New York State of Mind

Once again this year I will represent Medical Women’s International Association at the United Nations Commission on the Status of Women, in New York City. I keep pondering the irony that the priority theme of this year’s Commission is Challenges and opportunities in achieving gender equality and the empowerment of rural women and girls and that we are focusing on this theme in such an urban setting as New York City.

It is only five years ago that the plight of rural women was considered at the Commission. This same theme is being considered once again because the meetings five years ago did not result in agreement being reached on how to meet the challenges facing rural women and girls. During the past five years, UN agencies and Civil Society have been working regularly to develop a proposed Outcome Document that stands a better chance of agreement. This document sets out the legal framework for gender equality that member states agree to support by the end of the Commission on the Status of Women.

What are the issues facing rural women and girls in their quest for equality? Think of the impact of climate change and unsustainable farming practices on rural life. Think of the barriers to women owning land in some parts of the world. Think of the financial barriers women face even in our own country. The issues of migrancy are particularly problematic for rural women. Rural women and girls do not have the access to adequate health and reproductive health support. They do not have access to legal support when required. For all these difficulties, there is overlap with the issues faced by women and girls in an urban setting, but the remedies are more difficult to establish and maintain for rural women.

One of the most amazing aspects of this meeting is that there are always women attending who have never been to New York City or the United Nations. It is always inspiring to speak with them about their experience of the city and the institution. Over the years I have attended this meeting, and in all the years I have come to New York, I find that my faith in the city grows, while my faith in the organization diminishes.

The United Nations was built on lofty goals and tremendous idealism, but countries that deny women basic rights sit on the UN Human Rights Council. The treatment of the State of Israel by the United Nations has been worrisome at best. It is the Church Center for the United Nations that has most inspired me; its chaplains and its mission exemplify the spirit I wish I could find in all of the institutions of the UN.

The city, however, and the spirit of its people, have emerged stronger through the challenges they have faced. New York City lives and breathes and invigorates. I learn something every time I visit New York. I am like Tom Wolfe who said, “One belongs to New York instantly, one belongs to it as much in five minutes, as in five years.”

At the end of my time at the Commission on the Status of Women, I expect I will feel discouraged about my United Nations experience, but I will leave New York longing to hold on to a New York state of mind.

We Should All Be Feminists

As International Women’s Day approaches, I wanted to mention a short book, adopted from a TEDx talk that you could read to reflect on what feminism means in this #MeToo age. Chimamanda Ngozi Adichie is an award-winning novelist from Nigeria and she wrote We Should All Be Feminists.

Adichie argues that “Boys and girls are undeniably different biologically, but socialization exaggerates the differences.” (p. 35) If socialization exaggerates the differences in North America, this experience is even more extreme in Africa and this has clearly shaped Adichie’s narrative.

In fifty brief pages, we can review some of the most important challenges facing the gender equity movement and contemplate how to continue to move forward. Of all her messages, the strongest is that we must continue to raise both men and women differently. I believe that we are all trying to do this, and the evidence is that we are mostly successful.

Feminists, female and male, are not the only people trying to raise our children, however. There are many individuals and organizations around the world, with access to our children via media and social media, who are also influencing our youth. Many of these are seeking to maintain the status quo. Why even our culture, as Adichie points out, gravitates to the status quo all around the world.

In this week leading up to International Women’s Day, find Adichie’s text or TEDx talk. Contemplate the role you have played in improving women’s lives, and then keep going. There’s still a lot of work to do, but I hope this little book will renew your energy as it did mine.

(Note: I read the February 2015 Anchor Books edition of We Should All Be Feminists.)

Ongoing Discrimination Against Women Doctors

An article that I read recently emphasized how long and how unsuccessfully women physicians have been struggling to improve their working conditions to the point where they might be able to find some time with families along the road to career success. It is over 40 years since I was a fresh-faced seventeen year old starting medical school and it can be disheartening at times to realize how little real progress has been made. Articles like Krause et al’s Impact of Pregnancy and Gender on Internal Medicine Resident Evaluations: A Retrospective Cohort Study make this all too clear. The sophistication of the study techniques adds credibility to women physicians’ and learners’ own reported experiences but, at some level, I think it’s unfortunate that years of reporting have never been enough to force change upon our hospitals and our medical schools.

My consideration of this study, which examined the evaluation of internal medicine residents after their own pregnancy or a partner’s pregnancy, led me to ask how (or whether) Canada’s medical educational colleges, the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada, ensure that there is no gender-based discrimination in their own evaluation of trainees.

Neither College makes a statement that the organization is aware that there is gender discrimination in medicine, although this is no different from other professional credentialing bodies whose websites I examined. I also reviewed the website of the Association of Faculties of Medicine of Canada (AFMC). The AFMC does have an award, the May Cohen Award, for “outstanding effort or achievement in improving the gender equity environment in academic medicine in Canada.” However, there is nothing to indicate any work they are doing to ensure that there is no gender discrimination in the evaluation of trainees.

Most faculties of medicine in Canada do now have a person of reasonably high rank within a medical school tasked with addressing this gender-based discrimination and this is important to all women faculty, and even many men. I am beginning to think, however, that the problem is not bad intentions but rather implementing measures that have been proven to improve gender balance and reduce gender discrimination, and then tracking progress.

What could one do? Well, for one thing, both educational colleges could begin by recognizing that family life can really mess up a schedule. Both colleges have extensive details on how it manages accommodations for those candidates with special needs, but neither one makes any mention of whether family needs, e.g. the due date of your child’s birth coincides with the date of your examination, can be accommodated. At least half of medical graduates in the country would be significantly affected by this situation and the other half will likely also consider their child’s birth as the event they must attend.

This 2003 study on gender differences in academic advancement did offer some insight into the background of gender discrimination in medicine. The study also indicated some of the differences between the concrete treatment of men and women faculty that could be mitigated if departments and faculties of medicine undertook to implement change.

For example, from the study in question, women faculty were routinely paid less – they could be paid the same. Women faculty more often shared lab space – everyone could have their own lab space. Leadership positions were more often offered to men – departments could make a concerted effort to find leadership positions for capable women. These are all results that could be tracked for improved performance, and evidence of improved performance would certainly be welcomed and noticed by women. Also, while many medical faculties are working on these issues, it is evident from the article mentioned at the outset that there is still a long way to go.

But what could the educational colleges do about these issues? They could, in my view, acknowledge that they are aware of the gender discrimination that occurs in medicine. They could evaluate their own examination practices to ensure that the gender bias in these has been eliminated. They could emphasize to the Faculties of Medicine training their members that every candidate ought to have an equal opportunity to train and accredit programs accordingly. If they have taken any of these measures already, as a member and physician, I wish I could find that information on their website.

As someone who has spent over forty years working for gender equity in medicine, it would be reassuring to know that my efforts, and those of my colleagues, have not been for nothing.

#MeToo

Over the past week, the systematic victimization of women in Hollywood by a serial sexual predator has caused many women to look at their own life experience and consider whether they have also been the victims of sexual harassment, or worse, in their workplace. Today I have been watching the intensity of the #MeToo campaign build and I have been thinking of the experience with sexual harassment of most women physicians and medical students, including myself.

The essence of the #MeToo campaign is that a woman who has been sexually harassed copies a prepared text onto their Facebook page, or Instagram, or Twitter with the hash tag #MeToo to indicate that she has also been a victim of sexual harassment. This is the screen shot from my Facebook page:

 

As a physician who trained in the 1970’s at McGill University in Quebec, I studied medicine in my late teens and early twenties. When I applied to medical school, I was asked by one interviewer, “Are you interested in getting married?” Having always been a little too smart-mouthed for my own good, I answered, “I’ve only just met you. Can I have some time to think about it?” But over the years of repeating that story, no one was ever surprised that someone (a man) asked me this question.

My women colleagues and I became used to professors and staff physicians and senior residents enquiring about our menstrual cycles, our marriage plans and commenting on our suitability for senior leadership roles. At the time, I suspect that most women medical trainees were like me. We took for granted that this treatment was typical in medicine. All trainees were subjected to humiliation, verbal abuse and a work load that was essentially equivalent to slavery. The sexual harassment that woman trainees experienced was influenced by a medical environment, but women were mistreated in all work environments. In fact, the term sexual harassment may have been coined at Cornell University in 1975, but that was not the literature medical professors considered valuable.

Over the past forty years, with both male and female colleagues, many of us are working to change this culture in medicine and we even have days when we believe we have been somewhat successful. We can say that there is now excellent evidence that respectful medical workplace behavior is still a problem and that every physician or medical student or resident should now be aware of the principles of medical professionalism and disruptive behavior. That’s it, however. That’s the extent of our progress: that we should know better. Medical students and residents continue to tell us that there is a problem and women doctors and medical students on Social Medial today are recording their #MeToo’s along with women in every other profession.
Many women in medicine will say that this misogynistic treatment occurred mainly when we were students and residents, but it is just not true. Women are still being passed over for academic promotion, hospital leadership roles, association leadership roles and even association awards. If you look through this list of winners of the Canadian Medical Association’s Frederic Newton Gisborne Starr Award, you will find the name of one woman. Even if you don’t count all the early years of the CMA when women couldn’t be doctors in Canada – not one of the best reasons for this low number of women award winners, mind you – it is still a sad statement about how women are regarded in the profession. Finally, and probably most telling, the specialties in medicine with the lowest fees are those dominated by women.

From the moment in an admission interview that I gave that sarcastic answer to an inappropriate question, I have been working for medicine to be a more positive profession for women. The number of women in medicine has grown, but we still work harder for recognition than our male colleagues. We still do not call out sexual harassment in medicine to the extent that we should. For all my women colleagues who think I am exaggerating, I suggest that you have a conversation with some work friends about your own experiences in Medicine.

This is what you’ll learn after thinking about most medical workplaces: #YouToo

 

One Hundred Years of Women Doctors

Over the next ten years, various women’s medical organizations from around the world will be celebrating their centenaries. I was contemplating this while attending the Centenary of Britain’s Medical Women’s Federation last week. The American Medical Women’s Association celebrated its Centennial in 2015. The Federation of Medical Women of Canada was founded in 1924 and the Australian Medical Women’s Federation formed in 1927 even though Australia’s first medical women’s society was founded in 1896. In 2019, the international body to which all these associations belong, Medical Women’s International Association, will celebrate 100 years of operation, the oldest international medical association. Many of these organizations took as their inspiration the women’s suffrage movement – the theme colours of Britain’s Medical Women’s Federation are exactly those of Britain’s suffragette movement.

This means that there have been one hundred years of women physicians’ influence on medicine and health care. What has this meant for health and for the status of women physicians?

From the beginning of medical women’s organizing activity, women doctors have concerned themselves with the health of women and children and with advocating for opportunities for women doctors. All told, most of these women doctors’ organizations would likely believe that they have been more successful on behalf of their patients than on their own behalf.

Despite growing numbers of women in medicine, women continue to be underrepresented in the highest paid specialties, in university professorships, in clinical leadership positions and in most other medical leadership roles. This is true even in those countries in which women have formed the majority of the medical workforce for many years, such as China and Russia. The underrepresentation of women in powerful medical roles is of such concern in most first world medical women’s organizations that advancing the position of women doctors has become a primary concern for most of these organizations. “Equal pay for work of equal value” has its own meaning for women doctors!

As for health and healthcare, medical women and medical women’s organizations have championed women’s and children’s health, and especially women’s reproductive health. A look at the websites of any of the national organizations listed above will demonstrate this important work. The work of the members of Medical Women’s International Association (MWIA) has been so noteworthy that its projects have ensured that it has official working relations with the World Health Organization (W.H.O.).  MWIA also maintains Category II Status with the Economic and Social Council (ECOSOC) and is involved in the Immunization Programmes of the United Nations Children’s Fund (UNICEF). MWIA is represented in all three of the United Nation Centers, New York and Geneva by Permanent Representatives. MWIA is a Founding Member of the Council for International Organizations of Medical Sciences (CIOMS) and continues to be actively involved in that organization. MWIA also sends representatives to the European Women’s Lobby.

The projects of the various national organizations and of MWIA itself are as varied as its members. In recent years, MWIA has worked with ZONTA to distribute birthing kits to those women in poor countries who have their babies at home, often without any birth attendant – not even a neighbour. As well, one Past President, Dr. Gabrielle Caspar of Australia has collected ultrasound machines in that country to deliver to African countries. MWIA members from around the world are compiling a series of typical cases of intimate partner violence into a training manual for use around the world. The cases will cover an unprecedented example of cultural and social impact on intimate partner violence.

One hundred years ago, at the time that women around the world began to insist on a role in government by means of the vote, women doctors began to insist on a role in medicine that would allow them to have the impact on health, and especially women’s and children’s health, that was needed to improve health standards in general. These pioneering women physicians realized that healthcare must be equal for all. They fought for it then and continue to champion the same goals today.

(Note: The above photo is of the original members of MWIA in Geneva, Switzerland at the time of their founding meeting.)

Persons Day 2016

Famous five monument statues on Parliament Hill, Ottawa, Ontario, Canada

Famous five monument statues on Parliament Hill, Ottawa, Ontario, Canada

On October 18, 1929, the Judicial Committee of the Privy Council of Great Britain handed down the decision that women were “persons” under the law. Today it is easy to forget that this was not always considered to be the case and that women have had to fight for rights that men took for granted over many centuries.

Certainly, I never learned this piece of history in school and it is not clear that this is even taught in a routine fashion today despite the ongoing need to involve women in politics. To me, this means that we have to get young women interested in public life early. I doubt that few in Canada even remember the names of the Famous Five, the five women from Alberta responsible for challenging women’s legal standing in Canada. The women were Emily Murphy, Nellie McClung, Irene Parlby, Louise McKinney and Henrietta Muir Edwards. The women took their case to the Supreme Court of Canada who concluded that women were “persons” under Section 24 of the British North America Act. At the time the Judicial Committee of the Privy Council was a higher court than Canada’s Supreme Court, hence the women took their question forward.

I have always been puzzled by women’s equality. I spent Grade 1 in a Catholic School and could not understand why the nuns who were my teachers were so shocked that I aspired to be a priest at the time. No one ever gave me a good reason that women could not be priests, and certainly women in the Catholic Church still wonder about the theology, I am sure.

After my father died, despite having paid the mortgage for a year, my mother lost our family home since women were not allowed to have mortgages in Quebec in 1968.

In the 1970’s when I was in medical school, few people ever immediately took the female clinical clerks to be the medical students they were. I still have the green skirt that was the bottom portion of the green Operating Room uniform I was required to wear as a female medical student. Many of my male professors still addressed classes using “Gentlemen”, even in the late 70’s.  

In 2004, as the Chair of the Ontario Medical Association’s Women’s Issues Committee, I negotiated with a government representative the first maternity leave benefit for women physicians. It was inadequate then and it continues to be inadequate now and I remember feeling disappointed that it was such a footnote on such a large contract. Women physicians and their supporters, however, felt it was an opening that would become more significant over the years.

Women, however, still have to fight for their due in medicine. Politics in medical associations, university faculties, and even practice groups are still not engaging women to the same degree as they engage men. The research uncovers some reasons, but even as society seeks to address these, equality continues to elude us all.

I believe that one reason lies in the fact that the quest has been one-sided. Society paid particular attention at the turn of the century when the lack of women in medicine began to be addressed with the result that at least half of most medical classes are now women. The low numbers of women in Engineering and on Corporate Boards continues to be addressed in one way or another. But does anyone worry about the number of men in Teaching, or in Nursing, or in Library Science? It happens that my husband is a Librarian. He was one of few men in his M.L.S. Program forty years ago. My son is now studying for his Masters in Information Studies. He will be a Librarian – he is one of very few men in his class.

Maybe we need not just to focus on where there are few women. Maybe we also need to also change certain workplaces for men in order to change an entire culture.

Photo credit

Women’s Rights and Medical Women

Most of us know that the world’s leaders met this past weekend at the United Nations to discuss and commit to sustainable development goals. They formally agreed to a set of goals that they hope to bring to completion by 2030: http://www.un.org/apps/news/story.asp?NewsID=51968#.VgkpN3ldGUk

This was the second agreement of its kind, the first agreement, the United Nations’ Millenium Development Project, was launched in 2000 and, since that time, women’s groups have been measuring the extent to which these lofty goals have been addressed. These goals are outlined here and even a brief review will show that many are related to women’s empowerment and women’s health. The changes with this first set of goal have been so slow that one might wonder whether just building another set of goals will truly help. http://www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20Summary%20web_english.pdf

When one considers the Sustainable Development Goals developed for 2030, wondering if they can possibly be achieved, it is worth looking through the photographs on the link. Once you have, you will realize that most of the leaders discussing these are men. There are a few notable women, like Angela Merkel, but mostly men. Truthfully, on the ground, most of those actually working on the goals, getting their hands dirty and their egos bruised, are women and I want to be sure that their voices were heard and their suggestions included.

Each year at the United Nations Commission on the Status of Women, we gather into our groups and negotiate to improve and strengthen the statement and listen to talks about interventions that are succeeding in one goal. We cobble together an acceptable document only to have some state that does not value women remove certain key proposals or statements. Which states will hold women back? These include some of the Middle Eastern States and, of course, the Holy See.

Both sets of sustainable development goals are embraced by women’s groups for they represented the kind of world we wanted to leave for our children and grandchildren. Whatever the politics, it seemed as if women were more likely to get past it and get on with the work.

Women physicians, through Medical Women’s International Association, have always been involved in the consideration and development of the sustainable development goals. Each year a delegation attends the Commission on the Status of Women and lobbies for the inclusion of the most effective measures. While the progress is slow year to year, it is building. It is building to a point in the same way that women’s suffrage did. While medical women from every corner of the globe come together to provide evidence based care so that more girls and women are able to lead healthy, happy lives in careers of their choice, the world will be a better place.

This past weekend, the Federation of Medical Women of Canada met in Toronto. Like all women physicians groups, they are working toward those goals, focused on those very real Canadian concerns: poverty, domestic violence and, now, the arrival of Syrian refugees. Their numbers wax and wane as women do not always see the value of defending women’s rights until something happens to them personally to remind them that there are still barriers to woman’s advancement and equality.

At this Federation meeting, Canada’s women doctors were joined by doctors from around the world, the Executive Committee of Medical Women’s International Association. This group includes not only North American women but also women from Europe, Asia, Africa and South America. This group knows the hardship women face in getter better healthcare for themselves and their families on a daily basis and they work to improve health conditions for all.

These women are today’s suffragettes, although they are fighting for women’s status not just votes. They are also no longer going on hunger strikes. Rather, they are travelling to the United Nations and the World Health Organization and to the corners of the globe to ensure that there is a strong healthcare cornerstone in the building of women’s empowerment. Take a look at their website www.mwia.net Be inspired!