Paramedics are often the first point of contact in pre-hospital settings. They respond to emergency calls and are trained to provide clinical care to patients experiencing trauma or medical conditions. In most countries, men and women have equal opportunities to train and apply for paramedic roles [1]. However, this is not the case in some countries, such as Saudi Arabia, where longstanding cultural attitudes and systemic practices have limited access to certain professions for women and negatively affected national economic growth as a result [2].

In Saudi Arabia, women have important roles in the health professions, which recorded the first female physician in 1961 and the first two female nurses in 1982 [3], [4], [5], [6]. The representation of women in the Saudi health workforce has increased; for example, 36.3% of physicians and 61.8% of nurses are women [7]. The country’s emergency medical service (EMS) is mainly delivered through the Saudi Red Crescent Authority (SRCA) [8]. Some military, university and public hospitals and medical cities across the country also provide EMS to cases in their vicinity [9]. While paramedics are the backbone of such EMS programs in Saudi Arabia, the proportion of female-to-male paramedics is nearly nil in the pre-hospital setting, where the paramedic profession is still overwhelmingly dominated by men [10]. Before 2010, this disproportionate representation may have been attributed to the fact that all academic and training programs in paramedicine were male-oriented [2]. However, training and education in the field have evolved since 2010, providing equal access to women and resulting in the number of educationally qualified female paramedics increasing from 20 in 2010 to more than 1,500 in 2018. However, the number of registered Saudi female paramedics at the Saudi Commission for Health Specialties in 2021 is 634 (3.46%), compared with 17,702 male paramedics (96.54%) [2].

In the male-dominated paramedic discipline, Saudi women find it difficult to voice their concerns as the majority are limited by health organisations’ policies that women are not allowed to work in prehospital setting in the country. Such actions are considered disrespectful and disobedient, making it difficult for Saudi female paramedics to excel [11]. Traditionally, Saudi women have been tied to household affairs, while men have been the breadwinners [1]. This societal expectation has had a barrier effect for Saudi women since the husband, father or brother determines whether a woman can enter the paramedic profession. Moreover, Saudi female paramedic married or singles are expected to take care of her family first before focusing on career endeavours [12]. This cultural expectation requires her to be more family than career-oriented and makes her paramedic career options limited. These cultural challenges is not only faced female paramedics in Saudi Arabia, female Pakistani healthcare professionals are facing more challenges such as cultural and stereotypical barriers that affecting their availability in healthcare sectors [13]. Also, In Japan the cultural perspective on gender is influenced by society, family responsibility and work environment, which affects women’s careers because of their culture and political representation [14]. Little is known about employment in paramedicine from the perspective of women already serving as paramedics.

The big increase in qualified female paramedics did not translate into a similar increase in women employed as paramedics; the majority of female graduates are unemployed [9]. Statically number of female paramedics are lower than male paramedics around the world, such as the female paramedics in United States (USA) is approxmetly31.7% of all the paramedics around the States [15], where there no female paramedics are working in the Saudi prehospitsal setting. The reasons for this remain unclear and may be difficult to identify since the Saudi Government has, in recent years, developed and introduced several programs designed to empower women to participate in the workforce in greater numbers [16]. These include rapid access to leadership in public and private sector programs, an on-the-job training program, the transportation for working women program, and the supporting childcare for working women program [17].

The disproportionately small number of Saudi women who do work as paramedics underscores the importance of reviewing the system [1]. An inquiry or study – particularly one that involves the personal insights of working female paramedics – would result in better understanding of the longstanding and entrenched professional and personal challenges faced by female aspirants, which have resulted in a huge gender imbalance in paramedicine. Once these factors are identified, improvements can be made. To inform such developments, this study sought to explore working female paramedics’ perceptions of their challenges in the workplace in the Kingdom of Saudi Arabia (KSA).