By Tinsae Abera Worku
(Edited by Riya Sawhney )
Global surgery is a multidisciplinary field that was, in a manner, formalized in 2015 after the World Health Assembly resolution 68.151. The field aims to provide equitable surgical care worldwide and works to address the need, access, and quality of surgical care through study, research, practice, and advocacy [1]. Historically, the field has been under-prioritized, however, recently it has been effective in rallying people together to work towards increasing access to safe, affordable, and quality surgical services for 5 billion underserved people, primarily residing in low- and middle-income countries (LMICs) [2].
Research is one of the main grounding components of global surgery because of its pivotal role in driving innovation and health system strengthening in the field. Nevertheless, despite the fundamental nature of research to global surgery, gaps still persist, stifling equity in this sector. The disparity is particularly striking in LMICs, where research output is considerably lower compared to high-income countries [3]. Furthermore, even though equity is one of the field's core principles, there is a stark underrepresentation of women researchers globally. There is a significantly low representation of women authors, which at times has been as low as 9% of abstracts presented at international conferences [4]. This underrepresentation highlights a broader issue: without urgent action, achieving gender parity in academic global surgery—where women would comprise 50% of full professors—may remain a distant dream, stretching as far as 2096 [5,6].
Suffice it to say that evidence indicates the emphasis on the representation of women in global surgery is a relatively recent development [7]. Over the years, although the number of women in this field has steadily grown, research still shows that women in surgical fields occupy fewer leadership roles, participate less in research, and receive lower grant funding compared to their male counterparts6. Due to deeply entrenched structural, cultural, and social challenges including the novelty of the field, there is a dearth of established faculty members who can provide mentorship and female role models, leaving many junior researchers without support [8]. Furthermore, persistent 'old boys club' attitudes and unequal pay, hamper the progress of aspiring female surgeons6. These challenges, compounded by the systemic barriers women face in political, cultural, and economic contexts, perpetuate a cycle of underrepresentation, and limit the diversity of perspectives in global surgery research.
Women researchers have been at the forefront of advocating for women's health issues, including maternal mortality and access to obstetric care in low-resource settings. This contributes to better quality of care because of the lived experiences they bring to the table8. Recent studies have shown that female clinical researchers are more likely to include female study participants, addressing historical underrepresentation in research subjects. With their increased presence, surgical spaces are enriched by a shift in focus towards overlooked, often exclusively female, health conditions [8]. Moreover, increasing on-ground representation of local women in global surgery research enables the development of context-specific solutions, promotes equity in research participants recruitment, and addresses sensitive health considerations for female patient populations [9]. Furthermore, the inclusion of women in the surgical environment creates a more welcoming and cooperative atmosphere, enhancing collaboration and innovation for the whole team [8].
While there has been a commendable rise in publications authored by women in global surgery literature, there is still a lot that needs to be done to bridge the gap [10]. It is time to eliminate barriers hindering women's advancement in global surgery research and ensure their increased representation. Efforts from all relevant stakeholders are imperative to drive meaningful inclusion of women in global surgery research. Simply maintaining the status quo is not an option; proactive measures are needed to effect change and achieve gender parity before 2096.
Addressing these challenges requires concerted efforts, starting with acknowledging the current gaps. A comprehensive systemic approach is essential for accelerating gender equality, with initiatives such as leading research training focused on global surgery projects. Truly meaningful research collaboration and mentorship that include women as the influential first and last author positions on collaborative manuscripts, principal investigators on grants, and visiting professorships to deliver lectures beyond quotas should be employed. Integrating gender-sensitive approaches into research design and analysis ensuring the needs and perspectives of women are adequately represented is also another possible solution. Additionally, safety remains paramount, therefore robust safety monitoring mechanisms alongside mitigation and accountability actions are crucial to address gender-based violence during research, especially for research conducted in novel or under-resourced settings that require women to travel and work in a new environment.
Going forward, we need to closely monitor authorship trends in the field to identify areas that need priority support. We should also hold journals and funding organizations accountable for their equity metrics. Additionally, it is crucial to celebrate the achievements of women in this field, creating supportive environments that value diversity and inclusivity, inspiring future women researchers. Moreover, we must join forces with organizations like Gender Equity Initiative in Global Surgery (GEIGS) to advocate for systemic change and dismantle barriers that hold women back. Only then can we create an environment where all aspiring women researchers have equal opportunities to succeed and contribute to the advancement of global surgery research.
The inclusion of women in global surgery research brings invaluable benefits to the social, political, and economic aspects of society. Despite comprising a small proportion of principal investigators, the quality of work presented by women in conferences equals or surpasses that of their male counterparts [4]. Research demonstrates that diverse teams, inclusive of women and other minorities, consistently outperform homogeneous teams [11]. Their indispensable contributions underscore the importance of diverse teams in producing higher-quality outcomes and driving innovation. Consequently, women's voices in global surgery research are imperative in improving the quality and impact of research outcomes. As we strive to advance surgical care worldwide, let us commit to fostering an environment that values and amplifies the contributions of women. By doing so, there is a plausible chance of achieving gender equity in academic global surgery well before 2096, and we can create a more inclusive and effective global surgical community that serves the needs of all patients, regardless of gender.
Reference
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2. Bath M, Bashford T, Fitzgerald JE. What is ‘global surgery’? Defining the multidisciplinary interface between surgery, anaesthesia and public health. BMJ Glob Health. 2019 Oct;4(5):e001808.
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10. Padmanaban V, DaCosta A, Tran A, Kunac A, Swaroop M, Zhang WW, et al. Closing the Gender Gap in Global Surgery: Trends at the Academic Surgical Congress. J Surg Res. 2021 Jan;257:389–93.
11. Graner M, Buda AM, Moura CB, Campos L, Faria I, Truche P, et al. Is authorship by women in Brazilian academic surgery increasing? A five-year retrospective analysis. Sriram V, editor. PLOS Glob Public Health. 2022 Apr 27;2(4):e0000294.
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