literature review on gender inequalities

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Research Article

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

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

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

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

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

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

* E-mail: [email protected]

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

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

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

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

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

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

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

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

Editor: Elisa Ughetto, Politecnico di Torino, ITALY

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

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

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

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

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

Introduction

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

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

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

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

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

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

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

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

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

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

Data collection

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

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

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

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

Text processing and keyword extraction

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

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

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

Classification of research topics

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

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

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

Evaluation of semantic importance

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

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

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

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

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

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

Overview of main topics

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

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

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

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

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

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

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

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

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

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

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

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

Compensation.

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

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

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

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

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

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

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

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

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

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

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

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

Decision-making.

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

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

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

Career progression.

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

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

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

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

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

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

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

Performance.

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

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

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

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

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

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

Organization.

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

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

Human capital.

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

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

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

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

Emerging topics: Leadership and entrepreneurship

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

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

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

Research gaps and conclusions

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

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

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

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

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

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

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

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

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

Supporting information

S1 text. keywords used for paper selection..

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

Acknowledgments

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

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• Published: 22 September 2020

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

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

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

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Introduction

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

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

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

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

Material and methods

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

Search strategy

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

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

Study selection

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

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

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

Data extraction and synthesis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conclusions

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

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

Implications for practice and/or policy

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

Availability of data and materials

All available data is included in the publication.

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Acknowledgements

The authors thank Jonathan Whitehead and Jessica Gorlin for language editing.

This study was supported by CIBER in Epidemiology and Public Health. Funder had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

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

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20 Literature Review: Gender Relations and Expectations for Men and Women

Gender remains one of the most influential social constructs as it permeates individual behavior and societal norms. From childhood to adolescence and adulthood, gender defines the expectations and roles of men and women. Sifting through various sociological studies and concepts, it becomes apparent that existing inequalities dominate gender dynamics. This section will focus on synthesizing different academic studies to provide contextual information on themes and concepts relevant to gender imbalances between men and women.

Interestingly, men and women are encouraged to inhibit traits and values that are considered either feminine or masculine. In a study on the stigma of sexual promiscuity amongst teenage girls, Orenstein observed that young boys demonstrate an affinity towards technology and sports, whereas girls are attracted to make-up and clothing (116). Subjects relating to STEM are typically seen as boyish interests, while fashion and make-up are considered girly. Noticeably, in a study on the gendering of behaviors within preschool, teachers were more likely to scrutinize the girls’ clothing, which made them more conscientious of their bodily adornments and physical appearance (Martin 499). In the same study, 61% of girls wore pink every day, while boys tended to wear majorly primary colors, which shows that even arbitrary concepts like colors can become gendered (Martin 498). Conceptions of masculine behaviors and feminine behaviors carry on until adulthood and parenting. For example, when evaluating the role of gender in South Korean parenting, Park noted that fathers practice “public fathering” in the form of resource accumulation and networking, while mothers practiced “private mothering” by providing emotional support for their children (580). Such gender imbalances amongst parenting provide models that reinforce emotional intelligence as being feminine and career success as masculine. These examples and studies demonstrate how everyday activities and traits can become gendered through the influence of personal milieus.

Within gendered behaviors, those associated with femininity tend to require passivity and sensitivity, and those associated with masculinity are aggressive and assertive. A study found that activities among boys consisted of playing with blocks and pretending to be superheroes (all active activities), while girls crafted and played dolls (activities that required minimal body movement) (Martin 502). In another example, girls were more likely to be reprimanded for hyperactivity and loudness, which served to condition them towards a passive nature (Martin 504). On the other hand, boys and men are socialized to value physical strength and competition. While focusing on the correlation between masculinity and athleticism, Messner observed that public recognition concerning athletic skill served to reaffirm masculinity by increasing self-esteem (82). Sports provide a “competitive hierarchical environment” that men are encouraged to pursue, but which forces them to abandon their vulnerability to fit in with an archetypal macho man (Coontz 15). Besides male competitiveness, there exists a dynamic where men are believed to dominate women. Messner’s study showed that sports became the embodiment of masculinity as “men’s power over women becomes naturalized and linked to the social distribution of violence ” (79). In other words, sports affirm notions of dominance over women by portraying the male form as violent and powerful. Adding on, in fraternities, men are “initiators of sex,” while women are “passive partners” or “active resistors,” which illustrates the notion that men can conquer women as sexual exploits (Boswell and Spade 134). Furthermore, men contextualize sexual endeavors with women as “sexual conquests,” which perpetuates the association of a dominant man and a submissive woman (Boswell and Spade 138).

Studies also suggest that an element of gender dynamics consists of women being objects of desire for men. Studying the propagation of rape culture in fraternities, Boswell and Spade noticed that men defined hooking-up as a means of “getting as much sexual, physical pleasure” without any commitment, which equivocates women to objects of pleasure (139). Additionally, women involved in hook-ups are perceived as “faceless victims,” as men do not extend courtesy or respect towards them (Boswell and Spade 138). In her study on the role of women in providing narrative pleasure to men, Mulvey terms the “male gaze” to encapsulate the idea that in media, women are portrayed as a projection of the male fantasy (62). This type of gender relation is also further encouraged by the accentuation of physical appearance on women. Interest in make-up and clothing demonstrates that women seek desirability, therefore creating a system where their self-worth is dependent on their ability to be desired by men (Orenstein 116). Men are never held to the same standard as they can express their self-worth through technology and sports (Orenstein 116; Messner 75). All of this helps to create a system where women are encouraged and expected to be desirable for men, but the same is not necessarily reciprocated.

By fostering a society where behaviors and interests are gendered, inequalities will inevitably form. Currently, the patriarchal structure influences and controls the inequalities experienced by men and women. Conveying male dominance and female subserviency, women are viewed as objects of desire, and men are viewed as pillars of strength. Such beliefs help to create a system that facilitates the objectification of women and men.

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Gender Inequalities in the Military Service: A Systematic Literature Review

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This paper provides an in-depth analysis of the literature regarding gender inequalities in the military service. In doing so, it discloses challenges and opportunities for women’s integration and finds new avenues for future research. Recent scientific research has evidenced that women still represent a growing minority in most Western militaries. Women’s integration deserves equal opportunities across all branches and levels of responsibility in the military, however, their expansion to ground combat roles is still a challenge to the military and policy-makers. Scholars have also reported about the decision to increase the number of women in combat roles, as it may potentiate adverse experiences, due to closer proximity to men in circumstances with little or no privacy. Conversely, scientific research has shown that more egalitarian women reported significantly less sexual harassment victimization. Furthermore, our insights suggest that it might be fruitful to integrate women in ground combat roles as special forces’ operators, with a view to induce a reduction of marginalization and sexual harassment, by gaining respect in a male-dominant culture. The presented idea should be interpreted with caution and needs to be supported by empirical research; although we are convinced that future research will be revealing and might represent a game-changing situation to women inequalities in the armed forces.

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Acknowledgements

This project is under the sponsorship of Erasmus+ program. We would like to thank the European Commission for their support.

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Gender Inequality at Work: A Literature Review

• September 28, 2019
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• Categories: IJRISS, Social Science

International Journal of Research and Innovation in Social Science (IJRISS) | Volume III, Issue IX, September 2019 | ISSN 2454–6186

Dr Hemamalie Gunatilaka Department of Business Administration, University of Sri Jayewardenepura, Sri Lanka

Abstract: – Gender inequality at work is the focus of this article. Accordingly, it attempts to highlight the conceptual frameworks on gender inequality at work and present the practical applicability of these theories with the use of garment industry in Sri Lanka as an example. Women in the garment industry in Sri Lanka account for three fourth of the workforce in the industry and patriarchy plays a vital role within the social structure of the country. Buddhist philosophy highlights that a person becomes who s/he is with what s/he does, but not with what s/he has or who s/he is in the society. In contrast, Sri Lanka being a Buddhist country people’s position is still determined by who they are. Capitalist patriarchy, gender regimes, gendered organisations, creating subjectivities and resistance and agency are used as the conceptual frameworks to understand gender inequality at work. The literature on Sri Lankan women in the garment industry produce important evidence regarding women’s subordination, identities, agency, resistance etc. Most significantly patriarchy plays a vital role in creating gender subordination and government intervention facilitate the subordination of women employed in garment factories in Sri Lanka.

Key Words:- Gender Inequality, Garment Industry, Subordination of women, Patriarchy

I. INTRODUCTION

The main focus of the article is to present the conceptual frameworks found in literature in relation to gender inequality at work and to relate the theories to practice by using Sri Lankan garment industry as an example. Thus the broader frameworks on gender inequality will be discussed first. This will be followed by literature relating to the experiences of gender inequality by the employees in the Sri Lankan garment industry to highlight the applicability of the theories in a practical context. The garment industry is selected as a case study because: women employees’ account for 73% of the workforce in the garment industry (Savchenko and Acevedo, 2012); second, to understand the degree of subordination experienced by women and their awareness of being subordinated.

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• Published: 10 May 2024

Happiness amidst the COVID-19 pandemic in Indonesia: exploring gender, residence type, and pandemic severity

• Indera Ratna Irawati Pattinasarany   ORCID: orcid.org/0009-0008-1529-2751 1  

Humanities and Social Sciences Communications volume  11 , Article number:  609 ( 2024 ) Cite this article

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This study delves into the dynamics shaping happiness levels in Indonesia before and during the COVID-19 pandemic, specifically emphasizing gender and residence-type disparities. Using data from the 2017 and 2021 Happiness Level Measurement Survey, it offers insights into how different population segments were affected. The analysis employs a multilevel mixed-effects ordered logistic model, considering individuals nested within provinces, and measures pandemic severity using positive COVID-19 cases per 100,000 residents. This study evaluates pandemic-related happiness shifts using nationwide cross-sectional survey data from two timeframes. It derives substantial statistical strength from data involving 137,000+ respondents gathered through comprehensive face-to-face interviews. It mitigates recall bias by capturing happiness at two distinct time points, avoiding retrospective measures. The study examines and validates four research questions. First, higher COVID-19 cases in provinces correlate with lower happiness. Second, though women were happier than men, the pandemic reduced this gender-based gap. Third, urban residents were generally happier than rural residents, but the pandemic narrowed this difference. All the estimates exhibit statistical significance at the 1 percent level. Finally, while provincial poverty showed minimal happiness impact, a negative association between unequal per capita expenditure and happiness emerged, providing partial backing for investigating the role of macroeconomic conditions. This study reveals that the COVID-19 pandemic altered happiness dynamics in Indonesia, narrowing gender and residence-based gaps. It also emphasizes the role of socioeconomic factors, particularly unequal per capita expenditure, in influencing individual happiness, highlighting implications for targeted policy interventions.

Introduction

Studying factors influencing our happiness has been a persistent and important topic of investigation over the years. Happiness holds significant implications for our lives, serving not only as a personal aspiration but also as a societal objective (Petrovič et al. 2021 ; Veenhoven 2012 ). Scholars and policymakers have been paying growing attention to subjective well-being (SWB) measures in recent decades. These measures have been sought as alternative ways to gauge economic and social progress, addressing concerns with traditional welfare indicators (Ahmadiani et al. 2022 ; Deaton and Stone 2013 ; Delhey and Kroll 2013 ). Notably, Oishi and Diener’s ( 2014 ) study revealed that self-reported happiness and life satisfaction could effectively reflect objective societal and economic conditions, quantify individuals’ hardships, and evaluate the effectiveness of specific public policies.

The impact of COVID-19 on SWB presents various perspectives. Firstly, a global decline in SWB is evident across studies, including those in China (Yang and Ma, 2020 ), Germany (Bittmann, 2022a ; Möhring et al. 2021 ), and a multi-country study encompassing China, Japan, South Korea, Italy, the United Kingdom, and the United States (Nguyen 2021 ). Secondly, the World Happiness Report (WHR) 2021 indicates a non-significant increase in global life evaluation indicators from 2017–2019 to 2020 (Helliwell et al. 2021 ), similarly reflected in Rajkumar’s ( 2023 ) research across 78 countries. Thirdly, French researchers discovered improved self-reported health and well-being during lockdown compared to previous years (Recchi et al. 2020 ). These diverse outcomes underscore the complex link between the pandemic and individuals’ SWB, arising from individual and household differences, contextual factors, and varying COVID-19 severity across regions.

As the world’s fourth most populous nation, Indonesia has confronted profound repercussions from the pandemic, ranking 20th worldwide in total reported COVID-19 cases and 11th in COVID-19-related fatalities (Worldometer 2023 ). Moreover, the variability in COVID-19 exposure across provinces and the distinction between urban and rural areas within Indonesia is noteworthy. Footnote 1 In light of these circumstances, it becomes essential to undertake an exhaustive study of how the pandemic’s severity has uniquely influenced the happiness of Indonesians.

This study aims to empirically examine the factors influencing shifts in happiness levels before and during the COVID-19 pandemic in Indonesian society. Given the indications from prior research that the pandemic affects women (Dang and Nguyen 2020 ; Fortier 2020 ; Gausman and Langer 2020 ; Giurge et al. 2021 ) and urban dwellers (López-Ruiz et al. 2021 ; Shams and Kadow 2022 ) disproportionately compared to other their respected counterparts, our investigation will primarily focus on comprehending the distinct contributions of gender and residency to the observed changes in happiness levels. By exploring how being male or female and where people live affect changes in happiness during the pandemic, we can better understand the different experiences and difficulties faced by different population segments. Significantly, this study stands as a pioneering effort to investigate the changes in happiness levels stemming from the COVID-19 pandemic among the broader populace of Indonesia.

This study addresses several limitations of existing literature on changes in happiness during the COVID-19 pandemic. Many of these previous investigations have not effectively addressed the following limitations: concentration on specific population segments (e.g., healthcare workers, students), employment of single-point-in-time data collection, dependence on convenience sampling for participant recruitment, administration of online surveys, limited observation durations, and reliance on participants’ retrospective reports of pre-pandemic circumstances.

We overcome these limitations because we use national-level cross-sectional survey data for two different points in time. First, our survey data covers the period before and during the pandemic, enabling us to examine changes in self-reported happiness levels associated with the pandemic’s impact. Using survey data from over 137,000 respondents provides this study with robust statistical power, enhancing the precision of our analysis of happiness level changes over time. Second, our survey data was collected through face-to-face interviews, employing a rigorous sampling method. This approach ensures a more representative sample distribution, avoiding biases from self-selection in online surveys (Andrade 2020 ).

Third, our study evaluates happiness at multiple time points. This method acts as a temporal anchor, assisting respondents in recalling and distinguishing their experiences more accurately. Given that respondents often generalize or simplify their experiences when recalling over an extended timeframe, evaluating happiness at different times enables a comprehensive capture of fluctuations and variations in individuals’ emotional states. In this study, assessing happiness at two distinct time points, before and during the COVID-19 pandemic, guarantees a more accurate portrayal of an individual’s SWB and alleviates recall bias (Hyman 2013 ; Tadic et al. 2014 ).

This study consists of six sections. In Section 2, we offer a summary of pertinent prior studies, followed by an investigation into the research questions posed in this study. Section 3 explains the methodologies and models used and outlines the data sources. Section 4 examines and analyzes the outcomes from the estimations, while Section 5 discusses the results. Finally, Section 6 summarizes the findings and offers policy recommendations based on the results.

Literature review and research questions

Theoretical background.

The reactivity theory , embraced by social scientists, including economists and sociologists, asserts that SWB, particularly happiness, is influenced by objective external conditions at both the individual and social levels (Lee 2022 ). These objective conditions encompass various factors such as income, age, gender, marital status, occupation, family structure, geographic region, and government policies (Diener 1984 ). According to the reactivity theory, individuals’ perceptions and assessments of their happiness primarily stem from their passive responses to these objective conditions. In simpler terms, individuals tend to react to the circumstances and external factors surrounding them, significantly impacting their SWB. Within the framework of our study, positive events like economic improvements or technological advancements consistently raise happiness levels. In contrast, adverse events such as natural disasters (Calvo et al. 2015 ; Rehdanz et al. 2015 ; Sekulova and van den Bergh 2016 ) or the COVID-19 pandemic tend to decrease happiness.

The impact of the COVID-19 pandemic on happiness in Indonesia

Before the pandemic, numerous studies in Indonesia explored factors influencing happiness across various scopes. These studies encompassed general population happiness levels (Aryogi and Wulansari 2016 ; Landiyanto et al. 2011 ; Sohn 2013 ; Sujarwoto et al. 2017 ) and specific demographic segments (Anna et al. 2019 on fishermen; Sollis et al. 2023 on native-immigrant). Regional studies (Firmansyah et al. 2017 ; Nandini and Afiatno 2020 ) shed light on context-specific happiness factors. Specific topics like religiosity (Kurniawati and Pierewan 2020 ), height (Sohn 2014 ), decentralization (Sujarwoto and Tampubolon 2015 ), and income inequality (Furwanti et al. 2021 ) were examined, providing valuable insights. Furthermore, Pattinasarany ( 2018 ) conducted a cross-national analysis exploring happiness and life satisfaction determinants in Indonesia, Thailand, Japan, and South Korea.

In both pre-pandemic and pandemic contexts in Indonesia, the World Happiness Report (WHR) and the Happiness Index are commonly used measures of happiness. Footnote 2 However, these two references provide contradictory information regarding the impact of the COVID-19 pandemic on the happiness levels of individuals in Indonesia. The WHR indicates a decrease in the happiness level of Indonesian people from 5.345 from 2018 to 2020 to 5.240 from 2019 to 2021 (Helliwell et al. 2020 ; 2021 ; 2022 ). In contrast, the Happiness Index shows an increase from 70.69 in 2017 to 71.49 in 2021 (Badan Pusat Statistik 2021a ).

Multiple studies have explored the effects of the pandemic on SWB in Indonesia. Tjahjana et al. ( 2021 ) conducted an online survey a month after the pandemic, indicating that 41% of respondents reported decreased happiness. Rahmanita et al. ( 2021 ) collected data 1–3 months post-pandemic, revealing that 59% of respondents expressed happiness in staying at home. Iskandarsyah et al. ( 2022 ) explored the effects of COVID-19 information and behaviors on anxiety and happiness a month post-outbreak, noting increased information searches linked to higher anxiety but more testing and treatment information tied to less anxiety and greater happiness. Dwidienawati et al. ( 2021 ) found ongoing pandemic adaptation challenges, with no improvement in happiness or life satisfaction reported after a year. Halimatussadiah et al. ( 2021 ) conducted two cross-sectional online surveys in 2020 and 2021, revealing a trend towards heightened happiness. In a separate study, Borualogo and Casas ( 2022 ) collected data during the same period, discovering higher SWB and positive affect among boys during the pandemic and improved satisfaction in friend interactions.

The following are overviews of studies using general population survey data to understand the pandemic’s impact on SWB in Indonesia’s neighboring countries. Tambyah et al. ( 2023 ) found a significant decrease in life satisfaction among Singaporeans, dropping from 4.51 in 2016 to 4.18 in 2022 on a scale of 1–6. The study highlighted health risks and job security as primary concerns during the COVID-19 pandemic. Phulkerd et al. ( 2023 ) reported that Thai adults had an average life satisfaction score of 22.4 during the 2021 COVID-19 epidemic, down from 25.5 before the pandemic in 2019 on a 5–35-point scale.

Research questions

This study investigates four specific research questions (RQs) to elucidate and support the study objectives within the broader context of the Indonesian population. Limited research has explored the impact of COVID-19 severity on self-reported happiness at subnational levels due to a lack of reliable data. However, some exception studies exist (Bittmann 2022a ; Le and Nguyen 2021 ). In Indonesia, the impact of the pandemic varies across provinces and districts, each of which implemented unique policies to curb the spread of the pandemic and cope with its consequences (Arifin et al. 2022 ). This study examines a connection between the severity of COVID-19 and self-reported happiness, anticipating that increased severity will correspond to decreased reported happiness.

RQ1: To what extent does the severity of COVID-19 contribute to a reduction in individuals’ happiness levels?

Global research suggests women typically report higher life evaluations than men (Blanchflower and Bryson 2022 ; Blanchflower and Oswald 2011 ; Fortin et al. 2015 ). However, women worldwide bear a disproportionate burden of socio-economic challenges during crises like natural disasters, economic downturns, and pandemics. Such inequity stems from gender roles and undervaluation of women’s work, leading to increased caregiving responsibilities and exposing women to short-term economic instability and long-term welfare declines (Dinella et al. 2023 ; Fortier 2020 ; Langer et al. 2015 ). This study investigates whether the severity of COVID-19 has narrowed the gap in self-reported happiness between women and men.

RQ2: To what extent does the severity of the COVID-19 pandemic lessen women’s happiness advantage over men?

International evidence indicates that, at low levels of economic development, substantial gaps favor urban over rural areas in income, education, and occupational structure, resulting in higher SWB for urban residents than for rural residents. Such higher life satisfaction holds despite urban challenges like pollution and congestion. However, these economic disparities diminish as development progresses, enabling rural areas to close the gap and even surpass urban life satisfaction (Burger et al. 2020 ; Easterlin et al. 2011 ). In Indonesia, Sohn ( 2013 ) identified a positive association between living in urban areas and happiness. Additionally, Sujarwoto ( 2021 ) observed that individuals residing in rural settings expressed lower life satisfaction than their urban counterparts. Given the COVID-19 pandemic’s disproportionate impact on urban areas compared to rural regions, an intriguing query arises: How did the severity of the pandemic influence the link between urban living and self-reported happiness?

RQ3: To what extent does the severity of the COVID-19 pandemic diminish the happiness advantage of urban residents compared to rural residents?

Incorporating contextual variables in measuring self-reported happiness in a multilevel framework is crucial for more accurate analyses and informed policymaking (Ballas and Tranmer 2012 ; Gómez-Balcácer et al. 2023 ). Analytically, incorporating contextual variables like macroeconomic and socio-economic conditions enhances research depth and accuracy. From a policy standpoint, this approach provides a robust foundation for informed decision-making, resulting in more effective and targeted policies. This study utilizes three provincial-level contextual variables: COVID-19 severity (as discussed in RQ1), poverty incidence, and income inequality.

RQ4: To what extent do provincial macroeconomic conditions, specifically poverty and income inequality, impact individuals’ happiness levels?

These research questions delve into diverse facets of the pandemic’s influence on happiness levels within Indonesian society. They examine consequences such as health risks, economic disruptions, and social isolation (RQ1). Furthermore, they investigate the role of societal norms, gender roles, and structural inequalities in women’s experiences during the pandemic (RQ2) and assess potential challenges in urban areas (RQ3). Finally, the study evaluates the impact of macroeconomic factors, specifically poverty and income disparities, on happiness levels during the pandemic (RQ4).

Materials and methods

Multilevel mixed-effects ordered logistic model.

In this study, we estimate a multilevel mixed-effects ordered logistic model that incorporates nesting while considering the dependent variables’ categorical nature and providing adjusted standard errors that add precision to the coefficients (Rabe-Hesketh and Skrondal 2022 ). By using multilevel models, we can control for individual and province variables, isolating the impact of pandemic severity on self-reported happiness levels (Mehmetoglu and Jakobsen 2017 ; Snijders and Bosker 2012 ). Observations in our study comprise individuals (level 1) nested within provinces (level 2). Our multilevel regressions are computed with random intercepts for each province to account for the fact that provinces are affected differently by the pandemic and that respondents in one province might be more similar than respondents in another. Finally, we used an ordered logistic model due to the ordered nature of the dependent variable.

We postulate a latent variable (y*) representing an individual’s underlying happiness. In this study, we will estimate two models: the ‘main’ (hereafter: Main Model) and the ‘with interaction terms’ (hereafter: Interaction Model) models. The Main Model’s latent variable is associated with individual traits, household attributes, and provincial-level contextual variables. Individual traits encompass gender, age along with its squared term, marital status, highest education level attained, and employment status. Household-level attributes include residence type and household income. Three contextual variables at the provincial level consist of the poverty rate, income inequality, and the count of COVID-19-infected individuals per 100,000 population, reflecting COVID-19 severity. In contrast, the Interaction Model encompasses the Main Model and incorporates additional interaction variables between gender and residence-type covariates with the severity of the pandemic measure. Footnote 3 We assume that individuals residing in provinces hardest hit by the pandemic will experience a more significant decline in happiness than those in the less affected provinces.

The Main Model is specified as follows:

while the Interaction Model is specified as follows:

where: \({y}_{{ij}}^{* }\) is the unobserved happiness for individual i who resides in province j (latent variable); \({x1}_{{ij}}\) is the individual and household characteristics for individual i living in province j; \({x2}_{j}\) is the provincial contextual variables for province j; \({{COVID}}_{j}\) is the COVID-19 pandemic severity measure for province j; \({{x3}_{{ij}}* {COVID}}_{j}\) is the interaction terms of gender and type of residence covariates with COVID-19 severity measure; this study assesses three specifications incorporating interaction terms: one specific to women, another specific to urban settings, and a third encompassing both women and urban factors; \({z}_{{ij}}\) is the covariates corresponding to the random effects; as this model follows a random-intercept model, \({z}_{{ij}}\) is simply the scalar 1; \({u}_{j}\) is the random effects; and \({\epsilon }_{{ij}}\) is the errors, distributed as logistic with mean 0 and variance π 2 /3 and are independent of \({u}_{j}\) .

This model, \({x1}_{{ij}}\) and \({x2}_{j}\) do not contain a constant term because its effect is absorbed into the cutpoints (κ).

Table 1 illustrates the estimation strategies employed in this study, encompassing three distinct approaches presented in 12 specifications. First, the Main Model uses all observations to illustrate the relationship between happiness levels and each covariate. Second, the Interaction Model examines how COVID-19 severity affects the connection between being female, living in urban areas, and happiness levels. The second approach investigates moderation effects. Lastly, the third approach delves into the factors impacting happiness across specific subgroups based on gender, residence type, and region. This granular analysis offers insights into potential differences or similarities in the determinants of happiness among these subgroups, aiming to unravel complex relationships among predictors in understanding SWB across diverse contexts.

Model estimation is performed using the meologit procedure in Stata 17.0 (StataCorp 2021 ). The meologit procedure estimates ordered logistic regression containing both fixed effects (in this study: \({x1}_{{ij}}\) and \({x2}_{j}\) along with their interaction terms) and random effects ( \({u}_{j}\) ).

The Happiness Level Measurement Survey (SPTK)

This study relies on the Happiness Level Measurement Survey (SPTK) from 2017 and 2021, administered by the Central Statistics Agency of Indonesia (Badan Pusat Statistik; BPS) (Badan Pusat Statistik 2017 ; 2021a ). Footnote 4 The 2021 wave of SPTK fieldwork took place from July 1 to August 27, 2021, during Indonesia’s peak of the COVID-19 pandemic. The data relating to COVID-19 exposure, i.e., total positive cases of COVID-19, was taken from KawalCOVID19, who collected data primarily from the Ministry of Health. The macroeconomic data on poverty levels and inequality of per capita expenditures (Gini coefficient) are all sourced from the BPS.

SPTK extends across every province and district in Indonesia, where districts consist of kabupaten (regencies) and kota (municipalities). Within each district, the BPS has established a master sampling frame comprising Census Blocks (BS) for the periodic implementation of various surveys. A BS constitutes a designated enumeration zone within a village locality consisting of 80 to 120 residential, non-residential, or household census buildings with distinct boundaries identifiable in the field. BS selection for SPTK is selected probabilistically from the master sampling frame. Household updating takes place at each selected BS, with the selection of household respondents based on updated listings that are stratified according to factors such as the household head’s education and the household’s structure.

The data collection involves conducting direct interviews with respondents utilizing structured questionnaires and computer-assisted personal interviewing applications. Footnote 5 The unit of analysis is a randomly selected household. In each sampled household, the head of the household or the spouse of the head of the household (wife/husband) is selected as the respondent to represent the household. This study focuses on 137,958 respondents aged 25–80 years who are working or spend most of their time taking care of the household. Footnote 6 Apart from the level of happiness, SPTK contributed data at the individual and household levels.

Level of happiness

The level of happiness is evaluated using the so-called Cantril ladder (Cantril 1965 ; Levin and Currie 2014 ). The SPTK employs a ladder diagram to measure happiness, prompting respondents to visualize themselves on a scale with steps numbered from zero at the bottom to ten at the top. Respondents are asked to evaluate their happiness using the question, “How happy are you with life as a whole?” The answer ranges from 0 (very unhappy) to 10 (very happy).

Figure 1 shows that the distributions of happiness are skewed to the left. Most respondents evaluate their happiness on the eighth rung (34.1 percent in 2017 and 35.6 percent in 2022). The national average was calculated at 7.78 in 2017, while for 2021, it will be slightly lower at 7.76.

Source: Calculated from SPTK.

For a comparative analysis of self-reported happiness in this study with neighboring nations, Pattinasarany ( 2018 ) investigated happiness and life satisfaction in Indonesia, Thailand, Japan, and South Korea to compare self-reported happiness with neighboring nations. The study used collected data to explore lifestyles and values related to social well-being in seven Asian countries, including the Philippines, Taiwan, and Vietnam. Results revealed similar happiness distribution, with Indonesia and Thailand displaying a left-skewed pattern, indicating majority contentment. Indonesian adults reported slightly higher average happiness (7.68) than their Thai counterparts (7.65). In Japan (6.25) and Korea (5.93), happiness levels exhibited a more normal distribution, with averages not reaching the same highs as observed in Indonesia and Thailand.

Analyzing happiness at the provincial level indicates that Gorontalo and North Maluku reported the highest average levels in 2017 (8.43) and 2021 (8.54), respectively (Fig. 2 ). In contrast, the lowest averages were recorded in East Nusa Tenggara in 2017 (7.32) and Bali in 2021 (7.26). While the national average in 2017 and 2021 remains relatively unchanged, significant differences emerge at the provincial level between the two years. Providing context, half of the 34 provinces saw an increase in their average happiness levels from 2017 to 2021, while the remaining provinces experienced a decline. Central Sulawesi notably showed the most substantial surge, with an increase of 0.347 points, while Bengkulu province witnessed the most significant decrease, dropping by 0.387 points. Recognizing the nested nature of individuals within provinces, the variance in average happiness levels between years at the provincial level becomes a crucial consideration.

In our examination of gender and residence type on changes in SWB during the pandemic, Fig. 3 illustrates average happiness levels categorized by gender and residence type. The left panel reveals that, on average, women reported higher happiness levels than men. However, there was a slight increase in men’s average happiness during the pandemic (+0.03 points), while women experienced a decrease (−0.06 points). In the right panel, it is evident that individuals residing in urban areas typically demonstrated higher average happiness levels than those in rural settings. Interestingly, individuals in rural areas reported higher happiness levels in 2021 compared to 2017 (+0.08 points). In contrast, those living in urban areas displayed the opposite trend, experiencing a decline in happiness levels over the same period (−0.15 points).

Given the limited number of respondents rating their happiness level between zero and five, these five responses were aggregated to achieve a more balanced distribution. Furthermore, data recoding follows the ordered logistic method, requiring each cell to include at least three percent of observations.

Total COVID-19 cases per 100,000 population

In this study, the evaluation of the severity of the COVID-19 pandemic relies on the total population with confirmed exposure to COVID-19. Although daily data has been available since March 2, 2020, the SPTK data lacks specific interview date information. A cut-off point, set on June 30, 2021, was established to determine COVID-19 severity for all survey respondents, conveniently aligning with the day preceding the start of SPTK face-to-face interviews. We used a normalization process to enable meaningful province-to-province comparisons, specifically normalizing the data per 100,000 population.

Figure 4 illustrates the unequal distribution of confirmed COVID-19 cases among provinces. DKI Jakarta records the highest incidence of COVID-19 cases, reaching 5210 per 100,000 population. Conversely, North Sumatera reports the lowest number of cases, only 246 per 100,000 population. These findings underscore the diverse impact and transmission rates of COVID-19 observed across different provinces.

Source: Calculated from KawalCOVID-19.

Concluding the data discussion, Table 2 displays the mean and standard deviation of all variables used in this study, categorized by year.

Estimation results

Table 3 displays happiness level estimates from a multilevel mixed-effects ordered logistic analysis covering the Main and Interaction Models. The Main Model serves as the baseline, while the Interaction Model estimates examine potential changes in gender and type of residence covariates influenced by the COVID-19 pandemic.

We begin by discussing the results of the Null Model, which incorporates no predictors (Table 3 , column [1]). The Intraclass Correlation Coefficient (ICC) for the Null Model is 0.038 (second row from the bottom), indicating that approximately 3.8 percent of the variability in an underlying response is associated with differences between provinces. Footnote 7 Sommet and Morselli ( 2017 ) noted that many authors argue that an ICC below 5 percent, considered insignificant and negligible, leads them to treat the individual as a single unit of analysis, hence opting for a single-level analysis. Nevertheless, we persist with multilevel modeling, recognizing that the minimal ICC (except when zero) does not signify the absence of variation in respondents’ happiness levels between provinces. Moreover, disregarding this variation can lead to inaccurate estimates and potentially result in inappropriate policy decisions. The ICCs for the Main and Interaction Models are modest, ranging between 0.037 and 0.041.

The Likelihood Ratio (LR) test, located in the third row from the bottom, compares the multilevel mixed-effects ordered logistic model with the standard (single-level) ordered logistic model, favoring the former. A p-value of 0.000 for the LR test signifies significant variation in self-reported happiness levels between provinces. The “Variances: Province (constant)” estimates in the fourth row from the bottom indicate the variation in self-reported happiness levels attributed to differences between provinces after accounting for fixed effects and other covariates in the model. This information clarifies how the province-level factor (in our case, poverty rates, Gini coefficient of per capita expenditures, and severity of the pandemic measure) contributes to the overall variability in the outcome. A higher estimated variance suggests a more significant variation in the outcome between provinces.

The severity of the COVID-19 pandemic

The estimation results indicate that individuals in provinces with more COVID-19 cases per 100,000 population tended to assign lower ratings to their happiness (Table 3 , column [2]). Footnote 8 Our findings align with international research. A study across China, Japan, South Korea, Italy, the United Kingdom, and the United States found that individuals in areas with elevated COVID-19 rates are more likely to report lower happiness levels (Nguyen 2021 ). Similarly, a German study using panel data during the initial COVID-19 wave observed a decline in life satisfaction in regions with higher infection rates (Bittmann 2022a ).

Concerns about the robustness of conclusions drawn from estimations using the entire dataset when examining specific characteristics are typical. Table 4 provides Main Model estimates disaggregated by gender (assessing whether estimation results differ for male or female respondents), type of residence (rural versus urban), and major regions in Indonesia (Sumatera, Java-Bali, and Other regions). Table 5 facilitates a comparison of the three primary correlates: gender (women), residence type (urban), and the severity of the COVID-19 pandemic.

These findings indicate that the detrimental impact of the pandemic’s severity on happiness levels is observable for both men and women, as well as for residents in rural areas and the Java-Bali and Other regions of Indonesia. However, the absence of statistical significance for urban residents may be attributed to the predominant concentration of the COVID-19 pandemic in urban areas of Indonesia. Similarly, the lack of statistical significance for the Sumatera region is associated with the lower pandemic severity observed in that region. Despite variations across different samples, these consistent findings underscore the negative association between the severity of the COVID-19 pandemic and individuals’ happiness levels.

In Indonesia, on average, women reported higher happiness levels than men (Table 3 , column [2]). Upon analyzing a disaggregated sample by residence type, the results indicate that women exhibit higher happiness levels than men in both rural and urban areas (Table 4 , columns [8] and [9]). Moreover, women consistently report higher happiness levels than men across all three regions (Sumatera, Java, and others) (Table 4 , columns [10], [11], and [12]).

A noteworthy observation is the degree to which women in the Java-Bali region experience a smaller happiness advantage over men compared to their counterparts in Sumatera and other regions. One potential explanation is the Java-Bali region’s reputation for embracing a more egalitarian gender culture than other parts of Indonesia, suggesting that gender-based disparities in happiness might be comparatively smaller in the Java-Bali region than in other regions (Hayati et al. 2014 ; Utomo 2012 ). Moreover, the Java-Bali region’s higher level of development compared to other parts of Indonesia contributes to enhanced gender equality across various facets, including well-being and happiness.

The Interaction Model estimates reveal that in 2021, the severity of the pandemic led to a decline in women’s happiness relative to men’s (Table 3 , columns [3] and [5]). These results indicate that the pandemic’s effect diminishes the relative advantage of being female in terms of happiness levels. Our findings align with several studies (Blanchflower and Bryson 2022 ; Nguyen 2021 ), all reporting a decrease in women’s life satisfaction and happiness compared to men during the pandemic.

Type of residence

Individuals residing in urban areas generally experience higher levels of happiness than their rural counterparts (Table 3 , column [2]). Easterlin et al. ( 2011 ) provided a comprehensive explanation for such findings, highlighting that the availability of material goods like food, clothing, and shelter in urban areas contributes to higher happiness. However, they also caution that urban life comes with challenges, including traffic congestion, pollution, and feelings of alienation, which can negatively impact happiness.

The difference in happiness levels between urban and rural residents remains consistent across diverse demographics (Table 4 , columns [6], [7], [10], [11], and [12]). Particularly noteworthy is the narrower happiness gap between urban and rural residents in the Java-Bali region (Table 4 , column [11]), indicating that rural areas in Java-Bali may benefit from enhanced public services and infrastructure compared to other regions. This improved availability of resources in rural Java-Bali contributes to a more equitable distribution of opportunities and resources between urban and rural residents.

Nevertheless, as per the Interaction Model, the pandemic’s severity has weakened the traditional happiness advantage of individuals in urban areas compared to their rural counterparts (Table 2 , columns [4] and [5]). Our observation finds backing in urban Pakistan, where Shams and Kadow (2020) documented a decrease in socio-economic satisfaction amid the pandemic, particularly noticeable among unemployed individuals, married couples, men, and older demographics.

Contextual characteristics

The association between poverty levels and happiness lacked statistical significance, suggesting that the poverty rates in a respondent’s province do not influence their happiness. One possible explanation is the substantial variation in poverty rates among districts within a province. For example, in 2021, East Java Province exhibited a poverty rate of 11.4 percent, yet the rates across its 38 kabupaten / kota ranged from 4.1 to 23.8 percent (Badan Pusat Statistik 2021b ). Nevertheless, a deviation from the typical trend is evident in the Java-Bali region, exposing a negative correlation between higher poverty levels and happiness among respondents (Table 4 , column [11]). This finding aligns with the higher poverty population in the Java-Bali region compared other regions in Indonesia (Badan Pusat Statistik 2021b ).

Muthia and Isbah’s ( 2022 ) study sheds light on the lack of a correlation between poverty and happiness, particularly within the impoverished community of DI Yogyakarta Province, Indonesia. The authors argue that impoverished individuals may not find happiness in their economic situation but discover contentment. This occurrence is ascribed to the prevailing belief system and local culture, heavily influenced by the nerimo attitude, emphasizing the acceptance of one’s circumstances. By adopting this mindset, impoverished individuals improve their psychological well-being, regardless of their difficulties.

Regarding inequality, the estimation results reveal an inverse connection between per capita expenditure inequality at the provincial level and self-reported happiness levels. In another study, Furwanti et al. ( 2021 ) utilized cross-sectional data from all Indonesian provinces and a path analysis model, revealing that income inequality significantly and negatively influences happiness in Indonesia.

The findings of this study align with several international reviews exploring the relationship between inequality and happiness. For instance, a review by Ferrer-i-Carbonell and Ramos ( 2014 ) demonstrates a negative correlation between income inequality and happiness in Western countries. However, the connection in non-Western countries is diverse and less conclusive. In addition, Schroder ( 2018 ) discovered that individuals perceive their SWB as lower when inequality within their own country increases over time, but not when it is higher compared to another country.

Individual characteristics

Following is a concise discussion of individual characteristics that fall outside the scope of the four research questions outlined in this study.

Our model incorporates respondents’ age in quadratic terms, revealing a U-shaped pattern in happiness assessment (Easterlin 2004 ; Blanchflower 2021 ; Bittmann 2022b ; Toshkov 2022 ). Generally, happiness levels decline with age until reaching a certain point, after which they begin to rise. In the Main Model, this turning point is identified at 49. The U-shaped pattern corresponds to the “midlife dip” phenomenon, wherein individuals often undergo a decline in happiness during midlife before it subsequently increases later in life, as discussed by Blanchflower and Graham ( 2020 ). Factors such as heightened responsibilities, financial pressures, and changes in personal and professional circumstances can influence this midlife dip.

Individuals in a marital union tend to experience higher happiness levels than unmarried or divorced individuals. This observation is supported by Frey’s ( 2018 ) comprehensive review, affirming that married individuals generally express higher happiness levels than those living alone or in unmarried partnerships. The author highlights the role of marriage or a stable partnership in mitigating loneliness, thereby assisting in alleviating stress related to work life. Various studies (Addai et al. 2014 ; Tambyah et al. 2023 ; Wu and Zhu 2016 ) have also identified the positive influence of being in a marital relationship.

A positive correlation is evident between education and happiness. This finding indicates that higher educational attainment aligns with higher self-reported happiness levels. As noted by Frey ( 2018 ), individuals with advanced education tend to enhance their abilities and gain increased access to opportunities, resulting in heightened life satisfaction. The association between education and happiness has been thoroughly examined, including within Indonesia (Landiyanto et al. 2011 ; Sujarwoto and Tampubolon 2015 ; Rahayu 2016 ). These investigations consistently affirm a positive association between education and happiness within the Indonesian context.

In general, employed respondents report lower happiness levels, although differences exist between men and women. Among male respondents, those actively engaged in work display higher happiness levels than those who are not. This positive correlation between working and happiness among men corresponds with findings from various international studies (Clark and Oswald 1994 ; Di Tella et al. 2001 ; Winkelmann and Winkelmann 1998 ). Conversely, employed individuals report lower happiness within the female sample than those unemployed. To the extent that the SPTK dataset defines those not employed as spending most of their time taking care of the household, the negative association between employment and happiness among women can be interpreted as women who are employed facing a double burden of responsibilities at work and home (Chen et al. 2018 ).

Individuals reporting higher household earnings exhibit higher happiness levels. However, the ongoing debate on whether income contributes to increased happiness encompasses diverse viewpoints. Some studies advocate for a positive correlation between income and self-reported happiness and, therefore, in line with our findings (Diener and Biswas-Diener 2002 ; Frey and Stutzer 2002 ; Lim et al. 2020 ; Yiengprugsawan et al. 2011 ; Yu et al. 2019 ). Conversely, other studies propose that the impact of income on happiness becomes negligible once a certain income threshold is reached (Kahneman and Deaton 2010 ; Muresan et al. 2020 ).

Discussions

Our analysis reveals a significant decline in self-reported happiness among Indonesians due to the severity of the COVID-19 pandemic, addressing RQ1. The pandemic severity measure has eroded the longstanding happiness advantage for women and urban residents, addressing RQ2 and RQ3. A concerning negative correlation between income inequality and happiness is evident, addressing RQ4. These findings emphasize the urgent need for targeted interventions to mitigate these effects on the Indonesian populace’s well-being.

COVID-19 severity reduces happiness

The decrease in self-reported happiness among Indonesians amid the severity of the COVID-19 pandemic arises from various factors. First, increased vulnerability to COVID-19 elevates health apprehensions and anxiety, giving rise to concerns about the risk of infection for both oneself and loved ones. Consequently, this anxiety diminishes overall well-being (Cleofas and Oducado 2022 ; Demirbas and Kutlu 2021 ; van der Vegt and Kleinberg 2020 ). Second, provinces with higher COVID-19 cases face significant economic disruptions, including business closures, job losses, and reduced economic activity, resulting in financial stress, insecurity, and an overall happiness decline (Cheng et al. 2020 ; Greyling et al. 2021 ; Kuhn et al. 2020 ). Third, residents in heavily affected provinces may encounter challenges such as limited social support networks, reduced opportunities for social engagement, and feelings of loneliness or disconnection, significantly impacting their happiness levels (Lepinteur et al. 2022 ; Nguyen 2021 ). Lastly, the increased prevalence of anxiety, depression, or emotional distress among individuals in provinces with higher COVID-19 exposure further contributes to lower self-reported happiness levels (Iskandarsyah et al. 2022 ).

This study underscores the assessment of the COVID-19 pandemic’s impact on individuals’ happiness, specifically through a severity measure focusing on the number of affected individuals per 100,000 population. This choice differs from using time dummy variables, assigning 1 for 2021 survey data (during the pandemic) and 0 for 2017 survey data (pre-pandemic). The severity measure directly reflects the impact of the COVID-19 pandemic on the population, offering a tangible and quantifiable indicator of its scale within a region. This approach is especially appropriate given the considerable variation in pandemic severity across provinces in Indonesia. Nevertheless, we recognize that relying solely on the severity measure may oversimplify the complex dynamics of the pandemic’s impact. Furthermore, Bittmann, ( 2022a ) explores the functional relationship between the severity measure and self-reported happiness, considering alternatives such as linearity (as employed in this paper), quadratic, and others. This exploration opens up possibilities for future studies.

COVID-19 severity moderates gender-residence type association with happiness

The negative and statistically significant interaction terms between COVID-19 severity and gender (being female) indicate that the pandemic’s severity affects the relationship between gender and self-reported happiness. In periods of intensified pandemic severity, the conventional gender gap in happiness, where women usually report higher levels, is disturbed. The negative moderation implies that the pandemic has a more detrimental impact on women’s happiness levels than men.

Research conducted by Alon et al. ( 2020 ), Blanchflower and Bryson ( 2022 ), and Hansen et al. ( 2022 ) underscore that the decline in happiness levels among women can be attributed to heightened caregiving responsibilities, especially as primary caregivers for children. Transitioning to remote learning for children has introduced additional challenges and demands for women. Additionally, as frontline workers, women face elevated stress levels in their roles and are vulnerable to potential job layoffs and disruptions in their participation in the labor market. Conversely, a study by Choi et al. ( 2021 ) concluded that even before the onset of COVID-19, Korean women demonstrated lower levels of SWB compared to men. Therefore, the well-being disparities observed among Korean women are more likely rooted in pre-pandemic variations rather than directly caused by the effects of the pandemic.

Similarly, the adverse and statistically significant interaction terms between COVID-19 severity and residence type (urban) indicate that the severity of the pandemic influences the connection between living in urban areas and self-reported happiness. During periods of heightened pandemic severity, the typical gap in happiness based on residence type, where individuals in urban areas usually report higher levels, ceased to hold. This adverse moderation implies that the pandemic has a more harmful effect on the happiness levels of individuals in urban residences than those in rural areas.

Mayuzumi’s ( 2022 ) research provides valuable insights into the effects of the COVID-19 pandemic on the happiness of urban and rural communities in Bali, Indonesia. The results indicate that individuals in subsistence farming villages, heavily dependent on agriculture, witnessed minimal changes in their livelihoods, suggesting little impact from the pandemic. In contrast, urban residents, primarily reliant on tourism, experienced significant job losses and food accessibility challenges due to government curfews and economic stagnation. On the contrary, Nguyen ( 2021 ) introduces an alternative perspective by proposing that the pandemic has a more noticeable impact on the unhappiness levels of individuals residing in rural areas than those living in urban settings.

Inequality is a catalyst for diminishing happiness

Examining contextual characteristics unveils that, excluding the Java-Bali region, provincial poverty levels have negligible effects on happiness levels. Nonetheless, there is a discernible negative correlation between inequality in per capita expenditure and happiness.

An important observation from the analysis using region-specific breakdowns is the unexpected positive association between the Gini coefficient and happiness in the Sumatera region. The uniqueness of this result in Sumatera may be ascribed to distinct factors inherent to the region, such as particular social structures, values, or expectations. These regional peculiarities in Sumatra could influence individuals’ perspectives on happiness differently than in other locales. A more thorough investigation into the specific factors contributing to these anomalies across regions is necessary to grasp the patterns observed fully.

Study limitations

The research employed a single-question methodology using a 0–10 point Likert scale to assess individual happiness. Although this approach offers a valuable metric, we acknowledged that happiness is a complex concept with multiple dimensions that a single question may need to be more comprehensive. Consequently, the study recognizes the importance of incorporating additional aspects and nuances to understand better individuals’ well-being, including factors like self-evaluated life satisfaction, positive affect, and negative affect.

Moreover, it is essential to consider two significant data constraints when interpreting the findings. First, the SPTK datasets utilized in the study lack precise location information, restricting the analysis to the provincial level and hindering a more detailed examination of the impact of COVID-19 on specific regions or communities within a province. For instance, while information on the poverty rate is accessible at the district level, the unavailability of district codes necessitates using provincial poverty rates.

Second, the datasets do not incorporate information about the interview dates for respondents, which would have facilitated a more precise correlation with the daily severity rate of COVID-19 at the provincial level. Access to interview date information could have offered valuable insights into the temporal relationship between individuals’ experiences and the evolving severity of the pandemic in their respective provinces.

The global repercussions of COVID-19 on individuals’ lives and well-being are profound. In Indonesia, there is a pressing need for more research on the correlation between happiness and pandemic severity across the population. This study addresses this gap by examining the factors influencing happiness levels before and during the pandemic, specifically focusing on gender and residence type. By posing and answering four research questions (RQs), the study provides valuable insights into the intricate dynamics of happiness during the pandemic in Indonesia.

This study employed data from the 2017 and 2021 Happiness Level Measurement Survey (SPTK) to represent pre-pandemic and during-pandemic conditions, respectively. The data analysis involved using a multilevel mixed-effects ordered logistic model, with individuals nested within provinces as the analytical framework. The severity of the pandemic was proxied using the incidence of positive COVID-19 cases per 100,000 residents.

Our analysis underscores a statistically significant decline in self-reported happiness levels among Indonesians attributable to the severity of the COVID-19 pandemic, directly addressing RQ1. Notably, this severity measure has diminished the longstanding happiness advantage previously experienced by women and urban residents, aligning with the inquiries of RQ2 and RQ3. Additionally, our study highlights a negative correlation between income inequality and happiness, illuminating the intricate interplay of socioeconomic dynamics influencing individual well-being as per RQ4. The robust support for our research questions highlights the multifaceted impact of the pandemic on happiness levels in Indonesia.

Immediate policy interventions are required to tackle these findings, encompassing targeted mental health support to aid individuals in overcoming the challenges of lockdown restrictions and the loss of loved ones; economic assistance to support families facing sudden job loss and economic downturn; reinforced public health initiatives to curb the spread of the virus and mitigate the health impact of the pandemic; educational campaigns to inform the public about necessary health protocols; and community-based social support programs to lighten the overall burden faced by communities in dealing with the pandemic. These measures aim to alleviate the negative impact of the pandemic and socioeconomic disparities on the happiness and overall welfare of the Indonesian population.

In light of the adverse effects of COVID-19 on the happiness of women and urban residents, it is important to implement proactive government programs and policies. To address women’s heightened responsibilities, especially in home-based teaching, effective communication, and support between teachers and students, such as regular home visits, are essential. Providing physical visits and care for vulnerable populations, including the elderly, chronically ill, and disabled individuals, can help alleviate some of the burdens on women. Additionally, supporting urban residents involves reinforcing community associations, particularly within neighborhood and religious networks, through collaborative efforts between the Central Government and local administrations.

The future research agenda aims to enhance the comprehensiveness of this study by incorporating field visits that include in-depth interviews and focus group discussions. Validating the findings, gaining deeper insights into individual experiences amidst the challenges posed by COVID-19, and investigating the impact of government assistance are deemed crucial. Complementing the measurement of SWB by incorporating self-evaluated life satisfaction, positive affect, and negative affect will improve our knowledge of the well-being of Indonesians. Furthermore, expanding the study by incorporating subsequent SPTK data will allow for assessing happiness before, during, and after the pandemic.

Data availability

The primary datasets analyzed in this study, the Happiness Level Measurement Survey (SPTK) 2017 and 2021, are not accessible to the public. The author is contractually prohibited from granting access to the SPTK data, as specified in the agreement with the Badan Pusat Statistik (BPS). However, the datasets are available for purchase through the BPS ( https://www.bps.go.id/ ).

The BPS defines an urban area by its primary non-agricultural activities, a functional layout that accommodates urban settlements, and the concentration and distribution of government services, social services, and economic activities. In contrast, rural areas primarily involve agricultural activities, including managing natural resources, and have a functional arrangement that supports rural settlements, government services, social services, and economic activities. In 2022, the urban areas of Indonesia were home to 56.4 percent of the population, while 43.6 percent lived in rural areas.

The WHR, an annual report comparing happiness levels across countries, relies on three well-being indicators: life evaluation, positive affect, and negative affect (Helliwell et al. 2020 ). The Happiness Index, developed by the Central Statistics Agency of Indonesia (Badan Pusat Statistik; BPS), incorporates nineteen indicators that assess dimensions such as life satisfaction, affection, and the meaning of life ( eudaimonia ) (Badan Pusat Statistik 2021a ). It is important to acknowledge that these two measures evaluate distinct aspects. Hence, direct comparison between them is inappropriate, given their representation of separate entities.

These interaction terms capture the moderating effect of the severity of the COVID-19 pandemic on the relationships of interest.

The SPTK is cross-sectional and was conducted in 2012, 2013, 2014, 2017, and 2021. The SPTK has undergone conceptual and methodological improvements (Badan Pusat Statistik 2021a ). For comparability purposes, we will use the last two batches. We need to emphasize that the 2021 SPTK does not aim to study the pandemic’s effect on the happiness level.

Amid the COVID-19 pandemic, the 2021 SPTK data collection encountered many hurdles (Badan Pusat Statistik 2021a ). Originally scheduled for July 1–31, 2021, the fieldwork encountered setbacks due to local lockdowns and the emergence of the Delta variant. Consequently, the 2021 SPTK initiatives necessitated a two-phase extension, extending field activities to two months. Field enumerators grappled with significant challenges, especially in conducting face-to-face surveys amidst stringent health protocols. Setbacks were further compounded as certain respondents refrained from participation due to concerns about infection and the extent to which the virus infected some enumerators. Additionally, due to lockdown restrictions, some survey locations had to be substituted following a month-long delay.

This study includes 67,450 participants from the SPTK 2017 dataset and 70,508 from the SPTK 2021 dataset.

The ICC (Intra-Class Correlation) scale spans from 0 to 1. An ICC value of 0 signifies complete independence of residuals, indicating that the assessment of happiness by individuals does not differ across provinces. Conversely, an ICC value of 1 indicates perfect interdependence of residuals, suggesting that variations in individual happiness levels occur exclusively between provinces.

We also conducted a comparable analysis using the overall count of COVID-19-related deaths to indicate the pandemic’s severity. The results reflected similar patterns: Individuals residing in provinces with higher COVID-19 death tolls generally reported lower levels of happiness. Nevertheless, we opted to omit these findings from our report due to the intricacies associated with attributing a death specifically to COVID-19. Determining the precise cause of death poses challenges, as some individuals might have succumbed to the disease while others had concurrent comorbidities. Consequently, this indicator may be susceptible to inaccuracies, making it a relatively less reliable measure (Bittmann 2022a ).

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Acknowledgements

This study was supported by Grant No. NKB-1211/UN2.RST/HKP.05.00/2022 from the Publikasi Terindeks Internasional (PUTI) Q1, Directorate of Research and Development (Risbang), Universitas Indonesia. The author is grateful for the constructive inputs and discussions throughout the preparation of this study from Professor Masayuki Kanai from the School of Human Sciences, Senshu University, and Professor Iwan Gardono Sudjatmiko from the Department of Sociology, Universitas Indonesia. In addition, Peter Morley from the Australian Volunteers Indonesia assisted in shaping the report and editorial services.

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Pattinasarany, I.R.I. Happiness amidst the COVID-19 pandemic in Indonesia: exploring gender, residence type, and pandemic severity. Humanit Soc Sci Commun 11 , 609 (2024). https://doi.org/10.1057/s41599-024-03131-0

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Gender equality and social inclusion mainstreaming research: final report

This report sets out how gender equality and social inclusion can be integrated into British Embassy Kathmandu’s development programmes and lessons for global FCDO programmes.

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This report brings together the findings, recommendations and lessons from a one-year qualitative study, commissioned by British Embassy Kathmandu ( BEK ) and undertaken by Adam Smith International ( ASI ).

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Towards gender equality in forestry, livestock, fisheries and aquaculture

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Elias, Marlène; Zaremba, Haley; Zaremba, Haley; Ragasa, Catherine; Valencia, Ana Maria Paez; Choudhury, Afrina; and de Haan, Nicoline. 2024. Towards gender equality in forestry, livestock, fisheries and aquaculture. Global Food Security 41(June 2024): 100761. https://doi.org/10.1016/j.gfs.2024.100761

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The forestry, livestock, fisheries and aquaculture sectors are critical for sustaining rural livelihoods and achieving food and nutrition security around the world. Yet, these sectors are marred by significant gender and social inequalities. This review examines gender gaps in these sectors and what has worked to reduce inequalities. We show that gender norms underpin the invisibility, undervaluation, and weight of women's labor; rural women's typically limited and precarious control over resources; gender-unequal influence over decision-making and agency; and gender-blind and discriminatory policies, data systems, and governance in these sectors. We evidence the diverse and multipronged strategies that have been used to lift these barriers, from the individual-to the system-level and spanning informal to formal institutions, to promote gender equality.

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Single-sex toilets to be required in non-residential buildings in England

Ministers say move will combat growing concerns about ‘privacy and dignity’ in gender-neutral facilities

• How the single-sex toilet law in England will work

New restaurants, offices and hospitals in England will be required to have separate male and female toilets, in a move ministers say will combat growing concerns about “privacy and dignity” in gender-neutral facilities.

The law will mean newly built non-residential buildings require separate facilities, and cannot solely have “universal” lavatories.

According to ministers, 81% agreed with the intention for separate single-sex toilet facilities in a consultation on the proposals, while 82% also agreed with the intention to provide “universal” toilets – a self-contained, and a fully enclosed toilet room with a wash hand basin for individual use – where space allows.

The government said the new requirements will mean people of all genders have access to facilities, either through a separate single-sex space or a “universal” toilet.

However, the policy has been criticised as being transphobic since it was first proposed in 2021 because it offered no alternative plan for transgender and non-binary people.

Campaigners for trans rights have long argued that gender-neutral toilets can be reassuring for some transgender men and women who fear discrimination in binary toilets.

The equalities minister, Kemi Badenoch, said the move will help combat the rise of gender-neutral toilet spaces, which she said “deny privacy and dignity to both men and women”.

Last week, Badenoch said girls at a school who did not have access to single-sex toilets developed urinary tract infections (UTIs) because they did not want to use gender-neutral toilets.

She asked people to report public bodies that fail to provide single-sex spaces or have policies not in accordance with the Equality Act. She did not name the school or further substantiate the claim.

Badenoch said the move shows the government’s commitment to “ensuring single-sex spaces are protected for all” after plans to overhaul the NHS constitution by limiting the use of gender-neutral wards.

These changes will mean patients in England will have the right to be treated on single-sex wards and transgender people will be treated in single rooms.

In a statement about the legislation, she said: “Today’s announcement will also create better provision for women so that our particular biological, health and sanitary needs are met.

“This is following our work last week limiting the use of mixed-sex wards in the NHS and demonstrates how this government is committed to ensuring single-sex spaces are protected for all.”

The government draft guidelines for how schools in England deal with transgender and young people call for schools to protect separate toilets for children aged eight years and over as required by existing legislation, allow staff and students to ignore pronouns preferred by socially transitioning children, and allow for sport and PE activities to be segregated by sex if there are safety concerns.

Colleges are not subject to the same legal requirements, but the ministers said the same considerations about safeguarding should apply.

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Housing minister Lee Rowley said the legislation will help ensure the “right facilities” are in place “for everyone”.

A statement said: “We know all members of society value safety, privacy and dignity, and this new legislation will help ensure the right facilities are in place for everyone.

“It is vital that new buildings, particularly in public spaces, are serving the community with [the] right toilet provision.”

Mermaids, an LGBTQ+ charity, has responded to government proposals about gender-specific toilets.

A statement on its website said: “We hear that trans, non-binary and gender-diverse people are too often not made to feel welcome, or even safe when using toilet facilities. It is unacceptable that any child should be made to feel this way.

“All children, including those who are trans, non-binary and gender-diverse, should be able to access the toilet that makes them feel respected and affirmed.

“We want a future whereby every young person can choose a toilet with freedom and autonomy; for some this would be a gender-neutral toilet and for others it would be a gender-specific toilet.”

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