Evaluation of the cultural, health-related, and structural barriers to blood donation among women in Saudi Arabia: a cross-sectional study

Background: Blood transfusion is a critical component of healthcare systems worldwide, yet maintaining adequate blood supplies remains challenging, particularly when voluntary donation rates are low. In Saudi Arabia, women are markedly underrepresented among blood donors despite national efforts to promote donation. Understanding the cultural, social, and physiological factors influencing women's participation is essential for developing effective, gender-sensitive strategies. Methods: A cross-sectional, online survey was conducted among Saudi women aged 18-65 years between April and September 2025. The questionnaire assessed sociodemographic characteristics, knowledge, attitudes, health-related concerns, and accessibility related to blood donation. Descriptive statistics and nonparametric tests were used to analyze data from 503 respondents. Results: Although more than 85% of participants considered blood donation a social responsibility, only 15.1% reported a history of donation, indicating a clear attitude-behavior gap. Health-related uncertainty was prominent, with 47.7% avoiding donation due to uncertainty about eligibility and 24.1% reporting previous deferral for health reasons. Cultural misconceptions, particularly regarding menstruation and female health, were common. Structural barriers were also evident; nearly half cited lack of time, while willingness to donate increased substantially if mobile donation units were available (74.2%). Conclusion: Saudi women's low participation in blood donation is driven by the interaction of health-related uncertainty, cultural misconceptions, and limited accessibility rather than lack of altruistic motivation. Addressing these barriers through culturally sensitive education, clear communication about eligibility, and improved access-especially via mobile and community-based donation services-may help convert willingness into sustained donor participation and strengthen the national blood supply.