gender discrimination in health essay

Duke Health Referring Physicians

Recognizing, addressing unintended gender bias in patient care, how can you improve care for female patients.

Despite good intentions, gender bias persists in health care. A survey conducted in early 2019 by TODAY found that more than one-half of women, compared with one-third of men, believe gender discrimination in patient care is a serious problem. One in five women say they have felt that a health care provider has ignored or dismissed their symptoms, and 17% say they feel they have been treated differently because of their gender—compared with 14% and 6% of men, respectively.

Studies show that women’s perceptions of gender bias are correct. Compared with male patients, women who present with the same condition may not receive the same evidence-based care. In several key areas, such as cardiac care and pain management, women may get different treatment, leading to poorer outcomes.

Few physicians think intentional discrimination is at play here. Instead, it’s a result of the vestiges of disproved beliefs and outdated conventions. “The origins of this situation go back many years,” explains Janine Clayton, MD, director of the Office of Research on Women’s Health (ORWH) at the NIH. Much of medical science is based on the belief that male and female physiology differ only in terms of sex and reproductive organs, she says. Because of this, most research has been conducted on male animals and male cells, Clayton explains. “This is a major root of this issue.”

In addition, women—especially those in child-bearing years—were excluded from clinical trials for many years, in part to protect them and their fetuses from potential adverse effects. Researchers also felt that they could not adequately control for women’s variable hormonal status.

“Because we have studied women less, we know less about them,” Clayton says. “The result is that women may not have always received the most optimal care.”

Increasing the Knowledge Base

Women now constitute approximately one-half of participants in NIH-supported clinical research, which has increased the knowledge base about sex and gender differences.

“We now know that sex affects cell physiology, metabolism, and many other biological functions; symptoms and manifestations of disease; and responses to treatment,” says Clayton, pointing out that this research has led to a better understanding of both male and female physiology—knowledge that is critical as we move further into an era of precision/personalized medicine. The ORWH website ( www.nih.gov/women ) provides free courses on sex and gender differences in medicine that are open to the public. It also contains an A-to-Z guide on sex and gender influences on health and disease.

“It is important for everyone who works in a medical practice to know how sex and gender—as well as age and race/ethnicity—affect health,” says Clayton.

Recognizing and Addressing the Problem

Office-based physicians may face challenges when trying to recognize and address the effects of unintended gender bias in their practices, says Calvin Chou, MD, a primary care physician at the San Francisco Veterans Affairs Medical Center and a senior faculty adviser for external education for the Academy of Communication in Healthcare. “We interact with our patients one by one, without much [outside] observation.” Additionally, time constraints in a medical practice can encourage some clinicians to inadvertently cut corners or jump to conclusions during patient visits.

“I don’t think there are any practitioners who imagine that they are delivering different care based on gender,” says Chou. “The first step is awareness. You can’t change your practices without awareness.”

“Biases are not moral failings; they are habits of mind,” adds Denise Davis, MD, clinical professor of medicine at the University of California, San Francisco, and faculty physician at the San Francisco Veterans Affairs Medical Center. With effort, habits can be changed. The following tips can help clinicians identify and combat gender bias.

Diverse health care teams. Explicitly encouraging discussion of gender or other bias during team huddles can help team members feel comfortable speaking up about any concerns.

Open-ended questions. Questions that elicit a limited range of responses from patients are more easily “contaminated by bias,” Davis says. However, open-ended questions pave the way to optimal patient care. For example, clinicians can ask, “What are your concerns today? What am I missing that is important for us to talk about?”

Substitution. If Davis thinks bias may be slipping into her patient interaction, she asks herself what questions she would ask if the patient was a different gender. For example, she might be more likely to ask a young male patient about substance use or risky behavior, such as having guns at home. Additionally, she might assume a female patient has an ample social support system. Any of these assumptions can lead to missed opportunities for more comprehensive patient care.

Data collection and analysis. Collecting and analyzing data can illuminate differences in care that would otherwise go undetected. Davis suggests first examining areas where disparities have been documented, such as in rates of cardiology consultations.

Checklists and guidelines. Using computerized checklists that prompt providers to ask patients about risk factors, for example, can help ensure all patients undergo the same evaluation. Similarly, clinical guidelines for patient care can ensure that clinicians follow evidence-based methods for all patients.

Training opportunities. Bringing in practice coaches or attending training opportunities on patient experience or patient communication can also help clinicians become aware of their own biases.

“Awareness of the problem is growing, as is an appreciation of the fact that women can have different diagnostic and treatment needs. I am hopeful that gender bias in health care will decrease over time,” Clayton says.

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• Open access
• Published: 22 September 2020

Gender disparities in clinical practice: are there any solutions? Scoping review of interventions to overcome or reduce gender bias in clinical practice

• Lorena Alcalde-Rubio 1 ,
• Ildefonso Hernández-Aguado 1 , 2 ,
• Lucy Anne Parker 1 , 2 ,
• Eduardo Bueno-Vergara 1 &
• Elisa Chilet-Rosell   ORCID: orcid.org/0000-0002-9091-7255 1 , 2  

International Journal for Equity in Health volume  19 , Article number:  166 ( 2020 ) Cite this article

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Introduction

Gender, understood as “social relationships between males and females in terms of their roles, behaviours, activities, attributes and opportunities, and which are based on different levels of power”, [ 1 ] is one of the main social determinants of health [ 2 ]. The damage caused to population health by gender inequality across the globe is immense and justifies comprehensive actions addressing gender equity in health at all levels [ 3 ]. In the words of Hawkes and Buse, “Now is the time to take the call from Alma Ata in its literal sense—“Health is for All” not only for some. Embedding of gender in global health provides one promising route to attainment of the longstanding, but long-languishing, human right—the right to health” [ 4 ]. The root causes of gender inequality encompass all societal spheres and a multisectoral approach is required [ 5 ]. In fact, it has been shown that actions across multiple sectors in low and middle-income countries can improve a variety of health and development outcomes [ 6 ]. Therefore, there is no doubt that gender mainstreaming should pervade all policies. The UN Economic and Social Council embraced this approach in 1997 as “assessing the implications for women and men of any planned action, including legislation, policies, or programmes … so that women and men benefit equally, and inequality is not perpetuated” [ 7 ]. On global level, the impact of gender inequality on health was later included in the UN’s the Millennium Development Goals, and remains significant in the Sustainable Development Goals [ 8 ].

In the health domain, there has been a substantial interest in gender issues in the last two decades. Vlassof and García Montero explained why gender is key to understanding all dimensions of health including healthcare, health seeking behaviour and health status. Consequently, they proposed transformation in all areas of the health sector in order to integrate gender perspective [ 9 ]. This integral change should encompass actions on policy, research, training and programmes including interventions at the individual level. We have witnessed an appreciable increase in the consideration of gender in health plans [ 5 , 10 ] and particularly in those focused on women’s reproductive health [ 11 , 12 ]. However, more than 20 years of research from high-income, middle income and low-income countries shows that gender inequalities remain embedded in health systems [ 13 , 14 ]. Within health care systems, unconscious gender biases –based on gender stereotypes- and sexism affect patient care [ 15 , 16 ]. While policy and organisational changes are essential, the involvement of health workers can act as a catalyst of integral change in the healthcare system.

Since the recognition of gender bias in the clinical management of cardiovascular disease, [ 17 , 18 , 19 ] several other health problems have been the target of research, which shows the extent of gender inequity in health care. Last year, Nature Communications published a study analysing health data for almost 7 million men and women in the Danish healthcare system over a 21-year period, and showing that women were diagnosed later than men in more than 700 diseases [ 20 ]. Despite demonstrated disparities in women’s health and advocacy to improve women’s health, there is still a lack of patient centred care for women.

These contributions from research on the relevance of gender inequalities in health care have not gone along with research on effective interventions that could provide health workers with practical tools that facilitate the application of gender oriented clinical interventions. In addition, the lack of patient centred care for women has been reported recently [ 21 , 22 , 23 ]. In fact, Celik et al.’s 2010 review of the available literature, [ 24 ] the authors failed to find references that contributed to the development of procedures to increase health professionals’ skills related to gender. Health systems and health providers remain largely gender unresponsive [ 13 ]. In order to move forward we need to assess the available experience in reducing gender-based inequities and, where possible, learn how to scale-up effective interventions. Our objective here is to identify available tools that can be used to overcome or reduce gender bias in clinical practice.

Material and methods

This scoping review was developed following the Arksey and O’Malley’s methodological framework, which we used to guide our reporting where possible [ 25 ]. We specifically searched for articles examining interventions to reduce or prevent gender bias in clinical practice, as long as they were provider-focused and healthcare-based.

Search strategy

The primary search was performed in Medline through PubMed, Web of Science, Scielo and Lilacs. Modifications on our search strategy in Medline through PubMed were made several times to ensure highest sensitivity. Finally, we decided to combine two individual searches to expand our search in Pubmed and we then made minor modifications to adequate the search strategy to each database. The final search strategies combined Subject headings and MeSH terms related to “gender”, “healthcare”, “bias”, “disparities”,“inequality”,“inequity” and “intervention” (Table  1 ).

In order to retrieve as many interventions studies as possible, we applied no date limitations and retrieved all results published until December 2018.

Study selection

We included empirical studies designed to prevent or decrease gender bias in clinical practice and those that were focused on other types of prejudice (such as race, age …) as long as they also evaluated gender bias. Similarly, we included studies designed to evaluate the effect on gender bias of interventions already implemented for a different primary objective (e.g. improving adherence to guidelines). These interventions should be provider-focused and healthcare-based. We only included studies that evaluated the interventions. Given the heterogeneity in the evaluation of gender bias, we included studies that assessed or measured any outcome related to clinical practice in a gender-disaggregated way (e.g. in-hospital adverse events) or the effects of interventions designed to reduce gender-based vulnerability of specific population (LGBTI+ populations, women suffering from intimate partner violence). We only included studies that were published in peer-review journals in English, Spanish and Portuguese. Exclusion criteria included non-empirical or descriptive studies, interventions focused only on patients and description of programmes or interventions without an evaluation of the impact.

All search results were first screened based on title and abstract by two researchers. The full text of potentially useful records was reviewed. We read all potentially useful texts and their reference lists were also revised for additional interventions. A detailed flow diagram of study selection is showed in Fig.  1 .

Flow diagram for identification of interventions to reduce gender bias in clinical practice

Data extraction and synthesis

We carried out the data extraction using a standardized data extraction form. Data were collected on the health issue, country, description of intervention (later categorized in clinical decision support guidelines and standardized protocols; interventions that included staff, clinic and community interventions; interventions managed by an all women team for female patients; gender sensitive improvements in data collection, and routine screening for gender violence), type of evaluation (considering the comparison group and the use of routine or non-routine-data) clinical setting (hospital, specialized care, primary health care, and others), main results and conclusions (later classified as successful or partially successful and not successful).

In order to evaluate the application of gender perspective in research reporting, we used the SAGER guidelines checklist adapted to our data extraction form [ 26 ]. In this case, we obtained information from the following items: introduction (explanation on whether sex and/or gender differences may be expected); methods (explanation on how sex and gender were taken into account in the design of the study, whether they ensured adequate representation of males and females, and justification of the reasons for any exclusion of males or females); results (in addition to sex-disaggregated data, it includes variables that facilitate gender analysis); and, discussion (implications of sex and gender on the study results and discussion of the implications of the results stratified by sex or from gender perspective).

Firstly, we performed an initial analysis of five papers by two researchers in order to homogenize data coding. Researchers agreed in four papers. After consensus on the assessment of the main variables, we proceed with the remaining articles. For the second set of articles, two researchers extracted data independently. A third research was in charge of detect discrepancies between researchers. Discrepancies were detected in four papers and were solved by consensus between the two researchers that reviewed each paper. Those discrepancies were related to minor variations on the length of text extracted to justify their answers and did not influence the interpretation of the results.

We performed a descriptive analysis of the information obtained from items formerly described.

After removing duplicates, we screened 3082 abstracts retrieved through database search. Additional file 1 : Appendix 1 presents detailed information of the 22 [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ] studies included in our scoping review.

When reporting the interventions, information regarding sex differences and the gender perspective: two of the studies failed to include whether sex and/or gender may be an important variant of the health outcome assessed in the introduction section (9%), three of the studies failed to report how the researchers ensured adequate representation of males and females in the sample (14%), in nine of them lacked variables/information that enabled a gender-based analysis (40%). Five studies did not discuss sex differences or apply a gender perspective (23%) and six did not discuss the implications of the results from a gender perspective (27%) (Table  2 ).

The interventions analysed were mainly focused on cardiovascular disease ( n  = 13, 59%) and, sexual and reproductive health, including one intervention focused on sexual orientation and gender identity ( n  = 5, 23%). Other themes were gender-based violence ( n  = 1), unhealthy drinking (n = 1), diabetes (n = 1) and renal failure (n = 1) (Table  3 ). Seventeen studies were conducted in USA (77%); the others were located in Brazil ( n  = 2), India (n = 1), Tanzania (n = 1) and Singapore (1).

Interventions were conducted more frequently in hospitals ( n  = 14, 64%). We found several types of intervention. Most studies included clinical decision support decision support guidelines and standardized protocols (15, 68%). These studies were aimed to reduce variability in healthcare and were not specifically designed to reduce gender bias. There was a cluster of studies (5) related to the program in the United States called Get with the Guidelines (GWTG) [ 49 ]. This initiative was focused on the redesign of hospital systems in order to improve the quality of patients care and was based on a collaborative model and Internet-based Patient Management. The GWTG included interactive learning sessions, teleconferences, and electronic communication between multidisciplinary teams from hospitals in a variety of settings to facilitate the transfer of the “how-to”, which is considered necessary to produce system-wide change. Finally, there were interventions that included activities involving staff, clinic, and community interventions (3, 14%), two studies evaluated data collection in a more gender-sensitive way, one more was an intervention managed by an all women team for female patients (2, 9%), and finally one study evaluated the implementation of gender violence screening.

The evaluations of the interventions were mostly conducted without comparison group and using routine data (7, 32%) or with a pre and post comparison and using routine data (6, 27%). The other 9 studies used non routine data (quantitative, qualitative and mixed data) and a variety of designs: randomised control group (2, 9%), non- randomised control group (2, 9%), without comparison group (3, 14%) and pre-post comparison (2, 9%).

The majority of the interventions (19, 86%) were mostly successful in narrowing the gender gap (See Annex 1 for more details). Four of them were unable to narrow this gap in all outcomes. There was no difference in cardiovascular events, quality of life, knowledge, attitudes and practices in women with cardiovascular disease after intervention [ 42 ]. A discharge tool was less used in women after acute myocardial infarction than in men [ 38 ].. Fewer women than men with heart failure received hospital discharge instructions and the length of the stay was longer for women even after implementation [ 32 ]. Additionally, the gender violence screening raised doubts in clinicians [ 39 ]. On the other hand, three studies were not successful in any outcome: two interventions in cardiovascular disease [ 36 , 43 ] and one in unhealthy drinking [ 48 ]. The latter one stated that a non-gender-specific threshold for an intervention in alcohol misuse was detrimental as may increase gender differences in receipt of brief intervention among patients.

Despite the extensive and growing evidence of gender bias in clinical practice published in scientific journals since the 90s, our scoping review has shown that few studies have tried to tackle this bias. After screening over 3082 abstracts in health sciences databases, we identified only 22 evaluated provider-focused and healthcare-based interventions. Most of the analysed studies focused on cardiovascular diseases and were strategies to improve adherence to existing guidelines in order to reduce variability in healthcare. It is noteworthy that even though the studies included in our scoping review described interventions that could reduce gender bias in clinical practice, we identified shortcomings in the reporting of the information from a gender perspective. Most of the interventions were successful in narrowing the gender gap in at least one of the outcomes even when they were not intended or seeking to reduce the gender gaps. Therefore, it is likely that future innovative interventions designed according to the theoretical bases that originate gender bias could result in higher reductions on gender bias.

There are, however, some limitations in our study. Firstly, the difficulty to find suitable articles, which we addressed by redefining our search and inclusion criteria several times in order to increase sensitivity. Secondly, the methodology of the studies was heterogeneous and could hinder the comparisons between studies. In addition, considering that some of the results of the analysed interventions were based on studies lacking a comparison group, interpretations should be cautious. Finally, interventions were conducted on few countries, which could difficult to replicate them in different contexts.

Although we identified few studies which sought to reduce gender bias in clinical practice, the interventions examined were mostly successful, demonstrating that narrowing gender gaps in healthcare is possible. This scoping review is a starting point, which, along with barriers and facilitators of interventions to reduce gender gap in healthcare already described in literature [ 24 ], can guide future interventions. The analysed interventions showed that gender disparities in healthcare could be reduced and even eliminated if clinician’s adherence to guidelines increased. Most of these interventions proposed the protocolization of technical procedures that aimed to reduce differences by sex and other variables without seeking specifically to reduce gender biases in health care - and may or may not result in that reduction. In contrast, interventions designed with the aim of reducing gender bias included different strategies (like programs managed by an all women team or improvement of the data collection system) and all of them were successful or partially successful in their objectives.

Most of the studies, particularly those focused on technical procedures, were based on specialized health care and hospitals. There is a lack of studies addressing this problem in primary healthcare (only two studies were based on this setting). If the narrowing of gender biases occurs in primary care, its impact could be even greater due to the volume of patients treated in these centres and because it is the patient’s first contact with the healthcare system [ 50 ].

Gender bias in clinical practice was described for the first time in the New England Journal of Medicine [ 17 , 18 , 19 ]. Almost 30 ago, Bernadine Healy used the term “Yentl syndrome” equating women with myocardial infarction to the character Yentl - a Jewish woman who dressed herself as a man to be able to study the sacred texts [ 18 ]. Healy was denouncing the fact that women have to show the same symptoms as men to receive the appropriate diagnosis and treatments, because the knowledge of cardiovascular disease was based on studies conducted on men. Since then, many studies have addressed gender bias in clinical practice, particularly in cardiovascular disease. In concordance with this, cardiovascular health was the predominant issue addressed in the analysed interventions. However, gender bias has been described in the clinical practice of a great number of diseases, [ 20 ] so it is necessary to expand the field of work to other health issues.

Importantly, physicians –and, the health system in general– have the potential to either reproduce or perpetuate disparities, or to overcome them. Even if the results of the interventions are encouraging, we need to question the theoretical framework in which these gender inequities originated. This may be why some interventions were not successful, as simply implementing instruments, while necessary, is not enough to tackle gender bias in professionals. It is important to advocate for reforms aimed to include gender aspects in the curricula of medical schools and in health research in order to advance in the field of gender- specific medicine [ 51 ].

Conclusions

In contrast to the wide research identifying gender bias in health care, few studies, so far, have described and evaluated interventions aimed to tackle this bias. However, there is some empirical evidence showing how to narrow the gender gaps in healthcare, as the reviewed literature reveals that that most of the interventions were successful at achieving at least one of the expected outcomes. Nevertheless, it is alarming that studies of interventions in primary healthcare, where the impact of narrowing of gender bias could be greater, are almost absent in the present available research.

Based on the results of our review, we consider that knowledge about the causes of gender inequities in healthcare should permeate new research on how to increase gender equity and improve quality in clinical practice.

Implications for practice and/or policy

Future clinical practice interventions should be developed with a gender perspective and should be comprehensive, long-term, experimental, evaluated with standardized methods, and specifically developed to tackle gender bias. In addition, they should address not only the women-man dichotomy, but also the gender continuum. Interventions should consider facilitators and barriers to include gender perspective in healthcare and they should always be adapted to the specific context, moment and population targeted. Finally, successful implementation is not enough, monitoring is essential. Standardized indicators and audits need to be developed for a structural embedding of gender in clinical practice.

Availability of data and materials

All available data is included in the publication.

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Alcalde-Rubio, L., Hernández-Aguado, I., Parker, L.A. et al. Gender disparities in clinical practice: are there any solutions? Scoping review of interventions to overcome or reduce gender bias in clinical practice. Int J Equity Health 19 , 166 (2020). https://doi.org/10.1186/s12939-020-01283-4

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• 06 September 2023

Gender equality: the route to a better world

You have full access to this article via your institution.

The Mosuo people of China include sub-communities in which inheritance passes down either the male or the female line. Credit: TPG/Getty

The fight for global gender equality is nowhere close to being won. Take education: in 87 countries, less than half of women and girls complete secondary schooling, according to 2023 data. Afghanistan’s Taliban continues to ban women and girls from secondary schools and universities . Or take reproductive health: abortion rights have been curtailed in 22 US states since the Supreme Court struck down federal protections, depriving women and girls of autonomy and restricting access to sexual and reproductive health care .

SDG 5, whose stated aim is to “achieve gender equality and empower all women and girls”, is the fifth of the 17 United Nations Sustainable Development Goals, all of which Nature is examining in a series of editorials. SDG 5 includes targets for ending discrimination and violence against women and girls in both public and private spheres, eradicating child marriage and female genital mutilation, ensuring sexual and reproductive rights, achieving equal representation of women in leadership positions and granting equal rights to economic resources. Globally, the goal is not on track to being achieved, and just a handful of countries have hit all the targets.

How the world should oppose the Taliban’s war on women and girls

In July, the UN introduced two new indices (see go.nature.com/3eus9ue ), the Women’s Empowerment Index (WEI) and the Global Gender Parity Index (GGPI). The WEI measures women’s ability and freedoms to make their own choices; the GGPI describes the gap between women and men in areas such as health, education, inclusion and decision making. The indices reveal, depressingly, that even achieving a small gender gap does not automatically translate to high levels of women’s empowerment: 114 countries feature in both indices, but countries that do well on both scores cover fewer than 1% of all girls and women.

The COVID-19 pandemic has made things worse, with women bearing the highest burden of extra unpaid childcare when schools needed to close, and subjected to intensified domestic violence. Although child marriages declined from 21% of all marriages in 2016 to 19% in 2022, the pandemic threatened even this incremental progress, pushing up to 10 million more girls into risk of child marriage over the next decade, in addition to the 100 million girls who were at risk before the pandemic.

Of the 14 indicators for SDG 5, only one or two are close to being met by the 2030 deadline. As of 1 January 2023, women occupied 35.4% of seats in local-government assemblies, an increase from 33.9% in 2020 (the target is gender parity by 2030). In 115 countries for which data were available, around three-quarters, on average, of the necessary laws guaranteeing full and equal access to sexual and reproductive health and rights had been enacted. But the UN estimates that worldwide, only 57% of women who are married or in a union make their own decisions regarding sexual and reproductive health and rights.

Systemic discrimination against girls and women by men, in many contexts, remains a colossal barrier to achieving gender equality. But patriarchy is not some “natural order of things” , argues Ruth Mace, an anthropologist at University College London. Hundreds of women-centred societies exist around the world. As the science writer Angela Saini describes in her latest book, The Patriarchs , these are often not the polar opposite of male-dominated systems, but societies in which men and women share decision making .

After Roe v. Wade: dwindling US abortion access is harming health a year later

One example comes from the Mosuo people in China, who have both ‘matrilineal’ and ‘patrilineal’ communities, with rights such as inheritance passing down either the male or female line. Researchers compared outcomes for inflammation and hypertension in men and women in these communities, and found that women in matrilineal societies, in which they have greater autonomy and control over resources, experienced better health outcomes. The researchers found no significant negative effect of matriliny on health outcomes for men ( A.  Z. Reynolds et al. Proc. Natl Acad. Sci. USA 117 , 30324–30327; 2020 ).

When it comes to the SDGs, evidence is emerging that a more gender-equal approach to politics and power benefits many goals. In a study published in May, Nobue Amanuma, deputy director of the Integrated Sustainability Centre at the Institute for Global Environmental Strategies in Hayama, Japan, and two of her colleagues tested whether countries with more women legislators, and more younger legislators, are performing better in the SDGs ( N. Amanuma et al. Environ. Res. Lett. 18 , 054018; 2023 ). They found it was so, with the effect more marked for socio-economic goals such as ending poverty and hunger, than for environmental ones such as climate action or preserving life on land. The researchers recommend further qualitative and quantitative studies to better understand the reasons.

The reality that gender equality leads to better outcomes across other SDGs is not factored, however, into most of the goals themselves. Of the 230 unique indicators of the SDGs, 51 explicitly reference women, girls, gender or sex, including the 14 indicators in SDG 5. But there is not enough collaboration between organizations responsible for the different SDGs to ensure that sex and gender are taken into account. The indicator for the sanitation target (SDG 6) does not include data disaggregated by sex or gender ( Nature 620 , 7; 2023 ). Unless we have this knowledge, it will be hard to track improvements in this and other SDGs.

The road to a gender-equal world is long, and women’s power and freedom to make choices is still very constrained. But the evidence from science is getting stronger: distributing power between genders creates the kind of world we all need and want to be living in.

Nature 621 , 8 (2023)

doi: https://doi.org/10.1038/d41586-023-02745-9

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Gender and health

Gender norms, roles and relations, and gender inequality and inequity, affect people’s health all around the world. This Q&A examines the links between gender and health, highlighting WHO’s ongoing work to address gender-related barriers to healthcare, advance gender equality and the empowerment of women and girls in all their diversity, and achieve health for all.

Gender refers to socially constructed characteristics of women and men – such as norms, roles and relations of and between groups of women and men [1] .  Gender norms, roles and relations vary from society to society and evolve over time. They are often upheld and reproduced in the values, legislation, education systems, religion, media and other institutions of the society in which they exist. When individuals or groups do not “fit” established gender norms they often face stigma, discriminatory practices or social exclusion – all of which adversely affect health. Gender is also hierarchical and often reflects unequal relations of power, producing inequalities that intersect with other social and economic inequalities. 

[1] World Health Organization. (‎2011)‎.  Gender mainstreaming for health managers: a practical approach.  Geneva : World Health Organisation.

Gender interacts with but is different from sex. The two terms are distinct and should not be used interchangeably. It can be helpful to think of sex as a biological characteristic and gender as a social construct. Sex refers to a set of biological attributes in humans and animals. Sex is mainly associated with physical and physiological features including chromosomes, gene expression, hormone level and function, and reproductive and sexual anatomy.

Sex is often categorized as females and males, but there are variations of sex characteristics called intersex. The term ‘intersex’ is used as an umbrella term for individuals born with natural variations in biological or physiological characteristics (including sexual anatomy, reproductive organs and/or chromosomal patterns) that do not fit traditional definitions of male or female [1] . Infants are generally assigned the sex of male or female at birth based on the appearance of their external anatomy/genitalia.

[1] UN High Commissioner for Refugees. (2021). Need to Know Guidance: Working with Lesbian, Gay, Bisexual, Transgender, Intersex and Queer Persons in Forced Displacemen t .

Gender identity refers to a person’s innate, deeply felt internal and individual experience of gender, which may or may not correspond to the person’s physiology or designated sex at birth.

Gender expression refers to how an individual expresses their gender identity, including dress and speech [1] . Gender expression is not always indicative of gender identity. ‘Transgender’ is an umbrella term for people whose gender identity and expression does not conform to the norms and expectations traditionally associated with the sex assigned to them at birth; it includes people who are transsexual, transgender or otherwise gender non-conforming [2] .

Sexual orientation refers to a person’s physical, romantic and/or emotional attraction (or lack thereof) towards other people [3] .  It encompasses hetero-, homo- and bisexuality and a wide range of other expressions of sexual orientation [4] . Sexual orientation cannot be assumed from one’s assigned sex at birth, gender identity or gender expression. 

[1] World Health Organization. (‎2016)‎.  Frequently asked questions on health and sexual diversity: an introduction to key concepts . World Health Organization. 

[2] World Health Organization. (‎2016)‎.  Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations, 2016 update . World Health Organization.

[3] World Health Organization. (‎2016)‎.  Frequently asked questions on health and sexual diversity: an introduction to key concepts . World Health Organization.

[4] UN High Commissioner for Refugees. (2021). Need to Know Guidance: Working with Lesbian, Gay, Bisexual, Transgender, Intersex and Queer Persons in Forced Displacement .

Sex and gender interact in complex ways to affect health outcomes. Sex can affect disease risk, progression and outcomes through genetic (e.g. function of X and Y chromosomes), cellular and physiological, including hormonal, pathways. These pathways can produce differences in susceptibility to disease, progression of disease, treatment and health outcomes, and are likely to vary over the life-course.  For example, data shows that men experience more severe COVID-19 outcomes in terms of hospitalizations and deaths than women.  This is, in part, explained by higher quantities of angiotensin-converting enzyme found in men, which binds to the SARS-COV2 virus.

Gender norms, socialization, roles, differentials in power relations and in access to and control over resources contribute to differences in vulnerabilities and susceptibilities to illness, how illness is experienced, health behaviours (including health-seeking), access to and uptake of health services, treatment responses and health outcomes. For example, gender can determine health risks faced and taken. Data show that men’s increased risk of acquiring SARS-COV2, is also linked to their lower rates of handwashing, higher rates of smoking and alcohol misuse and, related to that – higher comorbidities for severe COVID-19 symptoms as compared to women.

Gender has implications for health across the course of every person’s life. Gender can influence a person’s experiences of crises and emergency situations, their exposure to diseases and their access to healthcare, water, hygiene and sanitation.

Gender inequality disproportionately affects women and girls. In most societies, they have lower status and have less control over decision-making about their bodies, in their intimate relationships, families and communities, exposing them to violence, coercion and harmful practices. Women and girls face high risks of unintended pregnancies, sexually transmitted infections including HIV, cervical cancer, malnutrition and depression, amongst others. Gender inequality also poses barriers for women and girls to access health information and critical services, including restrictions on mobility, lack of decision-making autonomy, limited access to finances, lower literacy rates and discriminatory attitudes of healthcare providers.

Gender diverse people are more likely to experience violence and coercion, stigma and discrimination, including from health workers. Data suggests that transgender individuals experience high levels of mental health illness – linked to the discrimination and stigma they face from societies and in healthcare settings [1] .

[1] Blondeel, Karel, de Vasconcelos, Sofia, García-Moreno, Claudia, Stephenson, Rob, Temmerman, Marleen. et al. (‎2018)‎.  Violence motivated by perception of sexual orientation and gender identity: a systematic review.   Bulletin of the World Health Organization, 96  (‎1)‎, 29 - 41L. World Health Organization. 

“Intersectionality” builds on, and extends, the understanding of how gender power dynamics interact with other power hierarchies of privilege or disadvantage, resulting in inequality and differential health outcomes for different people [1] . These factors include sex, gender, race, ethnicity, age, class, socioeconomic status, religion, language, geographical location, disability status, migration status, gender identity and sexual orientation.

For example, indigenous women have worse maternal health outcomes than non-indigenous women and are less likely to benefit from health care services in Latin America and the Caribbean. Therefore, inequities in maternal health between different ethnic groups should be monitored to identify critical, modifiable, health system and community factors that could limit health care coverage, including language, religion, territory and place of residence. Monitoring health inequities is essential for designing more effective programmes and policies to reduce health risks among indigenous women [2] .

[1] Manandhar, Mary, Hawkes, Sarah, Buse, Kent, Nosrati, Elias & Magar, Veronica. (‎2018)‎.  Gender, health and the 2030 agenda for sustainable development .  Bulletin of the World Health Organization, 96  (‎9)‎, 644 - 653. World Health Organization. 

[2] Paulino, Nancy Armenta, Vázquez, María Sandín & Bolúmar, Francisco. (‎2019)‎.  Indigenous language and inequitable maternal health care, Guatemala, Mexico, Peru and the Plurinational State of Bolivia .  Bulletin of the World Health Organization, 97  (‎1)‎, 59 - 67. World Health Organization. 

Harmful gender norms – including those related to rigid notions of masculinity – affect the health and well-being of boys and men. For example, notions of masculinity encourage boys and men to smoke, take sexual and other health risks, misuse alcohol and not seek help or health care. Such gender norms also contribute to boys and men perpetrating violence against women and girls. They also contribute to violence perpetrated against men including homicide, youth and gang violence, which are among leading causes of morbidity and mortality among young men. Harmful masculinities also have grave implications for men’s mental health.  

Societal expectations and norms around “manhood” lead men to engage in risk-taking behaviors; for example, being encouraged to have multiple sexual partners. In addition to affecting men’s health, this also leads to negative outcomes for women and children due to increased interpersonal violence, the transmission of sexually transmitted infections (STIs) and unintended pregnancy. Men’s lack of participation in domestic and care work adds to the high burden of unpaid care work often performed by women [1] .

[1] Pan American Health Organization. (2019). Masculinities and Health in the Region of the Americas . Washington, D.C.: PAHO. 

Gender mainstreaming is the process of assessing the implications for women, men and gender diverse people of any planned action within a health system, including legislation, policies, programmes or service delivery, in all technical areas and at all levels. It is a strategy for making the concerns and experiences of diverse women and men an integral dimension of the design, implementation, monitoring and evaluation of policies and programmes in all spheres so that they benefit equally and inequality is not perpetuated. Gender mainstreaming is not an end in itself but a strategy, an approach and a means to achieve the goal of gender equality.

Gender analysis identifies, assesses and informs actions to address inequality and inequity [1] . It is used to systematically identify differentials between groups of women and men, whether related to sex or gender, in terms of risk factors, exposures and manifestations of ill-health, severity and frequency of diseases, health seeking behaviours, access to care and experiences in health care settings, as well as outcomes and impact of ill-health. Systematically collecting and analyzing data disaggregated by sex and additional factors such as age, ethnicity, socio-economic status and disability, is critical.

[1] World Health Organization. (‎2011)‎.  Gender mainstreaming for health managers: a practical approach . Geneva : World Health Organisation. 

Gender equality and the empowerment of women and girls are central to the 2030 Agenda for Sustainable Development and all 17 Sustainable Development Goals (SDGs). Ensuring health and well-being for all at all ages (SDG 3) cannot be achieved without addressing the specific barriers and challenges faced by women, men, girls, boys and gender diverse people. Gender equality (SDG 5) is a development goal in its own right and there are 45 targets and 54 gender-specific indicators addressing gender equality across all of the SDGs. Achieving these targets and closing gender inequalities will therefore create a multiplier effect across all of the SDGs and accelerate their achievement.

WHO’s work on gender is aligned with and supports the advancement of the SDGs, especially SDG3 and SDG5. The achievement of SDG3 on universal health coverage and SDG 5 on gender equality are co-dependent – without strengthening gender equality in the health workforce, across communities and across the world, universal health coverage cannot be attained. The WHO is committed to non-discrimination and to leaving no-one behind and seeks to ensure that every person, regardless of gender or sex, has the opportunity to live a healthy life. 

WHO’s 13 th General Programme of Work (2019-23) recognizes the need to promote gender equality and to mainstream gender in all of the Organization’s work. WHO develops norms, standards and guidelines and delivers training on gender-responsive health service provision and delivery, and commissions research on issues focusing on gender equality, human rights and health equity.

WHO also supports country-level action to strengthen health sector response to gender-based violence as well as to address gender equality in health workforce development and gender-related barriers to health services. WHO works to challenge gender stereotypes and to implement programmes, services and policies that promote gender equality in order to achieve health equity and Universal Health Coverage.

WHO regularly reports on the UN System-wide Action Plan for Mainstreaming Gender Equality and the Empowerment of Women (UN-SWAP) to foster accountability and monitor progress towards gender equality.  WHO is committed to increasing diversity and women’s meaningful participation within the Organization at all levels. Institutional policies to promote women’s career development, increase gender parity, end all-male panels, address work−life balance and prevent harassment in the workplace are being implemented in the Organization. The WHO Director General is a Gender Champion for the International Gender Champion (IGC) Parity Panel Pledge.

Human rights

Violence against women

Gender mainstreaming for health managers

Improving women’s health and gender justice since the 1995 Beijing Platform for Action

International Gender Champion (IGC) Parity Panel

More From Forbes

Just your imagination the dangerous gender bias in women’s healthcare.

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Advocate for yourself

By Renee Goyeneche—

Can women expect to receive the same standard of medical care as their male counterparts?

 According to a 2019 study, most women believe the healthcare industry fails to address their needs appropriately – and that gender plays a role. In fact, 52% of women believe that gender discrimination  negatively impacts  their medical care. Women are far more likely than men to report they feel challenged to prove the legitimacy of their symptoms and pain levels, and the gender disparity rises even more sharply when the subject is a woman of color.

It’s not an unfounded impression; research bears out the claim that women have to push longer and harder to get a medical diagnosis. For example, women are typically diagnosed 2.5 years later for cancer and 4.5 years later for diabetes – and these aren’t isolated occurrences. All told, women are diagnosed  later than men  in more than 700 diseases.

 Part of the problem lies in a lack of understanding about how illnesses can manifest differently in men and women. Historically, women were excluded from clinical trials due to concerns about possible long-term effects on their fertility and unborn children. Their exemption from the bulk of research has translated to less insight regarding typical disease indicators for women. While current trials are beginning to turn the tide in that arena, the imbalance still exists.

 Consequently, a woman’s symptoms may fail to fall in line with the male-based “medical standard” – and the issue can be further complicated by gender stereotyping. Not only does her disease look different, but societal expectations also dictate that a woman should be accommodating and accepting. A strident refusal of diagnosis may be viewed as confidence in men but perceived as hysteria in women. The assumption is not that the diagnosis could be incorrect; rather, she cannot control her emotions and may have mental health issues. Messaging from the medical community will often suggest that a woman’s symptoms are “all in her head.” Doctors chalk her complaints up to psychosomatic illness and conduct no further testing.

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This “protocol” is not just frustrating. It’s dangerous. A dismissal of symptoms can cause a woman to second-guess her concerns and “learn to live with it” or, at the very least, force her to contact another provider. Either scenario serves to delay a correct diagnosis. In some cases, that delay may mean the difference between life and death.

This medical marginalization is a form of gaslighting, and it has to stop. 

Signs you’re being medically gaslighted by your healthcare provider 

Gaslighting is a phenomenon wherein someone manipulates you into feeling that you cannot (or should not) trust your memories, feelings, or senses. It involves a series of psychological tactics designed to invalidate your experience and can occur during a variety of interactions, including those with your medical provider.    Here are some red flags:  

• They question your account of the issue, even when you express no ambiguity or provide a specific description and/or documentation of the problem.
• They refuse to listen or seem to deliberately misunderstand what you’re saying. They’re condescending in their replies and imply that you’re misinterpreting the issue.
• They suggest that your symptoms are “normal” and that your feelings are either unimportant or, worse, irrational. They may indicate that you’re having a hysterical response and introduce the idea that mental health issues are the root of your “problem.”
• They redirect the conversation instead of responding to your concerns.

Victims of gaslighting may experience a loss of mental equilibrium, anxiety, and depression. They may lose self-confidence and self-esteem, question the legitimacy of their illness, or wonder whether they’ll ever see a resolution of their issue. Feeling unheard and dismissed may also foster a woman’s distrust of the medical community as a whole and contribute to a pattern of delayed reporting, diagnosis and treatment.

What you can do:

Prioritize your health . We can be our own worst enemies when it comes to our well-being. Studies conducted during COVID-19 show that the increased burden of responsibility women have borne during the pandemic has made them even more likely to  skip preventative care  than men. 

Look for a practice with a diverse medical team , including staff of both sexes and differing ethnicities. A good practice understands that various factors, including age, race, ethnicity, and gender influence health and know that a diverse team helps provide more comprehensive care. 

Advocate for yourself.  Don’t allow your concerns to be swept under the rug. If you leave your doctor’s office feeling like your worries have been dismissed or not taken seriously, get a second opinion or a third. Keep asking questions until the answers begin to make sense, even if that means demanding a consultation with a women’s health professional. 

  Renee Goyeneche: I am a writer and research editor focusing on information that benefits women, children, and families. Find me on  Twitter  and blogging at  Imperfect Perceptions .

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Gender Identity, Race, and Ethnicity-based Discrimination in Access to Mental Health Care: Evidence from an Audit Correspondence Field Experiment

Racial, ethnic, and gender minorities face mental health disparities. While mental health care can help, minoritized groups could face discriminatory barriers in accessing it. Discrimination may be particularly pronounced in mental health care because providers have more discretion over accepting patients. Research documents discrimination broadly, including in access to health care, but there is limited empirical research on discrimination in access to mental health care. We provide the first experimental evidence, from a correspondence audit field experiment (“simulated patients” study), of the extent to which transgender and non-binary people, African Americans, and Hispanics face discrimination in access to mental health care appointments. We find significant discrimination against transgender or non-binary African Americans and Hispanics. We do not find evidence of discrimination against White transgender and non-binary prospective patients. We are mostly inconclusive as to if cisgender African Americans or Hispanics face discrimination, except we find evidence of discrimination against cisgender African American women.

The views expressed in this paper do not necessarily represent the views of the Office of Evaluation Sciences, the General Services Administration, or the United States government. We are thankful for grant support from the National Science Foundation through an NSF CAREER grant to Patrick Button (#2046642), and funding from Tulane University’s Murphy Institute, the School of Liberal Arts, the Newcomb Institute, and the COR Research Fellowship. Luca Fumarco acknowledges the generous support from the NPO "Systemic Risk Institute" number LX22NPO5101, funded by European Union -Next Generation EU (Ministry of Education, Youth and Sports, NPO: EXCELES) and from the CERGE-EI Foundation Teaching Fellowship Program. The views expressed are our own and not those of any funders. We thank Sean Alvarez, Barb Lundebjerg, Emma Brick-Hezeau, Kyla Denwood, Batu El, Victoria Guest, Christopher Hoffler, Yu Liu, Lucía Paternostro, Nile Pierre, Matthew Shernicoff, Gregory Shoats, Kodhai Thirumalai, and Brandon Ware for excellent research assistance and comments. We also thank Stephanie Budge, Erik Plug, David Slusky, John Cawley, Joanna Lahey, Brigham Walker, and Janna Wisniewski for helpful feedback. We received helpful feedback from seminar and conference participants at ASSA 2021 and 2023 CSQIEP Virtual Seminar on Economics of LGBTQ+ Individuals, CERGE-EI, Charles University, FBK IRVAPP, Ohio University, Online Seminar on Discrimination and Disparities, RAND, SEA 2020 and 2022, University College Dublin, and the Vanderbilt LGBTQ+ Policy Lab Works in Progress Seminar. This study was approved by the Tulane University IRB (2019-1122-TU Uptown). This experiment was pre-registered at the American Economic Association's registry for randomized controlled trials (RCT ID: AEARCTR-0006560). The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

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• December 2, 2020

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Luca Fumarco & Benjamin J. Harrell & Patrick Button & David J. Schwegman & E Dils, 2024. " Gender Identity-, Race-, and Ethnicity-Based Discrimination in Access to Mental Health Care, " American Journal of Health Economics, vol 10(2), pages 182-214.

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Research: How Bias Against Women Persists in Female-Dominated Workplaces

• Amber L. Stephenson,
• Leanne M. Dzubinski

A look inside the ongoing barriers women face in law, health care, faith-based nonprofits, and higher education.

New research examines gender bias within four industries with more female than male workers — law, higher education, faith-based nonprofits, and health care. Having balanced or even greater numbers of women in an organization is not, by itself, changing women’s experiences of bias. Bias is built into the system and continues to operate even when more women than men are present. Leaders can use these findings to create gender-equitable practices and environments which reduce bias. First, replace competition with cooperation. Second, measure success by goals, not by time spent in the office or online. Third, implement equitable reward structures, and provide remote and flexible work with autonomy. Finally, increase transparency in decision making.

It’s been thought that once industries achieve gender balance, bias will decrease and gender gaps will close. Sometimes called the “ add women and stir ” approach, people tend to think that having more women present is all that’s needed to promote change. But simply adding women into a workplace does not change the organizational structures and systems that benefit men more than women . Our new research (to be published in a forthcoming issue of Personnel Review ) shows gender bias is still prevalent in gender-balanced and female-dominated industries.

• Amy Diehl , PhD is chief information officer at Wilson College and a gender equity researcher and speaker. She is coauthor of Glass Walls: Shattering the Six Gender Bias Barriers Still Holding Women Back at Work (Rowman & Littlefield). Find her on LinkedIn at Amy-Diehl , X/Twitter @amydiehl , and visit her website at amy-diehl.com .
• AS Amber L. Stephenson , PhD is an associate professor of management and director of healthcare management programs in the David D. Reh School of Business at Clarkson University. Her research focuses on the healthcare workforce, how professional identity influences attitudes and behaviors, and how women leaders experience gender bias.
• LD Leanne M. Dzubinski , PhD is professor of leadership and director of the Beeson International Center at Asbury Seminary, and a prominent researcher on women in leadership. She is coauthor of Glass Walls: Shattering the Six Gender Bias Barriers Still Holding Women Back at Work (Rowman & Littlefield).

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A qualitative study on gender inequality and gender-based violence in Nepal

• Pranab Dahal 1 ,
• Sunil Kumar Joshi 2 &
• Katarina Swahnberg 1  

BMC Public Health volume  22 , Article number:  2005 ( 2022 ) Cite this article

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Gender inequality and violence are not mutually exclusive phenomena but complex loops affecting each other. Women in Nepal face several inequalities and violence. The causes are diverse, but most of these results are due to socially assigned lower positioning of women. The hierarchies based on power make women face subordination and violence in Nepal. The study aims to explore participants' understanding and experience to identify the status of inequality for women and how violence emerges as one of its consequences. Furthermore, it explores the causes of sex trafficking as an example of an outcome of inequality and violence.

The study formulated separate male and female groups using a purposive sampling method. The study used a multistage focus group discussion, where the same groups met at different intervals. Six focus group discussions, three times each with male and female groups, were conducted in a year. Thirty-six individuals, including sixteen males and twenty females, were involved in the discussions. The study used constructivist grounded theory for the data analysis.

The study participants identify that a power play between men and women reinforce inequality and increases the likelihood of violence for women. The findings suggest that the subjugation of women occurs due to practices based on gender differences, constricted life opportunities, and internalization of constructed differences among women. The study identifies that interpersonal and socio-cultural violence can result due to established differences between men and women. Sex trafficking, as an example of the outcome of inequality and violence, occurs due to the disadvantageous position of women compounded by poverty and illiteracy. The study has developed a concept of power-play which is identified as a cause and consequence of women's subordination and violence. This power play is found operative at various levels with social approval for men to use violence and maintain/produce inequality.

The theoretical concept of power play shows that there are inequitable power relations between men and women. The male-centric socio-cultural norms and practices have endowed men with privilege, power, and an opportunity to exploit women. This lowers the status of women and the power-play help to produce and sustain inequality. The power-play exposes women to violence and manifests itself as one of the worst expressions used by men.

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Violence against women is identified as an attempt by men to maintain power and control over women [ 1 ] and is manifested as a form of structural inequality. This structural inequality is apparent with greater agency among men [ 2 ]. The differences between sexes are exhibited in the attainment of education and professional jobs, ownership of assets, the feminization of poverty, etc., and these differences increase the risk of violence towards women [ 3 ]. The global estimate identifies that thirty percent of women experience physical and/or sexual violence during their lifetime, illustrating the enormity of this problem [ 4 ]. From a feminist perspective, lending ideas of patriarchy [ 5 ] and gender performativity [ 6 ], the understanding of gender roles prescribed by male-dominated social structures and processes helps further explore the violence and abuse faced by women [ 7 ]. According to Heise [ 8 ], men who adhere to traditional, rigid, and misogynistic views on gender norms, attitudes, and behaviors are more likely to use violence towards women. The individual and collective attitudes of men toward different established gender norms, and their reproduction explain men’s use of violence toward women [ 9 ]. It is known that gender norms influence violence, but at the same time violence also directs and dictates gender performance with fear, sanction, and corrective measures for enacting respective prescribed gender functions [ 10 ].

It is difficult for women subjected to violence to enjoy legitimate rights, as most of the infringement of their rights and violence takes place inside a private sphere of the home [ 11 , 12 ]. Violence against women is the major cause of death and disability for women [ 13 ] and globally a major public health concern [ 14 ]. Establishing gender equality is fundamental for fostering justice and attaining sustainable development [ 15 ]; moreover, violence against women has to be acknowledged as a fundamental abuse of human rights [ 16 ]. A report on global violence has identified that violence against women exists at all levels of the family, community, and state. The report recommended the development of frameworks for respecting, protecting, and fulfilling women’s rights [ 17 ]. Fifteen years later, a review of the same identifies that violence continues with impunity, reaffirming violence as a major obstacle to the attainment of justice [ 18 ].

The inclusion of the gender lens to violence against women has provided more contextual evidence to explore these processes of violence. This requires the identification of unequal power relationships and an inquiry into the differences-producing various gender stereotypes [ 19 ]. This analysis of violence requires an understanding of behaviors that promote women’s subordination and factors that favor men to sustain these malpractices [ 8 ]. A closer look at the male-centric structural arrangements embedded in the social, political, and economic organization of life reveals that these structures provide lesser access and lower accountability toward women, promote systemic subordination, and create hierarchies, resulting in the increase of violence against women [ 20 ]. This unequal gender power relationship reinforced and manifested by social approval of men’s authority over women is found operative at multiple levels and helps to produce diversities of inequalities and violence [ 21 , 22 ].

The inequalities faced by women in Nepal majorly stem from socio-cultural, economic, and religious factors and influencers that define traditional roles and responsibilities between men and women [ 23 ]. The inequalities are more evident and pronounced in settings exhibiting prominent patriarchal norms restricting advantages and opportunities for the majority of women [ 24 ]. Women in Nepal are restricted inside their homes, have lesser access to life opportunities, and have limited or no involvement in decision-making on important issues directly affecting their lives [ 25 , 26 ]. Figures indicative of women’s inequalities in Nepal suggest that one-third of women have no education, fifty-two percent of women are involved in non-paid jobs, and women are less likely than men to own a home or land [ 27 ]. The men in Nepalese society are positioned higher and are expected to be the breadwinner and protectors of their families. Most of these men intend to earn respect and obedience from women and are socially expected to discipline women to achieve it [ 28 ]. Many societies across the world including Nepal, recognizes violence as a private affair requiring discussion only within a family. This has led to a serious underreporting of violence committed toward women in Nepal [ 29 ]. The national gender data in Nepal is scarce, the available Nepal Demographic Health Survey 2016 identifies that since the age of fifteen, twenty-two percent of women and seven percent of women experience physical and sexual violence, respectively in the past twelve months [ 27 ].

The contributing factors for violence against women in Nepal include the lower social status of women, illiteracy, economic dependency, patriarchal society, sex trafficking, alcohol-related abuse, dowry-related violence, infidelity, extramarital affairs of husband, unemployment, and denial of sex with husband [ 30 , 31 , 32 ]. Nepalese women have been repressing violence with silence due to the fear of breaking relationships, receiving less love and affection from family, fear of social norms by going against men, lack of faith in the justice system, and the threat of increased violence [ 33 ]. Women and girls in Nepal are sex trafficked to various countries. Sex trafficking in Nepal is prevalent due to persistent gender inequality, violence, stigma, and discriminatory socio-cultural structures; however, the actual extent of sex trafficking is still undetermined [ 17 , 34 , 35 ].

The recent trends in Nepal with the increasing number of out-migration of men for employment have provided women with temporary autonomy, and a shift in the gender roles. Earlier research has identified that migration of male spouses has provided a resistance to the power dynamics for women on the other hand it has limited their mobility, required them to share decision-making with household structures, face continued social vigilance on the money received from remittance, and get central attention with their personal sexual lives [ 36 , 37 ].

Morang district lies in the eastern region of Nepal. A district profile report based on a census survey [ 38 ] identifies that the place is inhabited by a close to a million population, out of which ethnic groups ( close to forty percent) live in the district with a majority (seventy-eight percent) of its population living in the rural areas. Tharu an ethnic group is one of the dominant population in the study area and all study participants for this study were from same Tharu population. A close to thirty-six percent of women in the district are illiterate and the average age of marriage is eighteen years. The report identifies that only twenty-three percent of women engage in economic activities apart from agricultural work and less than fourteen percent of women head the household. Almost eighty percent of the population in the district practice Hinduism.

This study is a part of a large intervention project and it was focused to establish a qualitative baseline of the gender status in the study area. This study aimed to explore participants’ experiences and understanding of gender inequality, violence against women, and information on sex trafficking in the Morang district of eastern Nepal. The selection of sex trafficking topic was motivated to assess the respondents’ general understanding of one of the consequences of inequality and violence faced by women. The study focused to explore factors that help to produce and sustain the practice of gender inequality and violence against women in the local community.

Participants

This study was part of a larger control-comparison project that used Forum Theatre interventions to promote gender equality, reduce violence against women, and increase awareness of sex trafficking [ 39 , 40 ]. The participants for the focus group discussion included the intervention population from one of the randomly sampled intervention sites. A multistage focus group discussion [ 41 ] was used involving the same participants discussing various emerging topics at different periods. The participants were recruited voluntarily during an earlier quantitative data collection for the project. The study used a purposive sampling method for the selection of participants. The local field staff at the study site facilitated the recruitment of the participants. The study formulated separate male and female groups. A total of six focus groups, three each with male and female groups were conducted over twelve months. Two inclusion criteria were set for participation. First, the participants had to be part of the population of the larger study. Secondly, they had to witness and/or participate in the Forum Theatre interventions conducted in between the study. The set inclusion criteria served a dual purpose of understanding the causes of inequality and violence and further helped to develop and determine the efficacy of participatory Forum Theater intervention for awareness-raising among the study intervention groups [ 39 ].

A total of thirty-six participants consisting of sixteen males and twenty females joined the discussions. The first discussion consisted of eight participants each from groups while the second and the third discussion missed two female and four male participants respectively. The majority of the participants were 20–29 years old. Tharu, an ethnic community of Nepal, is a dominant population in the study area, and all the participants belonged to the same Tharu community. Only one female participant was unmarried, and a single married male participated in the discussions. All participants were literate, with four males completing a bachelor's level of education. Seven female participants had education below the high school level. The nuclear family with parents and their children was the major family type identified in both male and female groups. Table 1 provides the detail of the participants.

The focus group discussions were conducted in January 2017, April–May 2017, and January 2018. The discussions were conducted in a place recommended by the participants. An isolated place in an open setting at the premise of a local temple was used for conducting all discussions. The participants were briefed about the objectives of the discussion and written consent was obtained for their participation. Verbal consent was taken for the audio recording of the discussions. Each participant was assigned a unique numerical code before the discussions to ensure anonymity during recording, note-taking, and analysis. The discussions averaged ninety minutes during each session. The discussions were conducted with the same participants and no new participants were added during the follow-ups. A single male and female participant were missing in the second follow up and two male participants missed the final follow-up. The reason for missing participants was due to their unavailability as they were out of the village due to personal reasons.

The discussions were conducted in the Nepali language. The first author moderated all six discussions, a support field staff member took the notes, and the last author observed the discussions. The audio recordings were translated into English, and the transcriptions were checked with the recordings to verify accuracy. The field and the discussion notes were used during various stages of data analysis. The notes provided information on the discussion setting, as well as the verbal and nonverbal expressions of the participants. The notes helped to assess the impressions, emphasis, and feelings of the participants during the discussions.

The discussions used pre-formulated discussion guides with open-ended questions on inequalities, gender practices, violence, and sex trafficking. The guiding questions were based on the theoretical premise of discrimination, patriarchy, oppression, hegemony, and participation of women. Three separate discussion guides were developed for each of discussions. The guides were developed by the first and last authors. Probing was done on several occasions during the discussion to gain more clarity on the issue. Cross-checking among the participants and between the groups was done to triangulate received information. Any topic deemed appropriate for discussions and/or any unclear issues identified during the initial data analysis came up subsequently in the discussion guide during the follow-ups.

Data analysis

This study used the constructivist grounded theory method. This method adheres to a constructivist philosophical approach wherein both researchers and participants mutually co-construct the meaning of a phenomenon [ 42 ]. This interaction is important since it helps to impart the meaning of shared experiences [ 42 ]. The constructivist grounded theory made it possible to (re) discover gender issues, important for both the researcher and the study participants. This method allowed the study to progress with responsiveness to emerging issues with an in-depth exploration of the identified issues. This clarity was achieved through repeated interactive discussions, analysis of explanations, and sharing of emergent findings with the study participants.

The audio recordings were translated and transcribed into English. Six transcripts from discussions were initially analyzed using a line-by-line coding process. The coding process helped with the fragmentation of data through interactive comparisons. Fifty-two initial codes such as gender differences, restricting women, alcohol-related violence, underreporting of sexual violence, coping, etc. were identified. The later stage of focused coding helped to achieve categorized data, providing logical sense to the developed initial codes. Three focused codes, namely, the subjugation of women, violence, and chasing dreams were formulated during the analysis. The abductive reasoning from the codes, memos, and discussion notes helped to develop the theoretical concept. The development of conceptual abstraction involved an iterative comparison of the data, codes, categories, memos, and discussion notes.

The constant communication between the authors during the stages of data analysis such as the formulation of codes, explanations of concepts, and categories helped to refine the analysis. The shared experiences of the participants and the description of the data collection and analysis included substantial details, enabling comparisons for future research and application to other similar contexts. The reliability of the study is warranted by the theoretical saturation [ 42 ] achieved by this study. This is supported by prolonged engagement with the study participants with communication on the emerging findings, and triangulation.

Reflexivity has a greater significance for the constructivist approach. The first and the second author of Nepalese origin were aware of the socio-cultural norms, stereotypes, values, and stigmas associated with gender in the local context. This helped the study to ascertain the depth of inquiry within the acceptable local normative limits. The non-Nepalese author, familiar with the study participants and Nepalese contexts, witnessed the discussions as an observer. The prior knowledge of the authors helped to critically assess different schemas, perspectives, and explanations shared by the participants. The universality of gender inequality and violence against women and its re-examination in the local context helped the authors to build upon existing knowledge by providing contextual explanations. The diversities among the authors and research participants established a basis for co-creating the perceived and observed realities.

The section below describes the participants’ perceptions and understanding of inequality and violence. The section contains subheadings that were derived as themes in the data analysis. The first theme subjugation of women; discusses how norms, beliefs, and practices produce inferior status and positions for women. The second theme domestic and gender violence; provides a narrative of interpersonal and socio-cultural violence present in the study area. The theme of chasing dreams; discusses the process of sex trafficking as an outcome of violence. The theoretically abstracted concept of power-play identifies the cause for the generation of power imbalance producing inequality and the use of violence by men.

Subjugation of women

The subjugation of women reflected practices and beliefs imparting positional differences for women and their social situation compared to men. The participants shared a common understanding that belief systems adhering to male supremacy have positioned women in a lower status. They provided examples of social practices of male supremacy such as males being considered as the carrier of a family name, legacy, and heritage, while women were referred to as someone else’s property. The socialization of the idea that girls will be married off to a husband and relocate themselves to their homes was identified as the major reason for instilling and perpetuating early gender differences. The participants mentioned that discriminatory practices and seclusion have situated women at the bottom rung of the gender hierarchy, establishing them as socially incompetent individuals or groups. Moreover, they inferred that selective preferences provided preparatory grounds for inequalities, and they remain attached to women throughout their lives. The participants provided examples of unequal access to education and life opportunities as a practice of selective preferences occurring in the community. They mentioned that socialization with these discriminatory beliefs and their practice helped to develop specialized gender roles from an early age. The participants provided an example of how gender intersected with mobility and resource generation in the community, it was clear from the discussions that this has restricted women inside homes but provided freedom and opportunities for men. A female participant expressed,

A woman from a poor family is more than willing to work and support her family. But she is not allowed by the men in the family to work outside of the home.

The participants informed that differences between the sexes were visible for women from a young age. Sharing practical examples from the community, the participants from both groups stated that girls received education mostly in low-cost government and community schools, while boys were enrolled in expensive private schools. They raised concerns that this selective investment for education, cited as the ‘building block of life’ by the participants, installed lesser capacity, and negotiating abilities in girls. A female participant stated,

There are differences in educational opportunities for boys and girls in our community. Family provides more support for a boy’s education by enrolling him in private schools, while a girl mostly gets her education in a community school together with engagement in household work.

The discussions revealed that women required several male anchors for their survival during their various stages of life. The participants provided examples of the shift of anchors for women which traversed from a father to a husband during marriage and later to the male child during her old age. They believed that this tradition of transferring women’s identity established men as a higher social category and stripped women of their individuality and identity. A male participant added,

Women have to remain dependent on men throughout their lives, first with their fathers and later with their husbands. They remain completely dependent as they are not economically active. This makes men believe that they have higher authority.

The female participants provided an example of marriage to illustrate how someone else’s decision-making had been affecting women’s lives. A participant explained that women were held responsible for household activities after marriage and any support for career progression or education was restricted despite her desire for its continuation. It was inferred that women had to drop their hopes and aspirations as the husband and his family made decisions for them. The female participants agreed that this continuous exposure to the ideas of male supremacy makes them start to believe and internalize the idea that women have lesser cognitive abilities and intelligence compared to men. A female participant stated,

Men and women certainly have different mental abilities. Men think and act differently often in a smart way compared to women.

The participants from both groups expressed that youth in the community were developing flexible attitudes and beliefs towards gender roles and responsibilities. They agreed that both young men and women were observed altering their roles and responsibilities shifting from traditional gender ideologies. The participants expressed that instilling these fluidity and flexible approaches in the older generation was impossible as they strictly followed traditional beliefs and practices. Few of the female participants admitted that at times young women also fail to accommodate the situation and reap benefits from available opportunities. The discussions revealed that a few of the women in the community received opportunities for independence and economic empowerment. These women had received entrepreneurial training and various skill development activities for sustaining livelihoods with practical skill-based training in tailoring, beautician, and doll-making. The female participants expressed that opportunities for independence and growth slipped away from them due to a lack of family support, financial constraints, and self-passivity. They explained that starting a business required approval from a family which was difficult to obtain. Moreover, if women made a self-decision to start up on their own, they lacked the initial capital and had to rely on men for obtaining resources. The participants further explained that the denial of men to support women were majorly due to the fear that norms of staying indoors for women will be breached and economic independence may enable women to have a similar financial footing as men. The participants stated that self-passivity in women emerged due to their engagement in household multiple roles, dependency upon males, and lack of decision-making power and abilities. A female participant summed it up by stating,

Some of us women in the community have received entrepreneurial skills training, but we have not been able to use our skills for our growth and development. Once the training finishes, we get back to our household chores and taking care of the children.

The female participants admitted that acceptance of belief systems requiring women to be docile, unseen, and unheard were the reasons for this self-passivity. The female participants resonated that the external controlling and unfavorable environment influenced by practices of discriminatory norms and beliefs developed self-passivity for women. A female participant expressed the cause and consequence of self-passivity as,

Women have inhibitions to speaking their minds; something stops us from making our position clear, making us lose all the time.

The discussions identified that gender norms were deeply engraved in various social interactions and daily life, and any deviance received strict criticism. The participants shared common examples of sanctions for women based on rigid norms like restrictive movements for women, social gossiping when women communicated with outsider men, prohibition for opinion giving in public, and lesser involvement during key decision-making at home. The participants shared that norms dictating gender roles were in place for both men and women with social sanctions and approval for their performance. A male discussion participant who occasionally got involved with cooking which was a so-called “women’s job” faced outright disapproval from his female relatives and neighbors. The male participant stated,

If I cook or get engaged in any household jobs, it is mostly females from the home and neighborhood who make fun of me and remind me that I am a man and that I should not be doing a woman’s job.

The foreign migration of youth looking for job opportunities has affected the Tharu community. It was known that a large number of men were absent from the community. The participants stated that women in such households with absent men had gained authority and control over resources, moreover, these women have been taking some of the men’s roles. The participants disclosed that these women had greater access and control over resources and were involved in the key decision-making positioning them in a relatively higher position compared to other women. It was known that this higher position for women came with a price, they were under higher social vigilance and at higher risk of abuse and violence due to the absence of ‘protective men’. It was known that women's foreign employment was associated with myths and sexist remarks. The participants shared that women had to face strict social criticisms and that their plans for livelihood and independence were related to an issue of sexual immorality and chastity. The participants from both groups strictly opposed the norms that associated women with sexual immorality but lamented that it continues. A male participant provided an insight into the social remarks received by women if she dares to go for foreign employment,

If a woman wants to go for a foreign job, she is considered to be of loose character. The idea that she is corrupt and will get involved in bad work will be her first impression of anyone.

Although the participant did not explicitly describe what bad work referred to as but it was inferred that he was relating it to sex work.

Domestic and gender violence

The participants identified violence as control, coercion, and use of force against someone will occurring due to unequal status. They primarily identified men as the perpetrators and women as the victims of violence. They explained that two types of violence were observed in the community. The first type occurred in an interpersonal relationship identified as physical, emotional, and sexual violence. The second type, as explained by the participants had its roots in socio-cultural belief systems. They provided examples of dowry exchange and witchcraft accusations for the latter type. The participants identified women as primary victims and listed both men and women as the perpetrators of both types of violence. They reported that physical violence against women by men under the influence of alcohol was the most commonly occurring violence in the community. The participants from both groups confirmed that wife-beating, verbal abuse, and quarrel frequently occurred in the community. It was known from discussions that alcohol consumption among men was widespread, and its cultural acceptance was also increasing episodes of violence. One of the female participants clarified further,

The most common violence occurring in our society is wife-beating by a husband under the influence of alcohol. We see it every day.

The participants reported the occurrence of sexual violence in the community but also pointed out that people refrained from discussing it considering it a taboo and private affair. The participants had hesitation to discuss freely on sexual violence. During the discussions, participants from both groups informed only of rape and attempted rape of women by men as sexual violence present in the community. Despite repeated probing, on several occasions, none of the participants from either group brought up issues and discussions about any other forms of sexual violence. Participants from both groups confirmed that stories about incidents of rape or attempted rape emerged only after cases were registered with the local police. The participants presumed that incidents of rape and attempted rape were not known to the wider community. A female participant stated,

Sexual violence does occur in our community, but people mostly do not report or disclose it, but they tend to keep it amongst themselves and their families.

The participants explained the identity of the rape perpetrator and victim. They identified the perpetrator as a rich, influential, and relatively powerful man from the community. The victim was portrayed as a poor and isolated woman which lesser social ties. It was known from the discussions that most of the rape cases in the community were settled with financial negotiations and monetary compensations for the victim rather than finding legal remedies. It can be inferred that the victimization of women intersects with gender, wealth, social stature, and affluence. The participants feared that this practice of settlement of rape with money could make rape a commodity available for the powerful, rich, and affluent men to exploit and victimize women. A male participant clarifies,

Recently, a man in his sixties raped a young girl near our village. The victim's family was ready to settle with monetary compensation offered by the rapist, but the involvement of the community stopped it and the rapist was handed over to the police.

The participants shared available coping mechanisms against violence practiced in the community by women. It was learned that the victim of household violence mostly used community consultation and police reporting to evade further violence. They divulged that community consultation and police reporting resulted in decisions in favor of victim women, directing abusive husbands to show decency and stop committing violence. The fear of legal repercussions such as spending time in police custody and getting charged under domestic violence cases was understood as the reasons for husbands to stop abuse and violence. The discussions revealed that women who file a formal complaint about their husband’s violent behavior could face an increased risk of violence. The participants disclosed that sharing such incidents publicly brought shame to some of the men and increased their anger, and often backlashed with increased violence. The participants in both groups stated that not all women in the community reported violence. They identified that women tend to be quiet despite facing continuous violence due to the fear of encountering more violence and to keeping their families together. A female participant clarifies,

Lodging public complaints against the abusive husband can sometimes escalate the violence. The husband’s anger for being humiliated in public must be faced by the woman inside the closed doors of the house with more violence and the men’s threat of abandoning the relationship.

The participants stated that socio-cultural violence against women in dowry-related cases was widespread and increasing. The dowry exchange was explained as a traditional practice with the family of the bride paying cash and kind to the groom's family. The participants clarified that the practice of dowry in the earlier days must have been an emergency fund for the newly wedded bride in a newer setting. According to the participants, the system of dowry has now developed and evolved as a practice of forced involuntary transfer of goods and cash demanded by the groom’s family. The discussions disclosed that the demands for dowry were increasing with time and failing to provide as promised immediately resulted in violence for the newly wedded bride. The participants described that dowry-related violence starts with taunts and progresses to withholding of food, verbal abuse, and finally, physical violence. They added that perpetrators of such violence were both men and women from the groom’s family. They stated that due to poverty not all bride families in the community were able to supply all demanded dowry which has exposed a large number of women to face dowry-related abuse and violence. The discussions also informed of a newer trend among girls by demanding goods during their wedding. It was shared that this new emerging trend had increased a two-fold financial burden on the bride’s family with heavy marriage debts. The male participants when questioned about the dowry demands cunningly shifted the responsibilities towards family and stated that it was not the groom but their families who were making such dowry demands. The discussions verified that dowry practice was so engraved in the community that it was impossible to even imagine a marriage without any dowry. A male participant reflected,

If I marry without any dowry, my family, neighbors, and all whom I know would consider that I am insane.

The participants also discussed and identified harmful traditional practices present in the community. The participants informed a common practice of accusing women of as witches existed in the community. It was mentioned that women faced witchcraft allegations in different situations. They provided examples of witchcraft allegations in common situations such as when someone’s cow stops producing milk when a child has a sore eye, when someone is bedridden due to sickness for days, or when a woman undergoes a miscarriage, etc. The participants stated that women accused of witch were always elderly/single women living in seclusion, poverty, and with fewer social ties. They also shared that the witch doctors, who ascertain whether a woman is a witch or not, were surprisingly mostly always men and hold higher status, respect, and social recognition. The consequences of being labeled as a witch, as explained by the participants, haunted victim women with torture, name-calling, social boycott, and extremes of physical violence. The participants informed that inhumane practices such as forceful feeding of human excreta prevailed during the witch cleansing sessions. A female participant explaining the witchcraft situation stated,

Witchcraft accusation is very real in our community; I know someone who has tortured his mother, citing reasons for his wife being childless. The old woman was called names, beaten, and later thrown out of the home.

The participants felt that men’s use of violence and its legitimization primarily existed due to gender hierarchy and internalization of the belief that violence was the best method to resolve any conflict. They inferred that men’s use of violence was further reinforced by women's acceptance and belief that violence had occurred due to their faults and carelessness. The female participants shared examples of common household situations that could result in an episode of violence such as women cooking distasteful food, failing to provide timely care to children and the elderly due to workload, and forgetting to clean rooms. These incidents make women believe that violence majorly occurred due to their mistakes. Furthermore, the participants believed that this self-blaming of the victim resulted due to constant exposure to violence and a non-negotiable social positioning of women for raising questions. The participants stated that beliefs instilled by religion increased the likelihood of victimization for women. They explained that religious practices and ideologies required women to refer to their husbands as godly figures, and a religious belief that anything said or done against husbands was a disgrace bringing sin upon her and family positioned women in an inferior position. A male participant added,

We belong to a culture where females worship their husbands as a god, and this might be an important reason for men to feel powerful as a god to exploit and abuse women.

The discussions put forward the idea that the existence of discriminatory beliefs, reinforcement of such beliefs, and a blind following of such practices produced differences and violence. The male participants acknowledged that the idea of male supremacy not only produced violence but also established a belief system that considered violence as an indispensable way to treat deviated women. One male participant stated this idea of male supremacy and privilege as,

The language of the feet is essential when words fail.

The participants also discussed violence committed toward men by women. The male participants burst into laughter when they stated that some men were beaten by their wives when they were drunk. The male participants admitted that intoxication reduced their strength and they got beaten. The female participants, on the other hand, assumed that women hit intoxicated men due to frustration and helplessness. They further clarified that the act of husband beating was a situational reaction towards men who had spent all of their daily earnings on alcohol. They stated that women with the responsibility to cook and feed family find themselves in an utterly helpless situation by the irresponsible drinking behavior of men. The male participants shared incidences of violence against men due to foreign migration. It was revealed in the discussions that some of the migrating men’s wives had run away with remitted money, abandoning marriage, and breaking up the family. The male participants identified this as a form of victimization of men, furthermore, the spreading of rumors and gossip caused emotional instability in those men. The female participants confirmed that some returning men failed to find their homes, property, money, and/or their wives. The discussion participants in both groups identified that this practice was on the rise in the community. It became apparent from the discussions that this increasing trend of women running away with the money and breaking away from family was a personal issue requiring social remedies.

Chasing dreams

The participants referred to sex trafficking as the exploitation of women, arising from poverty, illiteracy, and deceit. Explaining the causes of trafficking, the participants stated that women living in poverty, having dreams of prosperity and abundance were tricked by the traffickers making them victims of sex trafficking. The participants mentioned that women who had dreams larger than life and yearned for a comfortable and luxurious life in a short time were at a greater risk for sex trafficking. The participants from both groups resonated that the traffickers had been manipulating the dreams of poor women and deceiving them into trafficking. A female participant elaborated,

Women in poverty can be fooled easily with dreams. She can be tricked by a trafficker by saying I will find you employment with good pay abroad, and she gets into the trap easily.

A male participant further clarified,

Women readily fall into fraud and trickery shown by the traffickers who assure of luxurious life with foreign employment and this bait often leads to sex trafficking.

They identified that false hopes for foreign jobs were primarily used as an entry point by the traffickers to trap potential victims. Besides, they stated that some traffickers tricked women with false romantic relationships and marriages to win over their trust enabling traffickers to maneuver women as they wished.

It was identified that traffickers were not always strangers but known and familiar faces from the community, allowing the traffickers to gain the victim’s trust. The discussions divulged that traffickers strategically chose women who were less educated and poor. The participants explained that sex trafficking mostly occurred among women from a lower caste (the caste system is hierarchy-based in Hindu society which is determined by birth and unchangeable). They further explained that if one of these lower caste women went missing, it seldom raised any serious concerns in society, making these women easy targets for the traffickers. The discussions revealed that life for the survivors of sex trafficking was difficult. They identified that the survivor had to face strong stigmas and stereotypes which further increased their risk for re-victimization. The participants explained that the social acceptance of the trafficking survivors was minimal and finding a job for survival was very difficult. It was reported that social beliefs, norms, and practices were rigid for sex trafficking survivors and provided lesser opportunities for complete social integration. A female participant stated,

The story of a sex-trafficked woman does not end after her rescue. It is difficult for her to live in society, and this increases her chances of being a further victim.

The discussions in both groups highlighted that education and awareness were important for reducing sex trafficking. The participants felt that securing a livelihood for women was essential, but they identified it as a major challenge. The female participants recommended the use of education and awareness for reducing sex trafficking. They demanded effective legal actions and stringent enforcement of the law with maximum punishment for offending sex traffickers. They mentioned that the fear of law with maximum punishment for culprits could help decrease cases of trafficking.

The theoretical concept of power play

The discussions identified that gender inequality and violence against women occurred as men possessed and exercised greater authority. The participants explained that the authority emerging from male-centric beliefs was reinforced through established socio-cultural institutions. It was known that oppressive practices toward women in both public and private life have led to the domination and devaluation of women. The differences between men and women were known to be instilled by evoking discriminatory beliefs and due to internalization of them as fundamental truths by women which further helps to sustain these created differences.

The concept of power-play developed from the study has its roots in the belief systems and was found constantly used by men to maintain created differences. The power-play rise due to patriarchy, guiding discriminatory norms and unequal gender practices. These norms and practices in the canopy of patriarchy positions women inferior to men and impose control and restrictions. The power play possessed multi-dimensional effects on women such as creating further barriers, restricted life opportunities, the need for men-centered anchoring systems, and exclusion from the public arena. The power play gains its strength from the strict enforcement of stereotypical practices and committed adherence to gender performances. This leads to internalization of subordination as a natural occurrence by women. These further isolate women putting them into several non-negotiating positions. The power play at an individual level provides restrictive movement for women, barring them from quality education and other life opportunities, and is exhibited in alcohol-related assault and sexual violence. At the structural level, this power play limits women from economic opportunities, access to resources, and decision-making, and induces socio-cultural inequality exhibited in dowry and cases of witchcraft. The socio-cultural acceptance of power-play allows men to use violence as a misuse of power and use it as an effort to maintain authority. The use of power-play for committing violence was identified as the worst display of exercised power play.

Figure  1 describes the concept of power-play developed from the study. The power-play model is based on discussions and inferences made from data analysis. The model provides a description and explanation of how women are subjected to inequality and face violence. The concept of power play derives its strength from the subjugated status of women which are based on selective treatment, self-embodiment of inferiority, imposed restrictions and due to lesser life opportunities. The power play gain legitimacy through social approval of the status differences between men and women and through social systems and institutions majorly developed and favoring men. The status difference between men and women and its approval by developed social institutions and processes give rise to the concept of powerplay. It identifies that status differences allow men to gain and (mis)use power play not only to maintain differences but also enable men to use violence. The use of power-play exists at both interpersonal and cultural levels. Further, the model elaborates on influencers causing subjugation of women, display of power-play, and violence. The model identified that lodging public complaints and seeking legal remedies are the influencers that suppress violence against women. The influence of Forum Theater was perceived to have greater influence for victim, perpetrator, and bystanders. The influencers that aggravate violence are fear of further violence, the nature of the interpersonal relationship, alcohol-related abuse, and remaining silent especially on sexual violence. The cultural violence mentioned in the model refers to dowry and witchcraft-related violence and stands as systemic subordination. In the model, sex trafficking is depicted as one of the outcomes of inequality and violence faced by women majorly occurring due to deceit and fraud.

The theoretical concept of power-play developed in this study identifies that inequality produces violence and violence further reinforces inequality, creating a vicious circle. The power play situates hierarchy based on gender as the primary cause and identifies violence as an outcome of this power asymmetry. The authority to use power by men is received by social approval from embedded structures and institutions. The functioning of associated structures and norms is designed and run by men helping to perpetuate the dominance and subjugation of women. The study identifies that both interpersonal and socio-cultural violence emerges due to the positional differences and use of power. The study found that an element of control exists in interpersonal violence. The findings show that few victim women in the community took advantage of consultations and rely on the law to evade and /or cope during the occurrence of interpersonal violence. A large number of victims women however suffer silently as they are unable and unwilling to take a stand on violence due to their perceived positional differences and strict norms following. The study finds that violence originating from socio-cultural systems is widely accepted and no established means of control exists. The practice of heinous acts against a fellow human during witchcraft allegations and dowry exchanges is prohibited by the law of Nepal but is widespread. This situates that practices which are based on belief systems are more effective than prevailing national laws which try to stop them. Sex trafficking as a form of sexual violence use deceit and fraud against women. Poverty and illiteracy compel women to search for alternatives, and they become easy victims of sex trafficking when their dreams of a better life are manipulated by the traffickers. The false promise of a better life and highly paid job put women in a non-negotiating position with traffickers. The cherished dream of escaping the prevailing status-quo of oppression, subordination, violence, and poverty mesmerizes women to take risky decisions, falling into the risk and trap of sex trafficking.

The socio-cultural norms are the unwritten script of social operatives and functioning. These social norms function as codes of operation and are a major determinant for behavior and interactions between people [ 43 ]. The study has found that these norms were skewed, and most favored men, giving rise to status differences and producing inequalities for women. This is observed with lesser life opportunities, lower participation in decision-making, and a constant need to anchor women. This further helps men to maintain their hierarchical positional status and use violence. The subjugation of women does not occur in a linear process, it is influenced by the internalization of discrimination resulting in lower self-esteem, suppression, and domination of women based on norms and unequal practices. Earlier research has identified that norms and beliefs encourage men to control women, and direct them to use force to discipline women which increases the risk of violence occurrence [ 44 , 45 ]. An earlier study shows that traits of masculinity require men to become controlling, aggressive, and dominant over women to maintain status differences [ 46 ]. The study confirms that men upon receiving both normative and social approval for using violence against women can do so without hesitation.

Violence against women in Nepal mostly occurs inside the home and is only reported when it reaches higher levels of severity. The acceptance of violence as a private affair has restricted women from seeking support and discourages them from communicating their problems with outsiders [ 47 ] this increases more likelihood for men to use violence. The study finds issues related to sex and sexual violence is a taboo and are seldom reported. The study could only identify cases of sexual assault registered with the police and other cases known to the wider community as sexual violence. A community with known incidents of rape may have other cases of abuse, harassment, incest, forceful sexual contact, etc. Failure to report incidents of sexual violence infer that a large number of women could be suffering in silence. Earlier research identifies that increased stigmatization associated with sexual violence, and fear of seclusion cause reluctance in victims to report or seek support [ 48 ]. This silencing of victims provides men with greater sexual control over women [ 49 ] increasing more likelihood of use of violence. Gender-based inequality and violence intersect structures, institutions, and socio-cultural processes, making inequality and violence visible at all levels. The dowry-related violence and witchcraft allegation intersect interpersonal and structural violence. This cultural violence forces women to be a victim of lifelong abuse and trauma. The intersecting relationship between gender norms, social structures, and individual is so closely knitted that it produces varieties of inequality and violence at all levels [ 50 ]. Emotional violence in this study only emerged as a type of violence, during discussions in both groups. It did not emerge as a major concern for the participants except for dowry-related violence and violence against men. The intertwined nature of emotional violence and its occurrence with each abusive, exploitative, and violent situation may have influenced the participants understand it as a result, rather than as a specific type of violence.

The power play between sexes was found in synchronicity with the established norms and prevailing stereotypes, helping to perpetuate gender power imbalance. The gender system is influenced and governed by norms and the social arena becomes the site of its reproduction through the interaction and engagement of people. This interaction provides approval to the institutions and processes that are based on constructed differences between men and women [ 51 ]. The power, as identified by Fricker [ 52 ], controls a social group and operates and operates through the agent or established social structures. A man can actively use the vested power to either patronize and/or abuse women while passively women’s internalization of social settings and embedded norms can put them docile. The social controls as reported by Foucault [ 53 ] work with the embedded systems of internalization, discipline, and social monitoring and uses coercion rather than inflicting pain. The internalization of status differences among women as indicated by the study confirms this schema of social control. The dominance of men over women with patriarchal beliefs establishes the significance of male-centered kinship. This requires women to constantly anchor with men providing grounds for inequalities to perpetuate further. This idealizes men and reinforces the belief that women are non-existent without their presence. The requirement for male anchorage has an attachment to prevailing structural inequality. The family property and resources are mostly controlled by men and it usually transfers from father to son limiting inheritance to women [ 51 ]. These glorified idealizations of men's competence as described by Ridgeway [ 54 ] idealize men as individuals with abilities, status, power, and influences. The need for women to rely on men as anchors, fear of going against the norms and social sanctions explains the positional difference and show that men possess greater competencies. The internalization of men-centric superior beliefs by women occurs due to self-passivity and devalues women creating false impressions of their abilities. The gender roles and responsibilities were strict for both sexes but provided greater flexibility, privilege, and opportunity for men. Earlier studies in congruence with this study find that socio-cultural expectations limit women from deviation, and strictly adhere to their prescribed role and expectations [ 55 , 56 ] providing an upper hand to the men. The unequal social positioning of women, as defined by a few of the participants, can help define men's use of violence. As inferred by Kaufman [ 57 ], the disadvantageous position of women and support from the established structures enable men to use aggression and violence with considerable ease. The concept of power-play derived from this study also reflects that inequalities not only create hierarchies, putting women into a subordinating position but also legitimize norms of harmful masculinity and violence [ 57 , 58 , 59 , 60 ] creating a vicious cycle of inequality and violence. The concept of power-play developed by this study requires further exploration of gender relations, injustice, and patriarchy to identify multiple operatives of power with an outcome of inequality and violence.

Strengths and limitations of the study

The study followed the same participants over a period, which helped the study to achieve clarity on the topics through constant engagement. The data collection and the initial data analysis of the study were conducted by the same person, which reduced the risk of misrepresented findings. The study used follow-up discussions, which provided an opportunity to meet the participants again to resolve any ambiguities. The constant engagement with the participants helped to develop rapport and trust, which is essential to enable meaningful discussions. The study gathered rich data for developing the theory of power play in the Nepalese context. The study has attempted to explain the interplay of men’s use of power play, gender inequality, and violence against women, which, in itself, is a complex, but important issue. The study helped to develop a platform by identifying a level of awareness and needs for a Forum Theatre intervention study, a first of its kind in Nepal.

The major limitation of the study is that it was conducted with only one of the ethnic populations of Nepal; thus, the findings from this study cannot be generalized to a completely different setting. However, the transferability of the study is possible in a similar setting. The incidences of inequality and violence shared by the participants were self-reported, and no other means of verification were available to crosscheck those claims. The differences among the participants both in and between groups based on education and marital status might have influenced the study participants to understand, observe, and experience the phenomenon. The possibility of social desirability bias remains with the study, as a constant engagement with the study participants might have influenced them to answer differently. Furthermore, the discussions were conducted in groups, and participants might have had hesitation to bring up any opposing views. The study relied on collecting information on social norms and individual experiences and the perceptions of the study participants. It cannot be claimed that the study is devoid of any data rigidity as participants were free to choose what they wanted to share and express.

Study implications

The study explains gender practices, norms, violence against women, and sex trafficking in Nepal. The study helps to increase the understanding of how gender systems are operative in the daily lives of the Tharu community in the Morang district of Nepal. Future studies can explore the established linkages of interpersonal and socio-cultural violence. Like the complex link existing between gender inequality and violence against women, interpersonal violence and socio-cultural violence cannot be studied in isolation. The study provides an opportunity for future research on exploring how changing norms have been altering the position and victimization of women. The study finds that changing gender norms and responsibilities have, on the one hand, provided agency and empowerment for women, but on the other hand, they have also increased their risk of being a victim, an area that requires further exploration. The study has identified that constant engagement with the study participants through follow-up studies ensures the richness of data, which can be useful information for a future research study design. The study can be helpful for policy development, social activists, leaders, and researchers as it discusses prevalent gender oppressions and victimization, which need to be addressed. The findings from the study can be helpful for dialogue imitation and for designing intervention projects aimed at providing justice and equality to women.

The study identifies the presence of gender inequalities and violence against women in the study area. The positional differences based on norms, institutions, and practices have assigned greater privileges to men. The concept of power-play devised by the study ascertains the maintenance of gender hierarchy to produce inequality further and victimization of women. The subjugation of women based on the social-cultural process, embedded belief systems, and norms prevent women from life opportunities and dignified life. It situates men at the highest rung of the gender and social ladder providing a comparative advantage for men to use power. Violence emerges as men’s use of power play and as a strategy for the continued subjugation of women. Sex trafficking as a consequence of inequality and violence has its origins in illiteracy and poverty with women falling prey to the deceit of traffickers. It is important that dreams for progression provide motivation for women to develop further but at the same time, dreams should not be exchanged with trickery and fraud offered by the traffickers. Awareness and attitudinal changes are imperative to challenge unequal norms, and practices, and reduce the risks of sex trafficking. This can help to develop negotiations for power-sharing which helps to reduce inequality, violence, and preparedness in chasing dreams. Changes at both individual and societal levels are necessary to develop a collective action for establishing belief systems and practices providing women with an equal position and reducing the risk of violence.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to privacy but are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors are grateful to all the focus group discussion participants. The authors are indebted to Bhojraj Sharma, Deekshya Chaudhary, Subham Chaudhary, and Dev Kala Dhungana for their coordination and facilitation in reaching the discussion participants.

Open access funding provided by Linnaeus University.

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Pranab Dahal & Katarina Swahnberg

Department of Community Medicine, Kathmandu Medical College, 446 00, Kathmandu, Nepal

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Contributions

PD, SKJ, and KS were involved in the study design. PD and KS developed the discussion guides. PD was responsible for the data collection and the data analysis. All authors read and approved the final manuscript.

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Correspondence to Pranab Dahal .

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Dahal, P., Joshi, S.K. & Swahnberg, K. A qualitative study on gender inequality and gender-based violence in Nepal. BMC Public Health 22 , 2005 (2022). https://doi.org/10.1186/s12889-022-14389-x

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

Paola belingheri.

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

Filippo Chiarello

Andrea fronzetti colladon.

2 Department of Engineering, University of Perugia, Perugia, Italy

3 Department of Management, Kozminski University, Warsaw, Poland

Paola Rovelli

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

Associated Data

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.

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.

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.

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.

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.

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.

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.

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 ).

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.

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

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).

Funding Statement

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.

Data Availability

What is Gender Discrimination?

Around the world, individuals, businesses, governments, and other systems discriminate against people based on gender. Cis women and girls are the most recognized target, but trans people face significant gender discrimination, as well. Discrimination harms these groups and society as a whole. In this article, we’ll define gender and gender discrimination, provide three examples of gender discrimination in action, and explain its negative effects.

Gender discrimination occurs when a person is treated negatively or unequally based on their gender. It includes restricted access to education, jobs, and healthcare; unequal pay; sexual harassment; and much more.

What is gender?

Before we talk about gender discrimination, we need to know what “gender” is. The World Health Organization has a decent definition: “Gender refers to the characteristics of women, men, girls and boys that are socially constructed.” When society talks about “gender norms,” it’s referring to behaviors and roles associated with men, women, girls, and boys. While not inaccurate, the WHO’s definition is incomplete because it implies a kind of binary. There are more genders beyond men, women, girls, and boys. The Canadian Institutes of Health Research provides a fuller definition: “Gender refers to the socially constructed roles, behaviors, expressions and identities of girls, women, boys, men, and gender diverse people.” In short, gender is a social construct that varies over time and across societies.

How is gender different from sex? The CIHR defines sex as “a set of biological attributes in humans and animals.” These attributes include chromosomes, gene expression, hormone levels and function, and reproductive/sexual anatomy. Sex is typically categorized as “male” or “female,” but even within sex, categories are more complex than a binary. People can identify with the gender typically associated with their sex (cisgender) or identify with a different gender (transgender). If someone doesn’t identify with an exclusively male or female gender, they may call themselves “non-binary.” If someone is flexible about the gender they identify as they may call themselves “gender fluid.” These identities are considered part of the trans community, but because gender is tied to personal identity and self-representation, there are no fixed rules or definitions. Courses like the ones on this list provide further education on topics like sex and gender.

What is gender discrimination and is it a violation of someone’s rights?

Gender discrimination is when someone is treated unequally and unfairly based on their gender identity. Like all discrimination, gender discrimination is a human rights violation, though the distinction between “gender” and “sex” is a more recent development. Take the Universal Declaration of Human Rights as an example. Article 2 reads: “Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, color, sex [emphasis added], language, religion, political or other opinion, national or social origin, property, birth or other status (emphasis added).” Article 2 covers sex discrimination, but it doesn’t mention gender. This is most likely because when the UDHR was written, gender and sex were considered the same. Times have changed. The phrase “other status” has been used to expand the rights given in Article 2. A press release from the UN describes how the organization and regional instruments have based changes on this phrase.

What does gender discrimination look like?

There are countless instances of gender discrimination fueling gender inequality and gender-based violence. Let’s take a closer look at three examples to see how gender discrimination touches every part of societies around the world:

Paying women less for the same work

The gender pay gap is a global issue. According to the International Labor Organization, women make about 20 cents less than men. There are factors like differences in jobs, education, skills, and experience, but gender discrimination is a significant factor, as well. In the United States, Lilly Ledbetter experienced this firsthand. For almost 20 years, Ledbetter worked in managerial positions at a Goodyear tire manufacturing plant. According to a write-up from the National Women’s Law Center, she faced sexual harassment and discrimination from her boss, who believed women shouldn’t work at the plant. Ledbetter also wasn’t allowed to talk about her salary, so it wasn’t until she got an anonymous note that she learned she was paid less than men in the same position. Ledbetter filed a lawsuit.

The court process was a rollercoaster. First, a jury decided in her favor, awarding her back pay and damages. Then, Goodyear tried to vacate the judgment. It eventually went to the Supreme Court where Goodyear prevailed. The majority reasoned that Ledbetter lost her right to sue for pay discrimination because she hadn’t brought her claim within 180 days of getting the first discriminatory check. This ruling ignored the fact that the discrimination was ongoing and, because of the secrecy around salaries, there was no way Ledbetter could have known she was being paid less. While she may have lost the court case, Ledbetter’s lawsuit led to the Lilly Ledbetter Fair Pay Act in 2009. It resets the 180-day filing period each time discrimination happens. When people work to establish laws like this, they help close the gender gap in Economic Participation and Opportunity.

Restricting education access for girls

Gender discrimination in education is one of the root causes of gender inequality worldwide. Without a good education, individuals are severely limited when it comes to job opportunities. The consequences fan out from there, making a person more vulnerable to poverty, violence, human trafficking, poor health, and more. Globally, girls tend to be targets of discrimination. What’s happened recently in Afghanistan is a prime example.

From 1996-2001, the Taliban did not let girls study. In August 2021, the Taliban regained control in the region and began restricting girls from school once again. At first, the militant fundamentalist group said it would let girls attend secondary school, but in 2022 , they broke their promise. Girls had already shown up to their classrooms only to be turned away. The Taliban’s excuse? They were trying to decide on a school uniform. This is significant because back in 1996-2001, the Taliban didn’t technically outlaw education for girls. They kept saying school closures were temporary and that as soon as things were sorted out, girls could come back. That never happened. Now, people fear the same situation is unfolding today. There have also been restrictions at the university level . At Nangarhar University, girls are only allowed to choose from seven of the 13 faculties. They are not allowed to take subjects like engineering, economics, agriculture, veterinary medicine, and journalism. This is blatant gender discrimination.

Discriminating against trans people in healthcare settings

Trans people face significant gender discrimination. Some of the most consequential discrimination occurs in healthcare settings, which is a big reason why trans people are more vulnerable to health problems. In the largest study of transgender and gender non-conforming people in the US, 19% of participants said they were denied care because of their gender identity. 28% reported harassment in medical settings and high levels of delaying care when hurt or sick because of the discrimination. Half of the participants also said they needed to educate their medical providers on transgender care.

Delaying care because of discrimination and trauma – as well as receiving poor medical treatment – worsen health outcomes for transgender people. A 2019 study from the CDC found that trans people were twice as likely as cisgender adults to receive depression diagnoses. They’re also at a higher risk for asthma and heart disease. This shows a clear link between discrimination and poor health. The medical field needs to address transphobia and ignorance if it wants to stop discriminating based on gender. Some of the courses on this list provide further information on gender and health.

How does gender discrimination hurt everyone?

Gender discrimination impacts a person’s health. According to research compiled in a Medical News Today article , women who reported gender discrimination within the year got higher scores on a depression screening tool. Women also experience higher risks for anxiety, PTSD, and eating disorders. While men are more likely to die by suicide, women are 1.5 times more likely to attempt suicide. The exact reason isn’t clear, but experts believe discrimination plays a role. Gender discrimination also intersects with issues involving race, class, religion, and more, which complicates and compounds the discrimination.

Gender inequality negatively affects everyone, not just its targets. In a study from the Global Early Adolescent Study, gender stereotypes hurt both boys and girls. Boys are often taught to deal with their issues using violence. They’re also less equipped to handle difficult emotions, which could explain why men are more likely to die by suicide. When gender stereotypes exist, anyone who doesn’t fit the stereotypes – whether they’re women, men, or non-binary – faces discrimination. Still not sure of how significant gender discrimination is? It leads to gender inequality, which hurts a nation’s economy. According to the Organization for Economic Co-operation and Development, gender discrimination in social institutions leads to a $6 trillion loss for the global economy. When everyone is allowed full economic freedom and opportunities, it makes sense that the whole economy – and not just individuals and families – benefits. For the sake of everyone in society, ending gender discrimination is essential.

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About the author, emmaline soken-huberty.

Emmaline Soken-Huberty is a freelance writer based in Portland, Oregon. She started to become interested in human rights while attending college, eventually getting a concentration in human rights and humanitarianism. LGBTQ+ rights, women’s rights, and climate change are of special concern to her. In her spare time, she can be found reading or enjoying Oregon’s natural beauty with her husband and dog.

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Essay on Gender Discrimination

• Updated on  
• Jul 14, 2022

One of the challenges present in today’s society is gender discrimination. Gender discrimination is when someone is treated unequally based on their gender. Gender discrimination is not just present in the workplace but in schools, colleges and communities as well. As per the Civil Rights Act of 1964,  gender discrimination is illegal in India. This is also an important and common essay topic in schools and competitive exams such as IELTS , TOEFL , SAT , UPSC , etc. Let’s explore some samples of essay on gender discrimination and tips for writing an impactful essay.

Tips for Writing an Impactful Essay

If you want to write a scoring and deep impact essay, here are some tips for writing a perfect informative essay:

• The most important and first step is to write an introduction and background information about and related to the topic
• Then you are also required to use the formal style of writing and avoid using slang language
• To make an essay more impactful, write dates, quotations, and names to provide a better understanding
• You can use jargon wherever it is necessary as it sometimes makes an essay complicated
• To make an essay more creative, you can also add information in bulleted points wherever possible
• Always remember to add a conclusion where you need to summarise crucial points
• Once you are done read through the lines and check spelling and grammar mistakes before submission

Essay on Gender Discrimination in 200 Words

One of the important aspects of a democratic society is the elimination of gender discrimination. The root cause of this vigorous disease is the stereotypical society itself. When a child is born, the discrimination begins; if the child is male, he is given a car, bat and ball with blue, and red colour clothes, whereas when a child is female, she is given barbie dolls with pink clothes. We all are raised with a mentality that boys are good at sports and messy, but girls are not good at sports and are well organised. This discriminatory mentality has a deeper impact when girls are told not to work while boys are allowed to do much work. This categorising males and females into different categories discriminating based on gender are known as gender discrimination. Further, this discriminatory behaviour in society leads to hatred, injustice and much more. This gender discrimination is evident in every woman’s life at the workplace, in educational institutions, in sports, etc., where young girls and women are deprived of their rights and undervalued. This major issue prevailing in society can be solved only by providing equality to women and giving them all rights as given to men.

Essay on Gender Discrimination in 300 Words 

Gender Discrimination, as the term signifies, is discrimination or discriminatory behaviour based on gender. The stereotypical mindset of people in the past has led to the discrimination that women face today. According to Kahle Wolfe, in 2015, women earned 83% of the income paid to men by working the same hours. Almost all women are not only discriminated against based on their salaries but also on their looks.

Further, most women are allowed to follow a certain dress code depending upon the work field and the dress women wear also decides their future career.

This dominant male society teaches males that women are weak and innocent. Thus women are mostly victims and are targeted in crimes. For example, In a large portion of the globe, women are blamed for rapes despite being victims because of their clothes. This society also portrays women as weaker and not eligible enough to take a stand for themselves, leading to the major destruction of women’s personalities as men are taught to let women down. This mindset of people nowadays is a major social justice issue leading to gender discrimination in society.

Further, gender-based discrimination is evident across the globe in a plethora of things, including sports, education, health and law. Every 1 out of 3 women in the world is abused in various forms at some point in their lives by men. This social evil is present in most parts of the world; in India, women are burnt to death if they are incapable of affording financial requirements; in Egypt, women are killed by society if they are sensed doing something unclean in or out of their families, whereas in South Africa baby girls are abandoned or killed as they are considered as burden for the family. Thus gender discrimination can be only eliminated from society by educating people about giving equal rights and respect to every gender.

Top Universities for Gender Studies Abroad

UK, Canada and USA are the top three countries to study gender studies abroad. Here’s the list of top universities you can consider to study abroad for Indian students if you planning to pursue gender studies course abroad:

We hope this blog has helped you in structuring a terrific essay on gender discrimination. Planning to ace your IELTS, get expert tips from coaches at Leverage Live by Leverage Edu .

Sonal is a creative, enthusiastic writer and editor who has worked extensively for the Study Abroad domain. She splits her time between shooting fun insta reels and learning new tools for content marketing. If she is missing from her desk, you can find her with a group of people cracking silly jokes or petting neighbourhood dogs.

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Essay on Gender Discrimination

Students are often asked to write an essay on Gender Discrimination in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Gender Discrimination

Understanding gender discrimination.

Gender discrimination refers to the unjust treatment of individuals based on their gender. It occurs when people are treated less favorably because they are male or female.

Forms of Gender Discrimination

This discrimination can take many forms. It can be seen in the workplace with unequal pay or opportunities. In schools, it may manifest as biased treatment or stereotyping.

Effects of Gender Discrimination

The effects of gender discrimination are harmful. It can lead to a lack of self-esteem, depression, and reduced opportunities for those affected.

Combating Gender Discrimination

To combat gender discrimination, we need to promote equality, challenge stereotypes, and encourage respect for all genders.

250 Words Essay on Gender Discrimination

Introduction.

Gender discrimination, also known as sex discrimination, involves treating an individual unfavorably due to their gender. It is a pervasive issue that transcends geographical boundaries and socio-economic contexts, affecting individuals and societies at large.

Manifestations of Gender Discrimination

Gender discrimination manifests in diverse ways, including disparities in education, employment, and healthcare. Women, for instance, often experience wage gaps, occupational segregation, and limited access to education. On the other hand, men may encounter bias in child custody cases or in sectors traditionally dominated by women.

The Impact of Gender Discrimination

The impact of gender discrimination is far-reaching. It stifles economic growth, hampers social progress, and undermines human rights. Gender discrimination can also perpetuate harmful stereotypes, leading to a cycle of inequality that can span generations.

Addressing Gender Discrimination

Addressing gender discrimination requires a multi-faceted approach. Legal frameworks should be implemented and enforced to protect individuals against discrimination. Additionally, educational campaigns can help challenge harmful stereotypes and promote gender equality.

In conclusion, gender discrimination is a pressing issue that demands our collective attention and action. By promoting gender equality, we can create more inclusive societies that value and respect the rights of all individuals, regardless of their gender.

500 Words Essay on Gender Discrimination

Introduction: understanding gender discrimination.

Gender discrimination, a pervasive societal issue, refers to unequal treatment or perceptions of individuals based on their gender. It manifests in various areas of life, from employment and education to health care and personal relationships. This essay delves into the roots of gender discrimination, its implications, and potential solutions.

The Roots of Gender Discrimination

Gender discrimination originates from deep-seated cultural norms and stereotypes. Societies often have preconceived notions about the roles and behaviors appropriate for different genders. These stereotypes, perpetuated through generations, contribute to the discrimination faced by those who do not conform.

For instance, women are often expected to be nurturing, emotional, and submissive, while men are perceived as strong, rational, and dominant. Such binary perceptions not only limit individual potential but also create an environment ripe for discrimination.

Implications of Gender Discrimination

The implications of gender discrimination are far-reaching and multifaceted. In the workplace, it often results in unequal pay and limited opportunities for advancement. According to the World Economic Forum, it could take another 257 years to close the economic gender gap at the current pace of change.

In healthcare, women often face discrimination, leading to inadequate healthcare services. For instance, women’s pain is often taken less seriously than men’s, leading to misdiagnosis or under-treatment.

Addressing gender discrimination requires a multi-pronged approach. Firstly, legal measures should be implemented to ensure equal rights and opportunities for all genders. This includes laws against gender-based violence, policies for equal pay, and regulations ensuring equal access to education and healthcare.

Secondly, societal attitudes and stereotypes need to be challenged. This can be achieved through education and awareness campaigns that promote gender equality and challenge harmful stereotypes.

Finally, representation matters. Ensuring diverse representation in all areas of society, from politics to media, can challenge the status quo and promote a more balanced perception of gender roles.

Conclusion: Towards a Gender-Equal Society

Gender discrimination is a deeply ingrained societal issue with far-reaching implications. It is rooted in traditional gender roles and stereotypes, which limit individual potential and perpetuate inequality. Addressing this issue requires legal measures, societal change, and diverse representation. As we strive towards a more gender-equal society, it is crucial to challenge our perceptions and strive for equal rights and opportunities for all, regardless of gender.

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Gender Discrimination Essay

500 words gender discrimination essay.

Gender discrimination is when there are unfair rights between male and female. It differs because of their gender roles which ultimately leads to unequal treatment in life. Gender discrimination has been around for many centuries. However, as we are evolving, it is time to do away with such notions of gender roles. Thus, gender discrimination essay will take us through it in detail.

Causes of Gender Discrimination

There are many causes of gender discrimination. The first one has to be illiteracy . When people do not educate themselves, they continue to live in the old times. Thus, they follow the old-age sexist traditions and norms.

Education can bring about a change in this mindset because educated people will less likely partake in gender discrimination. Further, poverty is also another reason which is interlinked in a way.

It is the root cause in many places because the economic dependence remains on the male counterparts mostly. Thus, women suffer a lot from it because of the same reason. They never get out of this and stay financially dependent on men.

Furthermore, the patriarchal setup in our society plays a big role. In this setup, the male dominates almost every aspect of life. Thus, they consider themselves to be superior to others.

This way, a lot of violence and injustice is meted out against females. Thus, when there is a gender considering themselves to be superior, it becomes difficult for everyone to avail equal opportunities.

Impact of Gender Discrimination

Gender discrimination has a deep impact on society as a whole. It does not just impact a specific section of the society but every part of it. First of all, it impacts children as they fall prey to gender stereotypes from a young age.

Further, it impacts young people because it impacts their behaviour, study choices, ambitions, attitudes and more. Thus, many girls do not participate in many sports and women experience physical violence more than men.

Next up, we have gender discrimination affecting adults because there is a gender pay gap between the working class. Men earn more for doing the same work as women. In addition, older women have more risk of becoming homeless than men.

It also impacts the aboriginal women because they have it a lot worse. It is more likely to happen that they can die from family violence, 11 times more than men. Even for men, it is not beneficial as it sets difficult standards for men to follow.

It draws a line on men being emotional. Thus, they can never showcase their emotions truly without being judged. Similarly, men do not parental leave in many places. Ultimately, all this results in more suicide in men. Thus, it impacts everyone.

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Conclusion of Gender Discrimination Essay

Gender discrimination must be checked at every stage so that no person should be denied a chance to learn and grow. Thus, everyone, no matter male or female, must get a start in life in terms of educations and other opportunities. We must come together as a society to do this.

FAQ on Gender Discrimination Essay

Question 1: Who is affected by gender inequality?

Answer 1: Gender inequality affects everyone, which includes men as well. Stereotypes about how women and men, girls and boys should be, start from their childhood and follow us to adulthood. Thus, it does not affect just one but all.

Question 2: Give an example of gender discrimination.

Answer 2: There are many examples of gender discrimination. For instance, restriction on clothing. If a man wears shorts, no one will bat an eye. However, if a woman wears shorts, she will be seen in a bad light and be called names. Similar is the case for housework.

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Nursing home oversight would be tightened under a bill passed in Massachusetts

FILE - The Massachusetts Statehouse is seen, Jan. 2, 2019, in Boston. (AP Photo/Elise Amendola, File)

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BOSTON (AP) — Massachusetts’ oversight of nursing homes would be strengthened, LGBTQ+ nursing home residents would be protected against discrimination, and better controls would be in place to protect against the spread of infectious disease outbreaks, under a new bill lawmakers passed this week.

Approved on Thursday, the bill would require long-term care facilities to provide staff training on the rights of LGBTQ+ older adults and those living with HIV, and bar staff from discriminating based on a person’s sexual orientation, gender identity, gender expression, intersex status or HIV status.

The proposal also would streamline the licensing process for “small house nursing homes,” alternative care centers that focus on smaller groups of residents and using familiar domestic routines.

Long-term care facilities would also be required to develop outbreak response plans to help contain the spread of disease and ensure communication with state health officials, residents, families and staff.

The bill would also require state health officials to establish training programs on infection prevention and control, resident care plans and staff safety programs. The Department of Public Health would be required to come up with plans to let residents of a facility engage in face-to-face contact, communications, and religious and recreational activities.

Some long-term care facilities became hubs of COVID-19 transmission. In 2020, at least 76 people died in a long-term care veterans home in Massachusetts, one of the nation’s worst COVID-19 outbreaks.

Those who make the decision to put their loved ones in a nursing home or long-term care facility deserve to know they will be protected, said Democratic Senate President Karen Spilka.

“This bill will give the Commonwealth the resources and tools to ensure their safety, weed out bad actors in the field, and enforce oversight and accountability,” she said.

The legislation would also create a new fund to help recruit a long-term care workforce, including grants to develop new certified nursing assistants and grants for direct care workers to train to become licensed practical nurses.

Under the bill, the DPH would have the authority to revoke a long-term care facility’s license for a failure to provide adequate care or for a lack of financial capacity. The bill would also gives health officials the power to appoint a temporary manager.

The bill now heads to Gov. Maura Healey for her signature.

Nursing home oversight would be tightened under a bill passed in Massachusetts

Massachusetts lawmakers have approved a bill designed to strengthen the state’s oversight of nursing homes, provide anti-discrimination protections for LGBTQ+ nursing home residents, and help protect against the spread of infectious disease outbreaks

BOSTON -- Massachusetts' oversight of nursing homes would be strengthened, LGBTQ+ nursing home residents would be protected against discrimination, and better controls would be in place to protect against the spread of infectious disease outbreaks, under a new bill lawmakers passed this week.

Approved on Thursday, the bill would require long-term care facilities to provide staff training on the rights of LGBTQ+ older adults and those living with HIV, and bar staff from discriminating based on a person’s sexual orientation, gender identity, gender expression, intersex status or HIV status.

The proposal also would streamline the licensing process for “small house nursing homes,” alternative care centers that focus on smaller groups of residents and using familiar domestic routines.

Long-term care facilities would also be required to develop outbreak response plans to help contain the spread of disease and ensure communication with state health officials, residents, families and staff.

The bill would also require state health officials to establish training programs on infection prevention and control, resident care plans and staff safety programs. The Department of Public Health would be required to come up with plans to let residents of a facility engage in face-to-face contact, communications, and religious and recreational activities.

Some long-term care facilities became hubs of COVID-19 transmission. In 2020, at least 76 people died in a long-term care veterans home in Massachusetts, one of the nation’s worst COVID-19 outbreaks.

Those who make the decision to put their loved ones in a nursing home or long-term care facility deserve to know they will be protected, said Democratic Senate President Karen Spilka.

“This bill will give the Commonwealth the resources and tools to ensure their safety, weed out bad actors in the field, and enforce oversight and accountability," she said.

The legislation would also create a new fund to help recruit a long-term care workforce, including grants to develop new certified nursing assistants and grants for direct care workers to train to become licensed practical nurses.

Under the bill, the DPH would have the authority to revoke a long-term care facility’s license for a failure to provide adequate care or for a lack of financial capacity. The bill would also gives health officials the power to appoint a temporary manager.

The bill now heads to Gov. Maura Healey for her signature.

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