Welcome to the report for readers of this issue of O&G Magazine.
First up, I am happy to report some additions to our Editorial Board. Gynaecological oncologists Dr Bryony Simcock and Dr Rhonda Farrell have joined us in place of A/Prof Penny Blomfield, who will retire from the Board at the end of May. The number of high-quality oncology submissions likely to be of interest to the clinicians reading ANZJOG has increased significantly over the past two years, hence the decision to appoint two new Associate Editors in Penny’s place. I thank Penny for her major contribution to ANZJOG during her time with us.
Dr Jason Waugh has also joined the Board and brings with him enormous experience, both as a clinician and as the former editor of the RCOG publication, The Obstetrician and Gynaecologist. He will be a valuable addition to current Board members assessing the many submissions we are now receiving. In 2018, we saw a 10 per cent increase in numbers of submissions over the previous year and the majority of these are on obstetric topics.
I am also pleased to tell you that Sarah Ortenzio has returned as Senior Coordinator of Periodical Publications and has been joined by Lindsey Mathews and Foong-Ee Wyatt at Wiley who are assisting with submissions and managing many day-to-day queries from authors.
The April issue is now available and will, I hope, provide stimulating reading. Within it are two excellent reviews. Firstly, McCarthy et al review pregnancy outcomes for women with pre-pregnancy diabetes (PPDM) in Australia, in both urban and rural areas,1 concluding that women with PPDM ‘continue to experience excess adverse pregnancy outcomes, including maternal morbidity, complicated birth, perinatal loss, congenital anomalies and mother-infant separation’ and calling for more and better research around outcomes, especially in rural areas. Secondly, Tanaka et al present a systematic review of the incidence of adverse events, their predictability and their associated mortality in gynaecogical hospital admissions in Australia.2 These authors conclude that approximately one in ten gynaecological inpatients suffer at least one adverse event, and around 50 per cent of adverse events are considered preventable. Again, further research is needed on how adverse events may be prevented. Both reviews should be of considerable interest to clinician readers.
Among the many original articles on obstetric topics in this issue is a contribution from Yoong and associates recommending revisiting the techniques of abdomino-pelvic packing for intractable venous obstetric haemorrhage.3 This paper has provoked some spirited discussion in the Letters to the Editor, which can be found in the e-pages at the end of the April issue.4 5 As if to emphasise the importance of this topic, Flood et al present the recent figures for primary postpartum haemorrhage for the state of Victoria in 2009–2013;6 disturbingly, these show a significant increase. There are also a number of articles around the topics of diabetes and obesity in pregnancy, topics also linked to increased PPH rates. Meloncelli et al discuss the role of multidisciplinary teams,7 McGuane and others look at the role of early induction of labour for diabetes, obesity and/or macrosomia in their hospital8 and Little et al discuss the association of maternal obesity with failed induction of labour.9
Two original articles in gynaecology look at the role of ultrasound, both in assisting the diagnosis of superficial endometriosis,10 and in the post-operative assessment of treatment of endometriosis.11
In the area of sexual and reproductive health an interesting study from New Zealand finds that Māori women are willing to participate in self-taken collection of vaginal samples for HPV testing;12 these findings have relevance to Australian practice as well.
The Current Controversies series has been held over until the June issue, but under Opinion in the April issue you will find a very thoughtful and informative discussion by Hayden Homer on preimplantation genetic testing for aneuploidy;13 he concludes that the use of this ‘very expensive IVF add-on‘ has so far only been proven to be of benefit for small groups of patients likely to have a good prognosis, and thus ‘has not yet been shown to be effective, or indeed without harm’ for other patient populations. Definitely good reading.
I have left the April editorials until last; there are two of these and both deal with the hot topic of gender equity in obstetrics and gynaecology. Carcel et al14 (including two RANZCOG Fellows) make very important points, not only on education and training in O&G but also around research, stating that ‘when sex differences are neglected (in obstetric and gynaecological research) we risk making the same mistakes we have seen in cardiac or other diseases where one sex or gender is disadvantaged due to poor treatment or care.’ These authors also spell out the differences between sex and gender and acknowledge the issue of non-binary gender, which is receiving increasing recognition in our larger society. If we are truly to address the large issue of gender equity in O&G practice and as a College, we need first to acknowledge that gender is not binary.
The other editorial comes from Angstmann et al15 and I am an author of this. We have looked at the gender composition of the College – Fellows and trainees over the years 1978–2018 – and at the concurrent composition of College committees. We have used data from College reports across nearly 40 years to show that the percentage of female Fellows has risen from around 5 per cent at the beginning of the period to 50 per cent today. Figures for gender of trainees are not available for the earlier years but, as one of the few Fellows who was active in College affairs in 1981 and still active, I can assure readers that the percentage of women admitted to train in Australia in 1981 was less than 5 per cent; in 2018 it was 83 per cent. Across state committees now women are in the majority; only Queensland has less than 50 per cent female representation and most others are well above 50 per cent, with Tasmania being 100 per cent female. At Council level, 50 per cent of members are women. Only at Board level is there a major discrepancy – there has only been one woman on the Board for the past three Boards, with five or six men.
I understand the Board is addressing the latter issues by co-opting some members; lawyer Julie Hamblin has a new observational and consumer role, the Chair of the Diplomates’ group Dr Judith Gardiner and the RANZCOG CEO Vase Jovanoska are also present at meetings, so with Board member Dr Gill Gibson the makeup around the table is 36 per cent female. Board members almost always have been elected by the Council, the Councillors having themselves gained experience at state committee level before nominating for Council. Council membership requires attendance at three sets of meetings each year in Melbourne, each lasting several days, plus much work in preparation. Board membership requires considerably greater commitment in time and unpaid work. This of course can be much more difficult for women juggling O&G practice with family and home commitments, and I believe that innovative ways of running these various bodies, which are essential to the functioning of our College and hence our professional independence, need to be found if more women are to put their hands up to serve the College in these roles. Shared roles and more use of tele-and video-conferencing are among the sensible suggestions in this direction.
For the past three Council elections, the overall percentages of women among candidates nominating have been 25 per cent, 42 per cent and 39 per cent. In the first two of these elections, the resulting Council membership corresponded exactly to these percentages, but in the current Council the percentage of women is higher (50 per cent); women are being elected to Council by their peers both female and male.
I had hoped that these two editorials would provoke thoughtful Letters to the Editor of ANZJOG, but so far there have been none. There has, however, been much comment on social media and this has taken two directions: that the College should address what is seen as a ‘leadership crisis’ in committee membership, and that there is no barrier to male applicants for specialist FRANZCOG training.
In fact, figures show that we already have gender equity across almost all College committees; the ‘pipeline’ is not leaking, except at the Board level. This does need to be addressed and it seems that will happen.
I also dispute the claim that ‘there is no barrier to males entering specialist O&G training’ at this point in the 21st century. In the 1970s and early 1980s there was ‘no barrier’ to women entering O&G training (application then was to individual hospitals, there were no College training schemes), but in 1974, even though I had my MRCOG Part 1, I could not find a job, while I saw many men accepted who had not passed that exam. Now applicants for training must have completed at least two years doing O&G at house officer level, have followed the pre-vocational pathway, have at least one relevant publication as first author, possibly be part-way or fully through a relevant post-grad degree, and generally have spent four or five years preparing themselves for the RANZCOG application process. When they see that the gender composition of the trainee intake is 83 per cent female, and likely to reach 100 per cent if left unchecked, I believe interested junior docs who are male may decide upon another specialty. I believe this is genuinely a barrier. I also believe that having a completely female RANZCOG would be as dystopian as I found the virtually all-male College when I returned from training overseas in the early 1980s. We live in a gender- and ethnically-diverse society and this needs to be reflected in our membership.
I welcome Letters to the Editor for ANZJOG on these (and on other) important topics, and I look forward to the next three years of participating in a College that has enthusiastic teams both gender- and ethnically-diverse, working together in the area of women’s reproductive healthcare.