A total of 6146 references were identified and imported into Covidence for screening. Of these, 159 references were removed as duplicates and the remaining articles (n=5987) were screened by title/abstract, excluding irrelevant studies (n=5610, 94%) in line with the inclusion criteria. The reviewers then conducted a full-text review of 377 articles. Two hundred and forty articles were excluded due to: not including an LMIC in the study sample (n=124), not having the full-text available (n=26), being news articles, magazines, or commentaries (n=36), not measuring outcomes related to the effectiveness of women’s leadership (n=29), being unable to be accessed (n=12), and not being about women’s leadership (n=7). An additional two studies were excluded because they had <30% LMIC included in the study sample and did not disaggregate country data. One hundred and thirty-seven articles were included in the review. Figure 1 shows the PRISMA-ScR flow diagram of the selection process.
Descriptive statistics
Studies were mostly conducted in East Asia and the Pacific (n=70, 51%) and South Asia (n=40, 29%), particularly in China (n=37, 27%), India (n=30, 22%), and Malaysia (n=19, 14%). Study samples included countries in sub-Saharan Africa (n=21, 15%), Europe and Central Asia (n=20, 15%), Latin America and the Caribbean (n=17, 12%), the Middle East and North Africa (n=17, 12%), and North America (n=10, 7%). Approximately 6% (n=8) of the studies did not specify where the research was conducted, but rather that the sample was global or included over 120 countries. Only three multi-country studies included <30% LMIC representation but these studies disaggregated their data by geography.
Given the limited available literature in health, our review yielded results that largely focused on other industries. Included studies primarily assessed the effectiveness of women’s leadership in listed corporations or the stock exchange (n=90, 66%) followed by the financial sector (n=24, 18%), small-and-medium enterprises (SMEs) and ventures, including microfinance organisations (n=17, 12%), politics/government (n=9, 7%), and healthcare (n=6, 4%) . The studies assessed leadership outcomes at different leadership levels, including within the board of directors and top management teams (n=106, 77%), political leaders (n=16, 12%), committees (n=9, 7%), owners/founders/stakeholders (n=7, 5%), and managers (n=6, 4%). Some studies assessed more than one type of leadership (ie, reviewed the impact of women’s representation on committees and as directors).
How the effectiveness of women’s leadership was evaluated
Most studies utilised a cross-sectional study design (n=134, 98%), leveraging quantitative panel data. These panel datasets collected ‘observations’ of multiple variables in firms, organisations, or geographies over a period of many years. Datasets were often comprised of data on various aspects of the organisational structure of the top management team for multiple firms in multiple years. For example, datasets commonly contained both financial data and data on firm board composition for all firms listed on the national stock exchange over a period of 10 years. Other designs included quasi-experimental (n=1),12 comparative case studies (n=1),13 and qualitative (n=1).14
Studies employed a range of outcomes to assess the impact of women leaders. Forty-eight percent (n=66) of the studies measured financial performance and 20% (n=28) measured engagement with corporate social responsibility (CSR) or other ethical initiatives. Financial performance was measured by a range of indicators including but not limited to profitability, productivity and efficiency, return on investment, return of assets (ROA), and return on equity (ROE). CSR was measured by CSR reporting, expenditures, disclosures, violations, and scores. One study specifically assessed women leaders’ responsiveness to natural disasters.15
Eighteen studies (13%) assessed risk and stability, measured by indicators such as bank and government stability, credit risk and debt, risk aversion, and volatility of accounts. Studies measuring corporate governance (n=24, 18%) analysed indicators including audit fees, earnings management, earnings forecast bias, earnings quality, committee objectivity, chief executive officer (CEO) compensation, and anti-corruption disclosures.
Other outcomes can be categorised as interpersonal, organisational, and social/community. Interpersonal outcomes included women leaders’ impact on other women’s careers (n=6, 4%) and women’s political participation/involvement (n=1, 1%). Organisational outcomes included innovation (n=6, 4%), employee recruitment, retention, and training (n=2, 1%), organisational culture/climate (n=5, 4%), competitiveness (n=2, 1%), and entrepreneurship (n=1, 1%). Social/community outcomes included influence on health (n=9, 7%), supply chain commodities for health (n=1, 1%), and community outcomes (ie, social outreach, aspirations, educational attainment, public spending; n=4, 3%). Figure 2 shows a heat map of the degree of positive and negative outcomes by women’s leadership impact area. These are described below.
A heat map of the degree of positive and negative outcomes by women’s leadership impact area.
Impact
Most studies reported a positive impact of women’s leadership (positive and statistically significant: n=119, 87%; positive and statistically insignificant: n=12, 9%), followed by negative results (negative and statistically significant: n=35, 26%; negative and statistically insignificant: n=13, 9%), and null results (n=33, 24%). A study was tagged positive if it reported an improvement, increase, or benefit in the assessed outcome measured due to women’s leadership. It was tagged negative if it reported a decrease, weakening, or worsening of the assessed outcome due to women’s leadership. Null results did not report an improvement or worsening of the assessed outcome, rather no impact was noted in either direction. Approximately 39% of the studies reported mixed results, some combination of positive, negative, or null results (n=53) across a range of indicators. Online supplemental tables 1 and 2 present a comprehensive overview of women leaders’ significant positive and negative impact by article (online supplemental table 1) and by outcome area (online supplemental table 2)
Financial performance, risk, and stability
Women’s leadership was found to improve financial performance in 57 studies, 86% of all studies analysing this outcome. These studies found that companies with women directors and/or higher proportions of women among their board members had increased profitability for at least one indicator (ie, ROA, ROE),16–58 more cash flow,59 more capital for investment,60 less financial distress,61 62 ,63 stronger financial health,64 and improved market value and performance.21 23 27 28 30 33 42 44 46 53 55 56 65–67 One study found that women’s representation on the board of directors strengthens the positive effects of green business practices on firm financialization.68
Most mixed results (n=53, 39%) were related to financial performance outcomes or risk and stability, and compared women’s leadership in multiple roles (ie, board members, directors, and committee members). For example, one study which found positive results between board representation and firm performance found negative results between the presence of women directors and firm performance. These negative results appeared in countries with less gender equality, as measured by the United Nations Development Programme Gender Inequality Index, the World Economic Forum’s Gender Gap Index, the Gender Equity Index from Social Watch, and the Organization for Economic Cooperation and Development Centre’s Social Institutions and Gender Index.21 One study found that any negative results associated with women’s leadership can be reversed when women CEOs have higher education and more experience.39 Another study found that a women-dominated board alone had a null effect on financial performance but that women board members exerted leadership described as ‘inspirational’. That is, these boards achieved improved performance when they also worked with women CEOs and women subordinates.36 Garanina et al found positive relationships between having either three or at least four women directors on ROE and Tobin’s Q, but no effect with only one or two directors compared with none.27
Results on risk taking and stability were also largely positive but somewhat mixed; generally, women leaders take less risk and increase stability.18 21 25 28 29 37 44 46 65 69–72 One study found no statistically significant relationship between women directors and bank risk taking, but women directors positively affect risk in sound versus unsound banks (sound banks show a level of risk below the median risk, while unsound banks are characterised by a level of risk above the median).72 Another found that banks with women CEOs are more stable, that is, they have less insolvency risk, with the participation of women on board of directors decreasing stability.29 Kao et al found that women directors mitigate crash risk more substantially than directors who are men, positing that women directors are more careful and diligent.70
In Malaysia, a study exploring women’s representation on boards and auditing committees indicated that women’s representation did not protect against financial distress.73 Among 27 Sudanese Islamic banks, researchers reported that the presence of women at senior managerial positions and larger board sizes adversely affected the banks’ ROA and ROE.74 The authors stipulate that critical mass theory, where the impact of a minor group becomes more efficient only when a certain threshold of representation is attained, may explain these results, particularly given the limited number of women participating in the Islamic banking industry. Using ROA as a measure of performance, women CEOs in Jordanian banks underperform compared to men CEOs. However, this relationship is insignificant for women’s versus men’s presence on boards.75 According to authors, this underperformance may be explained by the women’s level of experience.
Eight studies assessed operational performance of companies led by women, including technical and working efficiency and productivity. Eighty-eight percent reported positive results. One study found that working efficiency and organisational performance improved due to women’s leadership and representation in the corporate hierarchy.14 The decisions of women executives had a higher impact on organisational performance, including expressions such as average productivity per employee, speed to market products and services, transaction cost per business, technology investment, and computing expenses.51 In India, increased women’s representation at the owner and managerial level of the workforce is also associated with improved productivity.50
Two studies found that individuals’ performance tends to improve due to gender diversity.76 77 Large firms that are managed by women have higher sales per worker compared with their counterparts that are managed by men, making women-managed firms 43% more productive than men-managed large firms. However, small-and-medium firms that are women-managed have lower sales per worker.77
In larger firms, the proportion of women managers has a positive result on customer development, that is, market share of the enterprise, number of new customers, and number of customers satisfied with enterprise and internal business processes, such as information technology systems and applications, capacity utilisation of machinery, customer service activities, and number of new products and new services. However, high proportions of women on boards of directors, the proportion of women leaders (directors, deputy directors), and women managers correlate negatively with internal business processes metrics.78
Across 148 countries, women top managers were found to perform better on exploitation activities — measured by productivity growth and capacity utilization– compared to men counterparts. However, they underperformed on firm exploration activities, as measured by sales growth, employment growth, and buying fixed assets.79
Three studies reported an exclusively negative result. One found that micro-commerce businesses in Togo run by women underperform those run by men, based on the firm’s revenue per permanent worker.80 Another reported that the proportion of female executives is negatively associated with ROA and market value in China.81 A study conducted in India found that female-headed firms gained less from subcontracting.82
Innovation
The process of innovation can be understood as two steps: (1) idea generation and conceptualisation, and (2) product development and launch.83 Six studies assessed the impact of women’s leadership on innovation measures. One study conducted in India among business leaders found that women-led firms exhibited less investment in innovation than men-led firms. The authors further explored this phenomenon and noted that women entrepreneurs perceive their environments as less supportive of pursuing innovative opportunities than men entrepreneurs.84 Another study in Thailand found a negative but insignificant correlation between women CEOs and the firm’s product innovation.39
Alternatively, a study conducted in China found that women CEOs innovate more than their men counterparts. This positive effect on initiating innovation is stronger in relatively poorer provinces (with the lowest gross domestic product) and provinces with less government support.85 Another study assessing innovation in emerging markets found that women’s leadership in small and medium size enterprises (SMEs) has significantly positive correlations with both product and process innovation; women-led SMEs have an equally high level of product innovation and a significantly higher level of process innovation than men-led SMEs.86 Similarly, a study in 29 developing nations found that firms are more innovative—product innovation, process innovation, and innovation index—when top managers and owners are women.87 In China, gender played a significant role in how open innovation practices relate to firm performance, with women-led firms engaged in open innovation outperforming those led by men.88
Engagement with ethical initiatives
Women’s leadership was found to increase engagement with corporate social responsibility and other ethical initiatives focused on the environment26 42 57 89–109 and disaster response.15
One study found that introducing women on a board starts to exert a positive effect on environmental performance, but once a critical mass of three women is reached, there is no further increasing effect. However, a critical mass of women on the board of directors has a more positive impact on the environmental performance of banks when those banks are also led by women CEOs.91 Another study also found that women directors’ expertise and the presence of independent women directors in conjunction with women board representation had a positive effect on CSR expenditures.102 The authors indicate that numbers alone might not be enough to achieve these results without considering the financial, social, and environmental knowledge of those leaders, as well as ensuring that they can operate in bias-free and independent environments.
In Bangladesh and Jordan, women’s leadership was found to affect CSR disclosures negatively.90 110 Both studies focused on women’s leadership in family-owned companies where women directors were appointed based on family ties. In Jordan, this negative relationship was reduced as the number of highly trained, skilled, and qualified women directors increased. In Indonesia, one study found that board gender diversity has a negative impact on the innovation of green processes, supporting the hypothesis that gender diversity has a negative impact on the innovation of green processes in countries with low gender parity.66
Health
Nine studies focused on the impact of women’s leadership on health, of which 78% reported positive outcomes.111–117 One study exploring non-agricultural enterprises in Niger found that women-managed enterprises resulted in greater food availability and accessibility.117 While these enterprises are often small, consisting of only a few members, this study found that every member in households with women managers consumed more food than those with men managers.
A study in India found that women occupying political seats at different levels reduced sex selection (the practice where females are selectively aborted in favour of male fetuses) and increased the likelihood of girls’ survival.115 The author suggests that these results are driven by exposure to women leaders and not through a specific change in health services. A multi-country study, spanning 101 LMICs, focused on women decision-makers at two levels, as health ministers and as parliamentarians, and examined their impact on the procurement quantity of contraceptives.116 Women health ministers are associated with an increase in the procurement quantity of contraceptives; a woman versus man minister is associated with an average 66% increase in this quantity. This positive effect is strengthened with an increase in the proportion of women representatives in parliament and this combined effect is stronger when the country’s unmet need for contraceptives is greater. This suggests that women decision-makers are likely to prioritise contraceptive procurement to an even greater extent in the face of higher unmet need. The study found a lack of a meaningful relationship between women decision-makers and the procurement of non-contraceptive health commodities.116
Alternatively, one study in Bangladesh, contrary to expectations, found that the presence of women parliamentarians in electoral districts did not lead to improved maternal health outcomes.118 The study found a statistically significant decrease in the likelihood of prenatal care attendance in districts led by women national parliament representatives (MPs), versus men MPs, and this finding was consistent across multiple analytical models. The authors suggest that women MPs in Bangladesh often enter office through dynastic ties, limiting their personal agency. The current dominance of men in elite positions, and the need to maintain these relationships might restrict their ability to advocate for women’s issues effectively. The authors also note that given the bias against women candidates, women MPs may focus more on broader constituency needs rather that prioritising gender-specific issues, to secure re-election.118
Five studies focused on the impact of women’s leadership during the COVID-19 pandemic, and overall countries with women leaders had fewer absolute numbers of COVID-19 cases and related deaths.111–114 One found that the effect of women leaders on COVID-19 rates and deaths is moderated by cultural traits. Specifically, cultures which value more short-term orientation and finding enjoyment in life, rather than cultures guided by stringent social norms and preparing for the future, seem to boost women’s effectiveness in responding to the pandemic.112 Only one study in Brazil found no difference between COVID-19 deaths in municipalities led by women mayors compared with those led by men mayors.119
Organisational culture and climate
Five studies reported a positive impact of women’s leadership on organisational culture and climate outcomes including organisational reputation,120 121 employee retention,122 increased motivation and intellectual stimulation,123 and team cohesion and communication.124
Women-led companies in Malaysia have higher reputation scores, with the authors stating that the presence of women on the board is perceived as a positive quality signal.121 Another study in India found that the presence of women in the boardroom increases the level of reputation disclosure provided by the company.120 One study sought to explore the gender and employee turnover in microfinance institutions, a field that has been negatively influenced by ‘brain drain’ or employee turnover. Increased percentages of women board members in four South Asian countries resulted in reduced voluntary and involuntary turnover. This effect was negative, though insignificant, for women loan officers and managers. The authors argue that women board members are more reliable in establishing rules and regulations to manage human resources.122
A study conducted in Colombia found that companies with greater gender diversity, as defined by mostly women on the board of directors and in management, developed a transformational style towards organisational change. This transformational style comprised four factors: idealised influence; individualised consideration; intellectual stimulation; and inspirational motivation. Gender diversity was significantly and positively associated with inspirational motivation, intellectual stimulation, and individualised consideration.123
One research team conducted a survey with 86 cross-functional innovation teams representing 837 individuals from 29 organisations to understand the extent to which and contexts where women leaders may be advantageous for teams. Among larger teams (as compared with smaller ones), which often require more coordination, women-led teams reported more cohesion, more cooperative learning, and more participative communication than those led by men. Among geographically dispersed teams, those led by women report more cooperative learning and more participative communication.124
One study found that firms with a woman CEO are 6.18% less likely to provide employee training than firms with men CEOs. However, this effect was reversed when women CEOs had more years of experience.39 The authors posit that women CEOs may be more likely to lead smaller firms which are less likely to provide training due to a lack of resources.
Influence on other women’s careers and aspirations
Results on the power of representation and women leaders’ influence on other women’s careers were positive, with three studies reporting mixed results. One study found that women-led SMEs, compared with men-led SMEs, have significantly more women represented in top manager, manager, production, and employee positions, suggesting that women-owned SMEs are more likely to provide job opportunities for other women.86 ,125 One study in Brazil studied the effect of top-level women leadership on subordinate women in public municipalities and found that women leaders with autonomy or ‘managerial discretion’ use their power to reduce gender imbalance in their organisations.12 Another study found that women directors are more likely to appoint audit firms lead by women, including women directors on their boards, women owners, and a larger share of women ownership. 125
One study reported mixed results related to women leaders’ impact on other women’s careers. The authors explored whether women’s presence in political party leadership influences the percentage of women political candidates and elected legislators and found that there was no significant association, with modest positive effects on the yield of women elected officials from the women candidate pool. However, this interaction was different depending on the type of electoral system. Women’s leadership in proportional representation systems was highly correlated with other women’s candidacy, while more competitive systems, where the inclusion of a woman necessarily indicates the exclusion of a man, resulted in a tradeoff where more women in leadership yielded fewer women candidates.126Another study reported that the involvement of women in local government affairs in the state of West Bengal, India is significantly increased when a Pradhan, an elected village leader, is a woman, though there is no effect in the state of Rajasthan. 127
Two studies explored the relationship between women’s representation and time. Beaman et al observed that including women in politics in India had a positive effect on parents’ aspirations for their daughters and on girls’ educational attainment and time use (ie, reduction of time spent on domestic chores), but only after the second election.128 Similarly, one of those studies noted that time was important for women leaders to have an opportunity to serve as role models to other women.12
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