Invisible Barriers to Female Participation in Orthopaedic Surgery in Karachi, Pakistan: A Cross-Sectional Study

Abstract

Background/Aims
Women remain markedly underrepresented in orthopaedic surgery despite increasing female enrolment in medical schools. This study aimed to assess perceptions, interests, and perceived barriers influencing female medical students and house officers in Pakistan when considering orthopaedic surgery as a career, and to identify factors that may hinder or facilitate females them.

Methods
A multicentre cross-sectional survey was conducted between March and June 2024 across public and private medical colleges and affiliated hospitals in Karachi, Pakistan. Fourth- and final-year medical students and house officers were recruited using convenience sampling. Data were collected using a validated, self-administered questionnaire assessing demographics, perceptions toward women in orthopaedics, subspecialty preferences, and perceived barriers. Descriptive statistics were calculated, and subgroup analyses were performed based on gender, training level, and orthopaedic exposure. Statistical analyses were conducted using SPSS and R, with a significance threshold of p < 0.05.

Results
A total of 368 participants were included (73% female; mean age 22.86 ± 2.44 years). Only 26% considered orthopaedic surgery for postgraduate training, with lower interest among females despite higher clinical exposure. Patient preference for male orthopaedic surgeons (78%), family and social commitments (75%), physical demands (67%), and gender discrimination (65%) were the most frequently reported barriers. Paediatric orthopaedics was perceived as the most suitable subspecialty for women. Participants with orthopaedic exposure demonstrated greater awareness of gender-based challenges.

Conclusion
Despite increasing awareness, substantial sociocultural and structural barriers continue to limit women’s participation in orthopaedic surgery in Pakistan. Targeted mentorship, institutional support, and strategies to address gender bias are essential to promote a more inclusive orthopaedic workforce.