We Need To Fight Sexism To Get More Female Surgeons In Developing Countries

There are only around three female surgeons for every 1 million people in low and middle income countries. It’s time to address this



Unsupportive work policies and sexist working environments can deter female medical students from pursuing surgical training.

On April 3 1866, Dr James Barry created history by being the first European man to do a caesarean section in Africa. The child – who was given the doctor’s name (full name James Barry Munnik Hertzog) – would go on to became the prime minister of South Africa. But the story of the doctor who had delivered him was no less extraordinary. For Dr Barry, born Margaret Ann Bulkley, was in fact a woman.

It is no secret that surgery has always been an old boy’s club. Even today when gender equality should be a norm, the world has barely acknowledged a woman’s role in a health system. Based on figures by the Lancet Commission on global surgery, under a best case scenario of equal distribution there are only around three female surgeons for every 1 million people in low-income countries.

In the face of this deficit, it would make sense to recruit both men and women from low and middle income countries (LMICs) into surgical careers. In fact, surgery is one of the most popular career choices for students as they begin medical school, but three quarters of female students never follow through, leading to this specialty having one of the worst gender inequities in medicine. This imbalance urgently needs addressing, especially considering the fact that billions of people around the world have no access to essential and emergency surgery when they need it, translating to a burden of preventable diseases that is more than those caused by malaria, tuberculosis and HIV/Aids together.

The catch-22

Studies have highlighted that enrolment of women in medical schools in LMICs is low. This disproportionately affects the number of women going into all specialties, let alone surgery. Female medical students face not just the rigours of the discipline but also rigid, unsupportive work policies and sexist, hostile working environments as deterrents to the pursuit of surgical training.

Globally, the field of surgery has a lack of women leaders. There are multiple reasons for this. Equally qualified women with similar leadership skills are passed over for promotions only because of their gender. Those hard-working women surgeons who do manage to reach the top are not compensated as well as their male counterparts. Why then would women surgeons take on all the extra work and frustrations that come with it? This situation creates a lack of role models and mentors for the next generation, leading to a vicious cycle.

Breaking the cycle

Sustainable development goal 5 aims to achieve gender equality and empower women worldwide by 2030. Accordingly, societies are trying to move towards a more gender-balanced environment. Now, the surgical community needs to catch up.

Systemic obstacles that a woman faces, that discourage her from pursuing a surgical career, must be done away with. We need to start by enabling more women from LMICs to be recruited into medical schools. During consideration for entry into the surgical training period, a woman should be evaluated on her merits, not on her potential to get pregnant during training.

Further, we need to get rid of the glass ceiling that exists for all women surgeons who want to advance to the next level as leaders in the field. Professional bodies and academic societies must actively recruit women surgeons into their decision-making committees to ensure this. This will result in having the female leaders that encourage the next generation of women surgeons.

When Dr James Barry died of dysentery in 1865, his maid Sophie Bishop reported that she’d discovered her master was a woman when she laid out the body, sending shockwaves through Victorian society. Over 150 years later, it’s sad to say that a female surgeon is still a rare sight.

Women surgeons are hardworking and purpose-driven, no less than their male counterparts. If we want to significantly increase the number of surgeons in LMICs, we need to take a better look at the 50% of the community that has so far been neglected and underrepresented in the surgical workforce. We need to expand our vision of the future of surgery to one that is no longer defined by presumed gender roles. We are sure Dr Barry would agree.

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