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Stanford University School of Medicine

Women less likely than men to receive surgery in conflict areas, study shows

Stanford researchers have found that men are more likely to receive surgery in armed conflict areas. Their findings were recently published in the journal Surgery.

The authors, led by Stanford general surgery resident Joseph Forrester, MD, MSc, analyzed the records of nearly 50,000 surgeries received at Medecins Sans Frontieres (Doctors Without Borders) facilities in 12 conflict areas across the Middle East and Africa between 2008 and 2014.

They found that men received 69 percent of all surgeries performed, and in some study countries, the sex disparity was even greater. In Syria, for example, men received 84 percent of the surgeries.

“It is critical to understand what factors may underlie this disparity to ensure equitable and appropriate care for all patients in an already tragic situation,” the authors write.

The study was the first to explore sex disparities in operative care in conflict zones, and comes at a time when nearly 1 percent of the global population – the most in history – is displaced due to conflict, according to a 2014 report by the United Nations.

Recognizing the immense need for surgery in areas often lacking health care infrastructure and overburdened by an influx of patients due to violence, the authors set out to understand “if, and why, women may be less likely to receive operative care.”

Based on their assessment of patient and country-level predictors of sex disparity, men were 1.7 times more likely than women to have an operative intervention in a predominantly Muslim country.

As might be expected in a conflict area, men received more surgeries than women resulting from violent trauma caused by gunshots or explosions, for example. Yet, men were recipients of 73 percent of surgical interventions from nonviolent trauma, including car crashes or earthquakes, and 61 percent of interventions not related to trauma, like tumor removal or cleft palate repair.

As for the cause of the dramatic sex differences? The authors can’t say for sure.

“The key question,” they write, “is whether sex inequities exist because of epidemiology of the conditions treated, or for other yet unidentified causes.”

The paper’s senior author, Sherry Wren, MD, has spent much of her career working in low-resource settings in sub-Saharan Africa and has been a strong advocate for women in surgery.

“We don’t know causality here. My hypothesis is we’re looking at societal judgment about how women are valued,” Wren said in a Reuters article. “I think it’s the same value judgments that keep males in school longer. It’s all about gender-based decisions.”

Wren is part of a growing movement advocating for continued research and discussions about gender disparities in global health, which will be a focus of Stanford’s upcoming Women Leaders in Global Health conference taking this October.

Previously: Stanford surgery chair Mary Hawn and the changing face of the OR, Surgery in the time of Ebola: A conversation and Study shows huge lag in surgery in poor nations
Photo courtesy of U.S. Army Africa by Capt. Charles An

Kate Nelson is a senior at Stanford studying human biology with a concentration in global health policy and infectious disease. 

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