Diversity and equity are both imperative when it comes to publishing high quality literature that promotes better health outcomes
In 2019, the Medical Journal of Australia put out a call for articles and asked the question: “Women in medicine and medical leadership in Australia — is there gender equity?”
Hempenstall and colleagues1 replied: “We answer with a resounding no. Indeed, we believe the question itself perpetuates gender disparity by suggesting that the answer is up for debate… There is an urgent need to shift our focus from asking whether gender inequity exists to implementing and evaluating sustainable strategies to change the status quo.”
Medical journals occupy a powerful position. The choices we make as editors amplify the voices and interests of the academics, researchers and health care providers who publish with, review for, and advise us. The pitfall in this is that journals may inadvertently contribute to the sidelining, or even silencing, of the perspectives and priorities of women and gender diverse groups as a result of both institutional and unconscious biases.2 Why is this important? First, the systematic exclusion of women and minoritised groups from access to leading, reviewing for, and publishing in high impact journals is, in itself, unjust and inequitable,3,4 and perpetuates inequalities in science and medicine more broadly. Second, decades of scholarship in clinical medicine, public health and the social sciences have established that sex and gender are important drivers of health outcomes and health inequities.5 We know that when women are involved as authors, published health research is more likely to attend to sex and gender.6
The centrality of sex and gender to health has been brought into sharp focus by increasing attacks on the rights of women and gender minorities both in Australia and abroad. Our recent federal election campaign featured despicable and ill informed rhetoric on access to medical treatment for transgender youth and participation of transgender women in sport.7,8 In the United States, the erosion of women’s reproductive rights and transgender rights has reached new levels. The landmark Roe v Wade ruling that has enabled legal (and therefore safe) access to abortion since 1973 has been overturned by the US Supreme Court, leaving millions of women without access to essential reproductive health services.9 Reproductive rights are vital for ensuring women’s health, dignity, wellbeing, and ability to participate in education and public life. Restricting access to safe abortion will cause avoidable morbidity and mortality, with the consequences disproportionally falling on the most vulnerable.10 Alongside this, policymakers in many jurisdictions are moving to effectively ban gender‐affirming care for transgender youth.11 And at this year’s World Health Assembly, lengthy debate over sexual and reproductive health and rights terminology threatened to derail adoption of a new global strategy on HIV, hepatitis B and sexually transmitted infections.12
Today, the MJA publishes a themed issue on gender and sexuality in recognition of the key role medical journals play in protecting and advancing the rights and wellbeing of women, gender diverse and sexually diverse individuals. In this issue, Wang and colleagues13 explore the sex differences in prehospital management of patients with confirmed stroke, finding that women are more likely than men to be assessed by paramedics as having non‐stroke diagnoses, such as migraine, anxiety, hypertension or headache, exemplifying the ways in which gender can influence the type and quality of care patients receive in the health system. Whyte14 shares a deeply moving reflection on their personal experience of surviving contemporary conversion practices in Australia, while Power and colleagues15 examine what formal and informal conversion practices look like today and how health care providers can support recovery. Letters to the Editor by Clayton et al16 and Pang et al17 discuss the evidence regarding improved mental health outcomes for transgender youth receiving gender‐affirming care. The relationship between gender norms and health is explored by Hegarty and colleagues,18 who present the current evidence for identifying and responding to gender‐based violence in Australia, a form of violence that disproportionally affects women, particularly Indigenous and Torres Strait Islander women. Fittingly, the obituary of Dr Donald James Grimes AO,19 whose pioneering work in the 1980s helped reduce the spread of HIV/AIDS through an “inclusive and bold” care response, is published alongside the latest research by Lee and colleagues20 on the acceptability and usability of two HIV self‐testing kits.
In keeping with the theme of this issue, it is an opportune time for the MJA itself to reflect on the role we play in gender equity and how we can promote positive change. We will continue to prioritise research and analysis on the intersections between health, rights, gender and sexuality. In terms of our own editorial policies and practices, we must move from asking questions to acknowledging the unacceptable persistence of gender inequity and implementing strategies that enable us to do better. An internal audit revealed that in 2021, just 28% of corresponding authors and 35% of all authors of our commissioned editorials were women. Similarly, approximately 40% of all experts invited to review for the Journal in 2021 were women. Currently, women represent around 40% of members of our Editorial Advisory Group. These figures are subject to limitations. First, as gender is not yet captured in our online submission system, reviewer and author gender was inferred on the basis of name, and where available, pronouns in online profiles. Second, for the purposes of this simple analysis, we treated gender as a binary category. Nonetheless, it is clear the MJA must do better at proactively including a more diverse set of authors, reviewers and advisors. To address this, the Journal will move towards ensuring gender balance in authors who are invited to write commissioned articles. We will strengthen our peer review process by improved engagement with women in medicine and research through broadening our reviewer database. We will also commit to achieving gender parity within our Editorial Advisory Group.
In recognising that interrogating the role of sex and gender is vital to the health outcomes of all individuals, the MJA will continue to endorse the International Committee of Medical Journal Editors recommendations for reporting of gender and sex within research.21 Today, we announce that we will also be recommending that authors of research published in the MJA follow the Sex and Gender Equity in Research (SAGER) guidelines22 as we strive towards comprehensively addressing reporting issues relating to sex and gender.
We hope you enjoy the gender and sexuality themed issue, and we take this opportunity to encourage women, gender diverse and sexually diverse people to engage with us through participating in the peer review process, editorial advisory roles or submitting scholarly works to be considered for publication. Diversity and equity are both imperative when it comes to publishing high quality literature that promotes better health outcomes. Research and commentary published in medical journals, therefore, must be from authors who are representative of all health experts and their patients across Australia and beyond.
Provenance: Not externally peer reviewed.
- 1. Hempenstall A, Tomlinson J, Bismark MM. Gender inequity in medicine and medical leadership. Med J Aust 2019; 211: 475. https://www.mja.com.au/journal/2019/211/10/gender‐inequity‐medicine‐and‐medical‐leadership
- 2. Lundine J, Bourgeault IL, Clark J, et al. The gendered system of academic publishing. Lancet 2018; 391: 1754‐1756.
- 3. Pinho‐Gomes A, Vassallo A, Woodward M, et al. Cross‐sectional study of the relationship between women’s representation among editors and peer reviewers in journals of the British Medical Journal Publishing Group. BMJ Open 2022; 12: e061054.
- 4. Loder E, Burch R. Underrepresentation of women among authors of invited commentaries in medical journals—where are the female editorialists? JAMA Netw Open 2019; 2: e1913665.
- 5. Shannon G, Jansen M, Williams K, et al. Gender equality in science, medicine, and global health: where are we at and why does it matter? Lancet 2019; 393: 560‐569.
- 6. Sugimoto CR, Ahn YY, Smith E, et al. Factors affecting sex‐related reporting in medical research: a cross‐disciplinary bibliometric analysis. Lancet 2019; 393: 550‐559.
- 7. Grant S. Katherine Deves’s trans women comments ignited another round of culture wars – and added another nail in the coffin of democracy. ABC News 2022; 24 Apr. https://www.abc.net.au/news/2022‐04‐24/katherine‐deves‐transgender‐women‐culture‐wars‐democracy/101006068 (viewed June 2022).
- 8. Karp P. Morrison stands by Katherine Deves and wrongly claims ‘young adolescents’ can have gender confirmation surgery. The Guardian 2022; 10 May. https://www.theguardian.com/australia‐news/2022/may/10/katherine‐deves‐backtracks‐on‐apology‐for‐comments‐about‐transgender‐children (viewed June 2022).
- 9. Editors. Lawmakers v. The Scientific Realities of Human Reproduction. N Engl J Med 2022; 24 Jun. doi: 10.1056/NEJMe2208288 (online ahead of print).
- 10. World Health Organization. Abortion. https://www.who.int/news‐room/fact‐sheets/detail/abortion (viewed June 2022).
- 11. Sharow E, Sederbaum, I. Texas isn’t the only state denying essential medical care to trans youths. Here’s what’s going on. Washington Post 2022; 10 Mar. https://www.washingtonpost.com/politics/2022/03/10/texas‐trans‐kids‐abortion‐lgbtq‐gender‐ideology/ (viewed May 2022).
- 12. Heilprin J, Fletcher E. WHA approves strategy on hiv, hepatitis B and STIs – after prolonged debate over sexual health terminology. Health Policy Watch 2022; 28 May. https://healthpolicy‐watch.news/assemblys‐last‐day‐bogs‐down‐over‐sexual‐health‐terminology/ (viewed June 2022).
- 13. Wang X, Carcel C, Hsu B, et al. Disparities in the prehospital management of stroke between women and men. Med J Aust 2022; 217: 143‐148.
- 14. Whyte S. Reflection on a personal experience of surviving contemporary conversion therapy in Australia. Med J Aust 2022; 217: 134‐135.
- 15. Power J, Jones T, Jones T, et al. Better understanding of the scope and nature of LGBTQA+ religious conversion practices will support recovery. Med J Aust 2022; 217: 119‐122.
- 16. Clayton A, D’Angelo R, Clarke P. Parental consent and the treatment of transgender youth: the impact of Re Imogen [letter]. Med J Aust 2022; 217: 167.
- 17. Pang K, Kelly F, Giordano S. Parental consent and the treatment of transgender youth: the impact of Re Imogen [letter]. Med J Aust 2022; 217: 167‐168.
- 18. Hegarty K, Andrews S, Tarzia L. Narrative review on gender‐based violence in Australia. Med J Aust 2022; 217: 159‐166.
- 19. Kirby M, Warn, P. The Honourable Dr Donald James Grimes AO. Med J Aust 2022; 217: 136‐137.
- 20. Lee DYL, Ong JJ, Smith K, et al. The acceptability and usability of two HIV self‐testing kits among Australian men who have sex with men: a randomised crossover trial. Med J Aust 2022; 217: 149‐154.
- 21. International Committee of Medical Journal Editors. Recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals. Updated May 2022. https://www.icmje.org/icmje‐recommendations.pdf (viewed June 2022).
- 22. Heidari S, Babor T, De Castro P, et al. Sex and gender equity in research: rationale for the SAGER guidelines and recommended use. Res Integr Peer Rev 2016; 1: 2.
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