In a survey of female oncologists, nearly one-third said they experienced pregnancy-related discrimination.
In addition, about one-third said they had fertility difficulties that required counseling and/or treatment. About two-thirds of respondents with at least 1 pregnancy said they had some pregnancy complications. These findings were published in JAMA Network Open.
The survey was given to female oncologists in the United States between May and June 2020. A total of 973 participants responded to a 39-item questionnaire on the topic of attitudes about and personal experiences with childbearing, fertility, family planning, and discrimination.
Most respondents were working at an academic center (61.4%) and worked full time (71.0%). Most were attending physicians, and more than half were within 5 years (34.4%) or 6-10 years (21.4%) of residency or fellowship.
The respondents reported having 0 children (24.4%), 1 child (20.8%), 2 children (37.2%), 3 children (14.0%), 4 children (2.4%), or 5 or more children (0.5%). Most respondents had children to whom they had given birth (73.2%); 2.2% had stepchildren, used a surrogate, or adopted. For 0.6% of respondents, their partner had given birth.
Most respondents had their first child as an attending physician (27.4%), in residency (21.0%), or during fellowship (20.3%). Few had their first child during medical school (4.3%) or before (1.4%).
Of the respondents who did not have children, 18.9% said they wanted to have children, 3.4% did not plan to have children, and 3.2% were unsure about having children.
Most respondents (94.7%) factored family planning into their career decisions. The most common negative factors associated with fertility planning were work hours and workload (66.6%), fertility concerns (47.6%), trainee income (40.4%), lack of nearby family support (37.1%), and bad or nonexistent maternity leave policies during training (31.3%) or as an attending physician (17.4%).
Overall, 32.1% of respondents reported experiencing some form of discrimination during pregnancy. For 17.9% of respondents, it was implied or explicitly stated that they should return to work before the end of their maternity leave. This was reported most often by surgical oncologists (21.0%) and least often by pediatric oncologists (16.5%; P =.004).
The likelihood of experiencing discrimination was higher among respondents with 3 or more children (odds ratio [OR], 1.84; P =.01) and those with 2 children (OR, 1.62; P =.02).
Among respondents who had reported at least 1 pregnancy, 65.7% had some pregnancy complications, and 31.7% reported having a miscarriage.
Fertility difficulties that required counseling and/or treatment were reported by 31.4% of respondents. Fertility medications were used by 16.3%, in vitro fertilization by 13.2%, intrauterine insemination by 12.9%, and cryopreservation of eggs by 5.3%.
“[A] considerable proportion of women in oncology reported facing infertility and difficult career choices associated with family planning,” the researchers concluded. “Systemic changes are necessary early in medical education and training to ensure that women are supported and able to advance equitably in the field.”
Lee A, Kuczmarska-Haas A, Dalwadi SM, et al. Family planning, fertility, and career decisions among female oncologists.JAMA Netw Open. Published online October 31, 2022. doi:10.1001/jamanetworkopen.2022.37558