Representation of women as lead authors in Indian Anaesthesiology Journals: Quo Vadis?

Women form a sizable proportion of the medical workforce in India, and anaesthesiology is no exception. According to the 2023 anaesthesia workforce data from India, the density of anaesthesiologists is 4.27 per 100,000 population, making the number of anaesthesiologists in India approximately 60,000.[1] Though the exact number of anaesthesiologists in the country is unknown, the Indian Society of Anaesthesiologists (ISA), the premier society for anaesthesiologists in the country, records more than 42,000 members, of which approximately 45% are women. In the last decade, many medical colleges and hospitals have reported an increase in the number of female postgraduate residents in anaesthesia training and fellowship programs. Anaesthesiology offers a reasonably good work-life balance as compared to other surgical disciplines and, therefore, is a much sought-after postgraduate course among women.[2] The question that arises is whether the boom in the number of women anaesthesiologists has translated into an increase in their contribution to academia and research in the speciality. Can scientific publications contributed by women anaesthesiologists in indexed journals be considered as a surrogate indicator? The role of publications in career progression is well known. Publications serve as the objective measure of academic growth, playing a crucial role in establishing credibility for editorial board or specialised society board membership positions. However, authorship of women in Indian anaesthesiology journal articles remains unknown. We, therefore, conducted a search to assess the representation of women as lead authors in Indian anaesthesiology journals. We searched the proportion of articles with women as lead authors in two prominent anaesthesiology journals from India (PubMed indexed): the Indian Journal of Anaesthesia (IJA) and the Journal of Anaesthesiology and Clinical Pharmacology (JOACP). We recorded all the articles published in these journals in 2023 and 2024, including metanalysis and systematic reviews, original studies, editorials, clinical/brief communications, and letters to the editor. We noted those in which women were the first author (FA), corresponding author (CA), or both. If the same woman served as FA and CA, a count was recorded for all three (FA, CA, and for both). The results were recorded as absolute numbers and percentages for each of these categories, for each article type and overall. The data were collected and cross-verified by two independent anaesthesiologists. A total of 777 articles were published in the two journals in the last two years. Women anaesthesiologists were FA in 45%, CA in 44%, and both as FA and CA in 21% of the total articles published [Table 1]. Among the articles where women were FA or CA, original studies (50% and 48%, respectively) and letters to the editor (30% and 31%, respectively) were the highest [Figure 1]. Among the different types of articles, articles with women as FA or CA were highest for original articles, being 53% and 51%, respectively. This was followed by narrative reviews (49% and 53%), case reports (42% and 50%), letters to the editor (42% and 43%) and brief commentaries (38% and 38%) for FA and CA, respectively. The proportion of articles with women as FA or CA was low for metanalysis and systematic review (29% and 21%, respectively) and editorials (13% and 11%, respectively) [Table 1].Figure 1: Pie diagrams showing the proportion of the various types of articles published in the Indian Journal of Anaesthesia and Journal of Anaesthesiology Clinical Pharmacology in percentages with women anaesthesiologists as a) First Author and b) Corresponding Author. BC/CC/C/TP = Brief communication/ clinical communication/commentary/trial protocol, CS/CR = Case series/reports, Ed = Editorial, LTE = Letter to Editor, MA: Meta-analysis, NA/SA = Narrative reviews/ Special articles, OA = Original ArticlesTable 1: Proportion of articles published in the Indian Journal of Anaesthesia and Journal of Anaesthesiology and Clinical Pharmacology with women as first author, corresponding author, or both in 2023 and 2024While women authorship in anaesthesia journals is not uncommon, it is important to note the proportion of articles led by women as first or corresponding authors. Having 45% and 44% of the articles in Indian anaesthesiology journals led by women as FA or CA, respectively, is quite encouraging. These numbers are proportionate to the representation of women in the anaesthesiology society. Interestingly, global statistics and various anaesthesia journals show that women account for only 22%–32% of first authorship in scientific publications.[3] A scoping review by Bosco et al.[4] concluded that women lag in journal authorship. Despite the fact that the incidence of female authorship has increased remarkably from 2008 to 2018, women constitute less than a third of first authors and less than a fifth of senior authors of original research papers published among reputed international anaesthesiology journals with a high impact factor: Anaesthesia, Anesthesia and Analgesia, Anesthesiology, British Journal of Anaesthesia, and European Journal of Anaesthesiology.[5] The overall female authorship in the Canadian Journal of Anaesthesiology reported a gradual increase from less than 20% in 1954 to 32% in 2017.[6] In contrast, original research articles published in Anesthesiology and Anesthesia and Analgesia over the past 15 years illustrate that women made up a higher percentage of first authorship with female senior authorship in non-experimental studies rather than experimental studies.[7] The results of this search reflect a positive tide towards increased scientific publications led by Indian women anaesthesiologists. Of note, research articles formed more than 50% of the articles published by women as FA or CA [Figure 1]. Among the research articles published, more than 50% were led by women as FA or CA [Table 1]. These results demonstrate not only an increase in the publication of articles by women anaesthesiologists as lead authors but also an increase in their research. The increased availability of favourable infrastructure for conducting research, research funding opportunities, access to scientific journals, mentorship opportunities, and functional ethical committees may be responsible for this. The pressure to publish for career progression and promotions in medical colleges or institutions in India may also be a reason for more publications by teaching faculty. Support from professional organisations, such as ISA and Research Society of Anaesthesiologists and Clinical Pharmacology (RSACP), has played a significant role in promoting gender equity through various initiatives, including workshops, awards, and recognition of the contributions made by women. We hope that this impetus in leading publications will transcend across other areas and inspire women to progress further in all aspects of their professional growth, including leadership positions. It is interesting to note that among the articles published with women as FA or CA, editorials had the lowest representation (13% and 11%, respectively). This may suggest a potential bias, considering that editorials are usually invited articles. To the best of our knowledge, this is the first evaluation of the representation of women as lead authors in Indian anaesthesiology journals. This data largely reflects the contribution of women anaesthesiologists from India, with less than 5% of articles led by women from foreign countries. The high representation of women as FA and CA among the published articles, with original articles being the highest, is indeed very encouraging. While we have only noted the proportion of articles led by women, the quality of the articles, as measured by the number of citations, is equally important.[8]. As suggested by Symonds and colleagues,[9] to avoid gender bias in research and publication, future studies should consider a measure that takes into account both the quality and quantity of the published articles. The momentum that has been created needs to be fuelled and taken forward. Women in leadership roles need to take the hidden faces to the forefront to make a bigger and larger pool of women leading in research, academics and publications. Women anaesthesiologists working in the corporate and private sectors require additional support to facilitate research and publication. Though these results are commendable, we still have a long way to go; till these numbers increase, institute and inspire…. Meanwhile, let us not forget to recognise and celebrate the journey, a journey towards empowerment. Women anaesthesiologists in India have steadily paved the way towards progress in leading publications in their speciality, almost in proportion to their representation in the speciality. It required a change in the mindset, and most importantly, the zeal to rise and shine. “The wheel of change turns fast and true, Dreams ignite in hues anew. Each barrier broken, each mountain scaled, Progress whispers: we have prevailed.”

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