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• Published: 28 April 2020

The impact a-gender: gendered orientations towards research Impact and its evaluation

• J. Chubb   ORCID: orcid.org/0000-0002-9716-820X 1 &
• G. E. Derrick   ORCID: orcid.org/0000-0001-5386-8653 2  

Palgrave Communications volume  6 , Article number:  72 ( 2020 ) Cite this article

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A Correction to this article was published on 19 May 2020

This article has been updated

Using an analysis of two independent, qualitative interview data sets: the first containing semi-structured interviews with mid-senior academics from across a range of disciplines at two research-intensive universities in Australia and the UK, collected between 2011 and 2013 ( n  = 51); and the second including pre- ( n  = 62), and post-evaluation ( n  = 57) interviews with UK REF2014 Main Panel A evaluators, this paper provides some of the first empirical work and the grounded uncovering of implicit (and in some cases explicit) gendered associations around impact generation and, by extension, its evaluation. In this paper, we explore the nature of gendered associations towards non-academic impact (Impact) generation and evaluation. The results suggest an underlying yet emergent gendered perception of Impact and its activities that is worthy of further research and exploration as the importance of valuing the ways in which research has an influence ‘beyond academia’ increases globally. In particular, it identifies how researchers perceive that there are some personality traits that are better orientated towards achieving Impact; how these may in fact be gendered. It also identifies how gender may play a role in the prioritisation of ‘hard’ Impacts (and research) that can be counted, in contrast to ‘soft’ Impacts (and research) that are far less quantifiable, reminiscent of deeper entrenched views about the value of different ‘modes’ of research. These orientations also translate to the evaluation of Impact, where panellists exhibit these tendencies prior to its evaluation and describe the organisation of panel work with respect to gender diversity.

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Introduction

The management and measurement of the non-academic impact Footnote 1 (Impact) of research is a consistent theme within the higher education (HE) research environment in the UK, reflective of a drive from government for greater visibility of the benefits of research for the public, policy and commercial sectors (Chubb, 2017 ). This is this mirrored on a global scale, particularly in Australia, where, at the ‘vanguard’ (Upton et al., 2014 , p. 352) of these developments, methods were first devised (but were subsequently abandoned) to measure research impact (Chubb, 2017 ; Hazelkorn and Gibson, 2019 ). What is broadly known in both contexts as an ‘Impact Agenda’—the move to forecast and assess the ways in which investment in academic research delivers measurable socio-economic benefit—initially sparked broad debate and in some instances controversy, among the academic community (and beyond) upon its inception (Chubb, 2017 ). Since then, the debate has continued to evolve and the ways in which impact can be better conceptualised and implemented in the UK, including its role in evaluation (Stern, 2016 ), and more recently in grant applications (UKRI, 2020 ) is robustly debated. Notwithstanding attempts to better the culture of equality and diversity in research, (Stern, 2016 ; Nature, 2019 ) in the broader sense, and despite the implementation of the Impact agenda being studied extensively, there has been very little critical engagement with theories of gender and how this translates specifically to more downstream gendered inequities in HE such as through an impact agenda.

The emergence of Impact brought with it many connotations, many of which were largely negative; freedom was questioned, and autonomy was seen to be at threat because of an audit surveillance culture in HE (Lorenz, 2012 ). Resistance was largely characterised by problematising the agenda as symptomatic of the marketisation of knowledge threatening traditional academic norms and ideals (Merton, 1942 ; Williams, 2002 ) and has led to concern about how the Impact agenda is conceived, implemented and evaluated. This concern extends to perceptions of gendered assumptions about certain kinds of knowledge and related activities of which there is already a corpus of work, i.e., in the case of gender and forms of public engagement (Johnson et al., 2014 ; Crettaz Von Roten, 2011 ). This paper explores what it terms as ‘the Impact a-gender’ (Chubb, 2017 ) where gendered notions of non-academic, societal impact and how it is generated feed into its evaluation. It does not wed itself to any feminist tradition specifically, however, draws on Carey et al. ( 2018 ) to examine, acknowledge and therefore amend how the range of policies within HE and how implicit power dynamics in policymaking produce gender inequalities. Instead, an impact fluidity is encouraged and supported. For this paper, this means examining how the impact a-gender feeds into expectations and the reward of non-academic impact. If left unchecked, the propagation of the impact a-gender, it is argued, has the potential to guard against a greater proportion of women generating and influencing the use of research evidence in public policy decision-making.

Scholars continue to reflect on ‘science as a gendered endeavour’ (Amâncio, 2005 ). The extensive corpus of historical literature on gender in science and its originators (Merton, 1942 ; Keller et al., 1978 ; Kuhn, 1962 ), note the ‘pervasiveness’ of the ‘masculine’ and the ‘objective and the scientific’. Indeed, Amancio affirmed in more recent times that ‘modern science was born as an exclusively masculine activity’ ( 2005 ). The Impact agenda raises yet more obstacles indicative of this pervasiveness, which is documented by the ‘Matthew’/‘Matilda’ effect in Science (Merton, 1942 ; Rossiter, 1993 ). Perceptions of gender bias (which Kretschmer and Kretschmer, 2013 hypothesise as myths in evaluative cultures) persist with respect to how gender effects publishing, pay and reward and other evaluative issues in HE (Ward and Grant, 1996 ). Some have argued that scientists and institutions perpetuate such issues (Amâncio, 2005 ). Irrespective of their origin, perceptions of gendered Impact impede evaluative cultures within HE and, more broadly, the quest for equality in excellence in research impact beyond academia.

To borrow from Van Den Brink and Benschop ( 2012 ), gender is conceptualised as an integral part of organisational practices, situated within a social construction of feminism (Lorber, 2005 ; Poggio, 2006 ). This article uses the notion of gender differences and inequality to refer to the ‘ hierarchical distinction in which either women and femininity and men and masculinity are valued over the other ’ (p. 73), though this is not precluding of individual preferences. Indeed, there is an emerging body of work focused on gendered associations not only about ‘types’ of research and/or ‘areas and topics’ (Thelwall et al., 2019 ), but also about what is referred to as non-academic impact. This is with particular reference to audit cultures in HE such as the Research Excellence Framework (REF), which is the UK’s system of assessing the quality of research (Morley, 2003 ; Yarrow and Davies, 2018 ; Weinstein et al., 2019 ). While scholars have long attended to researching gender differences in relation to the marketisation of HE (Ahmed, 2006 ; Bank, 2011 ; Clegg, 2008 ; Gromkowska-Melosik, 2014 ; Leathwood et al., 2008 ), and the gendering of Impact activities such as outreach and public engagement (Ward and Grant, 1996 ), there is less understanding of how far academic perceptions of Impact are gendered. Further, how these gendered tensions influence panel culture in the evaluation of impact beyond academia is also not well understood. As a recent discussion in the Lancet read ‘ the causes of gender disparities are complex and include both distal and proximal factors ’. (Lundine et al., 2019 , p. 742).

This paper examines the ways in which researchers and research evaluators implicitly perceive gender as related to excellence in Impact both in its generation and in its evaluation. Using an analysis of two existing data sets; the pre-evaluation interviews of evaluators in the UK’s 2014 Research Excellence Framework and interviews with mid-senior career academics from across the range of disciplines with experience of building impact into funding applications and/ or its evaluation in two research-intensive universities in the UK and Australia between 2011 and 2013, this paper explores the implicitly gendered references expressed by our participants relating to the generation of non-academic, impact which emerged inductively through analysis. Both data sets comprise researcher perceptions of impact prior to being subjected to any formalised assessment of research Impact, thus allowing for the identification of unconscious gendered orientations that emerged from participant’s emotional and more abstract views about Impact. It notes how researchers use loaded terminology around ‘hard’, and ‘soft’ when conceptualising Impact that is reminiscent of long-standing associations between epistemological domains of research and notions of masculinity/femininity. It refers to ‘hard’ impact as those that are associated with meaning economic/ tangible and efficiently/ quantifiably evaluated, and ‘soft’ as denoting social, abstract, potentially qualitative or less easily and inefficiently evaluated. By extending this analysis to the gendered notions expressed by REF2014 panellists (expert reviewers whose responsibility it is to review the quality of the retrospective impact articulated in case studies for the purposes of research evaluation) towards the evaluation of Impact, this paper highlights how instead of challenging these tendencies, shared constructions of Impact and gendered productivity in academia act to amplify and embed these gendered notions within the evaluation outcomes and practice. It explores how vulnerable seemingly independent assessments of Impact are to these widespread gendered- associations between Impact, engagement and success. Specifically, perceptions of the excellence and judgements of feasibility relating to attribution, and causality within the narrative of the Impact case study become gendered.

The article is structured as follows. First, it reviews the gender-orientations towards notions of ‘hard’ and ‘soft’ excellence in forms of scholarly distinction and explores how this relates to the REF Impact evaluation criteria, and the under-representation of women in the academic workforce. Specifically, it hypothesises the role of how gendered notions of excellence that construct academic identities contribute to a system that side-lines women in academia. This is despite associating the generation of Impact as a feminised skill. We label this as the ‘Impact a-gender’. The article then outlines the methodology and how the two, independent databases were combined and convergent themes developed. The results are then presented from academics in the UK and Australia and then from REF2014 panellists. This describes how the Impact a-gender currently operates through academic cultural orientations around Impact generation, and in its evaluation through peer-review panels by members of this same academic culture. The article concludes with a recommendation that the Impact a-gender be explored more thoroughly as a necessary step towards guiding against gender- bias in the academic evaluation, and reward system.

Literature review

Notions of impact excellence as ‘hard’ or ‘soft’.

Scholars have long attempted to consider the commonalities and differences across certain kinds of knowledge (Becher, 1989 , 1994 ; Biglan, 1973a ) and attempts to categorise, divide and harmonise the disciplines have been made (Biglan, 1973a , 1973b ; Becher, 1994 ; Caplan, 1979 ; Schommer–Aikins et al., 2003 ). Much of this was advanced with a typology of the disciplines from (Trowler, 2001 ), which categorised the disciplines as ‘hard’ or ‘soft’. Both anecdotally and in the literature, ‘soft’ science is associated with working more with people and less with ‘things’ (Cassell, 2002 ; Thelwall et al., 2019 ). These dichotomies often lead to a hierarchy of types of Impact and oppose valuation of activities based on their gendered connotations.

Biglan’s system of classifying disciplines into groups based on similarities and differences denotes particular behaviours or characteristics, which then form part of clusters or groups—‘pure’, ‘applied’, ‘soft’, ‘hard’ etc. Simpson ( 2017 ) argues that Biglan’s classification persists as one of the most commonly referred to models of the disciplines despite the prominence of some others (Pantin, 1968 ; Kuhn, 1962 ; Smart et al., 2000 ). Biglan ( 1973b ) classified the disciplines across three dimensions; hard and soft, pure and applied, life and non-life (whether the research is concerned with living things/organisms) . This ‘taxonomy of the disciplines’ states that ‘pure-hard’ domains tend toward the life and earth sciences,’pure-soft’ the social sciences and humanities, and ‘applied hard’ focus on engineering and physical science with ‘soft-applied’ tending toward professional practice such as nursing, medicine and education. Biglan’s classification looked at levels of social connectedness and specifically found that applied scholars Footnote 2 were more socially connected, more interested and involved in service activities, and more likely to publish in the form of technical reports than their counterparts in the pure (hard) areas of study. This resonates with how Impact brings renewed currency and academic prominence to applied researchers (Chubb, 2017 ). Historically, scholars inhabiting the ‘hard’ disciplines had a greater preference for research; whereas, scholars representing soft disciplines had a greater preference for teaching (Biglan, 1973b ). Further, Biglan ( 1973b ) also found that hard science scholars sought out greater collaborative efforts among colleagues when teaching as opposed to their soft science counterparts.

There are also long-standing gendered associations and connotations with notions of ‘hard’ and ‘soft’ (Storer, 1967 ). Typically used to refer to skills, but also used heavily with respect to the disciplines and knowledge domains, gendered assumptions and the mere use of ‘hard’ or ‘soft’ to describe knowledge production carries with it assumptions, which are often noted in the literature; ‘ we think of physics as hard and of political science as soft ’, Storer explains, adding how ‘hard seems to imply tough, brittle, impenetrable and strong, while soft on the other hand calls to mind the qualities of weakness, gentleness and malleability’ (p. 76). As described, hard science is typically associated with the natural sciences and quantitative paradigms whereas normative perceptions of feminine ‘soft’ skills or ‘soft’ science are often equated with qualitative social science. Scholars continue to debate dichotomised paradigms or ‘types’ of research or knowledge (Gibbons, 1999 ), which is emblematic of an undercurrent of epistemological hierarchy of the value of different kinds of knowledge. Such debates date back to the heated back and forth between scholars Snow (Snow, 2012 ) and literary critic Leavis who argued for their own ‘cultures’ of knowledge. Notwithstanding, these binary distinctions do few favours when gender is then ascribed to either knowledge domain or related activity (Yarrow and Davies, 2018 ). This is particularly pertinent in light of the current drive for more interdisciplinary research in the science system where there is also a focus on fairness, equality and diversity in the science system.

Academic performance and the Impact a-gender

Audit culture in academia impacts unfairly on women (Morley, 2003 ), and is seen as contributory to the wide gender disparities in academia, including the under-representation of women as professors (Ellemers et al., 2004 ), in leadership positions (Carnes et al., 2015 ), in receiving research acknowledgements (Larivière et al., 2013 ; Sugimoto et al., 2015 ), or being disproportionately concentrated in non-research-intensive universities (Santos and Dang Van Phu, 2019 ). Whereas gender discrimination also manifests in other ways such as during peer review (Lee and Noh, 2013 ), promotion (Paulus et al., 2016 ), and teaching evaluations (Kogan et al., 2010 ), the proliferation of an audit culture links gender disparities in HE to processes that emphasise ‘quantitative’ analysis methods, statistics, measurement, the creation of ‘experts’, and the production of ‘hard evidence’. The assumption here is that academic performance and the metrics used to value, and evaluate it, are heavily gendered in a way that benefits men over women, reflecting current disparities within the HE workforce. Indeed, Morely (2003) suggests that the way in which teaching quality is female dominated and research quality is male dominated, leads to a morality of quality resulting in the larger proportion of women being responsible for student-focused services within HE. In addition, the notion of ‘excellence’ within these audit cultures implicitly reflect images of masculinity such as rationality, measurement, objectivity, control and competitiveness (Burkinshaw, 2015 ).

The association of feminine and masculine traits in academia (Holt and Ellis, 1998 ), and ‘gendering its forms of knowledge production’ (Clegg, 2008 ), is not new. In these typologies, women are largely expected to be soft-spoken, nurturing and understanding (Bellas, 1999 ) yet often invisible and supportive in their ‘institutional housekeeping’ roles (Bird et al., 2004 ). Men, on the other hand are often associated with being competitive, ambitious and independent (Baker, 2008 ). When an individual’s behaviour is perceived to transcend these gendered norms, then this has detrimental effects on how others evaluate their competence, although some traits displayed outside of these typologies go somewhat ‘under the radar’. Nonetheless, studies show that women who display leadership qualities (competitiveness, ambition and decisiveness) are characterised more negatively than men (Rausch, 1989 ; Heilman et al., 1995 ; Rossiter, 1993 ). Incongruity between perceptions of ‘likeability’ and ‘competence’ and its relationship to gender bias is present in evaluations in academia, where success is dependent on the perceptions of others and compounded within an audit culture (Yarrow and Davis, 2018). This has been seen in peer review, reports for men and women applicants, where women were disadvantaged by the same characteristics that were seen as a strength on proposals by men (Severin et al., 2019 ); as well as in teaching evaluations where women receive higher evaluations if they are perceived as ‘nurturing’ and ‘supportive’ (Kogan et al., 2010 ). This results in various potential forms of prejudice in academia: Where traits normally associated with masculinity are more highly valued than those associated with femininity (direct) or when behaviour that is generally perceived to be ‘masculine’ is enacted by a woman and then perceived less favourably (indirect/ unconscious). That is not to mention direct sexism, rather than ‘through’ traits; a direct prejudice.

Gendered associations of Impact are not only oversimplified but also incredibly problematic for an inclusive, meaningful Impact agenda and research culture. Currently, in the UK, the main funding body for research in the UK, UK Research and Innovation (UKRI) uses a broad Impact definition: ‘ the demonstrable contribution that excellent research makes to society and the economy ’ (UKRI website, 2019 ). The most recent REF, REF2014, Impact was defined as ‘ …an effect on, change or benefit to the economy, society, culture, public policy or services, health, the environment or quality of life, beyond academia ’. In Australia, the Australian Research Council (ARC) proposed that researchers should ‘embed’ Impact into the research process from the outset. Both Australia and the UK have been engaged in policy borrowing around the evaluation of societal impact and share many similarities in approaches to generating and evaluating it. Indeed, Impact has been deliberately conceptualised by decision-makers, funders and governments as broad in order to increase the appearance of being inclusivity, to represent a broad range of disciplines, as well as to reflect the ‘diverse ways’ that potential beneficiaries of academic research can be reached ‘beyond academia’. The adoption of societal impact as a formalised criterion in the evaluation of research excellence was initially perceived to be potentially beneficial for women, due to its emphasis on concepts such as ‘public engagement’; ‘duty’ and non-academic ‘cooperation/collaboration’ (Yarrow and Davies, 2018 ). In addition, the adoption of narrative case studies to demonstrate Impact, rather than adopting a complete metrics-focused exercise, can also be seen as an opportunity for women to demonstrate excellence in the areas where they are over-represented, such as teaching, cultural enrichment, public engagement (Andrews et al., 2005 ), informing public policy and improving public services (Schatteman, 2014 ; Wheatle and BrckaLorenz, 2015). However, despite this, studies highlight how for the REF2014, only 25% of Impact Case Studies for business and management studies were from women (Davies et al., 2020 ).

With respect to Impact evaluation, previous research shows that there is a direct link between notions of academic culture, and how research (as a product of that culture) is valued and evaluated (Leathwood and Reid, 2008 ; p. 120). Geertz ( 1983 ) argues that academic membership is a ‘cultural frame that defines a great part of one’s life’ influences belief systems around how academic work is orientated. This also includes gendered associations implicit in the academic reward system, which in turn influences how academics believe success is to be evaluated, and in what form that success emerges. This has implications in how academic associations of the organisation of research work and the ongoing constructions of professional identity relative to gender, feeds into how these same academics operate as evaluators within a peer review system evaluation. In this case, instead of operating to challenge these tendencies, shared constructions of gendered academic work are amplified to the extent that they unconsciously influence perceptions of excellence and the judgements of feasibility as pertaining to the attribution and causality of the narrative argument. As such, in an evaluation of Impact with its ambiguous definition (Derrick, 2018 ), and the lack of external indicators to signal success independent of cultural constructions inherent in the panel membership, effects are assumed to be more acute. In this way, this paper argues that the Impact a-gender can act to further disadvantage women.

The research combines two existing research data sets in order to explore implicit notions of gender associated with the generation and evaluation of research Impact beyond academia. Below the two data sets and the steps involved in analysing and integrating findings are described along with our theoretical positioning within the feminist literature Where verbatim quotation is used, we have labelled the participants according to each study highlighting their role and gender. Further, the evaluator interviews specify the disciplinary panel and subpanel to which they belonged, as well as their evaluation responsibilities such as: ‘Outputs only’; ‘Outputs and Impact’; and ‘Impacts only’.

Analysis of qualitative data sets

This research involved the analysis and combination of two independently collected, qualitative interview databases. The characteristics and specifics of both databases are outlined below.

Interviews with mid-senior academics in the UK and Australia

Fifty-one semi-structured interviews were conducted between 2011 and 2013 with mid-senior academics at two research-intensive universities in Australia and the UK. The interviews were 30–60 min long and participants were sourced via the research offices at both sites. Participants were contacted via email and invited to participate in a study concerning resistance towards the Impact agenda in the UK and Australia and were specifically asked for their perceptions of its relationship with freedom, value and epistemic responsibility and variations across discipline, career stage and national context. Mostly focused on ex ante impact, some interviewees also described their experiences of Impact in the UK and Australia, in relation to its formal assessment as part of the Excellence Innovation Australia (EIA) for Australia and the Research Excellence Framework (REF) in the UK.

Participants comprised mid to senior career academics with experience of winning funding from across the range of disciplines broadly representative of the arts and humanities, social sciences, physical science, maths and engineering and the life and earth sciences. For the purposes of this paper, although participant demographic information was collected, the relationship between the gender of the participants, their roles, disciplines/career stage was not explicitly explored instead, such conditions were emergent in the subsequent inductive coding during thematic analysis. A reflexive log was collected in order to challenge and draw attention to assumptions and underlying biases, which may affect the author, inclusive of their own gender identity. Further information on this is provided in Chubb ( 2017 ).

Pre- and post-evaluation interviews with REF2014 evaluators

REF2014 in the UK represented the world’s first formalised evaluation of ex-post impact, comprising of 20% of the overall evaluation. This framework served as a unique experimental environment with which to explore baseline tendencies towards impact as a concept and evaluative object (Derrick, 2018 ).

Two sets of semi-structured interviews were conducted with willing participants: sixty-two panellists were interviewed from the UK’s REF2014 Main Panel A prior to the evaluation taking place; and a fifty-seven of these were re-interviewed post-evaluation. Main Panel A covers six Sub-panels: (1) Clinical Medicine; (2) Public Health, Health Services and Primary Care; (3) Allied Health Professions, Dentistry, Nursing and Pharmacy; (4) Psychology, Psychiatry and Neuroscience; (5) Biological Sciences; and (6) Agriculture, Veterinary and Food Sciences. Again, the relationship between the gender of the participants and their discipline is not the focus for the purposes of this paper.

Database combination and identification of common emergent themes

The inclusion of data sets using both Australian and UK researchers was pertinent to this study as both sites were at the cusp of implementing the evaluation of Impact formally. These researcher interviews, as well as the evaluator interviews were conducted prior to any formalised Impact evaluation took place, but when both contexts required ex ante impact in terms of certain funding allocation, meaning an analysis of these baseline perceptions between databases was possible. Further, the inclusion of the post-evaluation interviews with panellists in the UK allowed an exploration of how these gendered perceptions identified in the interviews with researchers and panellists prior to the evaluation, influenced panel behaviour during the evaluation of Impact.

Initially, both data sets were analysed using similar, inductive, grounded-theory-informed approaches inclusive of a discourse and thematic analysis of the language used by participants when describing impact, which allowed for the drawing out of metaphor (Zinken et al., 2008 ). This allowed data combination and analysis of the two databases to be conducted in line with the recommendations for data-synthesis as outlined in Weed ( 2005 ) as a form of interpretation. This approach guarded against the quantification of qualitative findings for the purposes of synthesis, and instead focused on an initial dialogic approach between the two authors (Chubb and Derrick), followed by a re-analysis of qualitative data sets (Heaton, 1998 ) in line with the outcomes of the initial author-dialogue as a method of circumventing many of the drawbacks associated with qualitative data-synthesis. Convergent themes from each, independently analysed data set were discussed between authors, before the construction of new themes that were an iterative analysis of the combined data set. Drawing on the feminist tradition the authors did not apply feminist standpoint theory, instead a fully inductive approach was used to unearth rich empirical data. An interpretative and inductive approach to coding the data using NVIVO software in both instances was used and a reflexive log maintained. The availability of both full, coded, qualitative data sets, as well as the large sample size of each, allowed this data-synthesis to happen.

Researcher’s perceptions of Impact as either ‘hard’ or ‘soft’

Both UK and Australian academic researchers (researchers) perceive a guideline of gendered productivity (Davies et al., 2017 ; Sax et al., 2002 ; Astin, 1978 ; Ward and Grant, 1996 ). This is where men or women are being dissuaded (by their inner narratives, their institutions or by colleagues) from engaging in Impact either in preference to other (more masculine) notions of academic productivity, or towards softer (for women) because they consider themselves and are considered by others to be ‘good at it’. Participants often gendered the language of Impact and introduced notions of ‘hard’ and ‘soft’. On the one hand, this rehearses and resurfaces long-standing views about the ‘Matthew Effect’ because often softer Impacts were seen as being of less value by participants, but also indicates that the word impact itself carries its own connotations, which are then weighed down further by more entrenched gender associations.

Our research shows that when describing Impact, it was not necessarily the masculinity or femininity of the researcher that was emphasised by participants, rather researchers made gendered presumptions around the type of Impact, or the activity used to generate it as either masculine or feminine. Some participants referred to their own research or others’ research as either ‘hard’ or as ‘soft and woolly’. Those who self-professed that their research was ‘soft’ or woolly’ felt that their research was less likely to qualify as having ‘hard’ impact in REF terms Footnote 3 ; instead, they claimed their research would impact socially, as opposed to economically; ‘ stuff that’s on a flaky edge — it’s very much about social engagement ’ (Languages, Australia, Professor, Male) . One researcher described Impact as ‘a nasty Treasury idea,’ comparing it to: a tsunami, crashing over everything which will knock out stuff that is precious ’ . (Theatre, Film and TV, UK, Professor, Male) . This imagery associates the concept of impact with force and weight (or hardness as mentioned earlier) particularly in disciplines where the effect of their research may be far more nuanced and subtle. One Australian research used force to depict the impact of teaching and claimed Impact was like a footprint, and teaching was ‘ a pretty heavy imprint ’ (Environment, UK, Professor, Male) . Participants characterised ‘force and weight’ as masculine, suggesting that some connotations of Impact and the associated activities may be gendered. The word ‘Impact’ was inherently perceived by many researchers as problematic, bound with linguistic connotations and those imposed by the official definitions, which in many cases are perceived as negative or maybe even gendered (Chubb, 2017 ): ‘ The etymology of a word like impact is interesting. I’ve always seen what I do as being a more subtle incremental engagement, relevance, a contribution ’. (Theatre, Film and TV, UK, Professor, Male) .

Researchers associated the word ‘impact’ with hard-ness, weight and force; ‘ anything that sorts of hits you ’ (Languages, UK, Senior Lecturer, Female) . One researcher suggested that Impact ‘ sounds kind of aggressive — the poor consumer! ’ (History, Australia, Professor, Female) . Talking about her own research in the performing arts, one Australian researcher commented: ‘ It’s such a pain in the arse because the Arts don’t fit the model. But in a way they do if you look at the impact as being something quite soft ’ (Music, Australia, Professor, Female) . Likewise, a similar comparison was seen by a female researcher from the mechanical engineering discipline: ‘ My impact case study wasn’t submitted mainly because I’m dealing with that slightly on the woolly side of things ’ (Mechanical Engineering, Australia, Professor, Female) . Largely, gender related comments hailed from the ‘hard’ science and from arts and humanities researchers. Social scientists commented less, and indeed, one levelled that Impact was perhaps less a matter of gender, and more a matter of ability (Chubb, 2017 ): ‘ It’s about being articulate! Both guys and women who are very articulate and communicate well are outward looking on all of these things ’ ( Engineering Education, Australia, Professor, Female).

Gendered notions of performativity were also very pronounced by evaluators who were assessing the outputs only, suggesting how these panel cultures are orientated around notions of gender and scientific outputs as ‘hard’ if represented by numbers. The focus on numbers was perceived by the following panellist as ‘ a real strong tendency particularly amongst the Alpha male types ’ within the panel that relate to findings about the association of certain traits—risk aversion, competitiveness, for example, with a masculinised market logic in HE;

And I like that a lot because I think that there is a real strong tendency particularly amongst the Alpha male types of always looking at the numbers, like the numbers and everything. And I just did feel that steer that we got from the panel chairs, both of them were men by the way, but they were very clear, the impact factors and citations and the rank order of a journal is this is information that can be useful, but it’s not your immediate first stop. (Panel 1, Outputs and Impact, Female)

However, a metric-dominant approach was not the result of a male-dominated panel environment and instead, to the panels credit, evaluators were encouraged not to use one-metric as the only deciding factor between star-rating of quality. However, this is not to suggest that metrics did not play a dominant role. In fact, in order to resolve arguments, evaluators were encouraged to ‘ reflect on these other metrics ’ (Panel 3, Outputs only, Male) in order to rectify arguments where the assessment of quality was in conflict. This use of ‘other metrics’ was preferential to a resolution of differences that are based on more ‘soft’ arguments that are based on understanding where differences in opinion might lie in the interpretation of the manuscript’s quality. Instead, the deciding factor in resolving arguments would be the responsibility, primarily, of a ‘hard’ concept of quality as dictated by a numerical value;

Read the paper, judge the quality, judge the originality, the rigour, the impact — if you have to because you’re in dispute with another assessor, then reflect on these other metrics. So I don’t think metrics are that helpful actually if and until you’ve got a real issue to be able to make a decision. But I worry very much that metrics are just such a simple way of making the process much easier, and I’m worried about that because I think there’s a bit of game playing going on with impact factors and that kind of thing. (Panel 3, Outputs Only, Male)

Table 1 outlines the emergent themes, which, through inductive coding participants broadly categorised domains of research, their qualities and associations, types of activities and the gendered assumption generally made by participants when describing that activity. The table is intended only to provide an indicative overview of the overall tendencies of participants toward certain narratives as is not exhaustive, as well as a guide to interpret the perceptions of Impact illustrated in the below results.

Table one describes the dichotomous views that seemed to emerge from the research but it’s important to note that researchers associated Impact as related to gender in subtle, and in some cases overt ways. The data suggests that some male participants felt that female academics might be better at Impact, suggesting that female academics might find it liberating, linked it to a sense of duty or public service, implying that it was second nature. In addition, some male participants associated types of Impact domains as female-orientated activity and the reverse was the case with female and male-orientated ‘types’ of Impact. For example, at one extreme, a few male researchers seemed to perceive public engagement as something, which females would be particularly good at, generalising that they are not competitive ‘ women are better at this! They are less competitive! ’ (Environment, UK, Professor, Male) . Indeed, one male researcher suggested that competitiveness actually helps academics have an impact and does not impede it:

I get a huge buzz from trying to communicate those to a wider audience and winning arguments and seeing them used. It’s not the use that motivates me it’s the process of winning, I’m competitive! (Economics, UK, Professor, Male)

Analysis also revealed evidence that some researchers has gendered perceptions of Impact activities just as evaluators did. Here, women were more likely to promote the importance of engaging in Impact activities, whereas men were focused on producing indicators with hard, quantitative indicators of success. Some researchers implied that public engagement was not something entirely associated with the kinds of Impact needed to advance one’s career and for a few male researchers, this was accordingly associated with female academics. Certain female researchers in the sciences and the arts suggested similarly that there was a strong commitment among women to carry out public engagement, but that this was not necessarily shared by their male counterparts who, they perceived, undervalued this kind of work:

I think the few of us women in the faculty will grapple with that a lot about the relevance of what we’re doing and the usefulness, but for the vast majority of people it’s not there… [She implies that]…I think there is a huge gender thing there that every woman that you talk to on campus would consider that the role of the university is along the latter statement (*to communicate to the public). The vast majority of men would not consider that’s a role of the university. There’s a strong gender thing. (Chemical Engineering, Australia, Professor, Female)

Notwithstanding, it is important to distinguish between engagement and Impact. This research shows that participants perceive Impact activities to be gendered. There was a sense from one arts female researcher that women might be more interested in getting out there and communicating their work but that crucially, it is not the be-all and end- all of doing research: ‘ Women feel that there’s something more liberating, I can empathise with that, but that couldn’t be the whole job ’. Music, Australia, Professor, Female Footnote 4 . When this researcher, who was very much orientated towards Impact, asked if there were enough interviewees, she added ‘ mind you, you’ve probably spoken to enough men in lab coats ’. This could imply that inward-facing roles are associated with male-orientated activity and outward facing roles as perceived as more female orientated. Such sentiments perhaps relate to a binary delineation of women as more caring, subjective, applied and of men as harder, scientific and theoretical/ rational. This links to a broader characterisation of HE as marketised and potentially, more ‘male’ or at least masculinised—where increasing competitiveness, marketisation and performativity can be seen as linked to an increasingly macho way of doing business (Blackmore, 2002 ; Deem, 1998 ; Grummell et al., 2009 ; Reay, n.d. ). The data is also suggestive of the attitude that communication is a ‘soft’ skill and the interpersonal is seen as a less masculine trait. ‘ This is a huge generalisation but I still say that the profession is so dominated by men, undergraduates are so dominated by men and most of those boys will come into engineering because they’re much more comfortable dealing with a computer than with people ’ (Chemical Engineering, Australia, Professor, Female) . Again, this suggests women are more likely to pursue those scientific subjects, which will make a difference or contribute to society (such as nursing or environmental research, certainly those subjects that would be perceived as less ‘hard’ science domains).

There was also a sense that Impact activity, namely in this case public engagement and community work, was associated with women more than men by some participants (Amâncio, 2005 ). However, public engagement and certain social impact domains appeared to have a lower status and intellectual worth in the eyes of some participants. Some inferred that social and ‘soft’ impacts are seen as associated. With discipline. For instance, research concerning STEM (Science, Technology, Engineering and Medicine) subjects with females. They in turn may be held in low esteem. Some of the accounts suggest that soft impacts are perceived by women as not ‘counting’ as Impact:

‘ At least two out of the four of us who are female are doing community service and that doesn’t count, we get zero credit, actually I would say it gets negative credit because it takes time away from everything else ’. (Education Engineering, Australia, Professor, Female)

This was intimated again by another female UK computer scientist who claimed that since her work was on the ‘woolly side’ of things, and her impacts were predominantly in the social and public domain, she would not be taken seriously enough to qualify as a REF Impact case study, despite having won an award for her work:

‘ I don’t think it helps that if I were a male professor doing the same work I might be taken more seriously. It’s interesting, why recently? Because I’ve never felt that I’ve not been taken seriously because I’m a woman, but something happened recently and I thought, oh, you’re not taking me seriously because I’m a woman. So I think it’s a part ’. (Computer Science, UK, Professor, Female)

Researchers also connect the ‘hard’ and ‘soft’ associations with Impact described earlier to male and female traits. The relationship between Impact and gender is not well understood and it is not clear how much these issues are directly relatable to Impact or more symptomatic of the broader picture in HE. In order to get a broader picture, it is important to examine how these gendered notions of Impact translate into its evaluation. Some participants suggested that gender is a factor in the securing of grant money—certainly this comment reveals a local speculation that ‘the big boys’ get the grants, in Australia, at least: ‘ ARC grants? I’ve had a few but nothing like the big boys that get one after the other ,’ (Chemical Engineering, Australia, Professor, Female) . This is not dissimilar to the ‘alpha male’ comments from the evaluators described below who note a tendency for male evaluators to rely on ‘hard’ numbers whose views are further examined in the following section.

Gendered excellence in Impact evaluation

In the pre-evaluation interviews, panellists were asked about what they perceived to be ‘excellent’ research and ‘excellent’ Impact. Within this context, are mirrored conceptualisations of impacts as either ‘soft’ or ‘hard’ as was seen with the interviews with researchers described above. These conceptualisations were captured prior to the evaluation began. They can therefore be interpreted as the raw, baseline assumptions of Impact that are free from the effects of the panel group, showed that there were differences in how evaluators perceived Impact, and that these perceptions were gendered.

Although all researchers conceptualised Impact as a linear process for the purposes of the REF2014 exercise (Derrick, 2018 ), there was a tendency for female evaluators to be open to considering the complexity of Impact, even in a best-case scenario. This included a consideration that Impact as dictated within the narrative might have different indicators of value to different evaluators; ‘ I just think that that whole framing means that there is a form of normative standard of perfect impact ’ (Main Panel, Outputs and Impacts, Female) . This evaluator, in particular, went further to state how that their impression of Impact would be constructed from the comparators available during the evaluation;

‘ Given that I’m presenting impact as a good story, it would be like you saying to me; ‘Can you describe to me a perfect Shakespearean play?’…. well now of course, I can’t. You can give me lots of plays but they all have different kinds of interesting features. Different people would say that their favourite play was different. To me, if you’re taking interpretivist view, constructivist view, there is no perfect normative standard. It’s just not possible ’. (Panel 1, Outputs and Impacts, Female)

Female evaluators were also more sensitive to other complex factors influencing the evaluation of Impact, including time lag; ‘ …So it takes a long time for things like that to be accepted…it took hundreds of studies before it was generally accepted as real ’ (Panel 1, Outputs and Impacts, Female ); as well as the indirect way that research influences policy as a form of Impact;

‘ I don’t think that anything would get four stars without even blinking. I think that is impossible to answer because you have to look at the whole evidence in this has gone on, and how that does link to the impact that is being claimed, and then you would then have to look at how that impact, exactly how that research has impacted on the ways of the world, in terms of change or in terms of society or whatever. I don’t think you can see this would easily get four stars because of the overall process is being looked at, as well as the actual outcome ’ . (Panel 3, Outputs and Impact, Female)

Although these typologies were not absolute, there was a lack of complexity in the nuances around Impact. There was also heavily gendered language around Impacts as measurable, or not, that mirrored the association of Impact as being either ‘hard’, and therefore measurable, or ‘soft, and therefore more nuanced in value. In this way, male evaluators expressed Impact as a causal, linear event that occurred ‘ in a very short time ’ (P2, Outputs and Impact, Male) and involved a single ‘ star ’ (P3, Impacts only, Male) or ‘ impact champion ’ (Main Panel, Outputs and Impacts, Male) that drove it from start (research), to finish (Impact). These associations about Impact being ‘soft’ and ‘hard’ made by evaluators, mirror the responses from researchers in the above sections. In the example below, the evaluator used words such as ‘ strong ’ and ‘ big way ’ to describe Impact success, as well as emphasises causality in the argument;

‘ …if it has affected a lot of people or affected policy in a strong way or created change in a big way, and it can be clearly linked back to the research, and it’s made a difference ’. (Panel 2, Outputs and Impact, Male)

These perhaps show disciplinary differences as much as gendered differences. Further, there was a stronger tendency for male evaluators to strive towards conceptualisations of excellence in Impact as measurable or ‘ it’s something that is decisive and actionable ’ (Panel 6, Impacts, Male) . One male evaluator explained his conceptualised version of Impact excellence as ‘ straightforward ’ and therefore ‘ obviously four-star ’ due to the presence of metrics with which to measure Impact. This was a perception more commonly associated with male evaluators;

‘ …if somebody has been able to devise a — let’s say pancreatic cancer — which is a molecular cancer, which hasn’t made any progress in the last 40 years, and where the mortality is close to 100% after diagnosis, if someone devised a treatment where now suddenly, after diagnosis of pancreatic cancer, 90 percent of the people are now still alive 5 years later, where the mortality rate is almost 0%, who are alive after 5 years. That, of course, would be a dramatic, transformative impact ’. (Panel 1, Outputs and Impact, Male)

In addition, his tendency to seek various numeric indicators for measuring, and therefore assessing Impact (predominantly economic impact), as well as compressing its realisation to a small period of time ( ‘ suddenly ’ ) in a causal fashion, was more commonly expressed in male evaluators. This tendency automatically indicates the association of impacts as either ‘soft’ or ‘hard’ and divided along gendered norms, but also expresses Impact in monetary terms;

‘ Something that went into a patient or the company has pronounced with…has spun out and been taken up by a commercial entity or a clinical entity ’ (Panel 3, Outputs and Impacts, Male) , as well as impacts that are marketised; ‘ A new antimicrobial drug to market ’. (Panel 6, Outputs and Impact, Male) .

There was also the perception that female academics would be better at engagement (Johnson et al., 2014 ; Crettaz Von Roten, 2011 ) due to its link with notions of ‘ duty ’ (as a mother), ‘ engagement ’ and ‘ public service ’ are reflected in how female evaluators were also more open to the idea that excellent Impact is achieved through productive, ongoing partnerships with non-academic stakeholders. Here, the reflections of ‘duty’ from the evaluators was also mirrored by in interviews with researchers. Indeed, the researchers merged perceptions of parenthood, an academic career and societal impact generation. One female researcher drew on her role as a mother as supportive of her ability to participate in Impact generation, ‘ I have kids that age so… ’ (Biology, UK, Senior Lecturer, Female) . Indeed, parenthood emerged from researchers of both genders in relation to the Impact agenda. Two male participants spoke positively about the need to transfer knowledge of all kinds to society referencing their role as parents: ‘ I’m all for that. I want my kids to have a rich culture when they go to school ’ (Engineering, Australia, Professor, Male, E2) , and ‘ My children are the extension of my biological life and my students are an extension of my thoughts ’ (Engineering, Australia, Professor, Male, E1) . One UK female biologist commented that she indeed enjoys delivering public engagement and outreach and implies a reference to having a family as enabling her ability to do so: ‘ It’s partly being involved with the really well-established outreach work ,’ (Biology, UK, Senior Lecturer, Female) .

For the evaluators, the idea that ‘public service’ as second nature for female academics, was reflected in how female evaluators perceived the long, arduous and serendipitous nature of Impact generation, as well as their commitment to assessing the value of Impact as a ‘pathway’ rather than in line with impact as a ‘product’. Indeed, this was highlighted by one male evaluator who suggested that the measurement and assessment of Impact ‘ …needs to be done by economists ’ and that

‘ you [need] to put in some quantification one everything…[that] puts a negative value on being sick and a positive large value on living longer. So, yeah, the greatest impact would be something that saves us money and generates income for the country but something broad and improves quality of life ’. (Panel 2, Impacts, Male)

Since evaluators tend to exercise cognitive bias in evaluative situations (Langfeldt, 2006 ), these preconceived ideas about Impact, its generation and the types of people responsible for its success are also likely to permeate the evaluative deliberations around Impact during the peer review process. What is uncertain is the extent that these messages are dominant within the panel discourse, and therefore the extent that they influence the formation of a consensus within the group, and the ‘dominant definition’ of Impact (Derrick, 2018 ) that emerges as a result.

Notions of gender from the evaluators post-evaluation

Similar notions of gender-roles in academia pertaining to notions of scientific productivity were echoed by academics who were charged with its evaluation as part of the UK’s 2014 Research Excellence Framework. Interviews with evaluators revealed not only that the panel working-methods and characteristics about what constituted a ‘good’ evaluator were implicitly along gendered norms, but also that the assumed credit assumptions of performativity were also based on gender.

In assessments of the Impact criterion, an assessment that is not as amenable to quantitative representation requiring panels to conceptualise a very complex process, with unstandardised measures of significance and reach, there was still a gendered perception of Impact being ‘women’s work’ in academia. This perception was based on the tendency towards conceptualising Impact as ‘slightly grubby’ and ‘not very pure’, which echoes previously reported pre-REF2014 tensions that Impact is a task that an academic does when they cannot do real research (de Jong et al., 2015 );

But I would say that something like research impact is — it seems something slightly grubby. It’s not seen as not — by the academics, as not very pure. To some of them, it seems women’s work. Talking to the public, do you see what I mean? (Main Panel, Outputs and Impact, Female)

In addition, gendered roles also relate to how the panel worked with the assessment of Impact. Previous research has outlined how the equality and diversity assessment of panels for REF2014 were not conducted until after panellists were appointed (Derrick, 2018 ), leading to a lack of equal-representation of women on most panels. Some of the female panellists reflected that this resulted not only in a hyper-awareness of one’s own identity and value as a woman on the panel, but also implicitly associating the role that a female panellist would play in generating the evaluation. One panellist below, reflected that she was the only female in a male-dominated panel, and that the only other females in the room were the panel secretariat. The panellist goes further to explain how this resulted in a gendered-division of labour surrounding the assessment of Impact;

I mean, there’s a gender thing as well which isn’t directing what you’re talking about what you’re researching, but I was the only woman on the original appointed panel. The only other women were the secretariat. In some ways I do — there was initially a very gendered division of perspective where the women were all the ones aggregate the quantitative research, or typing it all up or talking about impact whereas the men were the ones who represented the big agenda, big trials. (Main Panel, Outputs and Impact, Female)

In addition, evaluators expressed opinions about what constituted a good and a bad panel member. From this, the evaluation showed that traits such as the ability to work as a ‘team’ and to build on definitions and methods of assessment for Impact through deliberation and ‘feedback’ were perceived along gendered lines. In this regard, women perceived themselves as valuable if they were ‘happy to listen to discussions’, and not ‘too dogmatic about their opinion’. Here, women were valued if they played a supportive, supplementary role in line with Bellas ( 1999 ), which was in clear distinction to men who contributed as creative thinkers and forgers of new ideas. As one panellist described;

A good panel member is an Irish female. A good panel member was someone who was happy to — someone who is happy to listen to discussions; to not be too dogmatic about their opinion, but can listen and learn, because impact is something we are all learning from scratch. Somebody who wasn’t too outspoken, was a team player. (Panel 3, Outputs and Impact, Female)

Likewise, another female evaluator reflected on the reasons for her inclusion as a panel member was due to her ‘generalist perspective’ as opposed to a perspective that is over prescribed. This was suggestive of how an overly specialist perspective would run counter to the reasons that she was included as a panellist which was, in her opinion, due to her value as an ethnic and gender ‘token’ to the panel;

‘ I think it’s also being able to provide some perspective, some general perspective. I’m quite a generalist actually, I’m not a specialist……So I’m very generalist. And I think they’re also well aware of the ethnic and gender composition of that and lots of reasons why I’m asked on panels. (Panel 1, Outputs and Impact, Female)

Women perceived their value on the panel as supportive, as someone who is prepared to work on the team, and listen to other views towards as a generalist, and constructionist, rather than as an enforced of dogmatic views and raw, hard notions of Impact that were represented through quantitative indicators only. As such, how the panel operated reflects general studies of how work can be organised along gender lines, as well as specific to workload and power in the academy. The similarity between the gendered associations towards conceptualising Impact from the researchers and evaluators, combined with how the panel organises its work along gendered lines, suggests how panel culture echoes the implicit tendencies within the wider research community. The implications of this tendency in relation to the evaluation of non-academic Impact is discussed below.

Discussion: an Impact a-gender?

This study shows how researchers and evaluators in two, independent data sets echoed a gendered orientation towards Impact, and how this implies an Impact a-gender. That gendered notions of Impact emerged as a significant theme from two independent data sets speaks to the importance of the issue. It also illustrates the need for policymakers and funding organisations to acknowledge its potential effects as part of their efforts towards embedding a more inclusive research culture around the generation and evaluation of research impact beyond academia.

Specifically, this paper has identified gendered language around the generation of, and evaluation of Impact by researchers in Australia and the UK, as well as by evaluators by the UK’s most recent Research Excellence Framework in 2014. For the UK and Australia, the prominence of Impact, as well as the policy borrowing between each country (Chubb, 2017 ) means that a reliable comparison of pre-evaluation perceptions of researchers and evaluators can be made. In both data sets presumptions of Impact as either ‘soft’ or ‘hard’ by both researchers and evaluators were found to be gendered. Whereas it is not surprising that panel culture reflects the dominant trends within the wider academic culture, this paper raises the question of how the implicit operation of gender bias surrounding notions of scientific productivity and its measurement, invade and therefore unduly influence the evaluation of those notions during peer-review processes. This negates the motivation behind a broad Impact definition and evaluation as inclusive since unconscious bias towards women can still operate if left unchecked and unmanaged.

Gendered notions of excellence were also related to the ability to be ‘competitive’, and that once Impact became a formalised, countable and therefore competitive criterion, it also become masculine where previously it existed as a feminised concept related to female academic-ness. As a feminised concept, Impact once referred to notions of excellence requiring communication such as public engagement, or stakeholder coordination—the ‘softer’ impacts. However, this association only remains ‘soft’ insofar as Impact remains unmeasurable, or more nuanced in definition. This is especially pertinent for the evaluation of societal impact where already conceived ideas of engagement and ‘ women’s work ’ influence how evaluators assess the feasibility of impact narratives for the purposes of its assessment. This paper also raises the question that notions of gender in relation to Impact persist irrespective of the identities assumed for the purposes of its evaluation (i.e., as a peer reviewer). This is not to say that academic culture in the UK and Australia, where Impact is increasingly being formalised into rewards systems, is not changing. More that there is a tendency in some evaluations for the burden of evidence to be applied differently to genders due to tensions surrounding what women are ‘good’ at doing: engagement, versus what ‘men’ are good at doing regarding Impact. In this scenario, quantitative indicators of big, high-level impacts are to be attributable to male traits, rather than female. This has already been noted in student evaluations of teaching (Kogan et al., 2010 ) and of academic leadership performance where the focus on the evaluation is on how others interpret performance based on already held gendered views about competence based on behaviours (Williams et al., 2014 ; Holt and Ellis, 1998 ). As such, when researchers transcend these gendered identities that are specific to societal impact, there is a danger of an Impact-a-gender bias arising in the assessment and forecasting of Impact. This paper extends this understanding and outlines how this may also be the case for assessments of societal impact.

By examining perceptions, as well as using an inductive analysis, this study was able to unearth unconsciously employed gendered notions that would not have been prominent or possible to pick up if we asked the interviewees about gender directly. This was particularly the case for the re-analysis of the post-evaluation interviews. However, future studies might consider incorporating a disciplinary-specific perspective as although the evaluators were from the medical/biomedical disciplines, researchers were from a range of disciplines. This would identify any discipline-specific risk towards an Impact a-gender. Nonetheless, further work that characterises the impact a-gender, as well as explores its wider implications for gender inequities within HE is currently underway.

How research evidence is labelled as excellent and therefore trustworthy, is heavily dictated by an evaluation process that is perceived as impartial and fair. However, if evaluations are compounded by gender bias, this confounds assessments of excellence with gendered expectation of non-academic impact. Consequently, gendered expectations of excellence for non-academic impact has the potential to: unconsciously dissuade women from pursuing more masculinised types of impact; act as a barrier to how female researchers mobilise their research evidence; as well as limit the recognition female researchers gain as excellent and therefore trustworthy sources of evidence.

The aim of this paper was not to criticise the panellists and researchers for expressing gendered perspectives, nor to present evidence about how researchers are unduly influenced by gender bias. The results shown do not support either of these views. However, the aim of this paper was to acknowledge how gender bias in research Impact generation can lead to a panel culture dominated by academics that translate the implicit and explicit biases within academia that influence its evaluation. This paper raises an important question regarding what we term the ‘Impact a-gender’, which outlines a mechanism in which gender bias feeds into the generation and evaluation of a research criterion, which is not traditionally associated with a hard, metrics-masculinised output from research. Along with other techniques used to combat unconscious bias in research evaluation, simply by identifying, and naming the issue, this paper intends to combat its ill effects through a community-wide discussions as a mechanism for developing tools to mitigate its wider effect if left unchecked or merely accepted as ‘acceptable’. In addition, it is suggested that government and funding organisations explicitly refer to the impact a-gender as part of their wider EDI (Equity, Diversity and Inclusion) agendas towards minimising the influence of unconscious bias in research impact and evaluation.

Data availability

Data is available upon request subject to ethical considerations such as consent so as not to compromise the individual privacy of our participants.

Change history

19 may 2020.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

For the purposes of this paper, when the text refers to non-academic, societal impact, or the term ‘Impact’ we are referring to the change and effect as defined by REF2014/2021 and the larger conceptualisation of impact that is generated through knowledge exchange and engagement. In this way, the paper refers to a broad conceptualisation of research impact that occurs beyond academia. This allows a distinction between Impact as central to this article’s contribution, as opposed to academic impact, and general word ‘impact’.

Impact scholars or those who are ‘good at impact’ are often equated with applied researchers.

One might interpret this as meaning ‘economic impact’.

This is described in the next section as ‘women’s work’ by one evaluator.

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This research was funded by the UK Economic and Social Research Council (ESRC) Future Research Leaders Programme (ES/K008897/2). We would also like to acknowledge their peers for offering their views on the paper in advance of publication and in doing so thank Dr. Richard Watermeyer, University of Bath, Professor Paul Wakeling, University of York and Dr. Gabrielle Samuel, Kings College London.

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• Published: 03 May 2016

Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use

• Shirin Heidari 1 ,
• Thomas F. Babor 2 ,
• Paola De Castro 3 ,
• Sera Tort 4 &
• Mirjam Curno 5  

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An Erratum to this article was published on 24 June 2016

Sex and gender differences are often overlooked in research design, study implementation and scientific reporting, as well as in general science communication. This oversight limits the generalizability of research findings and their applicability to clinical practice, in particular for women but also for men. This article describes the rationale for an international set of guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines.

A panel of 13 experts representing nine countries developed the guidelines through a series of teleconferences, conference presentations and a 2-day workshop. An internet survey of 716 journal editors, scientists and other members of the international publishing community was conducted as well as a literature search on sex and gender policies in scientific publishing.

The Sex and Gender Equity in Research (SAGER) guidelines are a comprehensive procedure for reporting of sex and gender information in study design, data analyses, results and interpretation of findings.

Conclusions

The SAGER guidelines are designed primarily to guide authors in preparing their manuscripts, but they are also useful for editors, as gatekeepers of science, to integrate assessment of sex and gender into all manuscripts as an integral part of the editorial process.

Sex and gender are important determinants of health and well-being. Sex refers to a set of biological attributes in humans and animals that are associated with physical and physiological features including chromosomes, gene expression, hormone function and reproductive/sexual anatomy [ 1 ]. Sex is usually categorized as female or male, although there is variation in the biological attributes that constitute sex and how those attributes are expressed.

Gender refers to the socially constructed roles, behaviours and identities of female, male and gender-diverse people [ 1 ]. It influences how people perceive themselves and each other, how they behave and interact and the distribution of power and resources in society. Gender is usually incorrectly conceptualized as a binary (female/male) factor. In reality, there is a spectrum of gender identities and expressions defining how individuals identify themselves and express their gender. A glossary of terms is provided in Appendix 1 to define the meaning of sex, gender and related terms.

Sex and gender interactions influence health and well-being in a variety of ways. They both impact environmental and occupational risks, risk-taking behaviours, access to health care, health-seeking behaviour, health care utilization, and perceived experience with health care, and thus disease prevalence and treatment outcome. In addition, it is well-known that pharmacokinetics and pharmacodynamics of pharmaceutical agents differ between sexes, resulting in differential adverse event profiles and further impacting treatment outcomes. Thus, sex and gender are critical determinants of health [ 2 ].

Sex and gender bias in the conduct of research

Despite recognition of the importance of sex and gender in most areas of research, important knowledge gaps persist owing to the general orientation of scientific attention to one sex or gender category and because of a misconception that disaggregation of sex does not apply to other living organisms that can be classified by sex [ 3 – 6 ].

The gap in the representation of women in studies on human subjects has been well-documented [ 1 ]. A review of cardiovascular treatment trials included in Cochrane Reviews reveals that only 27 % of the total trial participants in the 258 clinical trials were women [ 7 ]. More importantly, among trials recruiting both men and women, only one third reported a gender-based analysis [ 8 ]. More than 79 % of animal studies published in Pain over a 10-year period included male subjects only, and only 4 % studied sex differences [ 9 ].

The underrepresentation of women in research can result in adverse consequences. Among the ten prescription pharmaceuticals withdrawn from the US market between 1997 and 2001, eight caused greater harm to women than men [ 10 ]. More recently, the US Food and Drug Administration (FDA) issued a safety communication, recommending half a dose of zolpidem for women, due to greater susceptibility to the risks of the drug [ 11 ]. Sex- and gender-based analysis, in all of these cases, would have provided sufficient information to guide dosing and applicability of drugs in men and women prior to approval.

Failure to conduct sex and gender-based analysis occurs in a range of disciplines. In the field of engineering, lack of consideration of differences in the physiology and anatomy of males and females in developing car seats has resulted in higher risk for whiplash injuries among female car occupants compared with men [ 12 , 13 ].

Although the term “gender gap” has most often been applied to women, the benefit that sex- and gender-based analysis has for our understanding of men’s health should also be noted. Despite the increasing representation of male and female subjects in research and reporting of sex-specific and gender-specific data, these examples indicate that existing policies have not been enforced [ 3 ]. Lack of interest in sex and gender differences may not only be harmful but also present missed opportunities for innovation. Understanding the underlying differences and similarities, exploring applicability, uptake and impact of technological innovations and getting deeper insight into cognitive variability will undoubtedly lead to more innovative approaches and better solutions to meet the needs of society.

The role of journal editors and editorial policies

Editors play an important role as gatekeepers of science, including the articulation of an ethical framework that influences the conduct of research. With an ever-increasing volume of information being published, concerns over the quality of publications have lead journal editors, publishers and professional associations to implement detailed guidelines. Ethical review procedures are now universally applied in human and animal research, in part because of journal requirements. The impact of journal policies on compliance to mandates has been clearly demonstrated in such diverse areas as clinical trial registration [ 14 ] and the reporting of systematic reviews after introduction of PRISMA guidelines [ 15 ]. Another illustration is the gradual adoption of the Consolidated Standards of Reporting Trials (CONSORT) statement, which has led to improved reporting of randomized controlled trials [ 16 , 17 ]. Following CONSORT and PRISMA, many other reporting guidelines have been developed, including the ARRIVE guidelines for animal research [ 18 ].

Although policy implementation and enforcement continue to be a critical challenge, journals could play an important role in advancing the quality and transparency of reported data by promoting sex- and gender-specific analysis of research data as a matter of routine. In a 2011 workshop on “Sex-specific reporting of scientific research,” convened by the US Institute of Medicine, a number of key issues were identified that journals and journal editors should address in order to improve gender-sensitive reporting of research [ 3 ], including the appropriateness of sex-specific data analyses and the absence of journal policies recommending sex and gender considerations in research design and reporting.

On the basis of the available evidence, a committee of the US Institute of Medicine in 2010 recommended that the International Committee of Medical Journal Editors (ICMJE) and other editors adopt a guideline that all papers reporting the results of clinical trials analyse data separately for men and women. The ICMJE has since published more robust guidance on sex and gender reporting, recommending that researchers include representative populations in all study types, provide descriptive data for sex and other relevant demographic variables and stratify reporting by sex [ 19 ].

Adequate inclusion of sufficient numbers of men and women (and other sub-populations) in research, along with appropriate analysis and transparent and complete reporting of research data, require a concerted effort among funders, researchers, reviewers and editors [ 20 ]. Although editors typically enter the research process late, after the research has already been concluded and the data analysed, they can still play an important role in ensuring effective, transparent and complete sex and gender reporting.

In recent years, several reviewers of sex and gender issues in scientific research have made recommendations regarding the best ways to address the problems that have been identified. Doull et al. [ 21 , 22 ] proposed that the methodology of systematic reviews and of sex- and gender-based analyses be refined and synchronized to enhance the collection, synthesis and analysis of evidence for decision-making, and they developed an appraisal tool for systematic reviews and adapted it to evaluate primary studies and protocols for new research [ 22 ]. Nowatski and Grant [ 23 ] provided a rationale for gender-based analysis, which is designed to identify the sources and consequences of inequalities between women and men and to develop strategies to address them. The Clinical Orthopedics and Research journal published an editorial on gender and sex in scientific reporting in 2014, including a set of recommendations [ 5 ].

Editorial associations, publishing houses, funding agencies and public interest organizations have also taken an interest in sex and gender issues. The Canadian Institutes of Health Research implemented a requirement in 2010 that all grant applicants respond to mandatory questions about whether their research designs include gender and sex [ 24 ]. Advances made in the inclusion of women as research participants in the USA can be attributed in large part to the actions taken at the NIH in 1993 that stipulated women and minorities should be included in phase 3 clinical trials so that valid analyses of differences in intervention effects could be performed [ 25 ]. More recently, the NIH announced plans to require grant applicants to describe how they will balance of male and female cells and animals in preclinical studies, unless sex-specific inclusion is unwarranted [ 6 ].

Despite a greater recognition of the importance of sex and gender considerations in research and scientific publishing, progress has been slow in some areas of science and further work is needed to build on preceding efforts by journals, journal editors and learned societies. As noted by Nieuwenhoven [ 26 ], vigorous approaches are needed to stimulate scientists to integrate sex and gender aspects into their research. For example, there is no overarching set of recommendations that provides guidelines for better reporting of sex and gender in scientific publications across disciplines. To address this need, the present article describes the development of a set of international guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines.

The European Association of Science Editors (EASE) established a Gender Policy Committee in 2012 and tasked it to develop a set of guidelines for reporting of Sex and Gender Equity in Research (SAGER). A panel of 13 experts (eight females, five males) representing nine countries were selected by the Chairperson of the GPC (Dr. Heidari). Eight members were senior editors for a variety of biomedical journals, and the remaining individuals had expertise on gender research and scientific publishing.

An internet survey of 716 journal editors, scientists and other members of the international publishing community was first conducted to gather information about existing sex and gender policies and opinions about the need for such policies. The survey focused on four policy areas: (1) instructions for authors that require or encourage disaggregation of data by sex or gender when feasible; (2) gender policies concerning the composition of editorial staff and boards; (3) policies that strive for gender balance among peer reviewers and (4) guidelines that ask reviewers to assess manuscripts for inclusion of sex-disaggregated data and gender analysis. The survey targeted four groups: EASE members; members of the International Society of Addiction Journal Editors (ISAJE); a random sample of 100 journals selected from the 8607 names in the Thomson Reuters SCI Expanded database of journals and an open sample in which any concerned individual could complete the survey. In total, 716 respondents took part in the survey, representing 338 unique journals and 114 unique publishing houses.

In addition to the survey, several other methods were used to identify policy options and expert recommendations. First, keyword searches were conducted (e.g. “sex” + “instructions for authors”) to identify journals that had specific policies on sex and gender. In addition, we scanned the websites of surveyed journals that explicitly expressed concerns about sex and gender knowledge gaps in science and the sex and gender reporting policies of peer-reviewed journals already known to the Gender Policy Committee.

Over a 3-year period, the Committee worked through a series of teleconferences, conference presentations and a 2-day workshop to develop its recommendations. Once the draft guidelines were developed, dissenting views were considered at editors’ meetings in Blankenberge, Belgium, and Split, Croatia. In addition, the draft guidelines were circulated to 36 experts in sex and gender research; any comments received were incorporated into the document where relevant.

Survey findings

The average proportion of respondents in each of the four samples who reported having sex and/or gender policies at their journals was 7 %. Respondents from countries where men and women are more equal (lower GII) were more likely to report that these policies are in place.

In the random sample of 100 journals and the EASE and ISAJE groups, a majority (75 %) were unsure or unwilling to introduce sex and gender considerations as requirements in Instructions for Authors. Female respondents were more likely to support sex and gender reporting policies than male respondents. While caution must be exercised in relation to the conclusions drawn, the survey results point to the paucity of sex- and gender-related policies concerning instructions for authors, guidelines for peer-reviewers and gender balance of both editorial boards and peer-reviewers.

Literature review

Our review identified policies developed and used by 62 journals, as well as 25 other sources of published materials in the form of journal articles, editorials, expert committee reports and conference proceedings.

The majority of sex and gender policies and guidelines fell into the Instructions for Authors category, covering a variety of scientific areas (e.g. “animal science,” “health – psychiatry”) and types of research (e.g. animal, human, cell or a combination of the three). In most cases, the instructions merely advise authors to report results for males and females separately, if appropriate.

Several journals [ 20 , 27 , 5 ] have used their editorial pages to announce the adoption of new policies or to promote the need for greater awareness of sex and gender issues. For example, the editors of Clinical Orthopaedic and Related Research published an editorial [ 5 ] recommending that researchers seeking publication in the journal use the following guidelines: (1) design studies that are sufficiently powered to answer research questions both for males and females if the health condition being studied occurs in all sexes and genders; (2) provide sex- and/or gender-specific data where relevant in all clinical, basic science and epidemiological studies; (3) analyse the influence (or association) of sex or gender on the results of the study, or indicate in the “ Methods ” section why such analyses were not performed, and consider this topic as a limitation to cover in the “ Discussion ” section and (4) if sex or gender analyses were performed post hoc, indicate that these analyses should be interpreted cautiously.

In a 2011 workshop “Sex-specific reporting of scientific research,” a broad cross section of stakeholders convened by the US Institute of Medicine identified key issues that journals and journal editors should address, such as requiring authors to report on the sex of study subjects, not only in studies with human participants but also in animal research and in studies with cells, tissues and other material from humans or animals.

Doull et al. [ 21 ] proposed that the methodologies of systematic reviews and of sex- and gender-based analysis be refined and synchronized to enhance the collection, synthesis and analysis of evidence for decision-making. Nowatski and Grant [ 23 ] provided a rationale for gender-based analysis (GBA), which is designed to identify the sources and consequences of inequalities between women and men and to develop strategies to address them. GBA focuses on gender differences in health and health care and appropriate policies.

SAGER guidelines

The policies, procedures and recommendations reviewed above were used as a basis for the SAGER guidelines, which are designed to promote systematic reporting of sex and gender in research. The guidelines provide researchers and authors with a tool to standardize sex and gender reporting in scientific publications, whenever appropriate. They are also aimed at editors to use as a practical instrument to evaluate a research manuscript and as a vehicle to raise awareness among authors and reviewers. Although reporting guidelines typically focus on how to report what was actually done in a study, we recognize that not all of the items included in the SAGER guidelines are feasible or applicable to a particular study. For this reason, SAGER encourages authors, editors and referees to consider if sex and gender are relevant to the topic of the study, and accordingly to follow the guidelines, whenever applicable. As a general principle, the SAGER guidelines recommend careful use of the words sex and gender in order to avoid confusing both terms. The use of common definitions will improve the ability to conduct meta-analyses of published and archived data. The term sex should be used as a classification of male or female based on biological distinction to the extent that this is possible to confirm. Authors should underline in the methods section whether sex of participants was defined based on self-report, or assigned following external or internal examination of body characteristics, or through genetic testing or other means. In studies of animals, the term sex should be used. In cell biological, molecular biological or biochemical experiments, the origin and sex chromosome constitutions of cells or tissue cultures should be stated. If unknown, the reasons should be stated. In other disciplines, such as the testing of devices or technology, authors should explain whether it will be applied or used by all genders and if it has been tested with a user’s gender in mind.

It is acknowledged that many studies will not have been “designed” to analyse sex and/or gender differences, but the panel felt these analyses are necessary to advance knowledge about sex and gender, especially in medical research.

Table  1 presents the SAGER guidelines. They apply to all research with humans, animals or any material originating from humans and animals (e.g. organs, cells, tissues), as well as other disciplines whose results will be applied to humans such as mechanics and engineering.

Title and abstract

If only one sex or gender is included in the study, the title and the abstract should specify the sex of animals or any cells, tissues and other material derived from these and the sex and gender of human participants. In applied sciences (technology, engineering, etc.), authors should indicate if the study model was based on one sex or the application was considered for the use of one specific sex. For studies (of a non-sex-specific issue) in which only one sex has been used, the article’s title should specify this fact by including “in males” or “in females” in the title and abstract. If cultures of primary cells, tissue, etc., were obtained from one sex, the sex should be indicated in the title [ 3 ].

Introduction

Authors should report, where relevant, previous studies that show presence or lack of sex or gender differences or similarities. If such studies are lacking, the authors should explain whether sex and/or gender may be an important variant and if differences may be expected.

Authors should report how sex and gender were taken into account in the design of the study, ensure adequate representation of males and females and justify reasons for the exclusion of males or females. Methodological choices about sex and gender in relation to study population and analytical approach should be reported and justified in the same way as other methodological choices.

In vivo and in vitro studies using primary cultures of cells, or cell lines from humans or animals, or ex vivo studies with tissues from humans or animals must state the sex of the subjects or source donors, except for immortalized cell lines, which are highly transformed [ 3 ]. In other cases, e.g. embryonic or early postnatal cultures, cell lines immortalized from a mixed culture or previously completed experiments for which sex was not documented, it is recommended that researchers determine the sex of cells or cell lines by chromosomal analysis and that the designations “mixed” or “unknown” should be used only when the sex cannot be determined through any methods.

Data should be reported disaggregated by sex, and an analysis of sex and gender differences and similarities should be described, where appropriate. Anatomical and physiological differences between men and women (height, weight, body mass, cell counts, hormonal cycles, etc.) as well as social and cultural variables (socio-economic status, education, etc.) should be taken into consideration in the presentation of data and/or analysis of the results. We recommend the use of the gendered innovations’ checklist for animals, tissues, cells and cultures [ 28 ]. If sex- and gender-based analyses have been performed, results should be reported regardless of the positive or negative outcome. In human studies, data on enrolment, participation, dropout, discontinuation and loss-to-follow up should be reported disaggregated by sex and gender (where appropriate), and the influence of sex and gender factors should be assessed a priori on the basis of their hypothesized role in the causation, course, treatment effectiveness, impact and outcome of health problems. Authors should refrain from conducting a post hoc gender-based analysis if the study design is insufficient to enable meaningful conclusions. In all cases, raw data should be published disaggregated by sex and gender for future pooling and meta-analysis.

In epidemiological studies, the impact of other exposures, such as socioeconomic variables, on health problems should be examined for all genders and should be analysed critically from a gender perspective.

We recognize that reporting guidelines focus on how to report what was actually done. However, not all of the items in the SAGER guidelines need to be done, as indicated by the words, “if appropriate.” The SAGER guidelines are intended to promote sex and gender equity in research; therefore, it encourages authors, editors and referees to consider if sex and gender are relevant to the topic of the study, and accordingly to follow the guidelines, whenever applicable.

The implications of sex and gender for the interpretation of study results should be elaborated, including the extent to which the findings can be generalized to all sexes and genders in a population. If no sex and gender-based analyses have been performed, authors should indicate the reasons for lack of such analyses when discussing the limitations of the study and discuss whether such analyses could have affected the results.

When interpreting research findings, past research should be examined for both methodological rigour and sex bias in procedure and interpretation. Authors should avoid confusing sex with gender and reducing complex or interactionist explanations to overly simple ones. Authors should consider all possible explanations for sex- and gender-related phenomena including social, cultural, biological and situational factors, recognizing that many sex-related behaviours might result from either cultural factors or biological factors. Covariation between biology and behaviour does not constitute evidence for physiological causation.

Appendix 2 provides a set of questions intended to raise awareness among authors. For many disciplines engaged in original scientific research, this list could serve as a basis for the preparation of a manuscript for submission.

The SAGER guidelines were developed over a 3-year period by a multidisciplinary group of academics, scientists and journal editors by means of literature reviews, expert feedback and public consultations at conferences. Authors, journal editors, publishers, reviewers and other members of the scientific community all have a role to play in addressing the neglect of the sex and gender dimension in scientific publishing.

The SAGER guidelines provide researchers and authors with a tool to standardize sex and gender reporting in scientific publications. They were designed to improve sex and gender reporting of scientific research, serve as a guide for authors and peer-reviewers, be flexible enough to accommodate a wide range of research areas and disciplines and improve the communication of research findings. Nevertheless, the guidelines do not make explicit recommendations regarding gender-diverse populations. We recognize that most studies will not be powered to detect differences in effects for gender-diverse populations such as transgender, especially in countries where such diversity is unknown. Yet authors need to consider the relevance of their research for gender-diverse populations.

Editors should make it clear that integration of sex and gender issues makes for more rigorous and ethical science. To the extent that mandates are difficult to implement, we recommend that journal editors endorse the SAGER guidelines and adapt them to the needs of their journals and their fields of science by including examples of good practice for each of the reporting items. At a minimum, journals publishing original research should request in their instructions to authors that all papers present data disaggregated by sex and gender and, where applicable, explain sex and gender differences or similarities adequately. Figure  1 provides a list of questions that could be used to guide the initial screening of submitted manuscripts. Editors should introduce specific questions in the checklist used to screen initial submissions, as an effort to systematize gender-conscious assessment of manuscripts among editorial staff. The following is an example of questions that can be introduced in peer-reviewers’ assessment forms:

SAGER flowchart guiding editors’ initial screening of submitted manuscripts

1. Are sex and gender relevant to the research in question?

2. Have authors adequately addressed sex and gender dimensions or justified absence of such analysis?

To be effective, the guidelines need to be endorsed by a broad cross section of the scientific community, including journal editors, publishers, editors’ societies, professional organizations, scientific advocacy groups, science journalists and other science communicators.

Editors should distribute the SAGER guidelines to their reviewers and encourage them to use them in the evaluation of manuscripts. They should ensure the manuscript assessment forms completed by peer-reviewers include specific questions regarding the importance and relevance of sex and gender.

Training the editorial staff on the importance of sex and gender-sensitive reporting should be conducted as part of regular training on ethical conduct and editorial practices.

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Acknowledgement

The SAGER guidelines are the result of collective effort by the EASE Gender Policy Committee (GPC) (please see EASE website for the list of committee members). The authors would particularly like to thank Joan Marsh, Ines Steffens and Paul Osborn for critically reading the manuscript and providing valuable comments on the various drafts of this paper. The authors would like to extend their gratitude to former EASE GPC members; Carina Sorensen, Joy Johnson, Meridith Sones, who made substantial contribution to the work of the committee and the process leading to the development of the SAGER guidelines. The EASE GPC would also like to thank the following individuals who offered expert advice during the consultation process: Enrico Alleva, Gustav Amberg, Magda Luz Atrián-Salazar, Vivienne Bachelet, Virginia Barbour, Janine Clayton, Sharon Bloom, Gillian Einstein, Helen Herman, Roderick Hunt, Astrid James, Ineke Klinge, Cameron Neylon, Elizabeth Pollitzer, Marta Rondon, and Londa Schiebinger.

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Shirin Heidari

Department of Community Medicine, University of Connecticut School of Medicine, Farmington, CT, 06030-6325, USA

Thomas F. Babor

Istituto Superiore di Sanità, Rome, Italy

Paola De Castro

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None of the authors have any financial competing interests. All authors are unpaid, voluntary members of the Gender Policy Committee of the European Association of Science Editors, a registered charity in the UK.

Authors’ contributions

SH had the idea for the SAGER guidelines and the article, wrote the sections of the article and organized the planning, conducting and reporting of the work described in the article. TFB drafted the article and served as the corresponding author. PDC and MC participated in the discussions leading to the production of the SAGER guidelines and continued to write and revise the sections of the article. ST participated in the discussions leading to the production of the SAGER guidelines and contributed to the written and revised sections of the article, including the table and references. All authors read and approved the final manuscript. SH and TFB are responsible for the overall content as guarantors.

Glossary of terms

Gender . Gender refers to the socially constructed roles, behaviours and identities of female, male and gender-diverse people [ 1 ]. It influences how people perceive themselves and each other, how they behave and interact and the distribution of power and resources in society. Gender is usually incorrectly conceptualized as a binary factor (female/male). In reality, there is a spectrum of gender identities and expressions defining how individuals identify themselves and express their gender.

Gender identity . A person’s concept of self as being male and masculine or female and feminine, or ambivalent, based in part on physical characteristics, parental responses and psychological and social pressures. It is the internal experience of gender role. (Mesh term, introduced in 1991, revised in 1975).

Gender-based analysis . An analytical tool that systematically integrates a gender perspective into the development of policies, programmes and legislation, as well as planning and decision-making processes. It helps to identify and clarify the differences between women and men and boys and girls and demonstrates how these differences affect health status, access to, and interaction with, the health care system.

( http://www.hc-sc.gc.ca/hl-vs/pubs/women-femmes/gender-sexes-eng.php )

Gender-sensitive analysis . Analysis of statistics that goes beyond simply disaggregating data according to sex (e.g. a mere “sex-counting” is not sufficient). Gender-sensitive analysis should question the underlying gender relations which are reflected in the data.

( http://www.oecd.org/dac/gender-development/44896238.pdf )

Gender perspective . The gender perspective looks at the impact of gender on people’s opportunities, social roles and interactions. Successful implementation of the policy, programme and project goals of international and national organizations is directly affected by the impact of gender and, in turn, influences the process of social development. Gender is an integral component of every aspect of the economic, social, daily and private lives of individuals and societies and of the different roles ascribed by society to men and women.

( http://www.fao.org/docrep/003/x2919e/x2919e04.htm )

Sex. Sex refers to a set of biological attributes in humans and animals that are associated with physical and physiological features including chromosomes, gene expression, hormone function and reproductive/sexual anatomy [ 1 ]. Sex is usually categorized as female or male, although there is variation in the biological attributes that constitute sex and how those attributes are expressed.

Sex- and Gender-Based Analysis . An analytical approach that integrates a sex and gender perspective into the development of health research, policies and programmes, as well as health planning and decision-making processes. It helps to identify and clarify the differences between women and men and boys and girls and demonstrates how these differences affect health status, access to, and interaction with, the health care system.

( http://www.hc-sc.gc.ca/hl-vs/gender-genre/analys/index-eng.php )

Sex-disaggregated data . Data that are collected and presented separately on men and women. Gender Mainstreaming Implementation Framework—UNESCO, 2003.

Sexism . Prejudice or discrimination based on gender or behaviour or attitudes that foster stereotyped social roles based on gender. (MESH term, introduced in 2013).

Transgender Persons, Transexual persons, Transgenders . Persons having a sense of persistent identification with, and expression of, gender-coded behaviours not typically associated with one’s anatomical sex at birth and with or without a desire to undergo sex reassignment procedures (MeSH term 2016 (2013).

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Heidari, S., Babor, T.F., De Castro, P. et al. Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use. Res Integr Peer Rev 1 , 2 (2016). https://doi.org/10.1186/s41073-016-0007-6

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Research Article

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

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

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

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

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

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

* E-mail: [email protected]

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

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

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

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

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

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

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

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

Editor: Elisa Ughetto, Politecnico di Torino, ITALY

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

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

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

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

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

Introduction

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

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

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

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

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

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

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

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

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

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

Data collection

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

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

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

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

Text processing and keyword extraction

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

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

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

Classification of research topics

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

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

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

Evaluation of semantic importance

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

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

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

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

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

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

Overview of main topics

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

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

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

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

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

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

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

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

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

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

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

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

Compensation.

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

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

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

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

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

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

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

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

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

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

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

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

Decision-making.

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

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

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

Career progression.

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

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

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

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

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

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

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

Performance.

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

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

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

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

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

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

Organization.

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

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

Human capital.

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

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

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

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

Emerging topics: Leadership and entrepreneurship

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

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

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

Research gaps and conclusions

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

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

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

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

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

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

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

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

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

Supporting information

S1 text. keywords used for paper selection..

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

Acknowledgments

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

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Gender inequality as a barrier to economic growth: a review of the theoretical literature

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• Published: 15 January 2021
• Volume 19 , pages 581–614, ( 2021 )

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• Manuel Santos Silva 1 &
• Stephan Klasen 1  

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In this article, we survey the theoretical literature investigating the role of gender inequality in economic development. The vast majority of theories reviewed argue that gender inequality is a barrier to development, particularly over the long run. Among the many plausible mechanisms through which inequality between men and women affects the aggregate economy, the role of women for fertility decisions and human capital investments is particularly emphasized in the literature. Yet, we believe the body of theories could be expanded in several directions.

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1 Introduction

Theories of long-run economic development have increasingly relied on two central forces: population growth and human capital accumulation. Both forces depend on decisions made primarily within households: population growth is partially determined by households’ fertility choices (e.g., Becker & Barro 1988 ), while human capital accumulation is partially dependent on parental investments in child education and health (e.g., Lucas 1988 ).

In an earlier survey of the literature linking family decisions to economic growth, Grimm ( 2003 ) laments that “[m]ost models ignore the two-sex issue. Parents are modeled as a fictive asexual human being” (p. 154). Footnote 1 Since then, however, economists are increasingly recognizing that gender plays a fundamental role in how households reproduce and care for their children. As a result, many models of economic growth are now populated with men and women. The “fictive asexual human being” is a dying species. In this article, we survey this rich new landscape in theoretical macroeconomics, reviewing, in particular, micro-founded theories where gender inequality affects economic development.

For the purpose of this survey, gender inequality is defined as any exogenously imposed difference between male and female economic agents that, by shaping their behavior, has implications for aggregate economic growth. In practice, gender inequality is typically modeled as differences between men and women in endowments, constraints, or preferences.

Many articles review the literature on gender inequality and economic growth. Footnote 2 Typically, both the theoretical and empirical literature are discussed, but, in almost all cases, the vast empirical literature receives most of the attention. In addition, some of the surveys examine both sides of the two-way relationship between gender inequality and economic growth: gender equality as a cause of economic growth and economic growth as a cause of gender equality. As a result, most surveys end up only scratching the surface of each of these distinct strands of literature.

There is, by now, a large and insightful body of micro-founded theories exploring how gender equality affects economic growth. In our view, these theories merit a separate review. Moreover, they have not received sufficient attention in empirical work, which has largely developed independently (see also Cuberes & Teignier 2014 ). By reviewing the theoretical literature, we hope to motivate empirical researchers in finding new ways of putting these theories to test. In doing so, our work complements several existing surveys. Doepke & Tertilt ( 2016 ) review the theoretical literature that incorporates families in macroeconomic models, without focusing exclusively on models that include gender inequality, as we do. Greenwood, Guner and Vandenbroucke ( 2017 ), in turn, review the theoretical literature from the opposite direction; they study how macroeconomic models can explain changes in family outcomes. Doepke, Tertilt and Voena ( 2012 ) survey the political economy of women’s rights, but without focusing explicitly on their impact on economic development.

To be precise, the scope of this survey consists of micro-founded macroeconomic models where gender inequality (in endowments, constraints, preferences) affects economic growth—either by influencing the economy’s growth rate or shaping the transition paths between multiple income equilibria. As a result, this survey does not cover several upstream fields of partial-equilibrium micro models, where gender inequality affects several intermediate growth-related outcomes, such as labor supply, education, health. Additionally, by focusing on micro-founded macro models, we do not review studies in heterodox macroeconomics, including the feminist economics tradition using structuralist, demand-driven models. For recent overviews of this literature, see Kabeer ( 2016 ) and Seguino ( 2013 , 2020 ). Overall, we find very little dialogue between the neoclassical and feminist heterodox literatures. In this review, we will show that actually these two traditions have several points of contact and reach similar conclusions in many areas, albeit following distinct intellectual routes.

Although the incorporation of gender in macroeconomic models of economic growth is a recent development, the main gendered ingredients of those models are not new. They were developed in at least two strands of literature. First, since the 1960s, “new home economics” has applied the analytical toolbox of rational choice theory to decisions being made within the boundaries of the family (see, e.g., Becker 1960 , 1981 ). Footnote 3 A second literature strand, mostly based on empirical work at the micro level in developing countries, described clear patterns of gender-specific behavior within households that differed across regions of the developing world (see, e.g., Boserup 1970 ). Footnote 4 As we shall see, most of the (micro-founded) macroeconomic models reviewed in this article use several analytical mechanisms from "new home economics”; these mechanisms can typically rationalize several of the gender-specific regularities observed in early studies of developing countries. The growth theorist is then left to explore the aggregate implications for economic development.

The first models we present focus on gender discrimination in (or on access to) the labor market as a distortionary tax on talent. If talent is randomly distributed in the population, men and women are imperfect substitutes in aggregate production, and, as a consequence, gender inequality (as long as determined by non-market processes) will misallocate talent and lower incentives for female human capital formation. These theories do not rely on typical household functions such as reproduction and childrearing. Therefore, in these models, individuals are not organized into households. We review this literature in section 2 .

From there, we proceed to theories where the household is the unit of analysis. In sections 3 and 4 , we cover models that take the household as given and avoid marriage markets or other household formation institutions. This is a world where marriage (or cohabitation) is universal, consensual, and monogamous; families are nuclear, and spouses are matched randomly. The first articles in this tradition model the household as a unitary entity with joint preferences and interests, and with an efficient and centralized decision making process. Footnote 5 These theories posit how men and women specialize into different activities and how parents interact with their children. Section 3 reviews these theories. Over time, the literature has incorporated intra-household dynamics. Now, family members are allowed to have different preferences and interests; they bargain, either cooperatively or not, over family decisions. Now, the theorist recognizes power asymmetries between family members and analyzes how spouses bargain over decisions. Footnote 6 These articles are surveyed in section 4 .

The final set of articles we survey take into account how households are formed. These theories show how gender inequality can influence economic growth and long-run development through marriage market institutions and family formation patterns. Among other topics, this literature has studied ages at first marriage, relative supply of potential partners, monogamy and polygyny, arranged and consensual marriages, and divorce risk. Upon marriage, these models assume different bargaining processes between the spouses, or even unitary households, but they all recognize, in one way or another, that marriage, labor supply, consumption, and investment decisions are interdependent. We review these theories in section 5 .

Table 1 offers a schematic overview of the literature. To improve readability, the table only includes studies that we review in detail, with articles listed in order of appearance in the text. The table also abstracts from models’ extensions and sensitivity checks, and focuses exclusively on the causal pathways leading from gender inequality to economic growth.

The vast majority of theories reviewed argue that gender inequality is a barrier to economic development, particularly over the long run. The focus on long-run supply-side models reflects a recent effort by growth theorists to incorporate two stylized facts of economic development in the last two centuries: (i) a strong positive association between gender equality and income per capita (Fig. 1 ), and (ii) a strong association between the timing of the fertility transition and income per capita (Fig. 2 ). Footnote 7 Models that endogenize a fertility transition are able to generate a transition from a Malthusian regime of stagnation to a modern regime of sustained economic growth, thus replicating the development experience of human societies in the very long run (e.g., Galor 2005a , b ; Guinnane 2011 ). In contrast, demand-driven models in the heterodox and feminist traditions have often argued that gender wage discrimination and gendered sectoral and occupational segregation can be conducive to economic growth in semi-industrialized export-oriented economies. Footnote 8 In these settings—that fit well the experience of East and Southeast Asian economies—gender wage discrimination in female-intensive export industries reduces production costs and boosts exports, profits, and investment (Blecker & Seguino 2002 ; Seguino 2010 ).

Income level and gender equality. Income is the natural log of per capita GDP (PPP-adjusted). The Gender Development Index is the ratio of gender-specific Human Development Indexes: female HDI/male HDI. Data are for the year 2000. Sources: UNDP

Income level and timing of the fertility transition. Income is the natural log of per capita GDP (PPP-adjusted) in 2000. Years since fertility transition are the number of years between 2000 and the onset year of the fertility decline. See Reher ( 2004 ) for details. Sources: UNDP and Reher ( 2004 )

In most long-run, supply-side models reviewed here, irrespectively of the underlying source of gender differences (e.g., biology, socialization, discrimination), the opportunity cost of women’s time in foregone labor market earnings is lower than that of men. This gender gap in the value of time affects economic growth through two main mechanisms. First, when the labor market value of women’s time is relatively low, women will be in charge of childrearing and domestic work in the family. A low value of female time means that children are cheap. Fertility will be high, and economic growth will be low, both because population growth has a direct negative impact on long-run economic performance and because human capital accumulates at a slower pace (through the quantity-quality trade-off). Second, if parents expect relatively low returns to female education, due to women specializing in domestic activities, they will invest relatively less in the education of girls. In the words of Harriet Martineau, one of the first to describe this mechanism, “as women have none of the objects in life for which an enlarged education is considered requisite, the education is not given” (Martineau 1837 , p. 107). In the long run, lower human capital investments (on girls) lead to slower economic development.

Overall, gender inequality can be conceptualized as a source of inefficiency, to the extent that it results in the misallocation of productive factors, such as talent or labor, and as a source of negative externalities, when it leads to higher fertility, skewed sex ratios, or lower human capital accumulation.

We conclude, in section 6 , by examining the limitations of the current literature and pointing ways forward. Among them, we suggest deeper investigations of the role of (endogenous) technological change on gender inequality, as well as greater attention to the role and interests of men in affecting gender inequality and its impact on growth.

2 Gender discrimination and misallocation of talent

Perhaps the single most intuitive argument for why gender discrimination leads to aggregate inefficiency and hampers economic growth concerns the allocation of talent. Assume that talent is randomly distributed in the population. Then, an economy that curbs women’s access to education, market employment, or certain occupations draws talent from a smaller pool than an economy without such restrictions. Gender inequality can thus be viewed as a distortionary tax on talent. Indeed, occupational choice models with heterogeneous talent (as in Roy 1951 ) show that exogenous barriers to women’s participation in the labor market or access to certain occupations reduce aggregate productivity and per capita output (Cuberes & Teignier 2016 , 2017 ; Esteve-Volart 2009 ; Hsieh, Hurst, Jones and Klenow 2019 ).

Hsieh et al. ( 2019 ) represent the US economy with a model where individuals sort into occupations based on innate ability. Footnote 9 Gender and race identity, however, are a source of discrimination, with three forces preventing women and black men from choosing the occupations best fitting their comparative advantage. First, these groups face labor market discrimination, which is modeled as a tax on wages and can vary by occupation. Second, there is discrimination in human capital formation, with the costs of occupation-specific human capital being higher for certain groups. This cost penalty is a composite term encompassing discrimination or quality differentials in private or public inputs into children’s human capital. The third force are group-specific social norms that generate utility premia or penalties across occupations. Footnote 10

Assuming that the distribution of innate ability across race and gender is constant over time, Hsieh et al. ( 2019 ) investigate and quantify how declines in labor market discrimination, barriers to human capital formation, and changing social norms affect aggregate output and productivity in the United States, between 1960 and 2010. Over that period, their general equilibrium model suggests that around 40 percent of growth in per capita GDP and 90 percent of growth in labor force participation can be attributed to reductions in the misallocation of talent across occupations. Declining in barriers to human capital formation account for most of these effects, followed by declining labor market discrimination. Changing social norms, on the other hand, explain only a residual share of aggregate changes.

Two main mechanisms drive these results. First, falling discrimination improves efficiency through a better match between individual ability and occupation. Second, because discrimination is higher in high-skill occupations, when discrimination decreases, high-ability women and black men invest more in human capital and supply more labor to the market. Overall, better allocation of talent, rising labor supply, and faster human capital accumulation raise aggregate growth and productivity.

Other occupational choice models assuming gender inequality in access to the labor market or certain occupations reach similar conclusions. In addition to the mechanisms in Hsieh et al. ( 2019 ), barriers to women’s work in managerial or entrepreneurial occupations reduce average talent in these positions, resulting in aggregate losses in innovation, technology adoption, and productivity (Cuberes & Teignier 2016 , 2017 ; Esteve-Volart 2009 ). The argument can be readily applied to talent misallocation across sectors (Lee 2020 ). In Lee’s model, female workers face discrimination in the non-agricultural sector. As a result, talented women end up sorting into ill-suited agricultural activities. This distortion reduces aggregate productivity in agriculture. Footnote 11

To sum up, when talent is randomly distributed in the population, barriers to women’s education, employment, or occupational choice effectively reduce the pool of talent in the economy. According to these models, dismantling these gendered barriers can have an immediate positive effect on economic growth.

3 Unitary households: parents and children

In this section, we review models built upon unitary households. A unitary household maximizes a joint utility function subject to pooled household resources. Intra-household decision making is assumed away; the household is effectively a black-box. In this class of models, gender inequality stems from a variety of sources. It is rooted in differences in physical strength (Galor & Weil 1996 ; Hiller 2014 ; Kimura & Yasui 2010 ) or health (Bloom et al. 2015 ); it is embedded in social norms (Hiller 2014 ; Lagerlöf 2003 ), labor market discrimination (Cavalcanti & Tavares 2016 ), or son preference (Zhang, Zhang and Li 1999 ). In all these models, gender inequality is a barrier to long-run economic development.

Galor & Weil ( 1996 ) model an economy with three factors of production: capital, physical labor (“brawn”), and mental labor (“brain”). Men and women are equally endowed with brains, but men have more brawn. In economies starting with very low levels of capital per worker, women fully specialize in childrearing because their opportunity cost in terms of foregone market earnings is lower than men’s. Over time, the stock of capital per worker builds up due to exogenous technological progress. The degree of complementarity between capital and mental labor is higher than that between capital and physical labor; as the economy accumulates capital per worker, the returns to brain rise relative to the returns to brawn. As a result, the relative wages of women rise, increasing the opportunity cost of childrearing. This negative substitution effect dominates the positive income effect on the demand for children and fertility falls. Footnote 12 As fertility falls, capital per worker accumulates faster creating a positive feedback loop that generates a fertility transition and kick starts a process of sustained economic growth.

The model has multiple stable equilibria. An economy starting from a low level of capital per worker is caught in a Malthusian poverty trap of high fertility, low income per capita, and low relative wages for women. In contrast, an economy starting from a sufficiently high level of capital per worker will converge to a virtuous equilibrium of low fertility, high income per capita, and high relative wages for women. Through exogenous technological progress, the economy can move from the low to the high equilibrium.

Gender inequality in labor market access or returns to brain can slow down or even prevent the escape from the Malthusian equilibrium. Wage discrimination or barriers to employment would work against the rise of relative female wages and, therefore, slow down the takeoff to modern economic growth.

The Galor and Weil model predicts how female labor supply and fertility evolve in the course of development. First, (married) women start participating in market work and only afterwards does fertility start declining. Historically, however, in the US and Western Europe, the decline in fertility occurred before women’s participation rates in the labor market started their dramatic increase. In addition, these regions experienced a mid-twentieth century baby boom which seems at odds with Galor and Weil’s theory.

Both these stylized facts can be addressed by adding home production to the modeling, as do Kimura & Yasui ( 2010 ). In their article, as capital per worker accumulates, the market wage for brains rises and the economy moves through four stages of development. In the first stage, with a sufficiently low market wage, both husband and wife are fully dedicated to home production and childrearing. The household does not supply labor to the market; fertility is high and constant. In the second stage, as the wage rate increases, men enter the labor market (supplying both brawn and brain), whereas women remain fully engaged in home production and childrearing. But as men partially withdraw from home production, women have to replace them. As a result, their time cost of childrearing goes up. At this stage of development, the negative substitution effect of rising wages on fertility dominates the positive income effect. Fertility starts declining, even though women have not yet entered the labor market. The third stage arrives when men stop working in home production. There is complete specialization of labor by gender; men only do market work, and women only do home production and childrearing. As the market wage rises for men, the positive income effect becomes dominant and fertility increases; this mimics the baby-boom period of the mid-twentieth century. In the fourth and final stage, once sufficient capital is accumulated, women enter the market sector as wage-earners. The negative substitution effect of rising female opportunity costs dominates once again, and fertility declines. The economy moves from a “breadwinner model” to a “dual-earnings model”.

Another important form of gender inequality is discrimination against women in the form of lower wages, holding male and female productivity constant. Cavalcanti & Tavares ( 2016 ) estimate the aggregate effects of wage discrimination using a model-based general equilibrium representation of the US economy. In their model, women are assumed to be more productive in childrearing than men, so they pay the full time cost of this activity. In the labor market, even though men and women are equally productive, women receive only a fraction of the male wage rate—this is the wage discrimination assumption. Wage discrimination works as a tax on female labor supply. Because women work less than they would without discrimination, there is a negative level effect on per capita output. In addition, there is a second negative effect of wage discrimination operating through endogenous fertility. Since lower wages reduce women’s opportunity costs of childrearing, fertility is relatively high, and output per capita is relatively low. The authors calibrate the model to US steady state parameters and estimate large negative output costs of the gender wage gap. Reducing wage discrimination against women by 50 percent would raise per capita income by 35 percent, in the long run.

Human capital accumulation plays no role in Galor & Weil ( 1996 ), Kimura & Yasui ( 2010 ), and Cavalcanti & Tavares ( 2016 ). Each person is exogenously endowed with a unit of brains. The fundamental trade-off in the these models is between the income and substitution effects of rising wages on the demand for children. When Lagerlöf ( 2003 ) adds education investments to a gender-based model, an additional trade-off emerges: that between the quantity and the quality of children.

Lagerlöf ( 2003 ) models gender inequality as a social norm: on average, men have higher human capital than women. Confronted with this fact, parents play a coordination game in which it is optimal for them to reproduce the inequality in the next generation. The reason is that parents expect the future husbands of their daughters to be, on average, relatively more educated than the future wives of their sons. Because, in the model, parents care for the total income of their children’s future households, they respond by investing relatively less in daughters’ human capital. Here, gender inequality does not arise from some intrinsic difference between men and women. It is instead the result of a coordination failure: “[i]f everyone else behaves in a discriminatory manner, it is optimal for the atomistic player to do the same” (Lagerlöf 2003 , p. 404).

With lower human capital, women earn lower wages than men and are therefore solely responsible for the time cost of childrearing. But if, exogenously, the social norm becomes more gender egalitarian over time, the gender gap in parental educational investment decreases. As better educated girls grow up and become mothers, their opportunity costs of childrearing are higher. Parents trade-off the quantity of children by their quality; fertility falls and human capital accumulates. However, rising wages have an offsetting positive income effect on fertility because parents pay a (fixed) “goods cost” per child. The goods cost is proportionally more important in poor societies than in richer ones. As a result, in poor economies, growth takes off slowly because the positive income effect offsets a large chunk of the negative substitution effect. As economies grow richer, the positive income effect vanishes (as a share of total income), and fertility declines faster. That is, growth accelerates over time even if gender equality increases only linearly.

The natural next step is to model how the social norm on gender roles evolves endogenously during the course of development. Hiller ( 2014 ) develops such a model by combining two main ingredients: a gender gap in the endowments of brawn (as in Galor & Weil 1996 ) generates a social norm, which each parental couple takes as given (as in Lagerlöf 2003 ). The social norm evolves endogenously, but slowly; it tracks the gender ratio of labor supply in the market, but with a small elasticity. When the male-female ratio in labor supply decreases, stereotypes adjust and the norm becomes less discriminatory against women.

The model generates a U-shaped relationship between economic development and female labor force participation. Footnote 13 In the preindustrial stage, there is no education and all labor activities are unskilled, i.e., produced with brawn. Because men have a comparative advantage in brawn, they supply more labor to the market than women, who specialize in home production. This gender gap in labor supply creates a social norm that favors boys over girls. Over time, exogenous skill-biased technological progress raises the relative returns to brains, inducing parents to invest in their children’s education. At the beginning, however, because of the social norm, only boys become educated. The economy accumulates human capital and grows, generating a positive income effect that, in isolation, would eventually drive up parental investments in girls’ education. Footnote 14 But endogenous social norms move in the opposite direction. When only boys receive education, the gender gap in returns to market work increases, and women withdraw to home production. As female relative labor supply in the market drops, the social norm becomes more discriminatory against women. As a result, parents want to invest relatively less in their daughters’ education.

In the end, initial conditions determine which of the forces dominates, thereby shaping long-term outcomes. If, initially, the social norm is very discriminatory, its effect is stronger than the income effect; the economy becomes trapped in an equilibrium with high gender inequality and low per capita income. If, on the other hand, social norms are relatively egalitarian to begin with, then the income effect dominates, and the economy converges to an equilibrium with gender equality and high income per capita.

In the models reviewed so far, human capital or brain endowments can be understood as combining both education and health. Bloom et al. ( 2015 ) explicitly distinguish these two dimensions. Health affects labor market earnings because sick people are out of work more often (participation effect) and are less productive per hour of work (productivity effect). Female health is assumed to be worse than male health, implying that women’s effective wages are lower than men’s. As a result, women are solely responsible for childrearing. Footnote 15

The model produces two growth regimes: a Malthusian trap with high fertility and no educational investments; and a regime of sustained growth, declining fertility, and rising educational investments. Once wages reach a certain threshold, the economy goes through a fertility transition and education expansion, taking off from the Malthusian regime to the sustained growth regime.

Female health promotes growth in both regimes, and it affects the timing of the takeoff. The healthier women are, the earlier the economy takes off. The reason is that a healthier woman earns a higher effective wage and, consequently, faces higher opportunity costs of raising children. When female health improves, the rising opportunity costs of children reduce the wage threshold at which educational investments become attractive; the fertility transition and mass education periods occur earlier.

In contrast, improved male health slows down economic growth and delays the fertility transition. When men become healthier, there is only a income effect on the demand for children, without the negative substitution effect (because male childrearing time is already zero). The policy conclusion would be to redistribute health from men to women. However, the policy would impose a static utility cost on the household. Because women’s time allocation to market work is constrained by childrearing responsibilities (whereas men work full-time), the marginal effect of health on household income is larger for men than for women. From the household’s point of view, reducing the gender gap in health produces a trade-off between short-term income maximization and long-term economic development.

In an extension of the model, the authors endogeneize health investments, while keeping the assumption that women pay the full time cost of childrearing. Because women participate less in the labor market (due to childrearing duties), it is optimal for households to invest more in male health. A health gender gap emerges from rational household behavior that takes into account how time-constraints differ by gender; assuming taste-based discrimination against girls or gender-specific preferences is not necessary.

In the models reviewed so far, parents invest in their children’s human capital for purely altruistic reasons. This is captured in the models by assuming that parents derive utility directly from the quantity and quality of children. This is the classical representation of children as durable consumption goods (e.g., Becker 1960 ). In reality, of course, parents may also have egoistic motivations for investing in child quantity and quality. A typical example is that, when parents get old and retire, they receive support from their children. The quantity and quality of children will affect the size of old-age transfers and parents internalize this in their fertility and childcare behavior. According to this view, children are best understood as investment goods.

Zhang et al. ( 1999 ) build an endogenous growth model that incorporates the old-age support mechanism in parental decisions. Another innovative element of their model is that parents can choose the gender of their children. The implicit assumption is that sex selection technologies are freely available to all parents.

At birth, there is a gender gap in human capital endowment, favoring boys over girls. Footnote 16 In adulthood, a child’s human capital depends on the initial endowment and on the parents’ human capital. In addition, the probability that a child survives to adulthood is exogenous and can differ by gender.

Parents receive old-age support from children that survive until adulthood. The more human capital children have, the more old-age support they provide to their parents. Beyond this egoistic motive, parents also enjoy the quantity and the quality of children (altruistic motive). Son preference is modeled by boys having a higher relative weight in the altruistic-component of the parental utility function. In other words, in their enjoyment of children as consumer goods, parents enjoy “consuming” a son more than “consuming” a girl. Parents who prefer sons want more boys than girls. A larger preference for sons, a higher relative survival probability of boys, and a higher human capital endowment of boys positively affect the sex ratio at birth, because, in the parents’ perspective, all these forces increase the marginal utility of boys relative to girls.

Zhang et al. ( 1999 ) show that, if human capital transmission from parents to children is efficient enough, the economy grows endogenously. When boys have a higher human capital endowment than girls, and the survival probability of sons is not smaller than the survival probability of daughters, then only sons provide old-age support. Anticipating this, parents invest more in the human capital of their sons than on the human capital of their daughters. As a result, the gender gap in human capital at birth widens endogenously.

When only boys provide old-age support, an exogenous increase in son preference harms long-run economic growth. The reason is that, when son preference increases, parents enjoy each son relatively more and demand less old-age support from him. Other things equal, parents want to “consume” more sons now and less old-age support later. Because parents want more sons, the sex ratio at birth increases; but because each son provides less old-age support, human capital investments per son decrease (such that the gender gap in human capital narrows). At the aggregate level, the pace of human capital accumulation slows down and, in the long run, economic growth is lower. Thus, an exogenous increase in son preference increases the sex ratio at birth, and reduces human capital accumulation and long-run growth (although it narrows the gender gap in education).

In summary, in growth models with unitary households, gender inequality is closely linked to the division of labor between family members. If women earn relatively less in market activities, they specialize in childrearing and home production, while men specialize in market work. And precisely due to this division of labor, the returns to female educational investments are relatively low. These household behaviors translate into higher fertility and lower human capital and thus pose a barrier to long-run development.

4 Intra-household bargaining: husbands and wives

In this section, we review models populated with non-unitary households, where decisions are the result of bargaining between the spouses. There are two broad types of bargaining processes: non-cooperative, where spouses act independently or interact in a non-cooperative game that often leads to inefficient outcomes (e.g., Doepke & Tertilt 2019 , Heath & Tan 2020 ); and cooperative, where the spouses are assumed to achieve an efficient outcome (e.g., De la Croix & Vander Donckt 2010 ; Diebolt & Perrin 2013 ). As in the previous section, all of these non-unitary models take the household as given, thereby abstracting from marriage markets or other household formation institutions, which will be discussed separately in section 5 . When preferences differ by gender, bargaining between the spouses matters for economic growth. If women care more about child quality than men do and human capital accumulation is the main engine of growth, then empowering women leads to faster economic growth (Prettner & Strulik 2017 ). If, however, men and women have similar preferences but are imperfect substitutes in the production of household public goods, then empowering women has an ambiguous effect on economic growth (Doepke & Tertilt 2019 ).

A separate channel concerns the intergenerational transmission of human capital and woman’s role as the main caregiver of children. If the education of the mother matters more than the education of the father in the production of children’s human capital, then empowering women will be conducive to growth (Agénor 2017 ; Diebolt & Perrin 2013 ), with the returns to education playing a crucial role in the political economy of female empowerment (Doepke & Tertilt 2009 ).

However, different dimensions of gender inequality have different growth impacts along the development process (De la Croix & Vander Donckt 2010 ). Policies that improve gender equality across many dimensions can be particularly effective for economic growth by reaping complementarities and positive externalities (Agénor 2017 ).

The idea that women might have stronger preferences for child-related expenditures than men can be easily incorporated in a Beckerian model of fertility. The necessary assumption is that women place a higher weight on child quality (relative to child quantity) than men do. Prettner & Strulik ( 2017 ) build a unified growth theory model with collective households. Men and women have different preferences, but they achieve efficient cooperation based on (reduced-form) bargaining parameters. The authors study the effect of two types of preferences: (i) women are assumed to have a relative preference for child quality, while men have a relative preference for child quantity; and (ii) parents are assumed to have a relative preference for the education of sons over the education of daughters. In addition, it is assumed that the time cost of childcare borne by men cannot be above that borne by women (but it could be the same).

When women have a relative preference for child quality, increasing female empowerment speeds up the economy’s escape from a Malthusian trap of high fertility, low education, and low income per capita. When female empowerment increases (exogenously), a woman’s relative preference for child quality has a higher impact on household’s decisions. As a consequence, fertility falls, human capital accumulates, and the economy starts growing. The model also predicts that the more preferences for child quality differ between husband and wife, the more effective is female empowerment in raising long-run per capita income, because the sooner the economy escapes the Malthusian trap. This effect is not affected by whether parents have a preference for the education of boys relative to that of girls. If, however, men and women have similar preferences with respect to the quantity and quality of their children, then female empowerment does not affect the timing of the transition to the sustained growth regime.

Strulik ( 2019 ) goes one step further and endogeneizes why men seem to prefer having more children than women. The reason is a different preference for sexual activity: other things equal, men enjoy having sex more than women. Footnote 17 When cheap and effective contraception is not available, a higher male desire for sexual activity explains why men also prefer to have more children than women. In a traditional economy, where no contraception is available, fertility is high, while human capital and economic growth are low. When female bargaining power increases, couples reduce their sexual activity, fertility declines, and human capital accumulates faster. Faster human capital accumulation increases household income and, as a consequence, the demand for contraception goes up. As contraception use increases, fertility declines further. Eventually, the economy undergoes a fertility transition and moves to a modern regime with low fertility, widespread use of contraception, high human capital, and high economic growth. In the modern regime, because contraception is widely used, men’s desire for sex is decoupled from fertility. Both sex and children cost time and money. When the two are decoupled, men prefer to have more sex at the expense of the number of children. There is a reversal in the gender gap in desired fertility. When contraceptives are not available, men desire more children than women; once contraceptives are widely used, men desire fewer children than women. If women are more empowered, the transition from the traditional equilibrium to the modern equilibrium occurs faster.

Both Prettner & Strulik ( 2017 ) and Strulik ( 2019 ) rely on gender-specific preferences. In contrast, Doepke & Tertilt ( 2019 ) are able to explain gender-specific expenditure patterns without having to assume that men and women have different preferences. They set up a non-cooperative model of household decision making and ask whether more female control of household resources leads to higher child expenditures and, thus, to economic development. Footnote 18

In their model, household public goods are produced with two inputs: time and goods. Instead of a single home-produced good (as in most models), there is a continuum of household public goods whose production technologies differ. Some public goods are more time-intensive to produce, while others are more goods-intensive. Each specific public good can only be produced by one spouse—i.e., time and good inputs are not separable. Women face wage discrimination in the labor market, so their opportunity cost of time is lower than men’s. As a result, women specialize in the production of the most time-intensive household public goods (e.g., childrearing activities), while men specialize in the production of goods-intensive household public goods (e.g., housing infrastructure). Notice that, because the household is non-cooperative, there is not only a division of labor between husband and wife, but also a division of decision making, since ultimately each spouse decides how much to provide of his or her public goods.

When household resources are redistributed from men to women (i.e., from the high-wage spouse to the low-wage spouse), women provide more public goods, in relative terms. It is ambiguous, however, whether the total provision of public goods increases with the re-distributive transfer. In a classic model of gender-specific preferences, a wife increases child expenditures and her own private consumption at the expense of the husband’s private consumption. In Doepke & Tertilt ( 2019 ), however, the rise in child expenditures (and time-intensive public goods in general) comes at the expense of male consumption and male-provided public goods.

Parents contribute to the welfare of the next generation in two ways: via human capital investments (time-intensive, typically done by the mother) and bequests of physical capital (goods-intensive, typically done by the father). Transferring resources to women increases human capital, but reduces the stock of physical capital. The effect of such transfers on economic growth depends on whether the aggregate production function is relatively intensive in human capital or in physical capital. If aggregate production is relatively human capital intensive, then transfers to women boost economic growth; if it is relatively intensive in physical capital, then transfers to women may reduce economic growth.

There is an interesting paradox here. On the one hand, transfers to women will be growth-enhancing in economies where production is intensive in human capital. These would be more developed, knowledge intensive, service economies. On the other hand, the positive growth effect of transfers to women increases with the size of the gender wage gap, that is, decreases with female empowerment. But the more advanced, human capital intensive economies are also the ones with more female empowerment (i.e., lower gender wage gaps). In other words, in settings where human capital investments are relatively beneficial, the contribution of female empowerment to human capital accumulation is reduced. Overall, Doepke and Tertilt’s ( 2019 ) model predicts that female empowerment has at best a limited positive effect and at worst a negative effect on economic growth.

Heath & Tan ( 2020 ) argue that, in a non-cooperative household model, income transfers to women may increase female labor supply. Footnote 19 This result may appear counter-intuitive at first, because in collective household models unearned income unambiguously reduces labor supply through a negative income effect. In Heath and Tan’s model, husband and wife derive utility from leisure, consuming private goods, and consuming a household public good. The spouses decide separately on labor supply and monetary contributions to the household public good. Men and women are identical in preferences and behavior, but women have limited control over resources, with a share of their income being captured by the husband. Female control over resources (i.e., autonomy) depends positively on the wife’s relative contribution to household income. Thus, an income transfer to the wife, keeping husband unearned income constant, raises the fraction of her own income that she privately controls. This autonomy effect unambiguously increases women’s labor supply, because the wife can now reap an additional share of her wage bill. Whenever the autonomy effect dominates the (negative) income effect, female labor supply increases. The net effect will be heterogeneous over the wage distribution, but the authors show that aggregate female labor supply is always weakly larger after the income transfer.

Diebolt & Perrin ( 2013 ) assume cooperative bargaining between husband and wife, but do not rely on sex-specific preferences or differences in ability. Men and women are only distinguished by different uses of their time endowments, with females in charge of all childrearing activities. In line with this labor division, the authors further assume that only the mother’s human capital is inherited by the child at birth. On top of the inherited maternal endowment, individuals can accumulate human capital during adulthood, through schooling. The higher the initial human capital endowment, the more effective is the accumulation of human capital via schooling.

A woman’s bargaining power in marriage determines her share in total household consumption and is a function of the relative female human capital of the previous generation. An increase in the human capital of mothers relative to that of fathers has two effects. First, it raises the incentives for human capital accumulation of the next generation, because inherited maternal human capital makes schooling more effective. Second, it raises the bargaining power of the next generation of women and, because women’s consumption share increases, boosts the returns on women’s education. The second effect is not internalized in women’s time allocation decisions; it is an intergenerational externality. Thus, an exogenous increase in women’s bargaining power would promote economic growth by speeding up the accumulation of human capital across overlapping generations.

De la Croix & Vander Donckt ( 2010 ) contribute to the literature by clearly distinguishing between different gender gaps: a gap in the probability of survival, a wage gap, a social and institutional gap, and a gender education gap. The first three are exogenously given, while the fourth is determined within the model.

By assumption, men and women have identical preferences and ability, but women pay the full time cost of childrearing. As in a typical collective household model, bargaining power is partially determined by the spouses’ earnings potential (i.e., their levels of human capital and their wage rates). But there is also a component of bargaining power that is exogenous and captures social norms that discriminate against women—this is the social and institutional gender gap.

Husbands and wives bargain over fertility and human capital investments for their children. A standard Beckerian result emerges: parents invest relatively less in the education of girls, because girls will be more time-constrained than boys and, therefore, the female returns to education are lower in relative terms.

There are at least two regimes in the economy: a corner regime and an interior regime. The corner regime consists of maximum fertility, full gender specialization (no women in the labor market), and large gender gaps in education (no education for girls). Reducing the wage gap or the social and institutional gap does not help the economy escaping this regime. Women are not in labor force, so the wage gap is meaningless. The social and institutional gap will determine women’s share in household consumption, but does not affect fertility and growth. At this stage, the only effective instruments for escaping the corner regime are reducing the gender survival gap or reducing child mortality. Reducing the gender survival gap increases women’s lifespan, which increases their time budget and attracts them to the labor market. Reducing child mortality decreases the time costs of kids, therefore drawing women into the labor market. In both cases, fertility decreases.

In the interior regime, fertility is below the maximum, women’s labor supply is above zero, and both boys and girls receive education. In this regime, with endogenous bargaining power, reducing all gender gaps will boost economic growth. Footnote 20 Thus, depending on the growth regime, some gender gaps affect economic growth, while others do not. Accordingly, the policy-maker should tackle different dimensions of gender inequality at different stages of the development process.

Agénor ( 2017 ) presents a computable general equilibrium that includes many of the elements of gender inequality reviewed so far. An important contribution of the model is to explicitly add the government as an agent whose policies interact with family decisions and, therefore, will impact women’s time allocation. Workers produce a market good and a home good and are organized in collective households. Bargaining power depends on the spouses’ relative human capital levels. By assumption, there is gender discrimination in market wages against women. On top, mothers are exclusively responsible for home production and childrearing, which takes the form of time spent improving children’s health and education. But public investments in education and health also improve these outcomes during childhood. Likewise, public investment in public infrastructure contributes positively to home production. In particular, the ratio of public infrastructure capital stock to private capital stock is a substitute for women’s time in home production. The underlying idea is that improving sanitation, transportation, and other infrastructure reduces time spent in home production. Health status in adulthood depends on health status in childhood, which, in turn, relates positively to mother’s health, her time inputs into childrearing, and government spending. Children’s human capital depends on similar factors, except that mother’s human capital replaces her health as an input. Additionally, women are assumed to derive less utility from current consumption and more utility from children’s health relative to men. Wives are also assumed to live longer than their husbands, which further down-weights female’s emphasis on current consumption. The final gendered assumption is that mother’s time use is biased towards boys. This bias alone creates a gender gap in education and health. As adults, women’s relative lower health and human capital are translated into relative lower bargaining power in household decisions.

Agénor ( 2017 ) calibrates this rich setup for Benin, a low income country, and runs a series of policy experiments on different dimensions of gender inequality: a fall in childrearing costs, a fall in gender pay discrimination, a fall in son bias in mother’s time allocation, and an exogenous increase in female bargaining power. Footnote 21 Interestingly, despite all policies improving gender equality in separate dimensions, not all unambiguously stimulate economic growth. For example, falling childrearing costs raise savings and private investments, which are growth-enhancing, but increase fertility (as children become ‘cheaper’) and reduce maternal time investment per child, thus reducing growth. In contrast, a fall in gender pay discrimination always leads to higher growth, through higher household income that, in turn, boosts savings, tax revenues, and public spending. Higher public spending further contributes to improved health and education of the next generation. Lastly, Agénor ( 2017 ) simulates the effect of a combined policy that improves gender equality in all domains simultaneously. Due to complementarities and positive externalities across dimensions, the combined policy generates more economic growth than the sum of the individual policies. Footnote 22

In the models reviewed so far, men are passive observers of women’s empowerment. Doepke & Tertilt ( 2009 ) set up an interesting political economy model of women’s rights, where men make the decisive choice. Their model is motivated by the fact that, historically, the economic rights of women were expanded before their political rights. Because the granting of economic rights empowers women in the household, and this was done before women were allowed to participate in the political process, the relevant question is why did men willingly share their power with their wives?

Doepke & Tertilt ( 2009 ) answer this question by arguing that men face a fundamental trade-off. On the one hand, husbands would vote for their wives to have no rights whatsoever, because husbands prefer as much intra-household bargaining power as possible. But, on the other hand, fathers would vote for their daughters to have economic rights in their future households. In addition, fathers want their children to marry highly educated spouses, and grandfathers want their grandchildren to be highly educated. By assumption, men and women have different preferences, with women having a relative preference for child quality over quantity. Accordingly, men internalize that, when women become empowered, human capital investments increase, making their children and grandchildren better-off.

Skill-biased (exogenous) technological progress that raises the returns to education over time can shift male incentives along this trade-off. When the returns to education are low, men prefer to make all decisions on their own and deny all rights to women. But once the returns to education are sufficiently high, men voluntarily share their power with women by granting them economic rights. As a result, human capital investments increase and the economy grows faster.

In summary, gender inequality in labor market earnings often implies power asymmetries within the household, with men having more bargaining power than women. If preferences differ by gender and female preferences are more conducive to development, then empowering women is beneficial for growth. When preferences are the same and the bargaining process is non-cooperative, the implications are less clear-cut, and more context-specific. If, in addition, women’s empowerment is curtailed by law (e.g., restrictions on women’s economic rights), then it is important to understand the political economy of women’s rights, in which men are crucial actors.

5 Marriage markets and household formation

Two-sex models of economic growth have largely ignored how households are formed. The marriage market is not explicitly modeled: spouses are matched randomly, marriage is universal and monogamous, and families are nuclear. In reality, however, household formation patterns vary substantially across societies, with some of these differences extending far back in history. For example, Hajnal ( 1965 , 1982 ) described a distinct household formation pattern in preindustrial Northwestern Europe (often referred to as the “European Marriage Pattern”) characterized by: (i) late ages at first marriage for women, (ii) most marriages done under individual consent, and (iii) neolocality (i.e., upon marriage, the bride and the groom leave their parental households to form a new household). In contrast, marriage systems in China and India consisted of: (i) very early female ages at first marriage, (ii) arranged marriages, and (iii) patrilocality (i.e., the bride joins the parental household of the groom).

Economic historians argue that the “European Marriage Pattern” empowered women, encouraging their participation in market activities and reducing fertility levels. While some view this as one of the deep-rooted factors explaining Northwestern Europe’s earlier takeoff to sustained economic growth (e.g., Carmichael, de Pleijt, van Zanden and De Moor 2016 ; De Moor & Van Zanden 2010 ; Hartman 2004 ), others have downplayed the long-run significance of this marriage pattern (e.g., Dennison & Ogilvie 2014 ; Ruggles 2009 ). Despite this lively debate, the topic has been largely ignored by growth theorists. The few exceptions are Voigtländer and Voth ( 2013 ), Edlund and Lagerlöf ( 2006 ), and Tertilt ( 2005 , 2006 ).

After exploring different marriage institutions, we zoom in on contemporary monogamous and consensual marriage and review models where gender inequality affects economic growth through marriage markets that facilitate household formation (Du & Wei 2013 ; Grossbard & Pereira 2015 ; Grossbard-Shechtman 1984 ; Guvenen & Rendall 2015 ). In contrast with the previous two sections, where the household is the starting point of the analysis, the literature on marriage markets and household formation recognizes that marriage, labor supply, and investment decisions are interlinked. The analysis of these interlinkages is sometimes done with unitary households (upon marriage) (Du & Wei 2013 ; Guvenen & Rendall 2015 ), or with non-cooperative models of individual decision-making within households (Grossbard & Pereira 2015 ; Grossbard-Shechtman 1984 ).

Voigtländer and Voth ( 2013 ) argue that the emergence of the “European Marriage Pattern” is a direct consequence of the mid-fourteen century Black Death. They set up a two-sector agricultural economy consisting of physically demanding cereal farming, and less physically demanding pastoral production. The economy is populated by many male and female peasants and by a class of idle, rent-maximizing landlords. Female peasants are heterogeneous with respect to physical strength, but, on average, are assumed to have less brawn relative to male peasants and, thus, have a comparative advantage in the pastoral sector. Both sectors use land as a production input, although the pastoral sector is more land-intensive than cereal production. All land is owned by the landlords, who can rent it out for peasant cereal farming, or use it for large-scale livestock farming, for which they hire female workers. Crucially, women can only work and earn wages in the pastoral sector as long as they are unmarried. Footnote 23 Peasant women decide when to marry and, upon marriage, a peasant couple forms a new household, where husband and wife both work on cereal farming, and have children at a given time frequency. Thus, the only contraceptive method available is delaying marriage. Because women derive utility from consumption and children, they face a trade-off between earned income and marriage.

Initially, the economy rests in a Malthusian regime, where land-labor ratios are relatively low, making the land-intensive pastoral sector unattractive and depressing relative female wages. As a result, women marry early and fertility is high. The initial regime ends in 1348–1350, when the Black Death kills between one third and half of Europe’s population, exogenously generating land abundance and, therefore, raising the relative wages of female labor in pastoral production. Women postpone marriage to reap higher wages, and fertility decreases—moving the economy to a regime of late marriages and low fertility.

In addition to late marital ages and reduced fertility, another important feature of the “European Marriage Pattern” was individual consent for marriage. Edlund and Lagerlöf ( 2006 ) study how rules of consent for marriage influence long-run economic development. In their model, marriages can be formed according to two types of consent rules: individual consent or parental consent. Under individual consent, young people are free to marry whomever they wish, while, under parental consent, their parents are in charge of arranging the marriage. Depending on the prevailing rule, the recipient of the bride-price differs. Under individual consent, a woman receives the bride-price from her husband, whereas, under parental consent, her father receives the bride-price from the father of the groom. Footnote 24 In both situations, the father of the groom owns the labor income of his son and, therefore, pays the bride-price, either directly, under parental consent, or indirectly, under individual consent. Under individual consent, the father needs to transfer resources to his son to nudge him into marrying. Thus, individual consent implies a transfer of resources from the old to the young and from men to women, relative to the rule of parental consent. Redistributing resources from the old to the young boosts long-run economic growth. Because the young have a longer timespan to extract income from their children’s labor, they invest relatively more in the human capital of the next generation. In addition, under individual consent, the reallocation of resources from men to women can have additional positive effects on growth, by increasing women’s bargaining power (see section 4 ), although this channel is not explicitly modeled in Edlund and Lagerlöf ( 2006 ).

Tertilt ( 2005 ) explores the effects of polygyny on long-run development through its impact on savings and fertility. In her model, parental consent applies to women, while individual consent applies to men. There is a competitive marriage market where fathers sell their daughters and men buy their wives. As each man is allowed (and wants) to marry several wives, a positive bride-price emerges in equilibrium. Footnote 25 Upon marriage, the reproductive rights of the bride are transferred from her father to her husband, who makes all fertility decisions on his own and, in turn, owns the reproductive rights of his daughters. From a father’s perspective, daughters are investments goods; they can be sold in the marriage market, at any time. This feature generates additional demand for daughters, which increases overall fertility, and reduces the incentives to save, which decreases the stock of physical capital. Under monogamy, in contrast, the equilibrium bride-price is negative (i.e., a dowry). The reason is that maintaining unmarried daughters is costly for their fathers, so they are better-off paying a (small enough) dowry to their future husbands. In this setting, the economic returns to daughters are lower and, consequently, so is the demand for children. Fertility decreases and savings increase. Thus, moving from polygny to monogamy lowers population growth and raises the capital stock in the long run, which translates into higher output per capita in the steady state.

Instead of enforcing monogamy in a traditionally polygynous setting, an alternative policy is to transfer marriage consent from fathers to daughters. Tertilt ( 2006 ) shows that when individual consent is extended to daughters, such that fathers do not receive the bride-price anymore, the consequences are qualitatively similar to a ban on polygyny. If fathers stop receiving the bride-price, they save more physical capital. In the long run, per capita output is higher when consent is transferred to daughters.

Grossbard-Shechtman ( 1984 ) develops the first non-cooperative model where (monogamous) marriage, home production, and labor supply decisions are interdependent. Footnote 26 Spouses are modeled as separate agents deciding over production and consumption. Marriage becomes an implicit contract for ‘work-in-household’ (WiHo), defined as “an activity that benefits another household member [typically a spouse] who could potentially compensate the individual for these efforts” (Grossbard 2015 , p. 21). Footnote 27 In particular, each spouse decides how much labor to supply to market work and WiHo, and how much labor to demand from the other spouse for WiHo. Through this lens, spousal decisions over the intra-marriage distribution of consumption and WiHo are akin to well-known principal-agent problems faced between firms and workers. In the marriage market equilibrium, a spouse benefiting from WiHo (the principal) must compensate the spouse producing it (the agent) via intra-household transfers (of goods or leisure). Footnote 28 Grossbard-Shechtman ( 1984 ) and Grossbard ( 2015 ) show that, under these conditions, the ratio of men to women (i.e., the sex ratio) in the marriage market is inversely related to female labor supply to the market. The reason is that, as the pool of potential wives shrinks, prospective husbands have to increase compensation for female WiHo. From the potential wife’s point of view, as the equilibrium price for her WiHo increases, market work becomes less attractive. Conversely, when sex ratios are lower, female labor supply outside the home increases. Although the model does not explicit derive growth implications, the relative increase in female labor supply is expected to be beneficial for economic growth, as argued by many of the theories reviewed so far.

In an extension of this framework, Grossbard & Pereira ( 2015 ) analyze how sex ratios affect gendered savings over the marital life-cycle. Assuming that women supply a disproportionate amount of labor for WiHo (due, for example, to traditional gender norms), the authors show that men and women will have very distinct saving trajectories. A higher sex ratio increases savings by single men, who anticipate higher compensation transfers for their wives’ WiHo, whereas it decreases savings by single women, who anticipate receiving those transfers upon marriage. But the pattern flips after marriage: precautionary savings raise among married women, because the possibility of marriage dissolution entails a loss of income from WiHo. The opposite effect happens for married men: marriage dissolution would imply less expenditures in the future. The higher the sex ratio, the higher will be the equilibrium compensation paid by husbands for their wives’ WiHo. Therefore, the sex ratio will positively affect savings among single men and married women, but negatively affect savings among single women and married men. The net effect on the aggregate savings rate and on economic growth will depend on the relative size of these demographic groups.

In a related article, Du & Wei ( 2013 ) propose a model where higher sex ratios worsen marriage markets prospects for young men and their families, who react by increasing savings. Women in turn reduce savings. However, because sex ratios shift the composition of the population in favor of men (high saving type) relative to women (low saving type) and men save additionally to compensate for women’s dis-saving, aggregate savings increase unambiguously with sex ratios.

In Guvenen & Rendall ( 2015 ), female education is, in part, demanded as insurance against divorce risk. The reason is that divorce laws often protect spouses’ future labor market earnings (i.e., returns to human capital), but force them to share their physical assets. Because, in the model, women are more likely to gain custody of their children after divorce, they face higher costs from divorce relative to their husbands. Therefore, the higher the risk of divorce, the more women invest in human capital, as insurance against a future vulnerable economic position. Guvenen & Rendall ( 2015 ) shows that, over time, divorce risk has increased (for example, consensual divorce became replaced by unilateral divorce in most US states in the 1970s). In the aggregate, higher divorce risk boosted female education and female labor supply.

In summary, the rules regulating marriage and household formation carry relevant theoretical consequences for economic development. While the few studies on this topic have focused on age at marriage, consent rules and polygyny, and the interaction between sex ratios, marriage, and labor supply, other features of the marriage market remain largely unexplored (Borella, De Nardi and Yang 2018 ). Growth theorists would benefit from further incorporating theories of household formation in gendered macro models. Footnote 29

6 Conclusion

In this article, we surveyed micro-founded theories linking gender inequality to economic development. This literature offers many plausible mechanisms through which inequality between men and women affects the aggregate economy (see Table 1 ). Yet, we believe the body of theories could be expanded in several directions. We discuss them below and highlight lessons for policy.

The first direction for future research concerns control over fertility. In models where fertility is endogenous, households are always able to achieve their preferred number of children (see Strulik 2019 , for an exception). The implicit assumption is that there is a free and infallible method of fertility control available for all households—a view rejected by most demographers. The gap between desired fertility and achieved fertility can be endogeneized at three levels. First, at the societal level, the diffusion of particular contraceptive methods may be influenced by cultural and religious norms. Second, at the household level, fertility control may be object of non-cooperative bargaining between the spouses, in particular, for contraceptive methods that only women perfectly observe (Ashraf, Field and Lee 2014 ; Doepke & Kindermann 2019 ). More generally, the role of asymmetric information within the household is not yet explored (Walther 2017 ). Third, if parents have preferences over the gender composition of their offspring, fertility is better modeled as a sequential and uncertain process, where household size is likely endogenous to the sex of the last born child (Hazan & Zoabi 2015 ).

A second direction worth exploring concerns gender inequality in a historical perspective. In models with multiple equilibria, an economy’s path is often determined by its initial level of gender equality. Therefore, it would be useful to develop theories explaining why initial conditions varied across societies. In particular, there is a large literature on economic and demographic history documenting how systems of marriage and household formation differed substantially across preindustrial societies (e.g., De Moor & Van Zanden 2010 ; Hajnal 1965 , 1982 ; Hartman 2004 ; Ruggles 2009 ). In our view, more theoretical work is needed to explain both the origins and the consequences of these historical systems.

A third avenue for future research concerns the role of technological change. In several models, technological change is the exogenous force that ultimately erodes gender gaps in education or labor supply (e.g., Bloom et al. 2015 ; Doepke & Tertilt 2009 ; Galor & Weil 1996 ). For that to happen, technological progress is assumed to be skill-biased, thus raising the returns to education—or, in other words, favoring brain over brawn. As such, new technologies make male advantage in physical strength ever more irrelevant, while making female time spent on childrearing and housework ever more expensive. Moreover, recent technological progress increased the efficiency of domestic activities, thereby relaxing women’s time constraints (e.g., Cavalcanti & Tavares 2008 ; Greenwood, Seshadri and Yorukoglu 2005 ). These mechanisms are plausible, but other aspects of technological change need not be equally favorable for women. In many countries, for example, the booming science, technology, and engineering sectors tend to be particularly male-intensive. And Tejani & Milberg ( 2016 ) provide evidence for developing countries that as manufacturing industries become more capital intensive, their female employment share decreases.

Even if current technological progress is assumed to weaken gender gaps, historically, technology may have played exactly the opposite role. If technology today is more complementary to brain, in the past it could have been more complementary to brawn. An example is the plow that, relative to alternative technologies for field preparation (e.g., hoe, digging stick), requires upper body strength, on which men have a comparative advantage over women (Alesina, Giuliano and Nunn 2013 ; Boserup 1970 ). Another, even more striking example, is the invention of agriculture itself—the Neolithic Revolution. The transition from a hunter-gatherer lifestyle to sedentary agriculture involved a relative loss of status for women (Dyble et al. 2015 ; Hansen, Jensen and Skovsgaard 2015 ). One explanation is that property rights on land were captured by men, who had an advantage on physical strength and, consequently, on physical violence. Thus, in the long view of human history, technological change appears to have shifted from being male-biased towards being female-biased. Endogeneizing technological progress and its interaction with gender inequality is a promising avenue for future research.

Fourth, open economy issues are still almost entirely absent. An exception is Rees & Riezman ( 2012 ), who model the effect of globalization on economic growth. Whether global capital flows generate jobs primarily in female or male intensive sectors matters for long-run growth. If globalization creates job opportunities for women, their bargaining power increases and households trade off child quantity by child quality. Fertility falls, human capital accumulates, and long-run per capita output is high. If, on the other hand, globalization creates jobs for men, their intra-household power increases; fertility increases, human capital decreases, and steady-state income per capita is low. The literature would benefit from engaging with open economy demand-driven models of the feminist tradition, such as Blecker & Seguino ( 2002 ), Seguino ( 2010 ). Other fruitful avenues for future research on open economy macro concern gender analysis of global value chains (Barrientos 2019 ), gendered patterns of international migration (Cortes 2015 ; Cortes & Tessada 2011 ), and the diffusion of gender norms through globalization (Beine, Docquier and Schiff 2013 ; Klasen 2020 ; Tuccio & Wahba 2018 ).

A final point concerns the role of men in this literature. In most theoretical models, gender inequality is not the result of an active male project that seeks the domination of women. Instead, inequality emerges as a rational best response to some underlying gender gap in endowments or constraints. Then, as the underlying gap becomes less relevant—for example, due to skill-biased technological change—, men passively relinquish their power (see Doepke & Tertilt 2009 , for an exception). There is never a male backlash against the short-term power loss that necessarily comes with female empowerment. In reality, it is more likely that men actively oppose losing power and resources towards women (Folbre 2020 ; Kabeer 2016 ; Klasen 2020 ). This possibility has not yet been explored in formal models, even though it could threaten the typical virtuous cycle between gender equality and growth. If men are forward-looking, and the short-run losses outweigh the dynamic gains from higher growth, they might ensure that women never get empowered to begin with. Power asymmetries tend to be sticky, because “any group that is able to claim a disproportionate share of the gains from cooperation can develop social institutions to fortify their position” (Folbre 2020 , p. 199). For example, Eswaran & Malhotra ( 2011 ) set up a household decision model where men use domestic violence against their wives as a tool to enhance male bargaining power. Thus, future theories should recognize more often that men have a vested interest on the process of female empowerment.

More generally, policymakers should pay attention to the possibility of a male backlash as an unintended consequence of female empowerment policies (Erten & Keskin 2018 ; Eswaran & Malhotra 2011 ). Likewise, whereas most theories reviewed here link lower fertility to higher economic growth, the relationship is non-monotonic. Fertility levels below the replacement rate will eventually generate aggregate social costs in the form of smaller future workforces, rapidly ageing societies, and increased pressure on welfare systems, to name a few.

Many theories presented in this survey make another important practical point: public policies should recognize that gender gaps in separate dimensions complement and reinforce one another and, therefore, have to be dealt with simultaneously. A naïve policy targeting a single gap in isolation is unlikely to have substantial growth effects in the short run. Typically, inequalities in separate dimensions are not independent from each other (Agénor 2017 ; Bandiera & Does 2013 ; Duflo 2012 ; Kabeer 2016 ). For example, if credit-constrained women face weak property rights, are unable to access certain markets, and have mobility and time constraints, then the marginal return to capital may nevertheless be larger for men. Similarly, the return to male education may well be above the female return if demand for female labor is low or concentrated in sectors with low productivity. In sum, “the fact that women face multiple constraints means that relaxing just one may not improve outcomes” (Duflo 2012 , p. 1076).

Promising policy directions that would benefit from further macroeconomic research are the role of public investments in physical infrastructure and care provision (Agénor 2017 ; Braunstein, Bouhia and Seguino 2020 ), gender-based taxation (Guner, Kaygusuz and Ventura 2012 ; Meier & Rainer 2015 ), and linkages between gender equality and pro-environmental agendas (Matsumoto 2014 ).

See Echevarria & Moe ( 2000 ) for a similar complaint that “theories of economic growth and development have consistently neglected to include gender as a variable” (p. 77).

A non-exhaustive list includes Bandiera & Does ( 2013 ), Braunstein ( 2013 ), Cuberes & Teignier ( 2014 ), Duflo ( 2012 ), Kabeer ( 2016 ), Kabeer & Natali ( 2013 ), Klasen ( 2018 ), Seguino ( 2013 , 2020 ), Sinha et al. ( 2007 ), Stotsky ( 2006 ), World Bank ( 2001 , 2011 ).

For an in-depth history of “new home economics” see Grossbard-Shechtman ( 2001 ) and Grossbard ( 2010 , 2011 ).

For recent empirical reviews see Duflo ( 2012 ) and Doss ( 2013 ).

Although the unitary approach has being rejected on theoretical (e.g., Echevarria & Moe 2000 ; Folbre 1986 ; Knowles 2013 ; Sen 1989 ) and empirical grounds (e.g., Doss 2013 ; Duflo 2003 ; Lundberg et al. 1997 ), these early models are foundational to the subsequent literature. As it turns out, some of the key mechanisms survive in non-unitary theories of the household.

For nice conceptual perspectives on conflict and cooperation in households see Sen ( 1989 ), Grossbard ( 2011 ), and Folbre ( 2020 ).

The relationship depicted in Fig. 1 is robust to using other composite measures of gender equality (e.g., UNDP’s Gender Inequality Index or OECD’s Social Institutions and Gender Index (SIGI) (see Branisa, Klasen and Ziegler 2013 )), and other years besides 2000. In Fig. 2 , the linear prediction explains 56 percent of the cross-country variation in per capita income.

See Seguino ( 2013 , 2020 ) for a review of this literature.

The model allows for sorting on ability (“some people are better teachers”) or sorting on occupation-specific preferences (“others derive more utility from working as a teacher”) (Hsieh et al. 2019 , p. 1441). Here, we restrict our presentation to the case where sorting occurs primarily on ability. The authors find little empirical support for sorting on preferences.

Because the home sector is treated as any other occupation, the model can capture, in a reduced-form fashion, social norms on women’s labor force participation. For example, a social norm on traditional gender roles can be represented as a utility premium obtained by all women working on the home sector.

Note, however, that discrimination against women raises productivity in the non-agricultural sector. The reason is that the few women who end up working outside agriculture are positively selected on talent. Lee ( 2020 ) shows that this countervailing effect is modest and dominated by the loss of productivity in agriculture.

This is not the classic Beckerian quantity-quality trade-off because parents cannot invest in the quality of their children. Instead, the mechanism is built by assumption in the household’s utility function. When women’s wages increase relative to male wages, the substitution effect dominates the income effect.

The hypothesis that female labor force participation and economic development have a U-shaped relationship—known as the feminization-U hypothesis—goes back to Boserup ( 1970 ). See also Goldin ( 1995 ). Recently, Gaddis & Klasen ( 2014 ) find only limited empirical support for the feminization-U.

The model does not consider fertility decisions. Parents derive utility from their children’s human capital (social status utility). When household income increases, parents want to “consume” more social status by investing in their children’s education—this is the positive income effect.

Bloom et al. ( 2015 ) build their main model with unitary households, but show that the key conclusions are robust to a collective representation of the household.

This assumption does not necessarily mean that boys are more talented than girls. It can be also interpreted as a reduced-form way of capturing labor market discrimination against women.

Many empirical studies are in line with this assumption, which is rooted in evolutionary psychology. See Strulik ( 2019 ) for references. There are several other evolutionary arguments for men wanting more children (including with different women). See, among others, Mulder & Rauch ( 2009 ), Penn & Smith ( 2007 ), von Rueden & Jaeggi ( 2016 ). However, for a different view, see Fine ( 2017 ).

They do not model fertility decisions. So there is no quantity-quality trade-off.

In their empirical application, Heath & Tan ( 2020 ) study the Hindu Succession Act, which, through improved female inheritance rights, increased the lifetime unearned income of Indian women. Other policies consistent with the model are, for example, unconditional cash transfers to women.

De la Croix & Vander Donckt ( 2010 ) show this with numerical simulations, because the interior regime becomes analytically intractable.

We focus on gender-related policies in our presentation, but the article simulates additional public policies.

Agénor and Agénor ( 2014 ) develop a similar model, but with unitary households, and Agénor and Canuto ( 2015 ) have a similar model of collective households for Brazil, where adult women can also invest time in human capital formation. Since public infrastructure substitutes for women’s time in home production, more (or better) infrastructure can free up time for female human capital accumulation and, thus, endogenously increase wives’ bargaining power.

Voigtländer and Voth ( 2013 ) justify this assumption arguing that, in England, employment contracts for farm servants working in animal husbandry were conditional on celibacy. However, see Edwards & Ogilvie ( 2018 ) for a critique of this assumption.

The bride-price under individual consent need not be paid explicitly as a lump-sum transfer. It could, instead, be paid to the bride implicitly in the form of higher lifetime consumption.

In Tertilt ( 2005 ), all men are similar (except in age). Widespread polygyny is possible because older men marry younger women and population growth is high. This setup reflects stylized facts for Sub-Saharan Africa. It differs from models that assume male heterogeneity in endowments, where polygyny emerges because a rich male elite owns several wives, while poor men remain single (e.g., Gould, Moav and Simhon 2008 ; Lagerlöf 2005 , 2010 ).

See Grossbard ( 2015 ) for more details and extensions of this model and Grossbard ( 2018 ) for a non-technical overview of the related literature. For an earlier application, see Grossbard ( 1976 ).

The concept of WiHo is closely related but not equivalent to the ‘black-box’ term home production used by much of the literature. It also relates to feminist perspectives on care and social reproduction labor (c.f. Folbre 1994 ).

In the general setup, the model need not lead to a corner solution where only one spouse specializes in WiHo.

For promising approaches, see, among others, Cubeddu and Ríos-Rull ( 2003 ), Goussé, Jacquemet and Robin ( 2017 ), Greenwood, Guner, Kocharkov and Santos ( 2016 ), Guler, Guvenen and Violante ( 2012 ), Walther ( 2017 ), Wong ( 2016 ).

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Acknowledgements

We thank the Editor, Shoshana Grossbard, and three anonymous reviewers for helpful comments. We gratefully acknowledge funding from the Growth and Economic Opportunities for Women (GrOW) initiative, a multi-funder partnership between the UK’s Department for International Development, the Hewlett Foundation and the International Development Research Centre. All views expressed here and remaining errors are our own. Manuel dedicates this article to Stephan Klasen, in loving memory.

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Santos Silva, M., Klasen, S. Gender inequality as a barrier to economic growth: a review of the theoretical literature. Rev Econ Household 19 , 581–614 (2021). https://doi.org/10.1007/s11150-020-09535-6

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Received : 27 May 2019

Accepted : 07 December 2020

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DOI : https://doi.org/10.1007/s11150-020-09535-6

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• The Cass review: an...

The Cass review: an opportunity to unite behind evidence informed care in gender medicine

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• Kamran Abbasi , editor in chief
• kabbasi{at}bmj.com
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At the heart of Hilary Cass’s review of gender identity services in the NHS is a concern for the welfare of “children and young people” (doi: 10.1136/bmj.q820 ). 1 Her stated ambition is to ensure that those experiencing gender dysphoria receive a high standard of care. This will be disputed, of course, by people and lobbying groups angered by her recommendations, but it is a theme running through the review. Cass, a past president of the UK’s Royal College of Paediatrics and Child Health, seeks to provide better care for children and adolescents on one of the defining issues of our age. Her conclusion is alarming for anybody who genuinely cares for child welfare: gender medicine is “built on shaky foundations” (doi: 10.1136/bmj.q814 ). 2

That verdict is supported by a series of review papers published in Archives of Disease in Childhood , a journal published by BMJ and the Royal College of Paediatrics and Child Health (doi: 10.1136/archdischild-2023-326669 doi: 10.1136/archdischild-2023-326670 doi: 10.1136/archdischild-2023-326499 doi: 10.1136/archdischild-2023-326500 ). 3 4 5 6 The evidence base for interventions in gender medicine is threadbare, whichever research question you wish to consider—from social transition to hormone treatment.

For example, of more than 100 studies examining the role of puberty blockers and hormone treatment for gender transition only two were of passable quality. To be clear, intervention studies—particularly of drug and surgical interventions—should include an appropriate control group, ideally be randomised, ensure concealment of treatment allocation (although open label studies are sometimes acceptable), and be designed to evaluate relevant outcomes with adequate follow-up.

One emerging criticism of the Cass review is that it set the methodological bar too high for research to be included in its analysis and discarded too many studies on the basis of quality. In fact, the reality is different: studies in gender medicine fall woefully short in terms of methodological rigour; the methodological bar for gender medicine studies was set too low, generating research findings that are therefore hard to interpret. The methodological quality of research matters because a drug efficacy study in humans with an inappropriate or no control group is a potential breach of research ethics. Offering treatments without an adequate understanding of benefits and harms is unethical. All of this matters even more when the treatments are not trivial; puberty blockers and hormone therapies are major, life altering interventions. Yet this inconclusive and unacceptable evidence base was used to inform influential clinical guidelines, such as those of the World Professional Association for Transgender Health (WPATH), which themselves were cascaded into the development of subsequent guidelines internationally (doi: 10.1136/bmj.q794 ). 7

The Cass review attempted to work with the Gender Identity Development Service (GIDS) and the NHS adult gender services to “fill some of the gaps in follow-up data for the approximately 9000 young people who have been through GIDS to develop a stronger evidence base.” However, despite encouragement from NHS England, “the necessary cooperation was not forthcoming.” Professionals withholding data from a national inquiry seems hard to imagine, but it is what happened.

A spiralling interventionist approach, in the context of an evidence void, amounted to overmedicalising care for vulnerable young people. A too narrow focus on gender dysphoria, says Cass, neglected other presenting features and failed to provide a holistic model of care. Gender care became superspecialised when a more general, multidisciplinary approach was required. In a broader sense, this failure is indicative of a societal failure in child and adolescent health (doi: 10.1136/bmj.q802 doi: 10.1136/bmj-2022-073448 ). 8 9 The review’s recommendations, which include confining prescription of puberty blockers and hormonal treatments to a research setting (doi: 10.1136/bmj.q660 ), now place the NHS firmly in line with emerging practice internationally, such as in Scandinavia (doi: 10.1136/bmj.p553 ). 10 11

Cass proposes a future model of regional multidisciplinary centres that provide better access and, importantly, standardised care for gender dysphoria, including a smoother transition between adolescent and adult services. Staff will need training. All children and young people embarking on a care pathway will be included in research to begin to rectify the problems with the evidence base, with long term outcomes being an important area of focus. An already stretched workforce will need to extend itself further (doi: 10.1136/bmj.q795 doi: 10.1136/bmj-2024-079474 ). 12 13 In the meantime, some children and young people will turn to the private sector or online providers to meet their needs. The dangers in this moment of service transition are apparent.

But it’s also a moment of opportunity. Families, carers, advocates, and clinicians—acting in the best interests of children and adolescents—face a clear choice whether to allow the Cass review to deepen division or use it as a driver of better care. The message from the evidence reviews in Archives of Disease in Childhood is as unequivocal as it could be. Cass’s review is independent and listened to people with lived experience. Without doubt, the advocacy and clinical practice for medical treatment of gender dysphoria had moved ahead of the evidence—a recipe for harm.

People who are gender non-conforming experience stigmatisation, marginalisation, and harassment in every society. They are vulnerable, particularly during childhood and adolescence. The best way to support them, however, is not with advocacy and activism based on substandard evidence. The Cass review is an opportunity to pause, recalibrate, and place evidence informed care at the heart of gender medicine. It is an opportunity not to be missed for the sake of the health of children and young people. It is an opportunity for unity.

• Mitchell A ,
• Langton T ,
• Heathcote C ,
• Hewitt CE ,
• Hardiman L ,
• Wilkinson E
• Dixon-Woods M ,
• Summers C ,

Gender Research Paper

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Introduction

Theorizing gender, heterosexual normality and biological/social reproduction, bodies, sex, and gender, conclusion: gender and future research.

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The use of the concept of gender to explain the social differences between males and females is a fairly recent focus in sociology. This is not to say that differences between the two have been ignored by sociologists but that those differences were understood as immutable biological facts and that the social was, in the last instance, powerless to change. The presumed “natural” binary of sex was taken for granted by nineteenth-century and most twentieth-century theorists, for whom men were the primary focus of sociological interest, with women making an appearance usually in discussions of marriage and the family.

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The relative invisibility of women in the sociological enterprise, as in all Western intellectual traditions, was challenged with the advent of second-wave feminism in the 1960s. The challenge was not confined to the academy. Betty Friedan’s (1963) popular best-seller, The Feminist Mystique, and Kate Millet’s (1970) Sexual Politics critiqued the oppressive nature of male/female relationships, and the numerous consciousness-raising groups as well as feminist groups that emerged from various left and civil rights organizations also mounted trenchant critiques. Central to the critiques was the conviction that the “personal is political,” that feminist scholarship must be allied to feminist activism. In the academy, the marginality of women to the “intellectual, cultural, and political world” (Smith 1987:1) was contested, and vital interdisciplinary exchanges began the process of putting the natural binary under the microscope (Hess and Ferree 1987).

In the early years, research focused on sex roles rather than gender. Sex as well as class and race were “traditional” variables used in social science research, with the assumption that sex, as a biological given, simply meant checking a box for male or female on government or social science survey forms. Using the concept of sex roles was a way of introducing social and cultural factors into the research. The assumption was that socialization into appropriate male/female roles, although resting on a “natural” biological foundation, allowed, in theory at least, some possibility of social change in the unequal relationships between men and women. But the influential work of Talcott Parsons indicated that there were limitations to the use of role theory. Parsons and Bales (1955) linked sex roles to differences in social functions, with males normatively adopting instrumental functions and females expressive functions. These functional social roles were, however, tied to the dictates of a biological binary, and any profound variation in the roles and functions, such as women having careers, was understood to be dysfunctional to the stability of the social system (Parsons [1942] 1954).

Sex-role research was fruitful, however, in producing several empirically based studies on male/female differences (Maccoby and Jacklin 1975), which tended to show that there were no significant differences and that “ women and men are psychologically very similar, as groups” (Connell 2002:42). Later research refined the concept of sex roles as defining “ situated identities —assumed and relinquished as the situation demands—rather than master identities, such as sex category, that cut across situations” (West and Zimmermann 1987:128). It was also pointed out that roles are prescriptive expectations that vary culturally and historically and are not enacted passively; rather, both men and women actively and reflexively shape their sex roles (Connell 1987; Stacy and Thorne 1985). Consequently, the “functional ideas embedded in the concepts of ‘sex role’ and ‘socialization’” were shown to be “inadequate” because people often “do not become what they are expected to be” (Hess and Ferree 1987:14). More significant, critics pointed out that the concept of sex roles could not explain why men were nearly always the more valued members of any social group. In addition, the concept was theoretically problematic because sociologists did not refer to “race roles” or “class roles” (Eichler 1980; Hess and Ferree 1987).

Critiquing the concept of sex roles did not, however, eliminate the problem of the foundational assumption of immutable biological differences, which made the issue of significant change in male/female relationships problematic. In attempting to navigate the nature/nurture binary, Stoller’s (1968) distinction between “sex” as the biological evidence from chromosomes, hormones, and external genitalia and “gender” as the social, psychological, and cultural manifestations was influential. The distinction was initially used in psychoanalytic work on sex and gender “anomalies,” such as hermaphrodites and transsexuals (see Money and Ehrhardt 1972). For feminists, the distinction was a useful way of acknowledging the significance of sex and at the same time freeing them to concentrate on the social elaborations of gender differences. As Dorothy Smith (2002) points out, the distinction was a “political move” because “we had to believe that change was possible, that the repressions to which women were subjected were not the simple effect of biology” (p. ix). For example, Rubin (1975) suggested that the existence of two sexes gave rise to the social organization of gender in kinship systems, which are the “observable and empirical forms of sex/gender systems” (p. 169). Rubin’s analysis retained the assumption of two sexes as foundational, whereas Delphy (1984) maintained that gender precedes sex and that choosing the “bodily type” to explain the hierarchical division of men and women is an arbitrary choice that does not make sense either logically or historically. Biology itself does not necessarily “give birth to gender,” and to assume that it does means that the “existence of genders—of different social positions for men and women—is thus taken as a given and not requiring explanation” (p. 25). It became apparent that the ubiquity of the two-sex model needed to be dismantled if gender was to, as Delphy (p. 24) put it, to “take wing” theoretically.

Before looking at how gender “took wing,” two points need to be made about the following discussion. First, the initial investigations into gender were largely undertaken by feminist researchers. Some male researchers did initiate research on male roles and masculinity, but these discussions were often marginal to the central feminist debates theorizing gender (Brod 1987; David and Brannon 1976; Farrell 1975; Kimmel and Messner 1989; Pleck 1981). The focus of most research, as the subsequent discussion will illustrate, was mainly on the position of women and their experiences, to the extent that it often seemed that men did not “have” gender, that the universal male subject of Western theory remained intact. The second point has to do with the sex/gender distinction, which will loom large in our discussion. As Donna Haraway (1991:127) discovered, when asked to contribute the sex/gender entry to a feminist keywords text, this is a distinction that other languages and other non-English-speaking feminists do not make. The concept of sex/gender remains a problem for cross-cultural feminist debates, exemplified most recently in the responses to Felski’s (1997) article “The Doxa of Difference” and Hawkesworth’s (1997) article “Confounding Gender” and the responses to Hawkesworth’s article. To the extent that the following concentrates largely on the work of Englishspeaking feminists, the somewhat contested epistemological status of the sex/gender distinction should be kept in mind.

By the late 1970s, gender was the central concept for feminist research, although the issue of “sex” in relation to gender remained contentious. For example, sociobiology maintained that women’s reproductive biological destiny invariably results in social, sexual, political, and economic double standards that favor males (Barash 1977; Dawkins 1976; Wilson 1975). The sociobiological position was not uncontested, but sex became the “Achilles’ heel of 1970s feminism” despite its being relegated to the “domain of biology and medicine” (Fausto-Sterling 2005:1493). In general, gender was used to “supplant sex” but “not to replace it” (Nicholson 1994:80).

In the initial forays into gender research, Marx and Freud were the two theorists whose work provided a basis for critique. Marxist analysis, with its focus on oppression and exploitation, seemed to promise an appropriate revolutionary perspective for change. Both Marx and Engels agreed that the first form of class subordination was the subordination of women to men, and for this reason, Engels (1935) maintained that “in any given society the degree of women’s emancipation is the natural measure of the general emancipation” (p. 39). Critiquing Freud’s work was seen as a necessity because it provided the psychological theory that supported the idea of universal patriarchy and offered an explanation for women’s compliance with these arrangements. At the same time, Freud’s assumption of pre-Oedipal bisexuality and a common libido offered the possibility of reconceptualizing the development of sexual difference.

Some of the first approaches concentrated on “documenting gender difference” and understanding “how gender difference is constructed” (Marshall 2000:26). In this context, unpacking the historical and social nature and impact of patriarchy was a central issue. Max Weber ([1925] 1978) had defined patriarchy as the power of “men against women and children; of able-bodied as against those of lesser capability; of the adult against the child; of the old against the young” (p. 359). Following Weber, patriarchy was used as a general term denoting the nearuniversal male domination of women, having its basis in the family and household. Gerda Lerner (1986) pointed out that the foundation for family patriarchy was the control of women’s “sexual and reproductive capacity,” which occurred “ prior to the formation of private property and class society” (p. 8). Women’s subordination preceded the formation of class societies, so class “is not a separate construct from gender; rather, class is expressed in genderic terms” (p. 213).

Although Lerner was at pains to point out that patriarchy was tied to the appropriation of women’s sexual and reproductive capacities, it was class issues filtered through Marx that initially took theoretical precedence in Anglophone sociology. Many feminists pursued the issue of patriarchy through vigorous debates over the connection between patriarchy and capitalism (Barrett 1980; Eisenstein 1979; Firestone 1970; Mitchell 1973; Sargent 1981; Walby 1990). What quickly became clear was that it was not possible to analytically separate the two, that capitalist patriarchy formed a unitary system. The debates produced important work on social class (Acker 1973; Giddens 1973; Kuhn and Wolpe 1978; Sargent 1981); the nature of women’s labor, especially domestic labor (Fox 1980; Luxton 1980; Oakley 1974; Seccombe 1974); and the variable role of the State in the perpetuation of gendered power relations (Balbus 1982; Coontz and Henderson 1986; Coward 1983; Eisenstein 1979; Elshtain 1982; Lowe and Hubbard 1983). In the last context, a considerable amount of work focused on the ways in which gender, class, and race have played out in civic entitlements, especially with respect to welfare benefits (Fraser 1989; Gordon 1994; Marshall 1994; Pateman 1988; Pringle and Watson 1992).

The focus on capitalist patriarchy, however, tended to leave traditional Marxist analyses of productive relations intact and simply added a “separate conception of the relations of gender hierarchy” (Young 1981:49). For example, the domestic labor debates of the 1970s pointed to the usefulness of domestic labor to capital but “became trapped in trying to assess whether housework produced surplus value or was just unproductive labor” (Thistle 2000:286). Furthermore, the dualisms of work/home, public/private appeared not as “mutually dependent but as separate and opposed. It is accordingly, virtually impossible to bring them together within a logically coherent and consistent account of social life” (Yeatman 1986:160). In general, the debates did not displace in practice or in theory what Connell (2002:142) calls the patriarchal dividend. 2 The dividend refers to the very real advantages that men, as a group, derive from the unequal gender order. These advantages operate at all levels, from the local to the global, whatever the cultural, racial, or social differences. Connell concludes that most men have an interest in “sustaining— and, where necessary, defending—the current gender order” (p. 143).

The concern with class and stratification was also critiqued as ignoring race, ethnicity, and sexuality. The assumption seemed to be that the visibility of gender oppression required the invisibility of race, ethnicity, sexual orientation, and even class (Mohanty 1992:75). Many women of color, as well as gays and lesbians, correctly identified the way in which earlier discussions had privileged the position and interests of white, Western, heterosexual women, similar to the way in which “man” had been shorthand for white, Western, heterosexual males in post-Enlightenment sociological discourse (Barrett 1980; Collins 1990; hooks 1981; Rattansi 1995).

At the beginning of the United Nations Decade of Women, 1976, the idea of a “global sisterhood” suffering the same gender oppression came under fire, and it was pointed out that many white, privileged Western women were implicated in the patriarchal dividend enjoyed by their male counterparts (Bhavnani 2001). Critics pointed out that gender is constructed in and through differences of “race and class and vice versa” (Lovell 1996:310) and that race is “integral to white women’s gender identities” (Glenn 1992:35).

But recognizing “race” often resulted in black women, Third World women, and native women becoming the trendy “Other.” Ann duCille (1994) asked, “Why have we—black women—become the subjected subjects of much contemporary investigation, the peasants under the glass of intellectual inquiry in the 1990s?” (p. 592). Gayatri Spivak (1988) also critiqued the privileging of “whiteness” as the natural, normal condition that produced the colonial object on the assumption that race is something that belongs to others. A particularly important observation was that many white, Western, academic feminists were complicit in the “othering” process in using “native” informants to “build their academic careers, while the knowledgeable ‘objects of study’ receive nothing in return” (Mihesuah 2000:1250).

The focus on race was particularly significant to U.S. sociology given its history of race relations. Patricia Hill Collins (1990) conceptualizes the black experience in the United States, in its critical difference from the experiences of “whites,” as embodying an “outsider-within” perspective. She illustrates how African American women have their own take on their oppression and that they are “neither passive victims of nor willing accomplices in their own oppression” (p. xii). Collins points to the significance of everyday practices as the basis for understanding the intersection of race and gender that produces a “Black women’s standpoint,” not a “Black woman’s standpoint,” emphasizing the “collective values in Afrocentric communities” (p. 40, fn. 5).

In Collins’s work and that of others, the key point is that there are multiple and interlocking layers of oppression and domination (see also B. Smith 1983; D. Smith 1987). The “matrix of domination” points to power relations tied to an individual’s location on the interrelated structures of gender, race, class, and sexuality (Collins 1990). A significant part of the matrix was a “heterosexual norm” that produced taken-for-granted assumptions about sex, sexual identity, sexual desire, and sexual practice (Blackwood 1994). Sex and the biological binary, always an undercurrent in any of the debates discussed above, took on greater significance as feminists examined how people “have” and “do” gender and how or if, when considering human reproduction, biological essentialism can be avoided.

Feminists recognized that Freud’s theories provided psychological support to biological assumptions of “natural” sex differences that, in turn, supported the structural subordination of women under patriarchy (Coward 1983; Mitchell 1975). Jacqueline Rose (1986) suggested that Freud’s work gave an “account of patriarchal culture as a trans-historical and cross-cultural force” that “conforms to the feminist demand for a theory which can explain women’s subordination across specific cultures and different historical moments” (p. 90). As Jean Walton (2001) points out, psychoanalysis has always excluded race. The reworking of Freud by Lacan and the comments of other theorists such as Foucault and Derrida provided, and continue to provide, significant contributions to these debates (Braidotti 1991; Butler 1990, 1993; Butler and Scott 1992; Diprose 1994; Irigaray 1974; Kristeva 1986; Rose 1986). A key issue addressed was the presumed inevitability of a tie between biological reproduction and social mothering, which, in turn, was tied to the assumption of heterosexual normality. Chrys Ingram (1994) maintains that the idea that “institutionalized heterosexuality constitutes the standard for legitimate and prescriptive sociosexual arrangements” is one of the “major premises” of sociology in general and of some “feminist sociology” (p. 204). And Rosalind Petchesky (1980) pointed out “women’s reproductive situation is never the result of biology alone, but of biology mediated by social and cultural organization” (p. 667).

The significance of reproduction, reproductive choice, motherhood, and mothering was the focus of what has been called maternal feminist debates. Nancy Chodorow’s (1978) work was important to these debates. She suggested that while there are historical and cross-cultural variations in family and kinship structures, it is generally the case that women mother. This “mother-monopolized childrearing produces women who are able to and will want to mother in their turn” in contrast to men “who have a separate sense of self and who lack the capacity or the desire to nurture others” (Sydie 1987:151). Chodorow’s (1978) object-relations psychoanalytic analysis focuses on the primary, pre-Oedipal identification of both male and female children with the mother and the different ways in which separation occurs for each child. While the son’s identification with the father follows the process described by Freud, that of the daughter is different. Chodorow maintains that the daughter, who shares her sex with her mother, does not completely reject the mother, and in her “personal identification with her mother” she learns “what it is to be womanlike” (pp. 175–76). It is not biological sex as such but the “early social object-relationships” located mainly in the unconscious that determine the development of sexed identities and, in the case of women, produce mothers (p. 54).

Masculinity is thus more difficult to achieve and is largely predicted on distinguishing self from the feminine. Dorothy Dinnerstein (1977), whose work parallels Chodorow’s in many respects, suggested that both sexes have a terror of “sinking back wholly into the helplessness of infancy” so that for “Mother-raised humans, male authority is bound to look like a reasonable refuge from female authority” (pp. 161, 175). According to Dinnerstien, Freud was unable to account for the nearuniversal fear and hatred of women, but she maintains that this stance is the logical result of mother-monopolized child rearing, producing the male need to control women and women’s more or less willing submission. Both Chodorow and Dinnerstein suggest that the solution is to change the nature of parenting to include both men and women.

The accounts by Chodorow and Dinnerstein were criticized on several counts, not the least of which were the implicit Western nuclear family model they assumed and the lack of clarity as to how men might be incorporated into parenting and what happens if this does occur, for the child’s primary identification (Hirsch 1981; Lorber 1981; Spelman 1988). In such a situation, would the identification be bisexual, and if so, what are the consequences? (O’Brien 1981; Sayers 1982). Interestingly, Freud did posit an original bisexuality and common libido in the preOedipal child that the castration fear resolves and that “normally” produces heterosexual gender identities (see Irigaray 1974). In general, it is this assumption of the normality of heterosexuality in these accounts that is a problem. MacKinnon (1982) summarized the heterosexual norm’s effects on women as follows: “Sexuality is to feminism what work is to marxism: that which is most one’s own, yet most taken away” (p. 515).

Adrienne Rich’s (1980) “Compulsory Heterosexuality and Lesbian Existence” was an influential intervention into the sexuality and maternal feminist debates. Rich claimed that heterosexuality, like motherhood, needed to be “recognized and studied as a political institution ” (p. 637). She points out that the structures that maintain heterosexuality and the ideology that claims its normality ensures the compliance of most women in their own subordination. Rich asks “ why in fact women would ever redirect that search ” (p. 637) if women are the primary love object. Her answer is that they are forced to do so because women’s identification with women could make them “indifferent” to men, introducing the possibility that “men could be allowed sexual and emotional—therefore economic—access to women only on women’s terms” (p. 643). Consequently, heterosexuality is something that has to be “imposed, managed, organized, propagandized, and maintained by force,” and lesbian existence and the lesbian continuum of “women-identified experience” throughout women’s lives has to be denied.

Many of the critiques on the hegemony of heterosexuality looked at its manifestations in and on the body, and about the body as a “ text of culture” and a “ practical, direct locus of social control” (Bordo 1989:13). 4 The body as “text” was indebted to Foucault’s concept of bio-power and body aesthetics. Other critiques concentrated on the Western conception of the organically discrete, natural, two-sex human body as a social construction (Laqueur 1990; O’Neill 1985; Schiebinger 1993). Donna Haraway (1991) went further in her claim that the naturalized body was a fiction, that bodies must be understood as “biotechnical-biomedical” bodies in a “semiotic system” that produces the “cyborg” as “our ontology” (pp. 150, 211). While not necessarily producing cyborgs, biotechnological and biomedical interventions in reproduction, such as in vitro fertilization, surrogacy, sex selection, and cloning, have been critiqued as not necessarily producing positive outcomes for women’s health and their social, political, and economic welfare (Overall 1989; Sawicki 1999; Shildrick and Price 1998).

Michel Foucault’s (1976) conceptualization of the body as the site for the exercise of power through “disciplines of the body and the regulation of populations” and his understanding of power as productive as well as prohibitive and punitive provided an initial entry into the conceptualization of the body as the effect of discourse. In addition, Foucault’s demonstration that sexuality has been a “central preoccupation” of modern society that required the confession of a “true” sex identity—male or female, certainly not hermaphrodite—was suggestive. For Foucault, sex was the “naturalised product of a moral code which, through techniques of discipline, surveillance, self-knowledge, and confession organizes social control by stimulation rather than repression” (Foucault 1980:57). But as several feminists pointed out, Foucault’s observation that power is all-pervasive and constituted in the practices of the subjected prompts the question, How is resistance possible? (Diamond and Quinby 1988; Fraser 1989; Ramazanoglu 1993; Sawicki 1991). Further, the relations of power/ knowledge charted by Foucault may change, but they seem to do so by reaffirming “women’s marginal status” (Ricci 1987:24), and there appears to be “no moral high ground where the individual can exercise agency outside of the social codes which constitute desire asymmetrically” (Diprose 1994:24). Foucault himself was not particularly concerned with the gender of dominated subjects of a power/knowledge regime and did not take account of the “relations between masculinist authority” and, therefore, the gendered “language, discourse and reason” (Diamond and Quinby 1988:xv).

Judith Butler (1990), however, found Foucault’s notion of the constructed subject useful. She pointed out that this does not preclude the possibility of the subject’s agency; on the contrary, the construction is the “necessary scene of agency” (p. 147). If subjects are discursive productions and identities unstable fictions, then this allows feminists to “contest the rigid codes of hierarchical binarisms.” The binaries anyway produce “failures”—the assertive female, the effeminate male, the lipstick lesbian, and so on (p. 145). Gender is not simply constructed; it is performed and performed in relation to the sexual obverse—that is, heterosexual and homosexual bodies and practices are interdependent, produced by the regulative norms of compulsory heterosexuality. Furthermore, gender must be continually reproduced; there is no “original.” Nor does anything, performatively, go. In Bodies That Matter, Butler (1993) points out that the construction and performance of gendered bodies does not mean that some constructions are not necessary constructions. For example, Evelyn Fox Keller (1989) suggests that it is the “vital process that issues in the production of new life” that has compelled “people of all kinds throughout history, and across culture, to distinguish some bodies from others” (p. 316). We may play with, perform, and deconstruct sex and gender, but how can we develop “strategies for eliminating (not only resisting) certain kinds of gendered and sexual subordination and violence, precisely those that are not easily subject to resignification” (Brown 2003:368)? And it is reproduction, and its extension mothering, that seems especially resistant to resignification.

The deconstruction of sex and gender and their manifestations in bodies was important in the development of queer theory and for the increasing focus on the “trans”— transgender, transsexual, intersexuality, bisexuality, and various other “transgressions” of sex and gender dimorphisms (Findlay 1995). More specifically, Eva Sedgwick (1990), in her Epistemology of the Closet, claimed that to understand “virtually any aspect of modern Western culture,” it is necessary to “incorporate a critical analysis of modern homo/heterosexual definition” (p. 1).

Queer theory seeks to challenge the “master categories” of heterosexuality and homosexuality as “marking the truth of sexual selves,” by understanding them as “categories of knowledge, a language that frames what we know as bodies, desires, sexualities, identities: . . . a normative language that erects moral boundaries and political hierarchies” (Seidman 1994:174). Queer theory also points to the poverty of sexuality studies in mainstream sociology, which has used labeling theory and/or a deviance perspective to study gay, lesbian, and alternative “subcultures” (Namaste 1994:227), although Epstein (1994:193) claims that the “involvement of sociologists in the study of sexuality” was a significant subset of mainstream sociology, stemming initially from Kinsey’s work, which has diminished only in recent years.

There has been a veritable explosion of research under the general rubric of queer theory, although much of the work also falls under the general rubric of cultural studies rather than sociology (for a general review of the academic history and current status of queer theory, see Marcus 2005). Steven Seidman (1994) states that although queer theory challenges the “regime of sexuality itself” and “aspires to transform homosexual theory into general social theory or one standpoint from which to analyze whole societies,” to date, “queer theory and sociology have barely acknowledged one another” (p. 174).

A critical issue for queer theorists remains the underlying question of how biology figures in these social constructions. Seeing identities as “multiple, unstable, and regulatory” as well as “pragmatic” and relating this to “concerns of situational advantage, political gain, and conceptual utility” may be a laudable standpoint for the contested social and cultural arena of sex/sexuality/gender studies (Seidman 1994:173). Meanwhile biology, especially evolutionary biology, continues to retain a binary take on physical bodies based on the assumption of natural chromosomal, hormonal, and genital binary difference (Haraway 1991).

Ignoring biology and concentrating on social construction seems to be a misguided position for feminists given the focus of some recent medical research. For example, medicine has searched for gay genes and for differences in brain structures between men and women as well as homosexuals and heterosexuals, and in biology, the studied attempts to deny the existence of “homosexuality” as well as the general “plethora of sex diversity” in the nonhuman animal world persists (Hird 2004). Anne Fausto-Sterling (2005) points out that although contemporary biomedical research seems to deal with sex “in the 1970s feminist meaning of the word, sex sometimes strays into arenas that traditional feminists claim for gender” (p. 1497). FaustoSterling concludes with a “call to arms” for feminists to recognize that “culture is a partner in producing body systems commonly referred to as biology” (p. 1516).

Attention to the treatment of the body of the intersexed is one of the ways in which the culture/body relation has been examined in recent years (Heyes 2003; Hird 2000, 2003, 2004; Kessler 1990). According to Hird (2003), the intersexed, defined as “infants born with genitals that are neither clearly ‘female’ nor ‘male,’” (p. 1067) are estimated to comprise up to 2 percent of births. These infants present a “profound challenge to those cultures dependent on a two-gender system,” and intersexed infants are “routinely surgically and hormonally gender reassigned” (p. 1068). The reassignment occurs despite some compelling evidence that for many of these infants, the process is traumatic and often less than successful in producing a stable gender identity in later years (see Hird 2004:135 on the John/Joan case). A critical point in the definition of and treatment of the intersexed is made by Wilchins, who asks, “Why are [intersex] people forced to produce a binary sexed identity? . . . What kinds of categories of analysis would emerge if nontransgendered anthropological bodies were forced to explicate themselves in terms of intersexuality, rather than the other way around?” (quoted in Hird 2003:1068).

Feminist attention to medical treatments of sex identity is more than warranted given the fact that although medicine “requires a biological definition of the intersexual’s ‘sex,’ the surgeons, endocrinologists and psychiatrists themselves clearly employ a social definition” (Hird 2004:136). Kessler (1998) calls medicine’s surgical interventions a “failure of the imagination” in not recognizing that “each of their management decisions is a moment when a specific instance of biological ‘sex’ is transformed into a culturally constructed gender” (p. 32). Furthermore, the insistence on choosing one of two “sexes” is ironic given the fact that the majority of human cells are intersexed, chromosomes have no sex, and there are many species that do not require sex for reproduction. In sum, although the corporeal body in its external fleshy manifestation is important, “beneath the surface of our skin exists an entire world of networks of bacteria, microbes, molecules, and inorganic life,” and they take “little account of ‘sexual difference’” and indeed exist and reproduce without any recourse to what we think of as reproduction” (Hird 2004:142). In addition, the insistence on “identity” as the manifestation of a sovereign “human” subject is compromised by the fact that the Human Genome Diversity Project has shown that humans share the vast majority of their genes with animals, especially with primates. The Genome Project “far from fixing ‘proper’ human identity . . . has shown it to be impure and fluid from the start,” illustrating “profound interconnections and shared genetic identity, with everyone drawing on a common gene pool” (Shildrick 2004:162, 160).

This more recent feminist focus on science, especially biological science, in attempting to sort out sex, sexuality, and gender returns to but confounds the old nature/nurture problem that the sex/gender and biology/social distinctions were to address. The distinctions were initially a fruitful way for feminism to mount important critiques of socialcultural gender inequity, but they were always unstable. Understanding the complexity of our animality is a part of the recognition that dichotomies, in any context, are poor science and poor sociology.

As the discussion above illustrates, the concept of gender has proven to be ambiguous, complex, and contradictory, and this is unlikely to change in the near future. In the midst of the debates, Chafetz’s (1999) point is worth remembering: “All theory pertaining to gender is not feminist, although all feminist theory centers much or all of its attention on gender” (p. 4). There is still a need to unpack the “taken-for-granted assumptions about gender that pervade sociological research, and social life generally” (Ferree, Lorber, and Hess 1999:xii). For example, Stephanie Knaak (2004) points out that when the “standard ‘gender = male/female’ variable” is used in research “as the main proxy for gender,” this superficial assumption threatens the “overall quality of our research” (p. 312).

There are some directions that might be fruitfully explored in the future, although they by no means exhaust all possibilities; others may have quite different ideas of how to go on in the sociological enterprise. One suggestion is to “bring men back in.” Jeff Hearn (2004) suggests that it is

time to go back from masculinity to men, to examine the hegemony of men and about men. The hegemony of men seeks to address the double complexity that men are both a social category formed by the gender system and dominant collective and individual agents of social practices. (P. 59)

Hearn points out that “men” are “ formed in men’s hegemony . . . and form that hegemony” and that the individual as well as the collective hegemony of men is reproduced and contested in all societies “both as a social category and in men’s practices” (p. 61). Tania Modleski (1991), however, registers a caution with respect to scholars who, under the guise of feminist sympathies, appropriate “feminist analysis” to “negate the critiques and undermine the goals of feminism—in effect delivering us back to a prefeminist world” (p. 3).

The second direction to explore in greater depth is the way in which control by bio-power is deployed on a global scale as bio-political power. Rather than the disciplined subject “whose behaviour expresses internalized social norms,” control, according to Clough (2003), “aims at a never-ending modulation of moods, capacities, affects, potentialities, assembled in genetic codes, identification numbers, ratings profiles and preference listings; that is to say, bodies of data and information (including the human body as information and data” (p. 360). If sex and gender are deployed as “natural” binaries in national and global statistical reports about “distributed chances of life and death, health and morbidity, fertility and infertility, happiness and unhappiness, freedom and imprisonment” (p. 361), the use of such information for any emancipatory practices is limited. For this reason, a return to macrolevel stratification theory on the order of Lenski’s application of POET—“population, organization, ecology and technology”—as suggested by Huber (2004:259), could be useful.

Gender theorists still contend with “two powerful, mutually canceling truths in feminism: on the one hand, there is no stable sex or gender and on the other, women too often find themselves unable to escape their gender and the sexual norms governing it” (Brown 2003:366). These two conceptions must also contend with the frequent reports of the “death of feminism,” most particularly from a variety of conservative, often religiously inspired, traditionalists—both male and female (Hawkesworth 2004). The view from the antifeminist or nonfeminist women must not be simplistically dismissed as “false consciousness”; what is needed is to “know how they think as they do, how and in what terms and with what conflicts they experience their femininity” (Scott 1997:701).

Finally, sociologists as gender theorists need to contend with the tendency of the discipline to marginalize or co-opt gender issues, especially when these issues are linked to systems of inequality in the politics of everyday life (Young 1994). This returns us to the initial starting point of feminist appropriation of gender—the recognition that the concept is a political, economic, and social marker of inequality, whatever its theoretical stability. As Nancy Fraser and Nancy A. Naples (2003) contend, some of the debates in recent feminist theory that tended to see inequities as problems of culture left us “defenseless against free-market fundamentalism” and helped to “consolidate a tragic historic disjunction between theory and practice” (p. 1117). This is particularly troubling given the “acceleration of globalization” and the transformation of “circumstances of justice” by undermining the sovereignty of states. The struggle over governance as “representation” must therefore be added to the “(economic) dimension of redistribution and the (cultural) dimension of recognition.”

The above suggestions are but a few that emerge from feminist struggles with the concept of gender. The issues, like all the issues and debates outlined above, are not confined to the disciplinary boundaries of sociology however they may be construed. But if sociology is to have any relevance in the twenty-first century, then gender, as a critical focus of sociological analysis, is important, especially if sociology is to be true to its origins as an engaged political and ethical scientific practice.

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‘This isn’t how good scientific debate happens’: academics on culture of fear in gender medicine research

Cass review found professionals in the field are scared to discuss views amid risk of reputational damage and online abuse

C ritical thinking and open debate are pillars of scientific and medical research. Yet experienced professionals are increasingly scared to openly discuss their views on the treatment of children questioning their gender identity.

This was the conclusion drawn by Hilary Cass in her review of gender identity services for children this week, which warned that a toxic debate had resulted in a culture of fear.

Her conclusion was echoed by doctors, academic researchers and scientists, who have said this climate has had a chilling effect on research in an area that is in desperate need of better evidence .

Some said they had been deterred from pursuing what they believed to be crucial studies, saying that merely entering the arena would put their reputation at risk. Others spoke of abuse on social media, academic conferences being shut down, biases in publishing and the personal cost of speaking out.

“In most areas of health, medical researchers have freedom to answer questions to problems without fear of judgment,” said Dr Channa Jayasena, a consultant in reproductive endocrinology at Imperial College London. “I’ve never quite known a field where the risks are also in how you’re seen and your beliefs. You have to be careful about what you say both in and out of the workplace.”

Sallie Baxendale, a professor of clinical neuropsychology at UCL’s Institute of Neurology, received abuse after publishing a systematic review of studies that investigated the impact of puberty blockers on brain development. Her review found that “critical questions” remained around the nature, extent and permanence of any arrested development of cognitive function linked to the treatment.

The paper, which summarised the state of relevant research, was met with an immediate backlash. “I’ve been accused of being an anti-trans activist, and that now comes up on Google and is never going to go away,” Baxendale said. “Imagine what it’s like if that is the first thing that comes up when people Google you? Anyone who publishes in this field has got to be prepared for that.”

The lack of high-quality research, highlighted by Cass, has been a subject of growing unease among doctors, according to Dr Juliet Singer, a consultant child and adolescent psychiatrist and former governor of the Tavistock and Portman NHS foundation trust.

In 2020, Singer conducted a survey of specialist child psychiatry trainees, which highlighted concerns about the lack of explanation for the exponential growth in referrals to adolescent gender services, the lack of long-term outcome studies on treatments, and insufficient evidence on the long-term effects of hormone blockers.

She said raising questions such as what was driving the unprecedented rise in birth-registered girls presenting with gender-related distress in puberty appeared to be deemed “unacceptable” by some senior leaders at Tavistock.

“There’s been a shutting down of anybody who has suggested we need to think about a deeper understanding of why these young people are in such distress,” she said. “It’s been remarkable the difference from other ordinary clinical practice.”

Others have found that commenting publicly on the scientific merits of work by other academics – normally a routine part of media coverage of science and health – has put scientists in the firing line when it comes to trans-related issues.

Jayasena described receiving hate mail after welcoming a US study in which a trans woman was given hormones to be able to have the experience of breastfeeding and, separately, being accused of transphobia after commenting on research about athletic performance in trans women .

“I felt concerns for my safety,” he said. “I find my quotes are weaponised. That is very worrying and most colleagues would never go near this type of topic for that reason.”

Another senior researcher in endocrinology, who wished to remain anonymous, said medical professionals had resorted to sharing concerns and views on anonymous WhatsApp groups.

“The bad-mouthing and the social media destruction of people’s reputation and careers is so damning,” the academic said. “Professional people are worried about how they will be characterised on social media and cannot express dissent without it resulting in very aggressive, inappropriate behaviours. It’s causing people to stop talking and just move away from it and not get involved.”

She added: “This isn’t how good scientific debate happens – it happens when people can talk honestly and without fear.”

The risk of being attacked is enough to deter younger researchers from entering the field, Baxendale believes. “It’s tough, I think most people would just walk away. Why risk your reputation? There are many people early in their careers, and I do not blame them one bit, who would not be prepared to accept that,” she said.

The situation hampers efforts to establish a firm medical basis for treatments, Baxendale believes. If the best researchers avoid the field, there is a danger it will become dominated by less rigorous scientists and those who have an interest in their results supporting particular beliefs.

After publishing her review, Baxendale was contacted by a senior expert outside the UK who said they had walked away from a study after being told the team would only publish “positive” findings.

Jayasena says there has been a perception of research being dominated by “a self-selected cohort of people who will be on either side of the fence and perhaps not so interested in advancing the field”. And in the absence of a robust evidence base, there has been greater scope for ideology to fill the knowledge gap.

“Ultimately, I’ve seen completely unhelpful views on both sides,” Jayasena said. “There’s an overly affirming view of let’s just do everything. This results in what I’d call bro-science. We’re getting that disconnect between evidence and assumed knowledge because the internet is an echo chamber. Then there’s the other side of things – a more rightwing, moralistic view. Unfortunately, some members of the medical community are immersed in these views.”

This can act as a disincentive for learned societies, NHS bodies and scientific journals to become involved at any level.

In an effort to find common ground among academics, doctors, patient groups and campaigners that might serve as a springboard for objective research, Singer attempted to organise a conference at Great Ormond Street hospital in 2022.

The meeting was an invite-only academic conference for specialist child psychiatry trainees and consultant child psychiatrists in London, and Cass was due to present her interim findings, alongside speakers with a diverse range of perspectives, including former gender identity development services clinicians.

“What I wanted to do with the conference was just bring together people with different perspectives,” she said. “So clinicians working with children and adolescents can hear different perspectives and, with an open mind, come to appropriate clinical and research questions to ask.”

However, after fielding significant numbers of complaints and making concessions aimed at achieving a balanced programme, the conference was cancelled by Health Education England the day before it was due to take place after a “protected whistleblower’s report” was sent in from someone describing themselves as a researcher on anti-trans conspiracy theories. Despite reassurances that the conference would be reorganised by HEE and the Royal College of Psychiatrists, it is yet to happen.

Others spoke of the challenge of getting studies published in high-profile journals, raising concerns that some journal editors may prefer to reject studies rather than face potential criticism. As a consequence, papers that flag knowledge gaps in gender medicine can become ghettoised in particular journals, making those publications appear overly critical.

Fuelled by concerns about the poor quality of research, the Cass report has set the stage for a major NHS trial that should start this year. It will look at the safety and efficacy of puberty blockers, but also cross-sex hormones that are used to masculinise or feminise people, and psychosocial interventions, with the aim of establishing a robust evidence base.

Many are hopeful that the Cass report, and the NHS trial it recommends, are an opportunity to draw a line under the infighting and abuse and establish a more constructive field of gender medicine.

“It will take time, but it’s allowed people to breathe and feel confident in questioning treatments,” said Singer. “People work in this field because they want to help young people and that drive will still be there. It’s important and valuable work. Cass has now given us permission to do it.”

Baxendale is acutely aware that many patients and their families, reading coverage of the Cass report this week, will be left wondering whether help will be available, whether treatments work and whether they can trust their doctors.

“It must be so distressing for them,” she said. “But I think there is hope. The NHS research will be rigorous, it’s balanced to look at benefits and harms, and I think once we’ve got the results we will have a proper service for these kids.”

• Transgender
• Medical research
• Young people

More on this story

Veteran trans campaigner: ‘Cass review has potential for positive change’

Cass review must be used as ‘watershed moment’ for NHS gender services, says Streeting

Five thousand children with gender-related distress awaiting NHS care in England

Ban on children’s puberty blockers to be enforced in private sector in England

What Cass review says about surge in children seeking gender services

Adult transgender clinics in England face inquiry into patient care

‘Children are being used as a football’: Hilary Cass on her review of gender identity services

Thousands of children unsure of gender identity ‘let down by NHS’, report finds

Review of gender services has major implications for mental health services

What are the key findings of the NHS gender identity review?

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The phenomenology of gender dysphoria in adults: A systematic review and meta-synthesis

Kate cooper.

a Centre for Applied Autism Research, Department of Psychology, University of Bath, BA2 7AY, UK

Ailsa Russell

William mandy.

b UCL Research Department of Clinical, Educational, and Health Psychology, Gower Street, London WC1E 6BT, UK

Catherine Butler

c Department of Psychology, University of Bath, BA2 7AY, UK

Gender dysphoria is distress due to a discrepancy between one's assigned gender and gender identity. Adults who wish to access gender clinics are assessed to ensure they meet the diagnostic criteria for gender dysphoria. Therefore, the definition of gender dysphoria has a significant impact on the lives of individuals who wish to undergo physical gender transition. This systematic review aimed to identify and synthesize all existing qualitative research literature about the lived experience of gender dysphoria in adults. A pre-planned systematic search identified 1491 papers, with 20 of those meeting full inclusion criteria, and a quality assessment of each paper was conducted. Data pertaining to the lived experience of gender dysphoria were extracted from each paper and a meta-ethnographic synthesis was conducted. Four overarching concepts were identified; distress due to dissonance of assigned and experienced gender; interface of assigned gender, gender identity and society; social consequences of gender identity; internal processing of rejection, and transphobia. A key finding was the reciprocal relationship between an individual's feelings about their gender and societal responses to transgender people. Other subthemes contributing to distress were misgendering, mismatch between gender identity and societal expectations, and hypervigilance for transphobia.

• • A systematic review of all papers on the lived experience of gender dysphoria
• • Twenty papers with 1606 participants were included in a meta-ethnographic synthesis.
• • Distress was due to gender and sex incongruence, as well as social factors.
• • Results give new insights into the relationships between factors causing distress.

1. Introduction

Transgender is an umbrella term used to describe individuals who have a gender identity which does not align with their assigned gender. Gender dysphoria in adolescents and adults is defined in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013 ) as marked incongruence between an individual's gender identity and assigned gender with associated distress or impairment; see Table 1 for further details of DSM-5 criteria for gender dysphoria in adolescents and adults. A UK survey found that 1% of adults were gender diverse, or transgender, but it is not known what proportion of these had gender dysphoria ( Reed, Rhodes, Schofield, & Wylie, 2009 ). This is in line with a recent review which suggested that between 0.5 and 1.3% of children, adolescents, and adults self-report a transgender identity ( Zucker, 2017 ). In the Netherlands the prevalence of gender dysphoria was 0.6% in adult natal males, and 0.2% in adult natal females, while 3.2% of adults assigned female at birth and 4.6% assigned male at birth reported an equal identification with each gender or “ambivalent gender identity” ( Kuyper & Wijsen, 2014 ).

Definitions.

The DSM-III (3rd ed.; DSM–III ; American Psychiatric Association, 1980 ) was the first edition of the DSM to include a gender-related diagnosis, called Transsexualism located within the “psychosexual disorders” category. The adult diagnosis of transsexualism referred to “discomfort and inappropriateness” of one's biological sex alongside the wish to be rid of one's genitals and live in one's gender identity. Many changes have been made to the diagnostic criteria since this time ( Beek, Cohen-Kettenis, & Kreukels, 2016 ). In the DSM-IV (4th ed.; DSM–IV ; American Psychiatric Association, 1994 ), the diagnostic terminology was changed and transsexualism became “Gender Identity Disorder”, but the focus on distress in relation to one's assigned gender remained a core component of diagnosis, as it continues to be in the DSM-5. Corneil, Eisfeld, and Botzer (2010) state that it is important to differentiate between transgender individuals who experience distress and those who do not. They argue this helps to normalize transgender identities and highlight that these cause distress in some, but not all cases. Significantly, the DSM-5 gender dysphoria diagnosis now accommodates a spectrum of gender identities, although the wording remains binary, referring to the other gender. This means that non-binary individuals who experience distress in relation to their gender identity can now be diagnosed and more readily receive support for gender dysphoria within the standard healthcare model. See Zucker et al. (2013) for a detailed description of the justification of changes to the diagnostic criteria from DSM IV to DSM-5.

The most recent DSM-5 classification for Gender Dysphoria published in 2013 is contentious ( Davy & Toze, 2018 ). Critics state that including gender dysphoria in the DSM implies that having a transgender identity is a mental health problem, although the DSM is clear that only cases where there is distress or impairment would meet criteria for a diagnosis, while proponents highlight that in current medical practice, diagnosis is a requirement for access to appropriate medical support ( Drescher, 2010 ). Indeed, in most settings a diagnosis of gender dysphoria is a prerequisite for receiving gender-focused support from healthcare services. This is in line with the World Professional Association for Transgender Health (WPATH) Standards of Care ( Coleman et al., 2012 ), although some authors have argued an assessment but not necessarily a diagnosis of gender dysphoria is required according to these guidelines ( Ashley, 2019 ). Therefore, the way in which gender dysphoria is defined affects service provision and availability. Intervention for gender dysphoria ranges from the provision of psychological support to explore gender identity or to make the social transition to live as one's affirmed gender identity, to medical interventions to enable the biological affirmation to one's gender identity through hormone treatment or gender affirming surgery ( Coleman et al., 2012 ).

Gender diversity is not considered a mental health problem. However, transgender people are more likely to experience mental health problems than the general population ( Downing & Przedworski, 2018 ). Individuals with gender dysphoria are also more likely to experience mental health problems, most commonly anxiety and depression ( Dhejne, Van Vlerken, Heylens, & Arcelus, 2016 ). In terms of well-being following transition, a study using the Amsterdam Cohort of Gender Dysphoria from 1972 to 2015 found that of individuals who received a gonadectomy, 0.6% of transwomen and 0.3% of transmen experienced regret ( Wiepjes et al., 2018 ). A meta-analysis investigating mental health quality of life in treatment-seeking transgender adults supported Dhejne et al.'s findings, as mental health quality of life was lower in the transgender population compared to controls ( Nobili, Glazebrook, & Arcelus, 2018 ). The authors then investigated quality of life following cross-sex hormonal treatment; seven studies were included, and mental health quality of life was found to significantly improve following treatment ( Nobili et al., 2018 ).

Some researchers have suggested that higher rates of mental health problems in the transgender population are linked to gender minority stress, or the experiences of stigma and discrimination transgender and gender nonconforming individuals experience which contribute to poor mental health ( Meyer, 2015 ; Testa, Habarth, Peta, Balsam, & Bockting, 2015 ). This has been supported by studies which have found associations in the transgender population between mental health conditions and level of social stigma experienced by participants due to their gender identity ( Bockting, Miner, Swinburne Romine, Hamilton, & Coleman, 2013 ). One example of a social stressor experienced by some transgender individuals is “misgendering” or being treated as or labelled a different gender to their own gender identity. Frequency of experiences of being misgendered, as well as feelings of being stigmatized, have been found to be positively associated with psychological distress in the transgender population ( McLemore, 2018 ).

These high rates of mental health problems need to be better understood through an investigation of the mechanisms contributing to distress in this population. Described above are two distinct conceptualizations of the experience of gender-related distress in individuals with gender dysphoria. There is the diagnostic conceptualization of dysphoria related to a discrepancy between assigned and experienced gender, as defined in diagnostic manuals such as the DSM-5 (5th ed.; DSM-5; American Psychiatric Association, 2013 ), and a more social, stigma focused understanding of distress as described by gender minority stress theory ( Meyer, 2015 ). It is not currently clear how these two forms of distress relate to one another. Zucker, Wood, and VanderLaan (2014) highlight that there is a lack of research investigating distress which is a direct result of gender dysphoria in children and adolescents, and we argue that the same gap is apparent in the adult literature. Given the rapidly increasing societal awareness of transgender identities (e.g. Steinmetz, 2014 ), and substantial increase in referrals to gender clinics (e.g. Aitken et al., 2015 ; Wiepjes et al., 2018 ), it is important to have an up-to-date understanding of the experience of gender dysphoria as described by the individuals themselves. This will help to guide care in clinical settings where an unprecedented number of referrals are being received, and ensure that the current understanding of gender dysphoria according to rigorous research findings is current. Therefore a contemporary systematic review of the phenomenology of gender related distress is critical to improve, update and develop coherence around our understanding of the experience of gender dysphoria, to ensure that it is conceptualized in a consistent way and in line with the current social context.

Scientific research has played an important role in clearly defining gender dysphoria and investigating the efficacy of various treatments for this group. There has been an emphasis on opinion pieces and narrative reviews compared to original empirical studies. A review of primary published literature on gender dysphoria from 1970 to 2011 found that the most common study type published was narrative review at 29% or 479 articles and that commentaries made up a further 7.5% or 124 papers ( Eftekhar et al., 2015 ). Empirical studies based on original data made up a smaller proportion of research at 34% or 555 articles, including qualitative studies, cross-sectional studies, cohort studies, case control studies and clinical trials. The least common method employed was systematic review at 0.4% or 6 articles. Narrative reviews allow authors to select the research they feel has the most value and to summarize this research, which increases the risk of bias in the review (e.g. Littell, 2008 ). There have not been any systematic reviews focused on the phenomenology of gender related-distress, despite distress related to gender identity being a central criterion for individuals hoping to access gender clinics. Given the high level of controversy and emotive nature of this particular research area, it is especially important that more systematic methods are utilized in order to reduce the likelihood of researcher bias and to improve the quality of evidence available.

Systematic reviews employ a replicable search strategy, with a clearly defined screening method to select papers relevant to the review question following predefined inclusion and exclusion criteria ( Moher et al., 2015 ). This significantly reduces the likelihood of bias in terms of studies included in the review. When qualitative evidence requires synthesis, standardized protocols can be followed such as meta-ethnography (Noblit & Hare, 1988), a widely used method of qualitative research synthesis, which ensures a high level of methodological rigor in the synthesis of qualitative results.

This study aims to systematically review and synthesize existing qualitative literature regarding the phenomenology of gender dysphoria in adults. This will result in a deeper and empirically informed understanding of the lived experience of gender related distress, focusing on the cognitive, psychological and physical experiences associated with gender dysphoria. 1

The methods section was developed using the ENTREQ guidelines ( Tong, Flemming, McInnes, Oliver, & Craig, 2012 ), which aim to standardize the reporting of qualitative syntheses. A protocol for this study was pre-registered on PROSPERO (CRD42019140899). The theoretical basis for the qualitative synthesis was interpretive constructivism ( Rubin & Rubin, 2012 ). Interpretive constructivism acknowledges that the findings regarding the phenomenology of gender dysphoria from the studies reviewed will have multiple and at times conflicting perspectives, which can exist alongside one another.

A meta-ethnography approach was selected for the current study ( Noblit & Hare, 1988 ). This entailed conducting a structured analysis for synthesising research about the phenomenology of gender dysphoria in transgender individuals. This methodology allowed for a” line-of-argument” synthesis, which allowed for the development of an integrating scheme which furthered understanding of the phenomena under investigation. A systematic search and screening against pre-defined criteria preceded a thorough synthesis of qualitative studies investigating the experience of gender dysphoria.

2.1. Inclusion criteria

The inclusion criteria were developed in order to identify in-depth qualitative data about the experience of gender dysphoria in transgender individuals (see Table 2 ). Gender-related distress was operationally defined as any negative emotions directly related to gender identity in transgender individuals. This broad definition of gender dysphoria was selected rather than attempting to apply diagnostic criteria in order to include a wide range of studies, and also in acknowledgement of the rapidly changing cultural understanding of gender diversity.

Inclusion and exclusion criteria.

2.2. Search strategy

We developed a pre-planned search strategy, using MEDLINE, PsycINFO, Embase and Web of Science and the search terms in Table 3 . A preliminary search on PubMed with the following terms: (((((((qualitative) OR interview) OR "focus group") OR experience) OR phenomenolog*)) AND (((((((((distress) OR "mental health") OR depression) OR "low mood") OR discomfort) OR dysphoria)) AND (((((((Transgender) OR "gender nonconforming") OR “gender atypical”) OR “gender variant”) OR non-binary) OR genderqueer))) OR (((transsexual*) OR "gender identity disorder") OR "gender dysphoria"))).

Planned search terms and criteria for review.

The searches were conducted in July 2019, and 1741 records were identified, reducing to 1370 once duplicates were removed. The searches were updated and run again in October 2019. This identified 121 new papers since the July search. Non-published “grey” literature was not included in the present study. The reference sections of included papers were scanned for further published studies that might meet inclusion criteria.

2.3. Screening

A total of 85 studies went to full text review. See Fig. 1 for further details of the identification, screening, and eligibility assessment of papers in this study. The first round of screening involved reading the title and abstract of identified references to assess whether papers met the above criteria. Where further information was required, the full text was assessed in the second screening round using the same method.

Identification, screening and eligibility of studies in the systematic review.

Twenty studies were included in the analysis, which included 1606 transgender participants in total. All studies which met the inclusion criteria were published from 2009 onwards. See Appendix A for details of each included study.

2.4. Inter-rater reliability

The first author screened studies using the inclusion and exclusion criteria, and a second researcher screened 10% of these. Discrepancies were resolved using a pre-defined strategy. Any disagreements between the two screeners were resolved by discussion. Where an agreement could not be reached, the final author was consulted. Agreement between the two researchers was measured; there was 99.3% agreement between the two researchers (Cohen's Kappa = 0.85), indicating near perfect agreement.

2.5. Data extraction

A data table was developed for the purpose of this study. As well as including data for the qualitative synthesis, the following data were collected: Author name(s); Year published; Title; Journal; Setting; Participant group (i.e. binary or non-binary participants, transgender women etc.); Number of participants; Qualitative methodology; Interview type (see Appendix A ). Data in the results and discussion section of the study pertaining to the inner experience of gender dysphoria were extracted. Specifically, data regarding the thoughts, feelings, and sensations that come with having a transgender identity and being distressed about this were included, but not broader data about the experience of accessing healthcare or education experiences. Once analysis had begun and the initial concepts were identified, a table was constructed to look at whether and how each study represents data pertaining to each concept ( Britten et al., 2002 ).

2.6. Quality assessment

The widely used CASP checklist ( Critical Appraisal Skills Programme, 2018 ) was used to assess the quality of studies included in the review (see Appendix B ). All studies were included in the synthesis irrespective of quality, but the CASP checklist results were considered carefully when conducting the data coding and synthesis. The CASP checklist was used to assess whether each included study had a clear statement of aims; used an appropriate methodology; had an appropriate research design and recruitment strategy; considered data collection, research relationships and ethical issues; analyzed data rigorously; stated findings clearly; and had value. Each item was given a score of 0–2 dependent on the quality of information provided in each category, see Duggleby et al. (2010) , with 2 representing higher quality and 0 lower quality. 10% of the studies were inter-rated by the final author, following the process outlined in the “screening” section, and inter-rater reliability was good (Cohen's Kappa = 0.67).

2.7. Data analysis

Data were coded and translated inductively based on Noblit and Hare (1988) , commencing with familiarization with each of the papers. The experiences of gender dysphoria in transgender individuals were the focus of the analysis. It is important to note at this stage the relationship between the following concepts:

• • First order constructs, or participant responses
• • Second order constructs, or how the original authors interpreted these responses
• • Third order constructs, or how the review authors interpret the second order constructs

Line-by-line coding was conducted to search for first order and second order concepts related to the target phenomena, i.e. inner experiences of gender dysphoria (e.g. Rice, 2002 ). Each study was analyzed in this way until the concepts from each paper were identified. This was done by the first author and the final author coded a subset of included papers. The second order constructs were used for the meta-synthesis, but the first order constructs were noted in order to ensure that the second order constructs accurately represented what the participants had said and demonstrated significant depth of description. In cases where the first order construct was not thought to align well with the corresponding second order construct, the second order construct was not included in the analysis.

Next concepts which recurred across multiple studies were used to translate the findings between each study (e.g. Britten et al., 2002 ). Concepts which were shared among studies were grouped together when their themes were similar to one another. This was done through an iterative process of grouping concepts together and reading and re-reading the included studies to ensure that concepts that were grouped together were done so in a meaningful way ( Toye et al., 2014 ). A summary of the concept from each relevant paper was written in the format of either a quote from the source paper or a summary written by the research team. Summaries used the original authors' words where possible.

A translational synthesis was undertaken, whereby included papers had sufficiently similar themes to be grouped together and resulted in a line of argument synthesis. At this stage, third order constructs were created to synthesize the findings of all the papers. The third order constructs were developed by the first author and then discussed in depth with the other authors. The authors discussed any differences in their understanding of the concepts and second order constructs of the included papers, and the third order constructs were refined until the authors reached agreement. Third order constructs would be divided into two types; subordinate themes and overarching themes which shaped the overall synthesis and findings. These over-arching themes represented the line of argument stage of the synthesis. At this point the synthesis was written in narrative form by the first author, and this synthesis described the concepts, second order, and third order constructs identified in the meta-synthesis. The narrative synthesis was then read and agreed upon by all the authors.

We identified four key concepts in the analysis, with twelve sub-themes. The overarching concepts identified were” distress due to dissonance of assigned and experienced gender”‘, “interface of assigned gender, gender identity, and society”,” negative social consequences of gender identity” and” internal processing of rejection and transphobia”. See Table 4 for an overview of the third order constructs we identified.

Overarching concepts and sub-themes.

3.1. Distress due to dissonance of assigned and experienced gender

The first concept we identified was participants' negative feelings about the mismatch between their gender identity and body. These feelings included gender-focused and body-focused distress which were interrelated. Participants experienced distress, conflict, confusion, and denial related to their gender identity, and as well as body dysphoria and disconnection. These feelings had consequences such as suicidal ideation and fear for the future.

The most prominent sub-theme we identified was body dysphoria, which included the unease, dysphoria, hatred, and disgust participants felt towards their bodies. The focus was frequently on the genitals and secondary sex characteristics such as the chest and body and facial hair, with some attempts to suppress these features. Studies identified a range of negative feelings towards the body from being troubled, experiencing discomfort, a destabilized sense of self, to disgust, hatred, and existential crisis. These feelings sometimes led to participants' attempts to suppress their femininity or masculinity, for example through restricting food intake to minimize the appearance of breasts. Some individuals also experienced detachment from the body. This referred to the sense of disconnection from the physical self which resulted from body and gender dissonance. The word” disembodiment” was used in two of the three studies which referred to detachment, and underlines the force of this feeling for participants, who felt such a powerful sense of gender dissonance that they experienced a total break between their sense of self and physical body. For some participants, this feeling of disgust towards their body led to suicidal thoughts or self-harm; individuals felt that death was preferable to continuing to live in their body.

The next subtheme was gender distress, which refers to distress relating to participants' gender identity, which in some participants extended to thoughts of death and suicide. Multiple papers described distress following conflict between participants' gender assigned at birth and self-concept, with the sense that this could be destabilizing and cause an existential crisis. Emotions reported included depression, anxiety, disappointment, and self-hatred, and these feelings could be overwhelming and tumultuous. One paper looked at the experience of transgender individuals undergoing transition and found that negative emotions were particularly experienced pre- and during transition, becoming less prominent post-transition.

The sense of conflict between participants' body and gender was a prominent sub-theme, with studies describing a mismatch between individuals' gender identities and anatomy, leading to feelings of dissonance, conflict, and distress. A range of vocabulary was used to describe this dissonance, demonstrating a spectrum of feelings from discomfort to significant distress and struggle. This use of the words” struggle” and” conflict” suggests that some people experienced the difference between their gender identity and bodies as something to be struggled against and overcome, with the implication that an internal conflict could lead to changes that would resolve the struggle. One paper highlighted that the distance between a person's gender identity and their experiences of their own body contributed to the intensity of gender dysphoria. Some papers conceptualized the dissonance as being between body and mind, whereas other focused more specifically on body and sense of self or gender identity. This dissonance was identified by non-binary participants as well as binary-identified participants.

The next subtheme we identified was confusion or uncertainty about gender identity which is experienced as distressing. Participants reported that they needed more support from society or from family members in order to understand their feelings about their gender. There was an implication that there are societal norms around being "certain” of one's gender identity or that one should conform to gender norms, and that transgressing societal expectations was therefore experienced as confusing and disorientating. It is of note that even a sense of uncertainty was experienced as distressing in contexts where the dominant narrative is that gender identity is fixed and in line with one's sex, and therefore certain.

Denial and suppression were another prominent feature of the studies, with denial of an individual's true gender identity leading to attempts to suppress it. This brought participants feelings of stress and of not being true to one's identity. In all the studies which discussed this theme there was the sense that transgender identities caused feelings of shame in participants due to negative views of transgender identities in society, or that suppressing one's gender identity was necessary to be accepted by others. Participants also felt shame around the suppression of their gender identity, implying that they felt caught between two contradictory ways of conceptualizing and expressing their gender identity, on the one hand conforming to traditional gender norms and suppressing their identity, and on the other hand fully embracing their gender identity.

The last sub-theme we identified within this concept was fear of the future. This referred to participants' difficulties envisaging how to navigate their gender identities, with a sense of hopelessness or fear for the future. This theme encapsulated the lack of control and anxiety transgender individuals felt about making life-altering decisions when they became more certain about their gender identity. Considering the earlier themes of death sometimes feeling preferable to continuing in one's current body, and the confusion or denial and suppression that comes with dissonance of assigned and experienced gender, huge emotional weight was associated with future-decision making for this group. While many participants were desperate to change their bodies and gender expression, for some this was associated with a fear of stepping into the unknown and of transgressing social norms.

3.2. Interface of assigned gender, gender identity, and society

The second concept we identified was the interface of assigned gender, gender identity, and society. This concept acknowledges the social nature of gender identity. Gender norms are culturally defined expectations about how gender-related behaviors and gender expression are interpreted. An individual's gender expression is interpreted by others using gender norms to work out their likely gender identity. The dissonance that the transgender individual experiences around their assigned gender and gender identity may be experienced by those they interact with, who may be unsure how to label the transgender person. The transgender individual who is undergoing transition wants to be seen as belonging to their experienced gender group and treated as such. In order to achieve this aim, individuals may wish to change others' perceptions of their body, and therefore others' perceptions of their gender expression. This concept underscores the effect of binary gender norms (i.e. the idea that gender is binary, either male or female) on the transgender individual, who may struggle with having a different gender journey to the dominant narratives around gender. These experiences of the interface of body, personal identity, and societal norms and responses to the individual led to a sense of not fitting in and transgressing societal norms, and a fear of others shaming or misgendering the individual. There are reciprocal relationships between feelings about the body, gender expression, and reactions of others. For example, an individual who is misgendered may then begin to feel higher levels of body dysphoria and conflict between their assigned and experienced gender. Moreover, feelings of anxiety or confusion around one's gender identity could affect an individual's gender expression, thereby shaping the social responses of people the transgender individual interacts with.

The first sub-theme was distress due to misgendering. This related to participants' fear of others misreading their gender identity and experiencing distress when this occurred, with a feeling of responsibility to ensure misgendering did not occur. A number of the studies identified feelings of fear, distress, embarrassment, anxiety, and stress at the thought or reality of being identified as belonging to a gender group which does not align with one's identity. Studies identified anticipatory fear of being misgendered or placing pressure on oneself to “pass” as one's gender identity, with some participants reporting suicidal ideation if they were not successful in this aim. This was linked with the earlier theme of body dysphoria and conflict of body and gender, as participants would measure their success in changing their bodies or gender expression by the reactions of others. Participants expressed fear of being labelled as transgender by others, with an implicit sense that this is a shameful, negative label. Moreover, participants wanted to be affirmed in their gender identity by others. This theme linked with the sense of struggle identified within the first theme, with misgendering being something that participants aimed to overcome. This demonstrates the complex interplay between gender identity, gender expression, and social interactions with others, with an individual's own sense of dissonance and negative feelings about their bodies and gender identity potentially being exacerbated by the reactions of other people. This theme has an emphasis on emotions linked to anxiety, suggesting that participants would spend time trying to predict and control the reactions of others.

The second sub-theme was the mismatch between participants' gender identity and societal expectations. This theme captured the dissonance between the individual's gender and societal expectations, rather than dissonance around the individual's own body and gender identity. Dominant social narratives that gender identity and biological sex should align did not fit the transgender person, which resulted in conflict and sadness. This links to the earlier theme of confusion, whereby participants were unsettled by their gender identity not aligning with societal expectations. Studies described participants' experience that they had been socialized to the incorrect gender, which caused dissonance and distress. This relates to the earlier theme of participants' suppression or denial of their gender identity, which happened as a result of not fitting societal norms. Furthermore, social interactions triggered gender dysphoria, and participants experienced shame and self-hatred when they perceived that others were looking at them and assessing their gender. Transgender individuals expected to be rejected due to the prevalence of binary gender norms, and so did not feel able to share their thoughts and feelings about their gender, even with close family members. Transgender men who chose to become pregnant felt isolated by the gender binary, as they did not conform to gender norms around parenthood. Therefore, societal expectations that assigned gender and gender identity should align, and that others should act in a gender conforming way, led participants to experience more negative feelings about their own gender identity, with shame being an important emotion in this process.

3.3. Negative social consequences of gender identity

The third concept was the social consequences of gender identity, primarily a sense of isolation due to the individual's gender identity. Transgender individuals felt and were cut-off from society and communities due to their gender identity. Participants reported that they felt outside of society due to their differences in gender identity, and the lack of acceptance in society for people who do not conform to traditional gender norms. Studies referred to a lack of community, reduced sense of belonging, invisibility, invalidation, and loneliness. Participants were clear that this was associated with their gender identity and that this caused distress, particularly loneliness. This concept highlights the loneliness of belonging to a group which can be ostracized by society. It is worth noting that some studies also referred to positive social consequences of gender identity, such as becoming close to other transgender people, however the negative social consequences came alongside these. The positive consequences are not reported here due to this paper's focus on distress in relation to gender identity.

3.4. Internal processing of rejection and transphobia

The final concept was the internal processing of rejection and transphobia, with hypervigilance for rejection due to gender identity and an internalized sense of shame and fear about one's gender. The focus of this concept was on the individual's internal cognitive processes and making meaning of their negative experiences as a transgender person in the world, with the difficult feelings that come with this including sadness, loss, and anxiety. This theme is conceptualized as resulting from the earlier theme of negative social consequences of gender identity; if participants had not either experienced or seen examples of rejection due to being transgender or transphobia, then they would not have developed internal narratives and processes to make sense of these experiences.

The most prominent sub-theme for this concept was fear of rejection, and sadness following rejection. This theme focused on how participants feared future rejection and ruminated on previous incidents of rejection, and these experiences were heightened by a high rate of previous rejections and awareness of negative societal attitudes towards transgender people. A high number of included studies discussed participants' fears of rejection, judgement or other negative responses from others, including family and friends. The range of emotions included fear, anxiety, loneliness, discomfort, frustration, pain, anger and depression. Participants experienced a sense of loss when rejected by people close to them such as friends or family. Participants wanted to fit in and hoped that others would not judge them, fearing rejection and judgement of others.

The next sub-theme was hypervigilance for transphobia, where an individual's expectation that they would be discriminated against or harmed due to being transgender was associated with attentional biases for threat and danger when out in public, with an understandable fear about leaving the home. Studies described participants' feelings of being unsafe due to fears of discrimination, violence or harassment. Such fears led to individuals looking out for signs of danger when out in public, in the hope of keeping themselves safe, presumably resulting in individuals spending long stretches of time in a state of high psychological arousal and anxiety, even at times when no threat is present. This was associated with a range of negative feelings such as anxiety, embarrassment, and depression.

The final sub-theme for this concept was internalized transphobia, or feelings of shame as negative external narratives about transgender people were internalized. Studies identified that individuals were highly aware of social stigma about their gender identity, and of transphobic narratives, and that for some people these became internalized, resulting in a sense of shame about their gender. One study highlighted that social messages about transgender people directly led to self-hate, confusion, and shame ( Rood et al., 2017 ). These feelings had consequences such as difficulties affirming gender identity, finding satisfaction with physical body, and hiding at home.

4. Discussion

This systematic review and meta-ethnographic study synthesized all the available qualitative studies about the lived experience of gender dysphoria in transgender adults. Twenty studies were included, all published since 2009, providing a rich dataset for the synthesis. Four overarching concepts were identified; distress due to dissonance of assigned and experienced gender, interface of assigned gender, gender identity, and society, social consequences of gender identity and internal processing of rejection and transphobia. These concepts demonstrated that distress caused by the dissonance of assigned and experienced gender is closely intertwined with distress due to the reactions of others to one's gender identity, whether that is reflected by strangers misgendering the individual, or rejection by close family or friends. This can then feed into the individual's thinking pattern and behaviors, for example through hypervigilance for transphobia, and fear of rejection due to being transgender. This demonstrates the complex relationships between an individual's feelings about their body, their gender identity, gender expression, and how outsiders interact with the individual, often guided by cultural gender norms and lack of awareness or acceptance of the transgender individual's experience. These findings are concordant with the quantitative literature available in this field. Participants described experiencing significant psychological distress in this study, in line with previous quantitative work ( Downing & Przedworski, 2018 ). Participants frequently reported experiencing anxiety and low mood in relation to their gender, and anxiety and depression are the most commonly reported conditions in this group ( Dhejne et al., 2016 ). While not a focus of this study, some studies included in this review did highlight the improved psychological wellbeing post-transition, in line with quantitative reviews about the effects of physical transition ( Nobili et al., 2018 ).

The first overarching theme we identified was dissonance of assigned and experienced gender. This concept aligns most closely with the DSM-5 definition of gender dysphoria ( American Psychiatric Association, 2013 ), particularly the sub-themes of body dysphoria, gender distress, and conflict of body and gender. These clearly align well with the criteria such as incongruence between gender identity and sex, the desire to be rid of one's sex characteristics and to have those of the other gender, a desire to be the other gender and the conviction that one has the feelings and responses of the other gender. This finding of significant distress in relation to the body supports the findings of quantitative outcome studies which find high levels of distress in those with gender dysphoria pre-transition ( Nobili et al., 2018 ). This is further supported by studies demonstrating that transgender people identify more with images of their body which are edited to be in line with their gender identity, compared to cisgender people who identify with unedited images of their body (e.g. Majid et al., 2019 ). The only part of the DSM-5 criteria which fits with another theme is the desire to be treated as the other gender, which aligns with the interface to assigned gender, gender identity, and society concept. The sub-themes which do not fit with the DSM-5 criteria are confusion, denial, and suppression and fear of the future. These features also contribute to distress but are not captured by the current DSM criteria, due to the focus of the DSM on intra-individual rather than societal and inter-individual processes. One explanation for these discrepancies is that they are not indicators of gender dysphoria, and rather are associated features. Another possible explanation for these discrepancies is the different types of gender related distress. The experience of gender distress which is alleviated through physical transition may diverge from the experience of gender distress which does not lead to a physical transition. There is limited research available in the adult population to further explore this at present.

This study provides further evidence for the concepts of negative social consequences of gender dysphoria and internal processing of rejection and transphobia, which fit within the framework of gender minority stress ( Meyer, 2015 ; Testa et al., 2015 ), as well as the rejection sensitivity model ( Downey & Feldman, 1996 ; Feinstein, 2019 ). Testa et al. (2015) developed a measure of gender minority stress in the transgender and gender nonconforming community. In their paper they highlight the role of difficult social experiences in the experience of psychological distress in gender nonconforming and transgender individuals. As well as experiences of discrimination, rejection and victimization, they measured internalized transphobia and gender non-affirmation, or misgendering, as well as negative expectations for future events, and nondisclosure. Their scale measuring these constructs was found to be valid for use with transgender people, providing quantitative support for the utility of these constructs. Our study has found a number of overlapping sub-themes, such as misgendering, isolation, internalized transphobia, and fear of rejection and sadness following rejection and so provides support for the gender minority stress framework. Further, Feinstein (2019) proposes an extension to minority stress theory using the rejection sensitivity model, which includes "anxious expectations of rejection", "perceptions of rejection", and "cognitive affective reactions" which contribute to distress following adverse social experiences ( Downey & Feldman, 1996 ). While Feinstein applied this model to sexual minority groups, other authors have proposed its potential relevance to the transgender population, if adapted to this group and supported by rigorous research evidence (e.g. Wells, Tucker, & Kraines, 2019 ). Our findings provide some support for these cognitive factors contributing to distress in the transgender population, with the “internal processing of rejection and transphobia” theme highlighting pre-emptory and post-hoc emotional responses to rejection due to transgender identity which are in line with components of the rejection sensitivity model. These similarities provide preliminary support for Feinstein's proposal that internal processing of rejection is central to distress, and suggests that this occurs in the transgender population as well as in sexual minority groups. While rejection sensitivity as a model to account for emotional distress has intuitive appeal and some evidence to support it, fluctuations in the level of rejection sensitivity in other groups, perhaps with social and interpersonal contexts playing a role, highlights the need for careful longitudinal research to establish rejection sensitivity as a valid theoretical framework for transgender people.

Our paper further extends the established understanding of gender dysphoria, and gender minority stress, to better understand the relationship between these two experiences. We found that societal expectations and gender norms caused participants to experience gender dysphoria when comparing their own gender experiences to those of others, or when sensing that their body and gender expression were being judged by others. On top of these factors, experience of actual rejection and social isolation due to gender caused significant distress. This led to increased body dysphoria, gender distress, conflict of body and gender, confusion, denial, and suppression and fear of the future, alongside internalized transphobia. All of these experiences in turn increased difficulties in leaving the home and hypervigilance when interacting with others. A strength of this study was the relatively recent publication of all the included studies; the oldest was from 2009. While the searches were not constrained by year, it appears that researchers have only recently begun investigating the lived experience of adults who experience gender dysphoria. Older studies were often excluded due to using quantitative or case study methods, rather than employing systematic qualitative methods. This means that this synthesis is highly relevant to current presentations of gender dysphoria and given the rapidly shifting context of this field (e.g. Aitken et al., 2015 ). A limitation was the relatively low number of studies that recruited non-binary participants, and none of the studies analyzed these data separately. Therefore, it was not possible to understand the similarities or differences in the experience of gender dysphoria between these groups. A further limitation is that our inclusion criteria restricted the synthesis to peer-reviewed, qualitatively analyzed studies. This means that the rich narratives of transgender individuals included in books or other non-peer reviewed sources were not included in the current study. This may have led to selection bias for the narratives which researchers have chosen to focus upon. Finally, we included papers which investigated the experiences of adults, and so the findings may not be transferrable to children. Systematic reviews focused on the experiences of children with gender dysphoria are therefore warranted.

We propose that the DSM definition of gender dysphoria requires increased conceptual clarity in its definition of distress. This is particularly important given the role of gender dysphoria diagnosis in current gender clinic practice ( Coleman et al., 2012 ). Our review demonstrates that significant distress is experienced by those with gender dysphoria as a result of social factors, which vary over time and age cohorts. Future quantitative research could compare the experience of gender dysphoria in individuals within more accepting cultural contexts versus less accepting contexts. This would help unpack the effects of the social environment on distress in gender dysphoria. Further research should investigate the relationships between distress due to dissonance of assigned and experienced gender, as well as processes such as: internal processing of rejection and transphobia including internalized transphobia; the interface of assigned gender, gender identity, and society, including misgendering or non-affirmation of gender; and negative social consequences of gender or discrimination, rejection, and victimization. Longitudinal studies investigating these processes over the course of coming out as transgender or transitioning would be well placed to elucidate the relationships between these concepts. Furthermore, research into the experience of non-binary individuals of gender dysphoria to understand how this relates to the experience of binary-identified transgender individuals is needed. This is particularly important given the flexibility of gender identities included in the DSM-5 criteria for gender dysphoria. Finally, the experience of distress in those who choose to physically transition versus those who choose another option is currently not known. This study provides further evidence for the need for society to accommodate people with different gender identities and journeys. It is clear from our findings that such societal shifts will improve the well-being of transgender people. Furthermore, societal responses to transgender people such as misgendering can exacerbate their negative feelings towards their body and their gender, adding further distress to the existing experience of gender dysphoria. Significantly, additional experiences of dysphoria than those in the DSM-5 came from the analysis. It is worth noting that confusion around gender identity, and suppression and denial of gender identity were often reported in relation to distress around gender identity. This study provides support for both the DSM-5 criteria for gender dysphoria and gender minority stress theory, while providing an important insight into how these experiences of distress are related to one another.

Kate Cooper is funded by a National Institute for Health Research (NIHR) Clinical Doctoral Research Fellowship for this research project.

Role of funding sources

Kate Cooper is funded by a National Institute for Health Research (NIHR) Clinical Doctoral Research Fellowship for this research project. The NIHR had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. This publication presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Contributors

KC, AR, WM and CB designed the study and KC wrote the protocol. KC conducted literature searches and screening. All authors contributed to the analysis. KC wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript.

Declaration of Competing Interest

Acknowledgements.

Thank you to Anna Lawes for her support with screening papers for this review.

Kate Cooper is a Research Fellow at the University of Bath and Clinical Psychologist in Oxford Health. Ailsa Russell is a Reader at the University of Bath and Director of the MSc in Applied Clinical Psychology. William Mandy is an Associate Professor and Research Director of the UCL Clinical Psychology Course. Catherine Butler is a Senior Lecturer/Clinical Director on the Doctorate in Clinical Psychology and Deputy Head of the Psychology Department at the University of Bath.

1 An original stated aim of this systematic review, as published on PROSPERO, was to compare the experiences of binary and non-binary transgender individuals' experiences of gender dysphoria. Following searches and screening, there were not enough data regarding the non-binary experience of gender dysphoria to keep this as an aim of this review.

Appendix A. Studies included in the meta-ethnography

Appendix b. casp quality assessment for included papers.