Commentary: Challenges and Opportunities for Women in Dental Research

Abstract

This commentary integrates and expands on the preceding articles in this issue that document and celebrate a century of women’s achievements in the International Association for Dental Research (IADR). The increasing participation and leadership of women in dental and craniofacial research and within the IADR were viewed from the perspective of a changing culture of science. The steps that have been taken by the IADR to develop greater inclusiveness are acknowledged, and some of the challenges that remain are discussed in terms of obstacles that are most often social or cultural in origin. Comparisons are made across countries, and the social determinants that lead to differences in women’s participation are described. Recommendations are made for developing strategies to change elements of our institutional cultures that have provided advantages to some groups of researchers more than to others. The unconscious biases and a lack of commitment to diversity, equity, and inclusion that limit the participation of members of some groups limit the progress and achievements of science in general.

Introduction

Authors of the preceding articles in this issue of Advances in Dental Research (ADR) have described both the current status of women actively engaged in oral health–related, dental, and craniofacial research and the strides that they have made to get here. Both the data and the individual stories behind those data demonstrate that women’s participation in the International Association for Dental Research (IADR) has increased dramatically in the last 50 years. That participation, including the assumption of leadership roles by women, has been most remarkable in the last 10 years. Yet this progress has not been without costs for the women involved, and unfortunately, it has not equally benefited women living and working in all areas of the world.

The problem of underrepresentation of women in some fields of endeavor, especially in positions of leadership and power, is not unique to clinical dentistry, dental education, or dental research. A recent issue of The Lancet (February 9, 2019; 393[1017]:493–610, e6–e28) comprised a series of articles describing aspects of the gender gap across STEM (science, technology, engineering, and mathematics) fields, as well as medical specialties and related academic fields. The Lancet editorial in that volume made several points worth considering as we ponder how to address the challenges identified by authors writing here in ADR. Among those points, we found most compelling the recommendation that solutions or actions to eliminate gender bias should address the systemic issues that create bias—that is, the aspects of our social and institutional systems that disproportionately give advantage to men. This is a critical perspective when we acknowledge that we are more often inclined to assign the solution of problems created by gender bias to the individual women who have been disadvantaged than to the culture that has disadvantaged them. For example, notwithstanding the importance and value of educational opportunities for women to learn how to write grants or negotiate more effectively, we need first to directly address the features of our systems—social, educational, institutional, economic, and otherwise—that favor, or privilege, men. It is these aspects of our environment that have created a world in which men have more easily than women acquired the skills associated with successful research careers.

In attempting to expand our thinking and creative problem solving about these matters, we considered the research area of health disparities and the now universally acknowledged role that “social determinants” play in the relative capacities of different population groups to engage in healthy behaviors, access health services, and achieve better health—including oral health. In studying health disparities, we have come to understand the impact of social determinants—those “upstream variables” that predetermine not only the resources that are available to different groups of people but also how those groups will behave, what they will know, what they will expect to do, and what will be expected of them by others. This understanding requires that we turn our attention to addressing not only the how and what of the immediate task at hand but also the social, economic, cultural, or other conditions that have created a disadvantage, a deficit, or a need within a given group. As one illustration, consider that if proper mentoring is essential for women to acquire the skills to develop research portfolios equal to those of their male colleagues, we must not just ask how women can learn to seek and work with mentors. Rather, we need to ask what has led to women not having equal access to mentors or to not having knowledge about how to seek and work with mentors, and then we must change or modify those determinants.

In medicine, quality of mentorship is the best predictor of job satisfaction, a key aspect in faculty retention (Krueger et al. 2017). This is not surprising, since a mentor’s career path serves as a blueprint in seeking the skills and values needed to reach the mentee’s goals. Mentors create opportunities, make connections, advocate for promotions, provide honest feedback, encourage participation in activities (local, national, and global), provide assistance to ensure success, and provide safety nets that enable risk taking. Yet surveys of mentees’ perceptions have demonstrated that the generational gap between them and their mentors may prevent them from realizing their full potential. Mentors’ careers and experiences often do not reflect current challenges (Strong et al. 2013). For instance, most women in academia are part of dual-career couples, where gender roles and spousal dynamics pose challenges for women that may not be readily noticeable to their mentors and supervisors, chairs, and deans, who are often older and male (Steele et al. 2013). Also, those mentors may not be prepared to navigate the current landscape of diversity, gender conformity, dual-career couples, and need for flexible schedules. This logic naturally leads us to explore how institutions might facilitate availability and access to appropriate mentors. Perhaps multiple mentors might be more strategic, and one or more might be from outside the home institution or even the home country. This approach is different from one that attempts to simply “fix” the deficits that are perceived to characterize women researchers.

The global inequalities that Tiwari and her coauthors (2019) have pointed out in this ADR issue were highlighted in The Lancet volume as well, and this challenge represents another type of social determinant that needs to be considered. It underscores what we know well—that there are major differences across countries and areas of the world in cultural attitudes toward women’s involvement in a range of endeavors, including dental research, as well as in the economic factors that are at play in supporting scientific research more generally. As citizens of a community of scientists which does not acknowledge national boundaries in its goals and methods, we must view the challenges of one as the challenge of all of us—regardless of national boundaries. In doing so, we can address the national boundaries and the associated cultural characteristics as social determinants that we work to influence for the benefit of all.

The remainder of this article explores this approach to the future of women in dental research. We address the challenges that have been identified by authors in the previous pages, and we discuss the potential solutions that have been offered and add some of our own. Our focus is on the ways in which these approaches address social determinants, including institutional, cultural, and systemic biases, as well as the specific needs that can be addressed by extending to women the structural and educational tools to support their continuing engagement and achievement in this world of dental research. In other words, we are looking for actions that will effect culture change in the ways that we think about women in dental research, the expectations that we have for their achievement, and the understanding that we have about what our organizations and institutions can do to support all dental researchers, regardless of gender identity.

Global Gender Inequalities

As identified previously, the task of Dr. Tiwari and her coauthors (2019) was to describe the relative achievements and progress of woman scientists in dental research across the countries or world regions that participate in the IADR. Using institutional data from the IADR and from academic institutions within countries when possible, they were able to describe where women are making greater progress in terms of participation in dental research and also those countries where women’s participation has lagged. Western countries generally are showing progress, and Brazil reports by far the strongest participation of women in dental research, representing >50% of that country’s dental research workforce. Aside from the large numeric representation in IADR membership, Brazilian female dental scientists have increasingly served the IADR as officers in several scientific groups and networks, including an IADR president. In contrast, Japan is a country that has contributed a great deal to dental and craniofacial research and discovery, yet it reports the lowest participation of women, even among the group of Asian and African countries that have historically shown such low participation. One of the next steps in mitigating such gender disparity is to identify the local and global factors that facilitate or impede the participation of women scientists in dental research and in the IADR. Once barriers and their social origins have been identified, tailored strategies can be devised, revised, implemented, and evaluated, thereby enhancing the abilities of women in the dental research workforce in ways that address the specific cultural determinants that may have limited prior progress.

One potential barrier that often perpetuates global gender inequality is the limited availability of parental leave policies and policies that can accommodate changing life events and family needs that affect women disproportionately. Another is resistance to the utilization of such policies when they are available, for fear of being perceived as a burden to others who will need to “step in” to cover one’s absence (Villablanca et al. 2013). A change in culture may be needed since research has shown that women (and men) are perceived as less committed to their work after utilizing parental leave policies or after simply becoming parents.

A commonality across the globe seems to be the fact that women are increasingly populating the faculty of dental schools but are underrepresented among the senior faculty, chairs, and deans. By the 1970s, US dental school classes consistently had more than a few female students, but meaningful increases in their ranks did not begin until the 1980s (Feldman 2015). Thus, the percentage of women making up the population of US dentists is only now significantly increasing. Yet, several hurdles remain, arising from biases that are conducive to a cyclic pattern of inequality. For example, it is acknowledged that scholarship, as evidenced by research publications in peer-reviewed journals, is one of the benchmarks of academic career advancement (Whelton and Wardman 2015). Given the limited institutional support in many countries for faculty to develop their skills as grant recipients, women who have parenting responsibilities tend more often to focus on teaching or clinical activities, rather than on research. Consequently, women may not be applying for research support and receiving research grants and subsequently will have less scholarly recognition, resulting in fewer women being promoted to senior academic positions and receiving the honors and awards that come from scholarly productivity.

Perhaps there are lessons to be learned from collaborative research comparing those countries with more productive female researchers and those with fewer. A related and critical question is whether dentistry is maintaining itself as a learned profession and whether faculty, regardless of gender identity, can function in dental schools that are removed from scholarly activity in their larger universities. Dental schools are increasingly being established with limited or no ties to larger academic institutions. Do these schools participate actively in research missions and goals similar to those of schools within academic health centers? Where are women faculty working? Where are the most productive women dental researchers working? These are questions that beg to be studied.

Role of the IADR

Dr. Ioannidou and her colleagues (2019) outlined five areas in which women often experience limited opportunities or barriers to success in dental research, including the workforce pipeline, economic inequality, workplace harassment, gender bias in publications, and work-life balance. They also described the limitations that we impose on scientific progress when we fail to acknowledge and address increasingly salient questions related to sexual orientation and gender conformity. The authors pointed out some of the actions and stances taken by the IADR that have served to acknowledge inequalities among groups of its members, including the recognition of the Women in Science Network; the sponsorship of workshops and training for addressing inequities; the creation of awards and fellowships that recognize, celebrate, and foster the development and accomplishments of women scientists in the field; the adoption of policies related to preventing harassment and supporting a safe and welcoming environments within its meeting venues; and additional statements and policies addressing such issues as family considerations, work-life balance, and gender parity in scientific publishing.

The authors express confidence in a future where gender diversity and equality will be organic within the world of research. This, of course, is the ultimate challenge. It is cultural change that we are seeking, for it is only through cultural change that we can address the insidious limitations imposed by beliefs, attitudes, and expectations. Ioannidou and her colleagues have advocated more aggressive efforts to put policy into action. We can ponder what that might mean, in the case of each of the areas of limited opportunities, but let’s take just one: the limitations related to work-life balance. At the policy level, organized science in the form of organizations such as the IADR has found few ways to address systemic problems. Instead, we tend to voice concerns and even study some of the issues raised in Ioannidou’s article—tenure clock considerations and gender differences related to domestic responsibilities, for example. What might have more direct impact on the culture, however, would be real steps to address these needs. For example, if women, more often than men, are constrained in attending IADR meetings because of child care responsibilities, it follows that younger women—who most need to attend the meetings as tools for building their careers—are especially affected. To address this issue, we should consider whether child care services should be provided at the meetings; this has been done by other associations. It is expensive; it requires a commitment at a higher level; and it is an action that could address—and legitimize—work-life issues for women and men. Just as many academic institutions have come to believe that they have a role in supporting scientists and scholars in their family responsibilities, our scientific and disciplinary organizations may need to move in this direction. Our sense is that ideas such as these should not be rejected because of expense; rather, they should be carefully studied to determine whether, how, and for whom such actions could make a difference.

There are other steps, too, that could be taken to support young scientists in managing their lives and careers. Just as important as the help for those individuals who need these services, however, would be the impact on perceptions of what is important and on beliefs about what it takes to do research and build careers in research; this is culture change.

Distinguished Scientist Awardees

In their ADR article, D’Silva and her coauthors (2019) acknowledged the “unconscious bias” that is implicated in the underrepresentation of women in such areas as recognition or awards for research. Assuming the unintentional nature of these decisions—perhaps because women are not always present in selection committees or their names are not close at hand—they suggested that corrective action means structural and procedural changes. This reasoning reflects the same cause of gender disparities in scientific achievement and recognition that we have already described: the inertia of our systems. Our organizations carry within their cultures a variety of social determinants, including our expectations about who is a distinguished scientist. These expectations and many others will not change simply because members come to believe that the organization needs to be more welcoming to women. Rather, clear and deliberate actions have to be taken to change the culture.

D’Silva and her colleagues made some very specific recommendations for ensuring that women are not overlooked for important research awards, including managing the membership of selection committees, the gender balance in the pool of candidates, and the criteria for procedures as well as selection. These are good suggestions, and they will be effective if they are carefully, thoroughly, and precisely implemented. It is important to remember why we are putting them in place, however—not just to influence the outcome of a specific award selection but to influence the culture of our organization and the community of scientists more generally. It is the culture that we want to change; we want to change the way that we think about the roles, capabilities, and talents of women, not just who receives an award in a particular case. This is a culture change that no one needs to fear, because it means simply bringing our culture in line with who we are and what we believe.

Summary

In conclusion, we must emphasize the remarkable progress that women have made as they have followed their natural talents to seek and achieve success in dental-related research. This issue’s stories of the 11 women who have been elected by their peers to lead the IADR (Shaddox and Letra 2019)—the world’s most important organization in their field—attest to the competence, strength, and spirit of these and many other women scientists. They also highlight experiences of blatant sexism in the United States and abroad. Several examples are given in which women were told that they belonged in the kitchen and not in research or that they would be taking the place of men who needed to enhance their careers. Fortunately, there also seems to be a sense that bias and discrimination have declined since the early years of these women’s careers—perhaps due to pressure from public opinion. Nonetheless, the prevailing perception is that women start their research careers at a disadvantage, having been discouraged from developing the attitudes and taking the courses that prepare them for serious scientific study early on. Women’s societal expectations and stereotypes related to their roles as wives and mothers (and later on as daughters with family responsibilities) continue to compromise the pace of their career advancement. Collectively, they feed the myth that if a woman has children, she will not work as hard as a man would.

We can say the same about the growing list of women who are honored as Distinguished Scientists by the IADR. The success of all of these women attests not only to their individual achievements but also to the integrity of an organization that increasingly recognizes the value of the participation and leadership of women in dental research. It also is important to highlight the value of corporate role models who are active members of the IADR, including Dr. Maria Ryan, vice president and chief dental officer at Colgate-Palmolive and past president of the American Association for Dental Research, and Dr. Teresa Dolan, vice president and chief clinical officer at Dentsply Sirona and former dean of the University of Florida College of Dentistry.

We have made the case here that the most important remaining steps are those that will change the culture of an organization and that of the scientific community. Only in these ways will we change the “unintentional disparities.” But we do need to be mindful of the paucity of our metrics for assessing how well we are achieving enhancements in our workforce and how gender identity might contribute to such enhancements.

Acknowledging the inadequacy of our information and our methods, we need to articulate another point. While we have focused on women as one demographic category of our research workforce, we are cognizant that many of these same issues might pertain to other gender identities. Perhaps stimulated by this effort to look at women, further research on characterizing the entire workforce capacity will inform everyone and incentivize us to treat one another in more personalized and equitable ways. The same barriers that hinder women’s progress—unconscious biases, as well as blatant discrimination or structural and organizational barriers—also function to keep other groups from reaching their full potential. According to US data, we might conclude that as many as 70% of potential participants could be excluded or disadvantaged in these ways. We simply cannot afford this loss of talent. Making research and the academic enterprise more inclusive and equitable for all should be our ultimate goal. Each member of the workforce has issues that need to be addressed if we are to maximize contributions to the advancement of the oral health sciences. The importance of respecting and supporting our differences is the core message of this special issue.

Finally, we want to note that we have not attempted to make the underlying case for increasing the participation of women in research; the women recognized in this issue have done that superbly. Now it is time to encourage more of the same by taking the additional steps suggested here to ensure that the next generation of women dental researchers will find the path less strewn with obstacles, more clearly marked, and more obviously inviting to all who have the talent, perseverance, and passion to pursue our collective goals.

Author Contributions

J. Albino, contributed to conception, design, and data acquisition, drafted and critically revised the manuscript; F. Teles, contributed to conception, drafted and critically revised the manuscript; L.K. Cohen, contributed to data interpretation, drafted and critically revised the manuscript. All authors gave final approval and agree to be accountable for all aspects of the work.