Women in Neurosurgery – The Road Less Traveled
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.355170
Source of Support: None, Conflict of Interest: None
Keywords: Gender equality, neurosurgery, T. S. Kanaka, women
“Look to your right… It is the path back home. If you choose, you can take it. It is safe, easy, and comfortable. You do not have to work out or fight or do anything else you do not want to…
Or you can keep moving forward. I will not lie to you. I cannot predict what may become of you. It will require a lot of training, hard work, study, and danger. But in the very end, you will know strength. I swear it. You might just become someone who will make a difference in the world.”
― Wesley Chu, The Lives of Tao
The Vedic period (2000–500 BCE) was considered as a golden era for Indian women. In ancient India, unlike other places in the world, Indian women enjoyed an exalted position in the society and were treated well and respected. Women had freedom to participate in war, gymnastics, education, public activities, archery, and horse riding and played a central role in decision-making. During this period, all genders were offered an equal educational opportunity to study the Vedic literature. The girls' education process passed through the stages of Upanayana and Brahmacharya, leading to the marital state. Women enjoyed complete economic freedom and were engaged in professions for increasing health and well-being, as well as in teaching professions. They earned money through spinning and weaving of clothes at home and also helped in agricultural activities. Thus, women enjoyed an honorable role in the society, and this dignified role of women continued through the Vedic period, the Epic period, and the Buddhism and Jainism period. This role was completely reduced to one of virtual subservience during the age of Dharmasastras, Manusmriti (200 BC–647 AD). This era led to a complete annihilation of women's role in the society and enforced a doctrine of complete dependence of the female in childhood to her father, in youth to her husband, and in old age to her sons. The education of women was restricted to only that required for household management. Practices such as child marriage and sati flourished and, in general, the role of women in the society declined. This gender inequality has continued through ages, and even though a lot of reforms have taken place in the 1900s, the female gender has still not attained the exalted position it enjoyed in the Vedic period.
Women and medicine
Though women have served as caregivers of health of their families and communities, it is not till recent times that women were formally accepted as medical practitioners. Ancient civilizations have several examples of women working as doctors and healers. In the medieval era, in western Europe, nuns were permitted limited roles as healers in nunneries. Women in the 1700–1800s made progress in the fields of midwifery and allied health. In 1849, Elizabeth Blackwell graduated from Geneva Medical College as the first woman physician. Reflecting on her experience, she writes: “I had not the slightest idea of the commotion created by my appearance as a medical student in the little town. Very slowly I perceived that a doctor's wife at the table avoided any communication with me, and that as I walked backwards and forwards to college the ladies stopped to stare at me, as at a curious animal. I afterwards found that I had so shocked Geneva propriety that the theory was fully established either that I was a bad woman, whose designs would gradually become evident, or that, being insane, an outbreak of insanity would soon be apparent.”
Many such women physicians worldwide faced enormous hurdles, but toiled on as they perhaps sensed that the future of the female gender rested on their shoulders.
Dr. Anandibai Joshi obtained her medical degree in Western Medicine from the Women's Medical College in Pennsylvania, USA, and is credited as being one of the first female physicians in India. At the time that India gained independence, the medical profession had a measly representation of women physicians. In 1952, the degrees earned by women in the field of medicine formed only 5%. The most glaring reason of this was that the Indian society was not ready to accept women as part of the medical profession. In 1988, the ratio of female medical students increased to 50%, but their subsequent entry into postgraduate programs was only one third. This was probably due to a number of restraining factors such as family commitments, child-rearing duties, and longer working hours required in certain specific fields. Though the trends have changed and the number of female medical graduates attaining a postgraduation has significantly increased, surgical specialities remain male dominated universally. This gender bias is still evident in the specialized branch of neurosurgery. It is only natural that females are attracted to the discipline of neurosurgery, which calls for great dedication, pure passion, astute judgment, compassion, and fine skills, which are qualities that a woman inherently possesses.
Current status of women neurosurgeons in world
In spite of this being the 21st century, worldwide, there still persists a significant disparity between the numbers of male and female neurosurgeons. While the technological advancements in neurosurgery have gone ahead by leaps and bounds, the recruitment of women in neurosurgery is still moving at a snail's pace.
Though Louise Eisenhardt (a renowned neuropathologist) became the first woman president of the Harvey Cushing Society in 1938, now the American Association of Neurological Surgeons (AAMS), it took 86 years before a female neurosurgeon (Dr. Shelley Timmons) became the first woman president of the AANS. Similarly, Dr. Najia El Abadi was elected as the first female president of the WFNS only in 2022.
The reasons of this discrepancy are manifold and include cultural and social norms, workplace harassment and bias, and a challenge in acquiring a work–home balance.
Currently, worldwide, women still remain a minority in the neurosurgical field and account for only 19% of all qualified neurosurgeons. There is a lack of women representation in leadership roles and neurosurgical academia. Many female neurosurgical trainees and neurosurgeons have reported that they have to work harder to prove that they are at par with male colleagues and also felt that they are given less surgical and job opportunities. Though not openly proclaimed, there exists an innate prejudice against women neurosurgeons, which is attributed to traits such as being the weaker sex and showing a lack of physical endurance. All these gender issues have led to the development of “Women in Neurosurgery (WINS)” societies in many countries worldwide. The first such organization was founded by a group of eight female neurosurgeons in North America in 1989 at a meeting in Atlanta –WINS. Their mission was to inspire, mentor, and encourage women neurosurgeons to achieve their professional and personal goals and to serve the branch of neurosurgery. Subsequent to this, many such societies have formed and work toward the goal of encouraging female neurosurgeons through all aspects of their career and life. Dr. Yoko Kato, the first female neurosurgeon in Japan, founded the Women's Neurosurgical Association of Japan in 1990 and the Asian Women's Neurosurgical Association in 1996. Dr. Hyo-Sook Chung, the first woman neurosurgeon in Korea, formed the Korean Women Neurosurgical Society in 2008. The WINS section of the Brazilian Society of Neurosurgeons was formed under the leadership of Dr. Nelci Zanon in 2014. In 2015, Dr. Aneela Darbar formed the Pakistan WINS. In India, a WINS forum was established under the aegis of the Neurological Society of India in 2016 and was inaugurated by Dr. T. S. Kanaka, the first woman neurosurgeon of India. The goals of all these societies were similar and involved recruiting female medical students to the field of neurosurgery, inspiring and mentoring female neurosurgical trainees, promoting and highlighting the scientific activity of female neurosurgeons, identifying and eliminating gender barriers and discriminatory practices, stimulating and endorsing leadership positions, and helping in achieving academic goals.
All in all, with the efforts of many trailblazing female neurosurgeon pioneers and the development of WINS, in spite of gender biases and being a minority section in the branch of neurosurgery, women neurosurgeons have thrived, achieved leadership and academic positions, and proved to be invaluable mentors to the next generation of neurosurgeons.
Prof. T. S. Kanaka – the first female neurosurgeon of India and Asia
Prof. Thanjavur Santhanakrishna Kanaka is credited as the first female neurosurgeon in India and in Asia. Dr. Kanaka was an exceptional student and was greatly encouraged by her parents and teachers. She was also gifted in mathematics, but ultimately, she was wooed away by neurosurgery. She was involved in academic medicine from very early in her career. This prompted her to achieve a PhD in Stereotactic and Functional neurosurgery, and this subspecialty became her area of interest and expertise in neurosurgery. Her passion was to develop medical devices that could be easily reproducible and used in underdeveloped areas. Along with her team, she performed a remarkable feat of approximately 1500 stereotactic procedures over a period of 15 years. As one of the first few women to pursue neurosurgery in the world, Dr. Kanaka faced several challenges during her career. She had to struggle for opportunities to participate in surgical cases and also had to tussle to appear for her final examinations in general surgery and neurosurgery. It was only after several attempts that she was awarded her degrees. Dr. Kanaka played a key role in encouraging and mentoring young women to pursue the field of neurosurgery. In 1996, she became the Honorary President of the Asian Women's Neurosurgical Association in recognition of her academic and mentoring roles. She also traveled extensively and lectured in several countries including the USA, Europe, Canada, South America, and Asia. Dr. Kanaka was a pioneer in functional neurosurgery, excelled in practicing the subject, in academic neurosurgery, and in mentoring young neurosurgeons. She is a benchmark for women in neurosurgery worldwide and continues to be a huge inspiration for females interested in the branch of neurosurgery.
Current status of women neurosurgeons in India
In India, the number of women neurosurgeons is still meager. Currently, India has approximately 100–110 neurosurgeons/neurosurgical trainees, which roughly corresponds to 2.5%–3.0% of the neurosurgical workforce of the country. This is due to the fact that neurosurgery is still not perceived as a female medical profession by the society at large and also by many woman physicians. A female neurosurgeon is still looked upon as an oddity and is often faced with questions as to why she has chosen this particular branch. This bias stems from certain social and cultural upbringings that are innate to the Indian society. The practice of arranged marriage and the notion that the responsibility of family and childcare rests solely on the female add to the barriers of taking up neurosurgery as a specialty by medical students.
A recent survey conducted on the status of women neurosurgeons in India showed that currently, 34.54% of Indian women neurosurgeons are undergoing their residency and 65.45% are younger than 40 years of age. Majority of them (92.72%) joined neurosurgery with passion, and only 30.9% had a medical professional who kindled their interest in neurosurgery. Also, 72.68% were discouraged before joining into neurosurgical residency. Moreover, 74.4% reported that they received good to excellent support from the parent department. Only 40% had another female colleague in the department and they received good to excellent support from the female colleagues. Though 74.5% received good support from male colleagues, the excellent support remained low. Also, 40% reported facing discrimination by gender; 74.5% were married and 96.4% reported receiving good to excellent support from the family members. Moreover, 80% faced difficulty in balancing their career and personal life, 70.9% had satisfaction in their professional life, and 69% led a satisfactory personal life. They concluded that in India, there is a positive trend for female physicians taking up neurosurgery. The present residency program in our country is supportive to women in majority, and the number of women medical graduates entering the field of neurosurgery is slowly rising. However, active measures should be taken to encourage female physicians to take up neurosurgery, reduce the existing gender discrimination, and improve the supportive system, especially during pregnancy and child rearing.
On a positive note, the Indian family structure makes it easier for female neurosurgeons to balance their work and personal life. Often times, the parents or parents-in-law are helpful in taking care of their children. The presence of female role models in neurosurgical departments affiliated with medical universities will serve a key role in recruiting more female neurosurgeons. Most of the major neurosurgical centers in the country have a female faculty as part of the department (Dr. B. Indira Devi, NIMHANS, Dr. Anita Jagetia, G. B. Pant Hospital, Dr. Shweta Kedia, All India Institute of Medical Sciences, Dr. Suchanda Bhattacharjee, NIZAM's institute, and Dr. Abhidha Shah, K. E. M Hospital, to name a few). There are many female neurosurgeons who have flourishing private practices in various parts of the country and hold lead positions in neurosurgical departments in private hospitals. Dr. B. Indira Devi has been the Chair of the Department of Neurosurgery at NIMHANS, Bangalore and is currently the dean of Neurosciences and controller of examiners at the institute. The Neurological Society of India recently commemorated the life of Dr. T. S. Kanaka by marking her birthday, March 31, to be celebrated as a National Women in Neurosurgery Day annually. Considering its rich cultural diversity and disparities, India is now seen to be welcoming women in neurosurgery and looks forward to having more female neurosurgeons as their workforce.
Looking toward the future
The field of neurosurgery calls for great resolve, diligence, and passion. It can be made into a beautiful journey to enjoy and cherish.
It is time that the gender discrimination in neurosurgery should end. The formation of WINS organizations worldwide has greatly promoted the cause of women in neurosurgery with success. However, we have to work toward a goal where such societies are not needed anymore. The issues of gender discrimination should be tackled by neurosurgical societies. The presence of a female neurosurgeon should not be looked upon as a one-off and should be the accepted norm. A female resident joining the subject should not be expected to be treated differently. She should work hard, be sincere to self and to her patients, and the rest will naturally follow. There should not be a need for separate WINS sessions in major neurosurgical conferences. Women neurosurgeons should be part of the core scientific program, and the only criteria for selection should be merit and academic and professional contributions.
We have to create a neurosurgical world that does not recognize gender and only cares about advances in science, hard work, perseverance, and serving humanity.
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Conflicts of interest
There are no conflicts of interest.