Author: Shaamalan Murugaya (@shaamalan_)
Co-author: Jaysukh Pindoriya (@JayPindoriya97)
Gender equity remains a challenge in various environments with the medical sector being conjugated in as well. Despite the massive influx of women in this noble profession, their roles are not fairly designed and represented. Gender equity remains a global goal that needs to be addressed and achieved. Therefore, to explore more on this vital topic.
Let us first hail the antiquity made by women against equity!
Sailing through the lines of historical texts, I find that the history of women against equity is truly inspiring. A meticulous insight into the saga of ancient dates around 3500 BC and Queen Shubad of Ur, ancient history reveals an active role of women in surgery in Egypt, Italy and Greece. 1
The history of women in Egypt brings to light the fact that females can introduce themselves energetically even in a male-dominated Kingdom. The history of women as surgeons begins as early as 3500 BC, with wall paintings adorning the tombs and temples of ancient Egypt depicting female surgeons performing procedures. In the first epoch, there is substantial evidence that woman were involved in surgical procedures. The grave of the Sumerian Queen Shubad of Ur (circa 3500 BC) contained instruments made of flint and bronze that showed that she practiced the art of surgery. At Sais, near the mouth of the Nile, women were both students and teachers at a woman's college where gynecology and obstetrics were specialized.1
Picture shows Egyptian Wall Painting. “Egyptian Surgery”
Source: http://www.glogster.com
On the other side of the coin, Agnodice, a legendary figure credited as the first female midwife and physician in ancient Athens is said to have courageously practiced medicine in Greece when women faced the death penalty for doing so. Agnodice wanted to be a doctor but the law forbade women and enslaved people from practicing medicine. Unafraid of the law, Agnodice decided to disguise herself as a man, cutting off her hair and dressing in clothing usually worn by men. Agnodice’s studied with a doctor called Herophilus, and soon she was seeing her own patients, all while remaining in disguise.
On one occasion, Agnodice visited a woman who was in labor. The woman was distrustful of the male doctor, but Agnodice revealed herself to the patient and, now satisfied that Agnodice was a woman, a bond of trust was established. 2 This galvanizing story clearly shows that women struggled during the remote time to get themselves to appear on a male-dominant stage.
Despite the added grievance during the ancient times, in the mid-19th century, an incredible woman named Elizabeth Blackwell, quoted;
“If society will not admit of woman's free development
then society must be remodelled”
This is a powerful saying on woman development. She was a teacher, aspired to become a doctor after she nursed a friend through an illness. However, the prevailing view in the 19th century was that women were unfit for medical service. She applied and was rejected by almost two dozen medical schools. Finally, she received an acceptance letter from Geneva College School of Medicine which turned out to be an “accident”. However Blackwell, who was born 200 years ago had become the first woman to qualify as a doctor in the USA. 3
Women had practiced medicine in different forms throughout the world since the earliest times. Some even disguised themselves as men to follow their vocation, -but Blackwell had made history by breaching the barriers of the all-male medical establishment formally and decisively.
Those facts clearly define that women have overcome much in history on the path to gender equity.
Yet, we have a long way to go to ensure equal endowments, engagement, and voice for women
Despite this meaningful amelioration, the gender gap remains widely open. To begin with, the COVID-19 pandemic highlighted the unprecedented pressure on the “real heroines in the fight against COVID-19”.4On a significant note, remarkable attention has been given to women political leaders in high-income settings, where it has been reported that women have led several countries’ effective national responses to COVID-19.4 However, little attention has been given to the role of women as leaders and decision-makers in conflict settings. In highlighting the gendered impact of COVID-19, the UN Office of the High Commissioner for Human Rights has stated that targeted measures to address the disproportionate impact of the crisis on women and girls are needed.
To quote the United States' first female Vice President and the daughter of a breast cancer researcher 5, Kamala Harris;
“While I may be the first woman to hold this office. But, I won’t be the last”
This clearly denotes how far we have come to include women in leadership roles, but there are still gender inequalities and gaps that remain in other areas, particularly in the healthcare system.
Diving into the healthcare system, gender disparities in the health workforce will lead to the misallocation of health workers in the formal and informal health workforces. The need has been well-founded for a gender-equal workforce. Yet in the public health workforce, gender disparities remain glaring. Women are not included in the main leadership roles and decision-making positions, despite the majority of the global health workforce comprise of physicians, nurses and other healthcare professionals are women.6
Graph 1 shows the distribution of physicians and nurses by gender in 2019
Source: Boniol and others (2019)
On a salient note, health experts argue that women should be involved in all stages of public health management, including planning, decision-making, and emergency response systems, as they account for approximately half of the world's population and are the primary caregivers in most households and health facilities for young people, the elderly and sick people (WHO, 2017). Despite these calls, women remain under-represented in top national and global health organizations (WHO, 2017) and even in government and legislative bodies (UNDP, 2020).
In certain fields of medicine, for instance, nursing and midwifery, women are not only underrepresented in leadership roles, but also over-concentrated (Graph 1). This presents a picture that gender is also horizontally segregated by global health jobs. Lower status, pay, and privilege are often associated with female-dominated areas such as nursing and midwifery. On the other hand, men enjoy senior management roles, greater status, and higher pay scales. This is true even if men enter female-dominated jobs or positions, as they are more likely than their female colleagues to climb the leadership ladder.
Graph 2 shows women in senior levels of healthcare are less likely than their male colleagues to be in line roles in 2018
Source: Women in the workplace 2018, a joint report from Leanln.org and McKinsey, womenintheworkplace.com
Among all that has happened, this pandemic has resulted in exposing and exacerbating the existing gaps and flaws in our societal system even though progress has been made since ancient times. We must highlight gender imbalances when they occur and continue to strive for fairness and justice in a gender-balanced, gender-based leadership team that is representative of both the broader health and social care workforce and the general population. We must send a clear message out there to all women to dream with ambition and lead with conviction, and to know that we will applaud them every step of the way. Even though the 8th of March and the women's march seem like another lifetime, the demand for gender equity remains. Therefore, the global question that requires an answer in the coming timeline.
“When we will ensure and start focusing on fairness and justice for women?”
References:
1. Pastena JA. Women in surgery. An ancient tradition. Arch Surg. 1993;128(6):622-626. doi:10.1001/archsurg.1993.01420180020004
2. King H. Agnodice. Pract Midwife. 2015;18(2):46.
3. Moore W. Elizabeth Blackwell: breaching the barriers for women in medicine. Lancet. Published online February 17, 2021. doi:10.1016/S0140-6736(21)00260-9
4. Meagher K, Singh NS, Patel P. The role of gender inclusive leadership during the COVID-19 pandemic to support vulnerable populations in conflict settings. BMJ Glob Heal. 2020;5(9):e003760. doi:10.1136/bmjgh-2020-003760
5. Bose P. Kamala Harris’s The Truths We Hold: An American Journey. Pres Campaign Autobiographies 2020. Published online 2020:25.
6. Shannon G, Minckas N, Tan D, Haghparast-Bidgoli H, Batura N, Mannell J. Feminisation of the health workforce and wage conditions of health professions: an exploratory analysis. Hum Resour Health. 2019;17(1):72. doi:10.1186/s12960-019-0406-0