BackgroundOrthopaedic surgery is the surgical specialty with the lowest proportion of women. Conflicting evidence regarding the potential challenges of pregnancy and parenthood in orthopaedics, such as the implications of delayed childbearing, may be a barrier to recruitment and retainment of women in orthopaedic surgery. A summary of studies is needed to ensure that women who have or wish to have children during their career in orthopaedic surgery are equipped with the relevant information to make informed decisions.Questions/purposesIn this systematic review, we asked: What are the key gender-related barriers pertaining to (1) family planning, (2) pregnancy, and (3) parenthood that women in orthopaedic surgery face?MethodsEmbase, MEDLINE, and PsychINFO were searched on June 7, 2021, for studies related to pregnancy or parenthood as a woman in orthopaedic surgery. Inclusion criteria were studies in the English language and studies describing the perceptions or experiences of attending surgeons, trainees, or program directors. Studies that sampled surgical populations without specific reference to orthopaedics were excluded. Quantitative and qualitative analyses were performed to identify important themes. Seventeen articles including surveys (13 studies), selective reviews (three studies), and an environmental scan (one study) met the inclusion criteria. The population sampled included 1691 attending surgeons, 864 trainees, and 391 program directors in the United States and United Kingdom. The Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices tool was used to evaluate the risk of bias in survey studies. A total of 2502 women and 560 men were sampled in 13 surveys addressing various topics related to pregnancy, parenthood, and family planning during an orthopaedic career. Three selective reviews provided information on occupational hazards in the orthopaedic work environment during pregnancy, while one environmental scan outlined the accessibility of parental leave policies at 160 residency programs. Many of the survey studies did not report formal clarity, validity, or reliability assessments, therefore increasing their risk of bias. However, our analysis of the provided instruments as well as the consistency of identified themes across multiple survey studies suggests the evidence we aggregated was sufficiently robust to answer the research questions posed in the current systematic review.ResultsThese data revealed that many women have witnessed or experienced discrimination related to pregnancy and parenthood, at times resulting in a decision to delay family planning. In one study, childbearing was reportedly delayed by 67% of respondents (304 of 452) because of their career choice in orthopaedics. Orthopaedic surgeons were more likely to experience pregnancy complications (range 24% to 31%) than the national mean in the United States (range 13% to 17%). Lastly, despite these challenging conditions, there was often limited support for women who had or wished to start a famil...
Drawing from Michel Foucault’s discussion of the plague and smallpox epidemics, this essay unpacks the “inextricable link” between racism and biopower. By looking at the role of essential workers and ideas of differential risk in the current Covid-19 pandemic, this essay argues that Foucault’s work allows us to trace the techniques that biopower uses to generate and normalize the increased vulnerability of racialized groups. Techniques of quarantine and their exception for essential work expose the way that biopower relies on state racism through the production of differential and racialized vulnerabilities. One can draw connections between Foucault’s analysis of those of "little substance” who continued to work during plague quarantines and modern day essential workers to demonstrate how biopower protects the population by increasing and normalizing the vulnerability of an expendable subclass. Foucault explains these differentiated normalities through the smallpox epidemic, where the risk of contracting and dying of smallpox was distinguished based on age, location, profession, etc. One should build on Foucault here, and consider ‘race’ as another factor that is used to differentiate ‘normal’ levels of risk. This normalization preserves a system which makes people of colour vulnerable under the regime of biopower. While Foucault does not directly engage with race in his analysis of plagues and epidemics, his ideas on biopower provide a framework through which we can better understand the ways that racism permeates our current pandemic.
In collaboration with the American College of Veterinary Pathologists
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