NIH Expert: Stigma Around Paternal Leave Contributes to Gender Inequity in Medical Research Field

Pharmacy Times interviewed Xenia Tigno, PhD, associate director for careers, Office of Research on Women’s Health (ORWH), National Institute of Health (NIH), and Reshma Jagsi, MD, DPhil, director of the Center for Bioethics and Social Sciences in Medicine, University of Michigan, on how the pandemic affected the trajectory of women’s careers in medical research and other medical fields in light of the need many women faced of shifting to provide child care and other family care and services during the shutdown in the spring of 2020.

Question: How might professional and societal pressures around the legitimacy of maternal leave versus paternal leave impact the trajectory of women’s careers in medical research?

Reshma Jagsi: I would say that it's important for us to reflect on what our professional bodies recommend as best policies. Within medicine, which is my field, the American Academy of Pediatrics has advocated for at least 12 weeks of paid parental leave for all workers, and many other countries provide even more.

Yet, in the United States, many scientists, professionals, including medical professionals, like myself, and pharmacy professionals like the audience that may well be listening to this when we're speaking—many of us work in organizations where we have access to far less paid parental leave. This has been particularly challenging in the setting of medical training, whereby medical trainees have faced limitations both in terms of their eligibility to sit for medical board examinations, and it was only recently that we saw some very important changes on the part of the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education that have really been progressive steps towards embracing the need to ensure a civilized amount of paid parental leave for all individuals, regardless of gender, regardless of whether they're birthing parents.

The reason I want to emphasize that last bit is that we really need all parents to take leave, because if we don't do that, there develops a stigma associated with parenting and caregiving, and there also develops a group of individuals who become the de facto expert parents, because those who birth children may at least be given some amount of leave to recover from that medical experience. They have more time, and they therefore develop the skills of parenting more than their partners who are not granted that level of leave.

What that means is that for the rest of that child's life, for eternity, they become the expert parent. I joke that one of the best things that ever happened to me was my obstetric complications, which actually led to emergency C sections and were not things that one would aspire to, but it's okay, healthy mom, healthy babies—we’re all okay. In the end, what happened was my husband really had to step up and became incredibly involved. Sadly for him, to this day, he's still the expert parent, because I wasn't able to get that training [laughing]. But usually those roles are reversed in terms of gender roles, and I think we have to be really mindful of including both partners or however many individuals are involved in parenting a child and ensure that they have the time to build those bonds, to build those skills to ensure greater equity in the ability to engage in the workforce later on, for all human beings.

Question: How has NIH looked to address internal factors that might limit new fathers from taking paternal leave, and have any of those strategies been effective?

Xenia Tigno: NIH recognizes the important role that fathers play in caregiving. NIH has several, what we call, “family friendly policies” in place, which other organizations may want to emulate. As Dr. Jagsi indicated, not all organizations have this paid parental leave that we, as federal employees, enjoy. So not just NIH, but all federal agencies. If you're an employee, you're entitled to paid parental leave. What does that mean? It means that you can have 12 weeks of paid leave in connection with a birth of a child. Not only that, you can also claim it if you're adopting or doing foster care, so even if you're not the birth parent, as Dr. Jagsi indicated. There are no sex or gender requirements for these. You can access these family friendly leaves, and employees of either sex can do it within the first 12 months of adoption or birth. There is no requirement for you to exhaust your other leaves before tapping into this paid parental leave, making it even more accessible for employees to use.

And if both you and your partner are feds, then each of you can take 12 weeks off as paid leave. You can do it like- one after the other, giving you not just 12 but 24 weeks of paid leave. So even our trainees, such as the fellows—and they could be of either gender—they can also receive stipends for up to 60 calendar days or even to 8 work weeks of parental leave per year for adoption or birth of a child.

In addition to these leave credits, we also have a number of funding opportunity announcements, such as Reentry supplements, the Continuity and Retention supplements which are sometimes called critical life events supplements, which include birth of child or adoption. These are accessible to both mothers and fathers. So, again, we do not distinguish by sex for those who want to apply for these leaves.

But what is more advantageous at NIH is that we have an NIH leave bank for those who have already exhausted their other leaves, you can tap on those as well, and that is open to both sexes. These are just some of the measures that NIH has taken to start fostering work-life balance.

Question: What are some effective ways of acknowledging and addressing societal norms within health care organizations that may be causing gender inequalities to persist within professional career trajectories?

Reshma Jagsi: I really like to think about interventions to promote gender equity in buckets based on the categories that I think of as the mechanisms or the challenges that have led to those gender inequities. When I think about one class of challenges, I think about overt incivility, harassment, microaggressions—to address that, we really need, as organizations, to embrace effective practices to promote civility within the workplace. We need clear policies, and that includes beginning with monitoring behavior with surveys. One of the strongest predictors of the incidence of sexual harassment in organizations is whether the organization is perceived by the employees to tolerate harassment. Not only does surveying a workforce allow an organization to gain insights about the unique nature of the incivility that is occurring within it, but it also gives it an opportunity to send a very visible signal that those behaviors are not tolerated.

[Clarifying policies are essential,] so clarifying policies also with respect to reporting systems--there is an unfortunate assumption that individuals who experience inappropriate behaviors are going to report them. In fact, our own research—and groups have certainly done this in other contexts as well—has shown that individuals who are harassed are actually very, very unlikely to report. And we can all understand why—by the time we become professionals in fields like pharmacy or medicine, we have dedicated a lot to our careers. We don't want to be identified on the basis of an inappropriate experience that has occurred, but rather, we want to be known for our scholarly contributions. We don't want to be marginalized. We don't want to be stigmatized. We don't want to be victimized, and we sure as heck don't want to face retaliation. Unfortunately, the evidence does suggest that when individuals do report, sometimes they do face experiences of institutions minimizing those experiences or allowing retaliation to occur. So, we really need policies that do not allow that. We need for institutions to be transparent about the range of complaints that have been filed, the nature of the investigations, and the range of the sanctions applied, even if it's not possible to detail in individual situations the exact nature of what transpired.

And we need to encourage allyship, because ultimately, all of us are present and see behaviors that are unwanted and wonder sometimes what we can do. We need to be empowered and enabled and develop the skills to stand up for one another. So, it's this “upstanding” idea—we shouldn't be bystanders, we should be upstanders.

We should learn that even those who are not particularly powerful in a given hierarchy can intervene in some way. For example, by removing the target of the aggression from the situation or by creating a distraction—there are effective things that can be done, and in addition, providing support to the target. If one does have sufficient power within the organization, then also potentially confronting the aggressor or engaging in reporting.

That's one category of behaviors, but we also know that much of what goes on is not intentional. It’s my firm belief that the vast majority of people in the world do not wake up in the morning and think to themselves, how can I oppress people who are not like me? It's really not that common to have people who are intentionally trying to hurt others, but far more common to have unconscious biases. We know that this exists. We've seen CV studies that have shown that if you send out the exact same resume, and you just change the name at the top of it [to] Karen Miller instead of Brian Miller, that all of a sudden, people will be more likely to hire the candidate who fits their presumptions of who belongs in that role. Brian Miller is more likely to be hired than Karen Miller for an academic psychology entry level position, and is given higher ratings for his merit, for his teaching, his service, his scholarship on the basis of the same CV. And if you think that's bad, there was another study that shows that an individual named Lakeisha or Jamal needs 9 extra years of experience on their CV to get job interviews at the same rate as individuals named Emily and Greg.

We know these unconscious biases exist. We also know that we all harbor biases, this is not just certain groups harboring biases. We all have this. It's an efficient heuristic that evolved in human beings. We make snap judgments, and they're habits we need to learn to break.

Molly Carnes has been funded by the NIH to do some really revolutionary work to develop interventions that are effective. Not all unconscious bias training interventions are effective, some of them actually backfire. But she has actually discovered some forms of training that really do appear to be quite effective.

Then finally, there's another whole category that we've talked about in the earlier part of this discussion about the gendered expectations of society, particularly with respect to family caregiving. My very first R01 grant from the NIH actually funded me to study physician scientists about how they were spending their time. What we found was that the women in our sample, which was actually some really high achieving NIH-funded researchers, individuals who had career development awards in the K-series at the national level, that are incredibly hard to get. Even in this elite population, the women were spending—even after adjustment for spousal employment status and many other factors—8 and a half more hours per week on parenting and domestic tasks. And that's before the pandemic. We saw that the women in that sample were 4 times as likely to stand up and step in if their usual childcare arrangements were disrupted. Again, this is before the pandemic, but we've seen it play out during the pandemic.

So, we need to consider more creative policies that provide support. For example, the Doris Duke Charitable Foundation has a fund to retain clinical scientists that provides funding for helping hands in the workplace, specifically for individuals who articulate a need related to family caregiving demands. Of course, NIH has done some really revolutionary work in this regard, as well, and so I'll turn it over to Dr. Tigno to speak to the kinds of interventions that NIH has had in that area, and in all of these areas—NIH has really been an exemplar in so many ways.

Xenia Tigno: Yes, you did mention the Doris Duke Foundation and the NIH, which I think I mentioned prior,has the Continuity and Retention supplements. As Dr. Jagsi had mentioned, K-awardees are also very vulnerable, because of that K-to-R transition. Although there are so many women who are K awardees—they predominate in the K-series, when it is time for them to apply for the R01- equivalent awards, which usually will ensure their tenure if they are in an academic institution, then that's where the cliff starts to become very steep. Because despite the fact that there are more women than men who have these career training awards, not as many women as men get the RO1- equivalent awards. And that's really a problem.

With this continuity supplement, what we try is that if a woman, or even a man, has additional caregiving, due to what we call “critical life events”, such as childbirth, then they can apply for additional funding; so then they can, for instance, hire a technician or a grad student during the time that they are on parental leave to do some of the work, so that their productivity is not sacrificed at that point, and give them more opportunities to be able to apply for the R01 equivalent awards.

The other vulnerable place for men and women, but especially for women, is when you're applying for your second R01 award or you are trying to extend your first R01 award. We have this continuity and retention supplements for our awardees as well who are trying to get their second award—and say experience childbirth, or have to provide caregiving for parents, or children, or even spouses—they can apply for the supplements as well. Those are just some of the measures that we have done, but in addition, the whole Careers section of ORWH is day and night trying to find ways and means to achieve gender equity, either at the institutional level or at the individual level.

Editor’s Note: Further information on NIH’s antiharassment policies and information can be found here: https://bit.ly/3PlYl4D.