International Women’s Day (8 March) is a day for us to join voices with people around the world, rallying people globally in the unwavering pursuit of equality.

On this day, we celebrate all women in their diversities and recognise how far we’ve come.

But we’re not there yet. According to a report published by the WHO, women in healthcare earn 24% less than men.^[1]��And in Australia, women represent only 28% of medical deans and 12.5% of hospital CEOs.^[2]��Globally, women continue to face significant obstacles to achieving equal participation in the economy, as well as in healthcare, employment, education, and leadership. Intersectional discrimination further exacerbates disparities.

The theme for International Women’s Day 2024�� serves as a call to action to address systemic injustices, and advocate for the empowerment of all women which is central to a gender-equal world.

����TV was proud to host a meaningful panel discussion exploring this year’s theme within the specialty of obstetrics and gynaecology during a Council Forum on 8 March. Five prolific women examined what is needed to attain greater inclusion for women and girls everywhere.

Current systems do not take into consideration the effects of reproductive health on women’s daily lives, or the disproportionate responsibility of care which women carry. “As women, our reproductive health impacts our lives and there’s often no room made for it in workplaces, particularly those dominated by men,” shared Consumer Representative, Tessa Kowaliw. “It all comes down to how well we can rethink measures of success so that women can we recognised for the things that we do despite what we manage on the daily.”

President, Dr Gibson explained how three biases – credibility, capability, and capacity bias – often prevent aspiring women from taking up senior leadership positions. “The approach has to be to look at those biases and why they exist, what the enablers are, and what can we do reduce them.” Associate Professor Henry commented, “Don’t assume that because a woman has young children or is working part time that she is not interested in leadership, or opportunities which will lead to a leadership position.”

An intersectional approach must be taken to understanding and combating inequities for First Nations women. With respect to closing the gap in healthcare between Aboriginal and Torres Strait Islander women and non-Indigenous women, Dr Clarke said, “Everyone needs to be a part of the solution… We all have influence in our daily clinical interactions… All of us play a role at an individual level but addressing inequities at a systematic level is required. Examine in your own clinical life what you are doing to close the gap.”

Gender equity within research and academia is still lacking and care systems focus on a siloed approach which negatively impacts health outcomes for women, said Associate Professor Henry. “It has been hard to gain traction and funding in this space…. We need to invest in holistic care systems to break down those silos and see care as a continuity throughout a woman’s lifespan.”

Dr Gibson, highlighted our responsibility as a College to advocate for women and girls’ rights every day. “As RANZCOG President, every day I look at the lives of different women, and how their lives impact upon their health. We all need to be actively thinking about how we can use our influence to impact better outcomes for women, every day.”

Gender equity is synonymous with a prospering economy and creates a more harmonious society for all. “Gender equity should be a positive for everybody… overall we’re all growing a better workplace, a better society through this. We have to be conscious of highlighting that and bringing everybody with us,” surmised Associate Professor Henry.

We thank our facilitator, Dr Nisha Khot, and panellists, Associate Professor Amanda Henry, Dr Marilyn Clarke, Tessa Kowaliw, and Dr Gillian Gibson, for sharing their perspectives and helping us to further these important conversations in pursuit of our mission.

The core value of RANZCOG is to strive for ‘excellence and equity in women’s health’ and as part of accomplishing this, we acknowledge the College’s responsibility to help accelerate the pace of reforms which will enable women to benefit fully and equally. To effect positive advancements on a wider scale, it’s imperative that the College embodies the change it hopes to see.

����TV is committed to championing inclusivity and gender equity in the workplace. Implementing a comprehensive��Gender Equity and Diversity Policy��to promote, advance, and support gender equity and diversity practices at the College has been an important step forward in our equity journey.

The policy sets out a framework to safeguard equitable participation for all, by effectively including gender equity as a top strategic priority. Key areas of focus include fostering a more representative leadership, transparent salary review processes, and promoting shared caring responsibility through the provision of gender-neutral parental leave. RANZCOG has also set a gold standard for paid menstruation and menopause leave.

Underscoring the College’s dedication to creating an inclusive and equitable workplace, for the second year running RANZCOG has been ranked within the����– a global jobs network helping connect women with workplaces they can trust.

Thousands of workplaces were scored across 10 standards, including hiring practices, leadership diversity, paid parental leave, flexible working, and inclusive and anti-discriminatory behaviour.�� – coming third in Australia for paid paternal leave specifically – rivalling some of Australia’s largest employers.

“It’s great to be one of those 101 organisations especially when we are competing against major employers with enormous resources. When it comes to our employees, I’m very proud of what we have achieved,” said Vase Jovanoska, RANZCOG’s CEO.

����TV recognises progress towards gender equality is enduring. Looking beyond International Women’s Day, the College encourages its trainees, members, and staff to amplify women’s voices, and lead efforts to tackle inequities. Only through collective efforts and solidarity will we create a world where every woman and girl can fulfil her true potential.

Read about��how this year’s IWD theme resonates with eleven clinicians from across the Pacific, Aotearoa New Zealand, and Australia.

1. The International Labour Organization and the World Health Organization, The gender pay gap in the health and care sector – a global analysis in the time of COVID-19. (2022):����

2. Hempenstall A, Tomlinson J and Bismark M. Gender inequity in medicine and medical leadership.��The Medical Journal of Australia��2019:����

Meet the people leading the way in wellbeing at the College in 2023.

The RANZCOG Wellbeing Awards have been running since 2021 as a way to recognise the important work undertaken by individuals supporting and championing the health and wellbeing of their fellow O&G peers.

Congratulations to the 2023 Wellbeing Award recipients and thank you to everyone who took the time to write a nomination – they were a joy to read.

Trainee, Eastern Health, VIC

Nominated by Dr Vanessa Gray (RANZCOG Trainee)

Dr Luiza Peculis is a recently elevated RANZCOG fellow who has spent her advanced trainee years acting as the Senior Registrar at Liverpool Hospital. Whilst working in this demanding role at a tertiary hospital, Luiza was responsible for supervising and overseeing a large team of junior doctors, including RANZCOG ITPs and SIMGs, prevocational doctors, interns, and residents. During this time Luiza championed the importance of doctor’s wellbeing through multiple means.

Luiza introduced and ran a regular departmental Wellbeing Meeting with the junior doctors, allowing them to raise any concerns in a supportive and confidential environment. She also introduced a regular ‘positive feedback’ session during departmental meetings so that positive feedback could be provided publicly so that junior doctors felt recognised for their hard work and professional successes.

By embracing the importance of health and wellbeing whilst in a leadership role, Luiza has ensured that the junior doctors under her leadership felt supported and heard. She also helped change hospital culture to ensure that doctors wellbeing was recognised as an essential and important aspect of a successfully functioning department.

By continuing the practice of running formalised Wellbeing meetings, junior doctors are provided with a safe space to discuss workplace health and wellbeing issues and are provided with a formal means of confidentially providing feedback or suggestions on how to create a healthy work environment.

Dr Luiza Peculis has provided leadership by showing kindness and respect in her everyday interactions with others and has been a strong advocate for the wellbeing of her colleagues around her.

Trainee, Eastern Health, VIC

Nominated by Dr Anousha Woods (RANZCOG Trainee)

Dr Christoph Lehner is very supportive to all members of the team. He stays in the hospital when he is on call to support the registrars, has a very positive attitude which helps the whole team function well and is always keen to teach all team members.

Dr Lehner supports the juniors 24 hours of the day and is happy to stay back in clinics and see the last patient. He is keen to teach juniors and extremely patient with all team members.

He is an inspiration to juniors of what we hope to be like in the future. I am confident that every person in our MDT enjoys working with Dr Lehner. He is kind, supportive, humble, skilled, and extremely knowledgeable.

Trainee, Eastern Health, VIC

Nominated by Dr Prithi Rajiv (RANZCOG Diplomate)

Dr Saima Wani is the current SR at Eastern Health O&G. She has been instrumental in maintaining team morale and fair distribution of workload while upskilling junior residents particularly in times of extensive sick leave and skeleton staff present on site. Saima has developed excellent relationships with junior and senior staff alike which has set the tone and maintained team cohesion at this health service.

During times of stress, heavy workload or skeleton staff Saima has actively ensured that every member of the team – junior and senior – is not working excessive hours beyond their means where possible. This includes reaching out to team members unprompted to ensure they are coping with the workload and where required organising roster swaps to ensure the mental health of all team members is prioritised.

Her advocacy for juniors to have more training opportunities has allowed for an ongoing impact of junior SRMOs having the chance to have minor procedural gynae lists with consultant supervision and opportunities to become involved in C/S lists assisting consultants which are both ongoing initiatives that will continue for future cohorts of junior staff.

Saima has been a compassionate, approachable, and considerate SR who is understanding of the mental and physical toll that a job such as O&G can have. She is a strong advocate for medical education and teaching and can provide guidance and learning in an approachable way. This sets an excellence precedence for a cohesive team culture.

While the Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ (RANZCOG’s) latest bullying, harassment and discrimination survey results indicate a drop in these behaviours in O&G workplaces, their incidence remains concerningly high.

41% of survey participants said that they had experienced bullying, harassment or discrimination by a professional colleague in the previous two years. This was a 21% decrease from the 62% reported in 2021, although the previous survey asked about experiences from any time in a person’s career.

While not a direct comparison, from a trending perspective, the 2023 results demonstrate that the prevalence of bullying, harassment and discrimination experienced by RANZCOG members and trainees has decreased.

When benchmarked against other medical colleges surveyed by BPA Analytics, the independent survey provider, the outcome is positive, with RANZCOG’s 2023 results benchmarking in the top quartile, with sexual harassment prevalence in the top decile.

����TV President Dr Gillian Gibson acknowledged the results and affirmed that more work needed to be done.

‘While these are positive signs, the prevalence of bullying, harassment and discrimination in O&G is still too high. These behaviours not only cause suffering to the individual affected, they can also compromise patient care and undermine patient safety,’ Dr Gibson said.

‘We’ll be going through the data to see where we can improve our education and training, our advocacy and our direct support to members and trainees.’

Reporting rates show room for improvement, with fewer than half of those affected reporting bullying, discrimination or sexual harassment. Reasons for not reporting included fear of career impact and retaliation. For those who did report, resolution rates were very low for discrimination (3%), harassment (6%) and bullying (8%).

Dr Gibson acknowledged the more than 1,000 members and trainees who completed the survey.

‘We sincerely thank you for taking the time to respond to our survey. Your voices are essential to ensuring that RANZCOG supports and represents you most effectively,’ she said.

‘We remain committed to implementing our four-year��Fostering Respect Action Plan��and helping to build safe workplaces for all who work in O&G, which will maximise the quality of care our patients receive.’

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has reaffirmed its pledge to ensuring that obstetrics and gynaecology is practised in a respectful and inclusive environment, by committing to an action plan that will help enact meaningful culture change across workplaces.

In February 2022, RANZCOG published a comprehensive external review of workplace culture that found unacceptable behaviour in workplaces across Australia and Aotearoa New Zealand.

“Any form of bullying, harassment or discrimination is unacceptable, and poses a risk to employee and patient health and safety. All our members and trainees deserve to work and train in a safe environment. Again, we regret that this behaviour has occurred and are sorry for any adverse impact it may have had on their lives,” RANZCOG President Dr Benjamin Bopp said.

“This action plan has been developed following widespread consultation with members, trainees and other stakeholders.”

The Action Plan includes measures such as:

• creating and delivering education on bullying, harassment and discrimination
• reviewing structural support for trainees returning to training from extended leave
• appointing an independent reviewer for RANZCOG complaints
• publishing our complaint statistics in annual progress updates
• collecting more equity and diversity data and acting on any identified under-representation.

An independent Bullying, Harassment and Discrimination (BHD) Advisory Working Group conducted the review and prepared a report to the College. The Working Group’s recommendations were shaped by the experiences, views and insights of members and trainees revealed in an online survey, listening sessions and in written submissions.

����TV is grateful to all members and trainees who made time to share their stories of unacceptable behaviour in workplaces across Australia and Aotearoa New Zealand.

“RANZCOG is concerned that so many of our members and trainees have reported gender bias, discrimination, bullying and harassment in the workplace. We regret that this has occurred and are sorry for any adverse impact it may have had on their lives. All our members and trainees deserve to work and train in a safe environment,” Dr Bopp said.

The Working Group’s report, makes 24 detailed recommendations and proposes a roadmap to help guide the College’s actions.

The RANZCOG Board has accepted the Working Group’s report in its entirety. In order to do justice to the report, the Board will carefully consider and respond to its recommendations.

“We recognise that cultural change takes time and requires a sustained commitment. RANZCOG is now developing an action plan to guide future work to help hospitals provide safe and respectful workplaces,” Dr Bopp said.

 

“We are in this for the long haul and look forward to working with our members, trainees and other stakeholders to help reinforce a culture of respect, in which we can all practise safely and provide the best care to our patients,” Dr Bopp said.

 

“RANZCOG is committed to upholding the highest possible professional standards in obstetrics and gynaecology, and to working with other stakeholders across the health system to address problems that can only be solved through collaboration and a shared commitment to common goals,” Dr Bopp said.

Survey findings

The member and trainee survey found that 62% of respondents answered that they had been subjected to discrimination, bullying, sexual harassment or harassment (DBSH) in the workplace by a professional colleague at any time in their career.

The survey found cohort differences in DBSH prevalence:

• women had significantly higher prevalence ratings for DBSH (70%) than men (47%)
• reports of sexual harassment were almost six times higher for women (19%) than for men (3%)
• O+G trainees were more likely to report bullying and sexual harassment than other membership groups.
  The operating theatre was the most common setting where DBSH occurred, followed by hospital wards.

Dr Bopp said: “We thank all of those who participated in the survey and acknowledge everyone who came forward to tell us of their experiences. We also acknowledge the many others who could not or did not participate but who may have experienced misconduct.”

“The telling of their stories cannot have been easy. The College has listened and we accept their calls for change.”

The Working Group’s report found there is a strong appetite for cultural change, acknowledging RANZCOG’s current work and initiatives involving training site accreditation, trainee support, education, complaint handling, equity and diversity, advocacy and wellbeing activities.

“We thank the Working Group and everyone who has come forward to share their experiences as part of its review. The College is determined that by continuing to implement strategies addressing the recommendations, and with the Board’s commitment to safety, respect and inclusiveness, we will make positive change and help strengthen workplace cultures for the long term,” Dr Bopp said.

Dr Bopp said the College recognised that quality health care outcomes are dependent on high functioning teams across hospital settings. “As the Working Group notes, bullying, harassment and discrimination are also patient safety issues. It is vital that we foster respectful O&G work environments so that women, their babies and families receive the best possible care,” he said.

 

Working Group Chair Jane Bell said: “We note the work that RANZCOG and its committees have already undertaken to tackle DBSH and promote respectful workplaces. There is clear recognition, however, that there is more to do. Our report highlights how RANZCOG can support the creation of respectful and inclusive O&G workplaces.”

Background

The six person Advisory Working Group was chaired by Jane Bell, a leading lawyer and non-executive director, former Chair of Melbourne Health (Royal Melbourne Hospital), current Deputy Chair of Monash Health and member of the Administrative Appeals Tribunal. The Deputy Chair was Dr Helen Szoke, formerly Victorian Equal Opportunity and Human Rights Commissioner and federal Race Discrimination Commissioner with the Australian Human Rights Commission.

At RANZCOG, we aim to create inclusive and flexible workplaces that support and enable all parents to take an active role in caring for their family and giving their children the best start in life.

Families come in all shapes and sizes, which is why our policies are designed to support all parents. This includes same-sex couples, adoptive and foster parents, kinship and surrogacy arrangements.

We are proud to announce that College staff across Australia and New Zealand are entitled to 26 weeks parental leave.

All parental leave entitlements are inclusive of LGBTQIA+ people, regardless of the gender, identity and expression of the staff member or their partner.

����TV calls on Federal and State governments to make 26 weeks parental leave universal for all doctors in training, no qualifying period, and to be transferable intrastate and interstate.

We are also pleased to announce a benefit for employees wanting to start or expand their family – paid leave (10 days) for fertility and IVF treatment.

The College also offers leave for miscarriage, pregnancy loss and for pregnancy-related illness.