Health Care and Medical Education to Promote Women's Health in Iran; Four Decades Efforts, Challenges and Recommendations.

Abstract

The aim of this paper is to present a synthesis of solutions for post-graduate medical education (PGME) and the health-care system in addressing challenges in relation to women's health. A critical review was conducted within three themes: women's health status, women's preferences for female physicians, and women in surgery. The study was conducted in two phases that consisted of an analysis of the trends of Iranian women's health and women's participation in PGME since 1979 followed by a thematic analysis to assess the current challenges and their implications on medical education. Our analysis revealed important trends and challenges. Since 1979, life expectancy has increased by 29% in Iranian women, while female adult mortality rate has decreased by 78%, and maternal mortality rate has decreased by 80%. The number of female medical specialists has increased by 933% , while the number of female subspecialists has increased by 1700%. According to our review, ten major challenges regarding women's health were identified: 1) Increase in chronic disease; 2) Increase in cancer cases; 3) Preference for same-gender physicians in sensitive procedures; 4) Delayed care-seeking due to lack of female surgeons; 5) Lack of gender-concordance in clinical settings; 6) Underestimating female surgeons' capabilities; 7) Female physicians' work-family conflicts; 8) Male-dominancy in surgical departments; 9) Women's under-representation in higher rank positions; and 10) Lack of women in academic leadership. We identified different solutions to bridge these gaps. Community-based education, Gender- concordant considerations, and empowering women in surgical departments could help medical education policy makers to address the challenges.