Gender equity in O&G leadership: Celebrating progress while navigating new challenges

Abstract

Two decades ago, obstetrics and gynaecology within Australia and Aotearoa New Zealand was predominantly a male-led specialty. Today, we observe a dramatic shift in gender representation across our workforce. This transformation prompts us to examine the current state of gender equity in our O&G leadership landscape and consider the implications of this demographic evolution.

The documentation of this transformation has been sparse. When commencing my own investigation and research into the gender landscape of O&G in Australia and Aotearoa New Zealand as part of a Master of Clinical Education in 2017 [1], I discovered little had been published on the situation. The first published article was written by our immediate past ANZJOG Editor-In-Chief, Professor Caroline de Costa [2], reflecting on being one of only seven female specialists amongst several hundred male specialists in the early 1980s. De Costa followed this up in 2012 with publication of her RANZCOG ASM Arthur Wilson Oration [3], “The Changing Roles of Women in Obstetrics and Gynaecology”. With females making up 80% of trainees in 2012 yet only 14% of the RANZCOG board, she highlighted the discordance between female membership and consequent leadership inequality.

By 2017, RANZCOG had undergone significant demographic change, mirroring trends in other local medical specialities and international O&G programs. Women comprised 46% of RANZCOG specialists and 80% of trainees, positioning O&G as one of the most gender-transformed specialities both locally and internationally. Despite this shift, a pronounced leadership gap persisted at the national level, with only one female member on the RANZCOG national board, and only one female College president since RANZCOG's inception in 1998 (though noting Dr Heather Munro AO was RACOG president from 1994–1996).

For many members, the lack of gender equity in leadership challenged the authenticity of representation by RANZCOG's leadership. This inequity contradicted the primary tenet of social justice that drives cultural reform for equity in all areas of society. This is particularly crucial in O&G, where our specialty's focus on women's healthcare demands leadership that reflects both our workforce and the patients we serve. Beyond fundamental human rights, national and international research has consistently shown leadership gender equity improves workplace productivity, emotional wellbeing, economic growth, and organisational reputation, with leadership gender diversity also demonstrating improved financial and organisational performance [4, 5].

Following a call to action at the 2018 RANZCOG Annual Scientific Meeting [6], then RANZCOG president Dr Vijay Roach announced the formation of the RANZCOG Gender Equity and Diversity Working Group (GEDWG).

Under the leadership of current RANZCOG president Dr Gillian Gibson, the committee worked with RANZCOG to drive equity-focused initiatives including: gender targets in leadership positions; Best Practice Guidelines on gender equity for ASM and academic meetings; feeding and parenting rooms; access to Implicit Bias and Leadership training; and a commitment to annual reporting to the Workplace Gender Equality Agency on RANZCOG's gender equality metrics, including statistics on gender balance, part-time work, parental leave and promotions within the organisation [7].

Fast forward six years, and Holmes, Ibinabo and Nippita [8] have provided a comprehensive assessment of gender leadership within Obstetrics and Gynaecology in Australia and Aotearoa New Zealand from 2022 to 2023. Their analysis demonstrates significant improvements in RANZCOG leadership gender equity, with women now comprising 74% of Council positions and 56% of Board positions, surpassing gender parity and better reflecting the College membership demographics. Within RANZCOG accredited training hospitals, women now hold 62% of departmental leadership positions, a dramatic change from only 35% in 2017 [1].

These improvements in leadership equity warrant reflection on the role of the gender ‘pipeline’ versus interventional strategies. The ‘pipeline theory’ of gender equity suggests that increased representation of women in training and early career positions will naturally lead to proportional representation in leadership positions over time. However, extensive research has demonstrated that this alone is insufficient to correct inequities, with both ‘leaky pipe’ and ‘glass ceiling’ effects creating systemic barriers to advancement [9, 10]. This is particularly evident in O&G, where despite women comprising the majority of trainees for over two decades, leadership equity has only significantly improved following RANZCOG's targeted interventional strategies [11].

In their international comparison, Holmes et al. demonstrated that Australia and Aotearoa New Zealand achieved the most substantial improvements in O&G leadership equity among comparable nations, despite similar gender pipeline patterns across international colleges. This suggests that RANZCOG's interventional strategies have played an instrumental role in the positive changes to O&G leadership equity, above and beyond any pipeline effect.

While acknowledging a lower-than-expected survey response, Holmes et al. highlight the ongoing barriers to leadership. As also observed in previous research [1], women continue to report several barriers to future leadership progression: lack of leadership skillset; caregiving obstacles; and lack of mentoring and support. This contrasted with male respondents, who again were more likely to report no barriers to leadership aspirations. These gender differences suggest the opportunity for further institutional support and progress to minimise leadership obstacles.

Holmes, Ibinabo and Nippita should be applauded for their detailed work in systematically evaluating the gender leadership landscape of obstetrics and gynaecology within Australia and Aotearoa New Zealand. Without this data, we lack the ability to accurately assess our progress within both RANZCOG and our wider specialty. RANZCOG should be commended for embracing the original call to action and addressing gender leadership inequity with policy changes and strategies to ensure leadership opportunities are available to all, irrespective of gender. The positive changes are a result to be celebrated.

Yet with success comes new challenges. The increasing feminisation of O&G, with women now comprising 83% of trainees, raises important considerations for the future. While addressing historical gender inequities remains crucial, we must also be mindful of maintaining gender diversity and ensuring opportunities for male O&G specialists, who bring valuable perspectives to our specialty. A significant gender imbalance in either direction may impact mentorship opportunities, workforce dynamics, and the broader representation of our specialty in the community.

While gender equity must remain a priority for our institutions, it is time to broaden this conversation. Intersectionality is now an essential consideration as we progress our society and acknowledge biases, particularly toward people of colour, LGBTQIA+ colleagues, and First Nations women. In O&G, where cultural safety and sensitivity are paramount to providing optimal healthcare, these diverse perspectives are crucial for developing inclusive clinical practices and policies. These considerations must shape our ongoing efforts to create a truly inclusive and representative leadership that can better serve our increasingly diverse patient population.

RANZCOG must continue its journey toward increasingly diverse and representative leadership at all levels. I encourage our membership to pursue further research in these areas, as we work to ensure that our leadership reflects both our membership demographics and the communities we serve, ultimately leading to better healthcare outcomes for all.