How are traditional livestock management and agro-pastoral systems being modified by women to cope with the impacts of climate stress, such as droughts or floods?
Short answer
Key finding
Women are reshaping traditional livestock management and agro-pastoral systems, expanding their roles in care, breeding, and diversification of practices to enhance resilience against climate stress.
Short summary
Women are adapting traditional livestock management and agro-pastoral systems to cope with climate stress by taking on critical roles in livestock care, including managing smaller, sick, and younger animals, and utilizing their traditional knowledge in milking, milk processing, and marketing. In regions like South Asia and Africa, they diversify livestock practices by rearing ducks, poultry, and small ruminants, and engaging in activities like grazing and fodder collection to maintain family nutrition and generate income. Women also play a key role in adopting improved livestock breeds and adjusting herd size and composition. As climate impacts force men to migrate or shift livelihoods, women increasingly manage livestock in homestead settings, ensuring household level nutritional and income stability and adaptation to climate stress.
Long answer
Long summary
What is this summary about?
This summary highlights how women are adapting livestock management and agro-pastoral systems to cope with climate challenges by taking on expanded roles and diversifying practices.
What evidence is this summary based on?
This summary is based on three systematic reviews:
Haque, A. T. M. S., Kumar, L., & Bhullar, N. (2023). Gendered perceptions of climate change and agricultural adaptation practices: a systematic review. Climate and Development, 15(10), 885–902. https://doi.org/10.1080/17565529.2023.2176185
Nahar, K., & Tajuddin, N. A. B. (2022). A systematic review on women’s disaster adaptation strategies in changing climate. Saudi Journal of Humanities Social Sciences, 7(6), 257-269. https://saudijournals.com/media/articles/SJHSS_76_257-269.pdf
Ramirez-Santos, A.G., Ravera, F., Rivera-Ferre, M.G. et al. (2023). Gendered traditional agroecological knowledge in agri-food systems: a systematic review. J Ethnobiology Ethnomedicine 19, 11. https://doi.org/10.1186/s13002-023-00576-6
What are the main findings?
Although traditionally their activities in these systems have been undervalued, Haque et al. (2023), Nahar and Tajuddin (2022), and Ramirez-Santos et al. (2023) highlight how women are crucial in livestock care, particularly in managing smaller, younger, and sick animals around the home. They possess vital agroecological knowledge, such as skills in milking, milk processing, and marketing, which are especially significant when men migrate for long periods in search of pasture or markets.
In many regions, like South Asia and Africa, women adapt their livestock practices to mitigate climate impacts by diversifying their activities. For example, in Bangladesh, women rear ducks, while in Niger, they manage poultry and participate in cattle grazing, firewood, and fodder collection. These activities help women maintain family nutrition and generate income during climate stress. Additionally, women have been instrumental in adapting livestock breeds to climate challenges, with some women preferring improved livestock breeds in regions like Tanzania.
Women are also adjusting herd composition and size to cope with climate variability. In Kenya, while men focus on limiting livestock numbers and diversifying feeds, women are diversifying their livestock portfolios by raising small ruminants and non-ruminant species. Moreover, in areas like Mali, the division of labor has shifted, with women taking on more livestock management roles, especially as men move away from agriculture to pastoralism or migration due to changing climatic conditions. These shifts in responsibilities and practices illustrate how women are reshaping livestock management to adapt to climate stress while supporting household survival and economic stability.
The evidence is based on three reviews, one with a moderate confidence rating and two with low confidence rating, as assessed using the AMSTAR tool for systematic reviews.
Review summaries
Gendered traditional agroecological knowledge in agri-food systems: a systematic review
Review
Geography
Year
Citation
Number of included studies
Review type
Critical appraisal of included studies
Assessment review
1. Key finding
Overall/Women and girls-related
Women are pivotal custodians of traditional agro-ecological knowledge (TAeK, driving climate resilience and agrobiodiversity conservation through practices like seed preservation, food security initiatives, and resource management, despite facing systemic barriers rooted in gendered norms and unequal access to land, water, and decision-making.
2. Short summary
The review highlights the critical role of gender in shaping traditional agro-ecological knowledge (TAeK) across diverse systems. Women play a vital role in subsistence farming, seed preservation, and food conservation, ensuring food security and agrobiodiversity conservation. In contrast, men often handle heavy labor, irrigation, and ethnoveterinary tasks. Regional differences exist; for instance, South Asian women excel in seed preservation, while men dominate infrastructure-related activities. Similarly, women in forestry gather edible and medicinal plants, while men manage tree species for fodder and construction.
Gendered inequities often restrict women’s access to land, seeds, forests, and water, marginalizing their contributions and limiting autonomy. Despite these barriers, women rely on informal networks to share knowledge, sustain TAeK, and address biodiversity loss and climate variability through strategies like soil conservation, crop protection, and wild plant gathering during food scarcity. Gendered divisions of labor in agroforestry, cropping, and home gardening further burden women, limiting their decision-making power while increasing domestic responsibilities. Yet, they remain crucial custodians of TAeK, particularly in seed conservation, medicinal plants, and food preservation. The review emphasises the importance of equitable access to resources to harness women’s knowledge for sustainable, climate-resilient agricultural practices.
3. Long summary
3.1 PICOS
Concept: Gendered exploration of TAeK in agri-food systems and traditional agricultural knowledge
Context: No specific region
3.2 Risk of bias - Not assessed
3.3 Publication bias - Not assessed
3.4 Findings
The review addresses gender as a critical factor influencing traditional agro-ecological knowledge (TAeK) across diverse agroecosystems. It underscores the necessity of exploring gendered differences in TAeK related to production, transformation, and conservation of resources, emphasizing how men’s and women’s daily experiences shape and sustain this knowledge. Women are primarily associated with gathering practices, which are often linked to subsistence farming and fulfilling family needs, whereas men tend to focus on gathering construction and fodder resources in distant locations. Both genders possess TAeK regarding plant characteristics, harvesting periods, and uses for culinary, medicinal, and ethnoveterinary purposes, but their expertise often differs by age, location, and societal roles.
In livestock management, gendered roles vary across regions. In East Africa, women focus on caring for smaller animals and milk processing, whereas men in West Africa are more knowledgeable about livestock. In Europe and Asia, studies highlight women’s involvement in feeding, milking, and administering medication, contrasting with men’s focus on transhumance and ethnoveterinary practices.
Gendered patterns in TAeK are evident in genetic resource conservation, cultivation methods, and small-scale farming. For instance, South Asian women play a significant role in seed collection and preservation, while men are more involved in irrigation and infrastructure. Women’s contributions to food sovereignty are notable in indigenous crop cultivation and home gardening, as observed in South Africa and West Africa, where they ensure food availability and household income.
Forestry-related TAeK also displays gender-based distinctions. In Asia, Africa, and the Americas, women often engage in gathering wild edible plants and medicinal resources, while men’s activities are more oriented toward managing specific tree species and their uses. Such practices contribute to health sovereignty and the sustainable use of forest resources, underscoring the complementary nature of gendered TAeK.
The review also explores gendered disparities in access to land, seeds, forests, and water, highlighting how patriarchal systems and customary laws often privilege men. Women face significant barriers, such as restricted land rights, limited participation in decision-making, and exclusion from seed and water resource management, which curtail their ability to utilize their traditional agro-ecological knowledge (TAeK). Although women often excel in seed conservation and crop management, societal norms and unequal resource control marginalize their contributions, particularly in regions like South Asia and West Africa. These inequities reinforce gender roles, limiting women's autonomy and compounding their workload in agricultural and domestic spheres.
Informal networks among women play a vital role in sustaining TAeK, which is crucial for adapting to climate change and conserving agrobiodiversity. Gendered divisions of labor are evident in agroforestry, cropping, and homegardening systems, where women typically handle tasks like seed conservation, weeding, and homegardeing, while men undertake heavier tasks such as land clearing and pruning. Women are key custodians of knowledge in areas like food conservation, seed preservation, and medicinal plant use, contributing significantly to family sustenance and agroecological resilience. However, sociocultural norms often restrict their roles, with men dominating tasks related to forage conservation, veterinary practices, and heavy labor. These disparities highlight the interplay between gendered labor divisions and knowledge systems, emphasizing the need for equitable resource access to harness the full potential of women’s knowledge in building climate-resilient and sustainable agroecosystems. Women adopt strategies like soil conservation, crop protection, and wild plant gathering to address biodiversity loss and food scarcity. They rely on informal networks and institutions to preserve and transfer knowledge across generations, while men's involvement is limited in some contexts, such as agropastoral systems in Europe
3.5 Sensitivity analysis - Not assessed
4. AMSTAR 2 assessment of the review
| 1 | Did the the review state clearly the components of PICOS (or appropriate equivalent)? | Yes | |
| 2 | Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol? (i.e. was there a protocol) | No | |
| 3 | Did the review authors use a comprehensive literature search strategy? | No | |
| 4 | Did the review authors perform study selection in duplicate? | No | |
| 5 | Did the review authors perform data extraction in duplicate? | No | |
| 6 | Did the review authors provide a list of excluded studies and justify the exclusions? | No | |
| 7 | Did the review authors describe the included studies in adequate detail? (Yes if table of included studies, partially if other descriptive overview) | No | |
| 8 | Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? | No | |
| 9 | Did the review authors report on the sources of funding for the studies included in the review? | No | |
| 10 | If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? | NA | |
| 11 | Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? | NA | |
| 12 | If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review? | NA | |
| 13 | Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? | Yes | |
| Overall (lowest rating on any critical item) | Low | ||
5. Count of references to the following words
| Sex | 0 |
| Gender | 157 |
| Women | 155 |
| Intra-household | 0 |
Included Studies
Gendered perceptions of climate change and agricultural adaptation practices: a systematic review
Review
Geography
Year
Citation
Number of included studies
Review type
Critical appraisal of included studies
Assessment review
1. Key finding
Overall
Perceptions of climate change, adaptation strategies, access to resources, and social networks for effective adaptation are distinctly shaped by gender, with men and women exhibiting differentiated roles, resources, and support systems that influence their adaptive capacities and responses to climate impacts.
Women and girls-related
Gender roles significantly shape adaptation strategies in agriculture, with men typically engaging in labor-intensive and resource-focused activities, while women prioritize less labor-demanding tasks and household food security, reflecting distinct responsibilities in response to climate challenges. Women face restricted access to productive resources, limiting their adoption of technical climate adaptation strategies and often confining them to managerial roles, while men tend to dominate resource-intensive activities due to cultural norms and differential resource ownership. Women face restricted access to productive resources, limiting their adoption of technical climate adaptation strategies and often confining them to managerial roles, while men tend to dominate resource-intensive activities due to cultural norms and differential resource ownership.
2. Short summary
Research reveals mixed evidence regarding gendered perceptions of climate change. While men and women share similar views, women often report greater concern, especially over specific threats like crop losses and saltwater intrusion. This heightened concern may stem from a more fatalistic outlook on climate, possibly due to limited access to information. Gender roles critically shape these perceptions; for example, women in Uganda focus on issues impacting fuel and water due to their domestic roles, while men emphasize soil fertility and livestock health.
Adaptation strategies also differ by gender. Women, restricted by unequal access to resources, tend to adopt managerial adaptations like crop rotation, while men typically engage in structural changes like flood prevention. Financial and technical adaptations vary; women in Bangladesh rely on savings or loans for small businesses, while men in Ghana often sell assets. The findings emphasize that women often face adaptation barriers due to poverty and limited capital. Gender roles and associated socioeconomic factors distinctly shape climate resilience. Women often rely more on localized, food security-focused social networks, while men access broader, crop-oriented institutional networks, with cultural practices further restricting women’s social connectivity and network access.
3. Long summary
3.1 PICOS
Population: Women
Concept: gender disaggregated perception and/or adaptation to cli-mate change in agriculture
Context: No specific region
3.2 Risk of bias - Not assessed
3.3 Publication bias - Not assessed
3.4 Findings
Evidence on gendered perceptions of climate change is mixed. Some studies suggest men and women share similar views, while others indicate women show slightly higher concern and greater sensitivity to temperature changes. Many studies note that women, often with limited climate information, are more fatalistic about climate change, sometimes viewing it as divine will. In China, women attribute climate change to human actions, whereas in Ghana, Malawi, and Bangladesh, both genders frequently cite deforestation and overpopulation. Female farmers generally express greater concerns over crop losses, reduced productivity, and environmental threats, while men more frequently report flood occurrences, with women focusing on flood impacts and prevention.
Gender roles significantly shape perceptions of climate change, leading men and women to experience and interpret impacts differently. For example, in India, men typically observe effects on activities they manage, like hunting and livestock health, while women are more attuned to changes affecting forest food plants, medicinal plants, and horticulture due to their responsibilities in these areas. In Ghana, women perceive reductions in food production more than men because of their role in securing food supplies. Similarly, in Uganda, women note prolonged droughts, saline water, and wetland changes for fuel cultivation, while men focus on soil fertility decline. These differences suggest that specific gender roles within communities lead to distinct climate change perceptions, even among people living in the same area. Climate change perception among farmers also varies by age, social status, and ethnicity, influencing adaptation behaviors. Older and poorer farmers in India and Mexico are more certain about climate impacts, while concerns about climate change strongly drive adaptation efforts, especially among women.
Some of the climate change adaptation strategies adopted and variation by gender:
Technical adaptation The adoption of improved crop varieties and livestock breeds varies by gender and location, with women favoring fast-maturing crops and men often prioritizing drought-resistant varieties. Gendered differences also affect adoption rates, with women in Bangladesh adopting diverse agriculture more than men, whereas men in Ghana lead in diversification efforts.
Financial adaptation: In response to climate change, men in Ghana and Kenya typically sell assets like livestock to cope with drought, while women rely more on borrowing or savings. Asset sale strategies also vary by climate impact and gender, with male-headed households selling assets during drought and female-headed households amid pest infestations. Women in Bangladesh and Malawi frequently join savings schemes and take loans for small businesses, whereas in India, more men take loans, borrow from neighbors, and use savings for adaptation.
Structural Adaptation: Structural adaptation strategies typically fall to men, such as flood prevention and drainage, while women often adopt water harvesting, pen reinforcement, and fire control measures, sometimes increasing their labor, as seen in Sudan.
Managerial Adaptation: Farmers, regardless of gender, widely adopt managerial adaptation strategies, with variations by gender; women in Tanzania focus on cropping and fertilization, men on conservation and feed improvement, and in Ghana, men prioritize fish farming, while women emphasize seasonal forecasting and post-harvest tech.
Socio-cultural adaptation: Key socio-cultural adaptation strategies include changes in food habits, gender roles, farming systems, and education. In Ghana and Eritrea, women reduced meal size and used wild plants during drought, while in Mali, women took on livestock rearing as men shifted to migration or sharecropping due to climate challenges.
Livelihood Adaptation: Farmers adapt to climate change by diversifying income through non-farm activities, with gender differences in preferred strategies. In Malawi, men leaned towards fisheries and agriculture-related activities, while women engaged more in petty businesses. Additionally, men in some regions pursued exclusive livelihoods like fishing or carpentry, while women focused on small-scale businesses, labor, and forest-based livelihoods.
Migration as adaptation: Migration as an adaptation strategy to climate change is primarily undertaken by men, though women also migrate for non-farm work, with some regions seeing higher female migration. Seasonal migration patterns vary, with men shifting pastures during droughts and women adopting circular migration for fishing. Migration can lead to positive outcomes, such as female empowerment through remittances, but also negatively impacts women left behind, increasing their workload and leading to female-headed households in certain regions.
3.5 Sensitivity analysis - Not assessed
4. AMSTAR 2 assessment of the review
| 1 | Did the the review state clearly the components of PICOS (or appropriate equivalent)? | YES | |
| 2 | Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol? (i.e. was there a protocol) | Partial Yes | |
| 3 | Did the review authors use a comprehensive literature search strategy? | Partial Yes | |
| 4 | Did the review authors perform study selection in duplicate? | No | |
| 5 | Did the review authors perform data extraction in duplicate? | No | |
| 6 | Did the review authors provide a list of excluded studies and justify the exclusions? | No | |
| 7 | Did the review authors describe the included studies in adequate detail? (Yes if table of included studies, partially if other descriptive overview) | Yes | |
| 8 | Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? | No | |
| 9 | Did the review authors report on the sources of funding for the studies included in the review? | No | |
| 10 | If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? | NA | |
| 11 | Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? | NA | |
| 12 | If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review? | NA | |
| 13 | Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? | Yes | |
| Overall (lowest rating on any critical item) | Moderate | ||
5. Count of references to the following words
| Sex | 3 |
| Gender | 205 |
| Women | 141 |
| Intra-household | 4 |
Included Studies
A Systematic Review on Women’s Disaster Adaptation Strategies in Changing Climate
Review
Geography
Review type
Critical appraisal of included studies
Assessment review
1. Key finding
Overall
Women in rural and agrarian communities adapt to climate change through diverse strategies such as livelihood diversification, altered crop practices, reliance on microcredit, migration, indigenous knowledge use, and income generation through trade and livestock rearing. However, systemic gender barriers limit their access to resources, impacting their resilience and adaptation effectiveness.
2. Short summary
Women in rural and agrarian communities employ diverse strategies to adapt to climate change impacts. In India, Bangladesh, Vietnam, and Mali, women turn to alternative livelihoods like making handicrafts, engaging in petty trade, livestock rearing, and forest-based activities when traditional agriculture becomes unsustainable due to environmental stressors. For instance, women in Bangladesh took up soil-cutting for income after Cyclone Aila, and Vietnamese women increasingly engage in waged labor due to water scarcity. In places where male migration shifts family roles, women assume greater adaptation responsibilities despite facing limited access to land, credit, and resources.
Women’s access to financial resources, often restricted, drives reliance on loans, microcredit, and savings to fund adaptation efforts, while education and training enhance adaptation abilities, especially where women receive support from NGOs. Local ecological knowledge is also critical; women in the Fijian Islands and Torres Strait use indigenous knowledge to manage food security and predict weather. Across regions, women reduce their own consumption to prioritize family needs in times of food scarcity, and they leverage diverse adaptation methods to support household resilience despite significant barriers posed by gender norms and financial limitations.
3. Long summary
3.1 PICOS
PCC: Population/concept/context framework
Population - women,
Concept - adaptation strategies in response to climate-related disasters
Context - no specific zone
3.2 Risk of bias - Not assessed
3.3 Publication bias - Not assessed
3.4 Findings
The review identifies a number of adaptation strategies taken up by women in the context of climate change, especially in rural and agrarian settings. These include:
Income source diversification: In India’s Katper village, women make rope from cotton waste due to declining incomes from fishing and gardening caused by climate change. After Cyclone Aila in 2009, Bangladeshi women in Khulna turned to soil-cutting for income. In Vietnam and Mali, women shifted to livestock raising and firewood collection as water scarcity hampers farming, while worsening droughts in Mali have led women to adopt forest-based livelihoods. Male migration has also prompted women to pursue off-farm income.
Livelihood diversification: In Bangladesh, women diversify their livelihoods by cultivating varied crops, albeit with lower adoption rates than men due to societal barriers. Vietnamese women often shift to waged labor instead of agriculture. In Nepal, decreased crop production due to warming leads women to rely on day labor. In northeastern Nigeria, both men and women adopt off-farm activities to manage food security amid drought. In India, coastal flooding in Gujarat and annual storms push women to shift away from traditional livelihoods like fishing, while in Uttarakhand and Mali, they take up wage labor and forest-based livelihoods to adapt
Altered cultivation/crop management/crop diversification: In agrarian societies, adaptation is vital, though gender norms limit women's roles in agricultural adaptation. While men control agricultural output, some societies allow or require limited female participation. Female-headed households employ adaptive strategies, like flood-resistant rice in India, drought-resistant crops in Nepal, and charcoal production in Mali. Nigerian women adopt intercropping and crop rotation at lower rates than men, while Bangladeshi women use salt-tolerant and mangrove farming, mixed cropping, and floating gardens for flood resilience. Vietnamese women adapt with drought-resistant rice, irrigation adjustments, and modified planting times to address water scarcity.
Personal loan/Microcredit/Borrowing money: Climate change adaptation is costly, and women, with fewer resources than men, face financial barriers that limit effective adaptation. Women often rely on microcredit, loans, or intermediaries. In Bangladesh, women leverage NGO loans for family support, while female-headed Nigerian households access agricultural loans. In Vietnam, women secure low-interest loans or start small businesses to offset declining rice yields. In Gujarat, India, women transitioned from farming to lobster rearing, funded by loans after a climate event.
Saving money and Property selling: During crises, women’s property is often sold before men’s, and their limited capacity to save reduces their coping ability. In Bangladesh, women in char areas engage in diverse income-generating activities to build savings, which supports family adaptation during events like floods (Naz et al.). Similarly, rural Vietnamese women prioritize saving in advance to prepare for climate-related challenges.
Migration: In regions like Uttarakhand, Gujarat, and coastal Bangladesh, male outmigration grants women greater decision-making power over adaptation and income diversification despite lacking land ownership. However, they face challenges in accessing irrigation water, credit, labor, and handling increased workloads. In water-scarce Vietnam, women, especially those with lower education, turn to local or seasonal wage labor during dry periods. In drought-prone Nigeria, female-headed households often migrate or send children for off-farm work to reduce consumption pressures.
Education/Training: In Bangladesh, flood-affected rural women receive NGO training to diversify livelihoods, while urban women emphasize children’s education as a preventive measure. In drought-prone regions of India, organizations provide training to help women adapt to climate impacts. Education level significantly influences households’ adaptation capabilities by enhancing analytical skills for resilience strategies. Women in Mali prioritize education as a long-term strategy, aiming for their children to secure paid work and reduce dependence on natural resources.
Use of local indigenous knowledge: Women’s reliance on natural resources and ecological knowledge strengthens their role in climate adaptation. Their expertise enables them to gather and disseminate ecosystem information crucial for resilience. In the Fijian islands, intergenerational knowledge sharing from past disasters informs future adaptation strategies. In the Torres Strait Islands, women, known as "aunties," use local materials and predict weather patterns to enhance food security and self-sufficiency. Similarly, women in Bangladesh employ indigenous knowledge for climate hazard management, while women in Uttarakhand, India, utilize natural indicators to predict weather events, safeguarding family food security.
Petty trade, livestock rearing, home-made product selling: Women in regions like Uttarakhand, Gujarat, and Bangladesh adapt to climate stresses by engaging in handicrafts, trade, and livestock rearing for income and family nutrition. In food-scarce rural areas, women often reduce their own consumption to prioritize family needs. Here, staying hungry becomes a way of adapting to climate stresses.
3.5 Sensitivity analysis - Not assessed
4. AMSTAR 2 assessment of the review
| 1 | Did the the review state clearly the components of PICOS (or appropriate equivalent)? | Yes | |
| 2 | Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol? (i.e. was there a protocol) | No | |
| 3 | Did the review authors use a comprehensive literature search strategy? | Partial yes | |
| 4 | Did the review authors perform study selection in duplicate? | No | |
| 5 | Did the review authors perform data extraction in duplicate? | No | |
| 6 | Did the review authors provide a list of excluded studies and justify the exclusions? | No | |
| 7 | Did the review authors describe the included studies in adequate detail? (Yes if table of included studies, partially if other descriptive overview) | No | |
| 8 | Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? | no | |
| 9 | Did the review authors report on the sources of funding for the studies included in the review? | No | |
| 10 | If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? | NA | |
| 11 | Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? | No | |
| 12 | If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review? | NA | |
| 13 | Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? | No | |
| Overall (lowest rating on any critical item) | Low | ||
5. Count of references to the following words
| Sex | 0 |
| Gender | 49 |
| Women/Woman | 221 |
| Intra-household | 0 |