia, Turkey, Turkmenistan, Ukraine, Uzbekistan; Eastern Mediterranean region : Afghanistan, Djibouti, Egypt, Iran, Iraq, Jordan, Lebanon, Libya, Morocco, Pakistan, Somalia, South Sudan, Sudan, Syria, Tunisia, Yemen; Western Pacific region : Cambodia, China, Cook Islands, Fiji, Kiribati, Lao, Malaysia, Marshall Islands, Micronesia, Mongolia, Nauru, Niue, Palau, Papua New Guinea, Philippines, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu, Viet Nam.

Deaths from non-communicable diseases among women in 2012, by cause, World Bank income category, and WHO region. Data were obtained from the Global Health Estimates 2014 Summary Tables 2 World Bank income category and WHO regions as in figure 1 .

Despite the importance of NCDs to women's health, medical research on NCDs has generally only involved men. This has occurred in part because of the widely held assumption that the occurrence and outcomes of NCDs, as well as the efficacy of preventative measures, are the same for men and women, and that the findings of studies into disease processes involving only men apply equally to women. There is an increasing notion that this is not the case and our knowledge about disease occurrence and disease outcomes—for men and women—can be improved by undertaking analyses of health data disaggregated by sex and informed by a gender perspective, as well as by including sufficient numbers of women in scientific studies. Hence, to optimise the health of women globally, the women's health agenda must have a broader definition and prioritise a sex-specific and gender-specific approach to the collection and usage of health data.

The recently launched policy paper, ‘Women's Health: A New Global Agenda’, 3 addresses the above issues, describes current practice and policy and calls for a redefinition and broadening of the women's health agenda so as to prioritise NCDs and ensure systematic sex-specific and gender-specific approaches to the collection, analyses and reporting of health data. A full-text version of the paper can be accessed in the online supplementary appendix . Box 1 describes the commonly used distinction between the terms sex and gender. Here, we provide a summary of the paper's main findings and recommendations.

Sex versus gender

Sex refers to the true biological and physiological differences between men and women, including differences in hormonal profiles and sex organs, which result from a single chromosomal difference between men (XY) and women (XX). Gender refers to the socially constructed roles, behaviours, activities and attributes that are considered appropriate for men and women, that is, the roles that a given society, or individual, considers as masculine and feminine. Aspects of sex are genetically determined and will not vary substantially between different societies. In contrast, aspects of gender may vary greatly by ethnicity, culture and socioeconomic environment. Sex-specific and gender-specific research addresses how experiences of the same disease vary with respect to biological sex and gender.

Supplementary appendix

Redefining women's health.

Current approaches to improving the health of women do not address those health conditions that are responsible for the greatest burden of ill health, namely NCDs. It also does not fully address the importance of certain reproductive health factors—such as gestational diabetes and pregnancy-induced hypertension—for the health of women in later life. This limits the opportunities to improve the health of the maximum number of women in the most effective ways possible. Moreover, a women's health agenda that focuses almost exclusively on women of childbearing age is discriminatory as it excludes those women who do not have children (either voluntarily or involuntarily) and women who are no longer of reproductive age. A broadened definition of women's health that incorporates a greater focus on NCDs—as well as a life-course approach to sexual and reproductive health (SRH) and NCDs—has the potential to lead to greater health benefits for women—and in effect the health of their communities—globally.

Leading causes of death and disability among women

NCDs are the leading causes of death and disability worldwide and their contribution to the global burden of disease is growing rapidly. In 2013, 7 out of 10 leading causes of death among women were NCDs, compared with 4 out of 10 leading causes of death in 1990. Since 1990, maternal and infant deaths have decreased sharply and neither is ranked in the top 10 causes of death globally. Instead, ischaemic heart disease (IHD) and stroke were the number 1 and 2 leading causes of death for women, followed by chronic obstructive pulmonary disease (COPD), Alzheimer's disease, diabetes, hypertensive heart disease and lung cancer. 4 Lower respiratory infections, diarrhoeal diseases and HIV/AIDS were the communicable diseases that completed the top 10 and were ranked at places 3, 7 and 8, respectively. Even in LMIC in Africa, NCDs account for an increasing burden of death among women. While infectious diseases, maternal and child conditions, and malnutrition remain a leading cause, NCDs caused a third of all deaths in 2012, compared with a quarter of all deaths in 2000 ( figure 1 ). 2 Similarly, five of the leading causes of disability-adjusted life years for women across the world in 2013 were NCDs, namely IHD, low back and neck pain, stroke, major depressive disorder, and COPD. Complications arising from preterm birth continue to be included in the top 10 leading causes of disability, ranked at the ninth position. 4 Lower respiratory infections, diarrhoeal diseases, HIV/AIDS and malaria completed the list of the top 10 leading causes of disability and were ranked at the third, sixth, seventh and eighth positions, respectively.

Current policies and practices

The United Nation's (UN) MDGs formed a blueprint agreed to by all the world's countries and major development institutions to improve international development and meet the need of the poorest. Improving maternal health is the fifth MDG and targeted to reduce maternal mortality by 75% from 1990 to 2015, primarily by improving access to reproductive health. 1

Progress in reducing the number of maternal deaths was initially limited in many countries. Therefore, the UN Secretary-General, Ban Ki-moon, launched the Global Strategy for Women's and Children's Health in 2010. The Global Strategy called for intensified international and national action to address the major health challenges facing women and children. 5 It led to the establishment of the Every Woman Every Child movement, which presents a roadmap on ending all preventable deaths among women and children and adolescents. 6 It also led to the establishment of the Global Financing Facility, the key financing platform of the Every Woman Every Child movement. 7

In September 2015, the updated Global Strategy for Women's, Children's and Adolescents' Health (2016–2030) was launched by the UN Secretary-General, in partnership with the WHO. 8 The Strategy comprises new and refreshed efforts to improve the health and end all preventable deaths of women, children and adolescents by 2030. In line with the Sustainable Development Goals (SDGs), a commitment was made to a one-third reduction in premature mortality from NCDs. 9 Concurrent with the release of the updated Global Strategy, the UN General Assembly hosted the ‘Global Leaders’ Meeting on ‘Gender Equality and Women's Empowerment: A Commitment to Action’. At this meeting, financial commitments totalling US$25 billion were made and substantial political support was expressed. 10 However, women's sexual and reproductive health remained a common theme of the meeting, with the occasional reference to violence against women and female genital mutilation. A full appreciation of women's health, in its broader sense, was lacking.

In contrast, the WHO has expressed support to the Global Strategy. However, the WHO also highlights the changing nature of the health problems facing women, especially in LMICs. It therefore emphasises the need to move the women's health agenda beyond a primary focus on reproductive health issues and to take a life-course approach to women's health. 11 In particular, the WHO stresses the inter-relationships between maternal health problems, such as gestational diabetes and pregnancy-induced hypertension, and the risk of NCDs in later life and emphasises the potential value of integrating maternal health services with those that identify and manage women at high risk of NCDs. In 2015, the report by the Lancet Commission on Women and Health's, ‘Women and Health: the key for sustainable development’ echoed many of the calls by the WHO. The Lancet Commission highlighted that the global response to NCDs was not proportionate to their burden among women and stressed the need for concerted efforts to integrate maternal and child health services with those that identify and manage women at high risk of NCDs in later life. 12

SDG 3 sets several targets for ‘ensuring healthy lives and promoting the well-being for all at all ages’, including further reductions in maternal mortality and a one-third reduction in premature mortality from NCDs by 2030. 9 SDG 5 sets targets for ‘achieving gender equality and empower all women and girls’. Gender equality and women's empowerment have the potential to improve women's health through better access to healthcare and reduced risks imposed by traditional social roles and constructs, such as greater exposure to smoke from biomass fuels used for cooking. Hence, while awareness about the significance of NCDs and strategies to reduce them are growing and are already high in high-income countries (HICs), sex-specific elements of risk awareness, access and quality of care are not well recognised and should be on global public health agendas, particularly in LMICs.

Sex-specific and gender-specific health research

Sex differences and gender disparities in the occurrence, management and outcomes of chronic health conditions have long been under-recognised. Health research in CVD, for instance, was once predominantly conducted in men and it was assumed that medical practices based on research findings involving men only were equally relevant for women. 13 This approach limits the generalisability of research findings and their applicability to clinical practice, in particular for women but also for men. A growing body of evidence from studies including both men and women suggests that such research is prejudiced, as well as potentially harmful for women. For example, between 1997 and 2000, 8 of 10 drugs withdrawn from the US market because of side effects were withdrawn because of greater health risks for women than for men. 14 Moreover, research on cardiovascular conditions increasingly demonstrates that there are clinically meaningful sex differences and gender disparities in the occurrence, management and outcomes of CVD. 15 16 In what follows, we highlight some recent findings relevant to sex differences in the area of CVDs. Most of these findings come from studies in HICs. The evidence from LMICs and for other NCDs, including for some cancers, osteoporosis and other conditions that are generally more common in women than in men, is much scarcer.

Sex differences in CVD

CVD is still widely considered as a male disease, an assumption that stems largely from observations that CVD in women develops later in life than in men, and the historical misperception that CVD among women may not be as serious as it is in men. This is despite the fact that CVD causes more deaths in women than any other disease in almost all countries in the world. Awareness of the importance of CVD in women has increased substantially in HICs. However, there remains a substantial gap between the perceived and actual risk of CVD in women, and few women see it as a threat to their health. 17

Recent evidence has demonstrated that are clinically relevant differences between men and women in the occurrence of the various manifestations of CVD. 18 19 Men tend to develop CVD at a younger age and, as such, have higher rates of IHD than women. In contrast, women are at a higher risk of having a stroke, which occurs more often at an older age. Healthcare services for the management of established CVD are also delivered differently between sexes. This is despite evidence that, generally speaking, preventative therapies are equally effective in women as in men. For example, women are less likely to receive pharmacological treatment for CVD risk factors than men and are also less likely to be referred for diagnostic and therapeutic procedures. 20–22 Suboptimal access to healthcare services could delay the diagnosis and treatment of CVD and may lead to worse prognosis and outcomes for women with CVD.

In addition to differences in the secondary prevention of CVD, there is now convincing evidence that the effects of some risk factors, such as smoking and diabetes, on the risk of CVD are disproportionally stronger in women than in men ( figure 3 ). 23–25 In contrast, the impact of excess weight, high blood pressure and elevated lipid levels on CVD outcomes appears to be similar between sexes. The mechanisms underpinning the differences in the relationship between smoking and diabetes and CVD outcomes are not fully understood. However, it is most likely that sex-specific biological factors, such as hormones and differences in body shape, as well as behavioural, social and cultural factors related to risk behaviours and gender disparities in access and usage of health services are involved.

Ratio of relative risks of heart disease and stroke associated with higher blood pressure, smoking, type I and II diabetes, and higher cholesterol in women compared with men. Women-to-men ratio of relative risks (RRs) of heart disease and stroke for (1) those with a 10 mm Hg higher value of systolic blood pressure; (2) smoking compared with not; (3) type I diabetes compared with not; (4) type II diabetes compared with not; (5) those with a 1 mmol/L higher value of total cholesterol. Ninety-five per cent CIs are shown as horizontal lines around the estimates on the graph.

Recently, marked progress has been made in the involvement of women in large-scale population studies and clinical trials and the conduct and report of sex-specific analyses. Moreover, the American Heart Association has been at the forefront of the development of clinical guidelines specific to the cardiovascular health of women. 17 26 However, several gaps in our understanding of sex differences or gender disparities in health outcomes remain. Systematic examination of sex differences and/or gender disparities in the presentation and outcomes of diseases, and understanding of their underlying mechanisms, are therefore needed. Such research makes optimal use of the data as they are available and have the potential to contribute significantly to the development and implementation of evidence-based efforts to improving the health of women (and men) worldwide.

Current policies and practices to sex-disaggregated health research

The Fourth World Conference on Women in 1995 was a major step forward in the promotion of sex-disaggregated health research. At this meeting, the Beijing Declaration and Platform of Action was developed, a progressive blueprint for advancing women's rights, gender equality and the empowerment of all women. 27 As a defining framework for change, the Platform for Action made comprehensive commitments under 12 critical areas of concern for women and girls. In the domain of health, the Platform for Action underscored the need to systematically collect and analyse health data by sex. Many governments, UN agencies and non-governmental organisations have subsequently committed to gender mainstreaming, that is, the evaluation of how any planned policy action might have different implications for women and men, as a strategy towards achieving gender equality.

The Roadmap for Action, 2014–2019, produced and endorsed by the WHO, also sets to ensure the integration of equity, human rights, gender and social determinants across all WHO programmes and in all Member States. 28 The promotion of sex-disaggregated data analysis and health inequality monitoring is one of the three key directions of this report.

Gender-sensitive and sex-disaggregated data are also essential to the attainment of all SDGs, as described in detail in the role of gender-based innovations for the UN SDG. 29 Also, in the advice paper ‘Gendered Research and Innovation’, the League of European Research Universities (LERU) builds the case for integrating sex and gender analysis into the research process. It provides illustrative case studies of how a gender-specific approach to science has led to new insights and knowledge. 30 The paper encourages members of LERU and other universities to engage with governments, funding agencies and peer-reviewed journals to highlight the importance of gender-based research and innovation, so as to ensure that sufficient funds and efforts are being allocated.

Similarly, policies have been developed in the Europe and North America to incorporate sex and gender systematically into the conduct of research. Major science funding bodies, such as Horizon 2020 in the European Union (EU), now request that researchers explicitly identify how sex-specific and gender-specific issues will inform and influence their research and, where relevant, show that their studies have been designed to facilitate such analyses. Several medical journals, including The Lancet , have developed policies requiring that women are routinely included in clinical trials and that authors report sex-specific analyses in their publications. Moreover, a global group of academics and practitioners recently published a report in which they argued for gender-sensitive research impact assessment as a means to improve gender equity in science policy and practice. 31

However, there is still some way to go to ensure that these recommendations are implemented. The 2009 European Commission report on Access to Healthcare and Long-Term Care concluded that little is known about gender disparities in access to, and usage of, healthcare services in the EU, 32 or the impact of these differences on service delivery. Additionally, the report stated that sex-based and gender-based health research is needed to increase knowledge about the complex ways in which biological, social, cultural and environmental factors interact to affect the health of women and men. A recent US publication showed that the majority of applications for high-risk cardiovascular devices to the US Food and Drug Administration (FDA) were lacking sex-specific data and that women were still under-represented in clinical trials. 33 The 2016 Sex and Gender Equity in Research (SAGER) guidelines are the next step forward in the need for a more systematic approach to sex-disaggregated health research. The guidelines provide comprehensive guidance to authors and journal editors in integrating assessment of sex and gender into all in study design, data analyses, results and interpretation of findings across disciplines. 34 Sustained and universal commitment is clearly needed to translate policy into practice.

The global agenda for women's health needs to be broadened and redefined and a sex-disaggregated approach to health research and policy is required. While NCDs are the leading causes of death and disability among women globally, they remain insufficiently addressed in global strategies to improve the health of women. Adequate resources and concerted efforts at local, national and international levels are required to improve NCD outcomes among women throughout the life course. Moreover, to design, evaluate and deliver the best healthcare interventions and policies for the prevention and treatment of diseases, sex differences need to be routinely considered across all areas of health and medicine. A life-course approach to NCDs, together with the sex-disaggregated collection and use of healthcare data, informed by a gender perspective, has the potential to make important contributions to the health of women (and men) globally.

Handling editor: Seye Abimbola

Twitter: Follow Vivekanand Jha at @vjha126

Contributors: SAEP and RN drafted the manuscript. MW, VJ and SK revised the manuscript and provided critical input.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data sharing statement: No additional data are available.

The independent source for health policy research, polling, and news.

Health Policy Issues in Women’s Health

Published: May 28, 2024

KFF Authors:

Ivette Gomez

Laurie Sobel

Alina Salganicoff

Usha Ranji , Karen Diep , Ivette Gomez , Laurie Sobel and Alina Salganicoff

Table of Contents

Introduction.

Health care is a central element of women’s lives, shaping their ability to care for themselves and their families, to be productive members of their communities, to contribute to the workforce, and to build a base of economic security. Women’s reproductive health care needs, their central roles managing family health as parents and as family caregivers, and their longer lifespans, albeit with greater rates of chronic health problems and functional limitations than men, all shape their relationships with the health care system. While women are major consumers of health care services and play a central role as health navigators and caregivers for their families, structural factors can challenge their ability to get the health care they need. Factors, including national and state policies that shape the health care delivery system to research priorities and discriminatory economic and societal forces, can deprioritize women’s health concerns. Access challenges are greater for women who are in low-income households, who face structural and societal racism and discrimination, who struggle with complex or understudied medical conditions, or who live in states or communities that have enacted or invested in policies and programs that do not support their health needs.

In the United States, the women’s health movement gained significant traction in the 1960s and 1970s as part of a larger grassroots women’s rights movement that challenged long-standing inequities and discrimination that limited women’s economic and social opportunities. The book, “ Our Bodies, Ourselves ,” brought a wide range of women’s health concerns, ranging from abortion and sexuality to menopause and cancer, into the mainstream. Over time, federal action also began to address many of the long-standing discriminatory sex and gender-based policies that were baked into our employment, health, and research policies. The 1973 U.S. Supreme Court ruling in Roe v. Wade decriminalized and protected the right to abortion care for nearly 50 years; the Pregnancy Discrimination Act of 1978 offered workplace and insurance protections to pregnant workers; the National Institutes of Health (NIH) Revitalization Act of 1993 mandated the inclusion of women in clinical research and formally established the NIH Office of Women’s Health; and in 2010, the Affordable Care Act (ACA) banned many of the discriminatory practices that had shaped women’s coverage of and access to care.

This primer focuses on some of the key areas disproportionately affecting women today that are shaped by national and state health policies. This includes health coverage and costs, reproductive health services, maternal health, mental health, and intimate partner violence. In addition, it highlights some of the structural factors and inequities that still impact women’s health, particularly women of color and gender-expansive individuals such as those who are transgender or non-binary or otherwise gender fluid or non-conforming who are at risk of being marginalized or discriminated against by their health coverage or providers. We note that while we refer to “women” and “women’s health” throughout this chapter, some persons assigned female sex at birth do not identify as women, such as transgender men, non-binary individuals, and otherwise gender-expansive individuals. Still, many of the issues discussed in this chapter also apply to them.

What Is the Demographic Profile of Women?

More than 128 million adult women over the age of 19 live in the U.S. today, with great diversity in many demographic characteristics. A third of adult women are between the ages of 35-54 (33%) and the majority are White (60%) (Figure 1). Nearly 1 in 5 (17%) women are Hispanic, 12% are Black and 6% are Asian.

Almost two-thirds (65%) of women live in a household with at least one full-time worker, while 1 in 10 (9%) live in a household with only part-time workers, and 25% of women live in households with no workers (data not shown). Given the important role of employment in shaping health coverage, workforce participation is a significant determinant of the type of health insurance that working women or women who live in households with full-time workers can obtain.

While most women in the U.S. report having good health, nearly 1 in 5 ( 18% ) women 18 and older rate their health as “fair” or “poor” and 14% report having a disability such as difficulty with vision, hearing, or walking. As women age, they are more likely to experience chronic health problems and declines in health status. These factors are highly predictive of their need for and use of health care services.

Income also plays a major role in health coverage and access to care. Income affects the resources that women have to pay for out-of-pocket health care costs and contribute to premium costs. Income also determines women’s eligibility for programs such as Medicaid or subsidies to secure coverage through the ACA Marketplace. Three in 10 (29%) adult women are part of households with low incomes (family income below 200% of the FPL was $47,112 for a family of three in 2022). Almost 4 in 10 (35%) women have completed a bachelor’s degree or higher, almost a third (27%) have a child under the age of 19 living at home, and 93% are U.S. citizens. Nearly 4 in 10 women live in the South (39%), almost a quarter (24%) live in the West, a fifth (20%) live in the Midwest, and 18% live in the Northeast (Figure 2).

What Are the Sources of Health Insurance Coverage for Women?

While most adult women have some form of either private or public health insurance, the coverage profile for those who are under and over age 65 differs considerably. For those who are under age 65 , employer-sponsored coverage, individually purchased policies, and Medicaid—the state-federal program for people with low incomes—comprise the majority of coverage options. However, nearly 1 in 10 women in that age group are currently uninsured. Among women 65 years and older, the Medicare program plays a critical role covering nearly all seniors in the U.S., though often with considerable coverage gaps (such as hearing, vision and long-term services and supports) and cost-sharing burdens.

Employer-Sponsored Insurance

Approximately 58.3 million women aged 19-64 (60%) received their health coverage from employer-sponsored insurance in 2022 (Figure 3). Women in families with at least one full-time worker are more likely to have job-based coverage (70%) than women in families with only part-time workers (33%) or without any workers (17%).

Employer-sponsored insurance can come with substantial out-of-pocket costs based on premiums, deductibles, co-insurance, and co-payment levels. In 2022, annual insurance premiums for employer-sponsored insurance averaged $7,911 for individuals and $22,463 for families. On average, workers paid 17% of premiums for individual coverage and 28% for family coverage with the employers picking up the balance.

Non-Group Insurance

In 2022, about 9% of women ages 19 to 64 (approximately 8.3 million women) and 8% of their male counterparts purchased insurance in the non-group market. This includes individuals who purchased private policies from state-based Marketplaces established under the ACA, as well as those who purchased coverage from private insurers that operate outside of the ACA Marketplaces.

Most individuals who seek insurance policies in their state’s Marketplace qualify for assistance with the coverage costs. Individuals with incomes below $58,320 (400% of the Federal Poverty Level in 2023) can receive federal tax credits which lower premium costs.

The ACA set new standards for all individually purchased plans and eliminated many historically discriminatory practices that affected disadvantaged women in particular. Today, plans are prohibited from charging women higher premiums than men for the same level of coverage (gender rating) or from disqualifying women from coverage because they had certain pre-existing medical conditions, including pregnancy. All direct purchase plans must also cover certain “essential health benefits” ( EHBs ) that fall under 10 different categories, including maternity and newborn care, mental health, and a wide range of preventive health care services. Prior to the ACA, many individual plans excluded maternity care benefits or required policyholders to purchase costly riders to obtain maternity coverage.

Medicaid, the state-federal program for individuals with low incomes, covered 19% of adult women ages 19 to 64  in 2022, compared to 14% of men. Historically, to qualify for Medicaid, women had to have very low incomes and be in one of Medicaid ’s eligibility categories: pregnant, mothers of children 18 and younger, a person with a disability, or over 65. Women who didn’t fall into these categories typically were not eligible regardless of how low their incomes were. The ACA allowed states to broaden Medicaid eligibility to most individuals with incomes less than 138% of the FPL regardless of their family or disability status, effective January 2014. As of December 2023, 40 states and Washington, D.C. have expanded their Medicaid programs under the ACA, but 10 states have not and still base eligibility on historical categorical and income standards. For example, in Mississippi, the Medicaid income eligibility for parents is 28% of the FPL, which was approximately $6,900 for a family of three in 2023. Therefore, parents in families of three in Mississippi with incomes above this amount do not qualify for Medicaid because their income exceeds the state’s eligibility level.

Medicaid covers the poorest segment of women in the U.S. Forty-three percent of women with incomes below 200% of the FPL and 52% of women with incomes below 100% of the FPL have Medicaid coverage. By federal law, all states must provide Medicaid coverage to pregnant women with incomes up to 133% of the FPL through 60 days postpartum. However, in recent years, there has been a growing interest in expanding the length of the postpartum coverage period and, as of March 2024, nearly all states have taken steps to extend postpartum Medicaid coverage to one year.

Medicaid covers many health services that are essential for women. Medicaid financed 41% of births in the U.S. in 2021 and accounts for 75% of all publicly-funded family planning services. State Medicaid programs are prohibited from charging any cost-sharing for pregnancy-related care or family planning services. Over half of states have established programs that use Medicaid funds to cover the costs of family planning services for women with low incomes who remain uninsured, and most states have limited scope Medicaid programs to pay for breast and cervical cancer treatment for certain uninsured women with low incomes. Conversely, coverage for abortion is very limited under Medicaid as a result of the Hyde Amendment, a rider to federal appropriations that bans any federal funds from being used to pay for abortions unless the pregnancy is determined to be a result of rape or incest or poses a threat to the pregnant person’s life (more on abortion in the following section).

Uninsured Women

In 2022, approximately 10% of non-elderly women (9.5 million) were uninsured. This rate is slightly lower than that of men (13%) because, on average, women have lower incomes and have been more likely to qualify for Medicaid than men under one of Medicaid’s eligibility categories: pregnant, parent of children under 18, disability, or over 65. The ACA opened the door for states to eliminate the categorical requirements, but the gender gap in the insured rates between men and women persists.

The disadvantage uninsured individuals experience in accessing care and health outcomes is well established. Compared to women with insurance, those who are uninsured have lower use of important preventive services such as mammograms, Pap tests , and timely blood pressure checks. They are also less likely to report having a regular doctor , which is associated with better access to care and higher rates of use of recommended preventive services.

Women with lower incomes, women of color, and non-citizen women are at greater risk of being uninsured (Figure 4). One in 5 Hispanic (20%) and American Indian and Alaska Native (20%) women and 18% of women with incomes under 200% of the FPL are uninsured. A higher share of single mothers are uninsured (10%) than women in two-parent households (8%) (data not shown). Most uninsured women live in a household where someone is working; 69% are in families with at least one adult working full-time; and 82% are in families with at least one part-time or full-time worker (data not shown).

Many women who are uninsured are eligible for financial assistance with the costs of coverage. A fifth of uninsured women (20%) are eligible for Medicaid coverage but are not enrolled in the program (Figure 5) . One in 4 uninsured women (39%), about 3.7 million women, qualify for subsidies to cover the premium costs and some of the out-of-pocket costs of Marketplace plans but may not be aware of coverage options or may face barriers to enrollment. However, 7% of uninsured women live in states that have not adopted the ACA Medicaid expansion and fall into a “ coverage gap ” because their incomes are above the thresholds to qualify for Medicaid but below the levels to qualify for Marketplace tax credits (below 100% of the FPL). Approximately 1 in 3 (34%) uninsured women are not eligible for any assistance with health coverage due to their immigration status, their income, or because they have an offer of coverage from their employer.

There is considerable state-level variation in uninsured rates across the nation, ranging from 21% of women in Texas to 3% of women in Washington D.C., Massachusetts, and Vermont (Figure 6). Of the 15 states with uninsured rates above the national average (10%), nine have not adopted the ACA Medicaid expansion.

Medicare is the federal program that provides health coverage to virtually all people ages 65 and older as well as younger people with long-term disabilities. In 2020, Medicare covered 35 million women, including nearly 31 million ages 65 and older, and over 4 million under age 65 with long-term disabilities.

More than half (55%) of all Medicare beneficiaries are women and 45% are men. The population of women covered by Medicare is diverse, with varying social, economic, and health circumstances. Women live longer than men on average (79 years vs. 73 years life expectancy at birth in 2021), and many live with certain chronic illnesses, cognitive and mental impairments, and functional problems at higher rates than men. A higher share of older women than men also experience urinary incontinence, depression, osteoporosis, pulmonary disease, and Alzheimer’s/dementia. Medicare plays a key role in supporting the health and well-being of women, covering a broad range of essential services, including preventive, primary and specialty care, and prescription drugs. However, reflecting Medicare’s original role as a program to serve the medical needs of older adults, coverage of services for enrollees of reproductive age may be more limited. For example, there is no federal requirement for Medicare to cover all contraceptive services and supplies for the purpose of preventing pregnancy for younger Medicare enrollees with permanent disabilities.

Another gap in the Medicare program is the absence of coverage for long-term care services and supports (LTSS), such as nursing home stays and home care services, which many older adults need and seek but are expensive and unaffordable for some. Compared with men, women are more likely to require these services because they have more chronic conditions, have higher rates of physical and cognitive impairments, and are more likely to live alone. Medicare only covers time-limited LTSS after a hospitalization and does not cover ongoing LTSS for those with chronic conditions or functional impairments. Some older women can qualify for Medicaid for LTSS, but only if they have low incomes and, in some cases, must spend down most of their assets. Just a small share of seniors have private long-term care insurance to help cover some of the costs of LTSS. As a result, unless they have incomes low enough to qualify for Medicaid, many older people do not have any coverage for LTSS and rely on unpaid caregiving provided by family, friends, or neighbors. The majority of informal caregivers are women, who are most commonly caring for aging parents and spouses.

Women with Medicare also tend to have more modest incomes than men—a consequence of smaller lifetime savings, lower retirement income, and divorce and widowhood that result in only one income. While Medicare covers many necessary health care services, gaps in benefits, cost-sharing requirements, and spending on premiums for Medicare and supplemental coverage can translate into high out-of-pocket expenses for some people in the program. In 2020, 13% of women and 11% of men with Medicare reported that they had faced cost-related challenges in the past 12 months, such as trouble getting care due to cost or problems paying medical bills. These challenges are more common among female Medicare enrollees who are Black (22%) and Hispanic (18%), do not have a bachelor’s degree (15%), and those with annual incomes below $20,000 (20%).

How Do Health Care Costs and Scope of Benefits Affect Women’s Access to Care?

The ACA set national standards for the scope of benefits offered in private plans. As mentioned earlier, many insurance plans had adopted practices that discriminated against women that were addressed in the ACA. In addition to the broad categories of essential health benefits (EHBs) offered by Marketplace plans, all privately purchased plans must cover maternity care, which had been historically excluded from most individually purchased plans requiring the purchase of an expensive rider for that benefit to be covered. In addition, most private plans must cover preventive services without co-payments or other cost sharing. This includes screenings for breast and cervical cancers, well-woman visits (including prenatal visits), prescribed contraceptives, breastfeeding supplies and supports such as breast pumps, and several services for sexually transmitted infections (STI). Higher shares of women with private and Medicaid coverage report having had recommended preventive services such as mammograms, Pap screenings or colonoscopies compared to those who were uninsured (Figure 7).

Affordability of coverage continues to be a significant concern for many women, both for those who are uninsured as well as those with coverage. The leading reason why uninsured adults report that they have not obtained coverage is that it is too expensive . Under employer-sponsored insurance, the major source of coverage for women, 61% of all covered workers with a general annual deductible have deductibles of at least $1,000 for single coverage. Despite having coverage, many insured women (31%) report that their plans did not always cover all of their needed care or paid less than they expected (Figure 8).

What Are the Issues Affecting Women's Care and Access?

Reproductive health.

Maternity Care

In 2022, there were approximately 3.6 million births in the U.S. Childbirth is the leading reason for hospitalization, and most private insurance plans and the Medicaid program are required to cover care associated with childbirth. Medicaid covers about 4 in 10 births nationally and, in some states, more than half. The Medicaid program prohibits plans from charging out-of-pocket charges for pregnancy-related care, and coverage lasts through one year postpartum in most, but not all, states. For people with private insurance, which finances just over half of  births ( 51% ), the federal Pregnancy Discrimination Act requires employer plans to cover maternity care benefits. However, even for those with private insurance, a pregnancy often comes with significant out-of-pocket health expenses that can reach thousands of dollars . A KFF analysis estimated that women enrolled in large group plans pay around $3,000 out-of-pocket for costs associated with pregnancy, childbirth, and post-partum care. On average, Caesarean section births, which account for approximately one-third of births in the U.S., are significantly more expensive than vaginal deliveries. The ACA also requires individual plans to cover maternity care and bans plans from implementing restrictions on coverage of pre-existing health conditions, including pregnancy.

In recent years, there has been growing attention to pregnancy-related quality of care and maternal health. Maternal and infant mortality rates in the U.S. are far higher than those in similarly large and developed countries, and people of color are at a considerably higher risk for poor maternal and infant health outcomes compared to their White peers. Despite continued advancements in medical care, rates of maternal mortality and morbidity and preterm birth have been rising in the U.S., characterized by stark racial disparities. Notably, rates of pregnancy-related death (deaths within one year of pregnancy) among Native Hawaiian or Pacific Islander (NHPI), Black, and American Indian and Alaska Native (AIAN) women are over four to two times higher, respectively, compared to the rate for White women (14.1 and 62.8 vs. 39.9 vs. 32 per 100,000 births) (Figure 9). The Centers for Disease Control and Prevention (CDC) has determined that many of these pregnancy-related deaths were preventable, caused by cardiac-related conditions, infection, hemorrhage, and mental health conditions , including substance use. Maternal death rates increased during the COVID-19 pandemic and racial disparities widened for Black women. Black, AIAN, and Native Hawaiian or Pacific Islander (NHPI) women also have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to White women. Infants born to Black, AIAN, and NHOPI people have markedly higher mortality rates than those born to White women.

The disparities in maternal and infant health are symptoms of broader underlying social and economic inequities  that are rooted in racism and discrimination. Differences in health insurance coverage and access to care play a role, but notably, disparities in maternal and infant health persist even when controlling for certain underlying social and economic factors, such as education and income, pointing to the roles racism and discrimination play in driving disparities. Moreover, with the overturning of Roe v. Wade and the numerous states that have enacted abortion bans across the nation, increased barriers to abortion for people of color may widen the already existing large disparities in maternal and infant health.

There have been efforts at the policy level and in clinical circles to improve maternal health and address disparities. The Biden Administration issued the White House Blueprint for Addressing the Maternal Health Crisis , outlining policy priorities and strategies. These include funding to expand and diversify the perinatal workforce, enhancing training for clinicians to better listen to patient concerns, investing in maternal mental health care, and strengthening perinatal care in rural communities. At the state and local levels, multidisciplinary maternal mortality review committees and perinatal quality collaboratives have focused on data collection and reviewing the causes behind pregnancy-related deaths in their communities to try to prevent deaths in the future.

Fertility Assistance

Many people require fertility assistance to have children. These services include diagnostic services, treatment services, and fertility preservation. People seek fertility assistance for several reasons, such as if they or their partner has infertility, or because they are in a same-sex relationship or are single and desire children. Both female and male factors contribute to infertility, including problems with ovulation (when the ovary releases an egg), structural problems with the uterus or fallopian tubes, problems with sperm quality or motility, and hormonal factors. About 25% of the time, infertility is caused by more than one factor, and in about 10% of cases , infertility is unexplained. Infertility estimates, however, do not account for LGBTQ+ or single individuals who may also need fertility assistance for family building. Thus, there are varied reasons that may prompt individuals to seek fertility care.

Despite a need for fertility services, fertility care in the U.S. is inaccessible to many due to the cost. Fertility treatments are expensive and often are not covered by insurance. While some private insurance plans cover diagnostic services, there is very little coverage for costly treatment services such as intrauterine insemination, in vitro fertilization, and cryopreservation.

Most people who use fertility services must pay out of pocket, with costs often reaching thousands of dollars depending on the services received. This means that in the absence of insurance coverage, fertility care is out of reach for many people. Few states require private insurance plans to cover fertility assistance services, but these only apply to a subset of insurance plans and beneficiaries. Additionally, even fewer states have any fertility coverage requirement under Medicaid, the health coverage program for people with low incomes.

Nearly 1 in 4 women in the U.S. have an abortion in their lifetime. Starting with the 1973 landmark Supreme Court ruling in Roe v. Wade , women in the U.S. had the right to abortion up until the point of viability, regardless of where they lived. On June 24, 2022, the Supreme Court issued a  ruling  in  Dobbs v. Jackson Women’s Health Organization  that overturned the constitutional right to abortion as well as the federal standards of abortion access, established by prior decisions in the cases  Roe v. Wade  and  Planned Parenthood v. Casey . The Dobbs decision allows states to set policies regarding the legality of abortions and establish gestational limits. Access to and availability of abortions vary widely between  states , with large swaths of the country banning or restricting almost all abortions, with few exceptions, and some states enshrining and protecting abortion rights (Figure 10).

Decades of research have shown that abortion is a very safe medical service. Still, despite its strong safety profile, abortion is the most highly regulated medical service in the country and is now banned or restricted to early gestational stages in many states. In addition to bans on abortion altogether,  many states  impose other limitations on abortion that are not medically indicated, including waiting periods, ultrasound requirements, and parental notification and consent requirements. These restrictions typically delay receipt of services and can increase costs associated with abortion care.

Obtaining an abortion can be costly, with median costs exceeding $500 in out-of-pocket expenses for patients who self-pay. On average, the costs are higher for abortions in the second trimester than in the first trimester. People may have to travel if abortions are prohibited or not available in their area, adding costs related to travel and lodging. Given abortion bans and Hyde Amendment restrictions on payment for abortions under Medicaid and state restrictions on insurance coverage of abortion services, many people pay for abortion services out of pocket. Some people are able to receive assistance from local abortion funds if they need financial support to obtain abortion services, particularly if they have to travel out of state or have low incomes and cannot afford the costs of the abortion. For some, however, the costs of abortion services and travel will put the service out of reach and force them to have a birth that is not desired or is a risk to their health or life.

Insurance coverage for abortion services is heavily restricted in some state-regulated private insurance plans and public programs, like Medicaid and Medicare. Private insurance  covers most women of reproductive age, and states can choose whether abortion coverage is included or excluded in private plans that are not self-insured. Prior to the  Dobbs  ruling, about half of the states  had enacted private plan restrictions and banned abortion coverage from ACA Marketplace plans. Since the  Dobbs  ruling, some of these states have also banned the provision of abortion services altogether. However, 10 states have enacted laws that require private plans to cover abortion, typically without cost-sharing.

The  Hyde Amendment has banned the use of federal funds for abortion unless the pregnancy is a result of rape, incest, or it endangers the woman’s life. States may use non-federal state-only funds to pay for abortions under other circumstances for women covered by Medicaid, which 17 states currently do. However, more than half ( 56% ) of women covered by Medicaid live in states where they have no coverage for abortion, unless they qualify for an exception.

The impact of the Dobbs decision goes far beyond abortion care. It has also affected the provision of related health care services, including management of miscarriages and pregnancy-related emergencies, treatments for cancer and other chronic illnesses , contraceptive options , and much more. Women with low incomes, women of color, sexual/gender minorities, and other pregnant people have been disproportionately affected by the sweeping impacts of this ruling, as they are less likely to have the resources to travel potentially long distances to seek care.

Since the Dobbs ruling, there has been a constant stream of legal challenges , with a plethora of cases that seek to challenge abortion bans as well as block access to abortion medication or services. While most of the litigation is in state courts, the Supreme Court is considering a case involving the FDA’s approved conditions for using mifepristone, one of the drugs used for medication abortion , as well as a case about potential conflict between state-level abortion bans and Emergency Medical Treatment and Labor Act (EMTALA), the federal law that requires hospitals to provide care to stabilize patients experiencing medical emergencies. The Supreme Court will likely issue its decision in these cases in June 2024.

Contraception

Contraceptive care is an important component of overall health care for many women and people capable of becoming pregnant. Federal and state policies shape access to and the availability of contraceptive care, but factors such as provider characteristics, as well as individual preferences and experiences also impact contraceptive choices and use. For most people, private insurance coverage and Medicaid greatly reduce or eliminate financial barriers to contraceptive care. However, access is still limited in many parts of the U.S. with more than 19 million women living in  contraceptive deserts  where they may not have access to a health center offering the full range of contraceptive methods. There have been more efforts to broaden contraceptive availability outside of traditional clinical settings, including through commercial apps that use telehealth platforms, state efforts to allow pharmacists to prescribe birth control, and, most recently, over-the-counter (OTC) access to contraceptives without a traditional prescription.

The importance and impact of contraceptives in women’s lives are unquestionable. The 2022 KFF Women’s Health Survey highlighted that the majority of females 18 to 64 (90%) have used contraception at some point in their reproductive years, with most reporting they have used oral contraceptives and male condoms at some point in their lives (Figure 11). Many women have used more than one contraceptive method throughout their lifetime (76%), a reflection of changing needs and preferences across the lifespan.

The ACA requires that most private plans cover contraceptive services for females without cost-sharing – this includes patient education and counseling and FDA-approved methods of contraception with a prescription. This provision has  dramatically reduced cost-sharing  for contraception among females with private insurance plans, though some privately insured females who are eligible for no-cost coverage are still paying some of the cost of their contraceptives (Figure 12 ) . Reasons include someone using a brand-name contraceptive that is not in the plan’s formulary or consumers unaware of or not offered a generic alternative.

Despite its far-reaching impact, the ACA’s requirement for contraceptive coverage has been challenged in the courts on multiple occasions, with three cases reaching the Supreme Court. The earlier cases, Burwell v. Hobby Lobby (2014) and Zubik v. Burwell (2016), challenged the Obama Administration's regulations implementing the contraceptive coverage requirement, contending that the requirement violated some employers’ religious rights. The most recent cases , Little Sisters of the Poor v. Pennsylvania (2020) and Trump v. Pennsylvania (2020), involved regulations issued by the Trump Administration, which currently exempt employers with religious objections from providing contraceptive coverage to their employees.

For people with lower incomes, the Medicaid program is the primary funding source for contraceptives. The federal Medicaid statute establishes minimum standards, and, for decades, has classified family planning as a mandatory benefit category that all state programs must cover. States may not charge any out-of-pocket costs for family planning services and must allow beneficiaries to see any Medicaid provider within their state for family planning care. Many states also have programs that provide Medicaid coverage just for family planning services to people who have lower incomes but do not qualify for full Medicaid benefits.

Additionally, the federal Title X family planning program, administered by the HHS Office of Population Affairs (OPA), is the only federal program specifically dedicated to supporting the delivery of family planning care for individuals who are uninsured and have lower incomes. The program provides funding to more than 4,000 health clinics, public health departments, and nonprofit agencies across the country to deliver contraceptives and other family planning services to individuals with low incomes. Title X-funded providers must follow the program’s requirements, which include offering a broad range of family planning methods for low or no cost and ensuring confidentiality for adolescents. Federal rules also require that participating clinics offer their patients non-directive pregnancy option counseling that includes abortion, adoption, and prenatal referral for those who seek those services.

While there have been numerous over-the-counter contraceptive methods available (e.g. condoms, spermicides), in July 2023, the Food and Drug Administration (FDA) approved the first over-the-counter daily oral contraceptive pill, known as Opill . FDA’s approval of  Opill  makes it the most effective form of contraception available OTC intended for regular use. Private insurers and Medicaid generally require a prescription to cover OTC products, so even though Opill and other OTC products are available without needing a prescription from a clinician, coverage without a prescription will be limited without federal or state action.

Mental Health

Mental health has emerged as a rapidly growing concern in recent years, with 90% of Americans saying there is a  mental health crisis  in a recent KFF-CNN poll. Women experience several mental health conditions such as anxiety, depression, and eating disorders more frequently than men, and some also experience mental health disorders that are  unique  to women, such as perinatal depression (including prenatal and postpartum depression) and premenstrual dysphoric disorders that may occur when hormone levels change.

A KFF survey found that in 2022, a significantly higher share of women (50%) than men (35%) thought they needed mental health services in the past two years. The rates were particularly higher among younger women (64% of women ages 18-25). However, barriers to accessing timely and affordable mental health services persist for many. Almost half of women who said they needed mental health services and tried to get care were able to get an appointment within a month, but more than one-third of women had to wait longer. Among those who could not get an appointment, women cite limited provider availability and cost as the main reasons they were unable to access mental health care. Significantly larger shares of women who are uninsured (60%) say they could not get an appointment due to affordability reasons, compared to those who have health insurance either through private plans (33%) or Medicaid (30%) (Figure 13).

Prior KFF research has documented the challenges some consumers with health insurance face when finding in-network mental health care. In fact, 2 in 10 privately insured women with a mental health care appointment in the past two years say their provider did not accept their insurance. The option is effectively not available to women who have low incomes or are on Medicaid and lack the financial resources to pay for out-of-network care.

Among the  COVID-19 pandemic and the rise of racist attacks , the ongoing opioid epidemic  is a commonly cited stressor that has exacerbated long-standing mental health issues and prompted growing demand for mental health services in the past several years. Women face unique gender and sex-related differences when it comes to substance use, including greater physical, psychological, and social harms associated with drug use. Use of certain substances in women has been linked to increased rates of depression and anxiety disorders. Studies have also shown that women who use substances are at risk for issues related to pregnancy , fertility, breastfeeding, menstrual cycle, and more. All of these factors also shape the availability of treatment and services accessible to women.

Intimate Partner Violence Against Women

Intimate partner violence (IPV), defined as sexual violence, stalking, physical violence, and psychological aggression perpetrated by a current or former intimate partner, affects nearly a third of all Americans at some point in their lives. Although IPV affects men and women of all ages, women experience IPV at higher rates. Rates are higher among some groups of women, particularly those who are young, Black, American Indian or Alaska Native, and LGBTQ. It is difficult to quantify the number of people who experience IPV, as many cases are not reported. Some studies have estimated 9 million women in the U.S. experience sexual violence, physical violence, or stalking by an intimate partner in a single year. People who experience IPV are more likely to experience a range of health problems such as chronic pain, cardiovascular problems, and neurological problems. Both the CDC and U.S. Preventive Services Task Force (USPSTF) have identified IPV as a significant public health issue in the US.

Several federal programs and laws fund health care services and supports to survivors of IPV. The Violence Against Women Act (VAWA) has a broad scope, covering domestic violence, sexual harassment, stalking, and sexual assault. VAWA provides grants to states, local governments, and other organizations to establish their own violence-related programs and protocols. While some of the focus of VAWA and other public policies is prosecution of those who commit violence, provisions in VAWA also address health care coverage and costs for people who have experienced IPV.

It is well recognized that the health care system can serve as a site of IPV screening and support, and some professional medical organizations recommend that clinicians screen women for IPV. Under the ACA, IPV screening is considered a preventive service as screening is recommended by the USPSTF  and Health Resources and Services Administration (HRSA) preventive services for women. When health care providers routinely screen patients for IPV, it helps identify cases and connect survivors to resources and supports. However, this can be challenging as a KFF survey of OBGYNs found that many clinicians say they do not have sufficient resources within their practices to provide follow-up services when cases of IPV are identified. Connections to community-based services are particularly important for clinicians to be able to care for patients who disclose IPV.

Future Outlook

Women’s health has become one of the most politicized issues in society and health care. The overturning of Roe v. Wade in 2022 marked a seismic change in an important aspect of women’s health care that has implications for all pregnancy-related care and women’s economic future and well-being. The high and rising rates of maternal mortality and morbidity in the U.S. and the persistent gaps in mortality rates experienced by women of color highlight the need to address the roles that poverty, racism, and discrimination play in women’s health. Some of the key challenges that remain to be addressed in women’s health include:

• How to address and eliminate the persistent inequities in health coverage and outcomes experienced by women of color
• How to build a delivery system and develop coverage policies that is responsive to the reproductive and sexual health needs of women and other gender minorities to promote optimal health outcomes
• How to shape policies that protect women with low incomes from experiencing financial barriers to care
• Identifying and implementing policies that improve maternal health outcomes and also eliminate the structural and systemic barriers to care
• Providing access to comprehensive care to pregnant people who live in areas where abortion is unavailable due to state-level bans and restrictions
• How to provide care to women dealing with issues that are heavily stigmatized and marginalized, such as intimate partner violence and mental health challenges.
• Abortion in the United States Dashboard
• State Profiles for Women's Health
• Women's Health Insurance Coverage
• Medicaid Coverage for Women | KFF
• State Health Facts Women's Health Indicators
• 2022 Women's Health Survey reports
• State and Federal Reproductive Rights and Abortion Litigation Tracker
• Preventative Services Tracker
• A Focus on Contraception in the Wake of Dobbs
• Resources about the Title X National Family Planning Program

Ranji, Usha, Diep, Karen, Gomez, Ivette, Sobel, Laurie, & Salganicoff, Alina, Health Policy Issues in Women's Health. In Altman, Drew (Editor), Health Policy 101, (KFF, May 28, 2024) https://www.kff.org/health-policy-101-health-policy-issues-in-womens-health/ (date accessed).

• Sex & Gender

Women Make Global Gains as Researchers, but Gaps Persist

A large-scale global study found that while the number of women in academic research is growing, STEM fields remain dominated by men.

By  Kathryn Palmer

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The proportion of active American female researchers in STEM increased from 17 percent in 2000 to 29 percent in 2022.

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Female representation among scholarly researchers has increased in the United States and across the globe over the past two decades. But when the numbers are broken down by field, career stage and research impact, among other factors, gender disparities persist, according to a large-scale study by Elsevier , a Dutch academic publishing and global information analytics company.

The study, which was published Monday, found that the global percentage of active female researchers jumped from 28 percent to 41 percent globally between 2001 and 2022.

In the U.S, the proportion of active female researchers has kept pace with global trends, rising from 30 percent in 2000 to 42 percent in 2022, according to the study.

“There’s progress, but there’s still a lot of areas to do better,“ said Mirit Eldor, managing director of Life Sciences Solutions at Elsevier and secretary of its Inclusion and Diversity External Advisory Board. “For researchers to tackle the most complex and important problems in the world—like the climate crisis and sustainability—we do need a wider talent pool and more diverse perspectives.”

To produce its new global analysis, Elsevier gathered records for around 20 million researchers from Scopus , an abstract and citation database of peer-reviewed literature including scientific journals, books and conference proceedings. The firm then used an AI-driven algorithm to infer the gender of the indexed authors.

The data showed a general upward trend in female representation, but a news release from Elsevier said it’s not enough.

“At the current pace of change, equality remains unacceptably far away,” the release said. “Although women’s representation in mathematics, engineering and computer science is increasing, it is not projected to reach parity with men’s until 2052.”

Men Dominate STEM in U.S., Globally

While American women producing research in the social and health sciences now make up 51 and 50 percent of researchers, men still dominate STEM in the U.S. and across the globe.

The share of global STEM researchers who were women increased from 26 percent in 2000 to nearly 39 percent in 2022, according to the study. The proportion of active American female researchers in STEM is even lower, though it increased from 17 percent in 2000 to 29 percent in 2022.

“We still have these perceptions on what is more woman-appropriate and what is less,” Eldor said, noting that globally, women represent more than half of researchers in nursing and psychology, but only about a quarter of mathematics researchers.

And while publications by female STEM researchers in the United States have a field-weighted citation impact of 1.21—well above the 0.98 global average for women—it’s still less than the impact of American male STEM researchers’ publications of 1.27.

Gender Disparities Vary by Country

The study also revealed that gender disparities among researchers vary widely by country, but that the U.S. falls just above the average.

While female researchers from Portugal and Argentina make up more than half of researchers (around 51 percent in both countries), female researchers from the U.S. remain outnumbered by men, making up 42 percent of active researchers. Japan and Egypt had the lowest female representation, with women making up roughly 22 percent and 30 percent, respectively.

The report also found that although women are well represented among early career researchers—making up 45 percent of researchers with fewer than five years of experience—their representation steadily decreases at more senior levels; Women make up 27 percent of active authors with 21 or more years of experience.

“Maintaining work-life balance, combating gender bias and navigating institutional and funding disparities all pose significant challenges,” the study said. “To support progress in gender diversity, policies must prioritize retaining earlier-career women in research.”

Eldor said that having fewer senior female researchers may also contribute to a leaky pipeline to the higher ranks of academia because it means fewer role models and mentors for early-career female researchers.

Women File Far Fewer Patents

That under-representation has implications beyond career success. Globally, women received 37 percent of research grants in 2022—up from 29 percent in 2009. Within that same timeframe, women in the United States had an increase in research grants from around 25 percent to a little over 30 percent, according to the report.

Globally, women also file far fewer patent applications than men, according to the study: While men appear as filers on 97 percent of all patent applications, women only appear on 26 percent of applications. The United States largely mirrors that breakdown, with men appearing as filers on 97 percent of applications compared to women appearing on 28 percent of applications.

Enacting policies that offer more support for female researchers throughout their careers (such as offering more paid maternity leave and flexible working conditions) are a part of the solution, but Eldor said collecting more data about gender disparities is also key.

“That shows us where we are and what interventions are working and where we need to try a different approach because we’re not moving the needle,” she said. “We did all of this with data we inferred with an algorithm, but self-ID would be better.”

There’s already some research about why American women remain underrepresented in scholarly publications.

A paper published in Science Advances in October concluded that women are likelier than men to leave the professoriate at all stages of their careers, and that workplace climate, not work-life balance, is the biggest reason they leave.

“Much of the retention literature has focused on work-life balance policies and mentorship programs, in part due to the emphasis on early-career women,” Katherine Spoon, the paper’s lead author and a doctoral student in the University of Colorado at Boulder’s computer science department, said in an email. “But the fact that we actually see a larger gender gap among senior researchers means that there’s something more happening.”

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Systematic and rigorous inquiry allows us to discover the fundamental mechanisms and causes of disease and disparities. At our Office of Research ( research@BSPH), we translate that knowledge to develop, evaluate, and disseminate treatment and prevention strategies and inform public health practice. Research along this entire spectrum represents a fundamental mission of the Johns Hopkins Bloomberg School of Public Health.

From laboratories at Baltimore’s Wolfe Street building, to Bangladesh maternity wards in densely   packed neighborhoods, to field studies in rural Botswana, Bloomberg School faculty lead research that directly addresses the most critical public health issues worldwide. Research spans from molecules to societies and relies on methodologies as diverse as bench science and epidemiology. That research is translated into impact, from discovering ways to eliminate malaria, increase healthy behavior, reduce the toll of chronic disease, improve the health of mothers and infants, or change the biology of aging.

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citations on  publications where BSPH was listed in the authors' affiliation in 2019-2023. 

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The Institutional Review Board (IRB) oversees two IRBs registered with the U.S. Office of Human Research Protections, IRB X and IRB FC, which meet weekly to review human subjects research applications for Bloomberg School faculty and students

Generosity helps our community think outside the traditional boundaries of public health, working across disciplines and industries, to translate research into innovative health interventions and practices

Introducing the research@BSPH Ecosystem

The   research@BSPH   ecosystem aims to foster an interdependent sense of community among faculty researchers, their research teams, administration, and staff that leverages knowledge and develops shared responses to challenges. The ultimate goal is to work collectively to reduce administrative and bureaucratic barriers related to conducting experiments, recruiting participants, analyzing data, hiring staff,   and more, so that faculty can focus on their core academic pursuits.

Research at the Bloomberg School is a team sport.

In order to provide  extensive guidance, infrastructure, and support in pursuit of its research mission,   research@BSPH  employs three core areas: strategy and development, implementation and impact, and integrity and oversight. Our exceptional research teams comprised of faculty, postdoctoral fellows, students, and committed staff are united in our collaborative, collegial, and entrepreneurial approach to problem solving. T he Bloomberg School ensures that our research is accomplished according to the highest ethical standards and complies with all regulatory requirements. In addition to our institutional review board (IRB) which provides oversight for human subjects research, basic science studies employee techniques to ensure the reproducibility of research. 

Research@BSPH in the News

Four bloomberg school faculty elected to national academy of medicine.

Considered one of the highest honors in the fields of health and medicine, NAM membership recognizes outstanding professional achievements and commitment to service.

The Maryland Maternal Health Innovation Program Grant Renewed with Johns Hopkins

Lerner center for public health advocacy announces inaugural sommer klag advocacy impact award winners.

Bloomberg School faculty Nadia Akseer and Cass Crifasi selected winners at Advocacy Impact Awards Pitch Competition

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• Cultural Issues and the 2024 Election

5. Gender identity, sexual orientation and the 2024 election

Table of contents.

• Voters’ views about race and society, the impact of the legacy of slavery
• Most voters, but not all, view the nation’s diversity as a strength
• How should the country handle undocumented immigrants currently in the U.S.?
• Attitudes toward hearing other languages in public places
• Biden and Trump supporters’ views about discussing America’s historical successes, failures
• How does the U.S. compare with other countries?
• Views of women’s progress
• How much of a priority should marriage and children be?
• Abortion, IVF access and birth control
• Views of gender identity
• Voters’ attitudes toward use of gender-neutral pronouns
• Societal impact of more social acceptance of lesbian, gay, bisexual people
• Religion and government policy
• How much influence should the Bible have on the nation’s laws, if any?
• Views on the federal government’s role in promoting Christian values
• Most voters say it is not necessary to believe in God to be moral
• Is the justice system too tough on criminals, or not tough enough?
• Policing and law enforcement
• How Trump, Biden supporters view gun rights and ownership
• Views on the increasing number of guns in the U.S.
• Acknowledgments
• The American Trends Panel survey methodology

Voters who support Joe Biden and Donald Trump have wide differences across a broad range of issues related to gender identity and sexual orientation.

Trump supporters overwhelmingly say a person’s gender is determined by the sex they were assigned at birth. A majority of Biden supporters, by a less one-sided margin, say someone can be a man or woman even if that is different from their sex at birth.

Biden’s supporters also are far more comfortable than Trump supporters with people using the pronouns “they” or “them” to describe themselves.

And two decades after the first same-sex marriages were legally performed in the U.S., Biden supporters are roughly five times as likely as Trump supporters to say legalizing same-sex marriage has been good for society.

Nearly two-thirds of registered voters (65%) say whether a person is a man or woman is determined by the sex assigned to them at birth. About a third (34%) say whether someone is a man or woman can be different from the sex at birth.

Nine-in-ten Trump supporters and about four-in-ten Biden supporters (39%) say sex at birth determines if someone is a man or a woman.

About six-in-ten Biden supporters (59%) say a person’s gender can be different from their sex at birth. Only about one-in-ten Trump supporters (9%) say this.

There are wider demographic differences in opinions about gender identity among Biden supporters than among Trump supporters.

Among Biden supporters

Nearly two-thirds of Black voters who support Biden (64%) say gender is determined by a person’s sex assigned at birth. That compares with 46% of Biden’s Hispanic supporters and smaller shares of his White (32%) and Asian supporters (27%).

Biden supporters without college degrees (47%) are more likely than those with college degrees or more education (30%) to say sex at birth determines someone’s gender.

Biden supporters under age 35 (29%) are less likely than older Biden supporters to say gender is determined by sex assigned at birth.

Among Trump supporters

Across demographic groups, wide majorities of Trump supporters say gender is determined by sex at birth.

However, there are some differences among these voters. Hispanic Trump supporters (79%) are less likely than White Trump supporters (92%) to say sex birth determines gender identity, and Trump supporters ages 18 to 34 (83%) are less likely to say this than older Trump supporters.

Changing views about gender identity

The share of voters who say that sex at birth determines whether someone is a man or a woman has increased since 2017, and this increase has occurred within both parties.

In 2017, 53% of voters said sex assigned at birth determines gender; 65% express this view today.

The share of Republican and Republican-leaning voters who say that sex at birth determines gender identity has grown from 79% in 2017 to 91% now.

In the same period, the share of Democratic and Democratic-leaning voters who say this has increased, from 30% to 39%.

Over half of voters (56%) say they are not comfortable with someone using the pronouns “they” or “them” to describe themselves, rather than “he” or “she.” Roughly four-in-ten (43%) are comfortable with the use of these pronouns.

Biden supporters are more than three times as likely as Trump supporters to say they are comfortable with the use of “they/them” pronouns (66% to 20%).

• Black voters who support Biden (55%) are less comfortable with the use of they/them pronouns than Biden’s White (69%), Hispanic (68%) and Asian (72%) backers.
• Hispanic Trump supporters (33%) are somewhat more likely than the former president’s White supporters (16%) to say they are comfortable.

Voters under 50 are more comfortable than those 50 and older with people using gender-neutral pronouns. There is an age gap on this question among both candidates’ supporters, but it is particularly stark among Biden voters: 79% of Biden’s supporters ages 18 to 49 say they are comfortable, compared with 56% of his supporters who are 50 and older.

Voters are divided over the societal effects of more people being comfortable with identifying as gay, lesbian or bisexual and same-sex marriages being legal in the U.S.

Roughly a third say each trend has been very or somewhat good for society, while about as many say the changes have been bad for society. The remainder say they have been neither good nor bad.

As with opinions about gender identity, there are sizable differences between Biden and Trump supporters.

About half of Biden supporters (51%) say more people being comfortable identifying as gay, lesbian or bisexual is good for society. And a majority of Biden supporters (57%) say legalization of same-sex marriage is good for society.

About half of Trump supporters say both changes are bad for society: 53% say this about increased comfort with people identifying as lesbian, gay or bisexual, and 51% say this about legalization of same-sex marriage.

There are age differences among both candidates’ supporters.

• Majorities of Biden supporters ages 18 to 49 view both trends positively: 63% say more people being comfortable identifying as lesbian, gay or bisexual is good for society, while 67% say the same of the legalization of same-sex marriage. About half or fewer of Biden supporters 50 and older share these views. (This group is more likely to instead say that these trends are neither good nor bad.)
• Older Trump supporters are more likely than his younger supporters to have a negative view of the impact of legalizing same-sex marriage (57% of those 50 and older say it is bad for society, compared with 41% of those younger than 50). There are no meaningful age differences in how Trump supporters assess the impact of more people being comfortable with identifying as lesbian, gay or bisexual.
• Black voters who support Biden are far less likely than Biden’s supporters in other racial and ethnic groups to say increased comfort with identifying as lesbian, gay or bisexual and legalized same-sex marriage are good for society. About a quarter of Black Biden supporters say these things are good, compared with about half or more among his White, Hispanic and Asian backers.

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Biden, Trump are least-liked pair of major party presidential candidates in at least 3 decades

More than half of americans are following election news closely, and many are already worn out, americans have mixed views about how the news media cover biden’s, trump’s ages, an early look at black voters’ views on biden, trump and election 2024, voters’ views of trump and biden differ sharply by religion, most popular, report materials.

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