Gender-based discrimination towards cisgender women in low- and middle-income countries: a scoping review of definitions and measures used in the health literature
Laurène Petitfour, Swati Srivastava, Rupal Shah-Rohlfs, Wilm Quentin, Manuela De AllegriIntroduction
Gender-based discrimination (GBD) has pervasive effects on women’s health outcomes. Measurement of GBD is essential in order both to understand and monitor progress against GBD and to study its relationship with health. We aimed to provide an overview of definitions and measures of GBD used in the literature on health in low- and middle-income countries (LMICs).
Methods
We conducted a mixed-method scoping review following Arksey and O’Malley’s methodological framework. We searched PubMed, Web of Science, CINAHL and EconLit and included studies from 1985 to 2025 if they had an explicit focus on GBD and health, were based in LMICs and if the measure of GBD was described. We excluded reviews and studies focusing on specific health conditions or subpopulations. We extracted information on study characteristics, definitions and measures of GBD (their content and their operationalisation). We synthesised data by identifying groups of similar GBD themes and summarising definitions and measures of GBD.
Results
We included 228 studies. Most studies (n=200) were quantitative or included a quantitative element (n=8, mixed-methods studies). Only 20 studies were qualitative. We identified 11 themes around GBD, namely healthcare behaviours, health state, son preference at birth, disrespect and abuse during childbirth, self-declared discrimination, cultural and legal practices, gender roles, access to economic resources, decision-making, education and violence against women. Most studies (n=148) used only an individual indicator measure to operationalise GBD, while 65 studies used one or more composite indicators. Only 30 studies provided a definition of GBD and these varied considerably.
Conclusions
This is the first review providing an overview of how GBD has been conceptualised and measured in LMICs in the literature on health. Results have several implications: (1) future studies should clearly define GBD when aiming to measure it; (2) a consensus should be reached about what GBD encompasses and (3) a comprehensive measurement tool is needed to capture discrimination with regard to the multiple manifestations of GBD.