Blocked from becoming a physician or nurse because of gender: global state-of-the-art review

Females were historically blocked from or under-represented among physicians, while males were historically discouraged from training as nurses, and previous systematic reviews and meta-analyses have reported the scale of problems such as sexual harassment. There are ongoing attempts at finding solutions, but there is a gap in literature which seeks to understand the surrounding historical, legal and sociocultural reasons why people behave that way. We segmented the world into regions and comprehensively reviewed different countries’ laws within OECD databases, World Health Organization databases about gender representation presently and historically, published literature about history, and current records of gender-related initiatives in medicine and nursing. For countries with available data, a global average of 47% of physicians are female, whereas 23% of nurses are male, but both vary widely, ranging 8–82% and 0–79% respectively. Good representation is associated with laws about female or male inclusion in medicine/nursing from the mid-19th century, whereas poor representation is associated with adverse sociocultural gender norms and inadequate or absent laws against workplace gender equality, gender-based violence, and unequal rights within families. We report the strengths and limitations of common solutions to the problem, noting that reactive law enforcement (e.g., through employment tribunals or lawsuits) is rare, and that for physicians/nurses gender inequalities often exist even in countries with laws against them because of historical and sociocultural influences. A promising solution to the problem is “professional norming” which transforms cultures about how to behave, and what is acceptable behavior, among physicians and nurses.