Women continue to be underrepresented in medical leadership and science worldwide. How is this reflected research on congenital heart defects?

What is the representation of women in publications relevant to medical careers? Which influencing factors are decisive for this?

Scientists from the Competence Network for Congenital Heart Defects have quantified this for the first time in a broad-based gender study.

Alarming Results

The researchers involved in the study evaluated more than 35,000 publications on research results in the field of congenital heart defects from 2006 to 2015. The results were clear: worldwide, only 25 percent of authors are women. They make up only 30.2 percent of all first authors of the publications studied, and only 20.8 percent of all senior authors.

"The extent of gender inequality in our field surprised us. Especially in a research area like congenital heart defects, such a result must be alarming. In such dynamically growing pioneering fields, there is a desperate search for talented young researchers," says Paul-Gerhard Diller, senior physician at the Department of Cardiology III: Congenital Heart Defects (EMAH) and Valvular Heart Disease at the University Hospital Münster.

Slight Increase with Large Regional Differences

According to the study, the proportion of female first authors in publications increased by about 0.8 percent worldwide over the entire period. Among senior female authors, the increase was just under 0.6 percent.

However, a closer look at individual regions and countries shows that the trend varies widely, and in some cases is even declining, as cardiologist and study author Margarita Brida points out: "While North America and some regions in Europe showed an increase in the proportion of female authorship, Eastern Europe and Western Asia showed an actual decrease in female first authorship."

The total number of female authors and senior authors also declined here, although the percentage of women in Eastern European countries was above average throughout the study period.

Germany Lags Behind

Some regions, but not all their countries, contributed to the global increase in the proportion of female authors. Germany, for example, one of the wealthiest countries in the world, is an outlier in the group of Western European countries and is lagging behind.

At 22.8 percent, the proportion of first authors in Germany is below both the global and Western European average of 33.2 percent. Among senior female authors, whose share of 18.3 percent in Western Europe is already well below the global average, Germany has a share of only 12.1 percent.

Female First Authors and Mixed Teams Perform Better

At the same time, the researchers found that both publications with a female first author and publications with a mixed team of authors were published in journals with a significantly higher impact factor and were cited much more frequently than those with a male first author.

Impact factors and citations in other recognized professional media are important for authors' medical careers, as Gerhard-Paul Diller explains: "Publications in peer-reviewed journals not only say something about the relative quality of research. They remain an integral part of the doctoral system and are generally considered essential for advancement to the top echelons of academic medicine.

In addition, such publications play an important role in the international competition for research funding and medical innovation. Here, too, the figures show that Germany as a research location falls far short of its potential in terms of academic production. In terms of the number of publications in the field of congenital heart defects, Germany ranks sixth behind the United States, Japan, China, the United Kingdom, and Italy.

In terms of landmark publications, Germany ranks third behind the United States and the United Kingdom. "This is a worrying state of affairs for the number one location for innovation. We will continue to lose competitiveness if we fail to promote the potential and know-how of women," the GUCH cardiologist fears.

Gender Bias Prevents Diversity

While women account for nearly one-third of all authorship in publications of their own research, they rarely appear in publications requested by professional publishers, such as prefaces, case reports, or guidelines. This suggests that male-dominated informal networks continue to favor men.

At the same time, female scientists wrote letters to editors significantly less often than their male colleagues. From the scientists' point of view, this is a sign that both gender diversity, which is conducive to research, and the self-esteem of female researchers suffer from male-dominated structures, traditional gender roles, and sometimes unconscious patterns of perception.

"The reluctance of women scientists is no coincidence. Active engagement in research must become more attractive to women. This also means that we, as male supervisors and decision-makers, need to rethink how we can consciously and specifically promote gender-diverse research activities," concludes Gerhard-Paul Diller.

Senior Female Authors Promote First Female Authors

In addition, the researchers' analysis of country-specific factors that have a positive impact on women's participation in research provides a glimpse of a possible solution to the problem. "The likelihood of a first author's participation increased especially when a senior female author was involved in the research," Margarita Brida summarizes the result of the analysis.

The researchers took into account the country's gross domestic product, the Human Development Index (HDI), the Gender Inequality Index (GII), the number of doctors per capita and the participation of senior female authors. Of these, 50 percent of publications by senior female authors were first female authors, while only a quarter of publications by men were first female authors.

In addition to appropriate support and compensation structures, the researchers recommend the targeted promotion of female leaders and role models, mentoring and sponsorship programs, and adequately funded local continuing education programs for this purpose.