Women hold up half the sky, they deserve half the research

Dr. Katrien Maes, Chief Policy Officer,
League of European Research Universities (LERU)

This article explores the issue of integrating sex and gender analysis into the funding, content and implementation process of research and innovation. Although a sex/gender-sensitive approach to research is rapidly becoming better embedded in certain research areas- for example, in biomedical research- in general, it is still under-recognised, not widely practised, and not well integrated into the research process. Yet, good policies and practices are vitally important to ensure that research results are equally valid for people of all genders and sexes, to improve global citizens’ lives in many ways and to help ensure that research and innovation are in tune with universities’ responsibilities to society.

The article is based on work carried out by an association of research-intensive universities (League of European Research Universities, LERU), which resulted in a policy paper that includes twenty recommendations for various stakeholders, including universities, funders, governments and journals.

1. Sex and gender analysis in research

What are the most common symptoms of a heart attack? Pain in the chest and arm(s), right? That is only half right, namely if you are a man. If you are a woman, you are more likely to exhibit nausea, general weakness, sweating or other symptoms. Men and their doctors are more likely to attribute chest pain to heart disease; women and their doctors are less likely to attribute their symptoms to heart disease. As a result, the so-called door to needle time for women who are admitted and diagnosed is significantly longer than for men (Dey et al., 2009).

Heart diseases, such as coronary artery disease, myocardial infarction and heart failure, often have different characteristics in men and women, which are linked both to sex and gender. The first is a biological concept, the latter a sociological concept, so that in heart disease it is a question of  physiology, chromosomes and hormones on the one side, and life-style and health-seeking behaviours on the other. Because heart disease research was for a long time focused mostly on men, the more typical female aspects of the disease were little known or recognised, with a consequent higher risk of suboptimal diagnosis and treatment, and higher mortality for women.

Luckily, that has been changing recently. The key point of this story, however, is that if research assumes that there is no significant difference between the sexes/genders, lives may be at stake. That is why it is vitally important to make sure that research results are equally valid for people of all genders and sexes, not just because it is the right thing to do, or because it is life-saving, but also because it saves money, improves the quality of research, leads to better products and services, and ultimately benefits all people and society at large.

Even when it may not be a question of life and death, it is essential that gender and sex analysis are properly – when needed - integrated into the research process. In health research, many diseases have been identified that affect women more seriously than men, such as cancer and osteoporosis. It is increasingly recognised that women and men may manifest and experience diseases differently, respond differently to treatment, metabolise drugs differently and respond differently to devices.

Some male/female differences can occur as early as during pregnancy and birth. Female infants, for instance, are more likely than males to contract HIV at birth, while male infants are more likely to be infected through breastfeeding. The differences between the sexes can be found at a very fundamental level, even in cells, cell lines and cell regulatory practices.

Remarkably little effort, however, has been spent on rigorously investigating and reporting the underlying sex and gender differences. For too long, medical research has not systematically focused on differences in disease prevalence, progression, clinical outcomes and responses to treatment between women and men. Too often it has been, and still may be, assumed that men can be used as the norm group for the entire population. As a result, women (and people who do not fit in the binary male-female scheme) continue to be under-represented in clinical trials and are frequently subject to medical practices based on data from a predominantly male population.

Women are not just under-represented in clinical trials. In laboratory studies and preclinical human research, male animals are much more frequently used than females. This is shown, for instance, in pain research: 79% of animal studies published in the journal Pain between 2001 and 2011 included males only, with only 8% of studies on females only, and a mere 4% explicitly designed to test for sex differences (the rest did not specify) (Buitendijk et al., 2011).

To be clear, sometimes it is not women, but men that are under-represented in the research. For example, because these diseases are perceived to be women’s illnesses, research has shown that eating disorders such as anorexia are under-diagnosed and under-treated in young men, even though they make up about a quarter of the cases (Räisänen and Hunt, 2015).

2. Relevance across many disciplines and across all stages of research

Moreover, while a gender-/sex-sensitive approach may seem more pertinent for biomedical research, it is by no means limited to it. On the contrary, researchers in all disciplines should and do ask themselves whether there are potentially sex and gender differences to be addressed in their research. Many examples are available - from urban transport to machine translation, employment, sustainable development, climate change, criminology, etc.

For instance, there are gender-related differences in the use of public and private means of transport, frequency and distance of travel, and patterns related to caring and parenting duties. A lack of gender analysis in transport research has resulted in under-reporting of the gender dimension of transport, which affects job opportunities, economic independence and well-being (Sánchez de Madariaga, 2013). When the gender/sex dimension is taken into account in research, it can lead to more innovative transport and urban planning policies, which help to improve people’s lives and to solve important societal challenges. In several Swedish cities, for example, snow-clearing priorities have been changed thanks to gender-/sex-sensitive research, resulting in more people getting to work and school faster with a lower likelihood of accidents.

Thus, a gender-/sex-sensitive approach in research is extremely valuable because it helps to answer societal challenges that all of us face. Whether it is about developing better transportation, adapting to climate change, finding solutions for ageing populations, solving energy challenges, and more, it has an important role to play in improving global citizens’ lives and ultimately in ensuring that research and innovation are in tune with universities’ responsibilities to society.

To give another example, analysing gender in relation to climate change and mitigation means comparing women’s and men’s behaviours and attitudes. Moreover, researchers must also ask: which women, which men? – and compare groups of women and men based on social factors, such as income, educational background and geographic location, which also predict climate footprint. Viewing women as an undifferentiated group and opposing this group to an undifferentiated group of men misses important factors that influence gendered behaviours. By studying not only gender/sex differences, but also by controlling for other social factors, one can avoid misleading stereotypes and false statistical correlations. More information about the interaction between gender and climate change research is available at the Gendered Innovations Project website (http://genderedinnovations.stanford.edu), which is a wonderful resource with many case studies and references on gender and sex in research.    

It is essential to involve scholars from the humanities and social sciences (SSH) in research aimed at solving societal challenges such as climate change, hunger, security, immigration and others. They bring important cultural, economic, historical, legal, psychological, sociological and other insights to these challenges, which pose not just scientific, technological, engineering or biomedical questions. Moreover, many SSH disciplines have a tradition of incorporating sex and gender analysis into research and have the methodological expertise for doing so. To solve societal challenges a multidisciplinary approach is extremely valuable, and incorporating SSH expertise and perspectives should be considered in all stages of the research process, not least right from the onset to help identify appropriate research questions and methods.

The latter point raises the issue that, just as with considering SSH issues at the earliest stages of societal challenge research, it is crucial that gender and sex analysis are taken into account at the very start. A gender-/sex-sensitive approach to research includes addressing potential sex and gender differences in each stage of the research cycle: at the outset, when governments, funders, universities and others make decisions about priorities for research spending; next, when researchers decide on the research focus, methodology and data collection and when they analyse and report on data; and finally, when researchers, journals and others disseminate research results and when  results are used by companies, governments or the public at large. A final point is that not all research topics will (need to) have a gender-/sex-sensitive dimension. When researchers have reasons to believe gender and sex will not constitute a factor in their research, they should explain this in their research funding proposal. Or when in the course of research no interactions with gender or sex are found, it is important to report that the question was posed but that no such effects were found.

3. What can be done?

While a gender/sex-sensitive approach in research is rapidly becoming better known and practised in certain research fields, in other areas it is still relatively unknown or not as well integrated in research practice as it should be. Awareness is increasing, but more can be done by researchers, universities, funders of research, and other stakeholders.

In a recent paper (Buitendijk i Maes, 2015), the League of European Research Universities has examined this issue. The report includes a varied set of examples showing the breadth and depth of research being performed at universities with a gender-/sex-sensitive approach. It also points to how universities are developing policies and practices to promote and support such an approach, with guidance documents for researchers, workshops to raise awareness and training, lectures and courses.

The paper formulates twenty recommendations for different stakeholders to act upon, emphasising the importance of support, promotion and resources for a gender-/sex-sensitive approach. For universities, the recommendations argue it is important that university leadership puts this issue on the agenda within the university and with others outside the university. Researchers need to be informed so they can assess whether or not it is important in their research and act accordingly. A recommendation for governments is that they should include a gender-sex dimension in research policies and programmes. Research funders can create financial incentives or support for researchers to do so. The EU funding programme Horizon 2020 can serve as a forward-looking model. Research journals should set standards for including the necessary information, with clear guidelines for authors.

Universities, governments, funders and journals have started to address the issue, but there is much work to be done. Concerted and systematic efforts are needed to raise awareness of and provide training to members of all research stakeholder communities. In addition, there is a need for links to and integration with other gender equality initiatives at all levels: through inclusion of this issue in government policies and strategies, funders’ programmes, universities’ gender equality strategies or action plans, research activities and researchers’ projects.

4. What can we learn from the European level?

The European Commission, in its European Research Area (ERA) policy framework and in its Horizon 2020 funding programme, has emphasised the importance of integrating gender-sex analysis in research and innovation content. Next to fostering gender balance in H2020 research teams and ensuring gender balance in decision making, integrating gender-sex analysis into research and innovation content is included to improve the scientific quality and societal relevance of the produced knowledge, technology and/or innovation.

Guidance to applicants for EU projects states that a topic is considered gender-relevant when it and/or its findings affect individuals or groups of persons. In these cases, gender issues should be integrated at various stages of the action and when relevant, specific studies can be included.

The EC has identified many sub-fields where data show that a gender analysis can benefit research; these range from computer hardware and architecture to nanotechnology, oceanography, geosciences, organic chemistry, aeronautics, space medicine, biodiversity, ecology and biophysics, among others. These topics are flagged so applicants can easily find them. In addition, it is stated that “this should not however prevent applicants to a non-flagged topic from including a gender dimension in their proposal if they find it relevant” (EC, 2014). In addition to applicants being asked in their H2020 proposals to describe how sex or gender analysis is taken into account, in the evaluation process evaluators with gender expertise check whether this has been done properly for the flagged topics. The Commission intends to monitor what the status is of the inclusion of gender in the content of research proposals that have been submitted and granted. Finally, gender training can be included in the eligible costs of an action.

The approach taken at the EU level is a model that can and does serve to inspire national and local approaches; it should be continued and strengthened.

 

5. Conclusions

When we talk about gender issues and academic research, we tend to concentrate on fixing the numbers and fixing the organisations. To fix the numbers means more women entering research careers, staying in and reaching leadership positions; while to fix the organisations refers to universities and other research organisations making structural changes in the way they recruit, support, retain and promote. This has not been the focus of this article. Instead, we have argued there is a third task when it comes to gender and research, which is fixing the knowledge (Schiebinger and Schraudner, 2011).

To “fix the knowledge” means making sure that research is done on both the male and female sex and gender variants, or for all sexes and genders, when needed and as appropriate. Taking a gender-/sex-sensitive approach in research has the capacity to improve people’s lives, save money, result in gender-equal and better products and services, help to address societal challenges and ultimately to improve society across a broad front. True innovation and robust responses to global problems will not come about if half the population is relatively under-served by existing research. If indeed it is the case that women hold up half the sky, as Mao Zedong has said, then surely “they deserve half the research as well” (quote attributed to Simone Buitendijk, co-author of the LERU paper).

 

Dr. Katrien Maes, Chief Policy Officer

League of European Research Universities (LERU)

6. References

Buitendijk, S., D. Corda, A. Flodström, A. Holdcroft et al. (2011): “Women in science and medicine”, letter to The Lancet, 377(9768).

Buitendijk, S., and K. Maes (2015): Gendered research and innovation: integrating sex and gender analysis into the research process, Leuven: League of European Research Universities.

Dey, S., M. Flather, G. Devlin, D. Brieger et al. (2009): “Sex-related differences in the presentation, treatment, and outcomes among patients with acute coronary syndromes: the global registry of acute coronary events”, Heart, 95(1).

European Commission (2014): Vademecum on gender equality in Horizon 2020, Brussels: European Commission.

Räisänen, U., and K. Hunt (2015): “The role of gendered constructions of eating disorders in delated help-seeking in men: a qualitative interview study”, BMJ Open, 4(4).

Sánchez de Madariaga, I. (2013): “Mobility of care. Introducing new concepts in urban transportation”, in I. Sánchez de Madariaga and M. Roberts (eds.): Fair shared cities: the impact of gender planning in Europe, Aldershot: Ashgate.

Schiebinger, L., and M. Schraudner (2011): “Interdisciplinary approaches to achieving gendered innovations in science, medicine, and engineering”, Interdisciplinary Science Reviews, 36(2).

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Dr. Katrien Maes, Chief Policy Officer,
League of European Research Universities (LERU)

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