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The Health Wrap: disrupted scientific careers, developments in maternity care, Thanksgiving – and “Hurricane” Hawkins

The pandemic’s inequitable impacts upon women’s health and wellbeing have been well documented – and the gender divide in research and university careers is also explored in the investigation below by Associate Professor Lesley Russell.

In her latest column, Russell also reports on developments in maternity care, including what’s happening with rural services, Birthing on Country, and the maternal health crisis in the United States.

She marks Thanksgiving with some historical truth-telling, and also shares some advice for healthy, happy ageing from Julia “Hurricane” Hawkins.


Lesley Russell writes:

Since early last year, every edition of The Health Wrap has kicked off with something about coronavirus. This edition continues that pattern – but the topic is slightly different from the epidemiological and biomedical issues I usually cover.

The coronavirus pandemic has powerfully highlighted the importance of scientific research and development – and also the importance of having a scientifically literate population. But even as researchers have become familiar names and faces through their media appearances that help describe and explain the issues, the pandemic is also disrupting scientific careers.

There’s been a rash of recent papers looking at the impact of this disruption, especially for women.

(I’m aware that there are almost certainly similar issues and studies for other professions, but this analysis is focused on science, technology, engineering, mathematics and medicine – STEMM.)

Earlier this month Nature published the results of its sixth Salary and Job Satisfaction Survey. The 2021 survey of 3,200 scientists takes an international look at the impact of the ongoing COVID-19 pandemic on careers, along with concerns about salaries, job satisfaction and issues of workforce diversity and inclusion.

While a small percentage (14 percent) of scientists, mainly those in the health field, saw a career-related upside to the pandemic, 43 percent felt professionally threatened by shutdowns with limited ability to conduct experiments and collect data, supply shortages, and strained collaborations. Staying productive and engaged and teaching were all harder.

Especially hard hit were researchers in the fields of ecology and evolution (51 percent) and physics (49 percent), perhaps because these areas require fieldwork or lab-based experiments. Researchers in the United States (38 percent), China (41 percent) and the United Kingdom (43 percent) were much less likely than those in Brazil (72 percent) and India (61 percent) to say the pandemic had slowed down their careers.

The pandemic has been especially challenging for researchers with childcare responsibilities.

The ways this has played out for women is highlighted in a recent study from the US National Academies of Sciences, Engineering and Medicine. It identifies and documents how the pandemic disrupted the careers of women in academic STEMM professions during the initial nine-month period of the pandemic from March 2020.

The take-outs from this report can be summarised succinctly:

  • The pandemic blurred the boundaries between work and non-work, infusing ambiguity into everyday activities.
  • While adaptations such as Zoom allowed people to stay connected, the evidence available at the end of 2020 suggested that the disruptions caused by the COVID-19 pandemic endangered the engagement, experience, and retention of women in academic STEMM.

A number of papers related to this report are accessible from this NAS webpage.

Australian perspectives

Australian studies highlight the same problems.

A report from the Australian Academy of Science released in July found that the impact of the pandemic on women in the STEM workforce (it did not include medicine) across the Asia-Pacific region has heightened the challenges and barriers they face in progressing their careers.

A survey conducted in 31 Asia-Pacific countries as part of the report found a worsening of gender inequity in the STEM workforce across the region brought about by changes in lifestyle and the blurring of boundaries between the spheres of work and home, along with increased domestic and caring responsibilities. This echoes precisely the findings of the NAS report.

Almost half of the women surveyed who had caring responsibilities do not have access to flexible work. These problems come on top of loss of some 40,000 tertiary positions  and the failure of the Morrison Government to apply JobKeeper to this sector.

An earlier report, commissioned by then Federal Science Minister Karen Andrews from the Rapid Research Information Forum last May, found that hard-won gains by women in STEM were especially at risk. The challenges are most acute for women with children aged under 12.

The report says female university staff are 50 percent more likely than men to be in insecure employment, with these jobs “likely to be the first to go”. It called for efforts to monitor and mitigate the pandemic’s impact on jobs and careers.

An article last year in The Lily (a publication of The Washington Post) highlighted that women are lodging fewer journal submissions than before the start of the pandemic, while men’s submission rates have increased. This trend could potentially harm women’s academic job and funding prospects for years to come.

There is also this article published in The Conversation in October 2020 on how the pandemic is widening the academic gender divide.

What can and should be done to address these serious issues that affect both gender equity but also productivity in STEMM?

It’s notable that despite the report commissioned by Minister Andrews, there has been no specific response from the Morrison Government.

The Academic Director of the University of Sydney’s Science in Australia Gender Equity (SAGE) program, Professor Renae Ryan, who is also a member of the OECD Women in STEM Engagement Group, says that leaders (in politics, business and academia) must be held to account to ensure gender equity gains are not lost because of COVID-19.

She notes that: “Women walked into this pandemic behind men, and we need to make sure we don’t lose decades of progress and push to make sure men and women walk out of this pandemic walking side by side.”

A Joint Sector Position Statement on “Preserving Gender Equity as a Higher Education Priority During and After COVID-19” has been signed by 18 higher education institutions in Australia.

The statement focuses on seeking equal representation of women in COVID-19 decision-making, formal monitoring and reporting on gender equity impacts, and maintaining gender diversity with efforts to ensure representation at senior levels and women in leadership positions.

As you think about these issues, here’s some additional, somewhat related, food for thought:

  • A recent paper looked at women’s career progression in an Australian regional university. If you think it’s tough for women at metropolitan universities, it’s even worse for women at regional campuses.
  • The 2021 Women for Media Report: Take the next steps from the Women’s Leadership Institute Australia. This report found that women are much less likely to be quoted in media articles about science and technology than men.

Think of all the amazing women who are experts in COVID-19 – yet when media articles on COVID-19 from May 2021 were scrutinised, only 27 percent of the quotes were from women.


Improving maternity care

This month the Australian Institute of Health and Welfare released three reports on maternity care.

Australia’s Mothers and Babies looks at the characteristics and health of mothers and their babies and trends on the antenatal period, labour and birth, and outcomes for babies at birth.

Maternity care in Australia: first national report on models of care, 2021 is the first report to look at the models of maternity care used in Australia. It’s surprising to learn that the 242 maternity services report using some 830 models of care that fall into 11 major categories.

National Core Maternity Indicators presents information on measures of clinical activity and outcomes to assist in improving the quality of maternity services. The indicators – which will serve as a baseline for future monitoring – cover data for the majority of women who gave birth in Australia from 2004 to 2019 and are grouped into 3 broad topic areas – antenatal period, labour and birth and birth outcomes.

Recent media reports have highlighted how maternity services are being stripped from rural and even some regional hospitals. The Rural Doctors’ Association of NSW says the loss of maternity departments is the “canary in the coalmine” that can spell the beginning of the end for what rural hospitals are able to offer patients.

This means that pregnant women living in rural and remote areas must travel long distances, away from family and community, to give birth.

It’s a particular issue for Indigenous women. In the Northern Territory for example, birthing services are only offered in four major hubs: Darwin, Alice Springs, Katherine and Nhulunbuy.

Maternity services are seen by rural people as essential for their community – a position highlighted by the Rural Doctors of Australia Association policy statement on rural maternity services.

However, there is no mention of this in the National Party’s health policy campaign promises from the last federal election. Nor is maternity care a part of the Government’s Stronger Rural Health Strategy.

The National Rural Health Commissioner, Dr Ruth Stewart, released a position statement on Birthing: A vital services for rural communities in October. She highlights that rural and remote families experience higher rates of maternal and neonatal deaths and that maternity care is not delivering equitable outcomes for Australian rural women whether they identify as Aboriginal or Torres Strait Islander or otherwise.

But it seems the Morrison Government is not listening to its rural health expert. Moreover, progressing work at the national level in this area is more difficult since COAG was abolished (the most recent national strategy for maternity services was released by the COAG Health Council in August 2019).

It is encouraging to see efforts at the coalface to enable more Indigenous women to give birth on Country.

In 2015 the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), the Council of Remote Area Nurses of Australia (CRANAplus) and the Australian College of Midwives (ACM) signed a joint position statement on “Birthing on Country” in support of establishing birthing on country models of care in Australia.

The Transforming Maternity Care Collaborative is helping to drive these efforts forward, both nationally and internationally.

There are also a number of on-the-ground consortia researching and delivering services, including the Molly Wardaguga Research Centre at Charles Darwin University and the Institute of Urban Indigenous Health in South-East Queensland. Both these organisations expressed disappointment that the last federal budget did not include any funding support for birthing on country services, despite growing evidence of their success.

This are highlighted in a very recent publication in The Lancet Global Health from Professor Sue Kildea and colleagues at the Molly Wardaguga Research Centre, which assessed the impact of a birthing on country model on Indigenous birth outcomes.

The research found that women who received a birthing on country service were 54 percent more likely to attend for antenatal visits, 38 percent less likely to give birth preterm, and 34 percent more likely to exclusively breastfeed on discharge from hospital.

These outcomes echo similar findings in studies with Indigenous-led services in Canada and Aotearoa New Zealand in a paper appropriately entitled “A call for action that cannot go to voicemail: Research activism to urgently improve Indigenous perinatal health and wellbeing.”

You can read more about the birthing on country agenda here.

ABC News has a wonderful video essay about the efforts to bring birthing on country back to Yolngu country here.

To conclude, a note about what is happening about maternal morbidity and mortality in the United States, where there is a maternal health crisis. The number of pregnant and birthing American women dying more than doubled between 1987 and 2018, rising from 7.2 deaths per 100,000 live births to 17.4 deaths per 100,000 live births.

Racial disparities are stark: Black Americans are three times more likely to die from pregnancy-related causes than their white counterparts; Indigenous Americans are approximately twice as likely. Geographic disparities are also evident, with rural Americans experiencing rates of maternal mortality twice as high as those for urban residents.

But maternal mortality is only the tip of the iceberg. Rates of severe maternal morbidity, which includes unexpected, life-threatening outcomes are also rising, with similarly wide racial and geographic disparities as those found with maternal mortality.

The Commonwealth Fund has just released a report intended to inform policy aimed at lowering rates of maternal morbidity and mortality and eliminating inequities. This is a focus of the Biden-Harris Administration.


More on the Health Technology Assessment review

In the September 28 edition of The Health Wrap, I wrote about the upcoming Health Technology Assessment (HTA) Policy and Methods Review, which is part of the new strategic agreements signed between the Federal Government and the pharmaceutical industry groups. This will involve the Therapeutic Goods Administration (TGA) and the Pharmaceutical Benefits Advisory Committee (PBAC) and may also include the Medical Services Advisory Committee (MSAC).

It is stated to cover “methods for evaluating medicines for rare diseases, emerging technologies such as cell and gene therapies, and other precision-based medicines, the use of real-world evidence in decision making, and the feasibility of international work-sharing for reimbursement submissions, amongst other issues”.

I confess to some cynicism and concerns about this, and worry that the Morrison Government will (as has become its modus operandi) attempt to keep the review out of the public gaze.

But I recently tuned in to an industry Zoom seminar and was somewhat relieved to hear from Professor Andrew Wilson, who heads the PBAC, about needed changes.

This is a summary of his presentation. It has been written up in online journals and newsletter, but these all require a subscription to access.

Wilson spoke frankly about how modern therapies have made the job of assessing the value of new products (that’s essentially the role of the PBAC) an increasing challenge.

As an example, he quoted single dose gene therapy (like CAR-T) where the upfront cost is very high (maybe more than a million dollars) and there is no information about how long the benefit lasts. Also in this new world of precision medicine, it is now necessary to think about the essential links between diagnostic testing and therapeutic treatment.

The pandemic has highlighted the need for speedy access to vaccines and treatments, but this often means the available evidence about comparative effectiveness and value is poor. While managed early entry programs can be attractive as a way for patients to get earlier access to treatment, Wilson describes these a challenge.

“At the moment we don’t have a framework where we can do this. We’ve got a few examples where we’ve done it – we’ve managed to reach contracts with companies to achieve it but it’s not actually a prescribed part of the way we can look at it and I’m hoping one of the things that will come out is a greater flexibility for us to look at this.”

The most heartening thing was to hear what Professor Wilson had to say about consumer involvement in the HTA process (if not the review).

“We’re certainly planning on trying to trial more open meetings for patient groups can come and hear the deliberations of PBAC,” he said. “We’re somewhat constrained in relation to that because of some of the commercial in confidence issues we have to deal with but to the extent that we can we’re interested in exploring that.”


On Thanksgiving

 Thursday November 25 is Thanksgiving Day in the United States and it’s a holiday we love to celebrate with friends here in Australia.

It means a mad scramble to get a turkey (even more expensive than usual this year) and find frozen cranberries and tinned pumpkin (because no-one makes pumpkin pie from scratch) and then a major cooking spree. The best part – leftovers, often for several days.

Every year we ask the guests around our table to bring a Thanksgiving story. This is about my story for this year, the 400th anniversary of the first Thanksgiving in 1621.

Despite being a big fan of American history, I must sadly confess that I had never really stopped to consider the veracity of the usual way the first Thanksgiving is outlined: local Native Americans welcomed the courageous, pioneering pilgrims to a celebratory feast.

But much of that story is a myth riddled with historical inaccuracies and the failure to recognise how the lives and society of the Wampanoag Indians were forever damaged after the English arrived in Plymouth, Massachusetts.

For the Wampanoags and many other American Indians, the fourth Thursday in November is considered a day of mourning, not a day of celebration. Because while the Wampanoags did help the Pilgrims survive, their support was followed by years of a slow, unfolding genocide of their people and the taking of their land.

You can read more here.

This year we will once again celebrate all that we have to be grateful for (politics perhaps excluded) but we will also pause to remember the sadness this day generates for many First Nations Americans.


The best of Croakey

Continuing the theme of historical truth-telling, don’t miss the 2021 Dr Charles Perkins Oration, delivered recently by Tony McAvoy SC, the first Indigenous Senior Counsel and Co-Chair of the Indigenous Legal Issues Committee of the Law Council of Australia.


The good news story

Regular readers won’t be surprised that I found this story  – about a 105-year-old runner – inspiring and uplifting.

At the Louisiana Senior Games on November 6, 105-year-old Julia Hawkins of Baton Rouge became the oldest woman to run the 100 meters in official competition – clocking in at 1 minute 3 seconds (a slightly slower time than she’d hoped for).

Not surprisingly, she was the only competitor in the race for people 105 and older.

“I want to keep running as long as I can,” Hawkins said. “My message to others is that you have to stay active if you want to be healthy and happy as you age.”

You can watch her run here.


Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.

Previous editions of The Health Wrap can be read here.

 

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