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• Original Article
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• Published: 29 October 2021

Corporate social responsibility in international business literature: results from text data mining of the Journal of International Business Studies

• Karen Paul 1 &
• Carlos M. Parra   ORCID: orcid.org/0000-0001-6029-4512 1  

International Journal of Corporate Social Responsibility volume  6 , Article number:  12 ( 2021 ) Cite this article

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Corporate social responsibility has been an important theme in management at least since the 1960s. International business became a recognized subfield in management around the same time. Logically, there might have been much dialogue about corporate social responsibility in international business research and publication, yet previous reviews of the literature indicate relatively little such research. This study complements previous literature reviews by employing text data mining to analyze a sample of 1188 articles published from 2000 to 2018 in the Journal of International Business Studies ( JIBS ). Results show that from 2000 to 2018 only 35 CSR focused articles appeared. CSR research has increased over time, highly influenced by editorial specification of special issues. These documents can be grouped into seven CSR topics, with corruption and embeddedness being the most salient. Strategies are suggested for increasing research on CSR in international business.

Introduction

The purpose of this research is to assess the inclusion of corporate social responsibility (CSR) or social responsibility (SR) in articles published from 2000 to 2018 in the Journal of International Business Studies (JIBS). JIBS is the official publication of the Academy of International Business (AIB) has ISSN: 0047-2506 (print) and 1478-6990 (electronic). Secondarily, this study assesses whether CSR focused articles have increased over time, and the geographic bases of authors represented by articles having at least 10% CSR topic weight. Many definitions of CSR and ways of measuring it have been proposed. The definition used to provide a framework in this study is the one put forth by the International Standards Organization (ISO) in ISO 26000. Moratis ( 2016 : 41) summarizes the dimensions included in this standard as the following: Environment, Social, Stakeholder, Societal obligation, Quality of life; Ethical conduct; Law abiding, Human rights, Transparency. The ISO uses Social Responsibility (SR) as its referent term. Following Moratis ( 2016 ), the term CSR is used in this study, because it is historically the term often used, and from a research methodology viewpoint the term CSR subsumes SR. Thus, this study’s methodology identifies documents in using either SR or CSR in their text.

Most previous literature reviews have asserted a neglect of CSR in the international business literature (Bhattacharyya, 2020 ; Doh et al., 2010 ; Kolk, 2016 ; Egri & Ralston, 2008 ; Pisani et al., 2017 ). Defining international business and enumerating all its representative scholarly outlets is beyond the scope of this analysis, but those articles appearing in the Journal of International Business Studies ( JIBS ) are deemed to be a logical representation of the field’s interests. However, this is not to suggest that there are no other meritorious journals in international business exist. Indeed, many other journals are also representative of the field, but JIBS is the first journal sponsored by the Academy of International Business and the only specifically international business journal listed in the Financial Times Index, widely used by universities as an indication of high-quality academic work (Saunders et al., 2011 ), and is widely recognized as the leading journal in international business (Tüselmann et al., 2016 ).

Looking at a broad range of journals in international business and related fields going back to 1985, Pisani et al. ( 2017 : 591) conclude, “CSR research is far from being global and still emerging in ‘mainstream’ IB.” On the other hand, Buckley et al. ( 2017 ), present topics related to CSR as important for the field of international business, indeed, as one of the “grand challenges” for maintaining relevance and developing the field in the future. This review seeks to answer the question of whether CSR has been a significant research topic in the international business literature, or whether it is a relatively neglected area. This review differs from others in several ways. First, previous reviews have generally used a more qualitative methodology, identifying themes and concepts the researchers considered to be associated with CSR. For example, in the case of Pisani et al. ( 2017 ), topics include items that might be associated with CSR, but also might have little to do with CSR, e.g., expatriate management. The study reported here uses a more quantitative methodology, one that allows terms and topics to emerge from textual analysis itself rather than to be derived from existing concepts and paradigms. The advantage of using this approach is that it facilitates a relatively objective analysis compared to content analysis or keyword analysis since it enables results to be obtained somewhat free from pre-existing, subjective paradigms. This technique has been used in analyzing the content of other academic journals (Guan et al., 2019 ; Kulkarni et al., 2014 ) as well as corporate reports (Parra et al., 2017 ).

However, text data mining analysis is subject to bias of its own. For example, the frequency of the word “environment” might suggest high interest in sustainability and other topics related to “green” issues. In the case of JIBS , this term generally applied to the business environment, e.g., competition, government regulation, etc.

Another contrast is that this study focuses on only one journal. Focusing on one leading journal allows us to see whether CSR has been represented at the center of the field of international business scholarship. An argument could be made that this focus is too exclusive, that an analysis should be as broad and deep as possible. However, many different topics can be identified in a wide and deep analysis including many meritorious journals, and filtering occurs insofar as certain topics attract leading researchers and become central to a field, which would naturally be the topics studied in its leading journal. Inclusion of a wide range of journals could amplify the noise surrounding any important topic of central interest to researchers, and might obscure the apparent coverage of topics like CSR which may or may not have attracted top researchers’ attention.

Another aspect of this study distinguishes it from others. Previous studies have gone back many decades in their analyses. One could argue that certain classic articles will provide a foundation for thought on CSR for decades to come, e.g., Friedman, 1970 , Carroll, 1991 . However, any scholarly field that survives evolves and develops with new scholarship, especially a field where data sources have expanded as rapidly as is the case with CSR. Inclusion of early time periods may be interesting from a sociology of knowledge perspective (Kot, 2014 ), but may dilute the significance of the CSR topic in the international business literature of most interest to scholars during recent decades. Thus, this study is restricted to 2000-2018.The structure of this paper starts with a review of international business literature reviews which focus on the inclusion of SR and CSR. Next comes a description of the methodology (text data mining-latent semantic analysis, or TDM-LSA) along with a discussion of the more technical details of this approach. Then results are presented. The final section of the paper presents limitations of the study along with implications of the findings for the inclusion of CSR in international business research, along with strategies and resources that may be useful for bringing CSR more into the scholarship of international business.

Literature review on the inclusion of CSR as topic in international business

Several recent reviews have indicated little attention being paid to CSR in international business (Doh et al., 2010 ; Kolk, 2016 ; Egri & Ralston, 2008 ; Pisani et al., 2017 ). Inkpen and Beamish ( 1994 ) conducted an analysis of the first 25 years of research published in JIBS, and categorized the corpus into 24 subdisciplines, none containing the words “social responsibility” or CSR. The most relevant term they identified was business-government interaction, finding it the 11th most frequent of 24 categorizations. A total of 53 articles were identified in this business-government interaction category, out of a total of 1220 articles in all categories. Buckley ( 2002 ) did a comprehensive analysis of the grand questions of the international business field in its formative years as a discipline, and no topic relating to CSR appears in the existing list or in the recommended topics for future research. Griffith et al. ( 2008 ) examined scholarly work in six leading international business journals from 1996 to 2006. They identified multinational enterprise (MNE) citizenship, ethical issues in international business, public policy issues, and environmental issues as emerging themes, however, these themes together constituted only about 10% of the total emerging themes. Kolk and Van Tulder, looking at CSR and sustainable development in the international business literature, observed:

“Sustainable development and CSR have only slowly been taken up as relevant concepts of study in mainstream management journals in general, and in International Business publications in particular…it is still remarkable that, except for specialized journals on business ethics and business and society where CSR has received most attention, more than 97% of the articles in main management journals over the past two decades have not referred to either CSR or sustainable development at all” (Kolk & Van Tulder, 2010 : 120).

Kolk examined the international business literature inclusion of social responsibility issues over a 50-year period, identifying three subthemes: “the (green) environment; ethics, rights and responsibilities; poverty and (sustainable) development” (Kolk, 2016 : 23). However, the three themes were not highly represented in the literature examined. Buckley, Doh, and Benische identified as a “grand challenge” the topic of “understanding how MNEs respond to greater pressures for social responsibility and sustainability in the global operations” (Buckley et al., 2017 : 1046).

It is interesting to compare the field of international business with international marketing, because a contrast can be seen. For example, Eteokleous et al. ( 2016 ), using LSA methods like those used here, found considerable attention paid to CSR themes in the international marketing literature, and Fatma and Rahman ( 2015 ) identified several CSR themes in the literature on consumers. It is also interesting to consider CSR coverage in business ethics specific journals, where many international topics have been studied, but with different and distinct theoretical approaches from international business. Some studies in business ethics or business and society journals compare CSR attitudes or practices in different countries, e.g., Chen and Bouvain ( 2009 ). Others look at international codes such as the U.S. Global Compact (Sethi & Schepers, 2014 ), or international monitoring such as that done by Transparency International (Wang & Rosenau, 2001 ). Sustainability has emerged as a unifying theme (Chabowski et al., 2011 ). Clearly, there has been considerable interest in CSR in areas related to international business.

Methodology

Text Data Mining (TDM) is built on the basic notion of the word count. Latent Semantic Analysis (LSA) is a mathematical method for inductively identifying themes based on word frequencies and word associations within articles in a whole corpus (all articles in the journal for the time selected). First, all words in all articles (often termed “documents”) are downloaded. Then words are excluded that have no special significance e.g., “the”, “thus.” Words appearing infrequently are also excluded, and terms containing a common stem are combined. The result is a matrix of words of interest with their frequency of appearance. Through filtering, terms are weighted by normalizing frequencies. This allows an assessment to be made of the relative importance of each term in relation to other terms and to identify connections between terms. For example, if the term “CSR” appears often, but mostly in connection with “human rights”, this connection will be shown.

Weights are assigned to identify associations between terms (i.e., topics) or between documents. LSA is used to obtain Singular Vector Decompositions (SVDs) from the resulting matrix composed of documents and their associated weighted terms. The SVDs show the importance of terms in each document (Manning et al., 2008 ). These SVDs can then be rotated to model the behavior of the data and to facilitate interpretation as well as labeling (Evangelopoulos & Visinescu, 2012 ; Evangelopoulos et al., 2012 ). Finally, post-LSA analysis may include comparing and classifying documents using either cosine similarity, or by using hierarchical or non-hierarchical clustering methods. Evangelopoulos et al. ( 2012 ) make some recommendations on LSA extensions and argue that researchers should use non-hierarchical clustering techniques such as K-means (Hartigan & Wong, 1979 ; Jain, 2010 ) or the expectation-maximization algorithm (Do & Batzoglou, 2008 ) for document summarization. However, for purposes of obtaining mutually exclusive groupings, when the number of groupings is not known, hierarchical clustering is preferred (Wang et al., 2009 ). To summarize, the frequency of terms, and the relationship (or clustering) of terms into topics emerges from the data, rather than from assignment to categories determined by human coding.

Figure  1 illustrates this methodology. The first step is Unsupervised Topic Discovery (UTD), which entails focusing on SVDs that include the term eigenvectors, placing special attention on factor loadings obtained from transposing matrices for terms, which represent term clusters/groupings (or topics). However, a single document may have high factor loadings in more than one SVD. In other words, one document may allude to more than one topic. Indeed, any scholarly article will probably contain several topics. The next question is how important this topic is for defining a document as a whole, and what other topics are alluded to in the document. Consequently, documents that discuss CSR topics are selected by calculating the total sum of the factor loadings per document (or total document weight) as well as the relative contribution made to that total by the CSR SVD. This is the second step shown in Fig.  1 . The third step is to then rank all documents in the collection and obtain a sub-collection of CSR documents including each article for which the CSR SVD contributed at least 10% to total document weight. Using a 10% cutoff conformed to standards within the acceptable range of other studies using LSA, as well as to results obtained in previous reviews of CSR treatment in international business literature (Inkpen & Beamish, 1994 ). The fourth step is to take this sub-collection and apply UTD once again to obtain CSR topics, and to identify CSR sub-categories. These steps are illustrated in Fig. 1 .

Methodological Approach to Obtain CSR Taxonomy from 2000 to 2018

The final step, illustrated in Fig.  2 , is to apply divisive hierarchical clustering to obtain a taxonomy of CSR topics treated from 2000 to 2018 (Wang et al., 2009 ). This taxonomical representation reveals connections between topics included the analysis. For example, corruption and embeddedness (or institutional logic) are split out into a branch that represents a separate cluster, while all other topics are remain in a different branch .

Topic Clusters in Articles Containing at Least 10% CSR Content

The application of TDM analysis on the 1188 JIBS articles (dating from 2000 to 2018) yields a total of 35 SVDs or topics. Table  1 provides a list of representative words for all topics. CSR appears as Topic 18. This listing is not a ranking, but rather an enumeration of topics appearing in JIBS, which are comprised of term clusters. The summary term may be viewed as a term of convenience and carries no special significance other than to enable communication that differentiates between themes typically treated in JIBS. By focusing on what the analysis has labeled Topic 18 one can see which articles have fallen within this category, what sub-themes have appeared (again identified by term clusters within Topic 18). Table 1 is a list of topics identified by TDM.

The next step is to identify the articles in the collection of 35 articles in the CSR topic cluster (Topic 18) that have at least a 10% weight on CSR SVD, to eliminate items such as book reviews and cases where, for example, the term “environment” refers to the general business environment rather than to some environmental issue. Also, two relevant articles that came corrupted from the publisher were manually included. Finally, the resulting articles are analyzed according to the article’s CSR SVD contribution using 10% as the basis for inclusion of the article in the sub-collection on which divisive hierarchical clustering is used. Table  2 provides a listing of the JIBS articles identified, arranged by subject, showing authors with the geographic location of their universities.

The next consideration is the frequency of CSR related materials over time. Figure  3 provides time series data. Two tendencies merit notice. First, there is an increasing incidence of CSR related topics over time. This is consistent with the more general analysis provided by Pisani et al. ( 2017 ).

Time Series of Articles with at Least 10% CSR Content

However, further examination shows that this incidence is heavily influenced by editorially determined special issues of JIBS. Note three CSR peaks in Fig. 3 . The 2006 peak corresponds to a special issue on corruption. The 2012 peak is associated with a special issue on cultural distance. Finally, in 2016 and 2017 there were special issues on internationalization in the information age and on international corporate governance.

Results show the proportion of CSR related articles appearing in JIBS is less than 5%, with robust statistical significance ( p  = .01). Editorial direction using special issues appears to have been a significant influence on the amount of CSR focused material appearing in JIBS. In particular, four of the nine articles in the legitimation category were published in the 2016 special issue on internationalization in information age. Furthermore, five of the six articles in the corruption category were published in the 2006 special issue on the topic. Foreignness and embeddedness each started as topics in 2012, coinciding with special issues on cultural distance and internationalization. The role of editorial direction and selection of appropriate topics for special issues has been critical for the inclusion of CSR material in this journal.

The geographical location of the CSR work that has appeared in JIBS during the period studied was also considered. Authors stating affiliations with universities from North America (the United States, Canada and Mexico) have contributed most CSR articles, with European authors contributing a substantial proportion, and a smaller proportion from Asia, mostly in co-authorships with North American or European authors. No authors publishing on CSR in JIBS during this period provided African, Middle Eastern, or South American university affiliations. This analysis indicates that JIBS has included relatively little CSR material during the period studied, 2000-2018. The articles which have featured CSR topics have tended to cluster around special issues where topics of specific CSR interest were solicited. This finding affirms previous studies but remains rather curious given that so many pressing CSR topics involve globalization, multinational companies, and governance issues of high international relevance.

Limitations and suggestions for further research

Although the journal used in this analysis is an obvious place to assess the significance of a topic in international business, many other journals could be considered. Perhaps CSR is a topic where interest develops at the margin of the field and flows from newcomers or outsiders to its central thought leaders, and from more marginal journals to the mainstream. Also, new topics may be in the pipeline, and even dissertations and conference presentations may include more CSR research than that which has passed through the entire review process and been published. However, the possibility that established academic networks and research teams may be resistant to new research topics and difficult for researchers interested in new topics to penetrate should be considered (Newburry & Gonzalez-Perez, 2015 ; Tilt, 2016 ). Another limitation is the use of TDM itself, a somewhat mechanical and arbitrary type of analysis that may miss critical, thoughtful, imaginative categorization or even subtleties of terminology.

The main question that arises from this study is why so little CSR material would be contained in the leading journal in international business. Prior to the period studied here, one might suspect that theory and data on CSR were not very well established, and this would limit publication of CSR research in a leading journal which would naturally require rigorous quantitative analysis as well as substantive theoretical contributions. However, CSR is now well established in the management literature with many data sources. Either a lack of familiarity with available data or a pragmatic calculation that CSR is not a career enhancing field of study for international business researchers might have influenced scholars not to focus on CSR.

Conclusions

A continuation of intentional efforts on the part of international business gatekeepers such as journal editors and accreditation organizations may be necessary if CSR topics are to gain more attention in international business. In addition, since quantitative studies dominate articles published in JIBS and other prestigious management journals, it might be helpful to promote awareness of the databases available on CSR topics. Since corruption is already an established area in international business research, the various indices on bribery and perceptions of corruption produced by Transparency International are highly relevant. Other publicly available data sources for international companies on a variety of CSR dimensions are available through the Global Reporting Initiative, a source which also collaborates with more than 150 other standards setting organizations in various areas of CSR. The International Standards Organization’s Standard 26,000 formed the basis for the definition of CSR that guided this study, and companies will be providing data structured around this standard (Zinenko et al., 2015 ), especially since it guides companies in compliance with the OECD Guidelines for Multinational Enterprises.

Whereas early articles on CSR had very little data to use for evaluating company CSR performance in connection with financial performance, the area has become more developed now, with many sources available, e.g., the MSCI KLD 400 Social Index, the MSCI USA ESG Select Index, the Calvert Index, and others that focus on aspects of CSR such as human rights and animal rights. The Global Impact Investor Network publishes an annual report including data from hundreds of socially screened funds. Many reviews of databases and indices may be found in the information technology and accounting literature, as well as the literature on socially responsible investing, now known as impact investing. Consequently, researchers in international business may find many relevant sources that have yet to be incorporated in international business research (Gkatziaki et al., 2018 ). Familiarity with these data may serve to expand the field of international business to include more CSR research.

Availability of data and materials

The dataset used and/or analyzed during this study are available from the corresponding author on reasonable request.

Abbreviations

• Corporate social responsibility

International Standards Organization

Journal of International Business Studies

Latent semantic analysis

MSCI KLD 400 Social Index is designed to provide exposure to companies with high MSCI ESG Ratings while excluding companies whose products may have negative social or environmental impacts

The MSCI USA ESG Universal Index is based on the MSCI USA Index, its parent index, and includes large and mid-cap securities of the U.S. equity markets

Organisation for Economic Co-operation and Development

• Social responsibility

Singular vector decompositions

• Text data mining

Unsupervised topic discovery

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Paul, K., Parra, C.M. Corporate social responsibility in international business literature: results from text data mining of the Journal of International Business Studies . Int J Corporate Soc Responsibility 6 , 12 (2021). https://doi.org/10.1186/s40991-021-00066-6

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Innovation and international business: A systematic literature review

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Introduction

Innovation and international business are essential to achieve competitive advantages in currently unforeseen business environments. Today's company seeks innovation in its country of origin and abroad in order to compete globally. Thus, incorporating this concept into international companies' strategies is a main issue nowadays.

The aim of this systematic study is to improve the current knowledge on the relationship between innovation and international business, as well as identifying innovation tendencies for corporations to acknowledge the opportunities and challenges of this area's development in the international business context.

Methodology

Despite the abundance of innovation and international business reviews, joint reviews of both of them cannot be found. This study is the first to combine the scholarly research on both topics with the systematic literature review of academic literature of 28 years, following the PRISMA guidelines and flowchart. A search was carried out in Web of Science database; 847 initial documents were obtained and, after reviewing multiple documents according to the inclusion/exclusion criteria, the results for this research work were reduced to 236 articles.

The results of this research provide an overview of the knowledge structure of innovation and international business. As the main contribution, the results highlight four themes of investigation within a comprehensive and multidimensional framework: Innovative activities of multinational corporations, Global value chains, Innovation in emerging economies, and Cross-border knowledge. With an international perspective, insights from how to face innovation development in the international business context are presented.

Conclusions

There is a strong relationship between innovation and international business. These four research trends highlight the strategic importance of innovation in the international business field. Finally, the most interesting paths for future research are identified, targeting opportunities for improvement in both areas. This systematic literature review is expected to make significant contributions to both theory and practice in the field of innovation and international business.

1. Introduction

Innovation, knowledge and technology are relevant concepts in the international business field [ 1 ] and both areas are essential to achieve competitive advantages in current business environments [ 2 ]. Cantwell [ 3 ] adds that innovation and internationalization processes have been increasingly interlinked as key drivers of development since the first industrial revolution, all the way to today's information age.

Innovation is the cornerstone of growth and sustains organizations to counter marketplace fluctuations and prepares them for long-term growth [ 4 ]. Business model innovation, although it is very difficult to achieve [ 5 ], can itself be a pathway to competitive advantage if the model is sufficiently differentiated and hard to replicate for incumbents and new entrants alike [ 6 ]. New models of innovation have encouraged many innovative firms to change the way they search for new ideas, adopting open search strategies that involve the use of a wide range of external actors and sources to help them achieve innovation [ 7 ].

The field of international business studies came to prominence in the 1980s and early 1990s with the growth of multinational corporations [ 8 ]. In this framework, two theoretical models are extremely relevant; on the one hand, gradual internationalization or Uppsala model, according to which internationalization is seen as an incremental process that begins in foreign markets, being in closer proximity to the domestic market in terms of physical distance [ 9 , 10 ] and, on the other hand, born global firms, that is to say, companies that internationalise at or near their founding, on an average period of three years of founding, generating at least twenty five percent of their total sales from foreign countries [ 11 ]. There is an extensive literature about this issue [ [12] , [13] , [14] ].

The systematic literature review on the topic of innovation has been a frequent research method over the last ten years. Different topics have been raised and discussed: organizational innovation [ 15 ], innovation capability in SMEs [ 16 ], or digital innovation in knowledge management systems [ 17 ] among others. In the same way, systematic literature review about international business is copious, holding various topics of investigation: knowledge flows in multinational corporations [ 18 ], business systems theory [ 19 ], social network [ 20 ], or culture [ 21 , 22 ].

Despite the abundance of innovation and international business reviews, joint reviews of both of them cannot be found, such review being needed since the emerging phenomena that are changing international business' frontiers require a change, as well, in the threshold of international business’ innovation [ 23 ]. From an economic point of view, Melitz [ 24 ] shows how high exposure to trade will induce only the most productive companies to enter the international markets; in addition, internationalization has a more positive effect on innovation in high productivity companies [ 25 ]. Likewise, the number of international relations increases the capacity to innovate [ 26 ] and exposure to foreign competition is associated with greater firm innovation [ 27 ]. Companies thus grow either through innovation or through internationalization (also through a mixed strategy), with a combination of internationalization and innovation being the most advisable option when domestic markets are limited [ 28 ].

International innovativeness is a significant dimension of international business competence [ 29 ], as a nuanced understanding of innovation and international business necessitates a multidisciplinary approach to reveal their multifaceted aspects [ 30 ]. Having this in mind, the aim of this study is to improve the current knowledge on the relationship between innovation and international business, that is to say, to identify trends for companies to know better the opportunities and challenges of innovation development in the international business context. Thus, the main innovative contribution of this systematic approach is the proposal of four themes of investigation within a comprehensive and multidimensional framework: Innovative activities of multinational corporations, Global value chains, Innovation in emerging economies, and Cross-border knowledge. This systematic review is motivated by the knowledge gap found in this issue since future research could fill that knowledge gap in the international business field through the development of new theoretical frameworks that draw on various disciplines [ 31 ]. On this wise, international business literature tends to develop a plurality of approaches that makes difficult to find single recurring or dominant forms [ 32 ].

Considering the ideas presented above and creating an intersection between both the literature of innovation and that of international business, this research provides several contributions to both areas. This is done with a methodologically systematic review of academic literature on both topics. A systematic review has been increasingly adopted in the management literature and is guided by a review question that defines the topics used for the database [ 33 ]. Following a previous theoretical study, two research questions were defined.

What themes about innovation and international business have been studied jointly to date?

Which themes about both areas require further research?

The rest of the paper is structured as follows: the section “Research method” presents the methodology and both the data search and selection used for the study; meanwhile, the section “Research results” presents the main results derived from that research, being categorized in those four themes of investigation posed earlier; the section “Discussion” also presents “Limitations” and “Recommendations for future research”, as further studies are needed to provide greater insight about this new approach; finally, the section “Conclusions” has also been included.

2. Research method

This paper presents the results of a systematic review of innovation in international business. Knowledge production within the field of business research is accelerating while at the same time remaining fragmented and interdisciplinary. This makes difficult to assess the global evidence in a specific area of business research, being the reason why literature review as a research method is more important than ever [ 34 ]. An advantage of the systematic review methodology is the generalizability of the results by allowing the accumulated knowledge in the field to be systematically synthesized and analysed [ 35 ]. A systematic review should have a list of specific steps to assure that important studies regarding the topic are acquired without any bias. Overall, following Tranfield et al. [ 36 ], (1) Identification for the need for a review, (2) Selecting a sample of potentially relevant works and the pertinent literature, (3) Data synthesis, (4) Reporting the results and recommendations. The cited steps are all followed in this study. Specifically, the preferred reporting items for systematic reviews and meta-analysis, commonly called PRISMA [ 37 ], were followed in this study.

In this analysis, a systematic search was carried out in Web of Science of Clarivate Analytics, including documents published from January 01, 1993 to December 31, 2020. Birkle et al. [ 38 ] claim that Web of Science is the world's oldest, most used and reliable database of research publications (around 34000 journals today). The query used in this systematic literature review is as it follows: TS = (“Innovation” AND “International Business”). Consequently, TS = Topic; and the search terms “innovation” and “international business” were combined with the Boolean Operator “AND”. Therefore, literature search was based on two simultaneous topics, “innovation” and “international business” (as stated in the title of the publication, the abstract, the author keywords and/or the keywords plus). Each document has been published between 1993 and 2020, since the first contribution was published in 1993. A total of 847 related documents were found. Thus, it can be affirmed that the importance and size of the literature on innovation and international business is more relevant.

Different criteria for inclusion and exclusion are considered in this study. The process is described through the PRISMA flowchart ( Fig. 1 ). Excluding meetings, books, review articles, editorial materials, and others, the reviewing process generated 630 articles. Only articles published in Business Economics have been considered due to its prominent research area regarding the topics of this paper; bearing this in mind, the number of the articles was reduced to 291. Each article is written in English language following Tenzer et al. [ 39 ], stating that 75% of articles in the social sciences are written in this language; therefore, the number of articles was delimited to 264. At last, each article was read in its entirety and various articles were excluded based on full-text or abstract due to their irrelevant nature to the research; thereby, the final sample has been finally reduced to 236 articles. Other criteria, as open access or funding agencies, have not been considered in this research work.

PRISMA flowchart of the systematic literature review.

One by one, data of each article were extracted, transferred, and sorted into Microsoft Excel spreadsheet for further analysis. Therefore, a wide Excel database was created with specific information for each article: journal, title, authors' keywords, keywords plus, year of publication, and author information (number, name, affiliation, and country). Specifically, the author keywords and the keywords plus have been studied. In total, 3064 keywords (authors’ keywords and keywords plus) were counted, analysed and categorized; this analysis has allowed to obtain four themes of investigation. Subsequently, in Web of Science, these research trends have been confirmed with the latest studies published from January 01, 2021 to November 03, 2022.

3. Research results

3.1. general results.

Fig. 2 shows the number of articles on innovation and international business published each year over time. 236 articles were published during the study period 1993–2020, with no consistent trend of the number of articles published, that is to say, with some ups and downs. 80% of the total articles reviewed (189) were published during the last ten years (2011–2020). The largest number of articles was published during 2020 (43 articles), followed by 2018 (31 articles), 2015 and 2019 (both with 21 articles), and finally 2017 (15 articles). There was a lack of publications during the following years: 1994, 1995, 1998, and 2001. Qualitative, quantitative and mixed methods are included in these articles (for instance, case study, literature review, bibliometric study, or regression analysis, among others).

Number of articles published each year.

The first article was published in the Strategic Management Journal by Hagedoorn [ 40 ]; this article presents interfirm strategic alliances in the international business area and their relationship with innovative efforts. The second article was published in the Journal of International Business Studies by Buckley and Casson [ 41 ], regarding international joint ventures in terms of the accelerating pace of technological innovation.

Number of authors per article is presented in Table 1 . The number of authors ranged from 1 to 9, with a predominance of two (35.59%) and three (30.93%) authors per article, that is to say, over 65% of the articles published. Besides, the mean of authors per article is considered to be 2.44.

Number of authors per article.

Following the previously mentioned line of thought, Table 2 shows the most relevant journals for research topic. The major journals included in this study are Journal of International Business Studies (48 articles; 20.34%), International Business Review (32 articles; 13.56%), International Marketing Review (14 articles; 5.93%), Management International Review (12 articles; 5.08%), Journal of International Management (8 articles; 3.39%), and Multinational Business Review (8 articles; 3.39%). These are believed to be the top six academic journals and represent more than a half (52%) of the total scientific production.

Main authors.

Principal journals.

Eight journals have published at least three articles (Thunderbird International Business Review, Journal of World Business, Entrepreneurial Business and Economics Review, Organization Studies, Industry and Innovation, Competitiveness Review: An International Business Journal, Journal of Business Research, and Management and Organization Review). Eleven journals have published two articles, and finally fifty-seven journals have published only one article. Table 2 also indicates that this study is related to other topics (for instance, strategy, human resources, or entrepreneurship, among others). 1

Fig. 3 represents the most productive universities. It is important to mention that in this study the first university of each author has been selected, rejecting other additional institutions according to the author's institutional information. Thus, the first institution is the University of Reading with a total of eight articles published, followed by the University of Manchester, University of Leeds, and Uppsala University (each one with six articles); after them, the Duke University, the Rutgers University, and the Temple University (each one with five articles). Twenty-nine universities are included in 113 articles.

Most productive universities.

Finally, Fig. 4 shows the distribution of the research topic according to the countries of origin of the authors. Overall, the United States of America (frequency in articles = 80; 33.90%), England (52; 22.03%), China (24; 10.17%), Australia (21; 8.90%), Canada (13; 5.51%), and Italy (12; 5.08%) are the most prominent countries. Twenty-three countries were included in the sample. A country is considered part of this figure if it appears in at least three articles.

Most prominent countries.

3.2. Thematic analysis

The current state of the literature is characterized by its complexity and fragmentation. As previously reported, 3064 keywords (authors’ keywords and keywords plus) were counted, analysed and categorized. Some of the most prominent keywords, with minimum occurrences of ten, are showed in Table 4 ; the semantic difference between singular and plural forms is not considered. Obviously, “innovation” and “international business” are the most relevant concepts among the ones displayed. These two keywords together, along with the other five keywords, influence four categories. Subsequently, “multinational corporation” and “knowledge” are the most common keywords in this research work.

Themes of investigation identified.

Thus, this section synthesizes the results of this study. Four themes of investigation about the relationship between innovation and international business are suggested: Innovative activities of multinational corporations, Global value chains, Innovation in emerging economies, and Cross-border knowledge. This thematic analysis allows to answer the RQ1 posed earlier, that is to say: “What themes about innovation and international business have been studied jointly to date?” Consequently, it provides the occasion to have a more complete understanding of the research topic within a comprehensive and multidimensional framework.

3.2.1. Innovative activities of multinational corporations

A classic topic in international business research is the multinational corporation. The widest theme of investigation studies the relationship between innovation and the multinational corporation because, as Venaik et al. [ 42 ] assert, the international business literature has placed ever-greater emphasis on the role that learning and innovation play in determining multinational corporation performance.

It is common to conceive multinational corporations as a set of geographically disseminated subsidiaries that are combinations of heterogeneous technology competencies and product market responsibilities [ 43 ] or, in previous years, as firms that control and manage production establishments located in at least two countries [ 44 ]. Competitive success hinges on a multinational corporation's ability to use effectively available knowledge, and to combine it with knowledge from other locations [ 45 ]. Therefore, by interacting with locations multinational corporations have the possibility to organize their activities for balancing the exploitation of their current knowledge base and that of the new knowledge bases [ 46 ].

Knowledge that is complex to measure [ 47 ] has been recognized as critical for subsidiaries' power [ 48 ] and its transfer is driven by subunits’ motivation: subunits whose activities are mostly complementary have a natural motivation to collaborate and to ensure that the transferred knowledge is adopted, while subunits with surrogate activity relationships are less motivated [ 49 ]; consequently Miller et al. [ 50 ] assert that the use of distant knowledge contributes to innovation.

The location choice for R&D subsidiaries has been a topic of interest for researchers [ 51 ] since national subsidiaries carry out different tasks in the distinct processes of creation and innovation in multinational corporations [ 52 , 53 ]. Moreover, according to Frost et al. [ 54 ], the formation of centres of excellence in foreign subsidiaries of multinational corporations is shaped by the conditions of the subsidiary's local environment, the fundamental role played by parent firm investment as well as the role of internal and external organizations in the development of subsidiary capabilities. As Castellani et al. [ 55 ] argue, multinational corporations have organizational and technical competencies that enable them to transfer knowledge within their internal networks at a relatively low cost, so that geographic distance has a relatively low impact on international R&D investments. Nevertheless, the within-country cultural distance between subsidiaries influences headquarters to transfer projects between those same subsidiaries [ 56 ].

Therefore, the degree to which the business model links to local idiosyncrasies, local knowledge, or local innovation, impacts on the business model-related specific advantages [ 57 ]. In this context, Cantwell [ 58 ] claims that changes in the environment for international business activities have facilitated more open networked formations. Such cooperation will often take place within the field of the multinational corporation orchestrated innovation network which may include open innovation activity [ 59 ]. Prashantham and Birkinshaw [ 60 ] add that multinational corporations can cooperate with small and medium sized-enterprises as a specific type of host country business stakeholder, although the extent to that cooperation being relatively weak or not is a result of the compatibility between the intents of these disparate sets of firms.

3.2.2. Global value chains

In recent years, firms have been increasingly implementing strategies to take advantage of the comparative advantages of locations. This results in a wider geographic dispersion of firms' activities, with direct implications for creative industries’ global value [ 61 ]. Buckley [ 62 ] proposes the concept of global factory as a structure through which multinational corporations integrate their global strategies through a combination of innovation, distribution and production of goods and services. The increasing international fragmentation of economic activity gives rise to the global value chain research stream, a conceptual approach that deals with managing disaggregated and geographically dispersed value chains of multinational corporations (see, for instance, Refs. [ [63] , [64] , [65] , [66] ]).

The global value chain concept recognizes that such value-creating chains were not restricted solely to commodities but could also be extended across manufacturing and indeed to services [ 67 ]. Large multinational corporations operate in global innovation systems that are highly complex and so interdependent that the sources of new knowledge creation are hard to pinpoint [ 68 ].

Traditionally, the cluster approach emphasizes horizontal links between firms and local organizations [ 69 ] and from a network perspective, the cluster is a mechanism for the share of knowledge and learning [ 70 ] and also to innovate [ 71 ]. Nevertheless, the global value chain is strongly related with the analysis of clusters in the globalization era [ [72] , [73] , [74] , [75] ] because the need to integrate the global industry and local cluster levels is a basic one [ 64 ]. As Carloni [ 76 ] develops, clusters are supporters and accelerators of internationalization processes. Moreover, the existence of strong local innovation systems tends to be a prerequisite to guarantee sustained learning through global value chain participation [ 77 ].

Overall, participation in the global value chain is positively related to the innovation result of a country, which suggests that the international fragmentation of production may be a channel that allows international technology transfer from developed to developing countries [ 78 ]. Integration in the global value chain is perceived as a fundamental way for companies in developing countries to access knowledge to innovate [ 79 ] and to access larger markets and new technologies too [ 80 ].

3.2.3. Innovation in emerging economies

Emerging economies are low-income, rapid-growth countries using economic liberalization as their primary engine of growth [ 81 ]. Since the end of the 20th century, emerging economies, or what is the same, emerging markets, constitute the major growth opportunity in the world economic order and their potential has created a shift in multinational corporations [ 82 ] seeking to do business in emerging economies with manifold stakeholders benefited [ 83 ], although characteristics of internationalization of emerging market multinational enterprises investment simultaneously have positive and negative development consequences in their home countries [ 84 ]. In any case, multinational corporation subsidiaries and local institutions can help emerging market stakeholders, as suppliers [ 85 ].

Innovation is an important driver of economic growth in emerging economies [ 86 ]. In this context, for instance, innovation has helped develop solutions for consumers at the bottom of the pyramid [ 87 ] and middle-class consumers [ 88 ]. Emerging economies have certain characteristics, such as immature capital markets, lack of resources for innovation, and poor legal framework to protect property rights [ 89 ], that make the innovation process different from developed countries, despite having recently begun to innovate at a rapid rate, regarding the challenges they face [ 90 ]. Moreover, developing country difficulties can foster innovation capabilities and international competition [ 91 ] since in emerging markets a company gains advantage by learning to improvise with scarce resources and, in the process, to become more innovative than its competition [ 92 ]. Summing up, as Anand et al. [ 93 ] claim, innovation to and from emerging economies is a systemic outcome of an entire innovation milieu and both firms and countries are heterogeneous, following each one an idiosyncratic path in its evolution.

3.2.4. Cross-border knowledge

International business and cross-border flows of trade and investment significantly impact on the economic growth, employment and innovation potential of countries [ 64 ]. In addition, the rapid reshaping of the global economic order requires fundamental changes in international business; as a result, innovation networks will require novel reconfigurations [ 94 , 95 ]. Thus, Cantwell [ 3 ] remembers that there has been an increasing awareness of the importance of absorptive capacity on the part of firms [ 96 ]. In this same line, Contreras et al. [ 97 ] show that companies should have an organizational climate that allows them to acquire and transform knowledge in order to increase their innovativeness and be more competitive in a globalized world. Having this in mind, firms and locations co-evolve with one another, and it is possible to appreciate the rise of knowledge connectivity in innovation systems, that is a new underlying reality of the international business field [ 98 ]. The dynamics of place, space and organization continually generate new domains within which knowledge is leveraged in unique ways [ 99 ]. Knowledge circulates through two types of networks; on the one hand, organization-based linkages, or in other words, pipelines [ 100 ] and, on the other, personal relationships [ 73 ]. Accordingly, digital platforms and ecosystems are a major venue for innovation and have considerable implications for international business [ 101 , 102 ].

Multinational enterprises and subnational governments have increased their level of cooperative activity and create the basis for sustainable economic growth [ 103 ]. Discontinuities between nation-states and spatial heterogeneity within national boundaries are a relevant part of international business with different reasons, such as the historical role of national borders, the magnitude of national governments in international trade, the importance of national institutions in the formulation of business strategy and the decision making and the availability of data [ 104 ]. Hence, it is necessary to refer to the concept of global cities, or in other words, the centres of political power, corporate decision-making, knowledge generation and the exchange and movements of human capital and ideas [ 105 ]. Goerzen et al. [ 106 ] argue that distinctive characteristics of global cities (global interconnectedness, cosmopolitanism, and abundance of advanced production services) help multinational corporations to overcome the costs of doing business abroad. Nevertheless, global cities are not always necessarily the key locations for future multinational investments since knowledge and technology as well as the connection with the capabilities and company goals are crucial [ 107 ]. In any case, as Van Burg et al. [ 108 ] remember, organizational actors’ decisions about interorganizational knowledge transfer might change over time because unforeseen events can prompt actors to quite radically reframe future developments as opportunities or threats.

4. Discussion

This paper performs a systematic literature review of the relationship between innovation and international business. Particularly, using a qualitative/interpretative methodology, evolutionary trends have been recognized and are described in detail. 236 articles were published during the depicted study period 1993–2020. The largest number of articles was published during 2020, highlighting the topicality of the subject. Moreover, to enrich this section, the most recent works are included. The results of this research provide an overview of the knowledge structure of innovation and international business. The results highlight four themes of investigation within a comprehensive and multidimensional framework: Innovative activities of multinational corporations, Global value chains, Innovation in emerging economies, and Cross-border knowledge.

About the first theme, this systematic literature review shows that the multinational corporation is the most important kind of firm for innovation development in the international scenery. Thus, the location choice for its subsidiaries and its local environment is basic for the innovations' development [ 51 , 52 ] and also for the geographies of innovation [ 109 ]. This agrees with a very current line of research, which shows that the growing tendency of local technological innovation of multinational corporations, together with the increasing relevance of subsidiaries, are promoting subsidiaries' engagement in conducting innovation activities [ 110 ]. In the same way, managers’ characteristics, such as prior multinational corporations work experience and industry experience, affect subsidiary innovation [ 111 ].

As previously reported, in the field of international business two models are basic; however, although the Uppsala model keeps capturing the interest of scholars and is still one of the most cited frameworks in this area [ 112 ], it is confirmed that the born global firms’ phenomenon is very present in current literature. As Hennart et al. [ 113 ] remember, born global firms make large foreign sales at birth or shortly afterwards since they own valuable resources (for instance, advanced technologies and a high international orientation), and specific internationalization strategies (such as networks). Given the nature of this study, it should be specified that innovation plays a relevant role in the creation of born global firms [ 114 , 115 ]; moreover, born global firms contend with environmental dynamism in global markets, compelling these companies to enhance their innovation capabilities [ 116 ].

The second theme reveals a new conceptual approach, the global value chains as referred in the relationship between multinational corporations and global innovation systems [ 64 ] in view of the fact that nowadays international lead firms integrate their geographically dispersed partners, specialized suppliers, and customers in these global value chains or global production networks [ 117 ]. This new conceptual approach is confirmed due to the necessity of the adoption of a more holistic view of global value chains since this action will provide a clearer picture of how the organization and outcomes of innovative activities have evolved in this specific context [ 118 ].

About the third theme, this study supports the forecasts that indicate that emerging economies will have more economic power in the upcoming years. Therefore, this stated theme emphasizes, in the context of innovation, the opportunities for multinational corporations, local institutions, and stakeholders [ 85 ]. In any case, legal systems in emerging countries must be strengthened by harder competition laws that encourage the kind of competition that is based on innovation [ 119 ]; moreover, emerging market multinational enterprises have consolidated their global presence recently, challenging international business’ theories [ 120 ]; consequently, strengths and weaknesses are more pronounced when firms face competitors from emerging markets [ 121 ].

Finally, the fourth theme is Cross-border knowledge, which, in the internationalization context, impacts on the potential innovation of the countries [ 64 ], requiring relevant changes in their innovation networks [ 95 ]. In this sense, interaction and communication among their different intra-organizational networks facilitate multinational corporation knowledge transfer [ 122 ], whereas born global firms exploit different types of knowledge and networks to develop international opportunities [ 123 ]. Consequently, Freixanet and Churakova [ 124 ] point out to a reduction in the transaction costs as companies gain internationalization knowledge. Hence, internationalized companies devote substantial efforts to deploying and maintaining digital platforms, which plays an increasingly important role in today's digitally connected world [ 125 ].

4.1. Limitations

This study is supported by official data from 236 articles located in the Web of Science database and it has followed a rigorous research methodology. However, the scope of this kind of study always tends to involve some limitations. Firstly, other databases (Scopus or Google Scholar, for instance) have been excluded from the search. Secondly, while keywords (as innovation and international business) have been selected to cover the chosen areas as completely as possible, it could still be possible that important contributions were missed. Furthermore, certain sources of information have been not targeted (meetings, review articles, books, and editorial materials, among others). It must also be taken into consideration that the only considered area of research has been the Business Economics area (other ones, such as Computer Science or Engineering were not considered relevant enough due to the topic of the current study). In order to finish, only English language publications have been included in this analysis (thus, other languages like Spanish, Korean, or Russian were eliminated). Overall, as Greenhalgh et al. [ 126 ] defend, the literature is complex and the approach is somewhat unconventional, leading to other researchers to inevitably identify a different set of primary sources; being this an inherent characteristic of any systematic review.

4.2. Recommendations for future research

This study has strong implications for researchers. Bearing in mind the results of this investigation, it is recommended to expand the scope of this specific study to related innovation and international business topics targeting opportunities for improvement in both areas. There are multiple themes that require further research. Thus, future studies should deepen into the relationship between those specific topics, although this subject could not be an easy one. As previously stated, to enrich this section, the most recent works have been included. The implications of this study allow to answer the RQ2 question posed earlier, that is to say: “Which themes about both areas require further research?”

For instance, the global value chain requires to be fully studied in order to address the participation of multinational corporations in an understandable way holding a comparative environment between countries [ 127 ] since, as Buciuni and Pisano [ 128 ] confirm, there are a plurality of global value chain structures and a variety of innovation models within the global value chain. Similarly, the international business literature has given little attention to the comparison between the performance of advanced economy multinational corporations and the emerging market multinational corporations acting in international markets [ 129 ]. In the same way, in recent years open innovation has become a basic paradigm regarding the specific literature about innovation. However, throughout this research only one article [ 130 ] discusses the relationship between this topic and multinational corporations. In addition, a lack of specificity has been observed in the current literature regarding the role of social innovation in multinational corporation since only one recent article of this study [ 131 ] suggests to ask why and how this companies engage in social innovations. Likewise, although corporate social responsibility is a relevant factor in multinational corporation's competitiveness, only one depicted article [ 132 ] studies the development of corporate social responsibility in international business.

Furthermore, the impact of the Covid-19 pandemic on international business has barely been discussed; leading to only one article in this study addressing this question [ 133 ]. The Covid-19 pandemic is an external shock that has disrupted the foundations of our everyday life [ 134 ], not only by changing the structure of the world economy, but also by leading to lasting impacts on the international business strategies of multinational corporations [ 135 ]. This pandemic encourages multinational firms to diversify their supply chains in order to retain innovation opportunities [ 136 ] due to the uncertainty of some innovations during that time [ 137 ]. Hence, it is necessary to shed light on the long-term impacts of the Covid-19 pandemic on international business, although the true effects on multinational corporations and global value chains can only be judged over time [ 138 ]. In any case, analysing the impact of this virus in the new context of the internationalized companies becomes a necessity.

Future studies could offer more evidence about different topics in the internationalization area (for instance, innovation network adaptation, economic performance, social media, stakeholders, and corruption). Also, the importance of human resource management in the international business context should be reviewed in the near future [ 139 ]. In the same way, the majority of the studies have examined outward firm internationalization; however the phenomenon of inbound internationalization is limited and, as Bianchi and Stoian [ 140 ] add, innovation drives that inbound internationalization.

On this basis, international business scholars may contribute to addressing these knowledge gaps through research and lecturing. Therefore, this study identifies a set of analysis challenges that can be used as a research agenda for the international business research community. To conclude the present section, final remarks for practitioners are advised since the results of this work could also be useful to CEOs and managers of multinational corporations, and overall, international entrepreneurs; particularly those working in the innovation field (management, processes, or networks, among others). From a managerial viewpoint, these practitioners have encountered difficulties to align their different strategies many times. Thus, these results provide guidance to practitioners that adjust their innovation strategies along with their international business strategies in a complex competitive environment. Likewise, this paper allows a better comprehension of the dynamic reality and identifies challenges that can be used and employed by decision-makers when dealing with the unforeseen internationalization process.

5. Conclusions

Nowadays, companies seek innovation in their countries of origin and abroad in order to compete globally. Therefore, innovation is a key factor for entering into international markets. This systematic literature review shows that there is indeed a strong relationship between innovation and international business; four themes of investigation within a comprehensive and multidimensional framework are found: Innovative activities of multinational corporations, Global value chains, Innovation in emerging economies, and Cross-border knowledge. These four research trends highlight the strategic importance of innovation in international business. Nevertheless, even when the number of articles addressing such topics is growing, this research work underlines that there is still a great opportunity for studying the relationship between those concepts. Thus, incorporating innovation into internationalized companies’ strategies is a main issue in current times, even more considering the changing and challenging world that we live in.

Author contribution statement

All authors listed have significantly contributed to the development and the writing of this article.

Funding statement

This research did not receive any specific grant from funding agencies in the public, private, or not-for-profit sectors. The Open access publishing of the article was funded by University of Malaga.

Data availability statement

Declaration of interest’s statement.

The authors declare no competing interests.

1 The 236 articles were written by 575 authors. Table 3 shows the most relevant authors to the research topic. Authors such as Knight, Gary A.; Buckley, Peter J.; Cantwell, John; Coviello, Nicole; Kim, Daekwan; Kolk, Ans; Lewin, Arie Y.; Luo, Yadong; Massini, Silvia; Mudambi, Ram; Peeters, Carine; and Tippmann, Esther, have each one three or more publications during the 1993–2020 period. Furthermore, thirty-nine authors contributed to at least two articles each one.

Exploring Muslim Communities’ Experiences and Barriers While Accessing Assisted Reproductive Technologies: A Scoping Review of International Literature

• ORIGINAL PAPER
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• Published: 19 May 2024

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• Kate Hammond   ORCID: orcid.org/0000-0002-9688-4220 1 &
• Nilab Hamidi   ORCID: orcid.org/0000-0002-3696-9476 2  

This study adopted a scoping review methodology to analyze international literature on the barriers impacting Muslim couples’ access to equitable assisted reproductive technologies (ART). A total of 27 studies were included for review. Results show that Muslim communities face several barriers when accessing ART. These include cultural and religious barriers that impacted which aspects of ART couples were open to adopting, diminished quality of care due to low cultural/religious capacity of practitioners, as well as gendered norms which intersect with experiences of ART treatments. Further research, based in western countries, should be conducted to better understand how these contexts can support Muslim patients accessing ART.

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Introduction

Infertility in muslim communities.

Family and procreation are strongly encouraged in the Islamic faith. Marriage is often considered a prerequisite to building a family, as it performs the function of uniting the ‘two elements’ of humanity (men and women), and fosters procreation (Sachedina, 1990 ). The Qur’ān states of marriage and procreation, ‘And it is God who has given you spouses from amongst yourselves and through them He has given you children and grandchildren and provided you with good things…’ ( Qur’ān, 16:72). Culturally, this religious belief is borne out in Muslim communities, where there is a strong emphasis on marriage, creating a family, and raising children (Al-Jayyousi et al., 2014 ).

A central component of Muslim family structures is transparency of lineage, particularly patrilineage. Establishing the patrilineal line of a child is paramount, as paternity has implications for other Islamic traditions and practices including inheritance, naming conventions, upholding maharam relationships (people with whom marriage is prohibited), and identifying daughters’ wali (male guardian) (Ayubi, 2021 ; Inhorn, 2006a ; Monsoor, 2015 ). Such are the concerns surrounding the paternity of a child, that adoption, in the common sense of the word, is not permitted under Islamic law (Chaudhry, 2010 ). With such a strong emphasis on building a family, and limited options in terms of adoption, experiencing infertility can be a significant struggle for couples (Obeidat et al., 2014 ).

Infertility, as defined by the World Health Organization, is a condition characterized by the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse (World Health Organization [WHO], 2023 ). Infertility is estimated to impact approximately one in six people at some stage of their life (WHO, 2023 ). While no prevalence data exists denoting infertility rates in Muslim communities globally, the World Health Organization’s prevalence estimates do suggest that rates of infertility may be lower in Muslim-majority countries throughout the Middle East and North African region, though this data is not conclusive (WHO, 2023 ).

Culturally, however, experiencing infertility may present additional pressures for Muslim couples, and the condition can be highly stigmatized in Muslim communities (Reaves & Hauck, 2019 ). The impacts of the cultural and religious pressures to have children, combined with religious teachings that infertility is a ‘decree from Allah’ (Butt & Shah, 2019 ), can mean that infertility is experienced as shameful. In fact, because parenthood is considered so central within Islam, and infertility is a direct barrier to this goal, one hadith (sayings and deeds of the Prophet Mohammed) recommends that Muslims avoid marrying barren women (Sunan Abi Dawud, 2050 ). These cultural and religious norms with regards to infertility have significant social and psychological costs for couples.

Assisted Reproductive Technologies

Assisted Reproductive Technologies (ARTs) are fertility related treatments in which eggs, embryos, and sperm are manipulated with the goal of achieving pregnancy (Jain & Singh, 2023 ). The first ART-assisted human was born in 1978 (Steptoe & Edwards, 1978 ), and since then, countless advances in ART procedures and treatments have been made to improve outcomes for patients (Kamel, 2013 ). In the modern era, ARTs comprise a number of procedures and techniques including: Intrauterine insemination (IUI), a type of ART in which the sperms are placed in the uterine cavity at the time of ovulation; in vitro fertilization (IVF), where one or more fertilized eggs (embryos) are placed inside the uterine cavity with the hopes of attachment; gamete intrafallopian transfer (GIFT), a procedure similar to IVF though uncommonly used nowadays; zygote intrafallopian transfer (ZIFT), where an embryo developed in vitro is transferred laparoscopically into to the fallopian tube; and intracytoplasmic sperm injection (ICSI), a technique in which a single spermatozoon is injected directly into the egg prior to IVF insertion (Amjad & Rehman, 2021 ).

Just like with natural conception, successful pregnancy via ARTs require three things: fertile spermatozoa (sperm), fertile eggs, and a female reproductive system that is capable of carrying a pregnancy. Obtaining these three things can, in some cases, be difficult. Individuals with female reproductive systems are required to go through a series of hormone treatments to encourage oocyte maturation, after which the mature ovum are retrieved via a surgical procedure (Pellicer & Gomez, 2020 ). Men, on the other hand, provide the sample utilized in embryo creation through masturbation to achieve ejaculation. Lastly, to achieve pregnancy via ART requires a female reproductive system, usually the mother. However, as some cases of infertility may be related to a person’s inability to carry a pregnancy to full term, some couples may seek the assistance of a surrogate.

ARTs and Islam

The use of assisted reproductive technologies in Muslim communities can be a contentious topic. Religiously, perspectives can differ depending on Islamic sect, school of thought, and individual interpretation. When it comes to the two largest Islamic sects—Sunni and Shi’a—divergences in religious jurisprudential rulings have led to vastly different understandings of the acceptability of certain ARTs in the respective communities (Khan & Konje, 2018 ; Serour, 2013 ).

This is particularly clear when it comes to third-party donations of gametes. In Shi’a-majority Iran, Ayatollah Ali Khamene’i issued a fatwa permitting the involvement of a third-party in couples’ fertility treatments, including through donations of eggs and sperm, as well as surrogacy (Serour, 2013 ). This fatwa made the acceptability of ART more flexible in Shi’a communities. However, in recent years, there has been some concern regarding the acceptability of using donated sperm. Consequently, many Shi’a scholars today forbid sperm donation (Serour, 2008 ). In comparison, Sunni perspectives are fairly unanimous on the prohibition on the use of any third-party material for artificial reproduction, and especially the use of donated sperm (Al-Bar & Chamsi-Pasha, 2015 ; Khan & Konje, 2018 ).

Despite these convergences on the use of third-party donations, both Sunni and Shi’a perspectives encourage the treatment of infertility through various ARTs (Serour, 2008 ). Modern fertility treatments are generally viewed as positive as they are the final way to facilitate procreation and parenthood, especially as adoption is often considered impermissible in Islam (Chaudhry, 2010 ). However, the permissibility of the use of ART is also contingent on the relationship status of the patient; ART is exclusively restricted to married, heterosexual couples. Single women or homosexual couples are not considered religiously permitted to receive assisted reproduction (Shamani et al., 2007 ).

It is important to note that religious rulings on certain practices pertain to how the religious establishment views a particular issue, and not necessarily to how that issue is interpreted or practiced within Muslim communities. There is a wide variety of personal perspectives on ARTs’ alignment with Islamic principles, some of which will be discussed in this study.

Research Methods

This research seeks to answer the following research question:

What are the barriers impacting Muslim individuals and couples' access to equitable Assisted Reproductive Technology (ART), with particular, though not exclusive focus on: religious belief and interpretation; community and familial norms; and cultural/religious capacity of service providers?

To explore the research question, a scoping review was undertaken. The review follows the framework set out by Arksey and O’Malley ( 2005 ) and the additional recommendations of Levac et al. ( 2010 ). The reporting of the findings follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews—PRISMA-ScR (Tricco et al., 2018 ).

Search Strategy

A four-step search strategy identified relevant studies. First, an initial limited search using Google Scholar and Medline (OVID) was undertaken, followed by a review of words used in titles, key words, subject headings, and index terms to identify relevant search terms (Box 1). A second search using the identified search terms was undertaken using MEDLINE, PsycINFO and 100 + other databases via OVID. No lower time limit was imposed as ART has only become widely available in the past 2–3 decades. Two researchers reviewed and discussed the results. Finally, a hand-search was undertaken using the reference lists of relevant literature to identify studies that may not have been picked up through the original searches. This review includes studies up until December 2023. No new articles beyond this date are included (Table  1 ).

Study Selection

Studies were extracted from the academic research databases Medline (Ovid), SCOPUS, and Web of Science, then uploaded into Covidence online screening tool. Duplicate articles were identified by Covidence and removed, with additional duplicates removed manually by the researchers. In the initial screening phase, both researchers conducted double-blind review of the titles and abstracts—two negatives would mark the article as irrelevant, two positives as relevant, and two different votes (yes, no, or maybe) would flag the article as a conflict. Conflicts were resolved by both reviewers after discussing the article together. Following this, the full text of the articles were reviewed following the same protocol. Articles that were screened as relevant were moved on to the data extraction phase, where both researchers reviewed and extracted the data for analysis.

Selection Criteria

Initially, the criteria for screening in studies for review was kept broad to get a full understanding of the scope of research into the topic. Studies were screened in if they focused on the intersection between Islam and/or Muslim communities and assisted reproductive technologies and/or fertility. Following further analysis, only studies that had human participants were included, and further to that, only those which focused on Muslim communities’ experiences of ART, community and patient beliefs and attitudes toward ART, or fertility sector professionals’ views surrounding access barriers for Muslim couples and communities. As much of the literature was analysis of the legal contexts surrounding ART in Muslim-majority countries, or the theological arguments for and against certain procedures, this left only a small number of studies relative to the initial search. Some studies also spoke of barriers unrelated to intracommunity religious and cultural issues (e.g., financial barriers to ART access, language barriers to ART access, racism in ART treatment). Though important, this is not the focus of this review.

A total of 2306 studies were extracted from the academic research databases Medline (Ovid), SCOPUS, and Web of Science, then uploaded into Covidence online screening tool. Of these, 212 were automatically removed and 20 were manually identified as duplicates and removed. This left a total of 2073 studies to be screened based on title and abstract. Of these, 1895 did not fit the inclusion criteria, leaving 178 for a full-text analysis. From this analysis, 26 articles were found to be relevant for this study (see Fig.  1 below). An additional study was found during the hand search, bringing the total number of included studies to 27. No additional gray literature studies were found. A list of articles and their details included in this study can be found in Appendix 1 .

Studies identified through search

Overview of Studies

There was a range of methodologies and foci of the studies that explored Muslim communities’ views on and experiences with ART. 10 studies were qualitative, utilizing data from interviews and/or focus group discussions with patients experiencing infertility (Batool & de Visser, 2016 ; Bokek-Cohen et al., 2022a , 2022b ; Gameiro et al., 2019 ; Husain & Imran, 2020 ; Martin-Anatias & Davies, 2023 ; Scully et al., 2017 ), both patients and medical practitioners (Behjati Ardakani et al., 2022 ; Bokek-Cohen et al., 2021 ; Murad et al., 2014 ), and in one study, patients, physicians, surrogates, egg donors, and religious leaders were interviewed (Hörbst, 2016 ).

7 studies were cross-sectional, focusing on quantitative data at one point in time (Ahmadi & Bamdad, 2017 ; Aslan et al., 2017 ; Bokek-Cohen & Tarabeih, 2022 ; Bokek-Cohen et al., 2022a , 2022b ; Iliyasu et al., 2013 ; Isikoglu et al., 2006 ; Salehi et al., 2015 ). Data for these studies were collected through surveys to assess the target cohorts’ views on and attitudes toward ART.

Another 7 studies were ethnographies (Blell, 2018 ; Clarke & Inhorn, 2011 ; Inhorn, 2004 , 2006a , 2006b , 2007 ; Monroe, 2022 ). In these studies, data were collected over long periods in the form of interviews with patients and practitioners, field notes, and observational methods to assess views on and experiences with accessing or providing ART.

Two studies (Igbolekwu et al., 2022 ; Lestari et al., 2022 ) used a mixed methods approach; Igbolekwu et al.’s ( 2022 ) research collected quantitative data through questionnaires with Muslim and Christians, and qualitative data through interviews with cultural/religious leaders to assess these communities’ views/knowledge on artificial insemination. Lestari et al.’s ( 2022 ) study also used questionnaires and interviews, though focused on students and faculty members of a university to measure beliefs and acceptability around the use of IVF.

The final article was a literature review (Reaves & Hauk, 2019 ). This review sought to collate findings related to Muslim migrant and refugee experiences of infertility in Middle Eastern countries. It included articles that focused on the use of ART among Muslim refugees, the impact of infertility on this cohort, and barriers to care.

The studies were based in a range of countries, though primarily Muslim-majority countries. Only 5 were based in Muslim-minority countries (Blell, 2018 ; Bokek-Cohen et al., 2022a , 2022b ; Gameiro et al., 2019 ; Martin-Anatias & Davies, 2023 ; Scully et al., 2017 ). Two were comparisons of experiences of ART or infertility in Muslim-majority and Muslim-minority countries, with one study based both in the UK and Pakistan (Batool & de Visser, 2016 ), and another based in Mali and Uganda (Hörbst, 2016 ). Further descriptions of the studies included in this research can be found in Appendix 1 .

Socio-cultural factors impacting patients’ views and acceptance of ART

There were many socio-cultural factors present within the studies that influenced use of and access to ART among the populations studied. The social pressure to have children was a consistent theme observed within many of the studies (Batool & de Visser, 2016 ; Blell, 2018 ; Bokek-Cohen et al., 2021 , 2022a , 2022b ; Gameiro et al., 2019 ; Martin-Anatias & Davies, 2023 ; Reaves & Hauck, 2019 ). These pressures left patients feeling stigmatized by their conditions (Batool & de Visser, 2016 ; Blell, 2018 ; Inhorn, 2004 ), and this social stigma presented as a barrier to accessing ARTs (Husain & Imran, 2020 ). For Muslim patients who did decide to access fertility treatments including ART, secrecy was sometimes adopted to maintain privacy, especially in contexts where patients were accessing treatments which were considered religiously impermissible by their respective communities (Bokek-Cohen et al., 2021 , 2022a , 2022b ; Inhorn, 2004 ; Reaves & Hauck, 2019 ).

The preference and desire for biological children was present across many of the articles included in this study (Behjati Ardakani et al., 2022 ; Clarke & Inhorn, 2011 ; Inhorn, 2006a ; Martin-Anatias & Davies, 2023 ). This preference presented as a barrier to accessing ART as it meant that some patients delayed or refused certain procedures, particularly the use of third-party gametes (Behjati Ardakani et al., 2022 ; Blell, 2018 ; Clarke & Inhorn, 2011 ; Inhorn, 2004 ). Yet some studies showed that parents who were hesitant to accept the use of donated gametes, nevertheless preferred non-biological children over no children (Behjati Ardakani et al., 2022 ; Martin-Anatias & Davies, 2023 ). Other studies, however, showed that couples often chose childlessness over violating religious prohibitions on donated gametes (Inhorn, 2006a , 2006b ).

Some studies also suggested that attitudes and barriers toward ARTs for infertile Muslim couples can differ depending on the country and location of treatment (Batool & de Visser, 2016 ; Inhorn, 2004 ). One study by Batool and de Visser ( 2016 ), for instance, compared Muslim women’s experiences of infertility in the United Kingdom and Pakistan. While there were some similarities in terms of participants’ desires for motherhood, women in Pakistan faced more societal and familiar pressure for children, though also had more religious reservations about IVF and the use of donated gametes (Batool & de Visser, 2016 ). Inhorn’s ( 2004 ) research compared men’s experiences of infertility in Cairo and Beirut. While in Cairo, men were generally more secretive regarding their infertility due to social stigma, in Beirut, infertility was more accepted as a medical problem (Inhorn, 2004 ). This meant that there were fewer social barriers to accessing ART in Lebanon than in Egypt (Inhorn, 2004 ). Another study (Inhorn, 2006b ) focused on experiences of accessing donor gametes in Iran and Lebanon, and highlighted a case study of a participant who had also received treatment in the United States. This participant spoke about the differences in attitudes toward egg donation in the US compared to Lebanon, and specifically that negative attitudes made it difficult to access the required treatment in the latter country (Inhorn, 2006b ).

Religious and legal barriers to treatment

The issue of legal and religious barriers to accessing or accepting ARTs was consistent across many of the studies included in this review (Batool & de Visser, 2016 ; Behjati Ardakani et al., 2022 ; Bokek-Cohen et al., 2021 , 2022a , 2022b ; Inhorn, 2006b ; Lestari et al., 2022 ). In several cases, due to the setting of the study, the religious and legal barriers were connected, as the legal system of certain countries were tied in with shari’a and fiqh (Behjati Ardakani et al., 2022 ; Bokek-Cohen et al., 2022a , 2022b ; Monroe, 2022 ).

Patients accessing treatments overcame these barriers through various means, though there remained differing views among participants across and even within studies surrounding which aspects of ART were religiously, legally, and even personally accepted. Studies showed that Muslim couples wished to conceive in a religiously permitted way (Martin-Anatias & Davies, 2023 ; Monroe, 2022 ; Murad et al., 2014 ), whatever that meant to them. Consistently, the most contentious aspect of ART was the use of third-party donated gametes (Aslan & Elter; 2017 ; Batool & de Visser, 2016 ; Behjati Ardakani et al., 2022 ; Hörbst, 2016 ; Inhorn, 2006a , 2006b ; Martin-Anatias & Davies, 2023 ). Husbands/men in particular displayed aversions toward the use of donated sperm (Behjati Ardakani et al., 2022 ; Hörbst, 2016 ; Inhorn, 2006b ), though this was a concern for women too (Batool & de Visser, 2016 ; Martin-Anatias & Davies, 2023 ). These aversions were connected to religious and legal permissibility of using donated gametes (Inhorn, 2004 , 2006b ) though in some cases, the rationale behind the disapproval or refusal of this service was unclear or unstated in the studies (Behjati Ardakani et al., 2022 ).

Another contentious religious issue with regards to ART was related to the collection of semen samples for IVF (Inhorn, 2007 ; Murad et al., 2014 ). One study by Inhorn ( 2007 ) looked at Lebanese and Egyptian Muslim men’s experiences providing semen samples, with specific focus on religious guilt and shame related to masturbation. Murad et al.’s ( 2014 ) study likewise showed that some patients accessing ARTs have questions surrounding the religious implications for engaging in masturbation to provide a semen sample. Although this was a theme that was absent from the rest of the studies included, it is important to highlight as Islam’s religious position on masturbation—that it is prohibited—presents a significant barrier to ARTs. In the case of Inhorn’s ( 2007 ) study, the experience of providing semen samples raised feelings of shame, sin, and impurity.

Across the studies, patients adopted different strategies to manage or overcome religious and legal barriers to accessing ARTs. Some studies even included examples of patients engaging in illegal or subversive activity to overcome legal prohibitions on certain procedures—for instance asking doctors to use donated sperm without the wife’s consent or knowledge (Behjati Ardakani et al., 2022 ; Inhorn, 2006a ), asking the doctor to use donated sperm without the husband’s knowledge (Bokek-Cohen et al., 2021 ), or accessing ‘underground’ markets of third-party donated gametes (Bokek-Cohen et al., ).

Many studies reported that patients access religious guidance and advice from clerics (Behjati Ardakani et al., 2022 ; Bokek-Cohen et al., 2021 , 2022a , 2022b ; Clarke & Inhorn, 2011 ; Martin-Anatias & Davies, 2023 ). Sometimes this guidance is accepted and influences couples’ acceptance of certain procedures (Clarke & Inhorn, 2011 ). In other cases, patients may change clerics until they can find someone who is willing to religiously endorse their preferred treatment (Behjati Ardakani et al., 2022 ; Martin-Anatias & Davies, 2023 ), or come to their own decision on the matter, contrary to the advice of their faith leaders (Bokek-Cohen et al., Inhorn, 2006b ; Martin-Anatias & Davies, 2023 ). On the other hand, one study by Hörbst ( 2016 ) demonstrated that some Muslim couples do not seek advice from religious clerics surrounding ART, and instead believe that questions related to the religious ethics of ART are a private negotiation with God.

Social and community attitudes surrounding ART

In the surrounding context of patients across the studies who were accessing ARTs were the perceptions of fertility treatments in their respective communities. Our review analyzed several studies that focused solely on community perceptions to demonstrate how Muslim communities, on a wider level, view and accept the use of ART and certain types of procedures that fall under ART. These community perceptions were important to understand as they inevitably impact choices decision-making surrounding ART within the societies in which the studies are performed.

The studies that focused on community perceptions of ARTs were performed in Iran (Ahmadi & Bamdad, 2017 ), Turkey (Aslan & Elter, 2017 ; Isikoglu et al., 2006 ), Israel (Bokek-Cohen & Tarabeih, 2022 ; Bokek-Cohen et al., 2022a , 2022b ), Nigeria (Igbolekwu et al., 2022 ; Iliyasu et al., 2013 ), and Indonesia (Lestari et al., 2022 ). While there were variations across these studies in terms of the levels of permissibility of certain ARTs, attitudes toward the use of donated eggs and sperm were consistently the most negative (Ahmadi & Bamdad, 2017 ; Aslan & Elter; 2017 ; Bokek-Cohen et al., 2022a , 2022b ; Bokek-Cohen & Tarabeih, 2022 ). It should also be mentioned that in studies where participants were asked about this factor, marriage was a clear condition of ARTs’ permissibility (Lestari et al., 2022 ).

Interestingly, in some studies where both men and women participated, the opposition to the use of donated materials was also gendered; women were less likely to disapprove of using donated eggs, embryos, or sperm than men (Ahmadi & Bamdad, 2017 ; Bokek-Cohen & Tarabeih ( 2022 ). However, in a separate study, the opposite was true—men displayed higher approval (Isikoglu et al., 2006 ), and in another still, results turned up no significant gender difference in levels of acceptance of different types of ART (Bokek-Cohen & Tarabeih, 2022 ). Among the cross-sectional studies focusing on levels of acceptance of ARTs in various populations (Ahmadi & Bamdad, 2017 ; Aslan & Elter; 2017 ; Bokek-Cohen et al., 2022a , 2022b ; Bokek-Cohen & Tarabeih, 2022 ; Iliyasu et al., 2013 ; Isikoglu et al., 2006 ), there were disparities in terms of the variables which correlated with higher or lower acceptance of ARTs. In Bokek-Cohen and Tarabeih’s ( 2022 ) study, for example, levels of religiosity were not associated with acceptance of any form of ART, while in Bokek-Cohen et al.'s, ( 2022a ) study, a higher level of religious observance was significantly (p < 0.01) associated with objection toward egg, embryo, and sperm donation. In Ahmadi and Bamdad’s ( 2017 ) study, the variations in levels of approval were not impacted by age, education, or marital status, but were significantly impacted by employment status (p < 0.05), and in Igbolekwu et al.’s ( 2022 ) study, Sunni Muslims were more likely to be accepting of artificial insemination than Shi’a Muslims. Evidently, correlative variables differed across the studies, and as no study investigated moderating factors, it is difficult to assess what the significant associations signify, where they did exist.

It is also worth noting that the populations included in each study differed. Ahmadi and Bambad’s ( 2017 ) study included male and female community members in Iran; Aslan and Elter’s ( 2017 ) study included fertile and infertile women in Turkey; Bokek-Cohen and Tarabeih’s ( 2022 ) study included married Sunni Muslims in Israel; Bokek-Cohen et al.’s ( 2022a , 2022b ) study included Sunni Muslim Palestinian physicians and medical students; Igbolekwu et al.’s ( 2022 ) study included Muslim and Christian community members and religious leaders in Nigeria; Iliyasu et al.’s ( 2013 ) study included married Muslim couples in Nigeria; Isikoglu et al.’s ( 2006 ) study included Muslim residents of two undisclosed cities in Turkey; and Lestari et al.’s ( 2022 ) study included university students in Indonesia.

Nature and quality of care

Several studies reported on patients’ experiences with relation to the quality of treatment, support from practitioners and professionals, and culturally competent care they had received (Blell, 2018 ; Gameiro et al., 2019 ; Scully et al., 2017 ). Other studies focused on practitioners’ perceptions of ARTs (Bokek-Cohen et al., ).

While experiences and quality of care differed widely across studies, the issues that arose were also connected to the location and population of the studies. For example, studies set in western contexts were more likely to focus on low levels of practitioner cultural, religious, and linguistic capacity, and structural barriers which impact patient experiences and quality of care (Blell, 2018 ; Gameiro et al., 2019 ; Martin-Anatias & Davies, 2023 ; Scully et al., 2017 ). In comparison, studies set in Muslim-majority countries highlighted issues such as costs of treatment, legal barriers, and differences of religious understanding between patients and practitioners (Husain & Imran, 2020 ; Inhorn, 2004 , 2006b ).

One study that focused on Pakistani Muslim men’s experiences accessing fertility treatment in the UK, for instance, found that staff from Muslim backgrounds were seen as having higher cultural knowledge when treating Pakistani patients (Blell, 2018 ). This was viewed as important as Pakistani men had high levels of disengagement from treatment, characterized by a refusal to provide semen samples and failure to attend appointments. In addition, language support was infrequently offered, leading to confusion and miscommunication surrounding what the various ART treatments involved (Blell, 2018 ). Similarly, Gameiro et al.’s ( 2019 ) study, set in Wales, showed that Muslim women receiving fertility treatments faced cultural, religious, and linguistic barriers which can intensify the already high levels of stress related to accessing treatment. Martin-Anatias and Davies’ ( 2023 ) study, set in New Zealand, highlighted practitioners’ insensitivity to patients’ religious beliefs surrounding which aspects of ART they would and would not accept as part of their treatment, and Scully et al.’s ( 2017 ) study, set in the UK, showed that Muslim patients felt that healthcare professionals were insensitive or disinterested in their religious considerations. Consistently across these studies based in western countries, many patients from Muslim backgrounds faced difficulties receiving culturally competent care from practitioners. Consequently, participants often felt compelled to do their own research and seek external advice from non-medical sources to inform their care choices.

It is also interesting to note the results from Bokek-Cohen et al.’s ( 2022a , 2022b ) study, which investigated Palestinian Sunni Muslims’ perceptions of ARTs. The results of this study suggested that among the cohort included, the vast majority of clinicians, regardless of training level, age, and religious observance, adopt positions on ARTs which are largely in line with Islamic rulings on the topic. That is; that donated gametes, and particularly donated sperm, is not permissible (Bokek-Cohen et al.,  2022a ). Although the results of this study cannot be extrapolated to Muslim clinicians in general, it does indicate that there are Muslim clinicians who have personal beliefs surround ARTs that may or may not impact the quality and nature of fertility care. This is supported by Monroe’s ( 2022 ) study, set in Qatar, which showed that although third-party donation was illegal in Qatar, physicians still told patients that these options existed elsewhere. Interestingly—and conversely to the above—there were also studies included in this review which demonstrated that some Sunni Muslim clinicians, despite the relatively consistent belief among Sunni clerics that third-part gamete donation is prohibited in Islam, perform IVF procedures with donated materials (Bokek-Cohen et al., 2021 , 2022a , 2022b ; Hörbst, 2016 ). Even in cases where the physicians themselves believe the procedures to be religiously prohibited, they may still inform patients of these treatment options to allow them to make their own informed decisions (Hörbst, 2016 ; Monroe, 2022 ).

However, accessing ARTs in Muslim-majority countries did not always guarantee a high level of religiously and culturally competent care. Inhorn’s ( 2007 ) study, which focused on Muslim men’s religious reservations related to providing semen samples via masturbation, highlighted how little clinics may be doing to assuage male patients of their reservations surrounding this necessary aspect of ART. In fact, Inhorn ( 2007 ) argues that clinics may be exacerbating men’s anxieties when privacy cannot be guaranteed, or when pornography is made available—the use of which compounds feelings of shame (Inhorn, 2007 ). Similarly, Murad et al.’s ( 2014 ) study, set in Malaysia, showed that both patients and clinicians have questions regarding what is and is not religiously permissible when it comes to receiving and providing ART. Consequently, patients have anxieties about accepting treatment that is not shari’ah compliant (Murad et al., 2014 ).

Gender, masculinity, and ARTs

Several studies explored how gender and masculinity could impact Muslim men and women’s experiences of ART treatments (Batool & de Visser, 2016 ; Blell, 2018 ; Bokek-Cohen et al., 2021 ; Inhorn, 2004 ).

Although infertility was often a shared issue between the couples, women were seen to be driving the active pursuit of fertility treatments and ART, with men sometimes taking a more passive role in treatment (Batool & de Visser, 2016 ). This often led to frustration from women, particularly when couples were experiencing male-factor infertility. Men’s more resistant or avoidance responses was indicative of the cultural perception that infertility is a woman’s issue, and several studies did mention the disproportionate blame that is often placed on women in cases of infertility (Batool & de Visser, 2016 ; Blell, 2018 ; Gameiro et al., 2019 ; Lestari et al., 2022 ; Reaves & Hauck, 2019 ).

Going further, in some studies, the belief that infertility was a woman’s issue led to male patients refusing to engage in necessary treatments (Blell, 2018 ; Inhorn, 2007 ). Cultural expectations, feelings of shame and stigma around infertility, and being unwilling to engage in necessary aspects of treatment (such as the provision of a semen sample for IVF) intersected with men’s views of their own masculinity (Blell, 2018 ; Inhorn, 2007 ). Some men reported feeling shame, inferiority, and threats to masculinity as a result of their infertility (Bokek-Cohen et al., 2021 ; Inhorn, 2004 ; Reaves & Hauck, 2019 ). And while these feelings caused some men to withdraw from accessing ARTs (Blell, 2018 ) in other cases, the stress and pressure of being unable to conceive led some men to access aspects of ART treatments that were religiously prohibited in their communities (Bokek-Cohen et al., 2021 ; Inhorn, 2007 ).

Family and procreation are of central importance both culturally and religiously in Muslim communities. This can mean that when infertility is experienced by couples, there are added pressures to find effective treatment, such as ART. Considering Muslim communities’ specific cultural, religious, and personal positions when it comes to accessing infertility treatments, this research sought to identify what barriers impact Muslim individuals and couples’ access to equitable ART treatments, as evidenced in the international literature. We aimed to focus primarily, though not exclusively on three areas: religious belief and interpretation; community and familial norms; and cultural/religious capacity of service providers.

Our results showed that Muslim communities face several primary barriers and considerations when accessing ART. Foremost, the cultural pressure to have children often drives couples to seek out treatment in the first instance. Yet this cultural pressure also impacts the type of ART that patients are open to accepting.

Community perceptions regarding certain types of ART—driven by underlying religious beliefs and teachings—render treatment options including third-party donation undesirable for many patients (Behjati Ardakani et al., 2022 ; Batool & de Visser, 2016 ; Aslan & Elter; 2017 ; Hörbst, 2016 ; Inhorn, 2006a , 2006b ; Martin-Anatias & Davies, 2023 ). Overall, couples highly valued religious prescriptions on ART, and wished to conceive in what they considered a ‘religiously permitted’ way (Martin-Anatias & Davies, 2023 ; Monroe, 2022 ; Murad et al., 2014 ). At the same time, several studies also showed that there are couples who, despite religious teachings that prohibit certain types of ARTs, choose to come to their own decision surrounding the acceptability of treatments (Bokek-Cohen et al., 2021 , 2022a , 2022b ; Inhorn, 2006b ; Martin-Anatias & Davies, 2023 ). This demonstrates that establishment positions on ART—which existing research shows often prohibit the use of third-party donations and especially or specifically donated sperm (Khan & Konje, 2018 ; Serour, 2013 )—do not always align with how patients behave in practice. While religious teachings remain a barrier to patients, especially where they are unable to access certain types of treatments due to religiously based legal prohibitions (Behjati Ardakani et al., 2022 ; Monroe, 2022 ), they do not necessarily mean that all couples will follow the religious guidance they receive.

In the context surrounding patients’ access to and acceptance of ARTs were the community perceptions of these treatment options. Our results showed that consistently across the countries included in the cross-sectional studies of community attitudes toward ARTs, the use of donated eggs and sperm were viewed as the most negative (Ahmadi & Bamdad, 2017 ; Aslan & Elter; 2017 ; Bokek-Cohen & Tarabeih, 2022 ; Bokek-Cohen et al., 2022a , 2022b ). With this context in mind, it becomes clearer why patients often adopt secrecy when going through treatment (Bokek-Cohen et al., 2021 , 2022a , 2022b ; Inhorn, 2004 ; Reaves & Hauck, 2019 ). The fear and shame of judgment both for the initial infertility as well as for the use of “impermissible” treatment options is likely to impact patients’ mental health and wellbeing throughout their infertility journey. Research shows that experiencing infertility and having to go through treatment can have many negative mental health implications, some of which can continue well after treatment has discontinued (Gameiro et al., 2016 ). At the same time, social support has been shown to be a protective factor for mental health outcomes among numerous populations across the globe, and can also influence health behaviors such as continuation with treatments (Umberson & Montez, 2010 ). Perceiving adequate support from social networks during IVF specifically is correlated with more positive mental health outcomes during treatment (Gameiro et al., 2016 ). There is therefore a potential for increased risk of negative mental health and wellbeing among couples who feel compelled to maintain secrecy, and who fear judgment surrounding disclosure of the diagnosis as well as the treatment received.

When looking at the quality-of-care Muslim couples receive when accessing ART, the results across studies showed a variety of experiences. Looking comparatively between studies set in Muslim-minority (namely western) and Muslim-majority contexts, results demonstrated that the primary barriers for Muslim patients in the former contexts were low levels of practitioner cultural, religious, and linguistic capacity, and structural barriers which impact patient experiences and quality of care (Blell, 2018 ; Gameiro et al., 2019 ; Martin-Anatias & Davies, 2023 ; Scully et al., 2017 ). In the latter, barriers included costs of treatment, legal barriers, and differences of religious understanding between patients and practitioners (Husain & Imran, 2020 ; Inhorn, 2004 , 2006b ).

Interestingly, though not the most central theme across studies, gendered aspects of care were highlighted both explicitly and implicitly in the research analyzed. While women often felt the most pressure and blame for the infertility (Batool & de Visser, 2016 ; Blell, 2018 ; Gameiro et al., 2019 ; Lestari et al., 2022 ; Reaves & Hauck, 2019 ), men were likewise navigating gendered pressures and expectations. Some men reported feeling shame, inferiority, and threats to masculinity due to their infertility (Bokek-Cohen et al., 2021 ; Inhorn, 2004 ; Reaves & Hauck, 2019 ). Men’s fears surrounding their masculinity resulted in various responses; some men became avoidant, refusing to engage in necessary treatments (Blell, 2018 ; Inhorn, 2007 ), while others moved to accept certain types of treatment they would otherwise have rejected (Bokek-Cohen et al., 2021 ; Inhorn, 2007 ). While issues of masculinity can certainly damage ART prospects and options, they may also be a motivating factor.

It was particularly notable when analyzing the studies included in this review that the vast majority of the research was conducted in Muslim-majority countries, or countries with large Muslim minorities. There is only a small amount of literature that focuses on how Muslim communities in the west experience infertility and the barriers to accessing ARTs. This gap in the literature is important to highlight, as Muslim communities in the west—and especially migrant and refugee Muslims—face many compounding issues which are likely to negatively impact their access to appropriate fertility treatments. For example, in Australia, where the authors of this research are based, Muslim communities are overrepresented in lower-income categories and significantly underrepresented in higher income categories (Hassan, 2018 ), may experience racism and Islamophobia in the healthcare setting (Ben et al., 2023 ), and often face language barriers and a lack of quality interpretative support when accessing Australian systems and services (Casimiro et al., 2007 ; Henderson & Kendall, 2011 ). On top of this, migrant or refugee Muslims may be on visa sub-classes which prohibit their access to Australia’s subsidized or free healthcare (Ziersche et al., 2020 ). These are all issues which have the potential to drastically impact Muslim communities’ access to ART. Further, it is likely that in the west, Muslim patients will experience the same levels of religious trepidation and questions with relation to their ART treatment options as in Muslim-majority countries, though will be doing so without the support of a practitioner who has knowledge and understanding of these issues and considerations. At the same time, it may be the case that other barriers are minimized in western contexts. Without increased research into Muslim communities’ experiences of accessing ART in the west, it is difficult to know definitively.

These findings have implications for policy and practice among healthcare practitioners offering ART treatment options to Muslim patients. Firstly, Muslim patients accessing ART place a high value on the religious contexts surrounding their care. The provision of culturally and religiously appropriate care for Muslim patients—whether in the Muslim-majority or Muslim-minority context—is therefore paramount. Research demonstrates that improved health and social care outcomes can be achieved for Muslim patients when health interventions are religiously tailored to their personal needs, and when notions of health are extended to include cultural and spiritual domains important to the patient (McLaren et al., 2022 ). It is therefore integral that practitioners are mindful of this context, and that they support their patients in a culturally—and religiously—safe manner to come to their own conclusions regarding their acceptance of treatment options. At the same time, where options have been exhausted, it should be ensured that patients have been provided with adequate mental health support.

Limitations

There are some limitations to this study that should be addressed. Firstly, it is important to highlight that although this review has primarily included studies based in countries where English is not the primary language, we have only included research published in English. There is therefore likely to be several studies conducted in languages other than English that are not analyzed here, but which have findings relevant to the research question. Furthermore, due to the diverse views and beliefs with regards to Islam and ART, there is a wide range of heterogeneity of the research included in this study. We therefore advise caution when attempting to generalize results to a specific target population.

This review makes an important contribution toward understanding the nuances, barriers, and struggles of infertile Muslim couples and their reproductive choices regarding ARTs. Despite moral and religious challenges, many Muslims around the world seek to find ways to achieve their desire of having children. Children are viewed as a religious investment and hold great importance in all cultures that have embraced Islam. Consequently, the mechanisms and means that allow Muslim couples and individuals to realize this goal should be analyzed and understood to facilitate the best possible care and treatment options for Muslim patients. Our review collates and analyzes the research to encourage its use within policy and practice in healthcare settings. Further research, based in western countries, should be conducted to better understand how these contexts can support Muslim patients accessing ART.

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KH conceived of the idea for the study, and both authors refined the concept. KH performed the literature search. Both authors screened studies, performed data extraction and analysis, and drafted the manuscript. Both authors provided comments and edits, revised the manuscript, and approved the final copy for submission.

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Hammond, K., Hamidi, N. Exploring Muslim Communities’ Experiences and Barriers While Accessing Assisted Reproductive Technologies: A Scoping Review of International Literature. J Relig Health (2024). https://doi.org/10.1007/s10943-024-02056-x

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