Representative image. Photo: Artur Tumasjan/Unsplash
New Delhi: Despite a growing number of women doctors in India opting to become surgeons, they are still significantly outnumbered by their male counterparts. Female surgeons with whom The Wire Science spoke say that patriarchal baggage continues to put barriers for Indian women in surgical fields, both inside and outside the operation theatre.
Sample this: the Association of Surgeons of India (ASI) has 32,000 members – of which only 4,160 (12.5%) are women. A March 2016 Times of India report said that only 10% of surgeons in corporate hospitals of Hyderabad were women, and almost all of them were obstetricians and gynaecologists, fields often considered more ‘feminine’.
The global situation is also skewed against women, although the average is significantly higher than in India: one-third of surgeons, including those in obstetrics and gynaecology, are females.
This phenomenon of ‘missing’ women in top positions has been observed in other science and technology fields too. Women make up nearly 43% of the total graduates in science, technology, engineering and mathematics (STEM) fields – one of the highest in the world, according to World Bank data. However, only 14% of them are enrolled in research development institutions and universities.
Why do female surgeons drop out?
Dr Ritu Khare is a laparoscopic surgeon with close to two decades of experience, practising in Dubai with a specialisation in breast cancer surgery. She says, “Today, there is a 50:50 gender ratio in surgical residencies. The question is why are these female surgeons who enter this field withering away? Why don’t women practise as much?”
A 2019 Lancet special edition report ‘Advancing women in science, medicine, and global health’ highlighted several factors that influence women to choose to leave surgical training soon after starting it, despite a desire to become surgeons. Several junior surgeons agree that senior surgeons tend to prefer male surgeons over female ones. Dr Shelly (name changed), a Delhi-based senior female paediatric surgeon, confirms that this trend continues even today in general surgery.
A May 2023 paper published in the IOSR Journal of Dental and Medical Sciences (IOSR Journal henceforth) observed that there is a dearth of recent literature on the challenges encountered by female surgeons in India. The authors – Dr Tasmina Nureen Huma and Dr Sheeba Perween at the Department of General Surgery, the Oxford Medical College Hospital and Research Centre in Bengaluru – said this was despite the projection that nearly half of the surgeons working in Indian hospitals will be female in the coming decade.
Sexism persists
Memes featuring sexist and sexualised depictions of female medical interns, nurses and doctors, sometimes shared by male doctors and later justified as harmless humour, are commonplace. This includes suggesting that women become doctors not because of their abilities but by using their bodies, to grouping female nurses and doctors as ‘sisters’. Dr Pallavi Tripathi, a resident surgeon in the department of ENT and head and neck surgery, has seen her seniors bear the brunt of societal prejudices. She has also faced it personally, with patients reluctant to accept a female surgeon.
Female surgeons who participated in a survey for the IOSR Journal paper revealed that 78% reported that gender affects the way they are treated at work, with most of them reporting gender-based discrimination
Dr Deepali Raina, a gynaecologic cancer surgeon and a fellow of Robotic Gynaecologic Oncology at Kokilaben Dhirubhai Ambani Hospital in Mumbai, notes that violence against female doctors also exhibits a gendered colour. While male doctors may face verbal and physical attacks, female doctors are targeted with sexist slurs.
The general perception of surgery being characterised by showmanship, strength and stamina has often contributed to the belief that surgeons are strong, well-built, broad-shouldered, taller men with charisma and aura. Naturally, a female surgeon finds it challenging to inspire such confidence among peers and patients in the traditionally male-dominated bastion, emphasised Mumbai-based general, laparoscopic and obesity surgeon Dr Jayashree Todkar.
Marriage, motherhood and carework
Overall, Indian women have been chronically underrepresented in STEM, rooted in faultlines in the broader socio-cultural fabric.
Notably, the IOSR Journal paper reported that at least 70% of female surgeons revealed that they were responsible for most of the household chores and child-care duties. This indicates an unequal distribution of labour and the persistence of traditional gender-based roles in Indian households. “If the male partner takes a transfer or moves to another city, the female partner has to uproot her life and follow him,” says Dr Raina.
Completing an MBBS takes nearly seven years, including one year of internship, and an additional three years are required for a postgraduate degree. Pursuing a super speciality degree in surgery via diploma courses adds further years.
Dr Raina, the Mumbai-based gynaecologic cancer surgeon, emphasises that women face a dual challenge. The 10- to 14-year timeline of medical education coincides with their peak “biological clock”. This results in women falling behind in the pipeline, hindering access to career advancement opportunities and widening the gender pay gap. The gap widens and even mid-to-senior level female doctors often struggle to catch up. Dr Raina also notes that it’s almost impossible to find female HODs in fields other than paediatrics/gynaecology.
Gynaecologist Dr Naima Afreen, who practises at Azamgarh in Uttar Pradesh, seconds this and highlights the lack of female role models and an overrepresentation of male mentors in positions of power. This acts as a barrier for women to access advanced learning and gain exposure to sophisticated procedures, she said.
Dr Gulshan Zehra, a gynaecologist who practises at Sub District Hospital Bijbehara in Anantnag district of Jammu and Kashmir, echoes this. “A woman is exhausted running double shifts; one at duty and the other at home. The biological events of a woman’s life from pregnancy through lactation, also means that a lack of support system can take a toll on a woman’s body. Where is the energy to pursue a career in orthopaedics or cardiac surgery?” She shares that even after a hard day’s work, she will have to make her own tea. She says it is critical for women to receive family support. Dr Namrata Srinivasan, senior resident, Orthopaedic Surgery Residency Programme, Mysore Medical College and Research Institute, calls out the “primitive burden of carework.”
Most agree that it’s a punishing system. However, Dr Kanagavel Manickavasagam, director, Gastropro, Department of General GI and Minimal Access Surgery St Isabel’s Hospital Chennai, presents a different perspective. “There are some evolving trends: women are marrying late, often in their mid-30s; there’s a growing demand for kitchen-less apartments (eliminating the traditional kitchen duty demanded of women); senior citizen creches are gaining visibility in a city like Chennai,” he says.
Navigating biases
There was a time when Dr Shelly (name changed) was subjected to dismissive remarks such as “female surgeons get nervous too quickly”, “they are too emotional”. Today, she says, there is greater acceptance of female surgeons.
Dr Anthony Rozario, professor, Department of General Surgery, St. John’s Medical College, Bengaluru, maintains that he has never encountered gender-based discrimination in the workplace. “There are many gifted women surgeons; being emotionally perturbed during a critical situation is a normal reaction irrespective of gender,” he adds.
Negative gender stereotypes have often perpetuated myths of muscle power, in fields like orthopaedics where women are severely underrepresented. “Regardless of gender, it is true that some component of physical strength is required to pursue a branch like orthopaedics, but it isn’t as herculean as it is commonly portrayed to be,” says Dr Namrata Srinivasan of Mysore Medical College and Research Institute. She also stresses that power tools are making orthopaedics more accessible for surgeons, irrespective of gender.
Looking ahead
Medical facilities lack pad-vending machines and breastfeeding facilities, while safe mobility remains a barrier to women’s workforce participation – especially where jobs demand late hours or emergency on-call duties.
Dr Todkar, the first female bariatric surgeon from Asia and the founder of the now-defunct Women’s Association of Surgeons of India, runs a close-knit WhatsApp group for female surgeons, offering mentoring and confidence-building through networking.
Alongside running her private practice, Dr Zehra is an icon of change in Anantnag, Jammu and Kashmir, as she raises awareness about women’s health via Facebook videos. She also recommends her female peers to patients and their families, strengthening the sisterhood of women in the medical field.
Fewer female surgeons have implications for patient outcomes. For instance, women may be hesitant to get their private parts examined by male doctors due to cultural conditioning, resulting in missed early cases of cancer.
Dr Afreen says that it’s important to correct women’s underrepresentation in decision-making roles, and to acknowledge the gendered division of labour in Indian households and create a system conducive for women to strike a work-life balance. While Dr Rozario agrees that a woman’s greater share of domestic labour has traditionally acted as a barrier, he believes that change is underway, highlighting that more women are now entering fields of surgery although it will take time for them to reach senior leadership positions. Dr Manickavasagam too believes that the surgical profession is showing a promising uptrend with a robust rise in women taking up surgery as a profession.
Dr Khare underscores the need for advanced training, focusing on the three Cs — “capability, confidence and competency” — for women to advance to leadership positions in a revenue-based leadership model.
Sanhati Banerjee is a journalist.