Gender Inequalities in Surgery in Low-Middle Income Countries

08 Nov 2023

By Maymona J. Choudry

Gender inequality is a pervasive issue in many fields, including the surgical field, particularly in low-middle-income countries. Surgery has long been regarded as a man’s field, with only a few women physicians proceeding to surgical residency. This has resulted in a significant disparity in the number of male and female surgeons, which has implications for healthcare and surgical education.

Firstly, cultural and societal norms play a significant role in this issue. Women are still viewed as caregivers and homemakers, with little emphasis placed on their professional pursuits. This has led to a lack of support and encouragement for women to enter into fields such as surgery, which are traditionally male-dominated. I remember at the beginning of my journey as a surgical resident, every time I would make rounds in a non-surgical ward, I was usually asked by the nurses or staff, whether I am a pediatrician or an internist. I always end up introducing myself as a surgical resident, and it made me wonder whether there was a certain stereotype in which I did not fit in that made me appear less of a surgical resident.

Women may face discrimination and harassment in the workplace, which can deter them from pursuing their careers as surgeons. From my experience as being the team leader, there are certain times during rounds when patients direct their questions and concerns to my male juniors instead of me. This kind of discrimination happens everyday in the life of women surgeons-in-training. It’s like we have to prove ourselves everyday, even though we become senior residents and excel in certain aspects of surgical residency training. Women may also face challenges in balancing professional and personal lives, which can limit the ability to advance in their careers. Whenever I am asked about my future plans in my surgical career, some will voice out their concerns of me getting married, and having a family before pursuing further fellowship training. 

Secondly, there are significant systemic barriers that limit women’s access to surgical education and training. These barriers include limited resources, a lack of female mentors and role models, and biases in the selection process for surgical training programs. Furthermore, women may face unique challenges in surgical training, such as lack of diversity in surgical education and training, which can have negative effects on the quality of healthcare. 

Thirdly, the lack of female representation in leadership positions in the surgical field. Women have often been excluded from opportunities in the field of surgery, despite their qualifications and expertise. Limited representation of women can limit the perspectives and experiences brought to decision-making processes, resulting in a lack of diversity in approaches to healthcare delivery and policy-making. In my 5-year journey in surgery, I am the only  Muslim woman in our department, and amongst my colleagues. Fortunately, my training officer is also a woman, and there are a few women surgeons in our department that have helped me throughout my training. Their dedication and hardwork has served as my inspiration in this field. Having a female representation in the training committee has provided various perspectives in the improvement of training for surgical residents.

In conclusion, gender inequalities in the surgical field in low-middle-income countries can have significant consequences for healthcare access and outcomes. The various factors contributing to these inequalities must be addressed through systemic changes, including increased support and encouragement for women to enter the surgical field, the removal of systemic barriers to education and training, and the promotion of diversity in leadership positions. By doing so, we can work towards a more equitable and inclusive healthcare system that benefits all members of society.

Maymona Choudry, MD, MPH, completed her graduate studies with a dual degree in Doctor of Medicine and Masters in Public Health from Ateneo de Zamboanga University. She is currently a PGY-5 in General Surgery from Vicente Sotto Memorial Medical Center, Cebu City, Philippines. Her interests include Thoraco-Cardiovascular Surgery, Global Surgery, Surgical Critical Care and Public Health. She is a member of Association of Women Surgeons, American College of Surgeons, Philippine College of Surgeons, and many more. Her hobbies include writing articles, reading journals, and participating in various medical and surgical webinars. 

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