Gender inequity in ASD caregiving: mothers face disproportionate social and environmental QoL burden

Background

Caregivers of children with ASD face substantial QoL reductions, yet domain-specific gender disparities remain fragmented. Reviews typically report overall QoL without disaggregating by caregiver subgroup, obscuring the burden borne by mothers. Understanding which domains are most affected in mothers versus fathers is essential for equity-sensitive family support policies.

Methods

Systematic review and meta-analysis per PRISMA guidelines (PROSPERO: CRD420251086038). Searches across PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar identified cross-sectional and case-control studies using WHOQoL-BREF among caregivers of children with ASD. Pooled mean scores were estimated using random-effects models, stratified by caregiver subgroup. Heterogeneity assessed via I2; publication bias via Egger test; certainty of evidence via GRADE.

Results

Thirteen studies (n = 1,754) were included. Mothers reported the lowest QoL: pooled social 30.31 (95% CI 13.29-47.33) and environmental 30.63 (95% CI 11.88-49.38), versus 43.89 and 43.03 among dual-parent dyads. The gap exceeded 13 points across both domains. Subgroup differences were consistent but did not reach significance, reflecting limited father-only studies. Certainty was rated low due to heterogeneity (I2=100%) and publication bias.

Conclusions

Mothers carry a disproportionate social and environmental QoL burden reflecting structural inequities in caregiving role distribution. Policies promoting paternal involvement, community support, and respite services address this disparity more directly than individually focused clinical interventions.

Key messages

• Mothers of children with ASD report lower QoL than fathers across all WHOQoL-BREF domains, with sharpest deficits in social (30.31) and environmental (30.63) domains, reflecting unequal caregiving.

• Social and environmental domains are most sensitive to caregiving arrangement: family-level policies targeting role distribution and community support outperform individual clinical approaches.