In December 2020, I got an invitation from the American College of Surgeons to join their panel discussion on the topic “International HeforShe: Why doing the Right Thing Matters”. I was pleasantly surprised and intrigued by the topic itself, and needless to say, I gladly accepted it (Fig. 1). I was also required to make a short presentation before the panel discussion. As I tried to prepare my slides for the same, I dug into what it really meant. Most of my presentations thus far have been academic related to some HPB & GI cancer topics, but this was different. Although I was aware of the struggle women face in day-to-day life, both in personal and professional fields, a glimpse into the hard reality that strikingly exists was an eye opener and that is what I intend to bring forth in this editorial.

Fig. 1
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The participants and the American College of Surgeons Webinar in progress

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HeForShe, often referred to as He for She, is a solidarity movement for the advancement of gender equality, initiated by the United Nations. It is an invitation for men and people of all genders to stand in solidarity with women to create a bold, visible, and united force for gender equality. Since its launch at the United Nations, on 20 September, 2014, by the Executive Director of UN Women, Phumzile Mlambo-Ngcuka, His Excellency Sam Kahamba Kutesa, president of the 69th session of the General Assembly, UN Secretary-General Ban Ki-moon, and UN Women Global Goodwill Ambassador, Emma Watson, hundreds of thousands of men from around the world including heads of state, CEOs, and global luminaries from all walks of life have committed to gender equality [1]. HeForShe points to studies showing that 257 more years will be necessary to close the gender gap and that 95% of the world’s CEOs and heads of states are men to illustrate the need for male allyship.

The Indian Landscape

There’s an alarming decrease in women labor work participation rate (LWPR) in India that has decreased from 42.7 (in 2004–2005) to 23.3% (in 2017–2018). Three out of 4 women are neither working nor seeking employment, and India is in the bottom 10 countries of the world in terms of women LWPR. Our neighboring country, Bangladesh, has on the contrary increased its women LWPR from 24 (in 1991) to 36% (in 2017). [2] A McKinsey Global Institute (MGI) study in 2015 found that in a “full-potential” scenario in which women participate in the economy identically to men, $2.9 trillion could be added to India’s annual GDP in 2025 or 60% of GDP. It further reported that women are currently particularly under-represented in India’s economy compared with their potential. At 17%, India has a lower share of women’s contribution to GDP than the global average of 37% and the lowest among all regions in the world. In comparison, China’s women contribute 41%, those in Sub-Saharan Africa 39%, and women in Latin America 33% [3]. Instead there is a steady fall in Indian women LWPR.

A big divide exists between rural vs. urban Indian women in terms of LWPR. Rural India lost approximately 24.7 million female workers between 2012 and 2018. The reasons are multifold but are essentially centered on labor displacement due to various factors such as contraction of agricultural land and as a consequence female participation in farms and in their own fields has dropped. Around 75% of women are employed in agriculture close to their place of residence, and hence, landlessness causes a significant drop in LWPR. With increase in agricultural mechanization, as it shifts from animal-based to machines (harvesters/drills/threshers etc.) along with growing commercialization of poultry and animal husbandry, women specifically bear the brunt as most have low to nil vocational training or adequate digital literacy and minimal basic education and hence lose out to their male counterparts in manual labor-related work. Men with 10–12 years of education on the other hand migrate and travel to engage in different fields such as construction workers, drivers, sales agents, courier boys, shop assistants, police constables, in equipment services and small trade as agricultural work employment falls [2].

Urban Indian women do appear to have a slightly advantageous position comparatively. More women are graduates or postgraduates in respectable white-collar jobs in government sectors, corporates, teachers, doctors, nurses, women pilots, wrestlers, lawyers, judges, and entrepreneurs, but an alarming gap still exists vis-a-vis their male counterparts. Timely marriage, children, looking after elderly, and household chores are still considered primary responsibilities of a woman. India is largely a patriarchal and patrilocal society wherein a woman is supposed to migrate to her husband’s workplace/residence area after marriage and rebuild her career, if at all. Compounded to these basic stumbling blocks are workplace and societal issues wherein there are no flexible work hours, safety issues for women during travelling, workplace harassment, and often improper implementation of maternity leave and crèche facilities at workplace [2].

It has also been observed that as the social status of the families increases, women tend not to go out for work as it carries some cultural/ societal stigma especially if a woman is engaged in manual labor work as it reflects negatively on the “man” of the house. There is an interesting hypothesis by Claudia Goldin, Henry Lee Professor of Economics at the Harvard University. It states that women LWPR follows a “U”-shaped curve over the course of economic development. As education levels increase in women, initially there is a fall in LWPR, but it gradually rises when there are enough educated women [4]. In India, unfortunately, there are not enough educated women workers to create the upward curve in LWPR, and the COVID pandemic is likely to worsen the situation further.

A look in to our own Association of Surgeons of India (ASI) will reveal that as of November 2020, we have some 27,100 registered members of which 2779 are women; only 9 have been in its governing council since 2010; only one woman president ASI since its inception in 1938; and the Indian Journal of Surgery has its first ever woman editor. Surgery per se remains a male-dominated specialty. Exceptionally few women join subspecialties like HPB/surgical oncology/transplant/neurosurgery/CVTS/urology and can be counted on fingers. Even at my current institute, the number of female general surgery residents was evidently low, 4 (in 2017), 2 (in 2018), and 3 (in 2019) in a batch of 20 residents. Women voluntarily avoid demanding branches with emergencies and opt instead for “cooler” end branches that lead to early settlement so that they could workout a homework balance, the burden of which essentially rests on the woman. Even those who opt for surgery seldom find a “mentor” and end up selecting relatively less challenging surgical fields. Their capabilities are often doubted; maternity leaves are not taken well by the management; and not surprisingly, the surviving lot is often stamped as being too “career oriented” and “aggressive”.

Interestingly, this gender gap is also evident in the Indian judicial system (advocates and judges), wherein a large majority of women lawyers deal with matrimony and child custody settlement matters with very few criminal lawyers. The ratio of female to male judges is skewed even in the Honorable Supreme Court of India (SCI). In 2020, the honorable SCI had only 2 women judges out of 34, a meager 7.2% of total judges; it never had a woman Chief Justice of India. In a landmark moment, President Ram Nath Kovind approved the appointment of Justice BV Nagarathna, and 8 others to the SCI, paving the way for her to be the likely first woman Chief Justice of India in 2027. There is only one woman Chief Justice in the Honorable High Court. Of an overall 1113 judges in the honorable SCI and High Courts of India, only 80 are women judges. Lamenting centuries of suppression of women at workplaces, Chief Justice NV Ramana called for an “urgent correction” in the state of affairs and said he strongly advocates reservation of a “significant percentage of seats” in law schools and universities for women. “Enough of suppression of thousands of years. It is high time we have 50% representation of women in judiciary. It is your right. It is not a matter of charity”. Of the 1.7 million advocates, only 15% are women. Only 2% of the elected representatives in the state bar councils are women. “(There is) no woman member in the Bar Council of India,” the Chief Justice said at an event organized by women advocates of the Supreme Court recently [5]. We need many more like him to actually show a path forward towards women empowerment and a gender-neutral society.

So, What’s the Way Forward?

Working women must gain freedom in polity, society, and in their own households. Women’s social, political, and legal status improves with economic progress. As Claudia Goldin rightly states “Gender equality and economic development share a synchronous existence”. Women in authority and position should encourage more women and be their role model. The scenario of having a gender-neutral society will not be possible unless initiatives are taken at home, society, and government levels.

Changing the mindset of the children starts from home. Parents need to encourage their daughters to be achievers. India is changing fast with amazing stories of wrestlers from small towns of highly patriarchal states like Haryana, and India has the highest numbers of women pilots in the world. Patriarchy should take a back seat with the aim of sowing the seed of a gender-neutral society in tender minds.

Society as a whole needs to encourage women in workforce without any gender biases, burying the stigma against working women and ensuring safety and dignity in travelling/stay and equal remuneration.

The government has the major responsibility in women empowerment that starts from subtle measures such as enough jobs for women near their home (e.g., MNREGA mandates 30% jobs to women, equal pay, in location close to their villages, and has been a game changer); offering vocational and digital training and upskilling women especially in handicraft, food, garment industry (vocal for local); encouraging female entrepreneurship with microcredit facilities for women (e.g., under PMMY); amendments in land ownership and inheritance rights; changes in the Maternity Benefit Act 2017 where leave with full pay has been increased from 12 to 26 weeks (but placed the entire cost burden on employers thereby affecting hiring of young women by employers) and also making crèche mandatory for facilities with at least 50 employees; ensuring equal wages with no discrimination based on gender (e.g., Equal Remuneration Act 1976 and Minimum Wages Act 1948); Domestic Violence Act 2005 to help married women; encouraging more women in politics starting at the ground level in local gram panchayats (village council where there is 33% reservation for women) and reservation in higher power echelons; and overall providing safety to women with good public transport and public washrooms, safe hostels for young and single women, and quick punishment for harassment at workplace.

I am quite hopeful that one day we will have a gender-neutral society where women will not be judged “less capable” to their male counterparts based on her gender/height/ complexion/ dressing sense/marital status, but only on her capabilities; if this bias is done away with, it will be a balanced society for everyone to grow, prosper, and pursue their dreams.