Autonomy under pressure: a scoping review of social egg freezing in the bottom quintile of the gender gap index

Abstract

Background: Social Egg Freezing (SEF), often promoted in Western contexts as a means to enhance reproductive autonomy, has seen varied uptake in countries with wider gender disparities. In such settings, where reproductive decisions are shaped by strong societal norms, SEF raises ethical concerns about whether it enables autonomy or reinforces prevailing expectations.

Objectives: This study examines how SEF is framed and regulated in countries ranking in the lowest quintile of the 2024 Gender Gap Index (GGI), where reproductive autonomy is emergent and SEF is increasingly promoted as a demographic intervention.

Methods: A scoping review was conducted on SEF literature published between 2013 and 2025 across 29 countries in the lowest GGI quintile. English-language sources were retrieved from PubMed, while Japanese (J-Stage, Ichushi-web) and Arabic (Arabase [al-manẓūma], E-Marefa) were searched. Supplementary materials-including government policies, religious texts, and professional guidelines-were identified through Google Advanced Search, manual screening, and documents from the International Islamic Fiqh Academy (IIFA). Eligible sources included empirical and normative publications addressing SEF in the countries under review. Three reviewers screened and extracted data. Themes were developed iteratively.

Results: Sixty-eight sources met inclusion criteria and were organized into five themes: (1) awareness and education; (2) sociocultural and religious values; (3) policy and legal frameworks; (4) clinical practices and outcomes; and (5) commercialization and autonomy. Most sources (73.9%) focused on themes (2)-(4), while awareness (12.2%) and commercialization (13.9%) received limited attention. In most Muslim-majority countries reviewed, religious frameworks restricted SEF to married women. Turkey is a notable exception, permitting SEF for single women though embryo transfer requires marriage. Only 23 of the 68 sources were empirical, and just four employed qualitative methods.

Conclusion: Although SEF is often framed as empowering, this promise is context-dependent and frequently illusory. Cultural and structural constraints shape women's choices, limiting the autonomy SEF claims to offer. Rather than imposing hegemonic neo-liberal assumptions, future policy and research should engage with local moral reasoning while examining how norms may reinforce inequality. Empirical studies are urgently needed to illuminate lived realities and improve policy development.

Keywords: Fertility preservation; Gender; Infertility; Islamic law; Oocyte cryopreservation; Pronatalism; Reproductive autonomy; Reproductive ethics; Social norms.

Fig. 1

PRISMA flow diagram

Fig. 2

Theme Frequency by Religious Backgrounds. The bar chart below visualizes the frequency of thematic codes assigned to 68 SEF literature documents. Some documents contributed multiple codes, resulting in 115 total coded instances