Integrating sex and gender into biomedical research requires policy and culture change.

Most biomedical, health and care research does not adequately account for sex and gender dimensions of health and illness. Overlooking and disregarding the influence of sex and gender in research reduces scientific rigour and reproducibility, which leads to less effective treatments and worse health outcomes for all, particularly women and sex and gender diverse people. Historically, there has been minimal sex and gender policy innovation in UK medical research. To address this, stakeholders from across the UK research sector have been collaborating since spring 2023 to co-design a sex and gender policy framework to be implemented by research funders, as part of the MESSAGE (Medical Science Sex and Gender Equity) project. In the first Policy Lab, held in London in May 2023, 50 participants, including representatives from funding organisations, medical journals, regulators, clinicians, academics and people with lived experience, identified two key priorities for future action: 1) A whole system approach to policy change, and 2) Technical capacity-building and wider culture change efforts. In pursuing these priorities and collaborating cross-sectorally, UK stakeholders are engaged in an internationally innovative approach aimed at realising sustainable and impactful sex and gender policy change. Drawing on MESSAGE Policy Lab discussions, we set out key actions needed for the UK research sector to embed meaningful accounting for sex and gender as a new norm for research practice.

Sex and Gender in COVID-19 Vaccine Research: Substantial Evidence Gaps Remain.

Since the start of the COVID-19 pandemic there has been a global call for sex/gender-disaggregated data to be made available, which has uncovered important findings about COVID-19 testing, incidence, severity, hospitalisations, and deaths. This mini review scopes the evidence base for efficacy, effectiveness, and safety of COVID-19 vaccines from both experimental and observational research, and asks whether (1) women and men were equally recruited and represented in vaccine research, (2) the outcomes of studies were presented or analysed by sex and/or gender, and (3) there is evidence of sex and/or gender differences in outcomes. Following a PubMed search, 41 articles were eligible for inclusion, including seven randomised controlled trials (RCTs), 11 cohort studies, eight cross-sectional surveys, eight routine surveillance studies, and seven case series. Overall, the RCTs contained equal representation of women and men; however, the observational studies contained a higher percentage of women. Of 10 studies with efficacy data, only three (30%) presented sex/gender-disaggregated results. Safety data was included in 35 studies and only 12 (34%) of these presented data by sex/gender. For those that did present disaggregated data, overall, the majority of participants reporting adverse events were women. There is a paucity of reporting and analysis of COVID-19 vaccine data by sex/gender. Research should be designed in a gender-sensitive way to present and, where possible analyse, data by sex/gender to ensure that there is a robust and specific evidence base of efficacy and safety data to assist in building public confidence and promote high vaccine coverage.

Representation of Women Among Editors in Chief of Leading Medical Journals.

Importance: Women remain underrepresented among editors of scientific journals, particularly in senior positions. However, to what extent this applies to medical journals of different specialties remains unclear. Objective: To investigate the gender distribution of the editors in chief at leading medical journals. Design, Setting, and Participants: Cross-sectional study of the editors in chief at the top 10 international medical journals of 41 categories related to the medical specialties of the Clarivate Analytics Web of Science Journal Citation Reports in 2019. Main Outcomes and Measures: Proportion of women as editors in chief. Results: This study found that, overall, women represented 21% (94 of 44) of the editors in chief, with wide variation across medical specialties from 0% to 82%. There were 5 categories for which none of the editors in chief were women (dentistry, oral surgery and medicine; allergy; psychiatry; anesthesiology; and ophthalmology) and only 3 categories for which women outnumbered men as editors in chief (primary health care, microbiology, and genetics and heredity). In 27 of the 41 categories, women represented less than a third of the editors in chief (eg, 1 of 10 for critical care medicine, 2 of 10 for gastroenterology and hepatology, and 3 of 10 for endocrinology and metabolism). Conclusions and Relevance: This study found that women are underrepresented among editors in chief of leading medical journals. For the benefit of medical research, a joint effort from editorial boards, publishers, authors, and academic institutions is required to address this gender gap.

Tackling inequality in maternal health: Beyond the postpartum.

Healthcare systems prioritise antenatal and intrapartum care over the postpartum period. This is reflected in clinical resource allocation and in research agendas. But from metabolic disease to mental health, many pregnancy-associated conditions significantly affect patients' lifelong health. Women from black and ethnic minority backgrounds and lower socioeconomic groups are at greater risk of physical and psychiatric complications of pregnancy compared to white British women. Without sufficiently tailored and accessible education about risk factors, and robust mechanisms for follow-up beyond the traditional 6-week postpartum period, these inequalities are further entrenched. Identifying approaches to address the needs of these patient populations is not only the responsibility of obstetricians and midwives; improvement requires cooperation from healthcare professionals from a wide range of specialties. Healthcare systems must encourage data collection on the long-term effects of metabolic and psychiatric conditions after the postpartum, and s support research that results in evidence-based care for the neglected field of women's postpartum health.