# Gender imbalance in intensive care: High time for action and evaluation!

Caroline Hauw-Berlemont, Charlotte Salmon Gandonnière, Florence Boissier, Nadia Aissaoui, Laetitia Bodet-Contentin, Muriel Sarah Fartoukh, Mercedes Jourdain, Julien Le Marec, Fabienne Tamion, Olfa Hamzaoui, et al.

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## To cite this version:

Caroline Hauw-Berlemont, Charlotte Salmon Gandonnière, Florence Boissier, Nadia Aissaoui, Laetitia Bodet-Contentin, et al. Gender imbalance in intensive care: High time for action and evaluation!. Critical Care, 2021, 25 (1), pp.239. 10.1186/s13054-021-03657-8 . hal-03285047

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Submitted on 13 Jul 2021

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EDITORIAL

Open Access

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Gender imbalance in intensive care: High
time for action and evaluation!

Caroline Hauw-Berlemont¹, Charlotte Salmon Gandonnière², Florence Boissier³,⁴, Nadia Aissaoui⁵,
Laetitia Bodet-Contentin⁶, Muriel Sarah Fartoukh⁷, Mercedes Jourdain⁸,⁹, Julien Le Marec¹⁰,¹¹,
Fabienne Tamion¹²,¹³, Olfa Hamzaoui¹⁴ and Cécile Aubron¹⁵* on behalf of the FEMMIR (Femme Médecins en
Médecine Intensive Réanimation) Group for the French Intensive Care Society

There is an accumulating evidence of persistent gender inequity in medicine including intensive care. In Science, the recognition of gender imbalance and the call for actions to redress it, has been reported since some years ago [1]. Unfortunately, the situation seems to last: recent literature in medicine has shown that women underrepresentation in leadership positions has not improved over the last 35 years [2–4]. Recent studies reported high rates of gender discrimination towards women intensivist with an impact on their professional and personal development [4, 5].

Assessing gender inequity is a key element of the poli-
cies fighting against women vertical segregation. How-
ever, awareness of the situation and willingness to change
might not be sufficient for a real shift in our behaviors
and for allowing gender equity in intensive care in the
near future.

Specific actions as those listed recently by Vincent et al. [6] to improve gender balance have been proposed many times in numerous contexts [7]; however many authors report the lack of qualitative evaluable measures to determine whether changes have been implemented and have led to better gender equity.

It is urgent for our intensive care community to actively
implement measurable actions and metrics to reach bet-
ter equity but also to evaluate the impact of those actions

(Fig. 1). Words proved themselves insufficient. There
will be no spontaneous transformation of what has been
happening for ages and we want to warn on the urgent
necessity to change the “standard of our behaviors.”

Working groups to guarantee diversity and equity are
crucial to assure identification, implementation and
respect of measures to reach better gender balance. The
French Intensive Care Society already created the FEM-
MIR (FEmmes Médecins en Médecine Intensive Réani-
mation) group in 2019 to promote women in intensive
care.

Vranas et al. showed that a profound gender gap in crit-
ical care literature still exists in 2020 [8]. What obstacles
can possibly be argued not to take measures in critical
care publications to reverse the current trend?

As an example, critical care journals could trigger
positive moves and take the lead by proposing the imple-
mentation of different measures that proved themselves
efficient [9]:

* Journals can use quotas to improve gender balance within the editorial boards. Although quotas remain debated, considered unfair and inequitable by some, it must be understood that they are essential to succeed in achieving gender balance. Quota must not be considered as an outcome but as a tool to reach equity. Once the parity will be reached and sustained, this temporary measure will end.

* All peer review journals should annually publish per-
centages of women members in their editorial board,
of women who have submitted/published a paper

<footnote>*Correspondence: cecile.aubron@chu-brest.fr; cecile.aubron@monash.edu
¹⁵ Médecine Intensive Réanimation, Centre Hospitalier Régional et Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
Full list of author information is available at the end of the article</footnote>
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as a first or senior author and of women who have reviewed a submitted manuscript. Raising awareness on those numbers can lead to substantial changes.

* National and international conferences should announce the percentage of women speakers and chairs on their program.

* National and international societies of Intensive Care should also announce the rate of women among their members, their board and committees and adopt policies to reach gender balance and use quotas as well.

We think that a domino effect would follow and other measurable actions in favor of gender equity would emerge.

The improvement of numbers and balanced ratios could enable more profound changes, which would improve women doctors' sense of belonging and inclusion:

* Work conditions to allow personal and professional women fulfillment would change. Women might have specific needs including those related to maternity. Those measures include "breast-feeding or mother room" for women who breast-feed, childcare facilities for doctors and access to part time work. The "breast-feeding room" should be the norm in any University, Scientific Conference and learned scientific society. We also believe that allowing men to commit fully in their parenthood (especially through paternity leave extension) would improve quality of life at work for both genders and reduce discriminations related to maternity.

* Specific classes and courses about unconscious gender biases should be part of the youngest doctors' curriculum.

We are aware that the gender gap is rooted in profound and societal dynamics that need to be modified too. Educational differences between males and females happen at the youngest age [10] and strong and sustainable changes are required for a durable success of what the critical care community yearns for.

From now on, research to define the most effective measures and possible obstacles to their implementation and their efficacy is warranted.

We know that our intensive care community is highly responsive and aware of what is at stake here: the improvement of equity and gender diversity will make our specialty fairer and more attractive for future generations.

**Authors' contributions**

C HB, C SG, OH and CA drafted the manuscript. NA, LBC, MSF, MJ, JLM and FT amended the draft. All the authors read and approved the final manuscript.

**Funding**

No funding.

**Availability of data and materials**

Not applicable.

**Declarations**

**Ethics approval and consent to participate**

Not applicable.

**Consent for publication**

Not applicable.
**Competing interests**

The authors declare that they have no competing interests.

**Author details**

¹Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France. ²Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriGGERSep Network, CHRU de Tours, Tours, France. ³Médecine Intensive Réanimation, Hôpital Universitaire de Poitiers, Poitiers, France. ⁴INSERM CIC 1402 (ALIVE Group), Université de Poitiers, Poitiers, France. ⁵INSERM Unit 970, Cardiovascular Research Center (PARCC), Hôpital Européen Georges Pompidou, APHP, Université de Paris, Paris, France. ⁶Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriGGERSep Network, CHRU de Tours and methodS in Patient-Centered Outcomes and Health ResEarch (SPHERE), INSERM UMR 1246, Université de Tours, Tours, France. ⁷Service de Médecine Intensive Réanimation, Faculté de Médecine Sorbonne, Université, Hôpital Tenon, APHP, Sorbonne Université, Paris, France. ⁸Médecine Intensive Et Réanimation - CHU de Lille, Lille, France. ⁹Membre de L'unité INSERM U1190 - Recherche Translationnelle Sur Le Diabète, Lille, France. ¹⁰Site Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive Réanimation, Département R3S, AP-HP Sorbonne Université, Paris, France. ¹¹INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Université, Paris, France. ¹²Médecine Intensive Réanimation, Hôpital Universitaire de Rouen, Rouen, France. ¹³INSERM U1096 EnVi, Université Normandie, UNIROUEN, Rouen, France. ¹⁴Service de Réanimation Polyvalente, Hôpital Antoine Beléère, AP-HP, Université Paris-Saclay, Clamart, France. ¹⁵Médecine Intensive Réanimation, Centre Hospitalier Régional et Universitaire de Brest, Université de Bretagne Occidentale, Brest, France.

Received: 11 June 2021 Accepted: 25 June 2021

Published online: 07 July 2021

**References**

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