An article
was recently published by the BBC news regarding the steadily declining number
of women in South Korea interested in childbearing and starting a family,
causing the country to have one of the world's lowest fertility rates - about 5.5 per 1,000 people.
Some of the
reasons cited in this article include that more and more women are choosing
their profession and personal interests over starting a family, as well as the
complications and costs associated with childbirth. One woman explicitly argues
that she would rather "be independent and live alone and achieve [her]
dreams" instead of "be part of a family." The independent
journeys on which these women choose to embark are deemed so abnormal in South
Korea that they were delegated their own title: "sampo,”
meaning “to give up relationships, marriage and children.”
This
mutually exclusive mindset is largely a consequence of mistreatment of and bias
towards women in the workforce. Similar to the policies in place in the United
States, women in South Korea are by law protected from such discrimination,
however as many women (including myself) have experienced, such laws are often
ignored or seldom enforced.
Another
woman cited in the article mentioned that after an argument with her boss and
being sent to the hospital due to concerns for miscarriage, her boss made a
concerted effort to have her fired.
This message hits home for me
particularly as a female entering the medical workforce in just a few months. While
trying to decide on a specialty during medical school, and as I prepare for
residency, one burning issue that arises almost invariably, especially with
female attendings, is the topic of childbearing. The reason I say “issue” is
that, unfortunately, the health professions environment often treats it as
such. “What if I get pregnant during residency?” for me induces the same
anxiety as “What if I get sick?” or “What if I break my leg?” Even as we
approach 2019 and the world achieves somewhat increased open-mindedness,
society still has a tendency to paint a picture of physicians that is not only
cis-white male, but invincible and without their own personal and private
challenges. And I think here lies part of the problem in making medical
education more family-friendly.
The Family and Medical Leave Act was
passed in the United States in 1993 as a means of guaranteeing 12 weeks of
"unpaid, job-protected leave" for certain reasons if covered by an
individual's employer. Reasons for taking leave include childbirth, but also
encompasses adoption, caring for severely ill relatives, personal illness, and
up to 26 weeks to care for a servicemember. I would like to emphasize here the
“unpaid” portion of this act, because given the rising cost of diapers,
clothing, and formula, one can only hope that the residents protected by this
act have enough income to support themselves and their baby, if not some
additional financial support from a spouse or other family member.
In 2000,
the AAFP published guidelines for Family Medicine residents who need to take
parental leave. The guidelines were revised most recently in 2017 and encourage
that residents be given ample time and accommodations in order to fulfill
parental duties. However, the "guidelines" are in actuality just
recommendations; each residency program is at liberty to ordain their own rules
regarding parental leave (within their legal rights), from the duration to when
leave can be taken, to the specific provisions offered (if any) in the event a
resident cannot complete certain requirements.
A blanket
argument against residency programs, however, is not being made here and should
never be made; there are plenty of programs willing to accommodate for
residents interested in or expecting to build on their families. And it is also
a fair argument that some residents in fact prefer not to have a family during
residency, or ever. However, I do think it is safe to say that a larger
discussion must be had so that if and when someone, including myself, decides
it is the “right” time to have a family, the decision will be treated with
respect and understanding, rather than a burden on my colleagues, program, and
patients.
Gabrielle
Pyronneau
DUCOM 2019
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