Family-building difficulties among female physicians, trainees ‘not hyperbole’

Key takeaways:

• Women physicians wait longer than the general public to build a family.
• More than one-third of physicians surveyed reported that the COVID-19 pandemic further delayed family planning.

Explicit and implicit messages toward female physicians and trainees to wait to have children have led to significant challenges in family building compared with women in other professions and the general public.

For many, it is suggested that physicians should delay family building until after medical training is finished, especially among those of us with a uterus, Arghavan Salles, MD, PhD, clinical associate professor and special advisor for diversity equity and inclusion programs in the department of medicine at Stanford University, told Healio.

“Physicians often wait until after training to build our families, and this is problematic because the time of our training often coincides with our peak reproductive years,” Salles said. “Higher rates of infertility means that we have fewer children than other individuals and we have our first child at a later age than others. We are also more likely to require assisted reproductive technologies, which are very expensive, time consuming and emotionally laden.”

Another challenge in family building among female physicians is a lack of workplace support.

“In the U.S., we don’t have federal paid parental leave and there are no adequate parental leave policies at most of our institutions,” Salles said. “We often don’t have onsite or low-cost child care. Bottom line, we don’t have the support in place for people to build their families, whether it is in training or after. It is very challenging for individuals in medicine to be able to build the families they want.”

Planning during a pandemic

Salles and colleagues conducted a cross-sectional study that included a fertility questionnaire distributed between April and May 2021 among 3,116 physicians and trainees (90.6% women) recruited via social media.

Among all participants, 1,885 (60.5%) responded to a question about how COVID-19 affected their family planning. Overall, 37.3% (n = 703) reported their family planning was impacted by the COVID-19 pandemic.

“We ended up adding in the question about the pandemic because we weren’t sure exactly how that was going to affect physicians,” Salles said. “The whole focus of the study was not necessarily COVID-19, but it was important to address this major world event that changed things for so many people in so many ways. I was surprised to learn that some decided this was a perfect time to have a baby. No ‘shade’ to them, but that surprised me.”

In the spring of 2020, Salles was a single woman, with no children, preparing to take the next step in her fertility journey when the COVID-19 pandemic hit.

“Fertility clinics shut down for a relatively brief period of time, which felt like a long time to me, and by the time they opened back up, I was not emotionally or mentally in the right headspace to move forward. I felt destabilized by what was happening around the world and the uncertainty of what the future held,” she said. “I volunteered in an ICU in New York City in April of 2020. I saw a lot of death. So even though right before the pandemic I was planning to move on to the next fertility step, I ended up not going back to see my reproductive endocrinologist for maybe more than a year later.”

Not hyperbole

While the early phase of the pandemic is over, the impact of it will be felt for many years to come, according to Salles.

“It might seem like the delays related to the pandemic were relatively minor, but it wasn’t hyperbole when we wrote in this manuscript that for some individuals, it was the difference between having a child and not having one,” she said.

Researchers additionally identified seven major themes surrounding family building in the study, including the most prominent theme of delaying family building because of fertility treatment challenges, inability to see a partner, delays in weddings, deliberate pauses in childbearing, COVID-19 vaccination, adoption delays, financial stressors and change in desire to have children at all.

Specifically regarding fertility treatment access challenges, individuals reported difficulty in scheduling appointments, fear of COVID-19 exposure and lack of work coverage.

When describing access to in vitro fertilization, one respondent in particular stated: “I had a lot of frustration as someone who was putting themselves on the line every day to help people during a pandemic and was then denied access to my own care.”

Moreover, many physicians and trainees reported the decision to not have children at all because of the COVID-19 pandemic.

“The increased stress that people experienced, the financial insecurity, the lack of access to clinics, women having to deliver without family or friend support, were all challenges of being pregnant during the pandemic. This finding was not at all unexpected based on what we knew having lived through it,” Salles said.

Advocacy needed

Salles said there are multiple ways for physicians to advocate for physician family building.

“One way is to change the culture of explicit and implicit messaging telling people to wait until after medical training for family building,” she said. “I would love for individuals to feel supported in building their families whenever they want, whether it’s during medical school, residency, in fellowship or after, and that support should include having insurance coverage for the health care needed to do that, whether it’s for cryopreservation of eggs, sperm or embryos, or if needing IVF.”

Cultural change should also include having backup when people go out on maternity leave so they don’t feel like they are burdening their coworkers, and so that coworkers don’t feel they’re being burdened, Salles added.

There is also a need for a standardized parental leave policy.

“With a standardized policy, people won’t have to negotiate parental leave on a case-by-case basis,” Salles said. “Child care and lactation support are also needed and we should do away with motherhood penalties and maternal discrimination, which we know exist. Financial support is needed for adoption and gestational carriers — all of the things that it takes to build a family should be supported through health insurance. Most of our institutions do not currently support most of those pathways. This is especially problematic for same-sex couples, and single people who don’t have any other way and are going to need some of these different reproductive technologies or other family building paths to be able to have children. It all needs to be fixed.”

For more information:

Arghavan Salles, MD, PhD, can be reached at arghavan@stanford.edu.