Editor’s Note: Dr. Jacquelyn Corley is a research fellow at the Harvard Program in Global Surgery and Social Change (@HarvardPGSSC), a neurological surgery resident at Duke University Medical Center and co-founder of the Gender Equity in Global Surgery Initiative. Follow her on Twitter @JacquelynCorley. Eliana E. Kim is a research assistant at the Harvard Program in Global Surgery and Social Change and co-founder of the Gender Equity in Global Surgery Initiative. She is an aspiring physician and advocate for women’s rights. Follow her on Twitter @eliana_e_kim. The opinions expressed in this commentary are those of the authors; view more opinion articles on CNN.
Humanity is facing a global surgery crisis. The Lancet Commission on Global Surgery reported in 2015 that there were 5 billion people in the world lacking access to safe and affordable surgical and anesthesia care. Approximately one third of all diseases globally were due to conditions that were treatable through surgical care, based on 2010 disease statistics, and this burden is greater than that of HIV/AIDS, malaria and tuberculosis combined.
Intuitively, the prevalence of disease resulting from surgically-treatable conditions makes sense, given that surgical health care is integral to a wide breadth of treatment strategies, including cesarean sections for childbirth, tumor removal in cancer care and operations after injuries. An additional 143 million surgical procedures are needed each year to meet the needs of the world’s growing population, according to the Lancet Commission on Global Surgery.
How can we possibly tackle these towering challenges? Research published in The World Journal of Surgery suggests that the surgical capabilities of developing nations can be improved through investments in medical equipment and surgical training programs. However, even with this proposed solution, there is a critical component that remains unaddressed. We have a large and robust untapped source of the potential surgical workforce: women.
Although women have made great strides in gender parity in medicine in the United States and now make up more than half of all medical school matriculants, much work remains to be done in the field of surgery. As of 2015, only 19.2% of American surgeons were women, and research shows that these female surgeons are less likely to receive career promotions and can expect to earn $1 million less in their careers than their male counterparts.
Globally, the picture is even bleaker. According to data from the Lancet Commission on Global Surgery, as of 2015 there are only three female surgeons for every 1 million people in low-income countries.
Unfortunately, the solution is not as simple as creating more residency training positions. In many countries, unequal childhoods between boys and girls have transformed into inferior educational opportunities for girls. The United Nations estimates 130 million girls ages 6 to 17 are no longer enrolled in school, and 15 million girls of primary school age will never set foot in a classroom.
Women in developing countries are a vast untapped resource. US policymakers should use America’s significant economic leverage to encourage and support improving educational opportunities for girls, and US private industry should be encouraged to invest in programs in developing nations that empower women.
But global efforts to provide funding for education are just a start. We must also build far-reaching awareness campaigns that aim to reverse decades of institutional biases against women, and it starts with powerful women in countries throughout the world, including here in the United States, who can serve as role models to the tens of millions of girls who are told every day that their voices don’t matter.
Expanding the role of women in developing nations would increase the number of physicians working to improve individual and public health and help those countries more quickly enhance their health systems, especially surgical systems. And in doing so, it would expedite the time needed for developing countries to be capable of independently serving their own populations.
Further, adding more women will benefit all patient care in those countries, as many studies demonstrate there are improved health outcomes when female physicians, including surgeons, are involved in treatment.
But still more must be done. Those women who are fortunate enough to obtain a quality education and enter medical school and surgical training are often met with many institutional and cultural biases that make it difficult to graduate. For example, even in the wealthiest nations, the attrition rate for female surgeons far outweighs the attrition rate for male surgeons.
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A study published in February in The Lancet identified six leading reasons why women prematurely end their surgical training: “unavailability of leave,” “distinction between valid and invalid reasons for leaving,” “poor mental health,” “absence of interactions with women in surgical section and other support,” “fear of repercussion” and “lack of pathways for independent and specific support.” These problems are exacerbated in many developing countries, where women continue to face harsh stigmas about their “proper” role in society as caregivers and homemakers.
The hurdles identified in the Lancet study should be used to guide institutional policies to create welcoming and supportive programs within medical schools and training departments, both in the United States and around the world. Such policies should encourage female participation and foster accessible avenues for family planning and child rearing.
The global surgical burden of disease is immense and cannot be addressed with vaccine campaigns or mission trips. We must build and strengthen health systems, especially surgical systems, which will require a greater emphasis on increasing the number of women in developing nations’ workforces, as well as significant institutional changes that allow women to work on equal footing with men.