Representation of Women in Published Articles at 3 Academic Pediatric Journals: 2001 to 2022

We analyzed original research articles published in 3 academic, high impact pediatric journals: Pediatrics, The Journal of Pediatrics, and JAMA Pediatrics in 5 1-year time periods from 2001-2022: 2001, 2006, 2011, 2016, and 2022. For each journal we included all original research articles published in the studied year. For each original research article, we recorded the name of the first and the last authors as well as their affiliated institution. We also recorded the composition of each journal’s editorial boards during these studied years. For consistency, we evaluated the editorial board during the January issue of each studied year. We chose to study in 5-year intervals to show macro trends over time. For the last time point, we used 2022, a 6-year interval rather than the previous 5, to provide an additional year buffer from the beginning of the pandemic to sidestep potential differential short-term adverse gender effects.^13,14  We include the data broken down by individual journal because of differences in number of original articles published annually in the 3 journals such that trends in individual journals may differ from the overall trend.

For papers that had multiple cofirst authors or colast authors (when noted by the journal), we included both authors in the respective authorship category. For comparisons with the most recent AAMC faculty data from 2021,¹²  we considered junior faculty to include instructors and assistant professors, and for senior faculty to include associate professors and full professors. To understand the changing US faculty demographics more fully, we evaluated authorship teams for all original research articles published by authors from US institutions. We did not evaluate authorship teams for international authors because the cohort comes from a wide variety of nations without readily available faculty appointment data. Because faculty demographic compositions are unknown, trends in the international data are uninterpretable.

Although the most accurate method of gender identification is through author self-identification, this is not yet current practice. Instead, we associated authors with the 2 most common gender identities, women and men, by assessment of first name, which has been previously described.^6,11  In brief, we used a highly specific algorithm with an error rate of <1% to make a first gender inference of the names. For names that were not identified by the program, the authors used internet sources (such as academic institution pages, LinkedIn, Research Gate, and Doximity) to make an identification, using provided pronouns or profiles for the inferences. Original research articles that included an author whose gender was not able to be inferred were excluded.

The data were captured and analyzed in a Microsoft Excel database. Comparisons between the journals with respect to gender proportion as well as comparisons of US authors to AAMC faculty data were evaluated with Pearson’s χ² squared tests. Cochran-Armitage tests were used to evaluate trends in gender proportion over time. Mann-Kendall tests were used to evaluate authorship team trends over time. A P value of <.05 was considered significant.

The University of Chicago Institutional Review Board provided an exemption for this research and waived the need for informed consent, as all data were publicly available.

From 2001 to 2022, a total of 4457 original research articles were published during 5 1-year intervals in Pediatrics, The Journal of Pediatrics, and JAMA Pediatrics. A total of 31 original research articles (<1%) were excluded from analysis because of inability to identify the gender of at least the first or last author, leaving 4426 included original research articles.

As displayed in Table 1, the proportion of first and senior women authors as well as the proportion of women on all 3 editorial boards increased significantly from 2001 to 2022 (P < .01, for first authors, senior authors, and editorial board membership). All 3 journals showed sizable increases in their rates of representation for women authorship and editorial board membership. Pediatrics and The Journal of Pediatrics had significant trends over time for both first and last authors over the last 2 decades (P < .01, for all). Pediatrics and JAMA Pediatrics had significant trends over time for representation of their editorial boards (P < .01 and P = .01, respectively).

As illustrated in Fig 1, the 3 journals combined share a similar trajectory for women over the 2-decade period, with a 23.7% increase in proportion of first authorship, 15.9% increase in proportion of senior authorship, and 28.8% increase in share of editorial boards globally with all trends significant over time (P < .01, for first authors, senior authors, and editorial board membership). There was no significant difference in the proportion of original research articles authored by women researchers with respect to each journal in 2022 (P = .37). There was no significant difference in the gender composition of editorial boards in 2022 between the 3 journals (P = .24).

Figure 2 shows the percentage of original research articles authored by women broken down by authorship seniority and country. International authors have consistently comprised nearly one third of published articles represented in these 3 journals. For example, first authors from international institutions were responsible for 29.1% of all published articles in 2001 and 32.7% in 2022. Similarly, last authors from international institutions authored 30.1% of 2001 articles and 31.9% of 2022 articles. In 2022 across all 3 journals, there was no statistically significant difference in the overall proportion of US and international women who serve as either first authors (P = .30) or last authors (P = .20). International women as first authors was the only group to show a drop, decreasing 0.8% since 2016. US authors had their largest increase in proportion of women since the 2001 to 2006 increase, with an increase in women of 16% for US first authors and 17.4% for US senior authors.

Over 2 decades in US academic medical centers, the proportion of women faculty increased from 44% in 2001% to 60% in 2021.¹²  As displayed in Fig 3, the largest overall growth for women in academic pediatrics in the United States has occurred in the last decade.¹²  The single largest change over this period was the 7% increase in full professorship between 2016 and 2021.¹²  In 2022, US women represented 78% of instructors but only 67% of assistant professors; their representation further decreases to 54% and 40% for associate and full professors, respectively.¹² 

In 2022, US women first authors contributed 67.3% of all US original research articles, which is still statistically lower than, but is approaching parity with, the 68.6% of women that are junior faculty from 2021 reported by the AAMC (P = .01).¹²  US women last authors made up 48.0% of all last authors, and for the first time in 2 decades was equivalent to the proportion of women senior faculty reported by the AAMC, 47.5% (in 2021) (P = .18).¹²  In 2022, there were 116 combined editors serving on the editorial boards of these 3 journals. Only 5 (4.3%) editors were from international institutions, and only 1 of the 5 were women. Of the 111 US members of the editorial boards, women accounted for 53 (47.7%), comparable to the 47.5% (in 2021) for senior faculty (P = .95).¹² 

Figure 4 shows US authorship team trends over time. Concordant gender teams made up 57.9% of teams in 2001 and 59.8% of teams in 2022. Whereas men-only first-senior authorship pairs were the most frequent team pairing for US original research articles in 2001 (43.0%); in 2022, women-only first-senior authorship pairs are now the most frequent team pairing (36.8%). Women paired as first and senior authors had a statistically significant trend increase over time, with a growth of 21.9% of all papers from 2001 to 2022 (P = .03) Men paired as first and senior authors saw the biggest proportional decrease, losing more than 20% of team representation between 2001 and 2022. The teams with mixed men and women as first and senior authors did not see significant changes over the studied period.

For the past 2 decades, the Accreditation Council for Graduate Medical Education data show that women have constituted around 70% of all pediatric residents in the United States, with a slight rise from 68.4% in 2003 to 72.9% in 2021.^15–17  This means that by 2016, women make up a higher percentage of instructors according to the AAMC than their percentage of graduating residents.¹²  However, the promotion from instructor to full professor in the United States continues to show a significant decline: the percentage of women as instructors is almost double the percentage of women as full professors.

Documenting the representation of women authors and gender differences in academic publications is important as publications are an integral component of promotion in academic medicine. Over the last 2 decades, there has been a significant increase in the proportion of original research articles with women as first and/or senior authors at Pediatrics, The Journal of Pediatrics, and JAMA Pediatrics. The field of academic pediatrics is nearing gender parity for published original research articles for first authors and junior academic faculty positions. Parity has been achieved for senior authors from US institutions compared with US academic faculty rank, and representation of women on the editorial boards of these 3 high-impact journals are consistent with representation of US women senior faculty. Given the predominance of women in pediatrics in the US, this is a major step for equity and inclusion in the field. However, although our findings of US women representativeness as first and last authors compared with AAMC data are encouraging, addressing the significant decline in the percentage of women from junior to senior faculty members is also critical to ameliorate gender equity gaps. Even when adjusting for publication productivity, women are less likely to achieve senior faculty positions in the United States.¹⁸ 

The increased proportion of women as first and last authors of original research articles has been seen in other fields of medical specialty journals,^19,20  which have also documented a missing link for the conversion of these equitable gains in publication into career promotion and financial compensation in the United States.⁸  Other factors may play an important role: women in academic medicine receive less grant money and are more likely to experience burnout and leave medicine altogether.^{1,2,8,18,21–23} 

While US all-women first-senior authorship teams have significantly increased and US all-men first-senior author teams have significantly decreased over our study period, the percentage of concordance has remained relatively constant. The phenomenon of homophily has been seen across a wide range of research areas.²⁴  Pediatrics is one of many STEMM (science, technology, engineering, mathematics, and medicine) fields that has more homophily than would be expected by chance alone.²⁵  The implications of concordance in academic pediatrics need to be explored, particularly in light of the changing demographics in the field.

Since we do not have data regarding the percentage of women in pediatrics in the various countries where the authors work, we cannot comment on representation of first authorship to junior faculty or last authorship to senior faculty outside of the United States, although it is notable that the proportion of publications written by international women has flattened as first authors since 2016 and as senior authors since 2011. In addition, although international authors represent nearly one third of both first and last authors, they consistently make up a very small share (∼4%) of editorial boards at these 3 journals. Other research groups have also noted a persistent dearth of women in senior leadership positions across non-US institutions.²⁶ 

Our study has several limitations. First is gender inference. The ideal method to learn the gender of researchers would be through self-identification; however, these data are not readily available. We acknowledge that inferences of gender based on pictures, names, and available pronouns may not always accurately reflect an individual’s self-identity and that binary inferences may be exclusionary to nonbinary individuals. To that end, we hope regular self-reporting of preferred pronouns and gender identity becomes more standard across researcher profiles, limiting the necessity of inference and allowing for more robust academic data. Furthermore, classification based on names may lead to some errors, particularly for androgynous names. However, this error rate was lowered by using a highly specific program, with a preference for author identification.

Second, our study only has academic faculty rank for US physicians. As such, we cannot compare international researchers with academic rank, which makes it hard to know how to interpret the flattening in the percentage of articles published by international women in the last 10 years. It is necessary to advocate for equitable opportunities for women and men across the globe.

Third, we chose not to make interjournal comparisons because JAMA Pediatrics publishes many fewer articles than the other 2 journals and so small changes in the acceptance of articles by gender may reflect a chance occurrence rather than a trend. We elected not to combine articles across years because our goal is to follow trends over time. Moreover, although we chose these 3 journals because of their reputation, it is possible that our gender findings are not generalizable to other pediatric journals. The value of using these 3 journals is that we have been evaluating trends for over 20 years.

Fourth, for comparisons to academic faculty ranks, we compared US first authors with US junior faculty appointments and US last authors with US senior faculty appointments. We acknowledge that this is not a 1:1 comparison. For example, there are many trainees that may be represented as first authors and are not faculty, and there may be articles in which senior faculty are first authors. We also assumed that editorial board members are senior faculty, although at least some journals are engaging more junior faculty to their editorial boards to improve generational diversity and promote junior faculty perspective.²⁷ 

The percentage of women as first and senior authors of original research articles in Pediatrics, The Journal of Pediatrics, and JAMA Pediatrics has significantly increased between 2001 and 2022. US women have nearly reached parity compared with their AAMC faculty ranks as first authors. For the first time, the percentage of women as senior authors, editorial board members, and senior faculty are equivalent. However, the reasons for the continued loss of women on the academic promotion ladder from instructor to professor and from first to last author need to be studied. To ensure that the advances in women first-authorship translate to career retention and promotion, we need to better understand the challenges women face in their career trajectories.

AAMC

Association of American Medical Colleges