Family planning and fertility are major issues for women in medicine

By Geir O'Rourke

15 Aug 2022

Women in medicine are delaying starting families and even facing infertility issues thanks to the demands and inflexibility of their careers, Australian research has shown.

The survey conducted last November also revealed half had experienced at least one pregnancy complication, while a shocking 36% had suffered a pregnancy loss.

Some 1040 doctors who had attempted or succeeded in becoming pregnant answered the poll, which was advertised on a Facebook page for medical parents in Australia and NZ.

More than 60% of respondents said they had delayed family planning due to work, reporting a median age of 32.4 at the time of their first child.

This was some three years higher than the national average of 29.4, the researchers noted in Frontiers in Medicine (link).

“The perceived expectation that young women should wait until the end of training to have children may account for the high rate of respondents who needed fertility testing (37%),” they added.

“Moreover, a substantial portion of them went on to require IVF (27.3%). The length of medical training, as much as 14 years in some sub-specialties, may well contribute to the older maternal age, and may necessitate a disproportionate number of doctors having to utilize assistive reproductive technology.”

Besides advanced age and long working hours, there was a long list of occupational hazards potentially impacting doctors’  fertility and leading to pregnancy loss.

These included ionising radiation, electromagnetic fields, communicable diseases, cytotoxic and other chemical agents, surgical smoke, and physical stress (such heavy lifting, stair climbing, or night shifts), the authors said.

It’s not the first time concerns have been raised about the challenges of raising a family while maintaining a medical career.

No flexibility

RACP training committee chair Dr Davina Buntsma has argued specialist trainees are now “limiting family size” or even being forced to leave the college’s training programs as they did not allow enough flexibility for family planning.

“Parental leave is currently limited to two years per training program,” she told the RACP congress in Melbourne earlier this year.

“One trainee had planned to have four children but was only able to have two due to the time limit on allowable leave.”

“This is our reality, many trainees are limiting their family size to accommodate training.”

She called for major improvements to the college’s parental leave policies, pointing out basic trainees now commenced at 31 years of age on average and advanced trainees at 34 – the same ages when many would seek to start a family.

This was supported by the study authors, led by Dr Jasmina Kevric, a surgical registrar at Northern Hospital in Melbourne.

“To address the inflexibility during training, part-time training positions should be incorporated into the training structure to minimise delay in starting a family and be part of accepted as part of a culture change across the profession,” they wrote.

“Access to parental leave (both males and females) should be prioritised to meet the demands of the rising number of female doctors.”

But there was also more to be done to ensure mothers were supported in returning to work, particularly given the need for spaces to enable breastfeeding, the authors wrote.

They noted one in four respondents said they never had an appropriate place to express at work.

Workplace demands resulted also in 21% of specialist physicians and trainees discontinuing breastfeeding, compared to just 13% of GPs and 49% of surgeons.

“Systemic factors within hospital rostering and infrastructure need to be addressed to reduce the inadequate time and space for working mothers to breastfeed or express,” the authors wrote.

“This study’s findings suggest that there is a need for simple structural strategies to be implemented, such as setting aside a room for expressing, furnishing the space with a fridge for storing expressed breast milk and allocating a break between clinic patients and operating lists.”

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