Beyond anemia: gendered social and structural determinants of women’s blood donation in the Eastern Mediterranean Region: a scoping review

Background Women are markedly underrepresented among blood donors in the Eastern Mediterranean Region (EMR), where they account for a median of only about 6% of donations despite contributing nearly one-third of donations globally. Conventional explanations emphasize biomedical and individual barriers, but these do not fully account for the magnitude and persistence of the gender gap in the EMR. Aims This scoping review maps and synthesizes evidence on the social, cultural, and structural determinants shaping women’s blood donation in the Eastern Mediterranean Region, with particular attention to how biomedical, individual, and structural factors intersect. The review examines how gendered norms, institutional designs, and political economies are associated with constraints on women’s participation, and proposes a structural lens for understanding inequity in blood donation. Methods A structured literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, and ScienceDirect, complemented by grey literature from WHO/EMRO reports, Arab Barometer surveys, and national blood service sources, covering publications between 2000 and 2025 (final search November 2025). A scoping review design was selected because the relevant evidence is heterogeneous in study design, methodology, and outcome measures, making it suitable for mapping the breadth of available evidence rather than estimating pooled effects. Sources were selected against predefined eligibility criteria, and data were charted and synthesized thematically following Joanna Briggs Institute (JBI) methodology for scoping reviews and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR), guided by social determinants of health and capability frameworks. Results The included evidence consistently reported low female participation in blood donation across the EMR, with higher female deferral rates commonly attributed to low hemoglobin, alongside social, cultural, and system-level barriers. Comparative regional data indicated that anemia alone does not correspond to the size of the gender gap in EMR blood donation: regions with higher anemia prevalence, such as East Asia and sub-Saharan Africa, reported substantially higher female donation rates than the EMR. Women reported strong altruistic intentions yet described intersecting constraints, including unpaid care burdens, mobility limits, restrictive norms, and family gatekeeping. System-level factors reported across studies included fixed-site, male-oriented service design; limited mobile units; family replacement practices; gender-blind recruitment and retention; digital divides; and a lack of sex-disaggregated data. Conclusion The findings of this scoping review are consistent with the interpretation that the gender gap in EMR blood donation reflects a systemic outcome of gendered inequities rather than merely individual biomedical deficits. Addressing this gap likely requires gender-responsive service design, routine sex-disaggregated data collection, and structural reforms that expand women’s capability to participate. Blood system sustainability in the region may depend on this shift.