Female participation in blood donation remains disproportionately low worldwide, despite decades of efforts to achieve 100 % voluntary and non-remunerated blood donation. Women contribute only around one-third of donations globally, and in some countries, their involvement is less than 5–10 %. This narrative review explores the complex interplay of physiological, psychological, social, and systemic factors that contribute to this disparity. Key challenges include deferral due to low hemoglobin or physiological states like menstruation and pregnancy, a higher incidence of vasovagal reactions, and iron deficiency, particularly among repeat female donors. Social and cultural barriers such as gender norms, caregiving responsibilities, misinformation, and stigma further restrict women’s participation.

Drawing on evidence from multiple disciplines and global regions, the review highlights strategies to improve recruitment and retention (Pink Drive), including donor education, iron supplementation, supportive infrastructure like child-friendly donation centers (Pink Blood Center), and inclusive messaging. Ultimately, promoting women’s participation in blood donation is not only a clinical and logistical necessity but also a powerful step toward health equity and gender inclusion in public health systems.