Abstract
The first caesarean delivery in South Africa was successfully performed on 25 July 1826, by Dr James Barry (1789–1865), an army surgeon in Cape Town. The newborn boy was named James Barry Munnik, after his doctor. Ironically, Dr James Barry was actually Margaret Ann Bulkley, who had changed her name when she was 20 years old in order to gain admission to study medicine at the University of Edinburgh. At that time, women were not permitted to study medicine. Barry graduated in 1812 and, after several hospital posts in London, joined the British army in 1813. Promotion to Assistant Staff Surgeon in 1816 brought Barry to the Cape of Good Hope. Only after Barry’s death was it discovered that she had concealed her sex for 56 years in order to practice medicine.
As illustrated by this narrative, gender disparities have existed for centuries. However, over the past decade, gender inequities have received increasing attention in the fields of science, technology, engineering, mathematics, and medicine. Despite the fact that women constitute nearly half of medical school students and residents, 1 there are persistent gender gaps in the workforce, in physician leadership, and in scholarly activities such as journal editorial boards.2,3 The gender gap appears to affect some specialties more than others, 4 and contributing factors include a lack of mentorship and role models, unconscious gender bias, and work–life integration challenges. Recent studies have demonstrated gender differences in authorship of clinical practice guidelines 5 and in speakers at international conferences. 6 Gender bias also affects trainees, with data suggesting that reference letters, by using different adjectives for men and women, inadvertently portray women as less competent than men. 7
The specialty of Obstetrics and Gynecology has the largest proportion of women residents and faculty compared to other specialties. 8 However, this female predominance in training and medical school faculty is not reflected in institutional leadership positions. 9 Obstetric Medicine, a sister specialty to Obstetrics, also attracts a significant proportion of women clinicians, but unlike Obstetrics, Obstetric Medicine has a significant number of women leaders and mentors.
National and international Obstetric Medicine specialty societies may provide a snapshot of women’s presence in the field. Currently, more than 60% of members of the North American Society of Obstetric Medicine (NASOM) are women. At the most recent International Society of Obstetric Medicine (ISOM) 2018 and NASOM 2019 annual conferences, women constituted 57% and 68% of all delegates, respectively. Reassuringly, women’s representation in leadership positions in Obstetric Medicine societies parallels the female membership gender distribution of these societies. In the past five years, ISOM has had 2/3 female presidents, NASOM has had 3/3 female presidents, Society of Obstetric Medicine in Australia and New Zealand (SOMANZ) has had 2/3 female presidents, and the Macdonald Obstetric Medicine Society (MOMS) has had 1/3 female presidents. A quick look at recent large Obstetric Medicine annual meetings shows that NASOM 2019 had 69% invited women speakers, and 88% at the 2017 meeting, while ISOM 2018 had 52% women speakers. These data are in contrast with findings from 181 medical conferences in the United States and Canada showing that women comprised only 24.6% of speakers in 2007 and 34.1% between 2013 and 2017. 10
While the Obstetric Medicine journal has historically had four out of six women Editors-in-Chief since its inception in 2008, the Editorial Board is currently male-dominated (75%). Reassuringly, the journal has a female first-author representation that parallels the membership in the various societies and reflects the academic engagement and productivity of women in the field. A random screen of one issue of the journal per year from 2016 to present (n = 42 manuscripts) shows that nearly 65% of all first authors are women.
While these preliminary data from the developed world are somewhat reassuring and show that women are well represented in Obstetric Medicine, many questions remain. Is this perceived equity also reflected in individual institutional leadership structures? Is there a similar gender pay gap in Obstetric Medicine as in other specialties? Is the equity that we perceive consistent across continents and countries? Do we need to create diversity guidelines and policies, as have some large international medical societies, 11 to ensure continued diversity in gender representation? Is the apparent representation of women in Obstetric Medicine leadership roles a reflection of the specialty being comprised mainly of women, or rather an indication of an attitude of fairness among members of the discipline? Do Obstetric Medicine societies have a role to play as allies in promoting diversity internationally among our related specialties and subspecialties?
It is fair to say that, at least at a societal level, Obstetric Medicine sets an example in gender equity and has been a leader in female representation by many standards. We strongly encourage hospital and university leaders to carefully evaluate their leadership structures, consider leadership at national societies as a model, and strive to achieve representation that is equitable to its faculty and trainees, and to ensure unbiased promotions and comparable job satisfaction, as well as adequate retention of female scientists and clinicians.