A growing body of international evidence demonstrates that women are less likely than men to receive life-saving bystander interventions during out-of-hospital cardiac arrest (OHCA), including CPR and AED application, particularly in public settings (Munot et al. 2024; Catalisano et al. 2025).

In some parts of Japan, these disparities were particularly evident among females of childbearing age (Kiyohara et al. 2020), while across Australia, women aged over 75 years were less likely to receive bystander CPR (Bray et al. 2025).

Munot et al. (2024) found that females were:
20% less likely to receive bystander CPR in private residential locations (aOR: 0.82, 95% CI: 0.70–0.95).
40% less likely to receive bystander CPR in public locations (aOR: 0.58, 95% CI: 0.39–0.88).

Furthermore, recognition of OHCA during emergency calls was less likely for females in public locations than for males (84.6% vs 91.6%, p = 0.002), partially explaining the lower rates of bystander CPR among women.

Although bystander AED use was lower among females (4.8% vs 9.6%, p < 0.001), this association was no longer statistically significant after adjustment for location and other covariates (aOR: 0.83, 95% CI: 0.60–1.12).

Females were also less likely to present in a shockable rhythm but were more likely to achieve return of spontaneous circulation (ROSC). No significant difference was observed in survival to hospital discharge (Munot et al. 2024).

Across Australia and New Zealand, similar findings have been reported. In an analysis of almost 30,000 OHCA cases (36% female) from the Aus-ROC Australia New Zealand Epistry, Bray et al. (2025) found that:
At younger ages, females were more likely than males to receive bystander CPR; however, after 75 years of age, men were more likely to receive CPR.
Women in public settings were 30% less likely to receive bystander CPR than men (72.2% vs 75.9%; aOR: 0.71, 95% CI: 0.54–0.93).

Women also had substantially lower rates of bystander AED application across all settings:
Overall: 1.0% vs 2.8% (aOR: 0.54, 95% CI: 0.43–0.68).
Public locations: 12.7% vs 19.1% (aOR: 0.57, 95% CI: 0.41–0.79).
Private locations: 0.3% vs 0.8% (aOR: 0.38, 95% CI: 0.25–0.59).
Bystander-witnessed arrests: 2.3% vs 7.3% (aOR: 0.47, 95% CI: 0.36–0.61).

Why are women less likely to receive bystander CPR?
While the exact reasons are likely to be multifactorial, research suggests that knowledge alone does not explain the disparity.

Perman et al. explored public perceptions of why women receive less bystander CPR than men during OHCA. Participants identified several barriers that may contribute to hesitation, particularly in public settings, including:
Fear of causing injury.
Concerns about touching a woman's chest or removing clothing.
Fear of accusations of inappropriate touching or sexual assault.
Difficulty recognising cardiac arrest in women.
Misconceptions that women are less likely to experience cardiac arrest.
Lower confidence performing CPR on women compared with men.

These findings suggest that the disparity is influenced not only by CPR knowledge and training, but also by social, cultural and psychological factors that may delay or prevent life-saving intervention (Perman et al.).

CPR is a Gender and Rights-Based Healthcare Issue

Increasing evidence suggests that disparities in CPR and AED use for women should not be viewed as isolated findings but as a broader healthcare equity issue.

Szabo et al. argue that CPR education, research and public messaging have historically been developed using a predominantly male-centred approach, with insufficient consideration of the social, cultural and educational barriers that may prevent women from receiving the same life-saving interventions.

The authors call for a gender-responsive approach to CPR education, research and policy that ensures women have equitable access to recognition, CPR and defibrillation during out-of-hospital cardiac arrest.

Collectively, the evidence demonstrates that although survival from cardiac arrest depends on rapid recognition, early CPR and prompt defibrillation, women continue to experience disparities in access to these critical interventions. These disparities are preventable. By addressing misconceptions, improving CPR education and ensuring women are represented in training, research and public awareness campaigns, we can help ensure everyone has an equal chance of receiving life-saving care when it matters most.