literature review on female education

The Importance of Women’s and Girl’s Education for the Achievement of Sustainable Development: A Literature-Based Review

• First Online: 06 January 2021

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• Luíza Luchi de Paulo Gewehr 4 ,
• Emanuelle Parenti 4 ,
• Manoela de Oliveira Veras 4 &
• José Baltazar Salgueirinho Osório de Andrade Guerra 4  

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Gender equality and the empowerment of girls and women became a popular debate within the discussion on sustainability since its establishment in 2015 as a sustainable development goal by the United Nations 2030 agenda, due to the fact that several issues related to the economic, social and environmental spheres impact women and men differently. In this sense, education emerges as a gender equality driver once it improves women’s access to productive assets, resources and opportunities, such as sustainability education, training and employment; this results in an adequate standard of living that contributes to women’s bargaining power within the family and the community, and the creation of a sustainable equality. From this perspective, this article uses a literature review to present the importance of women’s education for the promotion of sustainable development, contributing to future studies and the creation of public policies related to gender equality.

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Gewehr, L.L.P., Parenti, E., de Oliveira Veras, M., de Andrade Guerra, J.B.S.O. (2020). The Importance of Women’s and Girl’s Education for the Achievement of Sustainable Development: A Literature-Based Review. In: Leal Filho, W., de Andrade Guerra, J.B.S. (eds) Water, Energy and Food Nexus in the Context of Strategies for Climate Change Mitigation. Climate Change Management. Springer, Cham. https://doi.org/10.1007/978-3-030-57235-8_19

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Article contents

Feminist theory and its use in qualitative research in education.

• Emily Freeman Emily Freeman University of North Carolina at Chapel Hill
• https://doi.org/10.1093/acrefore/9780190264093.013.1193
• Published online: 28 August 2019

Feminist theory rose in prominence in educational research during the 1980s and experienced a resurgence in popularity during the late 1990s−2010s. Standpoint epistemologies, intersectionality, and feminist poststructuralism are the most prevalent theories, but feminist researchers often work across feminist theoretical thought. Feminist qualitative research in education encompasses a myriad of methods and methodologies, but projects share a commitment to feminist ethics and theories. Among the commitments are the understanding that knowledge is situated in the subjectivities and lived experiences of both researcher and participants and research is deeply reflexive. Feminist theory informs both research questions and the methodology of a project in addition to serving as a foundation for analysis. The goals of feminist educational research include dismantling systems of oppression, highlighting gender-based disparities, and seeking new ways of constructing knowledge.

• feminist theories
• qualitative research
• educational research
• positionality
• methodology

Introduction

Feminist qualitative research begins with the understanding that all knowledge is situated in the bodies and subjectivities of people, particularly women and historically marginalized groups. Donna Haraway ( 1988 ) wrote,

I am arguing for politics and epistemologies of location, position, and situating, where partiality and not universality is the condition of being heard to make rational knowledge claims. These are claims on people’s lives I’m arguing for the view from a body, always a complex, contradictory, structuring, and structured body, versus the view from above, from nowhere, from simplicity. Only the god trick is forbidden. . . . Feminism is about a critical vision consequent upon a critical positioning in unhomogeneous gendered social space. (p. 589)

By arguing that “politics and epistemologies” are always interpretive and partial, Haraway offered feminist qualitative researchers in education a way to understand all research as potentially political and always interpretive and partial. Because all humans bring their own histories, biases, and subjectivities with them to a research space or project, it is naïve to think that the written product of research could ever be considered neutral, but what does research with a strong commitment to feminism look like in the context of education?

Writing specifically about the ways researchers of both genders can use feminist ethnographic methods while conducting research on schools and schooling, Levinson ( 1998 ) stated, “I define feminist ethnography as intensive qualitative research, aimed toward the description and analysis of the gendered construction and representation of experience, which is informed by a political and intellectual commitment to the empowerment of women and the creation of more equitable arrangements between and among specific, culturally defined genders” (p. 339). The core of Levinson’s definition is helpful for understanding the ways that feminist educational anthropologists engage with schools as gendered and political constructs and the larger questions of feminist qualitative research in education. His message also extends to other forms of feminist qualitative research. By focusing on description, analysis, and representation of gendered constructs, educational researchers can move beyond simple binary analyses to more nuanced understandings of the myriad ways gender operates within educational contexts.

Feminist qualitative research spans the range of qualitative methodologies, but much early research emerged out of the feminist postmodern turn in anthropology (Behar & Gordon, 1995 ), which was a response to male anthropologists who ignored the gendered implications of ethnographic research (e.g., Clifford & Marcus, 1986 ). Historically, most of the work on feminist education was conducted in the 1980s and 1990s, with a resurgence in the late 2010s (Culley & Portuges, 1985 ; DuBois, Kelly, Kennedy, Korsmeyer, & Robinson, 1985 ; Gottesman, 2016 ; Maher & Tetreault, 1994 ; Thayer-Bacon, Stone, & Sprecher, 2013 ). Within this body of research, the majority focuses on higher education (Coffey & Delamont, 2000 ; Digiovanni & Liston, 2005 ; Diller, Houston, Morgan, & Ayim, 1996 ; Gabriel & Smithson, 1990 ; Mayberry & Rose, 1999 ). Even leading journals, such as Feminist Teacher ( 1984 −present), focus mostly on the challenges of teaching about and to women in higher education, although more scholarship on P–12 education has emerged in recent issues.

There is also a large collection of work on the links between gender, achievement, and self-esteem (American Association of University Women, 1992 , 1999 ; Digiovanni & Liston, 2005 ; Gilligan, 1982 ; Hancock, 1989 ; Jackson, Paechter, & Renold, 2010 ; National Coalition for Women and Girls in Education, 2002 ; Orenstein, 1994 ; Pipher, 1994 ; Sadker & Sadker, 1994 ). However, just because research examines gender does not mean that it is feminist. Simply using gender as a category of analysis does not mean the research project is informed by feminist theory, ethics, or methods, but it is often a starting point for researchers who are interested in the complex ways gender is constructed and the ways it operates in education.

This article examines the histories and theories of U.S.–based feminism, the tenets of feminist qualitative research and methodologies, examples of feminist qualitative studies, and the possibilities for feminist qualitative research in education to provide feminist educational researchers context and methods for engaging in transformative and subversive research. Each section provides a brief overview of the major concepts and conversations, along with examples from educational research to highlight the ways feminist theory has informed educational scholarship. Some examples are given limited attention and serve as entry points into a more detailed analysis of a few key examples. While there is a large body of non-Western feminist theory (e.g., the works of Lila Abu-Lughod, Sara Ahmed, Raewyn Connell, Saba Mahmood, Chandra Mohanty, and Gayatri Spivak), much of the educational research using feminist theory draws on Western feminist theory. This article focuses on U.S.–based research to show the ways that the utilization of feminist theory has changed since the 1980s.

Histories, Origins, and Theories of U.S.–Based Feminism

The normative historiography of feminist theory and activism in the United States is broken into three waves. First-wave feminism (1830s−1920s) primarily focused on women’s suffrage and women’s rights to legally exist in public spaces. During this time period, there were major schisms between feminist groups concerning abolition, rights for African American women, and the erasure of marginalized voices from larger feminist debates. The second wave (1960s and 1980s) worked to extend some of the rights won during the first wave. Activists of this time period focused on women’s rights to enter the workforce, sexual harassment, educational equality, and abortion rights. During this wave, colleges and universities started creating women’s studies departments and those scholars provided much of the theoretical work that informs feminist research and activism today. While there were major feminist victories during second-wave feminism, notably Title IX and Roe v. Wade , issues concerning the marginalization of race, sexual orientation, and gender identity led many feminists of color to separate from mainstream white feminist groups. The third wave (1990s to the present) is often characterized as the intersectional wave, as some feminist groups began utilizing Kimberlé Crenshaw’s concept of intersectionality ( 1991 ) to understand that oppression operates via multiple categories (e.g., gender, race, class, age, ability) and that intersecting oppressions lead to different lived experiences.

Historians and scholars of feminism argue that dividing feminist activism into three waves flattens and erases the major contributions of women of color and gender-nonconforming people. Thompson ( 2002 ) called this history a history of hegemonic feminism and proposed that we look at the contributions of multiracial feminism when discussing history. Her work, along with that of Allen ( 1984 ) about the indigenous roots of U.S. feminism, raised many questions about the ways that feminism operates within the public and academic spheres. For those who wish to engage in feminist research, it is vital to spend time understanding the historical, theoretical, and political ways that feminism(s) can both liberate and oppress, depending on the scholar’s understandings of, and orientations to, feminist projects.

Standpoint Epistemology

Much of the theoretical work that informs feminist qualitative research today emerged out of second-wave feminist scholarship. Standpoint epistemology, according to Harding ( 1991 , 2004 ), posits that knowledge comes from one’s particular social location, that it is subjective, and the further one is from the hegemonic norm, the clearer one can see oppression. This was a major challenge to androcentric and Enlightenment theories of knowledge because standpoint theory acknowledges that there is no universal understanding of the world. This theory aligns with the second-wave feminist slogan, “The personal is political,” and advocates for a view of knowledge that is produced from the body.

Greene ( 1994 ) wrote from a feminist postmodernist epistemology and attacked Enlightenment thinking by using standpoint theory as her starting point. Her work serves as an example of one way that educational scholars can use standpoint theory in their work. She theorized encounters with “imaginative literature” to help educators conceptualize new ways of using reading and writing in the classroom and called for teachers to think of literature as “a harbinger of the possible.” (Greene, 1994 , p. 218). Greene wrote from an explicitly feminist perspective and moved beyond simple analyses of gender to a larger critique of the ways that knowledge is constructed in classrooms.

Intersectionality

Crenshaw ( 1991 ) and Collins ( 2000 ) challenged and expanded standpoint theory to move it beyond an individual understanding of knowledge to a group-based theory of oppression. Their work, and that of other black and womanist feminists, opened up multiple spaces of possibility for feminist scholars and researchers because it challenged hegemonic feminist thought. For those interested in conducting feminist research in educational settings, their work is especially pertinent because they advocate for feminists to attend to all aspects of oppression rather than flattening them to one of simple gender-based oppression.

Haddix, McArthur, Muhammad, Price-Dennis, and Sealey-Ruiz ( 2016 ), all women-of-color feminist educators, wrote a provocateur piece in a special issue of English Education on black girls’ literacy. The four authors drew on black feminist thought and conducted a virtual kitchen-table conversation. By symbolically representing their conversations as one from the kitchen, this article pays homage to women-of-color feminism and pushes educators who read English Education to reconsider elements of their own subjectivities. Third-wave feminism and black feminism emphasize intersectionality, in that different demographic details like race, class, and gender are inextricably linked in power structures. Intersectionality is an important frame for educational research because identifying the unique experiences, realities, and narratives of those involved in educational systems can highlight the ways that power and oppression operate in society.

Feminist Poststructural Theory

Feminist poststructural theory has greatly informed many feminist projects in educational research. Deconstruction is

a critical practice that aims to ‘dismantle [ déconstruire ] the metaphysical and rhetorical structures that are at work, not in order to reject or discard them, but to reinscribe them in another way,’ (Derrida, quoted in Spivak, 1974 , p. lxxv). Thus, deconstruction is not about tearing down, but about looking at how a structure has been constructed, what holds it together, and what it produces. (St. Pierre, 2000 , p. 482)

Reality, subjectivity, knowledge, and truth are constructed through language and discourse (cultural practices, power relations, etc.), so truth is local and diverse, rather than a universal experience (St. Pierre, 2000 ). Feminist poststructuralist theory may be used to question structural inequality that is maintained in education through dominant discourses.

In Go Be a Writer! Expanding the Curricular Boundaries of Literacy Learning with Children , Kuby and Rucker ( 2016 ) explored early elementary literacy practices using poststructural and posthumanist theories. Their book drew on hours of classroom observations, student interviews and work, and their own musings on ways to de-standardize literacy instruction and curriculum. Through the process of pedagogical documentation, Kuby and Rucker drew on the works of Barad, Deleuze and Guattari, and Derrida to explore the ways they saw children engaging in what they call “literacy desiring(s).” One aim of the book is to find practical and applicable ways to “Disrupt literacy in ways that rewrite the curriculum, the interactions, and the power dynamics of the classroom even begetting a new kind of energy that spirals and bounces and explodes” (Kuby & Rucker, 2016 , p. 5). The second goal of their book is not only to understand what happened in Rucker’s classroom using the theories, but also to unbound the links between “teaching↔learning” (p. 202) and to write with the theories, rather than separating theory from the methodology and classroom enactments (p. 45) because “knowing/being/doing were not separate” (p. 28). This work engages with key tenets of feminist poststructuralist theory and adds to both the theoretical and pedagogical conversations about what counts as a literacy practice.

While the discussion in this section provides an overview of the histories and major feminist theories, it is by no means exhaustive. Scholars who wish to engage in feminist educational research need to spend time doing the work of understanding the various theories and trajectories that constitute feminist work so they are able to ground their projects and theories in a particular tradition that will inform the ethics and methods of research.

Tenets of Feminist Qualitative Research

Why engage in feminist qualitative research.

Evans and Spivak ( 2016 ) stated, “The only real and effective way you can sabotage something this way is when you are working intimately within it.” Feminist researchers are in the classroom and the academy, working intimately within curricular, pedagogical, and methodological constraints that serve neoliberal ideologies, so it is vital to better understand the ways that we can engage in affirmative sabotage to build a more just and equitable world. Spivak’s ( 2014 ) notion of affirmative sabotage has become a cornerstone for understanding feminist qualitative research and teaching. She borrowed and built on Gramsci’s role of the organic intellectual and stated that they/we need to engage in affirmative sabotage to transform the humanities.

I used the term “affirmative sabotage” to gloss on the usual meaning of sabotage: the deliberate ruining of the master’s machine from the inside. Affirmative sabotage doesn’t just ruin; the idea is of entering the discourse that you are criticizing fully, so that you can turn it around from inside. The only real and effective way you can sabotage something this way is when you are working intimately within it. (Evans & Spivak, 2016 )

While Spivak has been mostly concerned with literary education, her writings provide teachers and researchers numerous lines of inquiry into projects that can explode androcentric universal notions of knowledge and resist reproductive heteronormativity.

Spivak’s pedagogical musings center on deconstruction, primarily Derridean notions of deconstruction (Derrida, 2016 ; Jackson & Mazzei, 2012 ; Spivak, 2006 , 2009 , 2012 ) that seek to destabilize existing categories and to call into question previously unquestioned beliefs about the goals of education. Her works provide an excellent starting point for examining the links between feminism and educational research. The desire to create new worlds within classrooms, worlds that are fluid, interpretive, and inclusive in order to interrogate power structures, lies at the core of what it means to be a feminist education researcher. As researchers, we must seriously engage with feminist theory and include it in our research so that feminism is not seen as a dirty word, but as a movement/pedagogy/methodology that seeks the liberation of all (Davis, 2016 ).

Feminist research and feminist teaching are intrinsically linked. As Kerkhoff ( 2015 ) wrote, “Feminist pedagogy requires students to challenge the norms and to question whether existing practices privilege certain groups and marginalize others” (p. 444), and this is exactly what feminist educational research should do. Bailey ( 2001 ) called on teachers, particularly those who identify as feminists, to be activists, “The values of one’s teaching should not be separated sharply from the values one expresses outside the classroom, because teaching is not inherently pure or laboratory practice” (p. 126); however, we have to be careful not to glorify teachers as activists because that leads to the risk of misinterpreting actions. Bailey argued that teaching critical thinking is not enough if it is not coupled with curriculums and pedagogies that are antiheteronormative, antisexist, and antiracist. As Bailey warned, just using feminist theory or identifying as a feminist is not enough. It is very easy to use the language and theories of feminism without being actively feminist in one’s research. There are ethical and methodological issues that feminist scholars must consider when conducting research.

Feminist research requires one to discuss ethics, not as a bureaucratic move, but as a reflexive move that shows the researchers understand that, no matter how much they wish it didn’t, power always plays a role in the process. According to Davies ( 2014 ), “Ethics, as Barad defines it, is a matter of questioning what is being made to matter and how that mattering affects what it is possible to do and to think” (p. 11). In other words, ethics is what is made to matter in a particular time and place.

Davies ( 2016 ) extended her definition of ethics to the interactions one has with others.

This is not ethics as a matter of separate individuals following a set of rules. Ethical practice, as both Barad and Deleuze define it, requires thinking beyond the already known, being open in the moment of the encounter, pausing at the threshold and crossing over. Ethical practice is emergent in encounters with others, in emergent listening with others. It is a matter of questioning what is being made to matter and how that mattering affects what it is possible to do and to think. Ethics is emergent in the intra-active encounters in which knowing, being, and doing (epistemology, ontology, and ethics) are inextricably linked. (Barad, 2007 , p. 83)

The ethics of any project must be negotiated and contested before, during, and after the process of conducting research in conjunction with the participants. Feminist research is highly reflexive and should be conducted in ways that challenge power dynamics between individuals and social institutions. Educational researchers must heed the warning to avoid the “god-trick” (Haraway, 1988 ) and to continually question and re-question the ways we seek to define and present subjugated knowledge (Hesse-Biber, 2012 ).

Positionalities and Reflexivity

According to feminist ethnographer Noelle Stout, “Positionality isn’t meant to be a few sentences at the beginning of a work” (personal communication, April 5, 2016 ). In order to move to new ways of experiencing and studying the world, it is vital that scholars examine the ways that reflexivity and positionality are constructed. In a glorious footnote, Margery Wolf ( 1992 ) related reflexivity in anthropological writing to a bureaucratic procedure (p. 136), and that resonates with how positionality often operates in the field of education.

The current trend in educational research is to include a positionality statement that fixes the identity of the author in a particular place and time and is derived from feminist standpoint theory. Researchers should make their biases and the identities of the authors clear in a text, but there are serious issues with the way that positionality functions as a boundary around the authors. Examining how the researchers exert authority within a text allows the reader the opportunity to determine the intent and philosophy behind the text. If positionality were used in an embedded and reflexive manner, then educational research would be much richer and allow more nuanced views of schools, in addition to being more feminist in nature. The rest of this section briefly discussrs articles that engage with feminist ethics regarding researcher subjectivities and positionality, and two articles are examined in greater depth.

When looking for examples of research that includes deeply reflexive and embedded positionality, one finds that they mostly deal with issues of race, equity, and diversity. The highlighted articles provide examples of positionality statements that are deeply reflexive and represent the ways that feminist researchers can attend to the ethics of being part of a research project. These examples all come from feminist ethnographic projects, but they are applicable to a wide variety of feminist qualitative projects.

Martinez ( 2016 ) examined how research methods are or are not appropriate for specific contexts. Calderon ( 2016 ) examined autoethnography and the reproduction of “settler colonial understandings of marginalized communities” (p. 5). Similarly, Wissman, Staples, Vasudevan, and Nichols ( 2015 ) discussed how to research with adolescents through engaged participation and collaborative inquiry, and Ceglowski and Makovsky ( 2012 ) discussed the ways researchers can engage in duoethnography with young children.

Abajian ( 2016 ) uncovered the ways military recruiters operate in high schools and paid particular attention to the politics of remaining neutral while also working to subvert school militarization. She wrote,

Because of the sensitive and also controversial nature of my research, it was not possible to have a collaborative process with students, teachers, and parents. Purposefully intervening would have made documentation impossible because that would have (rightfully) aligned me with anti-war and counter-recruitment activists who were usually not welcomed on school campuses (Abajian & Guzman, 2013 ). It was difficult enough to find an administrator who gave me consent to conduct my research within her school, as I had explicitly stated in my participant recruitment letters and consent forms that I was going to research the promotion of post-secondary paths including the military. Hence, any purposeful intervention on my part would have resulted in the termination of my research project. At the same time, my documentation was, in essence, an intervention. I hoped that my presence as an observer positively shaped the context of my observation and also contributed to the larger struggle against the militarization of schools. (p. 26)

Her positionality played a vital role in the creation, implementation, and analysis of military recruitment, but it also forced her into unexpected silences in order to carry out her research. Abajian’s positionality statement brings up many questions about the ways researchers have to use or silence their positionality to further their research, especially if they are working in ostensibly “neutral” and “politically free” zones, such as schools. Her work drew on engaged anthropology (Low & Merry, 2010 ) and critical reflexivity (Duncan-Andrade & Morrell, 2008 ) to highlight how researchers’ subjectivities shape ethnographic projects. Questions of subjectivity and positionality in her work reflect the larger discourses around these topics in feminist theory and qualitative research.

Brown ( 2011 ) provided another example of embedded and reflexive positionality of the articles surveyed. Her entire study engaged with questions about how her positionality influenced the study during the field-work portion of her ethnography on how race and racism operate in ethnographic field-work. This excerpt from her study highlights how she conceived of positionality and how it informed her work and her process.

Next, I provide a brief overview of the research study from which this paper emerged and I follow this with a presentation of four, first-person narratives from key encounters I experienced while doing ethnographic field research. Each of these stories centres the role race played as I negotiated my multiple, complex positionality vis-á-vis different informants and participants in my study. These stories highlight the emotional pressures that race work has on the researcher and the research process, thus reaffirming why one needs to recognise the role race plays, and may play, in research prior to, during, and after conducting one’s study (Milner, 2007 ). I conclude by discussing the implications these insights have on preparing researchers of color to conduct cross-racial qualitative research. (Brown, 2011 , p. 98)

Brown centered the roles of race and subjectivity, both hers and her participants, by focusing her analysis on the four narratives. The researchers highlighted in this section thought deeply about the ethics of their projects and the ways that their positionality informed their choice of methods.

Methods and Challenges

Feminist qualitative research can take many forms, but the most common data collection methods include interviews, observations, and narrative or discourse analysis. For the purposes of this article, methods refer to the tools and techniques researchers use, while methodology refers to the larger philosophical and epistemological approaches to conducting research. It is also important to note that these are not fixed terms, and that there continues to be much debate about what constitutes feminist theory and feminist research methods among feminist qualitative researchers. This section discusses some of the tensions and constraints of using feminist theory in educational research.

Jackson and Mazzei ( 2012 ) called on researchers to think through their data with theory at all stages of the collection and analysis process. They also reminded us that all data collection is partial and informed by the researcher’s own beliefs (Koro-Ljungberg, Löytönen, & Tesar, 2017 ). Interviews are sites of power and critiques because they show the power of stories and serve as a method of worlding, the process of “making a world, turning insight into instrument, through and into a possible act of freedom” (Spivak, 2014 , p. xiii). Interviews allow researchers and participants ways to engage in new ways of understanding past experiences and connecting them to feminist theories. The narratives serve as data, but it is worth noting that the data collected from interviews are “partial, incomplete, and always being re-told and re-membered” (Jackson & Mazzei, 2012 , p. 3), much like the lived experiences of both researcher and participant.

Research, data collection, and interpretation are not neutral endeavors, particularly with interviews (Jackson & Mazzei, 2009 ; Mazzei, 2007 , 2013 ). Since education research emerged out of educational psychology (Lather, 1991 ; St. Pierre, 2016 ), historically there has been an emphasis on generalizability and positivist data collection methods. Most feminist research makes no claims of generalizability or truth; indeed, to do so would negate the hyperpersonal and particular nature of this type of research (Love, 2017 ). St. Pierre ( 2016 ) viewed the lack of generalizability as an asset of feminist and poststructural research, rather than a limitation, because it creates a space of resistance against positivist research methodologies.

Denzin and Giardina ( 2016 ) urged researchers to “consider an alternative mode of thinking about the critical turn in qualitative inquiry and posit the following suggestion: perhaps it is time we turned away from ‘methodology’ altogether ” (p. 5, italics original). Despite the contention over the term critical among some feminist scholars (e.g. Ellsworth, 1989 ), their suggestion is valid and has been picked up by feminist and poststructural scholars who examine the tensions between following a strict research method/ology and the theoretical systems out of which they operate because precision in method obscures the messy and human nature of research (Koro-Ljungberg, 2016 ; Koro-Ljungberg et al., 2017 ; Love, 2017 ; St. Pierre & Pillow, 2000 ). Feminist qualitative researchers should seek to complicate the question of what method and methodology mean when conducting feminist research (Lather, 1991 ), due to the feminist emphasis on reflexive and situated research methods (Hesse-Biber, 2012 ).

Examples of Feminist Qualitative Research in Education

A complete overview of the literature is not possible here, due to considerations of length, but the articles and books selected represent the various debates within feminist educational research. They also show how research preoccupations have changed over the course of feminist work in education. The literature review is divided into three broad categories: Power, canons, and gender; feminist pedagogies, curriculums, and classrooms; and teacher education, identities, and knowledge. Each section provides a broad overview of the literature to demonstrate the breadth of work using feminist theory, with some examples more deeply explicated to describe how feminist theories inform the scholarship.

Power, Canons, and Gender

The literature in this category contests disciplinary practices that are androcentric in both content and form, while asserting the value of using feminist knowledge to construct knowledge. The majority of the work was written in the 1980s and supported the creation of feminist ways of knowing, particularly via the creation of women’s studies programs or courses in existing departments that centered female voices and experiences.

Questioning the canon has long been a focus of feminist scholarship, as has the attempt to subvert its power in the disciplines. Bezucha ( 1985 ) focused on the ways that departments of history resist the inclusion of both women and feminism in the historical canon. Similarly, Miller ( 1985 ) discussed feminism as subversion when seeking to expand the canon of French literature in higher education.

Lauter and Dieterich ( 1972 ) examined a report by ERIC, “Women’s Place in Academe,” a collection of articles about the discrepancies by gender in jobs and tenure-track positions and the lack of inclusion of women authors in literature classes. They also found that women were relegated to “softer” disciplines and that feminist knowledge was not acknowledged as valid work. Culley and Portuges ( 1985 ) expanded the focus beyond disciplines to the larger structures of higher education and noted the varies ways that professors subvert from within their disciplines. DuBois et al. ( 1985 ) chronicled the development of feminist scholarship in the disciplines of anthropology, education, history, literature, and philosophy. They explained that the institutions of higher education often prevent feminist scholars from working across disciplines in an attempt to keep them separate. Raymond ( 1985 ) also critiqued the academy for not encouraging relationships across disciplines and offered the development of women’s, gender, and feminist studies as one solution to greater interdisciplinary work.

Parson ( 2016 ) examined the ways that STEM syllabi reinforce gendered norms in higher education. She specifically looked at eight syllabi from math, chemistry, biology, physics, and geology classes to determine how modal verbs showing stance, pronouns, intertextuality, interdiscursivity, and gender showed power relations in higher education. She framed the study through poststructuralist feminist critical discourse analysis to uncover “the ways that gendered practices that favor men are represented and replicated in the syllabus” (p. 103). She found that all the syllabi positioned knowledge as something that is, rather than something that can be co-constructed. Additionally, the syllabi also favored individual and masculine notions of what it means to learn by stressing the competitive and difficult nature of the classroom and content.

When reading newer work on feminism in higher education and the construction of knowledge, it is easy to feel that, while the conversations might have shifted somewhat, the challenge of conducting interdisciplinary feminist work in institutions of higher education remains as present as it was during the creation of women’s and gender studies departments. The articles all point to the fact that simply including women’s and marginalized voices in the academy does not erase or mitigate the larger issues of gender discrimination and androcentricity within the silos of the academy.

Feminist Pedagogies, Curricula, and Classrooms

This category of literature has many similarities to the previous one, but all the works focus more specifically on questions of curriculum and pedagogy. A review of the literature shows that the earliest conversations were about the role of women in academia and knowledge construction, and this selection builds on that work to emphasize the ways that feminism can influence the events within classes and expands the focus to more levels of education.

Rich ( 1985 ) explained that curriculum in higher education courses needs to validate gender identities while resisting patriarchal canons. Maher ( 1985 ) narrowed the focus to a critique of the lecture as a pedagogical technique that reinforces androcentric ways of learning and knowing. She called for classes in higher education to be “collaborative, cooperative, and interactive” (p. 30), a cry that still echoes across many college campuses today, especially from students in large lecture-based courses. Maher and Tetreault ( 1994 ) provided a collection of essays that are rooted in feminist classroom practice and moved from the classroom into theoretical possibilities for feminist education. Warren ( 1998 ) recommended using Peggy McIntosh’s five phases of curriculum development ( 1990 ) and extending it to include feminist pedagogies that challenge patriarchal ways of teaching. Exploring the relational encounters that exist in feminist classrooms, Sánchez-Pardo ( 2017 ) discussed the ethics of pedagogy as a politics of visibility and investigated the ways that democratic classrooms relate to feminist classrooms.

While all of the previously cited literature is U.S.–based, the next two works focus on the ways that feminist pedagogies and curriculum operate in a European context. Weiner ( 1994 ) used autobiography and narrative methodologies to provide an introduction to how feminism has influenced educational research and pedagogy in Britain. Revelles-Benavente and Ramos ( 2017 ) collected a series of studies about how situated feminist knowledge challenges the problems of neoliberal education across Europe. These two, among many European feminist works, demonstrate the range of scholarship and show the trans-Atlantic links between how feminism has been received in educational settings. However, much more work needs to be done in looking at the broader global context, and particularly by feminist scholars who come from non-Western contexts.

The following literature moves us into P–12 classrooms. DiGiovanni and Liston ( 2005 ) called for a new research agenda in K–5 education that explores the hidden curriculums surrounding gender and gender identity. One source of the hidden curriculum is classroom literature, which both Davies ( 2003 ) and Vandergrift ( 1995 ) discussed in their works. Davies ( 2003 ) used feminist ethnography to understand how children who were exposed to feminist picture books talked about gender and gender roles. Vandergrift ( 1995 ) presented a theoretical piece that explored the ways picture books reinforce or resist canons. She laid out a future research agenda using reader response theory to better comprehend how young children question gender in literature. Willinsky ( 1987 ) explored the ways that dictionary definitions reinforced constructions of gender. He looked at the definitions of the words clitoris, penis , and vagina in six school dictionaries and then compared them with A Feminist Dictionary to see how the definitions varied across texts. He found a stark difference in the treatment of the words vagina and penis ; definitions of the word vagina were treated as medical or anatomical and devoid of sexuality, while definitions of the term penis were linked to sex (p. 151).

Weisner ( 2004 ) addressed middle school classrooms and highlighted the various ways her school discouraged unconventional and feminist ways of teaching. She also brought up issues of silence, on the part of both teachers and students, regarding sexuality. By including students in the curriculum planning process, Weisner provided more possibilities for challenging power in classrooms. Wallace ( 1999 ) returned to the realm of higher education and pushed literature professors to expand pedagogy to be about more than just the texts that are read. She challenged the metaphoric dichotomy of classrooms as places of love or battlefields; in doing so, she “advocate[d] active ignorance and attention to resistances” (p. 194) as a method of subverting transference from students to teachers.

The works discussed in this section cover topics ranging from the place of women in curriculum to the gendered encounters teachers and students have with curriculums and pedagogies. They offer current feminist scholars many directions for future research, particularly in the arena of P–12 education.

Teacher Education, Identities, and Knowledge

The third subset of literature examines the ways that teachers exist in classrooms and some possibilities for feminist teacher education. The majority of the literature in this section starts from the premise that the teachers are engaged in feminist projects. The selections concerning teacher education offer critiques of existing heteropatriarchal normative teacher education and include possibilities for weaving feminism and feminist pedagogies into the education of preservice teachers.

Holzman ( 1986 ) explored the role of multicultural teaching and how it can challenge systematic oppression; however, she complicated the process with her personal narrative of being a lesbian and working to find a place within the school for her sexual identity. She questioned how teachers can protect their identities while also engaging in the fight for justice and equity. Hoffman ( 1985 ) discussed the ways teacher power operates in the classroom and how to balance the personal and political while still engaging in disciplinary curriculums. She contended that teachers can work from personal knowledge and connect it to the larger curricular concerns of their discipline. Golden ( 1998 ) used teacher narratives to unpack how teachers can become radicalized in the higher education classroom when faced with unrelenting patriarchal and heteronormative messages.

Extending this work, Bailey ( 2001 ) discussed teachers as activists within the classroom. She focused on three aspects of teaching: integrity with regard to relationships, course content, and teaching strategies. She concluded that teachers cannot separate their values from their profession. Simon ( 2007 ) conducted a case study of a secondary teacher and communities of inquiry to see how they impacted her work in the classroom. The teacher, Laura, explicitly tied her inquiry activities to activist teacher education and critical pedagogy, “For this study, inquiry is fundamental to critical pedagogy, shaped by power and ideology, relationships within and outside of the classroom, as well as teachers’ and students’ autochthonous histories and epistemologies” (Simon, 2007 , p. 47). Laura’s experiences during her teacher education program continued during her years in the classroom, leading her to create a larger activism-oriented teacher organization.

Collecting educational autobiographies from 17 college-level feminist professors, Maher and Tetreault ( 1994 ) worried that educators often conflated “the experience and values of white middle-class women like ourselves for gendered universals” (p. 15). They complicated the idea of a democratic feminist teacher, raised issues regarding the problematic ways hegemonic feminism flattens experience to that of just white women, and pushed feminist professors to pay particular attention to the intersections of race, class, gender, and sexuality when teaching.

Cheira ( 2017 ) called for gender-conscious teaching and literature-based teaching to confront the gender stereotypes she encountered in Portuguese secondary schools. Papoulis and Smith ( 1992 ) conducted summer sessions where teachers experienced writing activities they could teach their students. Conceptualized as an experiential professional development course, the article revolved around an incident where the seminar was reading Emily Dickinson and the men in the course asked the two female instructors why they had to read feminist literature and the conversations that arose. The stories the women told tie into Papoulis and Smith’s call for teacher educators to interrogate their underlying beliefs and ideologies about gender, race, and class, so they are able to foster communities of study that can purposefully and consciously address feminist inquiry.

McWilliam ( 1994 ) collected stories of preservice teachers in Australia to understand how feminism can influence teacher education. She explored how textual practices affect how preservice teachers understand teaching and their role. Robertson ( 1994 ) tackled the issue of teacher education and challenged teachers to move beyond the two metaphors of banking and midwifery when discussing feminist ways of teaching. She called for teacher educators to use feminist pedagogies within schools of education so that preservice teachers experience a feminist education. Maher and Rathbone ( 1986 ) explored the scholarship on women’s and girls’ educational experiences and used their findings to call for changes in teacher education. They argued that schools reinforce the notion that female qualities are inferior due to androcentric curriculums and ways of showing knowledge. Justice-oriented teacher education is a more recent iteration of this debate, and Jones and Hughes ( 2016 ) called for community-based practices to expand the traditional definitions of schooling and education. They called for preservice teachers to be conversant with, and open to, feminist storylines that defy existing gendered, raced, and classed stereotypes.

Bieler ( 2010 ) drew on feminist and critical definitions of dialogue (e.g., those by Bakhtin, Freire, Ellsworth, hooks, and Burbules) to reframe mentoring discourse in university supervision and dialogic praxis. She concluded by calling on university supervisors to change their methods of working with preservice teachers to “Explicitly and transparently cultivat[e] dialogic praxis-oriented mentoring relationships so that the newest members of our field can ‘feel their own strength at last,’ as Homer’s Telemachus aspired to do” (Bieler, 2010 , p. 422).

Johnson ( 2004 ) also examined the role of teacher educators, but she focused on the bodies and sexualities of preservice teachers. She explored the dynamics of sexual tension in secondary classrooms, the role of the body in teaching, and concerns about clothing when teaching. She explicitly worked to resist and undermine Cartesian dualities and, instead, explored the erotic power of teaching and seducing students into a love of subject matter. “But empowered women threaten the patriarchal structure of this society. Therefore, women have been acculturated to distrust erotic power” (Johnson, 2004 , p. 7). Like Bieler ( 2010 ), Johnson ( 2004 ) concluded that, “Teacher educators could play a role in creating a space within the larger framework of teacher education discourse such that bodily knowledge is considered along with pedagogical and content knowledge as a necessary component of teacher training and professional development” (p. 24). The articles about teacher education all sought to provoke questions about how we engage in the preparation and continuing development of educators.

Teacher identity and teacher education constitute how teachers construct knowledge, as both students and teachers. The works in this section raise issues of what identities are “acceptable” in the classroom, ways teachers and teacher educators can disrupt oppressive storylines and practices, and the challenges of utilizing feminist pedagogies without falling into hegemonic feminist practices.

Possibilities for Feminist Qualitative Research

Spivak ( 2012 ) believed that “gender is our first instrument of abstraction” (p. 30) and is often overlooked in a desire to understand political, curricular, or cultural moments. More work needs to be done to center gender and intersecting identities in educational research. One way is by using feminist qualitative methods. Classrooms and educational systems need to be examined through their gendered components, and the ways students operate within and negotiate systems of power and oppression need to be explored. We need to see if and how teachers are actively challenging patriarchal and heteronormative curriculums and to learn new methods for engaging in affirmative sabotage (Spivak, 2014 ). Given the historical emphasis on higher education, more work is needed regarding P–12 education, because it is in P–12 classrooms that affirmative sabotage may be the most necessary to subvert systems of oppression.

In order to engage in affirmative sabotage, it is vital that qualitative researchers who wish to use feminist theory spend time grappling with the complexity and multiplicity of feminist theory. It is only by doing this thought work that researchers will be able to understand the ongoing debates within feminist theory and to use it in a way that leads to a more equitable and just world. Simply using feminist theory because it may be trendy ignores the very real political nature of feminist activism. Researchers need to consider which theories they draw on and why they use those theories in their projects. One way of doing this is to explicitly think with theory (Jackson & Mazzei, 2012 ) at all stages of the research project and to consider which voices are being heard and which are being silenced (Gilligan, 2011 ; Spivak, 1988 ) in educational research. More consideration also needs to be given to non-U.S. and non-Western feminist theories and research to expand our understanding of education and schooling.

Paying close attention to feminist debates about method and methodology provides another possibility for qualitative research. The very process of challenging positivist research methods opens up new spaces and places for feminist qualitative research in education. It also allows researchers room to explore subjectivities that are often marginalized. When researchers engage in the deeply reflexive work that feminist research requires, it leads to acts of affirmative sabotage within the academy. These discussions create the spaces that lead to new visions and new worlds. Spivak ( 2006 ) once declared, “I am helpless before the fact that all my essays these days seem to end with projects for future work” (p. 35), but this is precisely the beauty of feminist qualitative research. We are setting ourselves and other feminist researchers up for future work, future questions, and actively changing the nature of qualitative research.

Acknowledgements

Dr. George Noblit provided the author with the opportunity to think deeply about qualitative methods and to write this article, for which the author is extremely grateful. Dr. Lynda Stone and Dr. Tanya Shields are thanked for encouraging the author’s passion for feminist theory and for providing many hours of fruitful conversation and book lists. A final thank you is owed to the author’s partner, Ben Skelton, for hours of listening to her talk about feminist methods, for always being a first reader, and for taking care of their infant while the author finished writing this article.

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• Published: 22 September 2023

The impact of education and digitalization on female labour force participation in BRICS: an advanced panel data analysis

• Yu Shuangshuang 1 ,
• Wenzhong Zhu 2 ,
• Nafeesa Mughal 3 ,
• Sergio Ivan Vargas Aparcana 4 &
• Iskandar Muda 5  

Humanities and Social Sciences Communications volume  10 , Article number:  598 ( 2023 ) Cite this article

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The present study empirically elucidates the interconnections between digitalization and FLFP in BRICS economies. Furthermore, we also assessed the influence of three essential economic indicators on FLFP, i.e., education, fertility and GDP. We used annual data from 1990 to 2020 and advanced panel estimation techniques such as Banerjee and Crrion-i-Selvestre cointegration, slope heterogeneity, and cross-sectional augmented autoregressive distributed lags model to effectuate these objectives. The study’s empirical results illustrate the existence of a positive interconnection between digitalization and FLFP in sample countries. In addition, education and GDP play an essential role in furthering FLFP in the long run. A similar interconnection is observed in the short period. However, the magnitude of the short-run impacts is smaller than the long-run impacts. The empirical analysis offers a few pertinent policy insights for policymakers to improve the situation in the selected sample.

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Introduction.

The female labour force participation (FLFP) rate is crucial to a nation’s socioeconomic development. In general, a high FLFP signifies an improvement in a nation’s social and economic standing, leading to the empowerment of women, which in turn promotes equity and boosts the utilization of human potential, hence fostering economic growth and reducing poverty (Andlib and Khan, 2018 ). Women’s economic participation is also connected to favourable outcomes, such as improved nutrition, educational attainment, and greater participation in household decision-making. Nonetheless, we must recognize the quality of the employment and the compensation it provides. Various contextual factors, such as mobility, segregation, and gender norms about reproduction and reproductive labour, affect women’s entry into the workforce (Andlib et al., 2022 ).

Digital technologies are causing a rapid transformation in the world of work. Today, digitalization has permeated almost all major economic sectors (Silva, 2022 ). From software developers and programmers to domestic workers on digital labour platforms to market vendors and microentrepreneurs who use digital tools to reach customers, digital labour encompasses a wide range of occupations. The COVID-19 pandemic has accelerated digitalization as work and livelihoods have shifted online. However, it also exposed and exacerbated inequalities between the global North and South along gender, race, caste, and class lines. Common reasons for this digital divide include limited access to digital infrastructure, low digital literacy, and repressive sociocultural norms (Prates and Barbosa, 2020 ; Sarfraz et al., 2021 ).

At the commencement of the COVID-19 pandemic, policy experts and scholars anticipated that the pandemic and succeeding restriction strategies would expedite digitalization with a potentially significant indication for labour markets and efficiency. Most of the workers had to shift from working in the office to working from home, and contact-concentrated economic activities were limited (Woźniak-Jęchorek and Marchewka-Bartkowiak, 2023 ). Consequently, numerous firms had to adapt to remote work and broaden their activities online, which necessitated variation in functioning, management and maybe a speedy investment in information and communication technology (ICT). Throughout the COVID-19 pandemic, these forms of digitalization that permit businesses to function remotely may have encouraged employment and labour efficiency; there were expectations that they would uplift firms’ and workers’ efficiency in the longer term (Asongu and Odhiambo, 2022 ). Contrary to it, hopes concerning the long-term influence on the labour market were more mixed with worry that digitalization could disturb the incomes of low and middle-skilled workers.

Governments in BRICS economies have embraced digitalization in the hope that it will boost productivity and competitiveness while also creating jobs. Given the high and rising unemployment, the latter is crucial. Indeed, international development agencies have widely promoted digitalization as a policy path towards sustainable, inclusive, and equitable economic growth, potentially improving women’s social and economic outcomes (UN Women, 2020 ). Huws ( 2014 ), on the other hand, contends that digital innovation has facilitated the concentration of capital across industries and geographies, increasing their monopoly power in a context where states’ regulatory capacity is already precarious. Workers’ bargaining power has been severely eroded as surplus value is increasingly derived from value extraction rather than commodity production (Sarfraz et al., 2022 ).

The digital economy in BRICS economies is rapidly expanding, helping to boost growth and expand economic opportunities at a time when global productivity growth has been disappointing. Digital platforms are assisting micro-businesses in low and middle-income countries in accessing new, and in some cases international, markets and supplementing traditional sources of income (Rani et al., 2021 ). The rapid increase in mobile phone availability and use in the region has assisted in lowering the costs of obtaining information and other transaction costs, lowering the costs of money transfer and financial services, improving access to credit, and helping women in balancing their work and family lives (Herman, 2020 ). Automation and skill-biased technological change have increased the demand for ‘brains’ relative to ‘brawn’ in both developed and developing economies, allowing women to close participation and pay gaps (Cirillo et al., 2021 ). While the Internet has increased women’s workforce participation in developed economies by enabling teleworking and flexible work arrangements, it has also reduced the time spent on household labour (Akarsu, 2023 ).

The relationship between female labour force participation and the total fertility rate has received much attention in the demographic and economic literature. It has also been debated in various regions and stages of development worldwide. In this regard, the presence of children impacts the mother’s activity, primarily if the mother works. Mothers with small children are traditionally thought to have low labour force attachment (Bhalotra et al., 2021 ). Female labour force participation will also have an impact on family size decisions. As a result, the discussion of female labour force participation cannot be separated from the discussion of fertility, as the two are inextricably linked. Generally, female labour force participation is high in countries with low fertility rates (Buyukkececi and Engelhardt, 2021 ).

The ongoing research confabulates the influence of digitalization on female labour force participation in BRICS nations. We have chosen BRICS nations for so many valid reasons. First, these nations are emerging nations and focusing a lot on digitalization. China and India’s services sectors are making their mark in the world. Secondly, these chosen nations occupy almost 42 per cent of the world’s population, and these nations have a 24 per cent share of the world’s GDP. Further, on average, these nations occupy a 16 per cent share of the world’s trade. The FLFP rate is 46 per cent in the chosen block, and China has the highest (World Development Indicators). In contrast, India has the lowest FLFP Russia has the highest number of people in the population who are using the Internet. India has the lowest percentage of the population using the Internet in this block.

The present analysis assesses the impact of digitalization, education, fertility and GDP on FLFP in BRICS economies. The study adds to prior work in many ways. It is the first-ever study on the digitalization and FLFP nexus for BRICS. The study uses new and comprehensive econometrics techniques for rigorous results. The study has included five emerging (B—Brazil, R—Russia, I—India, C—China, S—South Africa) economies with economic and geographic importance in the respective regions and a rich natural resource base. The study provides a few important policy implications which can be generalized for any other developing country or group of countries. Therefore, specific research questions which are assessed by our study are as follows: (1) Does digitalization help to enhance the female labour force participation rates in BRICS nations? (2) Does education increase the FLFP? (3) Does an increase in GDP facilitate FLFP in the chosen nations?

The rest of the study is organized as follows: “Literature review”, “Data sources and methodology”, ”Results and discussions” and “Conclusions and policy insights”.

Literature review

This section will briefly give an overview of the selected variables, digitalization, education, fertility and growth with FLFP. The empirical evidence is taken from different economies around the globe.

Suhaida et al. ( 2013 ) illuminate that ICT enacts as a driving force in escalating a woman’s decision to work. ICT permits workers to do their job more productively, owing to greater flexibility, allowing them to work from home in Malaysia. Nikulin ( 2017 ) ascertains that when the analysis takes the evidence from 60 developing countries, there is an existence of a direct association between ICT and FLFP. Efobi et al. ( 2018 ) evaluate that ICT is considered a dominant factor in boosting FLFP with increasing magnitude: mobile phone penetration, internet penetration, and fixed broadband subscriptions in the case of 48 African countries. Asongu and Odhiambo ( 2018 ) depict that ICT functions as a productive strategy in altering FLFP in the context of 48 African countries. ICT adjusts the financial approach to instigate approving impact on female economic contribution. Samargandi et al., ( 2019 ) determine that ICT impedes FLFP in the context of Saudi Arabia. It is also revealed that financial development modifies the unfavourable effect of ICT dispersion. Jain ( 2021 ) culminates that ICT tends to have a favourable influence on FLFP in the case of India. Moreover, the positive influence of ICTs on female employment is bound to the portion of females in the proficient workforce. Hafeez et al. ( 2020 ) evaluate in the case of selected South Asian countries ICT support in improving FLFP. As (ICT) is reviewed as one of the fundamental drivers concerning women’s empowerment. Ngoa and Song ( 2021 ) demonstrate that in the case of 48 African countries, ICT plays a critical role in encouraging FLFP The impact of ICT on female employment in Africa is predominant in the industrial sector. Tüzemen et al. ( 2021 ) interpret that in the case of Turkey, there is no interrelation between ICT and FLFP. The analysis recommends that developing countries require to prosper in other aspects to gain from the opportunities that ICT provides to empower society. Viollaz and Winkler ( 2022 ) elucidate that in the case of Jordan, ICT assists in expanding FLFP because internet adoption expands online job search. Women with higher levels of education undergo a rise in employment, attaining an internet approach. Galperin and Arcidiacono ( 2021 ) exemplify that the interconnection between employment and internet use is greater among women than men in four Latin American countries. Asongu and Odhiambo ( 2022 ) exhibit that in the context of sub-Saharan African nations, ICT in broadband subscriptions emboldens the female employment rate.

Faridi et al. ( 2009 ) illuminate that education facilitates enhanced Female Labour Force participation. The coefficients of all the levels of education except primary education up to the middle level are significant in the Logit Regression equation. It is revealed that educated females are leading toward economic growth. Ince ( 2010 ) illustrates that when the analysis takes evidence from Turkey, education is a critical factor in influencing female employment as education directly influences female employment. Khanie ( 2019 ) dictates that in the case of Botswana, education functions as a substantial element in improving FLFP as women with higher education are more likely to be wage employed. In contrast, those with lower to no education are less likely to be wage employed. Bhalla and Meher ( 2019 ) interpret that even though women’s educational level is constantly increasing, the employment rates have not improved at a similar speed in Kerala. Women’s individual job preferences, family constraints, lack of adequate skills, and discouraged worker’s effects are some causes of high unemployment among females. Onyeke and Ukwueze ( 2022 ) deduce in the context of Nigeria the primary school education enrolment for females secondary school education enrolment for females and have a long-run positive impact on the female labour force participation rate. So the government should arrange all social needs to motivate schooling among Nigerian females and all citizens.

Ukil ( 2015 ) regulates that fertility has an unfavourable influence on FLFP as fertility is endogenous to female labour participation in the case of Britain. Shittu and Abdullah ( 2019 ) clarify that fertility inhibits FLFP as it has a negative impact on FLFP in the case of ASEAN-7 countries. Nazah et al. ( 2021 ) consider that in the case of 39 Asian countries, fertility was negatively significant on female labour participation in the short run but not in the long run due to its close relationship with female labour force participation. Bawazir et al. ( 2022 ) enlighten that fertility obstructs the females’ labour force participation rate in the case of Middle East countries. Bloom et al. ( 2009 ) discovered a significant negative effect of fertility on female labour force participation in 97 countries between 1960 and 2000, using abortion as an instrument and simulation variable. Nakagaki ( 2018 ) examined 176 countries using a fixed effect and a random effect and found a correlation that shifted from negative to positive by the 1990s in OECD countries. However, no clear pattern was found between female labour force participation and fertility rates in the Asian-Pacific region.

Mishra et al. ( 2010 ) enlighten that for G-7 nations total fertility rate persuades the economy towards curtailing female labour force participation as they are adversely associated. Baah-Boatenga et al. ( 2013 ) exhibit that education and fertility are effective mechanisms for escalating female labour force participation in Ghana. Abu Bakar et al. ( 2014 ) demonstrate that for 6 Asian nations, there is a presence of unfavourable connotation between the total fertility rate and female labour force participation rate. Hartani et al. ( 2015 ) elucidate that for 6 ASEAN nations total fertility rate alleviates female labour force participation. The female labour force participation rate’s highest adverse impact is perceived for Indonesia and smallest for Thailand. Tanaka et al. ( 2020 ) deduce that in Bangladesh, education tends to have a favourable influence on female labour force participation. Moreover, education leads to a favourable influence on sanitation control and children’s health.

Chapman ( 2015 ) explains that in the case of 20 countries in MENA, there is the appearance of a U-shaped relationship between economic growth and female labour force participation rates. Their transformation regarding the bottom of the U-shaped curve demonstrates the low female labour force contribution rates. Lechman and Kaur ( 2015 ) inspect that in the case of 162 countries, a U-shaped link exists between economic growth and FLFP. However, only in the case of low-income countries the U-shaped feminization hypothesis was not positively certified. Belke and Bolat ( 2016 ) resolve that when the analysis takes the evidence from 148 developed and developing countries, the outcome validates the U-shape association between economic development and female labour participation. Tasseven ( 2017 ) expounds that gross domestic product plays a pivotal role in stimulating female labour force participation positively in the context of G8 countries because male and female labour force participation is required to achieve economic development. Sasongko et al. ( 2020 ) discover that in the context of 34 provinces in Indonesia female labour force participation rate is not altered by economic growth. The Indonesian government is obliged to examine minimum wages, education, work age, and work experience as policy tools to raise the female labour force participation rate. Beton Kalmaz ( 2023 ) ascertained that education facilitates increasing female labour force participation in Turkey as they are favourably connected.

We have done much prior work but have not found a comprehensive study on the specific and chosen connotations for BRICS economies. Therefore, this study is the first-ever attempt in this regard. By looking at the prior work on the interconnections between digitalization, education, fertility and FLFP, we can infer that there needs to be more literature on the said linkages for the group of five most significant economies in the region, i.e., BRICS. Thus, the present study attempts to illustrate the association between digitalization, education and FLFP. The study also incorporated other critical economic indicators. The empirical outcomes of the present research will pave the way for policymakers to formulate suitable policies for the developing economies included in the sample.

Theoretical framework and data

Even though we could not find any comprehensive study for the chosen nations based on a theoretical underpinning we have established from various notable works on the subject of interest (Hafeez et al., 2020 ; Onyeke and Ukwueze, 2022 ), we have developed our theoretical model, which we will discuss in this section. In the case of five selected BRICS economies, the current analysis evaluates the impact of digitalization and education on FLFP. Furthermore, it will also confabulate the impact of fertility and economic growth on FLFP. The period for the said analysis is from 1990 to 2020. We will have the following functional form to test the resource curse hypothesis.

FLFP signify female labour force participation, Edu is years of education, Digi is digitalization. Our analysis incorporates two other essential economic indicators, i.e., GDP and fertility, to elucidate their influence on FLFP. Equation ( 1 ) “ i” illustrates the cross-sections of Brazil, Russia, India, China and South Africa, whereas “ t ” is the time frame.

Equation ( 3 ) reveals the regression form for our analysis. \(\phi _{it}\) is a cross-section specification term, and it is the error term.

To reduce the skewness in the data, we have taken the natural logarithm of the selected variables. In Eq. ( 3 ), FLFP is the female labour force participation (World Development Indicators). GDP is the gross domestic product at constant dollars (2010) (WDI). Education stands for secondary school enrolment for women (WDI). Fertility is represented by the fertility rate. For digitalization, we have taken the number of internet users in the total population. Even though this number is gross and considers females and females, if the number of internet users increases, it will be evenly distributed in a household and the population.

We looked closely at the prior literature to specify the expected interconnections among selected variables.

We have also included education in our empirical study. Looking at the prior literature, we expect that Edu positively influences FLFP.

The interconnection between fertility and FLFP is expected to be positive.

In the end, we included GDP in our analysis; we expect a positive association between these two variables.

Methodology

Unit root tests.

Nowadays, economies are interconnected on different grounds, for instance, economic, financial, and cultural. Consequently, oil price shocks, financial crises, pandemics, the interdependence of residuals, and unobserved common factors are connected with cross-section dependence (Csd). Our empirical outcomes are spurious and biased if we do not consider the issue of Csd. Thus, it is mandatory to consider the issue of Csd in our analysis. Here to cope with the issue of Csd, we have utilized Pesaran ( 2015 ) Csd test. It is always better to Csd test before testing the stationarity of the data. Based on the Csd statistics, we specify the unit root we will apply to our selected variables.

In panel data studies, we divided unit root tests into various generations based on different issues we have to come across in panel data estimation. For example, first-generation tests (Maddala and Wu, 1999 ; Choi, 2001 ; Levin et al., 2002 ) are more likely to be dealt with non-stationarity with homogeneous panels. The issues related to non-stationarity with heterogeneous panels are solved by Im et al. ( 2003 ). Furthermore, to address the issue of structural breaks, we prefer to apply a test given by Lluís Carrion‐i‐Silvestre et al. ( 2005 ); however, this test cannot tackle the issue of Csd.

In a nutshell, second-generation tests can deal with the issues of heterogeneity and Csd between the units, but these tests cannot consider the issue of structural breaks. To overcome the issue of structural breaks in panel data, we prefer to apply third-generation unit root tests because these tests consider the three most compelling issues of panel data, heterogeneity, Csd, and structural breaks. Thus, the present analysis will apply two tests: Bai and Carrion-I-Silvestre ( 2009 ) and Pesaran ( 2007 ).

Cointegration testing

The most compelling drawback with first-generation cointegration approaches (McCoskey and Kao, 1998 ; Larsson, 2001 ; Pedroni, 2004 and Westerlund, 2005 ) is that in the presence of Csd, these approaches are unable to offer unbiased estimates—size properties distortions. In addition, a few other approaches, including Kao et al. ( 1999 ) and Pedroni ( 2001 ), cannot overcome the issue of Csd. We aim to use the most appropriate and comprehensive cointegration test, which can give us rigorous estimates even in the presence of heterogeneity, Csd, and structural breaks. Therefore we consider heterogeneous estimation methods, Westerlund and Edgerton ( 2008 ) and Banerjee and Carrion‐i‐Silvestre ( 2017 ). Also, these methods have the edge over a few other methods, like, Westerlund ( 2007 ), which deals with the issue of Csd and heterogeneous slopes parameters. Still, it is unable to solve the problem of structural breaks in the panel data. Thus, this method may reject the null hypothesis of no cointegration even if there is a cointegration. Westerlund and Edgerton’s ( 2008 ) comprehensive method also elucidates the issues of Csd, autocorrelation, heterogeneous slopes, and structural breaks. However, in the present analysis, we have utilized Banerjee and Carrion‐i‐Silvestre’s ( 2017 ) test, which considers common correlated effects mean group. This approach has many merits in dealing with non-stationary data, heterogeneity, and weak and strong Csd.

Cross-sectionally augmented autoregressive distributed lags (CSARDL) model

As previously mentioned that panel data has to suffer from different issues. Moreover, countries have to confront various kinds of shocks, for example, economic disturbances and financial shocks, pandemics and natural disasters. These shocks cause the issue of Csd. If we do not incorporate these shocks into our analysis, we get biased results. To deal with the issue of slope heterogeneity and also Csd, we apply the most compelling approach CSARDL. We start with,

Equation ( 3 ) elucidates the autoregressive distributed lags model, but in the presence of cross-section dependence, it provides biased results. Nonetheless, in Eq. ( 4 ), we have used a cross-section average of each regressor. To overcome the issue of Csd, Eq. ( 5 ) gives the advantage to solve the unfitting inference related to the presence of threshold effects (Chudik and Pesaran, 2015 ).

In Eq. ( 5 ) \({\bar{Y}}_{i,t-1}={\bar{V}}_{i,t-1},{\bar{X}}_{i,t-1}\) specify the averages of the dependent variable, i.e. FLFP and independent variables Digi, Edu, Fert and GDP. NW, \(n_z\) and \(n_y\) are lags of each variable. Also, \(V_{i,t}\) represents the dependent variable and \(X_{i,t}\) represents the set of independent variables. Whereas \({\bar{Y}}\) refers to the cross-section averages, this helps us to overcome cross-section dependence caused by any economic crisis.

Equation ( 6 ) has confabulated the long-run coefficients from the short-run coefficients estimated by the CSARDL model.

Next, we will derive the long-run coefficients and mean group estimates.

The short-run coefficients are

where \(\Delta _K = t - \left( {t - 1} \right)\)

Besides, short-run coefficients are

It is observed that the CSARDL approach is almost similar to the pooled mean group. In addition, the error correction term (Ect) elucidates the adjustment process towards equilibrium. The Ect quantifies the period an economy takes to reach equilibrium.

Robustness tests

In the presence of heterogeneity and Csd, the traditional econometrics approaches provide biased results (Yao et al., 2019 ). To get unbiased empirical results, we use two tests to check the robustness of the model; The first test is called augmented mean group (AGM) (Eberhardt and Teal, 2010 ). Similarly, the other test is established by Pesaran ( 2006 ), and it is called the common correlated effect mean group (CCEMG). These tests help researchers to cope with three issues, i.e., Csd, slope heterogeneity, and structural breaks. Another merit of applying the CCEMG is that it deals with the issue of identification and time-variant unobservable with heterogeneous slopes.

Furthermore, this test also overcomes all sorts of spillover effects by averaging dependent and independent variables for all the cross-sections. Simultaneously, it includes all kinds of global and country-specific shocks, such as oil price shocks or any other local spillover effects (Pesaran and Tosetti, 2011 ). The AMG is another compelling test considering issues like Csd, heterogeneity, and structural breaks. By including the years’ dummies, this test also solves the issues of unobservable factors (Eberhardt and Teal, 2010 ).

Empirical results and discussions

The present analysis confabulates the impact of Digi, Edu, Fert and GDP on FLFP for a sample of five developing economies, BRICS. Moreover, our analysis also illustrates the evidence of the “resource curse hypothesis” in these nations. In the past few years, economies have been economically and financially interconnected. Thus, fluctuation in aggregate demand of one economy may transfer to the other economies. In order to overcome the presence of any biasness and ambiguity in the model specification, we cannot ignore the integration of these financial, economic and cultural shocks within these economies. We may not get unbiased results if we do not consider these effects. Thus to overcome these issues, we apply the Csd test (Pesaran, 2015 ). We accepted the alternative hypothesis and inferred that our selected variables in selected countries are cross-sectionally dependent (Table 1 ).

By looking at issues like Csd, slope heterogeneity, and structural breaks, we utilized the two most suitable unit root tests belonging to the third-generation family. Table 2 shows the empirical outcomes of Pesaran ( 2007 ) and Bai and Carrion-I-Silvestre ( 2009 ) unit root tests. It is revealed from the empirical outcomes in Table 3 for Pesaran ( 2007 ) and Bai and Carrion-I-Silvestre ( 2009 ), which do not reject the null hypothesis at the level, i.e., I(0) and as illustrated previously that these tests have three main issues of panel data analysis. We do not reject the null hypothesis of non-stationarity for selected variables for the Bai and Carrion-I-Silvestre ( 2009 ) unit root test by considering the issue of possible structural breaks in the data. However, in the case of Pesaran ( 2007 ), all of the selected variables are stationary at the level. Considering this, we have utilized Bai and Carrion-I-Silvestre ( 2009 ) at the first difference, i.e., I(1). Table 3 also illustrates that by rejecting the null hypothesis, we know that selected variables, FLFP, Digi, Edu, Fert, and GDP are stationarity at the first difference.

We applied Swamy’s slope homogeneity test (Pesaran and Yamagata, 2008 ). This test confabulates the existence of homogenous or heterogeneous slope coefficients. As per prior literature, homogeneous slope coefficients give misleading results (Zhong and Yang, 2022 ). Our empirical outcomes in Table 3 accept the alternative hypothesis, i.e. slopes are heterogeneous at a 1 per cent level of significance.

Once we find out about the order of integration, that is, I (1), we will specify the suitable methods for the long-run interconnection among the included variables. For this purpose, we will consider the cointegration test by Westerlund and Edgerton ( 2008 ). The null hypothesis is that there is no evidence of cointegration among the selected variables. The main advantage of this test is that we can use this test in the presence of the four most fundamental problems: heterogeneity, serial correlation, structural breaks, and cross-sectional dependence. The Westerlund and Edgerton ( 2008 ) cointegration estimation technique illustrates that all of the selected variables are cointegrated. Therefore, we can conclude a long-run interconnection among the selected variables for the sample of BRICS economies (Table 4 ).

We have elaborated on the estimated results of Banerjee and Carrion‐i‐Silvestre’s ( 2017 ) cointegration analysis in Table 5 . The estimates confirm the cointegrating interconnections between FLFP, Edu, Fert and GDP and FLFP at a 1 per cent level of significance. This is also valid in the case of the full sample and for each country included in the sample, Brazil, Russia, India, China and South Africa. The empirical results for both tests, i.e. Westerlund and Edgerton ( 2008 ) and Banerjee and Carrion‐i‐Silvestre ( 2017 ), are consistent with the prior literature, for instance, Li et al. ( 2022 ) and Wei et al. ( 2022 ). Besides, the estimated results for Banerjee and Carrion‐i‐Silvestre ( 2017 ) for FLFP also support the cointegrating relationship.

Table 6 illustrates the empirical outcomes of the CSARDL model. The empirical analysis confabulates that digitalization positively affects FLFP with a coefficient of 0.261, which is highly significant. It shows that a 1 per cent increase in access to the Internet is resulting in an increase in FLFP in the BRICS block. Hafeez et al. ( 2020 ) assess the role of ICT in improving FLFP in selected South Asian nations. As (ICT) is recognized as one of the significant factors in women’s empowerment. Ngoa and Song ( 2021 ) demonstrate that ICT plays a crucial role in encouraging FLFP in 48 African nations. According to Tüzemen et al. ( 2021 ), in the case of Turkey, there is not any connection between ICT and FLFP. Viollaz and Winkler, 2022 explain that in the case of Jordan, ICT contributes to the growth of FLFP because internet penetration increases online job search. Women with higher levels of education experience an increase in internet-based employment attainment. Galperin and Arcidiacono ( 2021 ) demonstrate that the correlation between employment and internet use is stronger among women than men in four Latin American countries. Asongu and Odhiambo ( 2022 ) prove that in the context of sub-Saharan African countries, ICT in the form of broadband subscriptions boosts the female employment rate.

Furthermore, females’ education is positively interconnected with FLFP for BRICS economies. It has a coefficient of 0.361 and is highly significant at a 1 per cent significance level. It means that a 1 per cent increase in females’ education leads to a 0.361 per cent expansion in FLFP. The findings are in line with the prior studies on the same idea. Onyeke and Ukwueze ( 2022 ) deduce in the context of Nigeria that the primary school education enrolment for females and secondary schooling enrolment rates for females have a positive long-term impact on the female labour force participation rate.

On the same line, the next included variable is fertility with a coefficient value of 0.220, and it has a negative interconnection with FLFP and is significant at 5 per cent. It reveals that a 1 per cent upsurge in fertility will lead to a 0.220 per cent decrease in FLFP. Our results align with the prior literature; for instance, Ukil ( 2015 ) states that fertility has a negative effect on FLFP because fertility is endogenous to female labour participation in the United Kingdom. Shittu and Abdullah ( 2019 ) explain that fertility hinders FLFP because it has a negative effect on FLFP in ASEAN-7 countries. Due to its close relationship with female labour force participation, Nazah et al. ( 2021 ) deduce that in 39 Asian nations, fertility had a detrimental effect on female labour force participation in the short term but not in the long term. Bawazir et al. ( 2022 ) exemplify that fertility hinders female labour force participation in Middle Eastern nations.

To investigate the impact of economic growth on FLFP, we have included GDP in our empirical model and elucidated its interconnection with FLFP. We have seen from the empirical outcomes of the CSARDL model that GDP is exerting a favourable influence on FLFP in these economies. It is also significant at 1 per cent. We have compared our inferences with the prior literature. Belke and Bolat ( 2016 ) conclude that the U-shaped relationship between economic growth and female labour participation is supported by the evidence from 148 developed and developing countries. Tasseven ( 2017 ) describes that the gross domestic product plays a crucial role in positively stimulating female labour force participation in G8 countries. Sasongko et al. ( 2020 ) demonstrate that economic growth has no impact on the female labour force participation rate in 34 provinces of Indonesia.

After illustrating the long-run empirical outcomes of the CARDL model, we will now elucidate the short-run results of the CSARDL model. We can infer from the empirical outcome shown in Table 7 that digitalization, education and GDP are positively interconnected with FLFP in BRICS economies in the short run. On the other hand, fertility is negatively and significantly associated with FLFP in the selected region. Moreover, the negative value of the error correction term highlighted convergence toward equilibrium, and the coefficient value of ECT is −0.211, which also reveals the peace of adjustment in the short run in these economies. In addition, the short-run coefficient values of Digi (−0.176), Edu (0.125), Fert (0.081), and GDP (0.071) are lower than their long-run magnitudes. It elucidated that these economies are developing economies.

The AMG and CCEMG tests are applied to assess the model’s robustness. Both tests elucidate the positive influence of digitalization on FLFP, and it is significant at 1 per cent. Furthermore, Edu and GDP also influence FLFP favourably, which is significant at 1 per cent. The fertility is also negatively connected with FLFP in AMG and CCEMG test estimates and is significant at 1 per cent. These results replicate our prior results from the CSARDL model for the five developing economies (Table 8 ).

Conclusions and policy implications

Even with the rapid and pervasive digital change of the global economy over the past decade, remarkably few studies have evaluated the effects of digitalization on labour market outcomes, particularly for women and emerging economies.

The prime motive of the present analysis is to discuss the impact of digitalization, education, fertility and GDP on FLFP in the panel of five BRICS economies. The study has utilized the latest available econometrics approaches to test these interconnections. For the empirical results, the analysis inspects the cross-section dependence using the latest available tests proposed by Pesaran ( 2015 ). After discovering the cross-section dependence, the present study applied the advanced, third-generation unit root tests. The empirical analysis also elucidated the presence of a long-run relationship among selected variables in the case of five developing economies.

Moreover, we have utilized the cross-sectional augmented autoregressive distributed lags (CSARDL) approach to validate the presence of short-run and long-run interconnections among these variables. The most significant contribution of this study is that it validates the existence of a positive connection between digitalization and FLFP in these economies. Additionally, gross domestic product is positively connected with FFLP; GDP also positively influences FLFP. However, the fertility rate is negatively associated with FLFP in the short and long run. Nonetheless, we have observed that the magnitude of the coefficients of these variables is higher in the long run compared to the short run. It shows that these economies are developing economies.

Our study extends a few significant policy insights based on our empirical estimated results. It is an essential quest for the policymakers in these economies to bring about policies based on promoting digitalization in these economies. These economies must focus on the new investment in information and communication technologies. To promote FLFP, it is important to give access to the Internet to the population at cheaper rates. The second most important factor is education. Women should be encouraged to get higher education in BRICS economies to promote FLFP. These economies need to make it mandatory for all women to get the higher secondary level of education. The policy upfront applies equally to the rest of the world, especially emerging nations. The current wave of literature and empirical evidence believe working from home has become normal. Therefore the nations must take aid from digitalization to run the labour markets smoothly. The empirical findings and implications open new horizons for developing nations to invest in digitization and education for females. The other blocks, for example, South Asian and MINT economies, can benefit from the present study’s findings.

Our empirical findings provide a few interesting insights for future research. In the future, researchers and academicians may utilize the same panel of the selected economies and validate the digitalization and FLFP interconnection by adding different macroeconomic variables, for example, inflation, poverty indices, fiscal and monetary policy tools, technological innovations and remittances. Future research could be focused on a different set of economies and regions, and most essentially, they may compare the macroeconomic policies of low, middle and high-income economies.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Shuangshuang, Y., Zhu, W., Mughal, N. et al. The impact of education and digitalization on female labour force participation in BRICS: an advanced panel data analysis. Humanit Soc Sci Commun 10 , 598 (2023). https://doi.org/10.1057/s41599-023-02020-2

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DOI : https://doi.org/10.1057/s41599-023-02020-2

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INDIAN PARADOX: RISING EDUCATION, DECLINING WOMENS’ EMPLOYMENT

Esha chatterjee.

1 University of Maryland, College Park, USA. ude.dmu@tahcahse .

Sonalde Desai

2 University of Maryland, College Park, USA.

Reeve Vanneman

3 University of Maryland, College Park, USA.

Background:

Theories of human capital would suggest that with more education, women acquire greater skills and their earnings increase, resulting in higher labor force participation. However, it has been long known that in India, women’s education has a U-shaped relationship with labor force participation. Part of the decline at moderate levels of education may be due to an income effect whereby women with more education marry into richer families that enable them to withdraw from the labor force.

The paper uses the first comprehensive Indian income data to evaluate whether the other family income effect explains the negative relationship between moderate women’s education and their labor force participation.

Using two waves of the India Human Development Survey, a comprehensive measure of labor force participation is regressed on educational levels for currently married women, 25–59.

We find a strong other family income effect that explains some but not all of the U-shape education relationship. Further analyses suggest the importance of a lack of suitable employment opportunities for moderately educated women.

Conclusion:

Other factors need to be identified to explain the paradoxical U-shape relationship. We suggest the importance of occupational sex segregation, which excludes moderately educated Indian women from clerical and sales jobs.

Contribution:

This paper provides a more definitive test of the other family income effect and identifies new directions for future research that might explain the paradoxical U-curve relationship.

1. Introduction

The low rates of Indian women’s labor force participation have long been a magnet for academic inquiry. Most recent studies have noted the generally J-shaped or U-shaped relationship of women’s education with their labor force participation ( Reddy 1979 , Sathar and Desai 2000 , Das and Desai 2003 ; Kingdon and Unni 2001 , Das 2006 ; Klasen and Pieters 2015 ). As national participation rates have continued to decline over the last few decades ( Abraham 2013 ; Chatterjee, Murgai, and Rama 2015 ), cohort shifts out of low levels of education to intermediate and secondary education have been blamed for much of this decline ( Afridi, Dinkelman, and Mahajan 2016 ).

Nevertheless, the curvilinear relationship itself has received surprisingly little direct research attention. Most studies note the U-shaped relationship but usually fail to take the next step of trying to explain it empirically. This is especially surprising since the downward sloping part of the curve is so counter-theoretical. Neo-classical theory predicts that increases in women’s education should usually lead to a rise in women’s labor force participation rate. More education makes you more productive so your potential earnings rise, creating a greater incentive to join the labor force and substitute employment for leisure or home labor.

India is unusual but not unique for having lower rates of labor force participation among adult women with secondary education. Among 71 countries with appropriate census data in the IPUMS-I data archive, only 14 countries have lower rates of labor force participation for adult women with secondary education than for women with less than completed primary school. And India has the second largest gap (19% vs. 35%), exceeded only by Rwanda (72% vs. 92%). But several other countries also show lower rates of labor force participation for secondary educated women (e.g., Indonesia, 47% vs. 63%; Turkey, 34% vs. 46%; and Ghana, 76% vs. 84%). So, this counter-theoretical result deserves more research attention than it has been given.

Past studies have suggested that both cultural factors, such as norms restricting the mobility of women, and structural factors, such as a lack of appropriate job opportunities for educated women, play important roles in determining the U-shaped relationship between women’s education and labor force participation in India ( Das and Desai, 2003 ; Das 2006 ). But these cultural and structural explanations are more often asserted than tested.

Theory also predicts that the relationship between education and employment is governed by both an income and a substitution effect. The substitution effect implies that educated women command higher wages that would encourage them to substitute participation in the labor force for leisure or home work. But the income effect on the other hand posits that educated women have higher incomes for the same amount of work encouraging them to devote more time to leisure or home work. In addition, and more importantly, educated women tend to marry educated men with higher incomes so the higher (unearned) family incomes would further discourage women’s participation in the labor market. Combined with a cultural norm that confers higher status on women at home, other family income can act as a powerful deterrent to educated women’s labor force participation. Where patriarchal norms are less dominant, the substitution effect should overshadow the income effect ( Brinton, Lee, and Parish 1995 ). But in India, we would expect the income effect to be especially strong.

However, most past studies in India have used National Sample Survey data in which it is not possible to separate other family member’s income from a women’s own earnings, thus making it difficult to distinguish income and substitution effects. The present study uses the India Human Development Surveys (IHDS) that measure both a woman’s own earnings and other household income, thus permitting a better separation of income and substitution effects for educated women. While the results confirm a strong negative effect of other family income on women’s labor force participation, they again find a U-shaped relationship between women’s education and her labor force participation even after taking into account other family income. The other family income controls make the negative sloping part of the curve flatter and the positively sloping part steeper but the relationship remains curvilinear rather than uniformly positive.

A further analysis examines the relationship between women’s education and three different categories of work: salaried positions paid monthly, casual wage work, and work in family farms or businesses. For salary work, the expected positive linear relationship is observed: the more education she has, the more likely she is to work in a salaried position. However, for women employed in their family farms and businesses, or as wage labor, the relationship is also linear but negative. The observed U-curve is a resolution of these separate linear relationships.

The negative relationships are likely because more educated women do not want to work in jobs that do not match their aspirations. The positive relationship with salaried positions is not sufficient to produce the expected overall positive relationship because there are not enough salaried positions open to women with moderate levels of education. The paper concludes by noting the possible importance of occupational sex segregation in excluding women from clerical and sales jobs that in most countries have been a major source of employment for moderately educated women.

2. Literature Review

While “economic factors largely determine male participation in employment, the factors that influence a woman’s participation in work are varied and include reproductive, demographic, social, religious and cultural factors” ( Srivastava and Srivastava 2010 ). Of these, education and family income are especially important because of their prominent role in labor supply theory.

a) Education

Theories of human capital predict that an increase in skills would provide women a greater opportunity to earn higher wages, and this in turn would increase women’s labor force participation ( Smith and Ward 1985 ; Goldin 1990 ; England, Garcia-Beaulieu, and Ross 2004 ). In most developed countries, increases in education cause an increase in women’s labor force participation ( Cain 1966 ; Tienda, Donato, and Cordero-Guzman 1992 ; England, Gornick, and Shafer 2012 ). Interestingly, however, the story is often quite different in the low and middle-income countries. In Peru, King (1990) reported that while education was associated with a decline in women’s labor force participation, it did increase the proportion of women in paid employment. On the other hand, in Ecuador, Jakubson and Psacharopoulos (1992) find that schooling has a positive effect on women’s labor force participation even though the effect is small. The predicted probability of labor force participation of a woman with 16 years of schooling (other traits unchanged) is 11 percentage points higher than for a woman with no schooling.

Reports from South Asia have often highlighted a generally negative relation between increased levels of education and decreases in women’s workforce participation rate, noting that illiterate women are more likely to be employed than educated women ( Sathar and Desai 2000 ; Das and Desai 2003 ). Other studies with more educational detail (e.g., Reddy 1979 ) find a J-shaped relationship between women’s education and their labor force participation with increases only at the highest educational levels. Others ( Mathur 1994 , Kingdon and Unni 2001 , Das 2006 ) find a U-shaped relationship with schooling beyond the junior/middle level enhances women’s wage work participation.

Complex socio-economic phenomena underlie this paradox. Explanations generally rely on some combination of structural and normative ideas: the disincentives from other family income, restrictive gender norms especially those that attribute higher social status to non-working women, greater emphasis on domestic duties and child-rearing in a newly competitive educational system, and the lack of “suitable” work for educated women. But it is difficult to test these explanations empirically with existing data.

b) Other family Income

Increases in women’s labor force participation as education increases (as predicted by human capital theory) could be depressed somewhat due to the income effect of other family income. More educated women are likely to marry more educated men with higher incomes. If family income is high, women would have less incentive to work ( Goldin 1990 , England, Gornick, and Shafer 2012 ). Abraham (2013) argues that the rising incomes of Indian households have enabled Indian women to withdraw from the labor market and focus on their role in “status production”. As with the United States at the turn of the century, one of the markers of the household having attained a middle class status may be to ensure that women from these burgeoning middle classes do not have to work ( Treas 1987 ). Using unit level data from the National Employment Survey in urban areas of India, Klasen and Pieters (2015) have confirmed that rising levels of household income play an important role in declining rates of women’s labor force participation.

c) Other Factors

It has always been more socially acceptable for women of lower castes to be in the labor market ( Kingdon and Unni 2001 ). Women from the higher castes tend to face greater restrictions on their mobility. However, women from families of the middle and lower castes with improved social standing also prefer to stay at home as an effort at “Sanskritization” ( Srinivas 1966 , Chen and Drèze, 1995 ), an attempt to follow a more Brahminical way of life. The greater the seclusion for the woman, the greater would be the prestige for the family ( Chen 1995 ).

Caste also has an impact on the educational opportunities women face ( Dunn 1993 ). Thus, part of the higher rates of labor force participation among illiterate women may be a result of their lower caste status. Similarly, some of the decline in labor force participation with more education may result from the higher concentrations of forward castes among moderately educated women.

Historical perspectives on women’s labor force participation in India note that a majority of female workers have been involved in agriculture (e.g., Nath 1968 ). Consequently, women’s labor force participation has always been higher for rural then urban areas. Few women have been employed in the modern sector where educational credentials are more important. India is one of the exceptional countries where the modern sector has experienced a fall in women’s work force participation despite women’s rising education ( World Bank 1991 , Swaminathan 1994 ).

A slow shift in the industrial structure out of agriculture ( Abraham 2013 ) has been a leading cause of recent declines in women’s labor force participation ( Mehrotra and Perida forthcoming ). Critics of India’s Structural Adjustment Program, introduced in 1991, have argued that these policies also led to a decline in women’s employment because of declines in the unorganized sector ( Mundle 1992 ). Others (e.g., Papola 1994 ), on the other hand, proposed that a newly restructured economy could favor the unorganized sector where wages were low and working conditions poor, perhaps having a favorable impact on women’s employment. In India, the growth in the female share of employment in industries and services is behind other South and South East Asian countries (other than Nepal) although declines in female employment have long been theorized to follow the early stages of development ( Boserup 1970 ). Pampel and Tanaka (1986) and Mammen and Paxson (2000) , for instance, observe the expected U-shaped relationship between women’s labor force participation and GDP per capita. All of these studies point to the importance of the type of jobs available as a central moderating influence on the relationship between education and women’ labor force participation.

3. Why IHDS?

The IHDS enjoys several advantages over other surveys for analyzing employment. It has a more complete measure of women’s labor force participation by reviewing each household economic activity (own farm work, nonfarm businesses, wage or salaried labor) and asks which members participate in each activity. This gives a clearer picture of who is participating in the labor force than does a single question about each person’s principal or secondary activity. Even if a woman’s principal and secondary activities are household work, she could still be engaged in seasonal farm work or assisting other household enterprises. Another advantage of IHDS is that unlike previous studies that have information only on total household consumption (which is endogenous to the woman’s own earnings) or husband’s and other family members’ wage earnings, IHDS has more complete estimates of other family incomes. Abraham (2013) , for instance, recognizes the theoretical importance of other family income, but can only use household consumption (“a robust proxy”) from the NSS. He finds an unexpected curvilinear U-shape relationship of women’s labor force participation with household consumption levels for urban households, a result that we suspect is driven by the additional women’s income in high consumption households. In the IHDS measure, the relationship is consistently linear and negative, as theory would predict.

Klasen and Pieters (2015) measure total other household earnings in their NSS data but try to avoid problems of self-employed incomes by restricting their sample to urban areas and imputing self-employed earnings based on earnings of similar employees (“a fairly rough approximation”). The IHDS has a more direct measure of self-employed incomes and also has several additional measures of unearned income (e.g., remittances, rents, pensions). According to the two waves of IHDS about 45% of households are engaged in own farm work and 20% have at least one nonfarm business (29% in urban areas). Moreover, 46% of households report some type of unearned income. Thus, it is difficult to measure the impact of other household income effects if these income sources are ignored.

4. Hypotheses

The present study uses the IHDS data to test the following hypotheses: Hypothesis 1: More women’s education is associated with a decline in women’s labor force participation rate (LFPR) up to secondary education with a slight uptick for post secondary education.

Hypothesis 1 restates the often observed relationship between Indian women’s labor force participation and education as U-shaped. The next hypotheses evaluate two theories that could explain the U-shaped relationship. While hypothesis 2 evaluates the “income effect”, hypothesis 3 examines a labor market hypothesis.

Hypothesis 2a: Higher levels of other family income are associated with a decline in women’s LFPR.

Hypothesis 2b: Women with more education live in households with higher levels of other family income and those higher income levels explain the initial declines in their labor force participation.

As husband’s and other family income increases, women’s incentive to work declines. Holding constant other family income should straighten out the U-curve and reveal the more theoretically conventional positive increases with increasing education.

Hypothesis 3a: An increase in education is associated with an increase in women’s employment in salaried jobs.

Hypothesis 3b: An increase in education is associated with a decline in women’s employment in their own family farms and businesses.

Hypothesis 3c: An increase in education is associated with a decline in women’s employment in agricultural and non-agricultural wage work.

It is difficult for women with little education to get high quality, salaried, jobs. With post-secondary school education better quality jobs become more accessible, so the higher returns to a better quality job and the increase in social status associated with it lead to more employment. On the other hand, educated women would not want to work in outside jobs perceived to be below their educational level as it lowers their social status. Therefore employment in manual labor or even household enterprises would decline.

Hypotheses 3a to 3c explain the U-shaped relationship only when different types of work are aggregated together. While on one hand there will be a steady increase in demand for white-collar jobs among educated women, these jobs would be available only to women with the highest levels of education. Because there is a limited supply of such jobs, women with moderate levels of education are left out of the labor market.

5. Data and variables

The present study uses data from the two waves of IHDS ( India Human Development Survey 2016a ). IHDS1 is a nationally representative sample of 41,554 households in 2004–2005 spread across all the States and Union Territories of India (except for the small territories of Andaman Nicobar and Lakshadweep). The sample covers 384 districts, 1503 villages and 971 urban blocks. These 41,554 households include 215,754 individuals. In 2011–12 a second wave re-interviewed the same households with an 83% re-contact rate. The IHDS2 sample was augmented slightly to adjust for higher attrition in urban areas. The analysis sample is restricted to married women, age 25–59. Many women below 25 are still enrolled in an educational institution and women above the age of 59 would be likely to retire.

The IHDS is a multi-topic survey that encompasses different modules related to health, education, employment, marriage, gender relations, economic status, social capital, and other issues. The household economic questionnaire was usually answered by the head of the household, or by someone who had sufficient knowledge about the income, expenditure, and employment status of household members.

Measuring women’s employment can be especially challenging because often women are involved in part time or seasonal jobs, or they could work from home, or they may participate in the labor market only in times of a family crisis ( Beneria 1982 , Folbre 1995 , Hirway 2002 , Das 2006 ). As noted above, the IHDS measure of workforce participation is more detailed than for other surveys. Unlike the NSS that asks for a woman’s principal and secondary status activities, the IHDS has separate modules for different types of work (e.g., on the household farm, wage labor, in household nonfarm businesses) and asks which household members participated in each type of work during the previous year. In the present study anyone who worked for at least 240 hours in the previous year across all types of work is considered to be in the labor force. Caring for household animals, collection of firewood or other fuels, and fetching water from public sources were not included as labor force participation as these are usually regarded as normal household chores in India.

In addition to the overall measure of labor force participation, the analysis also disaggregates work participation into three types: self-employment in own farm and nonfarm businesses, salaried work (defined as monthly remuneration), and casual agricultural and nonagricultural wage labor paid daily. For each category of work, if the woman works for more than 0 hours per year in that type of work and for greater than 240 hours per year in any kind of work, they are considered to be working in that work category. It should be noted that women can be considered employed in multiple work categories.

Women’s education is divided into six categories: illiterate, pre-primary (0–4 years), primary & post primary (5–9 years), secondary (10–11 years), higher secondary (12 + years with no degree) and college graduate or higher.

Like employment, personal earnings and household incomes are also aggregate measures built up across many survey modules. In addition to income and benefits from each type of work, the survey also asked about household income from remittances, rental and property income, pensions, and government programs ( India Human Development Survey 2016b ). Other family income was calculated for each household member by subtracting that person’s earnings from total family income. For household enterprises with multiple household workers, each member’s own earnings were calculated as their proportion of total household hours worked multiplied by the net income from that enterprise. The log of other household income was calculated except for a small percentage (2.1%) of women with negative or negligible other household incomes below Rs.1000 (usually households with crop failures resulting in negative net incomes). A separate dummy variable identified these women who were then assigned the floor value of ln(1000) for other household incomes.

The analysis also includes controls for years of husband’s education (a continuous variable ranging from 0 to 15), the number of children under six and six to fifteen in the household; the number of married women in the household; age in five year categories; four caste groups: Forward Castes, Other Backward Castes, Scheduled Castes (SCs or Dalits), and Scheduled Tribes (STs or Adivasis); three religious groups: Hindus, Muslims, and other minority religions; urban or rural residence; and dummy variables for state fixed effects.

6. Analysis

6.1. descriptive statistics.

Table 1 gives descriptive statistics of all variables for the sample of 72,620 currently married women aged 25–59. Of these, 41.6% are employed in some kind of work for at least 240 hours in the preceding 12 months: 4.8% are employed in salaried work, 26.9 % work in family farms or businesses and 20.3% in agricultural and non-agricultural wage work. In the sample, 47.4% of women are illiterate, 26.7% have completed primary school education and only 5% are college graduates.

Summary Statistics

Source: IHDS1 and IHDS2.

The bivariate relationship between women’s LFP and their education is J-shaped as has been found in most previous research. Table 2 shows that increases in education from none to completed secondary school are associated with a steady, steep decline in women’s labor force participation from 53.3% to 22.4%. There is slight increase in women’s labor force participation thereafter; 28.1% of women who are college graduates are employed.

Labor Force Participation and Other Family Income by Women’s Education.

As expected, married women’s education is also closely related to her husband’s education and, thus, the income of her family. Column 2 reports the close relationship between wives’ and husbands’ education – the familiar fact of marriage homogamy. Partly as a result of this homogamy, column 3 reports the quite linear relationship with the logarithm of other family income. Each year of a woman’s education is associated with a similar proportional increase of her family’s income. For convenience, column 4 translates those annual averages to Rupees at 2012 prices. The bivariate association of other family income with women’s labor force participation is also predictably negative and linear (results not shown). Of women whose families have less than Rs 8000 income, 62.2% are in the labor force; for women in families with over Rs150,000 income, only 21.5% are in the labor force. The research question is whether these other family income relationships are sufficient to explain the steep decline of women’s labor force participation in column 1. We address that question in the next section.

Finally, columns 5 through 7 show the bivariate relationships of a woman’s education with the three types of employment: salaried work, family enterprises (farm or nonfarm), and casual wage labor. Each of these is a fairly linear relationship. With rising education, employment in salaried work increases steadily, falls dramatically for casual wage labor, and falls more gradually for work in family farms and businesses. What is important here is that whereas each relationship is quite linear, aggregated together the relationship becomes the familiar curvilinear J-shape (column 1).

6.2. Logistic Regressions of Labor Force Participation.

Three logistic regression models predicting the log odds of a woman being employed are estimated. In the first model, the log odds of a woman being employed is estimated using only the education categories. The estimated coefficients reflect the J-shape curve seen in the bivariate relationship of Table 2 . The odds decline steadily from illiteracy to secondary completion and then bend upwards for higher secondary and college graduates.

The second model adds other family income to the education categories. Not surprisingly, the estimated effect is quite large: a doubling of other family income (a little more than half a standard deviation) would reduce the average woman’s labor force participation rate from 41.6% to 33.4%. Our interest, however, is mainly in the consequences for the education estimates. The estimated decline in the log odds of employment from illiteracy to completed secondary schooling is reduced from −1.403 in model 1 to −1.038 in model 2. The estimate is still sharply negative however; controlling for the income effect does not transform the education association into the expected positive linear relationship (i.e., hypothesis 2b is not supported). A more noticeable change can be seen for the observed uptick among women with higher secondary education and college diplomas. The log odds for college graduates being in the labor force are 0.65 greater than those with secondary education after controls for other family income as compared to only 0.34 in model 1.

The third model adds basic control variables: husband’s education, her age, number of children under 6 and under 16, number of married women in the household, religion, caste, area of residence, and dummy variables for state fixed effects. Several of these relationships are quite strong. Dalits and especially Adivasis are much more likely to be in the labor force than Forward Castes, even at the same levels of education and other family income. Because Dalit and Adivasi women are clustered at lower levels of education, some of the steep negative relationship at lower levels of education is a consequence of these disadvantaged caste backgrounds, not educational levels. Similarly, the Forward Caste concentration among college graduates masks some of the positive effects of higher education on labor force participation. With controls, the education relationship assumes a clear U-shape so that college graduates are now the group most likely to be in the labor force, other factors being equal.

The effect of the income and other controls on the education relationship can be seen more clearly in the predicted probabilities displayed in Figure 1 . In comparison to the bivariate relationship (the heavy line), the graph after controls is more U-shaped. Though the control for other family income doesn’t make the association completely positive, it does reduce the negatively sloped part of the curve and shows a much greater increase in the probability of being employed at higher levels of education. The predicted probability of a woman college graduate being employed after controlling for other family income and background controls is 0.55 compared to 0.28 in the case without controls. This gives support to the “income effect” whereby women belonging to richer families have higher education but withdraw from the labor force because they do not have as great a need to work for additional income as compared to women belonging to poorer families.

Predicted probabilities of a married woman aged 25–59 being employed by education levels.

Even though the income effect does explain a part of the “paradoxical relationship” between women’s LFPR and her educational level, it doesn’t explain it fully. Secondary school matriculates are still less likely to be in the labor force than the uneducated despite their higher human capital that should make employment more attractive.

Urban residence has a powerful negative effect on women’s labor force participation, but, interestingly, a similar U-shape relationship with education is observed in both urban and rural areas (results not reported). In both rural and urban areas, women with completed secondary school have the lowest levels of labor force participation which rises with post-secondary education in both rural and urban areas (slightly stronger in urban areas) and declines from no education in both rural and urban areas (slightly stronger in rural areas). The strong but mostly additive effect of urban location suggests that to understand the U-shape curve, it may be necessary to observe the different kinds of jobs that educated women perform compared to the jobs of illiterate women.

6.3. Types of Work.

Table 2 above on the types of jobs held by working women showed that less educated women more often work on the family farm or as wage laborers; college graduates more likely are found in the more secure (and prestigious) salaried positions. As a next step, the study evaluates the role of job types by estimating three multivariate logistic regression equations to predict the log odds of a woman being employed in each type of work. Each equation controls for the same variables as Model 3 of Table 3 for overall work. Table 4 shows the results of the three logistic regressions. Again, calculating predicted probabilities for each educational level provides a more accessible picture of the education relationships (see Figure 2 ).

Predicted probabilities of a married woman aged 25–59 being employed for each of the three categories of work by education levels.

Logistic Regressions of Women’s Labor Force Participation.

Robust standard errors in parentheses

Logistic Regressions of Three Types of Women’s Labor Force Participation.

For salaried positions, more education has the expected positive relationship with a greater likelihood of work. The predicted probability of a currently married woman aged 25–59 being employed in a salaried position increases from 0.02 to 0.24 as her education level increases from being illiterate to being a college graduate. On the other hand, all other kinds of work show declining probabilities as her education level increases. The predicted probability of her being employed in a family farm or business decreases from 0.22 to 0.13; and in agricultural or nonagricultural wage labor from 0.13 to 0.01.

These results are consistent with an explanation of women’s labor force participation that educated women look mainly for better quality jobs, especially salaried work. The inference might be that if all or most available jobs were salaried, Indian women would show the usual positive relationship of higher rates of employment with more education. However, such jobs are limited and are accessible mainly with higher levels of education. If appropriate jobs were available for women with intermediate levels of education, we might expect higher levels of their labor force participation. The answers to the remaining paradoxical U-shape relationship should best be sought in the demand side of the Indian labor market.

7. Discussion and Conclusion

The present study examined the often-observed J-shaped relationship between education and Indian women’s labor force participation. This relationship, especially the strong decline from illiteracy to secondary completion, is contrary to what would be predicted by most human capital theory. Secondary school graduates have more skills and human capital than those with only primary education; and those with completed primary schooling have some literacy and numeracy compared to those without any education. These skills should make them more productive workers with higher earnings and thus more likely to be in the labor force. But the opposite is the case for Indian women.

The analysis takes advantage of the IHDS as the only national survey in India that has direct measures of other household income. The results show support for the other income effect; the greater the income women’s households have apart from their own earnings, the lower the chances of the woman being in the labor force. But other family incomes hardly explain all of the lower labor force participation of women with moderate levels of education. Caste and other background factors also explain some of these differences. But even after taking into account other family income, caste, and other background characteristics, the relationship between education and women’s labor force participation becomes just U-shaped but not uniformly positive. Although the lower participation rates of secondary school graduates are attenuated after the controls, they do not disappear. However, after controls, education beyond secondary levels does lead to a much steeper increase in the predicted probabilities of being a part of the labor force.

Further analysis points to the kinds of work available and the lack of demand for moderately educated women’s more skilled labor as the main suspect for explaining the declining segment of the U-curve. For salaried work, the probability of being employed steadily increases as a woman’s education increases, whereas for casual wage labor and for work in family farms and businesses, women’s LFPR decreases with an increase in education. Once they attain moderate levels of education, women do not work in manual labor. The decline in women’s LFPR with more education is greatest for agricultural and non-agricultural wage work, even more than for work in family enterprises. It is especially manual work outside the household that is perceived to be below one’s educational attainment. The preference for salaried jobs as women attain moderate education could reverse the downward part of the U-curve, but such jobs are limited for women.

The lack of demand in India, despite economic growth, has been noted by other researchers ( Klasen and Pieters 2015 ). But why economic growth has not generated these jobs remains mostly an unanswered question. One place to look for answers that has not been sufficiently appreciated would be the high levels of occupational segregation. In India, as everywhere, a major employer of moderately educated workers is white-collar employment in clerical and sales jobs. But in India, these jobs are still reserved for men. The 2001 census reports that 87.3% of office clerks, and 93.1% of sales jobs are held by men. It is not so much the lack of adequate jobs for moderate levels of education but the exclusion of women from these jobs that explains the low rates of labor force participation for these women.

In contrast, skilled work in education and health sectors is not nearly so gender segregated, perhaps in part because this type of work conforms better with gender stereotypes of women’s nurturing roles. But much of this work requires education beyond secondary school so the weaker sex segregation in these jobs results in a greater demand for educated female labor and the observed rise in labor force participation among female graduates. Over three quarters of teachers, for instance, have education above secondary level and over a third, 36.8%, are women.

Much of the recent work on Indian women’s labor force participation has focused on the important issue of declining rates over recent years. The U-shaped relationship between education and women’s labor participation receives notice in these studies and is recognized as one of the causes of the declining rates. Women’s increasing levels of education in recent years have put a larger share of women in the lowest portion of the U-curve ( Andres et al. 2017 ). But the U-curve itself has received surprisingly little research attention. The observed difference between illiterate women and women with some secondary education in fact exceeds the over time decline, but has not inspired the same level of research attention. This lack of interest is all the more surprising given its discrepancy with most labor supply theory. Explanations in the literature often cite restrictive gender norms or the lack of “suitable” work for educated women, but a lack of adequate data means that these explanations usually go untested. And the role of occupational segregation and the possibility of discrimination and exclusion of women from white-collar work is almost absent from this literature.

The IHDS results do show that an adequate measure of other family income does explain some of the paradoxical decline in women’s labor force participation with more education. But the U-curve remains, so we need a renewed focus on explaining why these additional levels of human capital are not brought into the labor market. Much of labor supply theory derives from high-income countries’ (especially U.S.) experience; the Indian results offer an opportunity to expand that limited background.

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Prevalence of metabolic syndrome and associated factors among patient with type 2 diabetes mellitus in Ethiopia, 2023: asystematic review and meta analysis

• Betelhem Mesfin Demissie 1 ,
• Fentaw Girmaw 2 ,
• Nimona Amena 3 &
• Getachew Ashagrie 2  

BMC Public Health volume  24 , Article number:  1128 ( 2024 ) Cite this article

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Metabolic syndrome is a complex pathophysiologic state which characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidaemia. The Adult Treatment Panel III report (ATP III) of the National Cholesterol Education Programme identified the metabolic syndrome as a serious public health issue in the modern era. In Western and Asian nations, the frequency of metabolic syndrome is rising, especially in developing regions experiencing rapid socio-environmental changes, in Sub-Saharan Africa; metabolic syndrome may be present in more than 70% of people with type 2 diabetes mellitus. Therefore the objective of our study was to estimate the pooled prevalence of metabolic syndrome and associated factors among type II diabetes mellitus patient.

This systematic review and meta-analysis included original articles of cross sectional studies published in the English language. Searches were carried out in PubMed, Web of Science, Google Scholar, and grey literature Journals from 2013 to June 2023. A random-effects model was used to estimate the pooled prevalence of metabolic syndrome among type II Diabetes mellitus patient in Ethiopia. Heterogeneity was assessed using the I 2 statistic. Subgroup analysis was also conducted based on study area. Egger’s test was used to assess publication bias. Sensitivity analysis was also conducted.

Out of 300 potential articles, 8 cross sectional studies were included in this systematic review and meta-analysis study. The pooled prevalence of metabolic syndrome among patient with type II diabetes mellitus in Ethiopia was found to be 64.49% (95% CI: 62.39, 66.59) and 52.38% (95% CI: 50.05, 54.73) by using NCEP/ATP III and IDF criteria, respectively. The weighted pooled prevalence of metabolic syndrome among type II diabetes mellitus patients by sub group analysis based on the study region was 63.79% (95% CI: 56.48, 71.11) and 52.23% (95%CI: 47.37, 57.22) by using NCEP/ATP III and IDF criteria, respectively. Being female and increased body mass index were factors associated with metabolic syndrome among type II diabetes mellitus patients.

The prevalence of metabolic syndrome among type II patient is high. Therefore, policymakers, clinicians, and concerned stakeholders shall urge effective strategies in the control, prevention, and management of metabolic syndrome among type II diabetes mellitus.

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Introduction

The complicated pathophysiologic condition known as the metabolic syndrome is characterised by insulin resistance, hypertension, hyperlipidaemia, and abdominal obesity and which originate primarily from an imbalance between energy expenditure and calorie intake [ 1 ]. Even though the NCEP-ATPIII, IDF, and WHO criteria are the most often utilised clinical criteria for the diagnosis of metabolic syndrome, there are numerous similarities between them, there are also notable differences in the perspectives on the underlying causes of the metabolic syndrome [ 2 ]. The prevalence of metabolic syndrome is increasing in Western and Asian countries, particularly in emerging areas that are undergoing fast socio-environmental change. Numerous studies have demonstrated that metabolic syndrome is a major risk factor for type 2 diabetes mellitus, cardiovascular disease (CVD), and overall mortality [ 3 ].

Global estimates suggest that about one-third of the world’s population, primarily in developing countries, may have metabolic syndrome [ 4 ]. The National Cholesterol Education Programme’s Adult Treatment Panel III report (ATP III) recognised metabolic syndrome as a significant contemporary public health concern. It is a multiplex risk factor for cardiovascular disease (CVD) that requires more therapeutic care, and it also raises the risk of cancer, mental problems, renal illness, and early mortality [ 2 , 5 ].

Compared to those in Western countries, the urban population in several developing nations has a greater prevalence of metabolic syndrome. The two main causes of this disease’s growth are the increase in fast food consumption—high-calorie, low-fiber foods—and the decline in physical activity brought on by sedentary leisure activities and the use of automated transportation [ 1 ].

In Sub-Saharan Africa, metabolic syndrome may be present in more than 70% of people with type 2 diabetes mellitus. According to research which is done in two rural clinics of Ghana, the prevalence of metabolic syndrome among type II diabetes mellitus patients was 68.6% (95% CI: 64.0-72.8), and having diabetes for more than five years, being female, and being overweight are significantly associated with metabolic syndrome [ 4 ]. A study done by Lira Neto JCG et al., Stated that among 201 study participants, 50.7% were diagnosed with metabolic syndrome [ 5 ].

A cross sectional study conducted in Ethiopia reported that the prevalence of metabolic syndrome was 20.3% among 325 study participants [ 6 ]. A Systematic Review and Meta-analysis study conducted in Ethiopia stated that the pooled prevalence of metabolic syndrome in Ethiopia was found to be 34.89% (95% CI: 26.77, 43.01) and 27.92% (95% CI: 21.32, 34.51) by using NCEP/ATP III and IDF criteria, respectively. Subgroup analysis based on the study subjects using NCEP/ATP III showed that the weighted pooled prevalence was 63.78%(95% CI: 56.17, 71.40) among type 2 Diabetes Mellitus patients [ 7 ].

Even though this topic has been studied before, our work is unique since we look at aspects outside prevalence. Thus, our study’s goal was to analyse the pooled prevalence of metabolic syndrome and associated factors among patients with type II diabetes mellitus. How much is the prevalence of metabolic syndrome among Ethiopian patients with type II diabetes mellitus? And what variables are associated with metabolic syndrome patients with type II diabetes in Ethiopian?

Protocol and search strategy

The systematic review and meta-analysis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guideline (Fig.  1 ). The study protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42023442704). An inclusive literature search was conducted to identify studies about the prevalence of metabolic syndrome among patients with type II diabetes mellitus reported among the Ethiopian population of various study subjects. Both electronic and gray literature searches were carried out systematically. PubMed, Web of Science, Google Scholar, and grey literature, were searched for material between 2013 and 2023. The search terms were used separately and in combination using Boolean operators like “OR” or “AND.” An example of keywords used in PubMed to select relevant studies was as follows: (((“Metabolic Syndrome“[Mesh] OR Metabolic syndrome*[tiab]) AND (“Diabetes Mellitus, Type 2“[Mesh] OR “Diabetes Mellitus, Type 2*“[tiab])) AND (“Prevalence“[Mesh] OR “Magnitude*“[tiab])) AND (“Ethiopia“[Mesh] OR “Ethiopia*“[tiab]). Moreover, each database’s specific search parameters were customized accordingly.

Study selection (inclusion and exclusion criteria)

Inclusion criteria.

Studies were selected according to the following criteria: study design, participants, exposures and condition or outcome(s) of interest. Eligible studies were only quantitative full- text, and observational studies (cross-sectional) reporting prevalence and associated factors in terms of the odds ratio. Only articles written in English were retrieved for review. We included studies involving only type II diabetes mellitus patients aged greater than 30.

The primary outcome was the prevalence of metabolic syndrome. We used author reported definitions (according ATP III &IDF) (Table  1 ). Secondary outcome was factors associated with metabolic syndrome among type 2 diabetes mellitus patients. We were used unpublished articles to identify any potential studies that might have been missed from our search.

Exclusion criteria

We excluded reviews, case reports, case series, qualitative studies, and opinion articles. We were exclude abstract-only papers.

Data extraction and quality assessment

Data extraction was done independently by the two reviewers in a pre-piloted data extraction form created in MS Excel. Any discrepancies in the extracted data were resolved by consensus or discussion with a third reviewer. The following details will be extracted from each study:- details of the study (first author’s last name, year of publication), study region, study design, sample size, Prevalence of metabolic syndrome, associated factors.

The Joanna Brigg Institute’s quality evaluation criteria’s (JBI) were used to evaluate the studies’ quality. We assessed each of the chosen publications using the JBI assessment checklist. Research with a quality score of at least 50% was deemed to be of high quality.

Data analysis

Version 17 of STATA was used to analyse the retrieved data after they were imported into Microsoft Excel. To get a general summary estimate of the prevalence across trials, a random-effects model was employed. We employed point estimate with a 95% confidence interval. Sensitivity analysis was used to evaluate each study’s contribution to the outcome by eliminating each one individually. Using Egger’s test, the existence of publication bias was evaluated. The Cochran’s Q statistic and I2 statistics were used to assess the heterogeneity of the studies. Moreover, meta-regression has been conducted that represents linear predictions for the metabolic syndrome among type 2 diabetes mellitus patients prevalence as a function of published year. Subgroup analysis was performed based on study region and study subjects since there was unexplained significant heterogeneity.

Publication bias

Funnel plot and Egger’s test was used to assess publication bias and a P-value of less than 0.05 was used to declare the publication bias. The included studies were assessed for potential publication bias and separate analyses were done based on IDF and NCEP/ATPIII criteria (p values were 0.58 and 0.88, respectively) which indicated the absence of publication bias (Figs.  2 and 3 ).

PRISMA flow diagram of study selection for systematic review and meta-analysis of prevalence of metabolic syndrome among type II Diabetes mellitus patients in Ethiopia [ 11 ]

Forest plot showing the pooled prevalence of metabolic syndrome among type II Diabetes mellitus patients in Ethiopia (according to NCEP ATP III Criteria)

Forest plot showing the pooled prevalence of metabolic syndrome among type II Diabetes mellitus patients in Ethiopia (according to IDF Criteria)

Characteristics of included studies

The title and abstract screening of 300 potential articles yielded 102 that were included relevant to the topic of interest; the full-text screening of 50 of these articles indicated their eligibility for full-text assessment; 8 of these articles, involving 2375 study participants, were found to be eligible for systematic review and meta-analysis. Based on the NCEP/ATPIII and IDF criteria, the prevalence of metabolic syndrome in patients with type 2 diabetes mellitus was assessed among the Ethiopian population of different study participants. Five studies reported the prevalence of metabolic syndrome among type 2 diabetes mellitus based on both IDF and NCEP/ATPIII criteria, whereas seven studies based on NCEP/ATPIII criteria only and six studies by IDF criteria only (Table  2 ).

Prevalence of metabolic syndrome among type 2 diabetes mellitus patients using IDF and NCEP ATP III Criteria

The random-effects model was applied since the heterogeneity index of the studies were significant. The pooled prevalence of metabolic syndrome was found to be 64.49% (95% CI: 62.39, 66.59) by using NCEP/ATP III (Figs.  4 ) and 52.38% (95% CI: 50.05, 54.73) by using IDF criteria (Fig.  5 ). Subgroup analysis based on the study region using NCEP/ ATP III showed that the weighted pooled prevalence was 63.79% (95% CI: 56.48, 71.11) among type 2 diabetes patients (Fig.  6 ). Using IDF criteria, subgroup analysis based on the study region showed that the weighted pooled prevalence was 52.23% (95%CI: 47.37, 57.22).

Sub group analysis based on study region using NCEP ATP III Criteria

the pooled odds ratio of the association between sex and prevalence of metabolic syndrome among type II diabetes mellitus patients

The pooled odds ratio of the association between BMI and prevalence of metabolic

Factors associated with metabolic syndrome among type II DM

Association between sex and prevalence of metabolic syndrome.

The association between being female and prevalence of metabolic syndrome was examined based on the finding from five studies ( 1 , 2 , 4 , 5 and 7 ). The pooled odds ratio (AOR: 0.5, 95% CI: -0.32-1.31) showed that prevalence of metabolic syndrome associated with being female. The studies showed very high heterogeneity (I²=86.3% and P  = 0.00) (Fig.  7 ). Hence, a random effects model was employed to do the final analysis.

Funnel plot for prevalence of metabolic syndrome according to NCE ATPIII

Association between BMI and prevalence of metabolic syndrome

The association between BMI and prevalence of metabolic syndrome was examined based on the finding from four studies ( 1 , 2 , 4 and 8 ). The pooled odds ratio (AOR: 3.86, 95% CI: 2.57–5.15) showed that prevalence of metabolic syndrome associated with BMI. The studies showed high heterogeneity (I²= 68.2% and P  = 0.034) (Fig.  8 ). Hence, a random effects model was employed to do the final analysis.

Funnel plot for prevalence of metabolic syndrome according to IDF

Sensitivity analysis

Sensitivity analysis was carried out by gradually removing each research from the analytic process according to the two provided diagnostic criteria (NCEP/ATP III and IDF) in order to evaluate the impact of each study on the pooled estimated prevalence of metabolic syndrome among type II diabetes mellitus patients. The result showed that excluded studies led to significant changes in the shared estimation of the prevalence of metabolic syndrome (Figs.  9 and 10 ).

Sensitivity analysis based on NCEP/ATP III diagnostic criteria

Sensitivity analysis based on IDF diagnostic criteria

This systematic review and meta- analysis study provides evidence of an estimated pooled prevalence of metabolic syndrome among type II diabetes mellitus patients of the Ethiopian population. According to this review, the combined pooled prevalence of Metabolic syndrome among type II diabetes mellitus patients were 64.49% (95% CI: 62.39, 66.59) and 52.38% (95% CI: 50.05, 54.73) by using NCEP/ATP III and IDF criteria, respectively.

The finding of this study similar with the study conducted in African populations, which reported that the prevalence of metabolic syndrome among type 2 diabetes mellitus was 66.9%(95%CI: 60.3–73.1) [ 9 ]. In addition, the study which was done in sub-Saharan African countries in line with this finding which reports that prevalence of metabolic syndrome among type II diabetes melituse patients were 64.8% (95% CI: 54.74, 74.86) and 57.15% by using NCEP/ATP III and IDF criteria, respectively.

Furture more, the study which was done in Sub-Saharan Africa reported that, among others sub-Saharan Africa countries the prevalence of metabolic syndrome was highest in Ethiopia, (61.14%, 95% CI: 51.74, 70.53), which is almost similar with our study findings [ 8 ].

Similarly the study conducted in Ethiopian population showed that the weighted pooled prevalence of metabolic syndrome among type II diabetes mellitus patient was 63.78% (95% CI: 56.17, 71.40) [ 7 ].

This study result supported by the fact that metabolic syndrome has been associated with type 2 diabetes due to its high prevalence worldwide since it is both related to the increase in obesity and a sedentary lifestyle. Several studies suggest that individuals with Metabolic syndrome are 5 times more likely to develop type 2 diabetes [ 10 ].

This meta-analysis assessed factors determining metabolic syndrome among type II diabetes mellitus patients. The current meta-analysis demonstrated that the prevalence rate of metabolic syndrome was higher in females compared to that in males. This has been shown in all the Middle Eastern countries, and the prevalence was much higher among women than men [ 6 ]. The prevalence rate of metabolic syndrome associated with the individual’s body mass index.

This study has implications for clinical practice. Determining the prevalence of metabolic syndrome among type 2 diabetic patients is critical to guide healthcare professionals to minimize the risk of metabolic syndrome by providing guidance to the patient who has undergone diabetic care follow up. Moreover, it gives information about the burden and public health impact of metabolic syndrome for possible consideration during routine diabetic patient care.

This meta-analysis study has its own limitations that should be considered in the future research. Few studies are included due to limited research in Ethiopia which makes it difficult to generalize the findings to all type 2 diabetic patients in the countery and which makes the discussion part more shallow.

In conclusion, according to this systematic review the prevalence of metabolic syndrome among type II patient is high in Ethiopia and recommends an urgent attention from both the clinical and public health viewpoint Therefore, policymakers, clinicians, and concerned stakeholders shall urge effective strategies in the control, prevention, and management of metabolic syndrome among type II diabetes mellitus. In addition country context-specific preventive strategies should be developed to reduce the burden of metabolic syndrome.

Data availability

The data used to support the findings of this study are available from the corresponding author upon request.

Abbreviations

Cardiovascular Disease

National Cholesterol Education Program–Adult Treatment Panel III

International diabetes federation

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

World Health Organization

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“B.M involved in the entire work of the manuscript which is a design of the study, review of literature, and data analysis, “F.G.” was involved in, design of the study, review of the literature, data extraction, and statistical analysis. “N.A”. and “G.A” were involved in data analysis and interpretation and drafting of the manuscript. All authors critically revised the paper, and they agreed to be accountable for all aspects of the work.

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Demissie, B.M., Girmaw, F., Amena, N. et al. Prevalence of metabolic syndrome and associated factors among patient with type 2 diabetes mellitus in Ethiopia, 2023: asystematic review and meta analysis. BMC Public Health 24 , 1128 (2024). https://doi.org/10.1186/s12889-024-18580-0

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Breast cancer screening motivation and behaviours of women aged over 75 years: a scoping review

• Virginia Dickson-Swift 1 ,
• Joanne Adams 1 ,
• Evelien Spelten 1 ,
• Irene Blackberry 2 ,
• Carlene Wilson 3 , 4 , 5 &
• Eva Yuen 3 , 6 , 7 , 8  

BMC Women's Health volume  24 , Article number:  256 ( 2024 ) Cite this article

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This scoping review aimed to identify and present the evidence describing key motivations for breast cancer screening among women aged ≥ 75 years. Few of the internationally available guidelines recommend continued biennial screening for this age group. Some suggest ongoing screening is unnecessary or should be determined on individual health status and life expectancy. Recent research has shown that despite recommendations regarding screening, older women continue to hold positive attitudes to breast screening and participate when the opportunity is available.

All original research articles that address motivation, intention and/or participation in screening for breast cancer among women aged ≥ 75 years were considered for inclusion. These included articles reporting on women who use public and private breast cancer screening services and those who do not use screening services (i.e., non-screeners).

The Joanna Briggs Institute (JBI) methodology for scoping reviews was used to guide this review. A comprehensive search strategy was developed with the assistance of a specialist librarian to access selected databases including: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Web of Science and PsychInfo. The review was restricted to original research studies published since 2009, available in English and focusing on high-income countries (as defined by the World Bank). Title and abstract screening, followed by an assessment of full-text studies against the inclusion criteria was completed by at least two reviewers. Data relating to key motivations, screening intention and behaviour were extracted, and a thematic analysis of study findings undertaken.

A total of fourteen (14) studies were included in the review. Thematic analysis resulted in identification of three themes from included studies highlighting that decisions about screening were influenced by: knowledge of the benefits and harms of screening and their relationship to age; underlying attitudes to the importance of cancer screening in women's lives; and use of decision aids to improve knowledge and guide decision-making.

The results of this review provide a comprehensive overview of current knowledge regarding the motivations and screening behaviour of older women about breast cancer screening which may inform policy development.

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Introduction

Breast cancer is now the most commonly diagnosed cancer in the world overtaking lung cancer in 2021 [ 1 ]. Across the globe, breast cancer contributed to 25.8% of the total number of new cases of cancer diagnosed in 2020 [ 2 ] and accounts for a high disease burden for women [ 3 ]. Screening for breast cancer is an effective means of detecting early-stage cancer and has been shown to significantly improve survival rates [ 4 ]. A recent systematic review of international screening guidelines found that most countries recommend that women have biennial mammograms between the ages of 40–70 years [ 5 ] with some recommending that there should be no upper age limit [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ] and others suggesting that benefits of continued screening for women over 75 are not clear [ 13 , 14 , 15 ].

Some guidelines suggest that the decision to end screening should be determined based on the individual health status of the woman, their life expectancy and current health issues [ 5 , 16 , 17 ]. This is because the benefits of mammography screening may be limited after 7 years due to existing comorbidities and limited life expectancy [ 18 , 19 , 20 , 21 ], with some jurisdictions recommending breast cancer screening for women ≥ 75 years only when life expectancy is estimated as at least 7–10 years [ 22 ]. Others have argued that decisions about continuing with screening mammography should depend on individual patient risk and health management preferences [ 23 ]. This decision is likely facilitated by a discussion between a health care provider and patient about the harms and benefits of screening outside the recommended ages [ 24 , 25 ]. While mammography may enable early detection of breast cancer, it is clear that false-positive results and overdiagnosis Footnote 1 may occur. Studies have estimated that up to 25% of breast cancer cases in the general population may be over diagnosed [ 26 , 27 , 28 ].

The risk of being diagnosed with breast cancer increases with age and approximately 80% of new cases of breast cancer in high-income countries are in women over the age of 50 [ 29 ]. The average age of first diagnosis of breast cancer in high income countries is comparable to that of Australian women which is now 61 years [ 2 , 4 , 29 ]. Studies show that women aged ≥ 75 years generally have positive attitudes to mammography screening and report high levels of perceived benefits including early detection of breast cancer and a desire to stay healthy as they age [ 21 , 30 , 31 , 32 ]. Some women aged over 74 participate, or plan to participate, in screening despite recommendations from health professionals and government guidelines advising against it [ 33 ]. Results of a recent review found that knowledge of the recommended guidelines and the potential harms of screening are limited and many older women believed that the benefits of continued screening outweighed the risks [ 30 ].

Very few studies have been undertaken to understand the motivations of women to screen or to establish screening participation rates among women aged ≥ 75 and older. This is surprising given that increasing age is recognised as a key risk factor for the development of breast cancer, and that screening is offered in many locations around the world every two years up until 74 years. The importance of this topic is high given the ambiguity around best practice for participation beyond 74 years. A preliminary search of Open Science Framework, PROSPERO, Cochrane Database of Systematic Reviews and JBI Evidence Synthesis in May 2022 did not locate any reviews on this topic.

This scoping review has allowed for the mapping of a broad range of research to explore the breadth and depth of the literature, summarize the evidence and identify knowledge gaps [ 34 , 35 ]. This information has supported the development of a comprehensive overview of current knowledge of motivations of women to screen and screening participation rates among women outside the targeted age of many international screening programs.

Materials and methods

Research question.

The research question for this scoping review was developed by applying the Population—Concept—Context (PCC) framework [ 36 ]. The current review addresses the research question “What research has been undertaken in high-income countries (context) exploring the key motivations to screen for breast cancer and screening participation (concepts) among women ≥ 75 years of age (population)?

Eligibility criteria

Participants.

Women aged ≥ 75 years were the key population. Specifically, motivations to screen and screening intention and behaviour and the variables that discriminate those who screen from those who do not (non-screeners) were utilised as the key predictors and outcomes respectively.

From a conceptual perspective it was considered that motivation led to behaviour, therefore articles that described motivation and corresponding behaviour were considered. These included articles reporting on women who use public (government funded) and private (fee for service) breast cancer screening services and those who do not use screening services (i.e., non-screeners).

The scope included high-income countries using the World Bank definition [ 37 ]. These countries have broadly similar health systems and opportunities for breast cancer screening in both public and private settings.

Types of sources

All studies reporting original research in peer-reviewed journals from January 2009 were eligible for inclusion, regardless of design. This date was selected due to an evaluation undertaken for BreastScreen Australia recommending expansion of the age group to include 70–74-year-old women [ 38 ]. This date was also indicative of international debate regarding breast cancer screening effectiveness at this time [ 39 , 40 ]. Reviews were also included, regardless of type—scoping, systematic, or narrative. Only sources published in English and available through the University’s extensive research holdings were eligible for inclusion. Ineligible materials were conference abstracts, letters to the editor, editorials, opinion pieces, commentaries, newspaper articles, dissertations and theses.

This scoping review was registered with the Open Science Framework database ( https://osf.io/fd3eh ) and followed Joanna Briggs Institute (JBI) methodology for scoping reviews [ 35 , 36 ]. Although ethics approval is not required for scoping reviews the broader study was approved by the University Ethics Committee (approval number HEC 21249).

Search strategy

A pilot search strategy was developed in consultation with an expert health librarian and tested in MEDLINE (OVID) and conducted on 3 June 2022. Articles from this pilot search were compared with seminal articles previously identified by the members of the team and used to refine the search terms. The search terms were then searched as both keywords and subject headings (e.g., MeSH) in the titles and abstracts and Boolean operators employed. A full MEDLINE search was then carried out by the librarian (see Table  1 ). This search strategy was adapted for use in each of the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science and PsychInfo databases. The references of included studies have been hand-searched to identify any additional evidence sources.

Study/source of evidence selection

Following the search, all identified citations were collated and uploaded into EndNote v.X20 (Clarivate Analytics, PA, USA) and duplicates removed. The resulting articles were then imported into Covidence – Cochrane’s systematic review management software [ 41 ]. Duplicates were removed once importation was complete, and title and abstract screening was undertaken against the eligibility criteria. A sample of 25 articles were assessed by all reviewers to ensure reliability in the application of the inclusion and exclusion criteria. Team discussion was used to ensure consistent application. The Covidence software supports blind reviewing with two reviewers required at each screening phase. Potentially relevant sources were retrieved in full text and were assessed against the inclusion criteria by two independent reviewers. Conflicts were flagged within the software which allows the team to discuss those that have disagreements until a consensus was reached. Reasons for exclusion of studies at full text were recorded and reported in the scoping review. The Preferred Reporting Items of Systematic Reviews extension for scoping reviews (PRISMA-ScR) checklist was used to guide the reporting of the review [ 42 ] and all stages were documented using the PRISMA-ScR flow chart [ 42 ].

Data extraction

A data extraction form was created in Covidence and used to extract study characteristics and to confirm the study’s relevance. This included specific details such as article author/s, title, year of publication, country, aim, population, setting, data collection methods and key findings relevant to the review question. The draft extraction form was modified as needed during the data extraction process.

Data analysis and presentation

Extracted data were summarised in tabular format (see Table  2 ). Consistent with the guidelines for the effective reporting of scoping reviews [ 43 ] and the JBI framework [ 35 ] the final stage of the review included thematic analysis of the key findings of the included studies. Study findings were imported into QSR NVivo with coding of each line of text. Descriptive codes reflected key aspects of the included studies related to the motivations and behaviours of women > 75 years about breast cancer screening.

In line with the reporting requirements for scoping reviews the search results for this review are presented in Fig.  1 [ 44 ].

PRISMA Flowchart. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71

A total of fourteen [ 14 ] studies were included in the review with studies from the following countries, US n  = 12 [ 33 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ], UK n  = 1 [ 23 ] and France n  = 1 [ 56 ]. Sample sizes varied, with most containing fewer than 50 women ( n  = 8) [ 33 , 45 , 46 , 48 , 51 , 52 , 55 ]. Two had larger samples including a French study with 136 women (a sub-set of a larger sample) [ 56 ], and one mixed method study in the UK with a sample of 26 women undertaking interviews and 479 women completing surveys [ 23 ]. One study did not report exact numbers [ 50 ]. Three studies [ 47 , 53 , 54 ] were undertaken by a group of researchers based in the US utilising the same sample of women, however each of the papers focused on different primary outcomes. The samples in the included studies were recruited from a range of locations including primary medical care clinics, specialist medical clinics, University affiliated medical clinics, community-based health centres and community outreach clinics [ 47 , 53 , 54 ].

Data collection methods varied and included: quantitative ( n  = 8), qualitative ( n  = 5) and mixed methods ( n  = 1). A range of data collection tools and research designs were utilised; pre/post, pilot and cross-sectional surveys, interviews, and secondary analysis of existing data sets. Seven studies focused on the use of a Decision Aids (DAs), either in original or modified form, developed by Schonberg et al. [ 55 ] as a tool to increase knowledge about the harms and benefits of screening for older women [ 45 , 47 , 48 , 49 , 52 , 54 , 55 ]. Three studies focused on intention to screen [ 33 , 53 , 56 ], two on knowledge of, and attitudes to, screening [ 23 , 46 ], one on information needs relating to risks and benefits of screening discontinuation [ 51 ], and one on perceptions about discontinuation of screening and impact of social interactions on screening [ 50 ].

The three themes developed from the analysis of the included studies highlighted that decisions about screening were primarily influenced by: (1) knowledge of the benefits and harms of screening and their relationship to age; (2) underlying attitudes to the importance of cancer screening in women's lives; and (3) exposure to decision aids designed to facilitate informed decision-making. Each of these themes will be presented below drawing on the key findings of the appropriate studies. The full dataset of extracted data can be found in Table  2 .

Knowledge of the benefits and harms of screening ≥ 75 years

The decision to participate in routine mammography is influenced by individual differences in cognition and affect, interpersonal relationships, provider characteristics, and healthcare system variables. Women typically perceive mammograms as a positive, beneficial and routine component of care [ 46 ] and an important aspect of taking care of themselves [ 23 , 46 , 49 ]. One qualitative study undertaken in the US showed that few women had discussed mammography cessation or the potential harms of screening with their health care providers and some women reported they would insist on receiving mammography even without a provider recommendation to continue screening [ 46 ].

Studies suggested that ageing itself, and even poor health, were not seen as reasonable reasons for screening cessation. For many women, guidance from a health care provider was deemed the most important influence on decision-making [ 46 ]. Preferences for communication about risk and benefits were varied with one study reporting women would like to learn more about harms and risks and recommended that this information be communicated via physicians or other healthcare providers, included in brochures/pamphlets, and presented outside of clinical settings (e.g., in community-based seniors groups) [ 51 ]. Others reported that women were sometimes sceptical of expert and government recommendations [ 33 ] although some were happy to participate in discussions with health educators or care providers about breast cancer screening harms and benefits and potential cessation [ 52 ].

Underlying attitudes to the importance of cancer screening at and beyond 75 years

Included studies varied in describing the importance of screening, with some attitudes based on past attendance and some based on future intentions to screen. Three studies reported findings indicating that some women intended to continue screening after 75 years of age [ 23 , 45 , 46 ], with one study in the UK reporting that women supported an extension of the automatic recall indefinitely, regardless of age or health status. In this study, failure to invite older women to screen was interpreted as age discrimination [ 23 ]. The desire to continue screening beyond 75 was also highlighted in a study from France that found that 60% of the women ( n  = 136 aged ≥ 75) intended to pursue screening in the future, and 27 women aged ≥ 75, who had never undergone mammography previously (36%), intended to do so in the future [ 56 ]. In this same study, intentions to screen varied significantly [ 56 ]. There were no sociodemographic differences observed between screened and unscreened women with regard to level of education, income, health risk behaviour (smoking, alcohol consumption), knowledge about the importance and the process of screening, or psychological features (fear of the test, fear of the results, fear of the disease, trust in screening impact) [ 56 ]. Further analysis showed that three items were statistically correlated with a higher rate of attendance at screening: (1) screening was initiated by a physician; (2) the women had a consultation with a gynaecologist during the past 12 months; and (3) the women had already undergone at least five screening mammograms. Analysis highlighted that although average income, level of education, psychological features or other types of health risk behaviours did not impact screening intention, having a mammogram previously impacted likelihood of ongoing screening. There was no information provided that explained why women who had not previously undergone screening might do so in the future.

A mixed methods study in the UK reported similar findings [ 23 ]. Utilising interviews ( n  = 26) and questionnaires ( n  = 479) with women ≥ 70 years (median age 75 years) the overwhelming result (90.1%) was that breast screening should be offered to all women indefinitely regardless of age, health status or fitness [ 23 ], and that many older women were keen to continue screening. Both the interview and survey data confirmed women were uncertain about eligibility for breast screening. The survey data showed that just over half the women (52.9%) were unaware that they could request mammography or knew how to access it. Key reasons for screening discontinuation were not being invited for screening (52.1%) and not knowing about self-referral (35.1%).

Women reported that not being invited to continue screening sent messages that screening was no longer important or required for this age group [ 23 ]. Almost two thirds of the women completing the survey (61.6%) said they would forget to attend screening without an invitation. Other reasons for screening discontinuation included transport difficulties (25%) and not wishing to burden family members (24.7%). By contrast, other studies have reported that women do not endorse discontinuation of screening mammography due to advancing age or poor health, but some may be receptive to reducing screening frequency on recommendation from their health care provider [ 46 , 51 ].

Use of Decision Aids (DAs) to improve knowledge and guide screening decision-making

Many women reported poor knowledge about the harms and benefits of screening with studies identifying an important role for DAs. These aids have been shown to be effective in improving knowledge of the harms and benefits of screening [ 45 , 54 , 55 ] including for women with low educational attainment; as compared to women with high educational attainment [ 47 ]. DAs can increase knowledge about screening [ 47 , 49 ] and may decrease the intention to continue screening after the recommended age [ 45 , 52 , 54 ]. They can be used by primary care providers to support a conversation about breast screening intention and reasons for discontinuing screening. In one pilot study undertaken in the US using a DA, 5 of the 8 women (62.5%) indicated they intended to continue to receive mammography; however, 3 participants planned to get them less often [ 45 ]. When asked whether they thought their physician would want them to get a mammogram, 80% said “yes” on pre-test; this figure decreased to 62.5% after exposure to the DA. This pilot study suggests that the use of a decision-aid may result in fewer women ≥ 75 years old continuing to screen for breast cancer [ 45 ].

Similar findings were evident in two studies drawing on the same data undertaken in the US [ 48 , 53 ]. Using a larger sample ( n  = 283), women’s intentions to screen prior to a visit with their primary care provider and then again after exposure to the DA were compared. Results showed that 21.7% of women reduced their intention to be screened, 7.9% increased their intentions to be screened, and 70.4% did not change. Compared to those who had no change or increased their screening intentions, women who had a decrease in screening intention were significantly less likely to receive screening after 18 months. Generally, studies have shown that women aged 75 and older find DAs acceptable and helpful [ 47 , 48 , 49 , 55 ] and using them had the potential to impact on a women’s intention to screen [ 55 ].

Cadet and colleagues [ 49 ] explored the impact of educational attainment on the use of DAs. Results highlight that education moderates the utility of these aids; women with lower educational attainment were less likely to understand all the DA’s content (46.3% vs 67.5%; P < 0.001); had less knowledge of the benefits and harms of mammography (adjusted mean ± standard error knowledge score, 7.1 ± 0.3 vs 8.1 ± 0.3; p < 0.001); and were less likely to have their screening intentions impacted (adjusted percentage, 11.4% vs 19.4%; p  = 0.01).

This scoping review summarises current knowledge regarding motivations and screening behaviours of women over 75 years. The findings suggest that awareness of the importance of breast cancer screening among women aged ≥ 75 years is high [ 23 , 46 , 49 ] and that many women wish to continue screening regardless of perceived health status or age. This highlights the importance of focusing on motivation and screening behaviours and the multiple factors that influence ongoing participation in breast screening programs.

The generally high regard attributed to screening among women aged ≥ 75 years presents a complex challenge for health professionals who are focused on potential harm (from available national and international guidelines) in ongoing screening for women beyond age 75 [ 18 , 20 , 57 ]. Included studies highlight that many women relied on the advice of health care providers regarding the benefits and harms when making the decision to continue breast screening [ 46 , 51 , 52 ], however there were some that did not [ 33 ]. Having a previous pattern of screening was noted as being more significant to ongoing intention than any other identified socio-demographic feature [ 56 ]. This is perhaps because women will not readily forgo health care practices that they have always considered important and that retain ongoing importance for the broader population.

For those women who had discontinued screening after the age of 74 it was apparent that the rationale for doing so was not often based on choice or receipt of information, but rather on factors that impact decision-making in relation to screening. These included no longer receiving an invitation to attend, transport difficulties and not wanting to be a burden on relatives or friends [ 23 , 46 , 51 ]. Ongoing receipt of invitations to screen was an important aspect of maintaining a capacity to choose [ 23 ]. This was particularly important for those women who had been regular screeners.

Women over 75 require more information to make decisions regarding screening [ 23 , 52 , 54 , 55 ], however health care providers must also be aware that the element of choice is important for older women. Having a capacity to choose avoids any notion of discrimination based on age, health status, gender or sociodemographic difference and acknowledges the importance of women retaining control over their health [ 23 ]. It was apparent that some women would choose to continue screening at a reduced frequency if this option was available and that women should have access to information facilitating self-referral [ 23 , 45 , 46 , 51 , 56 ].

Decision-making regarding ongoing breast cancer screening has been facilitated via the use of Decision Aids (DAs) within clinical settings [ 54 , 55 ]. While some studies suggest that women will make a decision regardless of health status, the use of DAs has impacted women’s decision to screen. While this may have limited benefit for those of lower educational attainment [ 48 ] they have been effective in improving knowledge relating to harms and benefits of screening particularly where they have been used to support a conversation with women about the value of screening [ 54 , 55 , 56 ].

Women have identified challenges in engaging in conversations with health care providers regarding ongoing screening, because providers frequently draw on projections of life expectancy and over-diagnosis [ 17 , 51 ]. As a result, these conversations about screening after age 75 years often do not occur [ 46 ]. It is likely that health providers may need more support and guidance in leading these conversations. This may be through the use of DAs or standardised checklists. It may be possible to incorporate these within existing health preventive measures for this age group. The potential for advice regarding ongoing breast cancer screening to be available outside of clinical settings may provide important pathways for conversations with women regarding health choices. Provision of information and advice in settings such as community based seniors groups [ 51 ] offers a potential platform to broaden conversations and align sources of information, not only with health professionals but amongst women themselves. This may help to address any misconception regarding eligibility and access to services [ 23 ]. It may also be aligned with other health promotion and lifestyle messages provided to this age group.

Limitations of the review

The searches that formed the basis of this review were carried in June 2022. Although the search was comprehensive, we have only captured those studies that were published in the included databases from 2009. There may have been other studies published outside of these periods. We also limited the search to studies published in English with full-text availability.

The emphasis of a scoping review is on comprehensive coverage and synthesis of the key findings, rather than on a particular standard of evidence and, consequently a quality assessment of the included studies was not undertaken. This has resulted in the inclusion of a wide range of study designs and data collection methods. It is important to note that three studies included in the review drew on the same sample of women (283 over > 75)[ 49 , 53 , 54 ]. The results of this review provide valuable insights into motivations and behaviours for breast cancer screening for older women, however they should be interpreted with caution given the specific methodological and geographical limitations.

Conclusion and recommendations

This scoping review highlighted a range of key motivations and behaviours in relation to breast cancer screening for women ≥ 75 years of age. The results provide some insight into how decisions about screening continuation after 74 are made and how informed decision-making can be supported. Specifically, this review supports the following suggestions for further research and policy direction:

Further research regarding breast cancer screening motivations and behaviours for women over 75 would provide valuable insight for health providers delivering services to women in this age group.

Health providers may benefit from the broader use of decision aids or structured checklists to guide conversations with women over 75 regarding ongoing health promotion/preventive measures.

Providing health-based information in non-clinical settings frequented by women in this age group may provide a broader reach of information and facilitate choices. This may help to reduce any perception of discrimination based on age, health status or socio-demographic factors.

Availability of data and materials

All data generated or analysed during this study is included in this published article (see Table  2 above).

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Acknowledgements

We would like to acknowledge Ange Hayden-Johns (expert librarian) who assisted with the development of the search criteria and undertook the relevant searches and Tejashree Kangutkar who assisted with some of the Covidence work.

This work was supported by funding from the Australian Government Department of Health and Aged Care (ID: Health/20–21/E21-10463).

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Virginia Dickson-Swift, Joanne Adams & Evelien Spelten

Care Economy Research Institute, La Trobe University, Wodonga, Australia

Irene Blackberry

Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia

Carlene Wilson & Eva Yuen

Melbourne School of Population and Global Health, Melbourne University, Melbourne, Australia

Carlene Wilson

School of Psychology and Public Health, La Trobe University, Bundoora, Australia

Institute for Health Transformation, Deakin University, Burwood, Australia

Centre for Quality and Patient Safety, Monash Health Partnership, Monash Health, Clayton, Australia

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VDS conceived and designed the scoping review. VDS & JA developed the search strategy with librarian support, and all authors (VDS, JA, ES, IB, CW, EY) participated in the screening and data extraction stages and assisted with writing the review. All authors provided editorial support and read and approved the final manuscript prior to submission.

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Correspondence to Joanne Adams .

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Dickson-Swift, V., Adams, J., Spelten, E. et al. Breast cancer screening motivation and behaviours of women aged over 75 years: a scoping review. BMC Women's Health 24 , 256 (2024). https://doi.org/10.1186/s12905-024-03094-z

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Received : 06 September 2023

Accepted : 15 April 2024

Published : 24 April 2024

DOI : https://doi.org/10.1186/s12905-024-03094-z

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