Why Women Are Less Likely to Receive CPR
With World Heart Day fast approaching on September 29th, it’s important to remember that CPR is an important lifesaving tool during cardiac emergencies. However, an important question remains: When cardiac arrest happens, does everyone have the same chance of receiving it?
Research suggests the answer is no. Women are 14% less likely than men to receive bystander CPR during cardiac arrest [1]. There are several possible reasons for this, including fear of causing injury, concerns about inappropriate touching, misconceptions about women's cardiac emergencies, and a lack of exposure to female anatomy during CPR training.
What is CPR and Why Does it Matter?
Cardiopulmonary resuscitation, or CPR, is a lifesaving technique used when someone experiences cardiac arrest. During cardiac arrest, the heart suddenly stops pumping blood effectively to the brain and other organs. CPR uses chest compressions to help circulate blood throughout the body until the heart can be restarted or an automated external defibrillator (AED) can be used to correct the rhythm of the heart [2].
Immediate CPR can double or even triple a person's chance of survival after cardiac arrest, making a bystander's response especially important [2]. Despite its significance, research has consistently found a gender gap in who receives CPR. One 2018 study found that 45% of men experiencing an out-of-hospital cardiac arrest received bystander CPR compared with only 39% of women [3]. A more recent analysis of more than 309,000 cardiac arrests also found that women were 14% less likely than men to receive bystander CPR and defibrillation in public settings [1].
So why does this disparity exist?
Training Gaps & Misconceptions
One possible explanation begins before a cardiac emergency ever happens: CPR training itself.
CPR is commonly taught using mannequins, but many training models don’t represent the diversity of real human bodies. Researchers examined 20 CPR mannequins available on the global market and found that 19, or 95%, were flat-chested. Although five of the models were marketed as “female,” only one actually had breasts [4].
This lack of representation may contribute to uncertainty when trainees encounter a person with breasts during a real emergency. A 2025 study found that only a small percentage of participants had previously practiced CPR using a female mannequin. At the same time, 87.22% of female participants supported including more female mannequin models in CPR training [5].
However, breasts do not change the basic technique of CPR. Compressions are still performed in the center of the chest over the sternum. This is important because being unfamiliar with someone's body should not be a reason to hesitate when CPR is needed.
There are also misconceptions about clothing and CPR. A bra, or any other undergarment, does not need to be removed to provide lifesaving CPR. However, if an AED is being used, the chest needs to be easy to get to so that the pads can be placed correctly [6].
Another misconception may be even more fundamental: whether women are experiencing a cardiac emergency at all. While looking into how public perceptions impact the CPR gender gap, researchers identified the belief that women do not experience cardiac arrest as one possible reason for lower intervention rates [6]. These misconceptions can be influenced by gender stereotypes and the way women's medical emergencies are perceived.
Fear of Injury and Inappropriate Touching
Knowing how to perform CPR does not always mean a person feels comfortable executing it.
People may hesitate because they fear causing injury, while others, particularly male rescuers, may worry about being accused of inappropriate touching or sexual assault. In addition, the misconceptions about women experiencing medical emergencies also contribute to the barriers to performing CPR on women [6,7].
However, delaying CPR during cardiac arrest can be far more dangerous than the possibility of causing an injury during compressions. CPR is an emergency medical intervention, and fear should not prevent a bystander from acting [6,7].
Does Anatomy Actually Make CPR Different?
The basic technique of CPR does not change based on someone's sex, but bodies are not anatomically identical.
Research has identified differences between male and female rib cages, including rib-cage size and geometry, rib inclination, and sternum thickness. These differences can affect how the chest responds mechanically to compression [8].
This does not mean that rescuers should use completely different CPR techniques for men and women. Rather, it highlights why CPR training should prepare people to respond to a variety of body types.
Could More Representative Mannequins Help?
Changing mannequin design alone will not solve the CPR gender gap, but it could be one part of the solution.
Practicing CPR on mannequins with different chest shapes and sizes could make trainees more comfortable with hand placement and compressions while also providing an opportunity to address concerns about breasts, clothing, and injury [7].
The goal is not to teach a different version of CPR for women. It is to make CPR training more representative of the people who may actually need it.
What Can We Do?
Reducing the gender gap in bystander CPR will require more than simply teaching people how to perform chest compressions. CPR training should also address the misconceptions and fears that may cause people to hesitate when helping women. Including more anatomically diverse mannequins could help trainees become more comfortable performing CPR on different types of bodies [8].
Bystanders can also help by remembering that CPR is lifesaving care, regardless of a person's sex or body type. If someone is unresponsive and not breathing normally, call emergency services, begin CPR, and use an AED as soon as one is available. Do not let fear of injury, inappropriate touching, or uncertainty about anatomy delay lifesaving care.
As World Heart Day approaches on September 29, we are presented with an opportunity to make CPR education more inclusive and ensure that everyone has an equal chance of receiving the care they need. Everyone deserves a bystander who is willing and prepared to help.
References
Cruel S. No Matter Where They Live Women are Less Likely to Get Bystander CPR [Internet]. Duke University School of Medicine. 2024 [cited 2026 Aug 23]. Available from: https://medschool.duke.edu/news/no-matter-where-they-live-women-are-less-likely-get-bystander-cpr
Red Cross Training & Certification, and Store [Internet]. Red Cross. 2025 [cited 2026 Aug 23]. Available from: https://www.redcross.org/take-a-class/cpr/performing-cpr/what-is-cpr?srsltid=AfmBOooY8ZAjQ406wyawCyQrIvgemdoI4sOg2PT-_fyo32Yf4RkBvURP
Perman SM, Shelton SK, Knoepke C, Rappaport K, Matlock DD, Adelgais K, et al. Public Perceptions on Why Women Receive Less Bystander CPR than Men in Out of Hospital Cardiac Arrest. Circulation [Internet]. 2019 Feb 19 [cited 2026 Aug 23];139(8):1060–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386169/
Szabo R. Women are less likely to receive CPR than men. Training on manikins with breasts could help [Internet]. Find an Expert : The University of Melbourne. The Conversation; 2024 [cited 2026 Aug 23]. Available from: https://findanexpert.unimelb.edu.au/news/95376-women-are-less-likely-to-receive-cpr-than-men.-training-on-manikins-with-breasts-could-help
Cheng W, Liu J, Zhou C, Wang X. Factors analysis of lower probability of receiving bystander CPR in females: a web-based survey. BMC Cardiovascular Disorders. 2025 Apr 8;25(1).
Why people fear performing CPR on women – and what to do about it [Internet]. www.heart.org. [cited 2026 Aug 23]. Available from: https://www.heart.org/en/news/2020/11/23/why-people-fear-performing-cpr-on-women-and-what-to-do-about-it
Kim RT. Implementation of a Breast Adjunct for CPR Training Manikins Increased Reported Comfort in Performing CPR on Women - JEMS: EMS, Emergency Medical Services - Training, Paramedic, EMT News [Internet]. JEMS: EMS, Emergency Medical Services - Training, Paramedic, EMT News. 2023 [cited 2026 Aug 23]. Available from: https://www.jems.com/ems-training/implementation-breast-adjunct-cpr-training-manikins/
María Ferrón‐Vivó, María José Rupérez. Gender‐Based Differences in the Biomechanical Behavior of the Thorax During CPR Maneuvers. International Journal for Numerical Methods in Biomedical Engineering. 2024 Nov 11.
Comments