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Research Article

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

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

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

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

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

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

* E-mail: [email protected]

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

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

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

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

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

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

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

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

Editor: Elisa Ughetto, Politecnico di Torino, ITALY

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

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

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

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

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

Introduction

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

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

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

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

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

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

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

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

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

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

Data collection

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

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

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

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

Text processing and keyword extraction

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

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

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

Classification of research topics

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

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

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

Evaluation of semantic importance

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

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

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

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

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

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

Overview of main topics

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

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

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

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

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

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

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

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

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

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

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

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

Compensation.

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

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

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

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

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

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

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

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

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

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

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

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

Decision-making.

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

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

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

Career progression.

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

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

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

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

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

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

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

Performance.

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

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

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

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

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

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

Organization.

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

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

Human capital.

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

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

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

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

Emerging topics: Leadership and entrepreneurship

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

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

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

Research gaps and conclusions

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

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

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

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

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

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

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

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

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

Supporting information

S1 text. keywords used for paper selection..

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

Acknowledgments

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

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• Published: 01 November 2022

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Participants

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

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

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

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

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

Data analysis

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

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

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

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

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

Subjugation of women

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Domestic and gender violence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The language of the feet is essential when words fail.

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

Chasing dreams

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

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

A male participant further clarified,

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

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

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

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

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

The theoretical concept of power play

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

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

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

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

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

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

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

Strengths and limitations of the study

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

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

Study implications

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

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

Availability of data and materials

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

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Acknowledgements

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

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

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

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Explainer: How gender inequality and climate change are interconnected

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Gender inequality coupled with the climate crisis is one of the greatest challenges of our time. It poses threats to ways of life, livelihoods, health, safety and security for women and girls around the world.

Historically, climate change scientists, researchers and policymakers have struggled with how to make the vital connections between gender, social equity, and climate change. As more and more data and research reveal their clear correlation, it’s time to talk about the disparate impacts of climate change and the linkages between women’s empowerment and effective, global climate action.

On International Women’s Day, we take a look at how climate change impacts women and girls, why gender equality is key to climate action, and what you can do to support solutions for women, by women.

How does climate change impact women and girls?

The climate crisis is not “gender neutral”. Women and girls experience the greatest impacts of climate change, which amplifies existing gender inequalities and poses unique threats to their livelihoods, health, and safety.

Across the world, women depend more on, yet have less access to, natural resources. In many regions, women bear a disproportionate responsibility for securing food, water, and fuel. Agriculture is the most important employment sector for women in low- and lower-middle income countries, during periods of drought and erratic rainfall, women, as agricultural workers and primary procurers, work harder to secure income and resources for their families. This puts added pressure on girls, who often have to leave school to help their mothers manage the increased burden.

Climate change is a “threat multiplier”, meaning it escalates social, political and economic tensions in fragile and conflict-affected settings. As climate change drives conflict across the world, women and girls face increased vulnerabilities to all forms of gender-based violence, including conflict-related sexual violence, human trafficking, child marriage, and other forms of violence.

When disasters strike, women are less likely to survive and more likely to be injured due to long standing gender inequalities that have created disparities in information, mobility, decision-making, and access to resources and training. In the aftermath, women and girls are less able to access relief and assistance, further threatening their livelihoods, wellbeing and recovery, and creating a vicious cycle of vulnerability to future disasters.

Women’s and girls’ health is endangered by climate change and disasters by limiting access to services and health care, as well as increasing risks related to maternal and child health. Research indicates that extreme heat increases incidence of stillbirth, and climate change is increasing the spread of vector-borne illnesses such as malaria, dengue fever, and Zika virus, which are linked to worse maternal and neonatal outcomes .

How does climate change intersect with other inequalities for women and girls?

While women and girls experience disproportionate impacts from climate change at the global level, the effects are not uniform. Looking at climate change through the lens of intersectional feminism , the way in which various forms of inequality often operate together and exacerbate each other, it is clear that climate change risks are acute for indigenous and Afro-descendent women and girls, older women, LGBTIQ+ people, women and girls with disabilities, migrant women, and those living in rural, remote, conflict and disaster-prone areas.

“If you are invisible in everyday life, your needs will not be thought of, let alone addressed, in a crisis situation,” says Matcha Phorn-In , a lesbian feminist human-rights defender who works to empower stateless and landless Indigenous women, girls and young LGBTIQ+ people in Thailand’s Chiang Mai, Mae Hong Son, and Tak provinces. “Humanitarian programmes tend to be heteronormative and can reinforce the patriarchal structure of society if they do not take into account sexual and gender diversity,” Phorn-in explains. “In addressing structural change, we are advocating for and working towards equality of all kinds.”

In the Brazilian Amazon, Dandara Rudsan , a Black and trans activist and an environmental racism specialist in the Public Defender’s Office of Pará State, knows firsthand that centering the experiences and challenges faced by different groups illuminates the connections between all fights for justice and liberation.

“In the Amazon, defending human rights means fighting for the survival of people and the rainforest every day, but there is no hierarchy between agendas… To finance social movements in the Amazon is to finance the survival of these communities, these people, and the rainforest.”

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A qualitative insight into researchers’ perceptions of gender inequality in medical and dental research institutions in Nigeria

Morenike oluwatoyin folayan.

1 Department of Physical Sports, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain

2 Department of Child Dental Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria

Adekemi Olowokeere

3 Department of Nursing, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria

Joanne Lusher

4 Provost’s Group, Regent’s University London, London, United Kingdom

Olabisi Aina

5 Department of Sociology, Faculty of Social Science, Obafemi Awolowo University, Ile-Ife, Nigeria

Guillermo Z. Martínez-Pérez

Associated data.

All relevant data are within the paper.

The aim of the study was to gain a qualitative insight into scientific researchers’ perceptions of gender inequality inside Nigerian research institutions through an investigation of how gender equality is enacted in medical and dental research institutions in Nigeria.

This descriptive and cross-sectional qualitative study probed decision-making around navigating gender inequity and explored opinions about how a supportive environment for female medical and dental researchers could be established. Data were collected through semi-structured telephone interviews with 54 scientific researchers across 17 medical and dental academic institutions in Nigeria between March and July 2022. Data were transcribed verbatim and analyzed using thematic analysis.

Three core themes emerged: institutionalized male dominance in research institutions; changing narratives on gender equalities in research and academic enterprise; and women driving the conscience for change in research institutions. Female medical and dental researchers’ perceived gender equality was challenging mainstream androcentric values in knowledge production within the medical and dental field; and queries the entrenchment of patriarchal values that promote a low number of female medical and dental trainees, fewer female research outputs, and few women in senior/managerial positions in the medical fields.

Despite the general view that change is occurring, a great deal remains to be done to facilitate the creation of a supportive environment for female medical and dental researchers in Nigeria.

Introduction

Gender equality is a visionary pursuit that carries an implication that economic, social, and cultural attributes and opportunities associated with different genders by different society should not confer difference in expectations that debar pursuits and aspirations, can positively influence individual and social development [ 1 ]. Moreover, equality is critical for the socioeconomic stability of countries as it promotes and guarantees peace and social justice. Three areas in which gender equality can foster progress is in science, education, and health [ 2 ]. Medical and dental researchers stand at the fulcrum of social development through their engagement in these three domains [ 3 ]. They also contribute to economic development through their work on understanding disease and promotion of medicine, vaccines, diagnostics, and effective public health messages. The work of scientists in research institutions often requires training others to advance science to support disease eradication and quality of life. This opportunity opened to medical and dental researchers through the promotion of gender equality has yet to be optimized.

In Africa, female researchers face greater challenges in the medical and dental health contexts limiting their ability to make optimal contributions to individuals and society [ 4 ]. For example, in West Africa, medical and dental researchers are faced with gender values and norms that assign women to domestic tasks and responsibilities that reduce the time they can dedicate to research [ 4 ]. This may explain why women spend more time teaching and less time researching, when compared with men [ 5 ]. Additionally, gender-blind organizational culture and institutional policies make it difficult for women to attain leadership positions and place them at risk of low opportunity for participation in science [ 4 , 5 ]. Moreover, female medical and dental health researchers can become distracted from investing in the process of challenging the gender-blind systems by dedicating attention to preserving relationships with their male spouses [ 4 ].

Like many other gender-blind research institutions in and outside of Nigeria, including medical research institutions, men in research have a greater number and quality of research outputs than women who are in research [ 6 – 8 ]; and fewer women are seen in top-office in research institutions [ 9 ]. The tendency for this is high because of the large number of male medical and dental students [ 10 , 11 ]. This is also driven by the high number of male students who pick a pre-college science track in secondary school [ 12 ]. The high number of men in medical and dental research institutions and the high number of men in managerial posts reflects a complex sociological phenomenon that enshrines these patriarchal practices through the use of gender exclusionary strategies that maintain the male monopoly [ 13 , 14 ].

There is limited information on the gender distribution of researchers in Nigeria. The available evidence indicates that the number of women in dental institutions had steadily increased from 36.2% in 2003, to 42.5% in 2013. Thus, the predominance of intake of men remains [ 15 ]. There are clearly gender differences in fields of specialization with a steady increase in the number of women in leadership positions [ 15 ]. However, this increase in female participation in dental academia may not quite reflect medical practice. For example, Ogunbodede [ 16 ] indicated an observed discrepancy in the increase in number of practicing female dentists versus practicing female medical practitioners over a 10-year period. While the number of dentists increased from 15% to 35% between 1981 and 2000, the increase for medical practitioners only shifted from 15% to 19%. Similarly, the number of male doctors in Nigeria is consistent with roughly twice the number between 2017 and 2019 [ 17 ]. Although male dentists do not double the number of female dentists, the number of male dentists (810) outweighs female dentists (555) [ 18 ].

A gender equality gap could not, however, be determined purely on grounds of numbers. This would be time-bound and to the continued detriment of developing an equal society. There is also no guarantee that a reduction in the number-gap would change the current paradigm. Prior studies have indicated that having more women educated in science not will change the status quo of more men holding senior positions [ 19 – 22 ]. The envisioned change in gender representation in the research institutions and research managerial positions needs to be driven by the collective concern and commitment to improving the quality of research outputs for the health and wellbeing of the society through the participation of women [ 23 ].

The theoretical perspective that informed the design of this study therefore, used a feminist institutionalism analytical lens that would enable the exploration of gendered institutions and their gendering effect [ 24 ]. The feminist institutionalism analytical approach enhances the exploration of the gendered dimensions of structures of power and behavior and the role played by institutional informal structures, processes, values, and norms. [ 25 , 26 ]. It enables an analysis of how informal institutions interacts with the formal systems; through roles played by gendered rules, actors, and outcomes, to produce gendered outcomes. Also, the feminist institutionalism analytical approach provides a theoretical lens that allows for gendered power relations and the processes that makes such relations visible [ 25 ].

Despite it being apparent that gender inequality practices exist among professions, little is known about how female medical and dental health researchers use the potentially transformative opportunities that do come their way. Are there career trajectories that make it possible for female medical and dental health researchers to access and maximize their use of these transformative opportunities in education and career development? Does the cultural context of female medical and dental health researchers support the institutionalization of gender inequality in ways that limits their ability to facilitate gender equality in their profession?

The present study aimed to address these research questions in order to provide insight into the career advancements of medical and dental academic health researchers irrespective of their gender. This qualitative study investigated how gender equality is enacted in the medical and dental research field; and explored male and female researchers’ perceptions of gender inequalities in medical and dental research institutions in Nigeria. It probed decision-making around navigating gender inequity within research institutions and explored opinions on how a supportive environment for female medical and dental researchers in Nigeria could be established.

Materials and methods

This study adopted an academic literacies perspective that accounts for context, culture, and genre [ 27 , 28 ]. The theoretical framework applied in this study was the preference theory due to its appropriateness for exploring researchers’ investment in efforts to mainstream gender considerations in institutional processes; whilst recognizing the need for women to simultaneously meet family and work responsibilities [ 29 ].

Study design, study site and study participants

This study formed part of a larger qualitative study that was conducted in Nigeria to determine barriers and ways to resolve gender equality in medical and dental research institutions in Nigeria. Female and male faculty members of 17 universities in Nigeria took part in this research study between March and July 2022. Participants were able to read and communicate in the English language and defined themselves as academics in either the health, medical, or dental education field because they promote, design, conduct and disseminate biomedical, clinical, and socio-epidemiological research in Nigeria. All participants resided in Nigeria, were adult members of academic or research institutions working on health issues and consented to take part in a one-hour interview.

Sample size

It was estimated that three study participants would be recruited from each of the 17 institutions that hosted a medical and dental school in Nigeria. Therefore, 54 interview slots were allocated equitably amongst professors, readers, senior lecturers, and lecturers (the entire spectrum of designations in the academia in Nigeria). The slots were also divided equitably among dentists and medical personnel, and in a proportion of 2:1 for female: male interviewees. These designates were then randomly allocated to each institution as indicated in the S1 Table . This sample size was adjudged to be adequate to generate rich information; and allow for saturation to occur. With a non-response rate of 20%, it was anticipated that the final sample size for the in-depth interview will be 43. Saturation is often reached with a sample size of 12 persons when working with a homogeneous group like that for this study [ 30 ].

Sampling procedure

A purposive and convenience sampling was used to identify potential participants working in a medical and dental health academic institution and conducting research in that institution. The diversity of respondents was ensured by recruiting study participants from all the academic cadres in the medical and dental institutions.

Study participants were recruited through a combination of purposive sampling and snowballing. Peers of the principal investigator in each of the 17 institutions were contacted and asked to identify a possible respondent that fit the profile of respondent to be interviewed in their institution. If the interviewee met the inclusion criteria, the principal investigator contacted her/him by telephone or via Email/WhatsApp. The purpose and objectives of this study was explained, the interviewee was invited to take part in an in-depth interview and a date was scheduled for the interview. Before the scheduled date, written informed consent was sought. When the consent form was filled and sent back, the interviewee was then enrolled as a study participant.

At the end of each interview, participants were asked to share the name of a colleague who may be interested in the interview. That colleague was then contacted and the process for enrolment was repeated until the target number of participants had been reached. Whenever a study participant refused study participation, the participant was replaced by an eligible study participant in the pool of contacted researchers.

Study procedure

An interview schedule was adapted based on a focus group discussion held with a convenience sample of 12 researchers working in medical and dental academic institutions. These were six male and six female researchers from Belgium, Brazil, Malaysia, Iran, Nigeria, United States of America, and Turkey. These researchers had a history of working in the West Africa region. The expert consultation was held via a conference call in June 2021 and aimed to explore perspectives on the scope of intervention carried out by university faculty members on gender equality in education and professional development. Before the discussion took place, participants received a one-page concept note about the main study, which included a brief description of the conceptual framework for the study; the working definitions of gender equality (people of all genders have equal rights, responsibilities and opportunities); and the aim of the discussion. The outcome of this discussion formed the basis of the interview schedule used in the main study.

In-depth interviews were conducted between March and July 2022 during the COVI-19 pandemic. Interviews were conducted using Telegram and WhatsApp video calls to identify interviewees perspectives on observed gender differences in career progression and trajectory of medical and dental researchers in Nigeria; as well as gender-related barriers to opportunities for changing this trajectory for future female researchers. Interviews were conducted between March and July 2022. All interviews were conducted in English and audio-recorded. Interviewees were required to switch on their video to enable the interviewer ensure the interview was being conducted in privacy. Notes were taken during the interview. The time range for the interview was 26 minutes to 71 minutes with a mean time of 55 minutes.

Data analysis

The purpose of data collection was to seek richness of information and to saturate all concepts and categories emerging from the in-depth interviews. After each interview, transcripts were transcribed verbatim, and were read and reread to reveal emergent themes. Table 1 presents ten broad topics that were explored through these interviews. Interviews were transcribed verbatim into a password protected Microsoft Word document accessible only via a single password protected computer. Anonymized transcripts of the recordings were checked to verify their accuracy and completeness compared to the audio recordings. Personal identifiers and names of places and institution were not transcribed.

Transcribed interview recordings were imported into Atlas.Ti and read and re-read to identify codes and categories using an inductive approach to code, analyze and report on [ 31 , 32 ]. This process helped gain familiarity with the data and achieve new insights by analyzing for recurring themes and issues that represented answers to the questions; and to draw conclusions from the responses.

A codebook was inductively developed from themes that had been generated and from analytical questions intended to elicit a thorough, nuanced exploration of gender equality in medical and dental research. Coding and analysis were led by the first author of this report. A second qualitative researcher was consulted for extra coding to ensure inter-coder reliability during the process. The adoption of this particular approach ensured the identification and description of new codes and subthemes within the transcripts and this procedure continued until the point of saturation was reached.

During this coding process, novel codes that emerged from the data were included to review the initial generated codebook. The transcripts were again re-read using the new codebook. This approach was employed to develop categories, which were then explored and used when discussing the pre-conceived topics. The concepts and categories of analysis were defined using the words of the participants. Data were organized into key themes and subthemes generated by the coding process, and excerpts and illustrative quotes of general insights and of deviant cases from the transcripts were selected to substantiate the presentation of the key findings in this report. The informants’ own words were also used to report the findings. Attention was paid to the researchers’ reflexive journals to ensure that informant biases were not introduced. The Consolidated criteria for Reporting Qualitative research guidelines were considered.

Ethics approval was obtained from the Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria (IPH/OAU/12/1617). All informants signed an informed consent form.

Participants’ characteristics

Table 2 presents data on the sociodemographic profile of the 54 female and male medical and dental professionals who participated in the in-depth interviews. The sample presents 48% females and 52% males, with their ages ranging from 33 to 62 years (what of the age mean?). Participants were educated to postgraduate level and most of whom were married. The number of children of interviewees ranged from 1 to 5.

Profile of refusals

An initial 44 (29 medical and 15 dental researchers; 30 females and 14 males) contacts were made. Of these, 12 (7 medical and 5 dental researchers; 10 women and 2 men) did not respond to contact made. One did not meet eligibility criteria, and eight (7 medical and 1 dental researchers; 4 females and 4 males) declined participation. The 21 consented respondents helped reach other participants through the snowballing process

Emergent themes

Three core themes emerged from the data that each reflected participants’ perceptions on how female medical and dental researchers’ make decisions to navigate the constraints within the research institutions in which they work; and how they act to promote a supportive environment for their female peers. These themes were: (1) Ingrained patterns of institutionalized male dominance in research institutions; (2) Hopes for a changing narrative on gender equalities in research; and (3) Women driving the conscience for change. These themes, along with the subthemes and extracts are presented in Table 3 .

Ingrained patterns of institutionalized male dominance in research institutions

Women felt under-represented and men overrepresented in most fields in the medical and dental fields. Women expressed an opinion that the medical and dental fields are male-dominated and that women need to compete more with lower status positions, as one participant expressed:

‘If you go to male -female enrollment in school, you will find out that the percentage is higher for males than females. Then, when you even come to the university, at least I can assert a guess that in my place, if we are like 35 doctors there will be like 7 females’ Dentist_male

Interviewees of both genders perceived that the number of women in the medical and dental profession is increasing, though they remain underrepresented in managerial positions in universities in Nigeria and are less likely to be promoted or elected to managerial positions. Women identified that they had had to put in a lot of effort to demonstrate that they were capable of doing just as well as or even better than men as indicated by the following extract:

It was not a small battle to convince learned people like professors, medical doctors saying a female can do this. Even up until now, we are yet to have our female first Vice Chancellor.’ Basic Sciences_Male

As per the participants’ opinions, gender inequality results in uneven power relations, entitlements, social values, responsibilities, and duties in patriarchal societies. The socialization process also affects how each gender perceives oneself and the power and influence they have. The majority of female researchers observed a male dominant culture in the medical and dental profession, which not only limits the opportunities for selection or nomination into leadership position, but also medical and dental specialization opportunities. As identified, men are perceived by female participants as afraid of women altering the status quo in academic and medical research:

‘Because of socialization the moment you are born, your parents tell you how to conform to gender expectations. Females are socialized not to do things that are tedious. This influences even professional. You see females being discouraged from being a surgeon and encouraged to be things like pediatric dentist, dentist.’ Medicine_Male

Hopes for a changing narrative on gender inequality in research

Participants of both genders voiced increasing public discussions on gender, gender equality, gender bias and discrimination; that is making it possible for a gradual shift in gender-biased practices in the medical and dental fields. These public discussions for change are happening by female professionals who speak up and advocate for evidence-based changes to gendered practice. The active drives for gender equality in the medical and dental fields is resulting in the rising enrolment of women in medical and dental schools, despite enrolment still being largely dominated by men. Participants opined that there is a growing awareness of opportunities for women to pursue careers in medicine and dentistry:

‘I will say that I think we have more of male researchers in medical and dental, but I think the trend is changing, there is also a male dominance in leading research but that is also changing because I think there is a lot of emphasis now on balancing the gender composition of researchers and also gender balance in recruitment. I think people are now thinking in that direction but before most of the research in medical and dental field include more of male than female as researchers and study participants. Dentist Male

There were testimonies of three female medical and dental professionals being the first to hold key managerial positions. For these women, breaking the gender barrier was an effort to create the needed pathway to make it easier for other women to come on board:

‘I was the first female consultant in the department, and the first female professor in the department’. You know most at times, if you are able to cross the first few hurdles, the rest becomes easier. So, maybe I’m the sacrificial lamb of the department. Surgeon_Female

Women driving conscience for change

Participants of both genders identified that the selection criteria for many grant opportunities were biased towards women; a number of male participants felt this skew opportunity for women gave women advantages. These biased opportunities were efforts by the granting agencies to drive gender equality in the medical and dental research fields. Male and female respondents, however, opined that the opportunities were not gender biased, while one female researcher commented that the opportunities open to women are not real opportunities, as women are often not able to make the best of these opportunities:

‘…an organization that gave gender differences in the cut-off age for application of grants–the cut-off age was lower for males than females. This was because the granting agency recognized that females start a lot later than males in their research career trajectory because of their social responsibility of caring for the babies and other unpaid care duties.’ Medicine_Female

Other opportunities for female researchers identified were gender mainstreaming into the composition of research teams not only for gender equality but also to improve the quality of the research outcomes, as diverse perspectives enhance the quality of the design and implementation of research. Gender mainstreaming was identified as important for many reasons, one of which for institutional building. Also, participants identified the need to build the capacity of women to be competitive, and for gender equality advocacy and sensitization of gender-blind research institutions.

To address barriers that prevent women from gaining access to tertiary education, professional research opportunities and promotion at the same rate as men. Few female and male participants identified the need for gender-sensitive policies that mainstream gender considerations in the appointments, recruitments, selection process of female medical and dental professionals into leadership roles; gender considerations in the access to grant opportunities; and opportunities for senior female mentoring of early career (female) researchers. Such policy drives and change can be achieved through the collaborative efforts of female medical and dental professionals. A few participants in this study proposed that gender study centers should be established within medical and dental institutions; and they be saddled to handle gender related issues:

‘The establishment of gender centers will probably promote gender equality generally. They can also generate research-based evidence that can address the ‘why’, ‘how’ and the value added by promoting gender equality.’ Medicine_female

Overall, participants in this study argued for institutional policies that help to drive gender sensitivity. Data pointed to policies needing to promote gender equity at the managerial and administrative levels while focusing on skills and expertise. The opportunities should be open equitably to everybody.

The current study identified a male dominance in the research outputs of medical and dental researchers in research institutions in Nigeria. This male dominance also reflects in the inequitable distribution of managerial positions of the institutions. The gendered operations of medical and dental research institutions is driven by the absorption of the societal patriarchal values. Individuals in this study expressed a paradigm shift driven by individual and collective bodies of women in academia driving a conscience for change. Other opportunities identified to drive the change process included enacting institutional policies that promote gender equality; establishing gender focused units in research institutions dedicated to implementing these policies; continued advocacy and awareness creation for the change to happen; mentorship by women for women and for men; and building the capacity for women to actively engage with others in the research enterprise.

A benefit of these findings is that they provide a contextual and rich foundation of evidence that supports prior research on the inequitable representation of women [ 4 , 33 , 34 ]. Moreover, a focus on medical and dental research institutions has allowed a deeper exploration of contextual professional factors that may promote gender inequality in a research setting.

Indeed, participants in this study perceived gender inequality as enacted through institutionalization of societal patriarchal and androcentric values that may make domestic responsibilities and career breaks for domestic reasons have far more reaching impact on women’s research outputs, and career progression; compared to their male counterparts. It is likely that poor environmental support for research in Nigerian institutions have more impact on women than men who are less able to access sponsored opportunities for capacity development due to the need to stay home even when these opportunities are presented [ 35 ]. For the same reasons, women may be less able to take up research grant opportunities even when grants are biased towards the selection of women, because of the care responsibilities they are encumbered with. These distractions from capacity building and empowerment opportunities during early career development years are challenging to catch up with in later years of a woman’s career, which thereby increases the gender competency gap. The failure to adjudge years of home management as human managerial skills, and poor accounting of home care as work skills continue to make women fall behind in the ratings for skills to handle managerial offices.

Though institutional policies and advocacies can help to bridge these gaps, they are unlikely to be eliminated. Gender equality policies are challenging to implement, but when implemented, significant progress can be made with gender mainstreaming [ 36 ]. Gender-sensitive institutional policies in medical and dental research institutions, implemented by established gender focal units, may help to drive the shift towards gender equality in research outputs and numbers of female appointments into senior cadres. These policies will need to promote a gender sensitive review of assessment criteria for appointment and promotion. Further research is necessary to better understand how home-management skills can be rated, groomed and adapted as administrative skills. Efforts in these directions may help to eliminate the managerial position gender equality gap. This may also facilitate men in taking on home care roles in the knowing that they will not be worse-off for doing so.

Furthermore, participants’ voices pointed to continued advocacy and awareness creation. One of the roles of the Medical Women’s Association of Nigeria is to advocate for favorable policies for women, and they have done so successfully for many issues related to clinical practice [ 37 ]. One of which is for paid maternity leave. They have, however, achieved little in driving equality in the field of research. Women in academia may need to form pressure groups to address the issues peculiar to their needs. Pressure groups also need to partner and engage with men to promote gender equality; and advocate for new masculinities and for human rights. Advocacy seeks to narrow the gap between what is known to be effective, acceptable, and efficient and what is practiced [ 38 ]. It involves a combination of individual and social actions designed to gain political commitment, social acceptance, and system support for a particular goal or program. Though it is an effective strategy for producing policy change, it can be difficult and complex for those with limited power and resources [ 38 ]. Future work is vital for understanding how gender equality in research institutions has contributed to the attainment of the sustainable goal more generally.

While advocacy may bring about change, slowly, the mentorship of women by women and men allies in the gender equality fight could bring about substantial change in the research context [ 39 ]. Female mentors promote aspirations of other females to pursue the same career pathways through a feeling of belonging and confidence. Participants in this study reported views on mentoring actions, though, as such, are unclearly defined. The suggested efforts of reaching out to other women in medical and dental research, by those who explained that they have made it to more senior positions, can be institutionalized by research organizations, or bodies, of female professionals. The mentorship process could also facilitate building the capacity of women to actively engage with others in research enterprise. However, mentorship is a non-formal educational system that should not replicate social norms, dominant values, or drivers that could otherwise entrench inequality and disempowerment of women by reproducing existing hierarchies and exclusions [ 40 ]. Training mentors on gender-sensitive mentorship strategies may help to avoid these possible risks.

One of the strengths of the study was the recruitment of study participants from Northern and Southern Nigeria thereby reflecting the views of male and female researchers from diverse cultural context in Nigeria. The study findings are therefore potentially comparable across research institutions in Nigeria. The study is, however, not without limitations. The data collected were limited to the perception of gender inequality in medical and dental research institutions and the coding and analysis of these data were conducted within this context. Additional themes and perspectives can be derived from the content-rich narratives of the participants; and this warrants further exploration as issues surrounding gender and cultural differences in light of gender equality in medical and dental research institutions are not fully understood. Differences in the perspectives of dental and medical researchers could also be examined separately, as the experiences of these two groups may differ.

Despite these potential limitations, results from the present study do provide insights that support a feminist institutionalist perspective that societal inequality is reproduced in political and social institutions such as higher institutions of learning [ 41 ]. Understanding how context specific institutional rules, processes and norms drives the enactment of gender inequality can help with the reform and improvement of institutional gender equality programs and strategies. This study is the first study to explore how and why gender inequality is enactment in medical and dental schools in Nigeria; and therefore, provides a framework to support possible gender reforms in these institutions.

In conclusion, medical and dental researchers perceive gender inequality as enacted in medical and dental research institutions in Nigeria through the entrenchment of societal, cultural and religious patriarchal values. These patriarchal values promote the low numbers of female medical and dental trainees, lower research outputs for female researchers when compared to that of male researchers, and fewer women in senior managerial positions. A lot still needs to be done to facilitate the creation of a supportive environment for female medical and dental researchers in Nigeria. This includes the development, monitoring and enforcing of newly created norms that assist in creating the needed support for gender equality. There is a necessity to establish a critical mass of gender experts in medical and dental research institutions who can design and promote effective mechanisms to promote gender equality practices in Nigeria.

Supporting information

Acknowledgments.

The authors acknowledge the contributions of the time and efforts of the participants to this study.

Funding Statement

The authors received no specific funding for this work

Data Availability

• PLoS One. 2023; 18(4): e0283756.

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PONE-D-22-27154A qualitative insight into researcher’s perceptions of gender inequality in medical and dental research institutions in Nigeria.PLOS ONE

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17 Jan 2023

We will like to thank the reviewers and the editor for the thorough review of this manuscript. It has helped improved the quality of the research.

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Decision Letter 1

16 Mar 2023

A qualitative insight into researchers' perceptions of gender inequality in medical and dental research institutions in Nigeria.

PONE-D-22-27154R1

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28 Mar 2023

A qualitative insight into researchers’ perceptions of gender inequality in medical and dental research institutions in Nigeria.

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Journal of International Development

Francesca Capparucci

Claudia Sanhueza , David Bravo

This papers studies the presence of discrimination in terms of gender and socioeconomic level of the place of residence in Argentina. In order to assess the existence of discrimination in these dimensions, we submited approximately 2700 fictitious Curriculum Vitae (CV) for real job vacancies published daily in an important Argentine job-search website. A set of realistic and representative resumes without effectively using resumes that belong to actual job seekers, which were equivalent in terms of qualifications and employment experience were sent out, varying the gender and residential area. We estimated a binary choice model to identify differences in callbacks depending on gender and socioeconomic level of the place of residence. A simple descriptive analysis of our data and also our formal econometric estimations do not suggest evidence of discrimination based on gender. However, our results do suggest evidence of discrimination in terms of socioeconomic level of the place of residence which seems to be important in magnitude.

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• House Republican Agendas and Project 2025 Would Increase Poverty and Hardship, Drive Up the Uninsured Rate, and Disinvest From People, Communities, and the Economy

CBPP Staff [1]

Executive Summary

Over the last several months, groups of House Republicans and the Heritage Foundation have released policy agendas that, taken together, would create a harsher country with higher poverty and less opportunity, where millions of people would face higher costs for health care, child care, and housing, and millions more would lose health coverage — all while wealthy households and corporations benefit from an unfair tax code that provides them with outsized tax breaks. These skewed priorities would exacerbate inequities in income, wealth, health, and hardship across lines of race and ethnicity, widening already glaring differences that have their roots in racism and other forms of discrimination.

Looking at three proposals — the House Republican Study Committee’s (RSC) budget plan, the Republican House Budget Committee’s (HBC) budget resolution, and the Heritage Foundation’s Project 2025 agenda — brings the implications of influential conservative policymakers’ and a think tank’s broader fiscal policy agenda into sharper focus. That agenda features:

Policies that raise costs and take away health coverage, food assistance, and other help affording the basics from people when they need them. These policies will create significant economic and health insecurity for millions of people while increasing poverty, hardship, and the number of people lacking health coverage. They will shortchange children’s futures, make it harder for millions of seniors to afford prescription drugs, and take away help that households need to afford food, housing, and child care.

For example, the RSC budget calls for $4.5 trillion in cuts over ten years in Medicaid, the Children’s Health Insurance Program (CHIP), and Affordable Care Act (ACA) marketplace coverage, [2] cutting these health coverage funds by more than half. The HBC budget plan, meanwhile, calls for $2.2 trillion in cuts to health coverage — all from Medicaid, the associated committee report suggests. [3] This cut would amount to 30 percent on average over ten years, and 40 percent in 2034. Nearly 74 million people receive health coverage through Medicaid, so cuts of this magnitude would result in millions losing access to comprehensive coverage.

Similarly, the RSC budget calls for cutting average Supplemental Nutrition Assistance Program (SNAP) benefits by about 22 percent by rescinding the updated 2021 Thrifty Food Plan, which adjusted SNAP benefits to reflect the cost of a healthy diet based on today’s dietary guidelines and food consumption patterns. [4] This cut would affect 41 million people participating in SNAP, formerly known as food stamps. (HBC and Project 2025 also sharply criticize the Thrifty Food Plan increase but are not clear about rescinding it. [5] ) And Project 2025 calls for gutting summer food assistance programs that children in families with low incomes rely on when school is out, which could include the new Summer EBT program that is expected to provide grocery benefits to more than 21 million children this summer. [6]

The HBC budget plan cuts the “income security” category of programs by almost $1 trillion over ten years; the accompanying report targets SNAP, the Earned Income Tax Credit (EITC) and Child Tax Credit, and Temporary Assistance for Needy Families (or TANF, which provides flexible funding that states use for a range of benefits and services to low-income families with children). If income security cuts are largely limited to these programs, benefits would be slashed by more than half by 2034. [7]

The RSC budget has very deep cuts in this part of the budget as well. It includes a cut that would convert Supplemental Security Income (SSI), a 50-year-old program that provided income assistance to 7.5 million low-income seniors and disabled people in 2022, to a block grant and end guaranteed cash aid through the program.

Many of the proposals in these agendas would shift large costs onto states, forcing them to either kick in far more money — a particular hardship for states with lower per capita incomes — or cut benefits and services to their residents.

• Massive disinvestment in public services, which will limit opportunity, hurt communities, undermine efforts to address climate change, erode basic government functions, and damage the economy. For example, both the HBC and RSC budget plans call for enormous cuts in the part of the budget that funds a wide range of federal services, activities, and assistance­­ — from education investments that build the skills of our future workforce, to transportation infrastructure that supports commerce and safety, to the nation’s weather forecasting system and scientific and medical research. In addition, all three plans would repeal or let expire climate provisions of the bipartisan Infrastructure Investment and Jobs Act. And all three plans call for repealing the Inflation Reduction Act’s groundbreaking investments in clean energy. [8]
• A doubling down on skewed, expensive, and ineffective tax cuts. The RSC and HBC budget plans call for extending all of the 2017 law’s expiring individual income tax cuts, [9] which would cost nearly $4 trillion over ten years (2026-2035), [10] and making additional business tax breaks permanent, which would cost nearly a trillion more. [11] Project 2025 goes even further, calling for a host of new tax cuts for wealthy households and corporations, including for multinational corporations that use overseas tax havens. The HBC budget plan shows none of the costs of extending the expiring 2017 tax cuts in its budget figures, but creates a new procedure allowing unlimited tax cuts. [12]
• Harsh treatment of immigrants, hurting families, shortchanging children’s futures, undermining immigrants’ contributions to communities and the economy, and hurting the country as a whole. Project 2025, the RSC budget plan, and the HBC budget plan call for a host of harmful policies that would take help away from families that include immigrants when they fall on hard times. Among other proposals, these plans seek to frighten immigrants and their families from participating in the Census, paying their taxes, and receiving benefits for which they are eligible. [13]

Behind these eye-popping budget numbers are millions of real people who will see health coverage, food assistance, and other forms of support taken away. (See Figure 1.) This will make it even harder for them to afford the basics, leading to serious hardships such as homelessness or overcrowded living, food insecurity, hunger, and untreated health conditions.

It is also notable what is missing from these agendas. Despite rhetoric from some Republicans about the need to support families — and children in particular — these sweeping agendas do not call for new or increased investments to help families afford child care or rent, to expand the Child Tax Credit, or to bolster the EITC for workers without children. And they do nothing to ensure that all workers have access to paid family and medical leave so they can take time off to welcome a new child, attend to a health issue, or care for a family member who needs them.

These agendas, particularly Project 2025, cover multiple areas and this report does not analyze them in full. It provides key examples of fiscal, economic, and health policies within the agendas and, critically, how the plans have broad similarities. Key areas, such as the agendas’ impact on the functioning of the Justice Department, on abortion rights and reproductive freedom, on civil rights protections, and on the potential politicization of federal agencies and the civil service, are critically important but outside the scope of this analysis.

Raising Health Care Costs and Taking Coverage and Other Help Away From People Who Need It

The three policy agendas all share a common thread — taking away help that families use to afford the basics such as food, child care, housing, and health care. The cuts would hit families with low and moderate incomes especially hard while leaving many high-income people largely unscathed. But because investing in areas such as health care and child care has long-term payoffs for the country and economy as a whole, ultimately everyone would lose.

Medicaid Cuts Would Take Away Health Coverage From Millions of People

As noted, HBC would cut Medicaid by $2.2 trillion over ten years; [14] RSC would cut Medicaid, CHIP, and ACA marketplace assistance by $4.5 trillion, likely by cutting Medicaid even more deeply than the HBC proposals and by making cuts to marketplace policies described below. [15] The size of the cuts in Project 2025 is less clear but also extremely large. (See Figure 2.)

The ACA’s changes to Medicaid and individual market coverage drove a precipitous decline in the uninsured rate. That is particularly true for people of color, who have historically experienced higher uninsured rates due to systemic racism, discrimination in employment and education, and other factors that diminish income and access to employer-based health insurance. Between 2013 and 2022, uninsured rates for people under age 65 dropped from 23.8 percent to 14.1 percent among American Indian and Alaska Native people, from 29.7 percent to 17.8 percent among Latino people, and from 18.7 percent to 9.9 percent among Black people. [16] Rolling back or eliminating key ACA improvements — including the Medicaid expansion — and gutting other key Medicaid and marketplace protections would disproportionately harm people of color.

Medicaid proposals in the three agendas include:

• Capping or block-granting Medicaid and providing less funding than is needed to maintain the current program, thereby cutting the number of people who can receive coverage, the services provided, or both (HBC, RSC, and Project 2025); [17]
• Sharply cutting the share of Medicaid costs the federal government covers while giving states new authority to cut both the number of people and the health benefits Medicaid covers (HBC, RSC, and Project 2025); [18]
• Taking away financing options states now use to pay their share of Medicaid costs, making enrollment and services cuts even more likely (RSC and Project 2025); [19]
• Increasing the costs states must bear if they continue or adopt the Medicaid expansion, or explicitly allowing states to shift funds from adult health care coverage to other populations such as children or people with disabilities, with the goal of reducing coverage for adults and potentially pushing some states that have adopted the Medicaid expansion to end it (HBC; Project 2025; and RSC, which has more of these details spelled out); [20]
• Taking Medicaid coverage away from people who don’t meet rigid work requirements, which evidence from states [21] has shown doesn’t increase employment and takes coverage away from large numbers of enrollees — including many who are working or who should be exempt given their health conditions (HBC, RSC, and Project 2025); [22] and
• Allowing states to raise Medicaid premiums (Project 2025) [23] and make its benefit package far less comprehensive (RSC and Project 2025). [24]

Gutting ACA Would Raise Health Insurance Costs Sharply and Leave Millions Uninsured

Both Project 2025 and the RSC budget would raise health insurance premiums for millions of people and weaken or eliminate the ACA’s most popular consumer and financial protections. Insurers in the individual market could charge higher premiums to people with pre-existing conditions and remove limits that protect people from very high out-of-pocket health care spending. The HBC and RSC proposals would also cut financial assistance for ACA marketplace coverage, [25] where more than 20 million people get their health coverage and more than 9 in 10 receive premium tax credits that reduce the cost of their premiums. [26] The agendas would also strip away anti-discrimination protections that apply to all health programs and activities receiving federal financial assistance. While it is not presented as repealing the ACA, dismantling the ACA piecemeal like this would have a similar impact, with millions losing coverage.

Project 2025 and the RSC budget would:

• Cut federal premium tax credits, raising people’s costs. The RSC plan would reduce and ultimately eliminate the financial assistance that most people in ACA marketplace plans receive to help them afford their premiums, deductibles, and other costs under comprehensive health insurance plans, shifting some funding into a block grant. [27] Project 2025 criticizes federal marketplace financial assistance [28] and references a separate Heritage Foundation paper that calls for establishing capped federal allotments for states in place of the current ACA subsidies. [29] The ACA financial assistance — especially with the improvements enacted in 2021 — has helped drive a marked increase in insurance coverage rates, particularly among Black people, Hispanic people, and people with low incomes. [30]
• Allowing existing improvements to premium tax credits to expire after 2025 — as the HBC budget plan and RSC proposal would do [31] — would mean premium spikes for nearly all marketplace enrollees. For example, a typical 60-year-old couple making $80,000 (405 percent of the poverty level) would see their marketplace premiums more than triple to over $24,000 per year. (See Figure 3 for estimates by state.) [32] In addition, an estimated 4 million people would become uninsured, with the greatest coverage losses occurring among Black and Hispanic people in states that have not expanded Medicaid. [33] Eliminating the PTCs entirely, [34] meanwhile, would lead to even greater coverage losses, increase people’s premium costs even further, and throw stable insurance markets into disarray. For example, without a PTC, a 40-year-old person making $29,000 (roughly 200 percent of the poverty level) would see their annual marketplace premiums increase from $570 to $5,700. [35]

Eviscerate federal protections for people with pre-existing conditions. The RSC and Project 2025 plans would roll back federal insurance protections for people in marketplace plans in favor of separating healthy people and those with pre-existing conditions into different markets that operate under different rules.

The RSC proposal would allow insurers to charge higher premiums for individual market coverage (both inside and outside the ACA marketplace) to people with pre-existing conditions and exclude certain benefits from plans they buy. [36] The proposal says people with chronic and complex conditions would get coverage through separate state-run high-risk pools, [37] but these existed prior to the ACA and had high premiums, gaps in benefits, and limited enrollment because of their cost. [38]

Project 2025 proposes “regulatory relief” that amounts to eliminating many critical federal health reforms; it doesn’t specify which ones but calls for the federal government to create a second insurance market not subject to ACA standards, [39] which would attract healthier enrollees, with the likely result that premiums for those with pre-existing conditions would become unaffordable. This would disproportionately harm Black people: due to racial inequities in social and economic factors — such as being likelier to live in communities with less access to health care or to have lower incomes that make it harder to afford healthy food — they have a higher prevalence of several common chronic conditions. [40]

Both the RSC plan and Project 2025 would increase the availability of health plans that are currently exempt from ACA standards and protections, such as short-term health plans. [41] This is another strategy to lead people with fewer health care needs away from the ACA marketplace’s comprehensive health plans, resulting in a sicker risk pool and higher premiums for those enrolled in marketplace plans. [42]

• Roll back federal protections that explicitly prohibit insurers and health care providers from discriminating against LGBTQ+ people and people who have had abortions or miscarriages. Section 1557 of the ACA prohibits Department of Health and Human Services (HHS) programs, as well as insurance companies and health care providers that receive HHS funding, from discriminating against members of certain protected groups. Project 2025 seeks to end protections that currently apply to LGBTQ+ individuals, pregnant people, and people who have had an abortion or miscarriage. [43]

Taking Food, Other Assistance Away From Low-Income Households Would Increase Poverty, Hunger

Both the RSC and HBC plans call for large cuts to the part of the budget that funds income and food assistance programs such as SNAP. The HBC plan, for example, calls for $962 billion in cuts over ten years to “income security” programs, and its accompanying report indicates that SNAP, TANF, and the tax refunds provided through the EITC and Child Tax Credit would be targeted for cuts. [44] If income security cuts are largely limited to these programs, benefits would be slashed by more than half by 2034. [45]

All three agendas — HBC, RSC, and Project 2025 — call explicitly for significant cuts to SNAP. This is the nation’s largest and most important anti-hunger program, providing families with funds on an electronic benefit card that they use to purchase food at the grocery store. Taken together, these cuts would reduce or take away entirely food assistance for millions of people.

More than 44 million people in the United States live in households that experience food insecurity. Due to past and ongoing racism and discrimination, households that are American Indian or Alaska Native, Black, Hispanic, or multiracial experience much higher than average levels of food insecurity. [46] SNAP is highly effective at reducing food insecurity, and there is emerging evidence that SNAP may mitigate racial inequities in food insecurity and poverty. [47] But the proposed cuts to SNAP could weaken its effectiveness and exacerbate these inequities.

The proposed cuts include the following:

• The RSC budget calls for SNAP benefits to be cut by an average of 22 percent by undoing the recent, congressionally mandated re-evaluation of the Thrifty Food Plan — a long-overdue step that resulted in an upward revision to SNAP benefits to more accurately reflect both the cost of a modest but healthy diet and U.S. food consumption patterns. [48] This update to the Thrifty Food Plan lifts over 2 million SNAP participants above the poverty line, with the greatest poverty-reducing impact for Black and Hispanic individuals. [49] Undoing the revision would reverse this progress and cut benefits to some 41 million SNAP enrollees, including nearly 17 million children, slashing the average SNAP benefit from about $6.20 per person per day to only $4.80 in 2025. (See Figure 4.) Both Project 2025 and the HBC budget resolution also sharply criticize the 2021 re-evaluation of the Thrifty Food Plan. [50]

Meeting one’s life-sustaining needs should not be contingent on meeting a work requirement. But both the RSC budget and Project 2025 call for expanding the number of SNAP enrollees whose benefits would be taken away if they aren’t able to meet rigid work requirements — a policy already in place for most adults aged 18 through 54 who don’t receive disability benefits and don’t live with children. [51]

Most SNAP participants who can work, do. [52] These requirements are premised on the false assumption that people who receive SNAP do not work and must be compelled to do so — an assumption rooted in a host of unfounded prejudices based on race, gender, disability status, and class. Rigorous studies have shown that the current work requirement policy is ineffective at increasing employment. Instead, it takes food assistance away from people with very low incomes and increases food insecurity and hardship. [53]

Policies that take food assistance away from people who don’t meet a rigid work requirement ignore the realities of the low-paid labor market, such as irregular hours and a lack of paid sick days that lead to frequent job loss; the impact of work-limiting health conditions and caregiving responsibilities on a participant’s ability to find and keep consistent work; and substantial ongoing labor market discrimination.

The report accompanying the HBC budget resolution also calls for expanding ineffective work requirements. [54]

• Both the RSC budget and Project 2025 propose eliminating a long-standing SNAP option — a popular one, used in more than 40 states led by governors of both parties — that modestly raises SNAP’s income eligibility limits for certain households, including many households with earnings . [55] This policy, known as broad-based categorical eligibility, extends SNAP eligibility to many working families with low incomes for whom affording food is difficult because they face high costs for necessities like housing or child care. This option also allows states to adopt a less restrictive asset test to qualify for SNAP, allowing low-income households to build modest savings without losing food assistance. Eliminating this option would terminate SNAP for millions of people with low incomes and would take food assistance away primarily from working families, older adults, and people with disabilities. Punishing asset building would particularly harm people of color who participate in SNAP, who face structural disadvantages to building wealth and getting ahead.

The attacks on food and other assistance to low-income families aren’t limited to SNAP. For example:

• Project 2025 would also end most summer food assistance programs, designed to mitigate food insecurity when school is out and children don’t get school meals . [56] Many children who receive free or reduced-price school meals struggle to access nutritious food when school lets out for the summer. Studies have shown that households with school-aged children experience higher rates of food hardship during the summer. [57] Project 2025 could take away food assistance from roughly 21 million children in low-income families who are expected to receive grocery benefits this year through the new Summer EBT program, which was established by Congress in 2022 on a bipartisan basis to address this seasonal spike in child hunger. Project 2025 would also gut the Summer Food Service Program, which provides meals to more than 2 million children on average each day when school is out.
• Project 2025 and the RSC budget would make it harder and more stigmatizing for children in low-income communities to get free school meals. Currently, schools in every state serving large numbers of children in low-income families can provide free school meals to all children in the school, reducing administrative costs and eliminating the stigma associated with targeted participation. Almost 20 million children nationwide attend a school that uses this option. [58] Both Project 2025 and RSC would end this policy. [59]
• Project 2025 calls for ending Head Start , which provides early learning and other services to about 800,000 preschoolers, toddlers, and infants. [60] More than a third (37 percent) of the children enrolled in Head Start are Latine, nearly 30 percent (28 percent) are Black, about one-quarter are white, 3 percent are American Indian and Alaskan Native, and 3 percent are Asian, Native Hawaiian, or Pacific Islander. [61]
• The RSC budget calls for effectively ending guaranteed income assistance through SSI , which provided cash assistance to 7.5 million very low-income seniors and people with disabilities in 2022 (the last year data are available). [62] The plan calls for converting the funding (at what level is unclear) to a block grant to states, jeopardizing basic assistance for people whom the federal government for 50 years has recognized need income assistance they can count on. [63] (See Figure 5.)

Project 2025 calls for taking away housing assistance from people who can’t meet a work requirement or who reach an arbitrary time limit on how long they can receive assistance, even if they still need help to afford rent and avoid eviction. It would also end effective strategies for addressing homelessness that pair rental assistance with personalized supportive services, in favor of policies that research has found are less effective. [64] Like in other areas, these policies would disproportionately harm people of color, and especially Black people, who are far more likely than white people to experience homelessness and eviction. Discrimination was and is prevalent in housing as in other sectors, with one of the most consequential examples being federal “redlining” policies that made it far more difficult for Black people to become homeowners.

Project 2025 and the RSC budget would eliminate or weaken fair housing tools and enforcement, allowing for greater discrimination in housing that would exacerbate existing inequities. [65]

Enormous Costs Shifted to States, Widening Gaps Between Wealthier and Poorer States

All three agendas would cut funding that goes to states and localities, both in “mandatory” programs such as Medicaid and SNAP and in “discretionary” programs funded through the annual appropriations process, from transportation to public health to child care (see next section). As discussed above, the HBC, Project 2025, and RSC plans include proposals explicitly designed to shift costs from the federal government to states, including block-granting Medicaid or cutting the share of the program funded by the federal government. [66] The RSC budget also proposes block-granting SNAP and combining child nutrition programs, including the National School Lunch Program, School Breakfast Program, Child and Adult Care Food Program, Summer Food Service Program, and Special Milk Program, into a single block grant, likely with reduced funding. [67]

Under the RSC proposal, which would replace the long-standing Medicaid matching rate formula with a 50 percent rate for all states, the sharpest increases in Medicaid costs would generally occur in states whose residents have lower incomes and experience higher poverty rates — the states that can least afford the cost shift. [68] These states would experience the biggest cuts under the RSC proposal because, under current law, the federal government pays a larger share of Medicaid costs in states that have lower per capita incomes, recognizing the challenges these states face in financing health care costs. These are the same states that will struggle to make up for cuts in other areas, such as education or child care (discussed below), making it particularly hard for them to backfill for federal Medicaid funds, likely widening gaps between wealthier and poorer states in areas such as quality of education or health care access and coverage.

Finally, as noted, the RSC calls for converting the SSI program from one that now provides seniors and people with disabilities with federally funded cash assistance they can count on every month, to instead be a block grant to states, presumably with reduced funding. If funding proved inadequate, low-income seniors or people with disabilities would either receive less help or states would have to pick up the tab.

Massive Disinvestment in People, Communities, and the Building Blocks of Our Economy

The federal budget funds a host of investments in people, communities, and the economy as well as core functions of government through programs and initiatives funded through the appropriations process. This part of the budget (whose amounts are set annually) funds efforts such as: medical and basic scientific research; the weather forecasting system; education from preschool through college; housing; child care; tax system customer service and enforcement of our tax laws; disease monitoring and response to public health crises; the processing of applications and benefits in Social Security; anti-fraud staff in Medicare; investments in roads, bridges, public transit, and ports; and environmental clean-up and enforcement.

This part of the budget is called “discretionary” to connote that the spending is not fixed in law and that Congress has the discretion to set funding levels each year. But these kinds of investments are not optional for the safety, well-being, and thriving of our country and its economy, now and into the future.

Moreover, many of these investments — some targeted and others more broad based — promote opportunity for people and communities that have been under-resourced for decades due to federal, state, and local policy, especially Black, Latino, and Indigenous communities, people with disabilities, and people with low incomes living in rural and urban communities alike. These include additional funding for schools that serve large numbers of children in low-income families, college financial aid that paves the way to higher education, and funds for child care and preschool and for affordable housing development and rental assistance. [69]

Despite these critical functions, both the RSC budget and the HBC budget resolution call for massive disinvestment in this part of the budget — non-defense discretionary spending. [70] Indeed, the HBC budget would cut this part of the budget by $3.1 trillion over the decade. The RSC budget would cut even more, $4.1 trillion over the decade, [71] by making the cuts occur immediately rather than phasing them in.

Under both plans, non-defense discretionary spending would fall from its current level of 3.3 percent of GDP to about 1.4 or 1.5 percent after a decade — levels not seen since the Coolidge Administration a century ago. The programs targeted for these cuts are almost entirely unspecified, but if veterans’ health care is shielded, then under either of these plans, by 2034 spending for the remaining programs would fall by half .

Even though the plans do not offer many specifics, the cuts are so large that there is simply no way that all critically important public services could be protected. The result would likely be damaging cuts in our education and child care investments that build the human capital of our future workforce and allow parents to work, our transportation infrastructure that is critical to moving goods and services and keeping people safe, and our weather forecasting system that is essential for basic safety and commerce. And it would mean cutting staffing for agencies that help people access Social Security, ensure that Medicare providers are providing good care and playing by the rules, and enforce environmental laws and mitigate hazardous conditions. All of these public services are critical to people, families, communities, and the basic functioning of society.

The cuts the three agendas do specify include, for example, Project 2025’s elimination of Head Start (discussed above), which is funded in this part of the budget. Other examples include the following:

• Project 2025 calls for the Department of Education to be eliminated over time , with some programs transferred elsewhere and the rest abolished. [72] It would phase out over ten years the largest federal K-12 program, “Title I Education for the Disadvantaged,” which provides critical funding for school districts in communities experiencing high levels of poverty. Given the disproportionate child poverty rates among Black, Latine, and Indigenous children, this cut would exacerbate educational inequities. The RSC budget would eliminate a number of grants to school systems, and while it wouldn’t do so for Title I outright, that program would be at risk under RSC’s proposal that allows states to opt to receive all of their federal education funds through a block grant. [73] Both Project 2025 and RSC would make it harder for students to afford college by cutting financial aid.
• The RSC budget would take away assistance that millions of low-income households use to pay for heating, and in some states cooling, their homes, by eliminating the Low-Income Home Energy Assistance Program (LIHEAP). [74]
• The RSC and HBC budgets would eliminate federal funds for the Legal Services Corporation, which provides financial support for roughly 130 nonprofit legal aid agencies nationwide. [75] Those agencies provide legal assistance to low-income families in handling non-criminal legal matters such as housing, child custody, domestic abuse, divorce, access to health care, employment law, and debt collection.
• The RSC budget calls for “significantly” reducing the Environmental Protection Agency’s (EPA) budget, which the agency uses to reduce pollution, clean up hazardous waste, develop and enforce environmental standards, and help finance facilities for wastewater and drinking water treatment. [76] Among other things, the RSC budget calls for termination of surface water protection programs, which protect coastal waters and sources of drinking water such as rivers and lakes. The budget claims that states are better equipped to manage those waters, yet many of them flow or lie between states. Project 2025 and the HBC plan also call for cuts in EPA funding. [77]
• The RSC budget calls for elimination of all Energy Department funding for researching, developing, demonstrating, and deploying technologies for reducing greenhouse gas emissions and promoting energy efficiency . [78] It would repeal clean energy provisions of the Infrastructure Investment and Jobs Act, including those supporting electric vehicles and low-emission school buses. [79] Project 2025 also calls for rescinding all remaining renewable energy funding appropriated in the Infrastructure Investment and Jobs Act. [80] The HBC plan criticized the infrastructure law and would not extend it, hampering efforts to combat climate change. [81] And, relatedly, all three plans call for repealing the Inflation Reduction Act’s investments in clean energy. [82]
• The RSC budget would eliminate both capital and operating funding for Amtrak , along with any further funding for high-speed rail. It would also end capital investment grants for mass transit and “RAISE” competitive grants for surface transportation infrastructure projects. [83]
• The RSC budget would both reduce the annual funding level for the IRS and repeal all that remains of funding provided in the Inflation Reduction Act to rebuild the IRS’ capacity to provide good customer service and enforce the tax laws and collect revenue that is due (discussed more below). [84]
• The RSC budget would eliminate funding for programs that are critical for states and localities to build and rehabilitate affordable housing and cut funding in half for fair housing education and enforcement . [85]

This is a recipe not for a thriving nation but for one retreating from its basic obligations to keep people safe and healthy and our economy strong. The impacts will at first fall most heavily on low- and middle-income people, who are least able to rely on private resources to replace basic government functions. Ultimately, though, these investments are critical for our economy and nation as a whole.

Doubling Down on Skewed, Expensive, and Failed Tax Policies

At the same time that these policy agendas call for massive disinvestment in public services and taking health coverage, food assistance, and other forms of assistance away from people who face challenges affording the basics, all three plans double down on expensive tax cuts mostly benefiting wealthy people and corporations. Project 2025 even calls for tax increases on low- and middle-income people.

Due to racial barriers to economic opportunity, households of color are overrepresented among households with incomes in the low end of the distribution, while non-Hispanic white households are heavily overrepresented among households with incomes at the top of the distribution. [86] Each of the three proposals would disproportionately benefit high-income households and exacerbate racial inequities.

For example, each agenda would double down on the 2017 tax cuts, whose core provisions are tilted heavily toward high-income households. [87] (See Figure 6.)

• The report accompanying the HBC budget resolution calls for extending all of the expiring 2017 tax cuts (at a cost of $4 trillion from 2026-2035) and making permanent costly business tax cuts . [88] But HBC does not include these costs in its budget resolution numbers, instead relying on language in the resolution allowing for consideration of these and other tax cuts regardless of cost. [89]
• The RSC budget calls for the continuation of all of the 2017 law’s individual income tax cuts and adds substantial tax cuts for corporations, wealthy shareholders, and large estates on top. [90] These include: repealing the estate tax, which less than 0.2 percent of estates now pay; lowering already low taxes on capital gains by indexing capital gains before calculating taxes; [91] repealing the Inflation Reduction Act provision that better ensures that large, highly profitable corporations pay at least some taxes; providing new tax breaks to already low-taxed corporations based on the amount they spend on certain investments; and expanding tax breaks for pass-through businesses, which saw large tax windfalls in the 2017 tax law from a special deduction that exempts from tax up to 20 percent of pass-through business income. [92]
• Changes to the tax brackets so that many low- and middle-income households would pay more while high-income households pay substantially less, by raising the lowest tax rate and lowering the highest tax rate. [94] Wealthy households would further benefit from cutting capital gains tax rates from 20 percent to 15 percent and eliminating a 3.8 percent surtax (known as the net investment income tax) on capital gains and other forms of unearned income. (See Figure 7.)
• Reducing the already too-low corporate tax rate even further, all the way to 18 percent. The 2017 tax law already gave corporations huge tax cuts by lowering the rate to 21 percent. This would provide a further tax cut of roughly $400 billion over ten years to large corporations on top of their 2017 windfall. [95]
• Giving new tax breaks to corporations that shift profits overseas.
• Cutting the estate tax, which only applies to the largest estates, and cutting the taxes shareholders pay when corporations distribute profits.
• Project 2025 also proposes long-term tax reforms that would dramatically shift the onus of taxation to middle- and low-income households. [96] Some of these proposals are vague, but they include shifting to a national sales tax (known as a consumption tax), which generally imposes far greater tax liability on middle- and low-income households who, compared to wealthy households, need to spend a larger share of their income on goods and services and who save a smaller share as they make ends meet. Project 2025 also proposes anti-democratic supermajority requirements on Congress to raise revenues, a tactic conservative states use to push taxes lower (there is no supermajority requirement to cut taxes), which would make it hard for the nation to respond to new needs or even raise revenues to lower deficits.

All three agendas call for repealing the Inflation Reduction Act’s funding for the IRS. [97] This funding is helping the IRS dramatically improve its customer service, operate the direct file mechanism so people can file their taxes directly with the IRS for free, and modernize and dramatically improve its tax enforcement efforts, which are already paying off in cracking down on wealthy tax cheats. [98]

Notably missing from these policy agendas is a positive tax agenda that would reflect some of the populist rhetoric some Republicans are employing about the need to support families and workers. These agendas would roll back rather than continue the expanded premium tax credits that have dramatically reduced the cost of health coverage for millions of people and expanded coverage, [99] and they don’t include Child Tax Credit and EITC expansions that would help middle- and lower-income families raising children and workers in lower-paid jobs.

Moreover, even as Project 2025 would raise taxes on middle- and low-income households, these families would all see sharp reductions in basic public services they benefit from, from quality schools and universities, to medical breakthroughs, to Medicaid, which serves nearly 74 million people.

Policies That Harm Immigrants and Their Families and Hurt Our Country as a Whole

Immigrants and their families are important parts of our communities. They bring vitality to our neighborhoods, they do important and often difficult work, they are business owners, and they contribute to the fabric of our nation in countless ways. Immigration has boosted our nation’s labor force at a time when the native-born population is aging, providing critical energy to our economy and helping to improve the financing of Social Security and Medicare over the coming decades. A recent Congressional Budget Office report highlights these economic contributions, showing that over a ten-year period (2024-2034), increased immigration would result in a GDP increase of $8.9 trillion and a decrease in the federal deficit by $900 billion. [100] CBO projects that in 2034, GDP will be an estimated 3.2 percent higher than it would be without these immigrants. [101]

Despite these contributions, the HBC budget plan, the RSC budget, and Project 2025 all treat immigrants — including those with a lawful immigration status — and their families harshly, putting concrete, harmful policies behind the ugly anti-immigrant rhetoric too prevalent in our public discourse.

For example, all three plans would reinstate the Trump Administration’s harsh public charge immigration policy, which essentially sought to create a wealth test for lawful immigration, preventing people from immigrating to the U.S. if they are not already economically successful. [102] The rule included an income test that could have blocked up to 99.2 percent of the population of South Asia, 98.5 percent of the population of Sub-Saharan Africa, and 79.0 percent of the population of Latin America and the Caribbean from immigrating to the U.S. [103] The rule ignores the record of achievement and upward mobility that immigrants and their descendants have shown for generations in the U.S.

The public charge changes also created fear among immigrants and their families that receiving benefits that Congress has made them eligible for would hurt their ability to remain in the country or have family members come. When proposed during the Trump Administration, the policy was shown to have a chilling effect on families’ willingness to access food assistance and health coverage that they qualified for. That includes forgoing help that their children — often citizens — needed. [104]

Even harsher, the RSC budget calls for a radical departure to how we treat immigrants who have lawful status, proposing to deny all public benefits (the precise scope is not clear) to anyone who is not a citizen, including immigrants who have lawful immigration status. [105] We already bar most lawful permanent residents from accessing public benefits such as Medicaid and SNAP during their first five years with that status in the U.S. People who have no documented status are blocked entirely for almost all benefits (with narrow exceptions such as Medicaid payment to health providers when people need emergency services in life-threatening circumstances). [106] But this proposal would further restrict benefits for immigrants, leaving many without any supports if they fall on hard times.

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[1] This report’s authors: Sharon Parrott, Allison Orris, Claire Heyison, Sarah Lueck, Katie Bergh, Dorothy Rosenbaum, Joseph Llobrera, Catlin Nchako, Sonya Acosta, Will Fischer, David Reich, Richard Kogan, Samantha Jacoby, Chuck Marr, and Shelby Gonzales.

[2] See pp. 96 and 176 of Republican Study Committee, “Fiscal Sanity to Save America: Republican Study Committee FY 2025 Budget Proposal” (hereinafter RSC budget proposal), March 20, 2024, https://hern.house.gov/uploadedfiles/final_budget_including_letter_word_doc-final_as_of_march_25.pdf . For a detailed analysis of the agendas’ health proposals, see Allison Orris and Claire Heyison, “Republican Health Coverage Proposals Would Increase Number of Uninsured, Raise People’s Costs,” CBPP, September 3, 2024, https://www.cbpp.org/research/health/republican-health-coverage-proposals-would-increase-number-of-uninsured-raise .

[3] See pp. 11 and 44-45 of House of Representatives Committee on the Budget, “Concurrent Resolution on the Budget — Fiscal Year 2025, Report to Accompany H. Con. Res. 117” (hereinafter HBC report), report 118-568, June 27, 2024, https://www.congress.gov/congressional-report/118th-congress/house-report/568/1?outputFormat=pdf&s=1&r=4&q=%7B%22search%22%3A%22HCR+117%22%7D . CBPP calculations relative to Congressional Budget Office’s (CBO) February 2024 baseline, available at CBO, “The Budget and Economic Outlook: 2024-2034,” February 7, 2024, https://www.cbo.gov/publication/59710 .

[4] See p. 42 of the RSC budget proposal.

[5] Heritage Foundation, “Mandate for Leadership” (hereinafter Project 2025), 2023, https://static.project2025.org/2025_MandateForLeadership_FULL.pdf , pp. 300-301; 118 th Congress, Second Session, “H. Con. Res. 117 [Report No. 118–568]” (hereinafter HBC budget proposal), Section 412, June 27, 2024, https://www.congress.gov/118/bills/hconres117/BILLS-118hconres117rh.pdf .

[6] As with SNAP, the grocery benefits are distributed through a debit-style, electronic benefit transfer (EBT) card. For the proposal see pp. 303 of Project 2025.

[7] See pp. 11 and 52-53 of the HBC report. CBPP calculations are relative to CBO’s February 2024 baseline, and take into account that some of the total savings in the income security category reflect cuts to civil service retirement, which is another program the HBC report targets.

[8] The climate provisions in the Inflation Reduction Act are primarily in the form of tax credits.

[9] See p. 29 of the RSC budget proposal and pp. 71-72 of the HBC report.

[10] CBPP estimates based on CBO estimates. See Congressional Budget Office, “Budgetary Outcomes Under Alternative Assumptions About Spending and Revenues,” May 8, 2024, https://www.cbo.gov/publication/60114 . We use the ten-year period 2026-2035 because extending the Trump tax cuts would reduce tax liability starting in 2026. And in 2025, when Congress will debate how to handle the scheduled expirations, it will be looking at the 2026-2035 ten-year budget window.

[11] Committee for a Responsible Federal Budget, “TCJA Extension Could Add $4 to $5 Trillion to Deficits,” June 13, 2024, https://www.crfb.org/blogs/tcja-extension-could-add-4-5-trillion-deficits#appendix .

[12] See Section 302 of the HBC budget proposal.

[13] See pp. 145 and 680 of Project 2025, pp. 84-85 of the RSC budget proposal, and pp. 52-53 of the HBC report.

[14] See pp. 11 and 44-45 of the HBC report. CBPP calculations relative to CBO’s February 2024 baseline. While the cuts could also affect CHIP and ACA marketplace coverage, the accompanying report discusses cuts only to Medicaid.

[15] See pp. 96 and 176 of the RSC budget proposal.

[16] CBPP analysis of 2013 and 2022 American Community Survey data. The American Indian and Alaska Native (AIAN) category includes people who may be AIAN alone or in combination with other races and ethnicities. The Latino category includes people of any race. The Black and white categories include only people who identify as a single race and not Latino. (The use of “Latino” does not necessarily reflect how everyone who is part of this community would describe themselves. Elsewhere in this report we also use “Hispanic,” and “Latine” for gender inclusivity.)

[17] See p. 45 of the HBC report, pp. 95-96 of the RSC budget proposal, and p. 466 of Project 2025. For analysis of prior attempts to cap and block-grant Medicaid, see Aviva Aron-Dine, “Medicaid ‘Block Grant’ Guidance Will Likely Encourage States to Undermine Coverage,” CBPP, January 29, 2020, https://www.cbpp.org/blog/medicaid-block-grant-guidance-will-likely-encourage-states-to-undermine-coverage ; and Gideon Lukens and Allison Orris, “Changing Medicaid’s Funding Structure to a Per Capita Cap Would Shift Costs to States, Force Deep Cuts, and Leave Millions Uninsured,” CBPP, March 27, 2023, https://www.cbpp.org/research/health/changing-medicaids-funding-structure-to-a-per-capita-cap-would-shift-costs-to .

[18] See p. 45 of the HBC report, p. 96 of the RSC budget proposal, and pp. 467-469 of Project 2025.

[19] See p. 96 of the RSC budget proposal and p. 467 of Project 2025.

[20] See p. 45 of the HBC report, pp. 466-467 of Project 2025, and pp. 95-96 of the RSC budget proposal.

[21] Laura Harker, “Pain But No Gain: Arkansas’ Failed Medicaid Work-Reporting Requirements Should Not Be a Model,” CBPP, August 8, 2023, https://www.cbpp.org/research/health/pain-but-no-gain-arkansas-failed-medicaid-work-reporting-requirements-should-not-be ; Laura Harker, “6 Months Into Georgia Pathways Program, Over 400,000 People Still Lack Health Coverage; Expanding Medicaid Would Improve Access for Low-Income Georgians,” CBPP, January 25, 2024, https://www.cbpp.org/blog/6-months-into-georgia-pathways-program-over-400000-people-still-lack-health-coverage-expanding .

[22] See p. 45 of the HBC report, pp. 38 and 96 of the RSC budget proposal, and pp. 468-469 of Project 2025.

[23] See p. 468 of Project 2025.

[24] See pp. 95-96 of the RSC budget proposal and pp. 468-469 of Project 2025.

[25] See p. 4 of the HBC report and pp. 87-88 of the RSC budget proposal.

[26] Jared Ortaleza et al. , “Inflation Reduction Act Health Insurance Subsidies: What is Their Impact and What Would Happen if They Expire?” KFF, July 26, 2024, https://www.kff.org/affordable-care-act/issue-brief/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/ .

[27] See pp. 87-88 of the RSC budget proposal.

[28] See pp. 469-470 of Project 2025.

[29] The Heritage Foundation paper, and the Health Policy Consensus Group proposal it cites, propose converting the PTC into state block grants. These grants would be based on current subsidy levels. While the proposal does not specify how block grants would be adjusted over time, prior repeal plans set adjustments to increase funding cuts year over year. States would not be obligated to accept block grant funding and could instead choose to provide no or limited premium assistance for individual market coverage. See Edmund F. Haislmaier and Abigail Slagle, “Premiums, Choices, Deductibles, Care Access, and Government Dependence Under the Affordable Care Act: 2021 State-by-State Review,” Heritage Foundation, November 2, 2021, https://www.heritage.org/sites/default/files/2021-11/BG3668.pdf .

[30] U.S. Department of Health and Human Services, “Health Insurance Marketplaces: 10 Years of Affordable Private Plan Options,” March 22, 2024, https://aspe.hhs.gov/sites/default/files/documents/00d1eccb776ac4abde9979aa793e2c7a/aspe-10-years-of-marketplace.pdf ; Ortaleza et al.

[31] See p. 4 of the HBC report and pp. 87-88 of the RSC budget proposal.

[32] Estimate is based on age-adjusted 2024 average benchmark premiums and 2023 poverty guidelines, which are used to determine premium tax credits for 2024 marketplace coverage. Gideon Lukens, “Health Insurance Costs Will Rise Steeply if Premium Tax Credit Improvements Expire,” CBPP, June 4, 2024, https://www.cbpp.org/research/health/health-insurance-costs-will-rise-steeply-if-premium-tax-credit-improvements-expire .

[33] Jessica Banthin, Michael Simpson, and Mohammed Akel, “The Impact of Enhanced Premium Tax Credits on Coverage by Race and Ethnicity,” Urban Institute, August 12, 2024, https://www.urban.org/research/publication/impact-enhanced-premium-tax-credits-coverage-race-and-ethnicity .

[34] The RSC proposal “adopts regulatory reforms developed by the RSC’s Health Care Task Force . . . and set forth in its report: A Framework for Personalized, Affordable Care. Republican Study Committee.” This report proposes eliminating the PTC and rolling back the ACA’s Medicaid expansion, and repurposing those funds for state “guaranteed coverage pools.” See p. 89 of the RSC budget proposal.

[35] KFF, “Health Insurance Marketplace Calculator,” updated October 27, 2023, https://www.kff.org/interactive/subsidy-calculator/ .

[36] See pp. 89-90 of the RSC budget proposal.

[37] See p. 90 of the RSC budget proposal.

[38] Edwin Park, “Trump, House GOP High-Risk Pool Proposals a Failed Approach,” CBPP, November 17, 2016, https://www.cbpp.org/blog/trump-house-gop-high-risk-pool-proposals-a-failed-approach .

[39] See pp. 469-470 of Project 2025.

[40] Nambi Ndugga, Latoya Hill, and Samantha Artiga, “Key Data on Health and Health Care by Race and Ethnicity,” KFF, June 11, 2023, https://www.kff.org/key-data-on-health-and-health-care-by-race-and-ethnicity .

[41] See pp. 91-92 of the RSC budget proposal and pp. 468 and 470 of Project 2025.

[42] Sarah Lueck, “Commentary: Growing Evidence Shows Need for Stronger Rules for Short-Term Health Plans,” CBPP, October 23, 2020, https://www.cbpp.org/research/health/commentary-growing-evidence-shows-need-for-stronger-rules-for-short-term-health .

[43] See pp. 475 and 495-496 of Project 2025.

[44] See p. 12 of the HBC report.

[45] See pp. 11 and 52-53 of the HBC report. CBPP calculations are relative to CBO’s February 2024 baseline, and take into account that some of the total savings in the income security category reflect cuts to civil service retirement, which is another program the HBC report targets.

[46] Lauren Hall, “Food Insecurity Increased in 2022, With Severe Impact on Households With Children and Ongoing Racial Disparities,” CBPP, October 26, 2023, https://www.cbpp.org/blog/food-insecurity-increased-in-2022-with-severe-impact-on-households-with-children-and-ongoing .

[47] Laura Samuel et al. , “Supplemental Nutrition Assistance Program Access and Racial Disparities in Food Insecurity,” JAMA Network Open, Vol. 6, No. 6, June 2023, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.20196 ; Benjamin Glasner et al. , “The Effectiveness of the Food Stamp Program at Reducing Differences in the Intergenerational Persistence of Poverty,” Washington Center for Equitable Growth, May 2023, https://equitablegrowth.org/wp-content/uploads/2023/05/053023-WP-The-Effectiveness-of-the-Food-Stamp-Program-at-Reducing-Racial-Differences-in-the-Intergenerational-Persistence-of-Poverty.pdf ; Alfonso Flores-Lagunes et al. , “Moving Policies toward Racial and Ethnic Equality: The Case of the Supplemental Nutrition Assistance Program,” American Journal of Agricultural Economics, Vol. 106, No. 2, May 2023, https://doi.org/10.1111/ajae.12402 .

[48] See p. 42 of the RSC budget proposal.

[49] Joseph Llobrera, “Recent Increase in SNAP Purchasing Power Invests in Children’s Health and Well-Being,” CBPP, August 29, 2022, https://www.cbpp.org/research/food-assistance/recent-increase-in-snap-purchasing-power-invests-in-childrens-health-and ; Laura Wheaton and Danielle Kwon, “Effect of the Reevaluated Thrifty Food Plan and Emergency Allotments on Supplemental Nutrition Assistance Program Benefits and Poverty,” Urban Institute, August 1, 2022, https://www.urban.org/research/publication/effect-reevaluated-thrifty-food-plan-and-emergency-allotments-supplemental .

[50] See pp. 300-301 of Project 2025 and Section 412 of the HBC budget proposal.

[51] Under the Fiscal Responsibility Act, 53- and 54-year-olds will become newly subject to this work requirement beginning October 1, 2024. See pp. 41-42 of the RSC budget proposal and pp. 299-300 of Project 2025.

[52] Joseph Llobrera, “Most Working-Age SNAP Participants Work But Job Instability Overstates Joblessness in Some Analyses,” CBPP, May 19, 2023, https://www.cbpp.org/blog/most-working-age-snap-participants-work-but-job-instability-overstates-joblessness-in-some .

[53] Tori Coan and Shawn Fremstad, “The Dismal Economics of SNAP’s Work-Hours Test and Time Limit,” Center for Economic and Policy Research, April 18, 2023, https://cepr.net/report/the-dismal-economics-of-snaps-work-hours-test-and-time-limit/ .

[54] See p. 52 of the HBC report.

[55] See pp. 42-43 of the RSC budget proposal and p. 300 of Project 2025.

[56] Project 2025 proposes providing summer meals to children in low-income families only if they are taking summer-school classes, which would substantially cut the Summer Food Service Program (which provides meals) and could mean eliminating the Summer EBT program (which provides grocery benefits to enable low-income households with children to purchase food). See p. 303 of Project 2025.

[57] Mark Nord and Kathleen Romig, “Hunger in the Summer: Seasonal food insecurity and the National School Lunch and Summer Food Service programs,” Journal of Children and Poverty, Vol. 12, No. 2, 2006, pp. 141-158, https://doi.org/10.1080/10796120600879582 ; Jin Huang, Ellen Barnidge, and Youngmi Kim, “Children Receiving Free or Reduced-Price School Lunch Have Higher Food Insufficiency Rates in Summer,” Journal of Nutrition, Vol. 145, No. 9, September 2015, pp. 2161-68, https://doi.org/10.3945/jn.115.214486 .

[58] Allyson Pérez and Crystal FitzSimons, “Community Eligibility: The Key to Hunger-Free Schools, School Year 2022-2023,” Food Research and Action Center, May 2023, https://frac.org/wp-content/uploads/cep-report-2023.pdf .

[59] See p. 303 of Project 2025 and p. 46 of the RSC budget proposal.

[60] U.S. Department of Health and Human Services, “Head Start Program Facts: Fiscal Year 2022,” https://eclkc.ohs.acf.hhs.gov/data-ongoing-monitoring/article/head-start-program-facts-fiscal-year-2022 .

[62] Social Security Administration, “SSI Recipients by State and County, 2022,” https://www.ssa.gov/policy/docs/statcomps/ssi_sc/2022/table01.html .

[63] RSC budget, p. 45.

[64] Project 2025, p. 509.

[65] Project 2025, p. 509, and RSC, p. 171.

[66] Another proposal, from the conservative Paragon Institute, would not only reduce the enhanced matching rate for the Medicaid expansion but also shift costs to some states by dropping the current Medicaid matching rate floor from 50 percent to 40 percent. The institute justifies its proposal by arguing that its policies would reorient spending in support of traditional populations, such as children and people with disabilities, but the proposal fails to acknowledge deep cuts states could make across their programs given the extreme cost shift to states they propose. Brian Blase and Drew Gonshorowski, “Medicaid Financing Reform: Stopping Discrimination Against the Most Vulnerable and Reducing Bias Favoring Wealthy States,” Paragon Health Institute, July 2024, https://paragoninstitute.org/medicaid/medicaid-financing-reform-stopping-discrimination-against-the-most-vulnerable-and-reducing-bias-favoring-wealthy-states/ .

[67] See pp. 41-42 and 46 of the RSC budget proposal.

[68] The RSC proposal would shrink the federal government’s commitment to sharing in Medicaid costs in the 40 states and the District of Columbia that would otherwise have a standard Medicaid matching rate over 50 percent in fiscal year 2025. U.S. territories presumably would face a cut as well, since their matching rates now exceed 50 percent. KFF, “Federal Medical Assistance Percentage (FMAP) for Medicaid and Multiplier,” FY 2025, https://www.kff.org/medicaid/state-indicator/federal-matching-rate-and-multiplier/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D .

[69] Also see Jabari Cook et al., “House Appropriations Bills Take Steps to Use the Federal Budget as a Tool for Antiracism,” CBPP, February 23, 2022, https://www.cbpp.org/research/house-appropriations-bills-take-steps-to-use-the-federal-budget-as-a-tool-for-antiracism .

[70] While Project 2025 includes a number of proposals for non-defense discretionary programs, it did not provide overall estimates for this budget category (unlike the HBC and RSC plans, which included full budget estimates).

[71] Cuts are measured from CBO’s February 2024 baseline but with the discretionary levels adjusted to reflect final appropriations for 2024 and the level of agreed-on adjustments to the 2025 non-defense discretionary cap that accompanied the enactment of that cap, which adds $652 billion in outlays over the decade. See the appendix of Richard Kogan et al., “More Revenue Is Required to Meet the Nation’s Commitments, Needs, and Challenges,” CBPP, June 17, 2024, https://www.cbpp.org/research/federal-budget/more-revenue-is-required-to-meet-the-nations-commitments-needs-and .

[72] Project 2025, Chapter 11, “Department of Education,” pp. 319-362.

[73] RSC budget, pp. 164-5.

[74] RSC budget, p. 163.

[75] RSC budget, p. 146; HBC report, p. 60.

[76] RSC budget, p. 155.

[77] Project 2025, Chapter 13, “Environmental Protection Agency,” pp. 417-448, and HBC report, p. 30.

[79] RSC budget, pp. 169-170.

[80] Project 2025, p. 365.

[81] HBC report, p. 35.

[82] RSC budget, p. 17; HBC report, p. 67; and Project 2025, p. 365. Note that the climate provisions in the Inflation Reduction Act are not funded by appropriations, but rather are in the form of tax incentives and mandatory spending.

[83] RSC budget, pp. 170-71.

[84] RSC budget, p. 151.

[85] RSC budget, pp. 171-172.

[86] For example, Latino and Black households represented 24 percent of all households in 2019, but they represented 32 percent of the least wealthy 60 percent of households and less than 1 percent of the wealthiest 1 percent. University of California at Berkeley, “Study: Survey of Consumer Finances (SCF) Combined Extract Data 1989-2019,” https://sda.berkeley.edu/sdaweb/analysis/?dataset=scfcomb2019 .

[87] White households in the highest-earning 1 percent receive 23.7 percent of the law’s total tax cuts, far more than the 13.8 percentage share that the bottom 60 percent of households of all races receive. Chye-Ching Huang and Roderick Taylor, “How the Federal Tax Code Can Better Advance Racial Equity,” CBPP, July 25, 2019, https://www.cbpp.org/research/federal-tax/how-the-federal-tax-code-can-better-advance-racial-equity .

[88] See pp. 71-72 of the HBC report.

[89] See Section 302 of HBC budget proposal.

[90] See pp. 29-33 of the RSC budget proposal.

[91] See Chye-Ching Huang and Kathleen Bryant, “Indexing Capital Gains for Inflation Would Worsen Fiscal Challenges, Give Another Tax Cut to the Top,” CBPP, September 6, 2018, https://www.cbpp.org/research/federal-tax/indexing-capital-gains-for-inflation-would-worsen-fiscal-challenges-give .

[92] Chuck Marr, Samantha Jacoby, and George Fenton, “The Pass-Through Deduction Is Skewed to the Rich, Costly, and Failed to Deliver on Its Promises,” CBPP, June 6, 2024, https://www.cbpp.org/research/federal-tax/the-pass-through-deduction-is-skewed-to-the-rich-costly-and-failed-to-deliver .

[93] See p. 696 of Project 2025.

[94] Brendan Duke, “Project 2025’s Tax Plan Would Raise Taxes on the Middle Class and Cut Taxes for the Wealthy,” Center for American Progress, August 27, 2024, https://www.americanprogress.org/article/project-2025s-tax-plan-would-raise-taxes-on-the-middle-class-and-cut-taxes-for-the-wealthy/ .

[95] CBPP calculations based on CBO, “Increase the Corporate Income Tax Rate by 1 Percentage Point,” December 7, 2022, https://www.cbo.gov/budget-options/58701 .

[96] See p. 698 of Project 2025.

[97] See p. 699 of Project 2025, p. 27 of the RSC budget proposal, and pp. 61 and 62 of the HBC report.

[98] Kayla Williams, “Tax Day Highlights IRS Progress and Need to Protect and Replenish Funding,” CBPP, April 10, 2024, https://www.cbpp.org/blog/tax-day-highlights-irs-progress-and-need-to-protect-and-replenish-funding .

[99] See pp. 87-88 of the RSC budget proposal, pp. 469-470 of Project 2025, and p. 4 of the HBC report.

[100] Congressional Budget Office, “An Update to the Budget and Economic Outlook: 2024 to 2034,” June 18, 2024, https://www.cbo.gov/publication/60039 .

[101] Congressional Budget Office, “Effects of the Immigration Surge on the Federal Budget and the Economy,” July 2024, https://www.cbo.gov/system/files/2024-07/60165-Immigration.pdf .

[102] See p. 145 of Project 2025, pp. 84-85 of the RSC budget proposal, and p. 52 of the HBC report.

[103] Danilo Trisi, “Trump Administration’s Overbroad Public Charge Definition Could Deny Those Without Substantial Means a Chance to Come to or Stay in the U.S.,” CBPP, May 30, 2019, https://www.cbpp.org/research/poverty-and-inequality/trump-administrations-overbroad-public-charge-definition-could-deny .

[104] Hamutal Bernstein et al. , “Amid Confusion over the Public Charge Rule, Immigrant Families Continued Avoiding Public Benefits in 2019,” Urban Institute, May 2020, https://www.urban.org/sites/default/files/publication/102221/amid-confusion-over-the-public-charge-rule-immigrant-families-continued-avoiding-public-benefits-in-2019_3.pdf .

[105] See p. 49 of the RSC budget proposal.

[106] Project 2025 also includes a range of harsh immigration policy measures, such as ending lawful immigration statuses for certain victims of trafficking and domestic violence, but those policies are beyond the scope of this analysis.

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