At the Mass General Research Institute, our community of 9,500+ investigators work diligently to publish peer-reviewed work and scientific findings to better understand disease and develop solutions to medicine’s most pressing challenges.

Footnotes in Science is a space where investigators bring you the behind-the-scenes details of their recently published work.

In this Q&A, we pick the brain of Suzanne Koven, MD, MFA, regarding her latest co-authorship in a recently published perspective in The New England Journal of Medicine.

Dr. Koven is the writer-in-residence at Massachusetts General Hospital.

Co-authors of the perspective include Jessica Haberer, MD, and Deborah Gomez Kwolek, MD.

What motivated you and your team to publish this perspective?

In my book, Letter to a Young Female Physician, I told of being pregnant as a medical resident in the 1980s. I didn’t ask for and didn’t receive any change in my work schedule and developed a life-threatening complication.

Whether or not that complication was caused by my work schedule, that schedule certainly added to the stress of illness, childbirth, and caring for a newborn. After the publication of the book, I spoke with female residents all over the U.S. and was alarmed to learn how many of them saw their reproductive choices as limited as mine were 35 years ago:

● Defer pregnancy and incur the higher risks of infertility and pregnancy complication older women face

● Work through pregnancy with a grueling schedule

● Take time off during residency and risk losing professional opportunities, such as fellowships

I discussed this issue with two colleagues, Deborah Gomez Kwolek, MD, and Jessica Haberer, MD, who had, like me, faced the challenge of combining residency and pregnancy decades ago, and both of whom are advocates for women in medicine and women’s health.

We decided to collaborate on a perspective, Pregnancy and Residency—Overdue for Equity, with the hope of highlighting this issue on behalf of our younger colleagues.

Can you expand on the limited options residents who wish to become pregnant face?

Other limitations, in addition to those mentioned above, include often-insufficient time and privacy for breastfeeding, the high cost of childcare (especially for those who work very long hours), short parental leaves compared to those offered in other professions and other nations, and little flexibility in schedules enabling trainees who become parents to graduate with their original residency classes.

Several of these limitations affect adoptive and foster parents, and non-birthing as well as birthing parents.

Have there been any improvements in the benefits residents who wish to become pregnant have in the past five years?

There have been some improvements. Many residency programs offer lactation rooms as well as helpful support from night float coverage and ancillary services such as phlebotomy. Policies established by the Accreditation Council for Graduate Medical Education and laws passed at the state and federal level regarding leave for new parents also represent progress. But implementation of policies has been inconsistent from one residency program to the next and even within and among departments at individual hospitals.

Plus, as essential workers, physicians may be exempt from protections offered by government programs such as FMLA. 

How can healthcare organizations help in changing the status quo to ensure a structural change?

First, recognize that the constrained choices residents who wish to become pregnant face result from systemic gender inequity in medicine.

This inequity is still in evidence in the gender pay gap and by many other measures. Consistent implementation of policies that support pregnant residents should be the norm, not “favors” offered by particularly enlightened program directors.  

What are the biggest takeaways from your published perspective?

In the U.S., women now outnumber men in medical schools and among physicians under 35. Most medical residents are in their 20s and 30s, the years when someone is most likely to be able to become pregnant, should they wish to do so, and have a healthy pregnancy.

Residency training was designed in the 19^th century by men for men who usually did not have children, since residents then were not permitted to marry.

We wrote this Perspective to call for new policies and attitudes toward pregnancy in residency that acknowledge the realities of biology and contribute to long-overdue equity.