A woman doctor at her desk in a hospital in Egypt. Though women still face challenges in fully participating in medical professions, women are increasingly getting recognition and inclusion in medicine around the world.
The presence of women in medicine, particularly in the practicing fields of surgery and as physicians, has been traced to the earliest of history. Women have historically had lower participation levels in medical fields compared to men with occupancy rates varying by race, socioeconomic status, and geography.
Women's informal practice of medicine in roles such as caregivers, or as allied health professionals, has been widespread. Since the start of the 20th century, most countries of the world provide women with access to medical education. Not all countries ensure equal employment opportunities,[1] and gender equality has yet to be achieved within medical specialties and around the world.[2]
The involvement of women in the field of medicine has been recorded in several early civilizations. An Egyptian of the Old Kingdom of Egypt, Peseshet, described in an inscription as "lady overseer of the female physicians", is the earliest woman named in the history of science. Ubartum lived around 2050 BC in Mesopotamia and came from a family of several physicians. Agamede was cited by Homer as a healer in ancient Greece before the Trojan War. Agnodice was the first female physician to practice legally in 4th century BC Athens. Metrodora was a physician and generally regarded as the first female medical writer.[3] Her book, On the Diseases and Cures of Women, was the oldest medical book written by a female and was referenced by many other female physicians.[3] She credited much of her writings to the ideologies of Hippocrates.[3]
Hildegard of Bingen, a Medieval German abbess who wrote Causae et Curae, 1175.
During the Middle Ages, convents were a centralized place of education for women, and some of these communities provided opportunities for women to contribute to scholarly research. An example is the German abbessHildegard of Bingen, whose prolific writings include treatments of various scientific subjects, including medicine, botany and natural history (c. 1151–58).[4] She is considered Germany's first female physician.[5]
Women in the Middle Ages participated in healing techniques and several capacities in medicine and medical education. Women occupied select ranks of medical personnel during the period.[6] They worked as herbalists, midwives, surgeons, barber-surgeons, nurses, and traditional empirics.[7] Women healers treated most patients, not limiting themselves to treating solely women.[citation needed] The names of 24 women described as surgeons in Naples, Italy between 1273 and 1410 have been recorded, and references have been found to 15 women practitioners, most of them Jewish and none described as midwives, in Frankfurt, Germany between 1387 and 1497.[8] The earliest known English women doctors, Solicita and Matilda Ford, date to the late twelfth century; they were referred to as medica, a term for trained physicians.[9][10]
Women also engaged in midwifery and healing arts without having their activities recorded in written records, and practiced in rural areas or where there was little access to medical care. Society in the Middle Ages limited women's role as physician. Once universities established faculties of medicine during the thirteenth century, women were excluded from advanced medical education.[6] Licensure began to require clerical vows for which women were ineligible, and healing as a profession became male-dominated.[7]
In many occasions, women had to fight against accusation of illegal practice done by males, putting into question their motives. If they were not accused of malpractice, then women were considered "witches" by both clerical and civil authorities.[11] Surgeons and barber-surgeons were often organized into guilds, which could hold out longer against the pressures of licensure. Like other guilds, a number of the barber-surgeon guilds allowed the daughters and wives of their members to take up membership in the guild, generally after the man's death. Katherine "la surgiene" of London, daughter of Thomas the surgeon and sister of William the Surgeon, belonged to a guild in 1286.[12] Documentation of female members in the guilds of Lincoln, Norwich, Dublin and York continue until late in the period.[citation needed]
Midwives, those who assisted pregnant women through childbirth and some aftercare, included only women. Midwives constituted roughly one third of female medical practitioners.[7] Men did not involve themselves in women's medical care; women did not involve themselves in men's health care.[6] The southern Italian coastal town of Salerno was a center of medical education and practice in the 12th century. In Salerno the physician Trota of Salerno compiled a number of her medical practices in several written collections. One work on women's medicine that was associated with her, the De curis mulierum ('On Treatments for Women') formed the core of what came to be known as the Trotula ensemble, a compendium of three texts that circulated throughout medieval Europe. Trota herself gained a reputation that spread as far as France and England. There are also references in the writings of other Salernitan physicians to the mulieres Salernitane ('Salernitan women'), which give some idea of local empirical practices.[13]
For the medieval Islamic world, little information is known about female medical practitioners although it is likely that women were regularly involved in medical practice in some capacity.[18][19] Male medical writers refer to the presence of female practitioners (a ṭabība) in describing certain procedures or situations.[18][19] The late-10th to early-11th century Andalusi physician and surgeon al-Zahrawi wrote that certain medical procedures were difficult for male doctors practicing on female patients because of the need to touch the genitalia.[18][19] The male practitioner was required to either find a female doctor who could perform the procedure, or a eunuch physician, or a midwife who took instruction from the male surgeon.[18][19] The existence of female practitioners can be inferred, albeit not explicitly, through direct evidence.[18][19] Midwives played a prominent role in the delivery of women's healthcare. For these practitioners, there is more detailed information, both in terms of the prestige of their craft (ibn Khaldun calls it a noble craft, "something necessary in civilization") and in terms of biographical information on historic women.[20][21] To date, no known medical treatise written by a woman in the medieval Islamic world has been identified.
Due to the social custom that men and women should not be near to one another, Chinese women were reluctant to be treated by Western male doctors. This resulted in a need for female doctors. One of these was Sigourney Trask of the Methodist Episcopal Church, who set-up a hospital in Fuzhou during the mid-19th century. Trask also arranged for a local girl, Hü King Eng, to study medicine at Ohio Wesleyan Female College, with the intention that Hü would return to practise western medicine in Fuzhou. After graduation, Hü became the resident physician at Fuzhou's Woolston Memorial Hospital in 1899 and trained several female physicians.[24] Another female medical missionary Mary H. Fulton (1854–1927)[25] was sent by the Foreign Missions Board of the Presbyterian Church (US) to found the first medical college for women in China. Known as the Hackett Medical College for Women (夏葛女子醫學院),[26][27][28][29] this college was located in Guangzhou, China, and was enabled by a large donation from Edward A. K. Hackett (1851–1916) of Indiana. The college was dedicated in 1902 and offered a four-year curriculum. By 1915, there were more than 60 students, mostly in residence. Most students became Christians, due to the influence of Fulton. The college was aimed at the spreading of Christianity and modern medicine and the elevation of Chinese women's social status. The graduates of this college included Chau Lee-sun (周理信, 1890–1979) and Wong Yuen-hing (黃婉卿), both of whom graduated in the late 1910s and then practiced medicine in the hospitals in Guangdong province.[30]
During this era, the majority of American women whether European or African American, childbirth was considered a female event where female friends, relatives, and the local midwife gathered to support the birthing mother. Midwives gained their knowledge through experience and apprenticeship.[31] Out of the different occupations women took on around this time, midwifery was one of the highest-paying industries.[32] In the 18th century, households tended to have an abundance of children largely in part to having hired help and diminished mortality rates.[33] Despite the high chance of complications in labor, American midwife Martha Ballard, specifically, had high success rates in delivering healthy babies to healthy mothers.[32]
The 1970s marked an increase of women entering and graduating from medical school in the United States.[34] From 1930 to 1970, a period of 40 years, around 14,000 women graduated from medical school.[34] From 1970 to 1980, a period of 10 years, over 20,000 women graduated from medical school.[34] This increase of women in the medical field was due to both political and cultural changes. Two laws in the U.S. lifted restrictions for women in the medical field – Title IX of the Higher Education Act Amendments of 1972 and the Public Health Service Act of 1975, banning discrimination on grounds of gender.[34] In November 1970, the Assembly of the Association of American Medical Colleges rallied for equal rights in the medical field.[34]
Throughout the decade women's ideas about themselves and their relation to the medical field were shifting due to the women's feminist movement.[35] A sharp increase of women in the medical field led to developments in doctor-patient relationships, changes in terminology and theory.[35] One area of medical practice that was challenged and changed was gynecology.[35] Author Wendy Kline noted that "to ensure that young brides were ready for the wedding night, [doctors] used the pelvic exam as a form of sex instruction."[36]
With higher numbers of women enrolled in medical school, medical practices like gynecology were challenged and subsequently altered.[37] In 1972, the University of Iowa Medical School instituted a new training program for pelvic and breast examinations.[37] Students would act both as the doctor and the patient, allowing each student to understand the procedure and create a more gentle, respectful examination.[37] With changes in ideologies and practices throughout the 70s, by 1980 over 75 schools had adopted this new method.[37]
Along with women entering the medical field and feminist rights movement, came along the women's health movement which sought alternative methods of health care for women. This came through the creation of self-help books, most notably Our Bodies, Ourselves: A Book by and for Women.[38] This book gave women a "manual" to help understand their body. It challenged hospital treatment, and doctors' practices.[38] Aside from self-help books, many help centres were opened: birth centres run by midwives, safe abortion centres, and classes for educating women on their bodies, all with the aim of providing non-judgmental care for women.[39] The women's health movement, along with women involved in the medical field, opened the doors for research and awareness for female illness like breast cancer and cervical cancer.[39]
Scholars in the history of medicine had developed some study of women in the field—biographies of pioneering women physicians were common prior to the 1960s—and study of women in medicine took particular root with the advent of the women's movement in the 1960s, and in conjunction with the women's health movement.[citation needed]
In 1540, Henry VIII of England granted the charter for the Company of Barber-Surgeons;[40] while this led to the specialization of healthcare professions (i.e. surgeons and barbers), women were barred from professional practice.[41] Women did continue to practice during this time without formal training or recognition in England and eventually North America for the next several centuries.[41]
Women's participation in the medical professions was generally limited by legal and social practices during the decades while medicine was professionalizing.[42] Women openly practiced medicine in the allied health professions (nursing, midwifery, etc.), and throughout the nineteenth and twentieth centuries, women made significant gains in access to medical education and medical work through much of the world. These gains were sometimes tempered by setbacks; for instance, Mary Roth Walsh documented a decline in women physicians in the US in the first half of the twentieth century, such that there were fewer women physicians in 1950 than there were in 1900.[43] Through the latter half of the twentieth century, women made gains generally across the board. In the United States, for instance, women were 9% of total US medical school enrollment in 1969; this had increased to 20% in 1976.[43] By 1985, women constituted 16% of practicing American physicians.[44]
At the beginning of the 21st century in industrialized nations, women have made significant gains, but have yet to achieve parity throughout the medical profession. Women have achieved parity in medical school in some industrialized countries, since 2003 forming the majority of the United States medical school applicants.[45] In 2007–2008, women accounted for 49% of medical school applicants and 48.3% of those accepted.[46] According to the Association of American Medical Colleges (AAMC) 48.4% (8,396) of medical degrees awarded in the US in 2010–2011 were earned by women, an increase from 26.8% in 1982–1983.[47] While more women are taking part in the medical field, a 2013–2014 study reported that there are significantly fewer women in leadership positions within the academic realm of medicine. This study found that women accounted for 16% of deans, 21% of the professors, and 38% of faculty, as compared to their male counterparts.[48]
The practice of medicine remains disproportionately male overall. In industrialized nations, the recent parity in gender of medical students has not yet trickled into parity in practice. In many developing nations, neither medical school nor practice approach gender parity.[citation needed] Moreover, there are skews within the medical profession: some medical specialties, such as surgery, are significantly male-dominated,[49] while other specialties are significantly female-dominated, or are becoming so. For example, in the United States, As of 2006[update] female physicians outnumber male physicians in pediatrics and female residents outnumber male residents in family medicine, obstetrics and gynecology, pathology, and psychiatry.[50][51] In several different areas of medicine (general practice, medical specialties, surgical specialties) and in various roles, medical professionals tend to overestimate women's true representation, and this correlates with a decreased willingness to support gender-based initiatives among men, impeding further progress towards gender parity.[52]
Women continue to dominate in nursing. In 2000, 94.6% of registered nurses in the United States were women.[53] In health care professions as a whole in the US, women numbered approximately 14.8 million, as of 2011.[54]
Biomedical research and academic medical professions—i.e., faculty at medical schools—are also disproportionately male. Research on this issue, called the "leaky pipeline" by the National Institutes of Health and other researchers, shows that while women have achieved parity with men in entering graduate school, a variety of discrimination causes them to drop out at each stage in the academic pipeline: graduate school, postdoc, faculty positions, achieving tenure; and, ultimately, in receiving recognition for groundbreaking work.[55][56][57][58]
The "glass ceiling" is a metaphor to convey the undefined obstacles that women and minorities face in the workplace. Female physicians of the late 19th-century faced discrimination in many forms due to the prevailing Victorian era attitude that the ideal woman be demure, display a gentle demeanor, act submissively, and enjoy a perceived form of power that should be exercised over and from within the home.[citation needed] Medical degrees were difficult for women to earn, and once practicing, discrimination from landlords for medical offices, left female physicians to set up their practices on "Scab Row" or "bachelor's apartments."[59]
The Journal of Women's Health surveyed physician mothers and their physician daughters to analyze the effect that discrimination and harassment have on the individual and their career.[60] This study included 84% of physician mothers that graduated medical school prior to 1970, with the majority of these physicians graduating in the 1950s and 1960s.[60] The authors of this study stated that discrimination in the medical field persisted after the title VII discrimination legislation was passed in 1965.[60] This was the case until 1970, when the National Organization for Women (NOW) filed a class action lawsuit against all medical schools in the United States. By 1975, the number of women in medicine had nearly tripled, and has continued to grow. By 2005, more than 25% of physicians and around 50% of medical school students were women. The increase of women in medicine also came with an increase of women identifying as a racial/ethnic minority, yet this population is still largely underrepresented in comparison to the general population of the medical field.[60]
Within this specific study, 22% of physician mothers and 24% of physician daughters identified themselves as being an ethnic minority. These women reported experiencing instances of exclusion from career opportunities as a result of their race and gender. According to this article, females tend to have lessened confidence in their abilities as a doctor, yet their performance is equivalent to that of their male counterparts. This study also commented on the impact of power dynamics within medical school, which is established as a hierarchy that ultimately shapes the educational experience.[61] Instances of sexual harassment attribute to the high attrition rates of females in the STEM fields.[62]
A shift from women midwifery to male obstetrics occurs in the growth of medical practices such as the founding of the American Medical Association.[63] Instead of assisting labor in the basis of an emergency, doctors took over the delivery of babies completely; putting midwifery second.[32] This is an example of the growing sense of competition between male physicians and female midwives as a rise in obstetrics took hold. The education of women on the basis of midwifery was stunted by both physicians and public-health reformers, driving midwifery to be seen as out of practice.[64] Societal roles also played a fact in the downfall of the practice in midwifery because women were unable to obtain the education needed for licensing and once married, women were to embrace a domestic lifestyle.[63] In 2018, there were 11,826 certified nurse midwives (CNMs).[65] In 2019 there were 42,720 active physicians in Obstetrics and Gynecology.[66]
Outside of the United States, midwifery is still practiced in several countries such as in Africa. The first school of midwives in Africa was supposedly founded by Dr. Ernst Rodenwalt in Togo in 1912.[67][68] In comparison, The Juba College of Nursing and Midwifery in South Sudan (a country that gained its independence in 2011) graduated its first class of students in 2013.[69]
Woman's Medical College of Pennsylvania in 1886: Anandibai Joshi, a Marathi Hindu from India (left) with Kei Okami, a Christian from Japan (center) and Sabat Islambooly, a Kurdish-Jewish woman from Syria (right). All three completed their medical studies and each of them was the first woman from their respective countries to obtain a degree in Western medicine.
When women were routinely forbidden from medical school, they sought to form their own medical schools.
Madeleine-Françoise Calais (c. 1713 – fl. 1740) was a pioneer who is referred to as the first female dentist in France.[71]
Dorothea Erxleben (1715–1762) was the first female doctor in Germany and the first woman worldwide to be granted an MD by a university.
Salomée Halpir (1718 – after 1763) was a Polish medic and oculist who is often referred to as the first female doctor from the Grand Duchy of Lithuania.
Lovisa Årberg (1801–1881) was the first female doctor and surgeon in Sweden; whereas, Amalia Assur (1803–1889) was the first female dentist in Sweden and possibly Europe.
Marie Durocher (1809–1893) was a Brazilian obstetrician, midwife and physician. She is considered the first female doctor in Brazil and the Americas.
Elizabeth Blackwell (1821–1910), who was England-born, was the first woman to graduate from medical school in the United States. She obtained her MD in 1849 from Geneva College, New York City.
Frances Hoggan (1843–1927) became the first female doctor in Wales in 1870.[75] She was also the first British woman to receive a doctorate in medicine (1870).
Jennie Kidd Trout (1841–1921) was the first woman in Canada to become a licensed medical doctor in March 1875.
Mary Scharlieb (1845–1930) was a pioneer British female physician, as she was the first woman to be elected to the honorary visiting staff of a hospital in the United Kingdom.
Vilma Hugonnai (1847–1922) was the first female doctor in Hungary. She studied medicine in Zürich and received her degree in 1879. However, she had to work as a midwife until 1897 when the Hungarian authorities finally accepted her degree. Hugonnai then started her own medical practice.
Margaret Cleaves (1848–1917) was a pioneering doctor in brachytherapy who obtained her M.D. in 1873. She was the first female appointed to the University of Iowa Medical Department's examining committee in 1885.
Anastasia Golovina, also known as Anastassya Nikolau Berladsky-Golovina, and Atanasya Golovina (1850–1933), was the first female doctor in Bulgaria.[77][78]
Ogino Ginko (1851–1913) was the first licensed and practicing female physician of Western medicine in Japan.
Ana Galvis Hotz (1855–1934) was the first female doctor in Colombia. She was also the first Colombian woman (and first woman from Latin America) to obtain a medical degree.
Constance Stone (1856–1902) was the first woman to practice medicine in Australia.
Dolors Aleu i Riera (1857–1913) was the first female medical doctor in Spain when she started practicing medicine in 1879.[84]
Annie Lowrie Alexander (1864–1929) was the first licensed female physician in the Southern United States[87]
Emily Charlotte Thomson (1864–1955) was one of the first women admitted to professional medical societies in Scotland and co-founded the Dundee Women's Hospital in 1896.
Eloísa Díaz (1866–1950) became the first female doctor in Chile upon graduating from the Universidad de Chile on 27 December 1886. She obtained her degree on 3 January 1887.
Merbai Ardesir Vakil (1868–1941) was an Indian physician and the first Asian woman to graduate from a Scottish university.
Emma K. Willits (1869–1965) was believed to be only the third woman to specialize in surgery and the first to head a Department of General Surgery at Children's Hospital in San Francisco, 1921–1934.[92]
Alice Hamilton (1869–1970) was an American physician, research scientist, and author who is best known as a leading expert in the field of occupational health and a pioneer in the field of industrial toxicology. She was also the first woman appointed to the faculty of Harvard University.
Vera Gedroitz (1870–1932) was the first female professor of surgery in the world, as well as the first female military surgeon in Russia.
Maria Montessori (1870–1952), renowned educator and one of the first female medical doctors in Italy.
Milica Šviglin Čavov (b. unknown, circa 1870s) was the first Croatian female doctor.[93][94] She graduated from the Medical School in Zürich in 1893, but was not allowed to work in Croatia.[93]
Elizabeth Blackwell, MD, the first woman to graduate from medical school in the United States (1849).
Ernestina Paper (b. unknown, circa mid–1800s) was the first Italian woman to receive an advanced degree (in medicine) in 1877.[102]
Doctor Ethel Constance Cousins (1882–1944) and nurse Elizabeth Brodie were the first European women admitted to Bhutan in 1918 as part of a missionary effort to curtail a cholera outbreak.[103][104]
Muthulakshmi Reddi (1886–1968) was one of the early female medical doctors in India and a major social reformer.
Anna Petronella van Heerden (1887–1975) was the first Afrikaner woman to qualify as a medical doctor in South Africa.[110] Her thesis, which she obtained a doctorate on in 1923, was the first medical thesis written in Afrikaans.[111]
Johanna Hellman (1889–1982) was a German physician who specialized in surgery, and the first woman to be a member of the German Society for Surgery.[112]
Sun Chau Lee (周理信, 1890–1979) was one of the first female Chinese doctors of Western medicine in China.[113]
The small island nation of Tuvalu welcomed its first Tuvaluan female doctors in 2008 as a result of Australian aid.[124]Kakish Ryskulova was the first woman from Kyrgyzstan to become a surgeon.
Ana Aslan (1897–1988) was a Romanian biologist and physician, specialist in gerontology, academician from 1974 and the director of the National Institute of Geriatrics and Gerontology (1958–1988).[citation needed]
Emily Siedeberg (1873–1968) became the first female doctor in New Zealand in 1896.[125]Ellen Dougherty (1844–1919) became New Zealand's first registered nurse in 1902[126] whereas Akenehi Hei (1878–1910) was the first Māori female to qualify as a nurse in 1908 in New Zealand.[127]
Sophie Redmond (1907–1955) became the first female doctor in Suriname after graduating from medical school in 1935.[151]
Alma Dea Morani (1907–2001) was the first woman admitted to the American Society of Plastic and Reconstructive Surgeons.[152]
Yvonne Sylvain (1907–1989) was the first female doctor in Haiti.[153] She was the first woman accepted into the medical school of the University of Haiti, and earned her medical degree there in 1940.[153]
Jane Elizabeth Hodgson (1915–2006) was a pioneering provider of reproductive healthcare for women and advocate for women's rights.
Matilda J. Clerk (1916–1984) was the first Ghanaian woman to win a scholarship for university education abroad and the second Ghanaian woman to become a physician. She was also the first woman to obtain a postgraduate diploma in colonial Ghana and West Africa.[146]
Mary Malahele-Xakana (1917–1982) was the first black woman to register as a medical doctor in South Africa (in 1947).[159]
Katherine Burdon, wife of the then-government administrator, was among the women formally registered as midwives for St. Kitts and Anguilla in 1920.[164]
Ogotu Head (1920–2001) was the first female nursing graduate from Niue after having completed her training in Samoa in 1939.[165]
Ethna Gaffney (1920–2011) was the first female RCSI Professor of Chemistry.
Gabriela Valenzuela and Froilana Mereles were the first women to graduate with a medical degree in Paraguay in 1924. Valenzuela, however, is considered Paraguay's first practicing female doctor.[168]
Augusta Jawara (1924–1981) was the first woman from The Gambia to qualify as a state certified midwife in 1953. She completed her training in England.[169]
Josephine Nambooze (born 1930) started her practice as the first female doctor in Uganda in 1962.[178] Selina Rwashana was the first psychiatric nurse in Uganda after having completed her training in the United Kingdom during the 1950s.[179]
Rear Adm. Dalva MendesDalva Maria Carvalho Mendes (born 1956), Brazilian doctor and soldier; first woman to be made a rear admiral in the Brazilian Navy
Rosa Mari Mandicó (born 1951) became the first qualified female nurse in Andorra in 1971.[198] In 1991, Concepció Álvarez Martínez, Isabel Navarro Gilabert, Dominica Ramond Punsola, Montserrat Rue Capella, Pilar Serrano Gascón, Purificación Valverde Hernández and Maria Líria Viñolas Blasco were the first nurse graduates in Andorra.[199]
Under the tutelage of matron Daw Dem, Pem Choden, Nim Dem, Choni Zangmo, Gyem, Namgay Dem and Tsendra Pem became the first nurses in Bhutan in 1962.[205]
Clara Raquel Epstein (born 1963), first Mexican-American woman U.S. trained and U.S. board certified in neurological surgery and youngest recipient of the prestigious Lifetime Achievement Award in Neurosurgery.[206][207][208]
Madeline Nyamwanza-Makonese (b. unknown, mid-20th century) was the first female doctor in Zimbabwe. She was the second African woman to become a doctor and the first African woman to graduate from the University of Rhodesia Medical School in 1970.
Rehana Kausar (b. mid-20th century) became the first woman doctor from Azad Kashmir to graduate from Medical School in Pakistan in 1971.
Margaret Allen (born 1948) became the first female heart transplant surgeon in the United States after having performed a transplant performed in 1985[217]
Kinneh Sogur was the first home-trained female medical doctor to graduate from the University of the Gambia (UTG) in 2007.[220] The medical school was the first one to be established in the country in 1999.[221]
Alice Niragire was the first Rwandan female to graduate with a master's degree in surgery in 2015 since the course was introduced in 2006.[229] In 2018, Claire Karekezi returned to Rwanda to become the country's first female neurosurgeon.[230]
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