Gender diversity of clinical practice guideline panels in Australia: important opportunities for progress

Gender balance can lead to more focused recommendations and better health outcomes for everyone

Clinical practice guidelines are recommendations for standards of care that are supported by strong scientific evidence. They can inform individual clinical practice decisions, improve health care quality and safety, and facilitate the translation of research into practice.1 To some extent, these recommendations are guided by the opinions, clinical experience, and composition of the guideline development panel.2 It is consequently vital that these panels represent the community to whom the guidelines will apply.

In recent years, the underrepresentation of women in key aspects of research has been reported, including as first and senior journal authors,3 journal editors,4 and participants in clinical trials.5 In this issue of the MJA, Shalit and colleagues6 report that women were also underrepresented in the authorship of Australian clinical guidelines published during 2010–2020. The authors identified guidelines in the PubMed, Guidelines International Network Library, and Trip databases and in the National Health and Medical Research Council (NHMRC) Clinical Practice Guideline Portal, and classified the proportions of guideline panel members who were women (based on gender‐specific titles) as fewer than 40%, 40–60%, or more than 60%.

The 335 guidelines named 7472 contributors (guideline panel members and other contributors), of whom 47.0% were men, 44.8% women, and gender could not be identified for 8.2%. The proportion of women on guideline panels was smaller than 40% for 179 guidelines (53%) and larger than 60% for 71 (21%). In all but two years of the 11‐year study period, the median proportion of women guideline panel members was below 50%. More guideline panel chairs were men (215, 54.8%) than women (280, 42%). Seventeen of the 59 guidelines approved by the NHMRC had guideline panels with fewer than 40% women (29%), compared with 162 of 276 of guidelines without NHMRC approval (59%).6

These findings are unfortunately consistent with overseas studies.7 One of the limitations of the study acknowledged by Shalit and colleagues was how they collected gender information. The Australian Bureau of Statistics has published a Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables for the collection of sex and gender data,8 but its application is often not practical, especially when analysing retrospective data.

The underrepresentation of women in guideline panels is a critical area of gender inequality in academic medicine. With the increasingly visible campaign for gender equality over the past ten years, why have we not achieved parity, or, as shown by Shalit and colleagues, even moved towards parity? The authors suggest that unconscious bias against women is possible because the guideline panel selection process is not clearly structured. We would add that organisational barriers, including career inflexibility and family‐unfriendly policies,9 dissuade women from working in guideline development groups even if invited to join.

Gender equity in guideline development groups is not difficult to achieve; we believe that every professional organisation or scientific society has enough qualified women to nominate for these prestigious positions. In a systematic review of organisational interventions,9 strategies for improving the advancement of women in health care leadership were categorised as organisational processes, awareness and engagement, mentoring and networking, leader training, and development and support tools. Many of these strategies could be applied; in particular, policies that support better work–life balance, strong mentors and sponsors (including high status male leaders), and explicit encouragement of women to apply for leadership roles. As mentioned by Shalit and colleagues, transparent reporting of sex and gender balance should be encouraged in all aspects of research, but investigation of the reasons for inequality is also needed. In some cases, notwithstanding their shortcomings, temporary quotas for women could be considered.10

Why is adequate gender representation in guideline development groups important? First, these important roles are career highpoints that improved promotion chances and provide role models for others. Most important is the trickle‐down effect of gender equality that benefits everyone, regardless of their gender.11 Sex‐ and gender‐specific data are more frequently reported in research led and reported by women,12 which in turn improves its scientific rigour and the interpretation of its findings. Similarly, we can expect gender balance on guideline committees to lead to fairer highlighting of questions of particular concern to women and men, leading to more focused recommendations and ultimately better health outcomes for all.