Prof Fionnuala Breathnach, consultant obstetrician gynaecologist (and maternal foetal medicine specialist) at RCSI Rotunda Hospital, Dublin, has witnessed a transformative improvement in women’s healthcare. “Obstetrics is a speciality quite unique in its involvement in what should be a very natural and physiologic event: pregnancy,” she says.
“Unfortunately, in the hands of nature, there is lots of scope for things to go wrong, from formation and development of the embryo to delivery itself. Medical intervention cannot come close to preventing or correcting all of the problems that can arise. However, increasingly, through research-driven pursuit of the highest standards of care, pregnancy outcomes continue to improve.
“As a junior doctor, I witnessed poor pregnancy outcomes that I don’t see any more. If it were not the case that health outcomes are improving, it would prove impossible for those of us working in this field to show up for work every day.”
The perceived gender bias within the health system knowingly affects the patient. However, interestingly, studies have shown that both women and men receive better care from female surgeons. They are deemed to spend more time with patients, ask questions about their social circumstances, and follow guidelines, while also collaborating with specialists, all of which are determinants for better patient outcomes. And yet, women’s participation and contribution to medicine has been overlooked and at times erased.
Women have paid the price for gender stereotyping in medicine in more ways than one. Not only has the gender health gap affected how women receive healthcare and how women’s health issues are researched, represented and understood, but gender bias has also stalled women’s advancement in medicine. The biases that still exist in our society have the potential to prevent women from pursuing or advancing their career in medicine.
Historically, both men and women have been responsible for a long-standing paternalistic approach to medical care— Prof Fionnuala Breathnach
Men continue to disproportionately dominate the majority of surgical disciplines, with the exception of obstetrics and gynaecology, which has witnessed a shift in the gender divide. However, women practising in this field and others report higher rates of discrimination and disproportionately low opportunities for advancement in their careers. The gender barriers and stereotypes faced by women can restrict them from accessing male-dominated specialities as a leadership gender gap also continues to exist.
Several studies published in leading peer-reviewed journals have shown that the gender bias in science and medicine is pervasive and enduring among faculty and students. A study in the Journal of Surgical Education investigated the possible gendered expectations of female medical residents as a result of implicit or explicit bias. It was determined that female residents were evaluated differently than their male counterparts.
[ Amongst women: Why are there so few men in caring roles? ]
These studies show that the gender bias affects mentorship and sponsorship opportunities, respect, grading, hiring, promotion, awards and pay, with sexual harassment continuing to be a significant barrier. Enacting and pursuing a cultural change will lead to the retention of women in medicine and better health outcomes with improved quality of care.
As Prof Breathnach says, “historically, both men and women have been responsible for a long-standing paternalistic approach to medical care. But this is steadily starting to change”.
The gender discrepancy is caused by a number of factors. According to a 2021 study, the gender gap is created by personal choices and interests, working conditions, absence of role models and mentorship, institutional policies which make gender disparities more evident, and unintentional learning from culture and education.
More women are entering this profession than ever before, so that there is a natural and logical shift toward greater numbers of women occupying these roles— Prof Fionnuala Breathnach
Research studies in the area also advocate for and highlight that professional programmes aim to target gender bias in order to improve equity of science by definitively identifying the systemic nature of gender bias, increasing awareness of the significant contribution women make to the fields of science and medicine, advocating for more female role models, implementing focused inclusivity training, increasing transparency of professional development and pay, and advocating for professional fairness.
[ Women in science event highlights progress and persisting barriers ]
[ Doctors on the medical profession: ‘We often describe it as designed for 1950s men with wives’ ]
“Precisely half of the newborns in our delivery unit are female,” says Prof Breathnach. “We strive to ensure that gender equality doesn’t stop there. Traditionally, certain specialties and senior roles in particular have been disproportionately assumed by men. More women are entering this profession than ever before, so that there is a natural and logical shift toward greater numbers of women occupying these roles.”
However, Prof Breathnach is cognisant of the fact that it remains the case that women will often struggle with competing demands of family life and childcare.
“The ideal situation would see women having children either well before or well after they embark on the nine-to-12-year (post-graduate) training programme required for specialist training,” she says. “Unfortunately, nature doesn’t tend to facilitate that kind of master plan.”