When Are You Going To Give Birth?: How Sexism Prevents You From Building A Career In Medicine

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When Are You Going To Give Birth?: How Sexism Prevents You From Building A Career In Medicine
When Are You Going To Give Birth?: How Sexism Prevents You From Building A Career In Medicine
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In medicine, sexism is often encountered not only female patients, but also female doctors - and for those who are not involved in this area, this may sound unexpected, because the majority of medical workers are women. We figure out who divides medical specialties into "women" and "men", how many doctors and nurses are faced with harassment and what can be done about it.

Text: Evdokia Tsvetkova, endocrinologist


Shameless asexual creatures

In ancient times, caring for the sick and many household medical manipulations were a woman's prerogative - but as soon as medicine began to form as a profession, men declared a monopoly on it. Since antiquity, only men were allowed to study the art of healing. The names of women who have become exceptions - Merit-Ptah, Aspazia, Trotula - can be counted on one hand, and they are known exclusively as gynecologists. If their scientific interests involved something other than obstetrics, history did not preserve this data. Until the end of the 19th century, women did not have the opportunity to receive a higher medical education and claim anything more than the position of a nurse or midwife. Women passed on knowledge of obstetrics and nursing to each other in religious communities.

They began to break the tradition relatively recently - a couple of hundred years ago, and not always openly. So, nee Margaret Ann Bulkley lived a long life, graduated from the University of Edinburgh and practiced as a military surgeon under the name James Barry. The secret hidden by the woman was revealed only after her death. Under her real name, Elizabeth Blackwell was the first to receive her medical degree in 1849. The rector of the College of Geneva gave the decision on her admission to the university at the mercy of students, on the condition that if at least one out of one hundred and fifty people voted against, the woman would not be accepted - and everyone voted for.

In 1850, the world's first women's medical college, Boston, was founded. Its founder, Samuel Gregory, considered childbirth too easy for male doctors, and created a women's college to rid men of this occupation. True, the program of the educational institution did not provide for full qualifications and admission of female students to clinical practice - and without it, a full-fledged medical education cannot be obtained; the college was soon disbanded. The fallen banner was picked up by the Pennsylvania Women's Medical College, where women from all over the world began to come. Nineteenth-century newspapers spoke of women receiving medical education as "asexual, shameless creatures, discrediting the noble title of a lady by their mere appearance," but the process could no longer be stopped.

In 2019, experts compared the features of gender discrimination in 187 countries

over the past ten years, and in the overall ranking Russia took 121st place

The first Russian woman doctor was Nadezhda Prokofievna Suslova. Due to the government ban on women from attending lectures, even as a student, she left Russia and entered the medical faculty of the University of Zurich. A year after graduating from university, Nadezhda returned to her homeland to work as an obstetrician-gynecologist. Varvara Andreevna Kashevarova-Rudneva became the first woman to receive a higher medical education in Russia, and not abroad, in 1863. In 1876, she became the first woman in the country to defend her dissertation. True, she was never allowed to practice and only helped her husband-doctor in his work. After the death of her husband, Varvara Andreevna was subjected to public persecution - newspapers published mocking cartoons and published malicious articles, after which she moved from the capital and worked as a rural doctor until the end of her life.

In our country, the first women's medical courses ("Special women's course for the education of learned midwives") opened in 1872 in St. Petersburg, and in 1897 the first Petersburg women's medical institute was created. In 1917, after the change of government, the system of training medical personnel also changed - and only then women became commonplace within the walls of medical universities.

Of course, this was not the end of gender discrimination in the labor sphere (including in medicine) that still exists today. In 2019, experts compared the features of gender discrimination in 187 countries over the past ten years, and Russia took 121st place in the overall ranking. The rating was compiled taking into account thirty-five criteria in various areas: labor, property and family law. Gender inequality was found in a quarter of the countries surveyed. The average global ranking was 74.71 out of the 100 maximum points. Russia received 73.13 points in the rating and is adjacent to Morocco and Uganda. According to the World Bank, the problems are related to wages and career start.

Surgery is not for girls

Already during their studies at a medical school, students are pressured in matters of their future specialty. "Surgery is not for girls", "How will you start a family with an irregular schedule?" many have heard more than once during the training. According to endocrinologist Anna S. (the names of the heroines have been changed at their request. - Approx. ed.), who wanted to become an operating gynecologist and actively attended topographic anatomy circles, under pressure from teachers she chose another - more "female" specialization. There are those who manage to ignore insults, although this is not easy. Coloproctologist surgeon Evgenia T shared her experience: the doctor tells how, on duty in the surgical department and internship in general surgery, she was constantly subjected to misogynistic statements and jokes like “How will you stand at the table [operating room], take care of your legs - on them no one wants to look,”“A woman's place is at the kitchen table, not a surgical one,”and the like.

Unfortunately, in the minds of many, including doctors, specialties are divided into "female" and "male". According to the results of a sociological study by Marina Kovaleva, while writing her dissertation "The gender status of women in modern medicine," it turned out that female doctors experience more difficulties in mastering the profession than men. The reasons for this are seen both in the multifunctionality of the “female” social role (unpaid domestic work) and in the prejudices existing in society. As of 2017, women accounted for only 19.2% of surgeons in the United States.

In addition to potential learning difficulties, female doctors in Russia are often denied employment due to the presence or likelihood of having children. Specific data cannot be cited here: unfortunately, no statistics are kept. But often when interviewing for a job, the second question after "What institute did you graduate from?" becomes "When are you planning to give birth?" According to the doctor Alexandra K., she even had a situation when she was denied employment, arguing that she is a young woman - of course, she plans to acquire a husband and children in the near future, which means: “Well, why do we need you? ?"

Glass ceiling

In 1991, the US Congress established that despite the increased number of women workers, they were still underrepresented in leadership positions. A commission examining this phenomenon, in a 1995 report, confirmed the artificiality of the barriers erected to prevent women from reaching managerial positions. These barriers include social (related to gender bias and stereotypes), managerial (related to lack of consistent government control over the observance of the rights of citizens of the country),internal and structural (due to the personnel policy of the institution). The commission also found that even women in leadership positions were paid lower than their male counterparts. In addition, the findings of the commission showed that women in leadership positions were mainly represented in the areas of human resources management and accounting (in Russia in 2018 the situation is exactly the same).

The wage gap between men and women, according to

for 1983-2000, in the United States was 21%. According to data from the Ministry of Labor for 2018, women's wages in the world are on average 16-22% lower than men's. In Russia this figure is 28%. True, in recent years the gap has narrowed - in 2001, men received an average of 37% more than women. Deputy Prime Minister Olga Golodets at the opening of the forum "The role of women in the development of industrial regions" said that the average salary of women in Russia is 70% of the salary of men. Golodets tried to explain inequality by saying that "women do not achieve the same level of education and career growth as men."

In the medical field, the educational level of workers is the same - and the difference in wages may be due to gender discrimination in the workplace or discrimination in what profession or position women can occupy. Research results also show that working mothers face an additional pay gap compared to women without children (about 7%).

Although women make up nearly 78% of the health workforce, gender gap persists in senior and executive management

According to the 1995 American College of Health Executives (ACHE), although women make up nearly 78% of the health workforce, there remains a significant gender gap in senior and executive management (11% of women in health leadership versus 25% of men, in general management 46 % and 62%, respectively). Moreover, women leaders tend to be represented in specialized areas such as nursing, planning, marketing and quality control, which are not part of the usual career paths to leadership positions. ACHE also reports on the pay gap between men and women in leadership positions. With an equal level of education and work experience, in 2000 the gap in the average annual salaries of women and men was 19%.

A subsequent ACHE report in 2006 noted the movement of women into the upper echelons of hospital management (44% women and 57% men). But the wage gap continued to exist, and women generally earned 18% less.

Harassment epidemic

The difficulties of working in a male team are faced not only by representatives of traditionally “male” specialties. Misogynistic jokes among colleagues and management, according to medical experts, are common. As sociological studies show, the general attitude of the team and the leader is important for the formation of the atmosphere. So, when infused into a social group where such behavior is considered acceptable, even those who were not inclined to sexism perceived the local norm of tolerance for discrimination. Particularly sad is the evidence that sexist jokes contribute to the formation of prejudices and the acceptance of stereotypes among women working in a team.

Sexism on the part of patients in relation to women of traditionally "male" specialties is, for example, a request to change a surgeon from a woman to a man. According to general surgeon Ekaterina P., once this happened to her at the very beginning of her career, but, unfortunately, no one keeps statistics in Russia, so it is impossible to reliably assert the frequency of such cases. Harassment in medical institutions in our country is also practically not talked about, although in other countries we are talking about "an epidemic of harassment in hospitals."

A 1995 study showed that 52% of women in medicine have experienced sexual harassment at least once. According to a 2016 study that included 1,719 women, 62% of them were harassed (of which 30% were sexually motivated). Of those subjected to sexual harassment (150 people), 40% describe its severe forms, and 59% noted the negative consequences of what happened in their professional activities. Ophthalmologist Inna S. says that she was forced to change the place of her residency, because the head of the department locked her in his office, refusing to let her out until she agreed to have sex.

A 1995 study found that 52% of women

in medicine have been sexually harassed at least once

According to the #MeToo movement, nurses and female doctors are often harassed not only by colleagues (often in higher positions - managers, teachers), but also by patients. It can include insistent invitations to an informal meeting, attempts to give expensive items with persuasion for subsequent relationships, attempts at physical contact, an offer to fund scientific research in exchange for sex. Christina P., an endocrinologist, recalls how one day a patient found out her address and was on duty at the door with flowers; Psychiatrist Alexandra K. also talks about the persecution by the patient. Nurses and residents of the clinic shared stories of how they were harassed in single wards, cutting off the way to the exit; Nurse Lyubov N. told how one day on duty a patient came to her in underwear with a request to sleep in the nurse's room with her.

In this regard, the video of the medical channel Med2Med is very indicative, full of strategies on how to “avoid harassment”: instead of publicizing the actions of the aggressor, it is suggested to behave “non-defiantly”, avoid the aggressor, and not be alone with him. A 2018 study found that gender discrimination and harassment at work significantly affects the mental and physical health of women.


Discrimination in science

Doctors are not only practitioners, but also scientists, and they can work not only in hospitals, but also in university departments. According to the UNESCO Statistical Instrument, in 2018 the share of women in world science was 28.8%. In Russia, according to Rosstat, in 2016, 370,379 researchers worked in science, of which 40% were women. Until now, in the minds of many, the division of science into "female" and "male" specializations remains. The overall picture of women's employment in research and development has remained stable over the past twenty years, although overall there has been a shift towards maturity in science. Thus, in 1995, the share of female researchers was 48.4%, and in 2016 it dropped to 40%.

Among the disciplines united in the English-speaking environment in the STEMM group (science, technology, engineering, mathematics and medicine - science, technology, engineering, mathematics and medicine), men still predominate. In the new work, researchers at the University of Melbourne in Australia analyzed 9.7 million articles from the PubMed and arXiv databases. In automatic mode, it was possible to determine the gender of 1.18 million authors of 538,688 articles published since 1991. Of the 115 disciplines examined in 87, the proportion of women was less than 45%.

Women working in the scientific field receive an average salary of 26% less than men (data for 2015). In teaching, men earn on average 16.3% more than women. There is a clear minority in the posts of managers in science and education of women: 13.3% are among the rectors of universities of the Ministry of Health. The average income of women - directors of institutes is 66.9% of men's salaries, and of rectors - 89.2%.

What can be done

A government program being implemented in the United States is gradually narrowing the gap between the wages of men and women.And in China, they recently banned asking women about family and children when applying for a job and removed a pregnancy test from the list of mandatory tests for passing a medical commission. We don't have to talk about help from the state yet, but we can do something - for example, not to support misogynistic jokes and a sexist atmosphere in the team and to publicize cases of harassment.

When trying to discriminate in employment, you can refuse to discuss personal issues (about family, marriage, having children or plans to have them), record the interview on a dictaphone (warning about the desire to make a recording, since during the discussion personal data or information that is state or commercial secrets), carefully study the employment contract and, if necessary, discuss the introduction of changes. An employer can be prosecuted in court for unlawful refusal of employment. And, perhaps, the most important thing is to talk about the problem. After all, it's like with health - if we hide our "complaints", then we will not wait for "diagnostics" with "treatment".

Photos: Piman Khrutmuang - stock.adobe.com, Joytasa - stock.adobe.com, New Africa - stock.adobe.com


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