In a recent study published in JAMA Network Open, researchers used a survey-based approach to elucidate how much women in medicine modify career trajectories or delay pregnancy for motherhood.

The findings revealed that despite an in-depth understanding of age-related fertility decline, more than 75% of female physicians delayed childbearing, some even to the point of infertility. Women who chose motherhood reported career advancement opportunities changes due to their decisions.

Study: Childbearing, Infertility, and Career Trajectories Among Women in Medicine. Image Credit: SydaProductions/Shutterstock.com

Women in medicine

Despite the growing representation of women in medicine, multiple studies have found significant gender disparities between male and female physicians, especially in career advancement. Association of American Medical Colleges (AAMC) data reports that 43% of medical school faculty are women, and only 22% advance to becoming department chairs or deans.

Previous research has suggested that fertility and family building contribute partly to this disparity, especially since peak medical training often coincides with female peak reproductive years. Studies have shown that female doctors had a greater likelihood of delaying childbirth when compared to women in non-medical professions.

While publications have focused on the association between medical careers and fertility, they have failed to test the contributions of family building and career.

About the study

In the present study, researchers used a cross-sectional survey to evaluate patterns of delayed pregnancy and infertility in female physicians and any contributions of differences in fertility knowledge in these patterns.

The study also aimed to elucidate if female doctors altered their career choices or turned down advancement opportunities in favor of parenthood.

Reproductive endocrinologists designed the questionnaire, which qualitative and survey researchers validated. A pilot survey was conducted with women physicians, whose feedback was used to refine and tailor the study.

The survey tested respondents’ fertility knowledge while cataloging demographics, work hours, careers, and perceptions of household responsibilities.

The survey was circulated to the medical association- and institution mailing lists and personally emailed to alumni associations, residency program directors, and over social media, including Facebook. Women were invited to participate irrespective of nationality or medical career stream and included trainees.

Researchers used descriptive statistics, Chi-squared tests, and Bonferroni-adjusted z-tests to analyze and present results.

Study findings

Despite the test being open to all nationalities, more than 98% of respondents were found to be American, resulting in this study best representing women physicians in the US.

Out of the 1,136 responses received, 80 were excluded resulting in a sample cohort of 1,056 respondents. Race and ethnicity were dominated by White women (70.3%), with Black (7.5%) and Hispanic (4.0%) forming the minorities.

The survey captured almost the entire spectrum of medical specialties, with obstetrics and gynecology (30.4%), internal medicine (17.9%), and pediatrics (12.6) showing the highest representation.

Of the 1,056 participants, 910 had partners, and 690 had children. Nearly 32% and 80% of mothers, and planned mothers, respectively, wanted children in the future.

Statistical analyses elucidated that 30% of single and 14.3% of partnered respondents work 60 hours or more per week. All respondents with partners ascribed most of the household chores to themselves, with mothers (58.4%) showing slightly higher proportions than women without children (49.2%).

Most respondents understood fertility well, with 78% correctly identifying the age of female fertility decline.

“Obstetrics and gynecology physicians demonstrated higher fertility knowledge vs. other physicians, with 274 respondents (85.4%) vs. 567 respondents (77.1%) correctly identifying the age of fertility decline.”

Analyses revealed that knowledge about cumulative live birth (CLB) in women undergoing in vitro fertilization (IVF) was not as good, with 61.4% correct answers.

A high proportion of women in medicine (71.8% of respondents) reported believing that stress causes infertility, with both obstetrics and gynecology physicians (61%) and other physicians (76.3%) ascribing to this cohort.

Over 75% of women in medicine reported delaying pregnancy due to medical school or practice, with more than 22% waiting for five years or more.

“Among respondents who delayed, 105 individuals (13.1%) had concerns about lack of support from leadership “very much” or “extremely.” No association existed between fertility knowledge and delay or between specialty and delay.”

An alarming 36.8% of respondents experienced infertility, with more than half resorting to IVF. When comparing these results to the pregnancy delay ones, a strong association is seen, with 52.6% of women reporting delaying also reporting infertility.

Women who reported delaying by five years or more were 64.3% likely also to report infertility. This dataset is one of the most extensive US datasets available, and the US average infertility rate ranges between 6% and 19% from previous studies, highlighting the urgent need for policy implementation in favor of earlier family building in female medical professionals.

Almost half of all respondents (45.7%) wished they had attempted conception earlier, and a similar proportion wished for reduced work hours or extended maternity leave. Previous work has shown that the mean age at first birth for female medical professionals in the US was five years higher than for women in other careers.

A growing body of literature documents fertility declines in women with increasing age. This study highlights the urgent need for policies in medical institutions, half of which do not, to allow for paid maternal leave.

“Encouragingly, a recent Accreditation Council for Graduate Medical Education mandate specifies that sponsoring institutions must have policies including 6 or more paid weeks of parental leave. While this falls short of the 12 weeks recommended by the American Academy of Pediatrics on the basis of parental and infant benefits, it represents an important step.”

Conclusion

The present study represents one of the most extensive sample-size investigations into the relationship between pregnancy timing and fertility and the first to evaluate the impact of the medical career on family-building decisions in women.

More than 1,000 women, mainly from the US, were included in the study, revealing that more than two-thirds of women physicians delayed pregnancy, and an alarming 36.8% were infertile.

This, despite 78% of respondents being aware of the association between increasing female age and infertility. Respondents cited career pressure influencing family building; most cited parenthood as linked with marked career alteration.

These results highlight the need for policy changes in medical establishments to accommodate parenthood in female physicians and increase awareness of the 12 weeks of recommended parental leave (American Academy of Pediatrics).

Future studies with global cohorts could build upon these results to measure similar patterns and suggest specific policies for people from different racial and ethnic backgrounds.