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Sexual harassment and other abusive behaviors are prevalent within the ob/gyn field, despite the specialty being female dominant for the last decade, according to a systematic review.

The prevalence of sexual harassment ranged from 27.6% for physicians to 70.9% for female gynecologic oncologists, workplace discrimination was reported by 57% to 67.2% of women and 38.5% of men, and bullying was reported by 52.8% of all respondents, reported Ankita Gupta, MD, MPH, of the University of Louisville Health in Kentucky, and co-authors in .

"The thought has been that if we introduce more women into the workforce, specifically into academic medicine, that the rates of these behaviors will go down," Gupta told 番茄社区app. "And within ob/gyn, which is predominantly female, we're not really seeing that. We're still seeing really high rates of these behaviors, which makes us wonder, what else are we missing about power dynamics, leadership, and the environment that we work in?"

Despite research showing that more trainees recognize harassment in the years since #MeToo and #MedToo, instances of sexual harassment were often not reported, with only 8.4% of AAGL (formerly the American Association of Gynecologic Laparoscopists) members and 12.5% of gynecologic oncologists reporting their sexual harassment to anyone. In addition, 69.1% of ob/gyn trainees experienced sexual harassment, yet only 32.6% reported it.

The men who experienced sexual harassment and gender discrimination often had female perpetrators. Gupta and team wrote that this finding "suggests that focus should be on perpetrators and leadership demographics to identify harassment behaviors." While a high number of women occupy ob/gyn residency director roles, they only make up a third of ob/gyn department chairs as of 2021.

Perpetrators of harassment included physicians (30.1%), other trainees (13.1%), and operating room staff (7.7%).

Much of the research on interventions didn't actually quantify how effective the interventions were at reducing bad behaviors, Gupta said. She and her team noted, "no significant decrease in the frequency of sexual harassment was found with any intervention."

Gupta pointed out that interventions that "require institutional buy-in -- like setting up offices of diversity or abuse prevention or making professionalism a part of promotion criteria -- those things tend to be more impactful when we're talking about improving mistreatment rates."

Ultimately, the authors concluded that "simply increasing the number of women in medicine is inadequate to address gender bias and discrimination," and instead, "the role of power dynamics should be better studied and addressed to reduce harassment."

Nikki Zite, MD, MPH, professor of obstetrics and gynecology at the University of Tennessee Graduate School of Medicine in Knoxville who wasn't involved in the study, told 番茄社区app that "figuring out how to accurately study and address sexual harassment, abuse, and discrimination in medicine should be a priority of institutions and organizations in medical education or in medicine in general."

She noted that while she hoped to see ob/gyn doing better than other specialties, this research showed that's not the case and ob/gyn has a lot of work to do despite a majority-female workforce.

The study authors weren't able to do a meta-analysis due to the heterogeneity of the data, which would have provided helpful insight, Zite said.

For this systematic review, the team searched PubMed, Embase, and ClinicalTrials.gov for relevant research in the U.S. and Canada through June 13, 2023. In total, 10 studies with 5,852 participants met the inclusion criteria for prevalence and 12 studies with 2,906 participants met the inclusion criteria for interventions. Harassment from family or patients was excluded. Most of the included studies were cross-sectional studies based on surveys.

In terms of limitations, the authors noted the heterogenous evidence base, the fact that most studies were survey-based and retrospective with low-quality evidence, and the possibility of non-response and recall bias in the included studies.

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