Introduction

Heightened interest in health equity in recent decades has led to investigations into health equity [1–6] and the uptake of key concepts, including the original Dahlgren-Whitehead rainbow model receiving “worldwide acclaim” [7]. This model, focused on the determinants of health, has been drawn upon in numerous reports focused on health inequalities and has been helpful for policymakers operating outside of the health sector to understand their role in health and health inequities and allowing them to take ownership and responsibility to accordingly act [7]. However, the way policymakers can act in a routine or consistent manner to promote equity in their work is less clear.

Efforts have been undertaken to promote gender “mainstreaming”—a global strategy to promote gender equality [8]—which is in alignment with Sustainable Development Goal 5 on gender equality that seeks to “achieve gender equality and empower all women and girls” [9]. Gender mainstreaming entails considering gender perspectives and aiming for gender equality in all activities, including policy development and decision-making [8]. Gender mainstreaming has been regarded as having “the potential to transform social relations” [10], but at the same time, has been regarded as being “rather hollow when considered within the national setting” [11] and a “mythical beast” [12]. Gender mainstreaming has been noted as being applied across countries in a “technocratic” and “nonsystemic” manner [11]. Thus, the view that gender mainstreaming approaches need to reconsider agency and transformation [12], and more carefully articulate the relationship with societal change [11]. However, there appears to be a gap in knowledge synthesis around how mainstreaming has been carried out.

Therefore, we want to understand precisely how gender mainstreaming, and equity considerations more broadly, have been considered by policymakers globally. As an illustrative example, the Canadian government has adopted Gender-based Analysis Plus, which is an “analytical tool used to support the development of responsive and inclusive policies, programs, and other initiatives” [13]. In doing this analysis, we hope to provide an overview of actions undertaken and related insights that will be helpful for improving public policymaking processes. We seek to search the peer-reviewed and grey literature to compile evidence of approaches to gender mainstreaming and equity considerations more broadly, not focusing in on any specific geography, level of government, or policy domain. Accordingly, we ask the question: “what are the ways in which policymakers have routinely or systematically considered equity and/or gender in their work?” We hope this analysis will also shed light on successes and failures of varying approaches and elucidate if relationships with societal change are explicit. We believe that undertaking this scoping review can result in producing information and guidance for governments to initiate, sustain, and improve such gender and equity mainstreaming approaches in the development of public policy.

Methods

This scoping review protocol was developed by drawing on the PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) [14], PRISMA guidelines for Scoping Reviews (PRISMA-ScR) [15] (as other studies have done [16–20]), and with the expert guidance of a research librarian. The PRISMA/PRISMA-ScR guidelines were followed as they are widely used and can be considered as a best practice tool in evidence syntheses, given that they allow for a largely rigorous and transparent approach to literature searches.

Information sources

This study will compile hits from both the peer-reviewed and grey literatures and searches databases from 1995 to the date the search is conducted on. The search will be conducted from 1995 and onwards, as there were no hits prior to this date that included the term “gender mainstream*” in Ovid MEDLINE, Ovid EMBASE, PAIS Index, or Scopus (Fig 1 shows data through the end of 2023, the most recent complete calendar year to maintain comparability).

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Fig 1. Articles containing the term "gender mainstream*" across four databases.

https://doi.org/10.1371/journal.pone.0299124.g001

Search strategy

Ovid MEDLINE, Ovid EMBASE, PAIS Index, and Scopus databases will be searched to cast a wide net encompassing both biomedical and multidisciplinary databases, complemented with a custom Google search strategy developed by the research librarian to search government documents. The specific rationale for each database and grey literature search, with associated database-specific search strings, are noted in Table 1. In addition to searching for gender mainstreaming, the search strings include gender responsive and gender integrative as terms, given the differing preference for these terms that are synonymous and close in meaning.

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Table 1. Planned searches, rationale for each database, and associated search strings.

https://doi.org/10.1371/journal.pone.0299124.t001

Conclusion

The development of this protocol serves two key purposes. First, it improves rigour because it sets a priori bounds to maintain a consistent scope of inquiry. It is important to note that setting such rigid bounds early in the study process is designed to lead to limited alterations as the study progresses to reduce cherry-picking of results. However, this can also be restrictive when seeking to report on unpredicted dimensions apparent in retrieved hits. And second, this protocol promotes transparency by publicly documenting our methods. Thus, we hope those interested in this work can benefit from this detailed reporting on our search strategy and approach, along with those designing scoping reviews in adjacent fields.

This protocol will support a scoping review of the ways in which policymakers have routinely or systematically considered equity and/or gender in their work. We will generate findings to inform government efforts to initiate, sustain, and improve gender and equity mainstreaming approaches in policymaking. This is important given persistent gender inequities and the lack of attention to these inequities, notably even in institutions focused on global health, many of which have a central focus in mitigating inequities [21]. And similarly, that the learnings can be applied to multisectoral policy approaches that incorporate or center around health equity, including the Health in All Policies approach and Healthy Cities [22]. This is of particular importance in light of COVID-19 potentially affording an opportunity to refocus on health equity [23] and drawing attention to the need to focus on equity outcomes, instead of prioritizing fiscal considerations [24].

Supporting information