Gender Equality in Indian Urology.

An evaluation of where we stand often requires a careful assessment of where it all began. The Urological Society of India took birth in an era when few women chose a career in medicine, let alone a surgical subspecialty that included the management of diseases involving the male genitalia. Back then, classrooms barely had any women, and universities often reserved a few undergraduate seats for them. While recent years have seen a steady change, there is evidence to suggest that women choosing a career in urology are disadvantaged.[1]

According to the United Nations, gender equality implies that “access to opportunities and life changes is neither dependent on nor constrained” by gender.[2] This implies equal opportunity for women to choose a career in urology including the perceived freedom to choose a subspecialty dictated by choice rather than societal or departmental pressures, gender-neutral promotion, remuneration opportunities in academia and private practice, merit-based selection as faculty for teaching programs, gender-friendly workplaces and professional meetings.

ON THESE METRICS, HOW DOES INDIAN UROLOGY SCORE?

Currently, the number of women graduating medicine from Indian universities matches men. For the academic year 2019–2020, women comprised 48% of enrolments into the MBBS undergraduate program in India.[3] However, the number of women choosing a career in surgery and choosing to specialize in urology remains remarkably low. This has translated into an abysmally low membership representation in the Urological Society of India accounting for 35 of 3077 members (1.1%).[4] This contrasts rather unfavorably with global urological associations where female representation is about five to ten times higher.[5] This is not entirely an issue of gender equality but also represents choices and and apprehension with regard to job opportunities. However, the perception of urology as a “male bastion” cannot be helpful for individuals and society at large.

Data about remuneration are hard to come by. Globally, women in all fields of medicine including urology have been shown to start with lower salaries and have slower growth in earnings.[6] While public sector salary structures in India are gender-neutral, anecdotally, the private sector is not.

The work environment remains challenging regardless of geographical area. It is not unusual for male urologists (and surgeons) to have a designated changing room in the operating complex, whereas female surgeons are expected to share changing rooms designated for female nurses.

The track record for academia is checkered. Currently, only one public sector academic urology department and not even one private sector department in India is chaired by a woman. Public sector promotions are all equal opportunity. Part of the explanation might lie in the small number of senior-level women currently working in urology services. Global urology associations are increasingly recognizing the impact of historical demographic trends which have favored the position of men in urologic academia.[7] The Indian Journal of Urology has never had a female editor although there are women on the editorial board. To put that in perspective, a recent report noted that none of four major global urology journals have ever had a female editor.[8] However, encouraging signs can be seen in the clear trend for more women authorship of urology manuscripts.[9]

There has been a recent focus on the lack of adequate representation for female gender urologists in academic teaching activities at conferences. The word “manel” which shot into prominence to highlight the underrepresentation of women in academic panel discussions has taken on a larger meaning. A recent study noted that over 90% of moderators in urological conferences were male (except the International Continence Society (which had a 48% representation).[1] While the Urological Society of India has taken redressal steps to include female representation in the Functional and Female Urology Subsection, most other sections have sparse female representation. Toward this end, several associations worldwide have set up frameworks to address the issues of gender equity.

WHAT DOES THE FUTURE HOLD?

The rising tide of women choosing a career in medicine will likely ensure a steady rise in their representation in the field of urology. Early signs are visible with a sharp rise in the number of female trainees in urology in India. Over time, more women will inevitably rise to pole positions in departments.

Within these parameters, several relatively easier steps can and must be taken both at the personal and collective professional level to improve gender equality in urology. First, we must recognize that we face a problem with gender equality. Second, we must acknowledge the much larger responsibilities beyond their profession that women often shoulder as compared with men. Third, we must actively seek to create a gender-friendly environment. Ensuring gender nondiscriminatory workplaces, professional organizations, and conferences as well as creating support structures to address the unique needs of women are critical steps toward building a future where women can thrive, excel, and contribute to future of Indian urology.