Gender equity in neurosurgery requires structural reform

Area of Science:

• Neurosurgery
• Medical Education
• Global Health Equity

Background:

• Women constitute only ~7% of the global neurosurgical workforce, with significant disparities between high-income countries (HICs) and low- and middle-income countries (LMICs).
• HICs offer structured pathways and mentorship, while LMICs struggle with infrastructure, training capacity, and gender equity policies.
• The brain drain phenomenon disproportionately impacts female physicians from LMICs, exacerbating local neurosurgical workforce shortages.

Purpose of the Study:

• To analyze global disparities in women neurosurgeons and identify factors contributing to underrepresentation.
• To explore the impact of economic status and gender gap indices on female neurosurgical workforce representation.
• To highlight potential strategies for improving gender equity in neurosurgery, drawing lessons from LMICs and Africa.

Main Methods:

• Comparative analysis of global neurosurgical workforce data, focusing on gender representation.
• Examination of systemic factors including infrastructure, governance, education, and mentorship in HICs versus LMICs.
• Correlation of economic status and Global Gender Gap Index with female neurosurgeon proportions.

Main Results:

• Underrepresentation persists in both HICs and LMICs, despite differing systemic challenges.
• Africa shows the highest proportional representation (~15%) but faces challenges due to a small overall workforce and inter-country variability.
• Lack of female leadership and mentorship creates self-reinforcing cycles of underrepresentation.

Conclusions:

• Achieving gender equity in neurosurgery requires addressing multifaceted systemic barriers.
• National Surgical, Obstetric, and Anesthesia Plans (NSOAP) provide a framework for systematic improvement.
• Targeted interventions focusing on infrastructure, mentorship, and policy are essential to increase women's representation and leadership in neurosurgery.