As I write this, it’s International Women’s Day and I have been enjoying all the support on twitter and the media. Last month we also had Women and Girls in Science Day, championing full and equal access and participation for women and girls in science.
Why do we have this in our calendars? There seem to be a few claims as to how this started, one is that the date was picked to commemorate an event in 1917. That was when a group of women in Russia held a four-day strike to demand peace, bread, and the right to vote. It is a day to celebrate the global, social, economic, cultural political and of course scientific and medical achievements of women. It is also, an opportunity to think about how to advance gender equality. This year they had the theme #BreaktheBias —spotlighting the individual and collective biases against women that fuel gender inequality.
So, what about medicine? What’s changed for women in medicine in the last 30 years? At these times I can’t help but reflect on my own experience and although I am hesitant to share them, I am sure I was not alone in these experiences. Looking back, I can’t believe what I thought I had to do, and how I thought I had to act to fit in as a junior doctor and a junior researcher 20 years ago. I remember thinking that I could not talk freely about having children, or that I wanted to get home early for them, in case it gave people the wrong impression about my commitment. I was on call at Great Ormond Street Hospital and holding the arrest bleep nine months pregnant; imagine how fast I could run? I worried about how the length of my maternity leave would affect my work and my research endeavours. I went back to full time clinical work too soon, only four months after having my first child, with my patient husband bringing her in to me for her feeds whilst I was on call. I didn’t want to stand out. Surely, it should have been easier than that?
Indeed, I am glad to see how things have changed during the last two decades, but we can always do more. As I became more confident, I also learnt how to manage. I changed how I viewed things and moved to looking for inspiring women as mentors and supervisors. This is one of the reasons I chose to come to work here in Southampton where my specialty was populated by an inspiring group of female consultants.
Expectations are important and can shape how we think. We should expect women to accomplish. Yet, although there are many more women entering medical school, two thirds of consultants are men and we still have a gender pay gap. I am sure much of this doesn’t happen intentionally, but is influenced by pre-conceptions of what makes a good consultant with both men and women guilty of unconscious bias. This unconscious bias may also be affecting our decision making as clinicians as we treat our patients. Has the research undertaken for our evidence-based practice been free of this bias, or has it been male orientated, or gender neutral?
The long-standing gender differences in working practices and career choices have important implications that should be a priority for workforce planners to ensure that women are sufficiently represented across all spheres of medicine.
We also have to transform the cultural and social roles of women at work and in the home which are so ingrained and slow to change. My daughter, who studies Sociology, told me the other day that she was learning about the old double shift sociological theory (which concluded that working women had a dual burden of paid work and unpaid domestic work) and that this had now become the triple burden where emotional work supporting the family is added to domestic work and paid work.
On a positive note, we are currently well represented by women in senior leadership positions in our Faculty of Medicine. We have our second only female Dean supported by five Associate Deans, of which, four are women. I am not going to hide my domestic life and want to proudly let you know that I have five children, four of which are daughters. I enjoy my triple shift. I hope that I have taught them that there are more possibilities for them now than ever before.
I’ll end with the medical feminist Dr Hillman’s top five ways to achieve gender equality in medicine:
- Include women in the decision making, from research to policy making to NHS leadership
- Ensure research thinks about gender. Are women represented even if it is at a cellular level? How do you know that gender doesn’t play a role in the outcome?
- Teach students about gender inequality, include it in the curriculum. These people are our medical future
- Stop and listen to patients. Question what you thought you knew. In a system that was driven by men for men historically, how much of what we practice now is wrong for women?
- Call yourself out when your unconscious bias becomes fleetingly conscious. It’s an uncomfortable thing to do, but if you start you will realise how often you will make an assumption based on someone’s gender.