Mary Magdi, Education Lead
Gender equity is a fundamental principle in today's society, and it extends to various domains, including scientific research. In the realm of academia, it is essential to ensure that research practices are free from gender bias and discrimination. While the term "gender gap" has traditionally been associated with women, it's crucial to recognize the value of sex- and gender-based analysis in enhancing our comprehension of the experiences of all genders beyond the binary. To address this, the Sex and Gender Equity in Research (SAGER) guidelines have been developed. In this blog post, we'll explore what the SAGER guidelines are, why they are important, and how they promote gender equity in research. We'll also provide references for further reading and understanding of this critical topic.
What are the SAGER guidelines?
The European Association of Science Editors (EASE) formed a Gender Policy Committee (GPC) in 2012 to create guidelines for reporting Sex and Gender Equity in Research (SAGER). The committee utilised various methods, including keyword searches and website scans, to identify policy options. The SAGER guidelines were developed by a collaborative effort from leading medical and scientific journals, aiming to establish a set of principles to promote transparency and equity in research related to sex and gender. These guidelines offer a systematic approach to integrating sex and gender considerations into research design, analysis, and reporting. During the development phase, there was significant opposition to the implementation of policies related to sex and gender, indicating a lack of understanding regarding the crucial role of sex and gender as determinants of health and well-being.The guidelines have now been translated into six languages, adopted by a growing number of journals, encouraged by major publishers, and extensively used by researchers worldwide.
Why are the SAGER guidelines important?
The importance of considering the influence of sex and gender on health and disease burden is increasingly acknowledged. The WHO Roadmap for action from 2014-2019 underscores the essential integration of equity, gender, human rights, and social determinants throughout all WHO programs, offices, and management processes. Emphasis is placed on promoting detailed data analysis and monitoring of health inequalities, as well as providing guidance on incorporating sustainable, gender-responsive approaches. In the year 2023, the World Health Organization (WHO) embraced the SAGER guidelines to address the inconsistent and less-than-ideal reporting of data related to sex and gender.
There are several reasons why gender equity in research is considered essential, notably:
Healthcare Disparities: Gender differences can significantly impact the presentation, diagnosis, and treatment of diseases. Failing to account for these differences can lead to healthcare disparities and ineffective treatments.
Scientific Rigour: Ensuring gender equity in research contributes to the scientific rigour of studies. It improves the validity and generalizability of research findings.
Ethical Considerations: Gender bias in research is an ethical concern. All individuals, regardless of their gender, should have equal access to quality healthcare and research participation.
Public Health Implications: Gender-sensitive research can inform public health policies and strategies, leading to better health outcomes for all.
How do SAGER guidelines promote gender equity?
Citation : De Castro P, Heidari S, Babor TF. Sex And Gender Equity in Research (SAGER): reporting guidelines as a framework of innovation for an equitable approach to gender medicine.
The SAGER guidelines provide a comprehensive framework for researchers to address gender equity in their work. They encourage researchers to:
Explicitly Report on Sex and Gender: Researchers are urged to clearly report the sex and gender of study participants and analyse the potential impacts on research outcomes.
Justify Exclusion of Sex or Gender Considerations: If the research design excludes the consideration of sex and gender, authors must provide a clear rationale for this decision.
Consider Gender in Data Analysis: Researchers should analyse their data for gender differences and report these findings.
Be Transparent: Journals following the SAGER guidelines encourage transparent reporting, facilitating peer review and accountability.
What is the significance of SAGER guidelines within Global Surgery?
In the context of global surgery, the SAGER guidelines are particularly relevant due to the intersection of gender disparities and access to surgical care. Research has shown that marginalised genders from low- and middle-income countries and other underserved regions around the world face unique challenges in accessing surgical services, and their specific healthcare needs are often overlooked. By incorporating the SAGER guidelines into global surgery research, medical students and doctors can contribute to a more comprehensive understanding of these intersectional disparities and work towards developing gender-sensitive surgical interventions.
Why isn’t SAGER more widely adopted?
However, despite the promising trajectory, there are barriers to the comprehensive implementation of these guidelines.
Concerns have been raised regarding the following:
The perceived additional time and costs associated with the required larger sample sizes and distinct statistical analyses for sex-based and gender-based analyses.
The potential burden on reviewers tasked with enforcing the SAGER guidelines.
The lack of time, capacity, and resources among journal editors is identified as a significant challenge to formalising the SAGER guidelines as a policy. Journals with infrequent issues every year may find it particularly challenging due to less frequent board meetings and competing priorities.
Resistance or lack of awareness among some journals is recognized as another hurdle.
Technical challenges are acknowledged, with individual journals potentially unable to modify instructions to authors or electronic submission systems to align with the SAGER guidelines.
Final thoughts
In conclusion, the SAGER guidelines play a pivotal role in promoting gender equity within the context of global surgery. Medical students can benefit immensely from integrating these guidelines into their education and practice, as they pave the way for a more inclusive, equitable, and effective approach to surgical care. By championing gender equity in global surgery, future healthcare leaders can contribute to creating a world where every individual has access to safe and dignified surgical care, irrespective of gender.
References and further reading
Heidari S, Babor TF, De Castro P, Tort S, Curno M. Sex and gender equity in research: rationale for the SAGER guidelines and recommended use. Res Integr Peer Rev. 2016;1:2. doi:10.1186/s41073-016-0007-6
De Castro P, Heidari S, Babor TF. Sex And Gender Equity in Research (SAGER): reporting guidelines as a framework of innovation for an equitable approach to gender medicine. Commentary. Ann Ist Super Sanita. 2016;52(2):154-157. doi:10.4415/ANN_16_02_05
Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, et al. Sex and gender: modifiers of health, disease, and medicine [published correction appears in Lancet. 2020 Sep 5;396(10252):668]. Lancet. 2020;396(10250):565-582. doi:10.1016/S0140-6736(20)31561-0
Haverfield J, Tannenbaum C. A 10-year longitudinal evaluation of science policy interventions to promote sex and gender in health research. Health Res Policy Syst. 2021;19(1):94. Published 2021 Jun 15. doi:10.1186/s12961-021-00741-x
Elsevier Connect . The importance of sex and gender reporting: In support of the SAGER guidelines. Available: https://www.elsevier.com/connect/editors-update/the-importance-of-sex-and-gender-reporting
Canadian Institutes of Health Research & Health . Sex and gender training modules. Available: http://www.cihr-irsc-igh-isfh.ca/
FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017;18(1):19. Published 2017 Mar 1. doi:10.1186/s12910-017-0179-8
Peters SAE, Babor TF, Norton RN, et al. Fifth anniversary of the Sex And Gender Equity in Research (SAGER) guidelines: taking stock and looking ahead. BMJ Glob Health. 2021;6(11):e007853. doi:10.1136/bmjgh-2021-007853