Skip to main content
NCBI home page
Asian Bioethics Review logoLink to Asian Bioethics Review
. 2023 Feb 7;15(3):241–258. doi: 10.1007/s41649-023-00241-w

Poor Representation of Developing Countries in Editorial Boards of Leading Obstetrics and Gynaecology Journals

Seema Rawat 1, Priyanka Mathe 1, Vishnu B Unnithan 2, Pratyush Kumar 3,✉, Kumar Abhishek 3, Nazia Praveen 1, Kiran Guleria 1
PMCID: PMC9902818  PMID: 37399006

Abstract

Evidence suggests a limited contribution to the total research output in leading obstetrics and gynaecology journals by researchers from the developing world. Editorial bias, quality of scientific research produced and language barriers have been attributed as possible causes for this phenomenon. The aim of this study was to understand the prevalence of editorial board members based out of low and lower-middle income countries in leading journals in the field of obstetrics and gynaecology. The top 21 journals in the field of obstetrics and gynaecology were selected based on their impact factor, SCImago ranking and literature search. The composition of the editorial boards of these journals was studied based on World Bank Income Criteria to understand the representation status of researchers from low and lower-middle income countries. A total of 1315 board members make up the editorial composition of leading obstetrics and gynaecology journals. The majority of these editors belong to high-income countries (n = 1148; 87.3%). Low (n = 6; 0.45%) and lower-middle income (n = 55; 4.18%) countries make up for a very minuscule proportion of editorial board members. Only a meagre 9 out of 21 journals have editorial board members from these countries (42.85%). Low and low-middle countries have poor representation in the editorial boards of leading obstetrics and gynaecology journals. Poor representation in research from these countries has grave consequences for a large proportion of the global population and multidisciplinary collaborative efforts must be taken to rapidly change this statistic with immediate effect.

Keywords: Editorial board, Obstetrics, Gynaecology, LMICs, Publication ethics

Introduction

The advent of the COVID pandemic has pushed a large proportion of scientific gatherings into virtual zones with conferences, teaching projects and partnerships now occurring online (Almusharraf and Bailey 2021; Edelhauser and Lupu-Dima 2021; Tegos et al. 2021). Though this has its cons, this shift to a virtual medium has significantly made working in international teams a lot easier and more possible than ever before. Online communication ensures that distance barriers are overcome and allows for teams to work asynchronously on a project in different time zones. This is especially useful in a field like research where inter-institute expertise can stimulate developments in novel trajectories. The new scope for collaboration that is now available justifies a fresh need to re-examine the debate of inclusion that has been impacting medical research for long.

Medical research output from low and lower middle-income countries in indexed publications has always been consistently lower across multiple medical disciplines (Aluede et al. 2012; Rohra 2011; Saxena et al. 2006). This trend has been consistent across both clinical and non-clinical specialities. This is a matter of very serious concern because these countries house a large proportion of the global population. In fact, 5 of the 10 most populous countries in the world (namely, India, Indonesia, Pakistan, Nigeria and Bangladesh) are low and lower-middle income countries (Hamadeh et al. 2022).

There is also evidence to further indicate that even in cases where the subject under discussion is pertaining to low and lower-middle income countries, the available literature is authored by physicians from upper-middle income and high income countries (Yach and Kenya 1992). Whilst editorial bias and lack of scientific rigour are the common causes to which this imbalance is often attributed (Rohra 2011), it is important to note that this disproportionate representation between countries in published scientific literature can lead to misleading conclusions and numerous biases.

This trend also further raises concerns about whether these regions serve as ‘experimental arenas’ for authors from privileged economies to carry out their research activities, considering the rich diversity of patient populations in these regions. Though a large chunk of infectious disease research is conducted in low and lower-middle income countries due to the epidemiological distribution of the disease, a study examining the authorship trends in published articles on infectious diseases between 1998 and 2018 reported a rising trend of exclusion of low income affiliated investigators from being published as first authors (Modlin et al. 2022). It is also worthwhile to note that physicians hailing locally from these regions, who may be expected to be better informed about the presentation of the conditions being discussed, have perceived an editorial bias against them solely due to their geographical location (Horton 2000). This skewed representation also has graver consequences.

Epidemiologically prevalent diseases which are rampant in these countries are unable to find adequate importance in published literature (Sumathipala et al. 2004). This leads to variations and local risk factors which greatly impact the progression and management of an illness being relatively unknown. Since systematic reviews and evidence summaries are based upon published literature, this leads to proliferation of a ‘one size fits all’ kind of practise. There is a large gap between the knowledge and ground requirements of physicians on the field in these non-high-income countries. In a world which is slowly advancing towards theranostics and precision medicine (Bhujwalla et al. 2018), such shortcomings are not acceptable.

The skewed representation of low and lower-middle income countries extends to not only published literature output but also to corresponding authorship, journal indexations and citations (Rohra 2011; Igoumenou et al. 2014; Mari et al. 2010). Editorial boards, being a very key factor in making publication decisions, exert great control over the entire academic publication process. Though editorial board compositions have been studied in a few clinical specialities (Harris et al. 2019; Saxena et al. 2003), the authors noticed a gap in available literature on this data with respect to leading obstetrics and gynaecology journals. The aim of this study was to plug this research gap and understand the prevalence of editorial board members based out of low and lower middle-income countries in leading journals in the field.

Materials and Methods

Study Design

This is a descriptive report on editorial board composition of leading international journals in obstetrics and gynaecology.

Ethical Considerations

The study does not collect data from any human participant directly. It is strictly restricted to using publicly available open-access secondary data, and thus, no ethical approval was needed.

Methodology

The editorial board composition of the top 21 journals in the subject category of “obstetrics and gynaecology” based on their SCImago journal ranking, impact factor and journal citation report was identified. SCImago journal ranking takes into account the open-access nature of the manuscripts with a larger source database as well as an assessment of the quality of citations. The novelty of this ranking is already scientifically proven (Falagas et al. 2008). Screening of the journals was done based on the inclusion and exclusion criteria.

Inclusion Criteria

English-language journals with their primary scope in the field of obstetrics and gynaecology were included in the study.

Exclusion Criteria

Journals which had not reported their editorial board members with respective countries on their website. Such journals were planned to be approached by email to inquire about the same. In case the data could still not be extracted, the journal was excluded.

Expert advice was taken from a senior author (KG) to make the final selection of the journals.

The journal websites were initially perused to verify the scope, language and availability of editorial board information. For composition of the editorial boards, publicly declared appointments, as indicated by these websites, were noted as of June 2022. In case such information was unavailable on the journal website, the authors mailed the journal. Figure 1 surmises the search strategy followed.

Fig. 1.

Fig. 1

Open in a new tab

Search strategy and inclusion of journals

A sequential approach was adopted to identify the country of the editor: primarily the journal website, followed by research author databases like ResearchGate and their individual ORCIDs, and finally an assessment of their affiliations based on their recent publications. All the investigators used separate Google Sheets to extract the countries of the editorial board members as noted from their affiliations. For each editor, university and hospital websites were seen to confirm their identity by matching full names. For calculation of the count of editorial board members and their national representation, all formal editorial positions and roles like chief editor, executive editor, senior editor, section editor, as well as advisory, general, and administrative editorial roles as mentioned on the journal official website were taken into consideration. Further classification of each of these countries into income categories was done as per the World Income classification (Hamadeh et al. 2022). All conflicts during the extraction process throughout were resolved by mutual discussion followed by arbitration by the senior author (KG).

Results

A total of 1315 board members make up the editorial composition of leading obstetrics and gynaecology journals, and the findings are summarised in Table 1. Majority of these editors belong to high income countries (n = 1148; 87.3%). Low (n = 6; 0.45%) and lower-middle income (n = 55; 4.18%) countries make up for a very miniscule proportion of editorial board members.

Table 1.

Composition of editorial boards of top 21 Obstetrics and Gynaecology Journals

SCImago rank SCImago Journal Ranking indicator Impact factor Journal Total members in editorial boards LIC LMIC UMIC HIC
1 4.977 15.61 Human Reproduction Update 32 2 30
2 3.497 8.661 American Journal of Obstetrics and Gynaecology 49 1 1 47
3 3.202 7.299. Ultrasound in Obstetrics and Gynaecology 76 4 72
4 2.664 8.661 Obstetrics and Gynaecology 43 43
5 2.446 6.918 Human Reproduction 80 2 2 76
6 2.272 7.329 Fertility and Sterility 165 4 20 141
7 2.157 6.531 BJOG: An International Journal of Obstetrics and Gynaecology 80 2 5 73
8 2.105 5.482 Gynaecologic Oncology 56 2 54
9 2.040 2.335 Contraception 44 2 42
10 1.957 5.747 Archives of Disease in Childhood: Foetal and Neonatal Edition 36 36
11 1.818 3.571 Perspectives on Sexual and Reproductive Health 20 20
12 1.622 4.95 Best Practise and Research in Clinical Obstetrics and Gynaecology 44 3 4 37
13 1.529 2.682 Seminars in Perinatology 4 4
14 1.505 2.295 Reproductive Health 66 2 15 9 40
15 1.458 3.72 Journal of Reproductive Immunology 43 1 4 38
16 1.416 4.151 LGBT Health 48 48
17 1.401 2.426 Acta Obstetricia et Gynecologica Scandinavica 40 40
18 1.358 5.482 Journal of Gynaecologic Oncology 78 7 16 55
19 1.346 4.342 Maturitas 96 5 91
20 1.325 1.811 Women’s Health Issues 23 23
21 1.299 2.938 BMC Pregnancy and Childbirth 192 4 20 30 138
Total 1315 6 55 106 1148
Open in a new tab

Only a meagre 9 out of 21 journals (42.85%) have editorial board members from these countries. Only 9.52% and 42.5% have an editorial member from LIC and LMIC respectively, represented in Fig. 2.

Fig. 2.

Fig. 2

Open in a new tab

Highlighting the skewed composition of editorial boards of leading international obstetrics and gynaecology journals

Only 2 journals (BMC Pregnancy and Childbirth; Reproductive Health) contribute to more than half (n = 35; 57.37%) of the editorial board representation from low and lower-middle income countries. These are also the only journals having double-digit representation from these groups of countries (BMC Pregnancy and Childbirth = 12.5%; Reproductive Health = 25.7%) whilst the remaining 7 have only single digit representations.

Discussion

Editorial board details were available for all journals on their websites. This is a very encouraging sign and is indicative of adherence to good publication practises. Predatory journals are often opaque about the finer details of their editorial processes and with the rapid proliferation of these journals in wake of the publish-or-perish trend (Elmore and Weston 2020), it becomes increasingly essential to adhere to prescribed policies for disseminating quality scientific work.

Skewed Editorial Board Representations

Our study noted that high-income countries make up a large chunk of the editorial board members with respect to leading obstetrics and gynaecology journals. This finding is similar to previous studies conducted in other related disciplines (Saxena et al. 2003; Dotson 2012; Tutarel 2004). As indicated from these papers, this is an issue which plagues not just clinical medicine but also extends to non-clinical and allied healthcare fields including medical education and pharmacology. Though some of these studies were conducted nearly a decade ago, there has not been significant change in the inclusion of these countries on editorial boards and their representation is still grossly inadequate.

A study examining the editorial board diversity of global health journals noted that 26 out of 27 leading international journals in Global Health were published in a high-income country (Bhaumik and Jagnoor 2019). The same study further identified that only one editor-in-chief was from a lower-middle income country and none from a low-income country, whilst a majority (68%) of editors were from high income countries. Though developed countries are indulging in cutting-edge research which could somewhat justify a relatively higher proportional representation, their high representation even in disciplines which are not technology or resource-intensive and are supposedly a platform to provide insights into a ‘global’ scenario suggests a pervasive trend.

Another similar study conducted in 2019, on editorial board composition of top 12 global health journals, revealed that only 33% of editors across all journals came from low middle income countries (Nafade et al. 2019). This skewness is further exacerbated when it is considered that large proportions of the population live in lower-middle income countries like India, Nigeria and Indonesia. In the growing clamour about equitable representation worldwide to ensure that no vulnerable group is subjected to majoritarian insensitive decisions, editorial boards seemed to have remained largely impervious to these trends necessitating the need for a change in the functioning of academia.

Author Representations: Mirrored Skewness on the Other End of the Spectrum

Contrary to expectations, the rate of progress with respect to author representation has also been far from satisfactory. This can be understood from a Lancet correspondence highlighting that though three-quarters of the global cardiovascular disease burden is from the developing world, when examined at consequent 5-year intervals, only 6%, 7% and 8% publications on the subject originated from developing countries (Mendis et al. 2003). Another retrospective review of articles published over a period of three years in six leading psychiatry journals revealed that 90% articles originated from Euro-American societies, thus highlighting that findings from none of them can be considered as a truly international perspective of psychiatry research (Patel and Sumathipala 2001). This biased distribution truly puts editors’ claims of leading journals being ‘international’ under scrutiny (Meena and Chowdhury 2014). There are a number of far-reaching consequences that this has on the overall medical research scenario.

Socio-ethical Implications of Skewed Representation: Challenges to be Tackled

A. Accounting for Variations in Population Effects

It is elementary to note that due to individual variations, any interventions: invasive, therapeutic or otherwise, may have a complex consequence that is impacted by myriad other factors. Whilst in the bygone days, limited population inclusions could be attributed to reasons like lack of geographical access to these vulnerable subsets and unavailability of easy data distribution channels that would prevent duplication of performed research; these arguments no longer hold ground in the digitised world of today. Data from diverse samples allows for stronger generalizability of conclusions. A very relevant historical example is the impact of the multi-centre intercontinental eclampsia trial which established the utility of magnesium sulphate in management, evidence for which was controversial till then (Eclampsia Trial Collaborative Group 1995).

The recent global vaccine trials for COVID-19 had volunteers across all groups. With the advent of social media platforms and digital health, advertisements for clinical trial recruitments now enjoy greater visibility as well. This is encouraging for the scientific research community since any untoward events can be monitored and rectified before widespread use leads to uncontrollable cascades. However, research representation in sample subsets is far from equitable (Algahtani et al. 2018; Samalik et al. 2022; Smyth et al. 2019). The thalidomide tragedy needs no revisiting (Kim and Scialli 2011) and with the availability of preprint sites, virtual conferences and other collaborative mediums that permit the rapid dissemination of research findings, having equitable representation amongst patient populations before drawing research conclusions is more feasible than before.

Efforts like the American College of Clinical Cardiology Guidelines for hypertension (Whelton et al. 2018) that provide management goals for specific patient groups are a welcome step in the right direction. Data lacunae in patient subsets can be improved by enhancing research participation and providing equitable representation to the physician groups in low and lower-middle income countries who primarily engage with these populations. Attention must also be paid to post-marketing surveillance reports for new approved drugs from these regions.

B. Utility of Published Research: Stepping Away from Neocolonialism

There exists a growing trend of research which does not have any significant inherent value and only serves to boost statistics or fulfil grant requirements (Ioannidis 2016). The same paper also highlights that close to 85% of the investment on medical research could possibly be classified as ‘waste’ which translates to billions of dollars not optimally utilised. Instead of devoting resources to publish such research, data-backed efforts could be instituted to reduce the significant influence of neocolonial models, which largely dominate the current healthcare landscape (Giuliani et al. 2020; Teixeira da Silva 2022). There is a significant need for non-majoritarian perspectives from the other end of the spectrum to radically reform and bring to light hitherto underdiscussed issues. Representations on editorial boards will allow these voices a platform to generate significant traction.

Neocolonial models have also resulted in ballooning ‘parachute’ research produced from international collaborations (Teixeira da Silva 2022; Morton et al. 2022). This refers to the practise of using low and lower-middle income researchers to gain access and develop the framework for undertaking research efforts but trivialising or ignoring their contributions during deliberations on authorship. Protecting interests of researchers from low and lower-middle income regions can also be championed by equitably drafted editorial boards in an efficient manner including mandating the declaration of reflexivity statements.

An ancient aphorism propounds that true independence can be achieved if people are ‘taught how to fish’. Similarly, in regions with low research outputs, necessary mentorship and capacity-building can set the stage for high-quality impactful research. Rather than resorting to ‘parachute’ research models, local researchers need to be empowered to be able to independently partake in scientifically sound projects. Numerous kinds of capacity-building initiatives can always be launched in this regard (Pitman et al. 2019). With online collaborative opportunities that have become the norm, these initiatives need not be very resource-intensive, which improves the sustainability of these efforts as well. This is especially important in a world where nascent, yet reassuring steps are being taken towards global health and global surgery as a means of ensuring equity (Hedt-Gauthier et al. 2019).

C. Language Bias: Moving Towards Global Research Equity

Whilst efforts are being consistently taken to improve accessibility to research globally, it is pertinent to note that a large majority of research manuscripts continue to be in English. Unlike other disciplines, a patient-centric field like medical research involves undertaking a lot of work in regional and national languages. Taking informed consent, counselling patients as well as collecting data via validated questionnaires occurs in the language which patients are most comfortable with. Though initiatives like Open Access Week aim to promote the free sharing of research results amongst entire reader populations, the envisioned utility is diminished by the language barrier as a majority of patients are not necessarily comfortable with the English language.

Even amongst researchers conducting systematic reviews and meta-analyses, the Tower of Babel bias often creeps in with data from papers in regional languages (Fovet et al. 2020) being considered unextractable and, thus, excluded which reduces the impact of such work. This further discourages researchers from publishing in regional languages and has contributed to the decreasing trend of non-English papers in medical literature (Šember and Petrak 2014). As such, regional research is poorly referenced; this also leads to a vicious cycle where physicians who are most comfortable with these languages often have to undertake expensive language-editing services to ensure that their research gets the deserved readership. A feasible alternative for them would have been to publish their work in their regional language, which is the language of choice of both the authors as well as their patients.

Journals could consider implementing a multi-lingual publishing model with each issue having articles from multiple languages. Innovative solutions that would allow for effective translation rather than placeholder translations available using automated services could also provide for enhanced views as well as citations with readers truly being able to benefit from the tag of ‘open access’.

D. The Conundrum of ‘Citable’ Research: Relook at Impact Metrics

Research metrics are based on citations and readership statistics. Highly cited research gains more visibility and these papers improve journal performance in bibliometric analyses. Leading journals publish articles routinely receiving the greatest number of citations but they are also based out of high-income countries which further puts into focus the 10/90 gap that plagues medical research (Global Forum for Health Research 2000). This was also noted in the famous Bradford’s Law of Dispersion which stated that few select journals together account for the largest proportion of bibliography for a specific topic (Cascajares et al. 2021). These lead to the development of a vicious cycle where more research is published from a select few countries whilst literature from the remaining countries is ignored. There is also an unfortunate trend where editors and reviewers favour an acceptance trend for manuscripts in which their subscribers have demonstrated high interest (Patel and Sumathipala 2001). Since the language of most research is English (Šember and Petrak 2014) with the resultant readership demographic being primarily based in developed countries, articles from low income and lower-middle income countries have higher chances of rejection on grounds of being ‘non-relevant to readers’.

Though there is a constant pressure on even these clinicians to publish their work so as to fulfil criteria for promotions and benefits, there is a common perception of bias which they experience (Horton 2000). Corrective steps like enhancing representation in editorial boards can serve as a useful starting point to actively change this perception and is the need of the hour. In a survey of corresponding authors from articles published in 131 Medline-indexed pharmacology journals, it was reported that 40% of the authors held the view that editors and reviewers do not believe in the research produced by authors from low and lower-middle income countries (Rohra 2011). This extends to concerns over research methodology as well as data collection. However, encouraging involvement would enhance exposure of these clinicians and allow for the necessary improvement in research skills as has been discussed later in this article.

E. Barriers to Publication: Cost and Accessibility

The research scenario in low-income and lower-middle income countries is radically different from higher-income countries. Many of these clinicians have no protected time to undertake research and are expected to juggle clinical duties, teaching and research responsibilities as part of the triumvirate of being a doctor. Though heavy clinical workloads provide plenty of opportunity for access to diverse study populations, the ignored research landscape translates to poor funding opportunities for researchers in these regions (Dandona et al. 2017). These available grants are also disproportionate to the epidemiological disease burdens making impactful research difficult.

Publication in reputed indexed journals is also a costly affair with Article Processing Charges routinely levied being in the range of thousands of dollars (Solomon and Björk 2016). In the absence of funding support, researchers are often expected to bear these costs themselves. For low-income and lower-middle income countries, this often translates to significant portion of annual salaries. Though many publishers provide waivers, it is important to note that even these waived costs are often prohibitively expensive for physicians. Welfare initiatives like Research4Life use the income bracket a country is classified in as a blanket estimate of the socioeconomic state of every researcher submitting from that nation. Though it would not be feasible for journals to always make individualised assessments of fee waivers for every manuscript from low and lower-middle income countries, this approach puts those practising in underserved rural and marginalised locations altruistically for low wages at a disadvantage. It is interesting to note that even within countries, the generation of published articles is skewed with certain institutes making up a major chunk of the research output (Ghosh and Ghosh 2019). Thus, a re-examination of the process in which waivers are granted is necessary. A welcome step has been the recent announcement of free article processing for principally accepted manuscripts from low-income and lower-middle income group authors by the Nature publishing group that will hopefully empower these physicians with adequate representation transcending traditional cost barriers.

In the publish-or-perish scenario, many researchers often succumb to predatory journals and end up submitting valuable research work on low-quality platforms due to cheap publishing costs. Pushing for holistic development of accessible research facilities that will allow for quality research to be carried out needs to be undertaken at the highest policy level. Journal publishers can attempt to improve the percolation of waiver benefits to ensure that those with scientifically sound research are able to publish at the right avenues without being economically burdened. This would also serve as a source of encouragement to indulge in further high-quality work, allowing for the establishment of self-sustainable positive feedback loops.

The Pandemic Impact: Push for Research

More than ever before, the COVID-19 and monkeypox outbreaks have highlighted the need to improve global healthcare systems and international research frameworks. An old adage iterates that the strength of a chain is in its weakest link and with regard to matters of human health, all progress has to be global. With the emergence of threats like antimicrobial resistance and wild virus variants, the necessity of ensuring that improvements in public health policies are effectively implemented even in lower-middle income and lower income countries has never been as acutely felt before. Adequate editorial board representation would be an extremely significant initiative in stimulating improved research from these areas, which is an essential foundation for global health. They could also advocate for laying the groundwork for better research facilities with national stakeholders in their respective regions.

Though extensive research in maternal health is being conducted in low and lower-middle income countries, the skewed representation of editors from these countries in international obstetrics and gynaecology journals poses an important ethical dilemma. The findings reported by these journals can be said to represent a ‘high-income perspective’. A truly global perspective is needed in a public health discipline like maternal care since developing low and lower-middle income countries have high maternal mortality rates compared to upper-middle and high income countries.

Recommendations for Improvement

A. Transparency in Editorial Board Appointments

Appointments to editorial boards are often opaque practises. Many journals often consider applications for appointment to editorial boards on a rolling basis. Plenty of editorial board members are often associated with journals in more honorary advisory roles and are affiliated with multiple journals. Whilst this is not necessarily a practise to be discouraged, the entire process places a lot of emphasis on marketability of the editor’s reputation in academia with focus on references, citations and personal achievements. The subjective nature of the entire process leaves a lot of room for scrutiny.

On most journal websites, there is scant information about timelines followed for regeneration or notification about vacant editorial board posts. Sometimes, recruitments also happen internally within universities and academic circles without invitation of external applications which leads to many potential suitable applicants missing out on these opportunities. Majority of the journals do not provide any public statistics on the number of applications received for these positions or the process followed for fair, transparent appointments.

Just like statistics made available for a residency match or grant position, it is recommended that journals should share data on their appointment statistics. It is also imperative that these journals provide a transparent insight into the kind of criteria they consider whilst making these appointments (Teixeira da Silva and Al-Khatib 2017) which would not only improve confidence in the selection process but also enable rejected participants to take necessary steps so that they are able to compete fairly with their distinguished peers.

B. Representation to Marginalised Communities

Akin to the paradox of ‘needing experience to get experience’, it may be challenging for physicians from low income and lower-middle income countries to break into academic circles of editorial boards due to obstacles including resources, funds and language barriers. To help overcome this, efforts need to be undertaken to support the establishment of relevant interest groups and sociodemographic research bodies that could effectively advocate with relevant stakeholders to ensure that needs of specific subsets are not unintentionally ignored. Clinical groups like BAPIO (British Association of Physicians of Indian Origin) already exist and the establishment of similar research groups could allow for more streamlined attempts in equitable representation. Appointments from these research groups would also smoothen the logistics of the entire process though as always, caution would need to be exercised to prevent any untoward practises. This practise should also be extended to include gender representation (Anaesthesia Journal Editorial Board Diversity and Representation Study Group 2022; Leung et al. 2021) as well as racial, ethnic and other sociodemographic considerations. The insight and fresh perspectives that can be obtained by having such diverse editorial boards would allow for a more inclusive academia.

Internationally, editorial board positions are often evaluated as a part of a larger research responsibilities of a physician. Further, editorial board work is often done ‘pro-bono’ and understood by researchers as part of their responsibility towards the scientific community (Reichardt et al. 2022). This places great burden on doctors from socioeconomically disadvantaged countries, who may feel the need prioritise their ‘paying-work’ commitments and other research undertakings having ‘more value’, owing to time constraints. Allocation of objective prominence for the time allocated to editorial board work would ensure that these opportunities are enthusiastically taken up. This would make it easier to guarantee organic participation from local physicians, providing for representation without the need to compromise on quality.

C. Efforts Towards Promoting Research Involvement

Research is a life-long commitment and excellence can only be attained by starting early. With the shift towards evidence-based medicine, there is an added emphasis on critical appraisal skills and students need to be encouraged to be actively involved in research from their medical training itself. This skill upgradation and effort investment at the grassroots level would pave the way for development of efficient clinician-researchers of tomorrow.

The recent introduction of elective research rotations in medical schools in India is a step in the right direction but plenty more needs to be done. Student involvement in the manuscript assessment process can enrich their understanding of the nuances of academic writing. Though there are a number of student-led research journals, student editorial boards could be instituted at all journals which provide early career young academicians an exposure to the world of publishing (Shlobin et al. 2022). These boards need not even be involved in the eventual decision-making process but giving these eager learners an opportunity to work under the supervision of distinguished stalwarts would boost their skill sets and equip them with insights which would not have been possible without such an ‘internship’.

Workshops targeting specific aspects of the research process like protocol writing and proposal formulation have already shown positive results in improving not only the quality of academic material produced but also the confidence of participants to independently implement the key takeaways (Sahoo and Mohammed 2018; Shrestha et al. 2019). Although many easily accessible resources like Cochrane Training (Cochrane 2023) are available online for researchers to fine tune their skills, large-scale implementation of joint training programmes would also be a useful alternative that would provide for targeted improvement in these transferable skills. This will effectively allay the concerns of poor-quality research output of low income and lower-middle income countries which has been previously discussed.

A limitation of this study was that it made use of income groups as a means for examining equitable international representation. It has been argued that with the rapidly changing global scenarios, the income classification is somewhat ‘arbitrary’ and ‘losing relevance’ (Beer Prydz and Wadhwa 2019) but in the lack of other suitable social indicators for which comparable data is available globally, income group classification continues to remain as a reasonably true reflection of national development characteristics. The hierarchy in the editorial boards of the leading journals was also ignored in the current paper. Future studies could look at the distribution of the countries of origin of the editor-in-chief, assistant editors and section editors since the impact that each of them has on the decision to publish is different.

Analysis of patterns of authorship distribution in these journals would bring to light regions which are yet to receive equitable representation necessary for the formulation of effective global policies by high-interest high-power stakeholders not just in obstetrics and gynaecology but also in other medical disciplines. Specific studies covering journals within particular subfields of obstetrics and gynaecology like fertility, reproductive oncology and sexually transmitted diseases could also be analysed to identify need for research collaborations in regions where data is lacking.

Conclusion

Low and low-middle countries have poor representation in the editorial boards of leading obstetrics and gynaecology journals. Poor representation in medical research and decision-making from these countries puts a large proportion of the global population at risk. Large-scale international collaborative efforts and striving for the incorporation of suitable facilities that will promote equitable research involvement are urgent steps that must be taken to change this statistic. Leading obstetrics and gynaecology journals can set an example by actively balancing out national representation of their editorial board members. Having a higher proportion of editors from low and lower-middle income countries in these reputed editorial boards will provide exposure as well as lead to equitability in global research. This will allow for all decisions based on research to be taken from a truly global standpoint that will ultimately ensure that each patient is able to receive the care they truly deserve.

Author Contribution

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Mr Pratyush Kumar, Dr Vishnu B. Unnithan and Mr Kumar Abhishek. The first draft of the manuscript was written by Dr Seema Rawat, Dr Priyanka Mathe, Dr Vishnu B. Unnithan, Mr Pratyush Kumar and Mr Kumar Abhishek and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Data availability

Data is available with the authors and can be made available upon request.

Declarations

Ethics Approval

This is a descriptive report using open-access data and no participant and therefore no ethics approval was required for conduction of the study.

Consent to Participate

Not applicable as no human data used.

Consent for Publication

Not applicable as no human data used.

Competing Interests

The authors declare no competing interests.

Footnotes

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

  1. Algahtani H, Bajunaid M, Shirah B. Unethical human research in the field of neuroscience: a historical review. Neurological Sciences. 2018;39(5):829–834. doi: 10.1007/s10072-018-3245-1. [DOI] [PubMed] [Google Scholar]
  2. Almusharraf NM, Bailey D. Online engagement during COVID-19: role of agency on collaborative learning orientation and learning expectations. Journal of Computer Assisted Learning. 2021;37(5):1285–1295. doi: 10.1111/jcal.12569. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Aluede EE, Phillips J, Bleyer J, Jergesen HE, Coughlin R. Representation of developing countries in orthopaedic journals: a survey of four influential orthopaedic journals. Clinical Orthopaedics and Related Research. 2012;470(8):2313–2318. doi: 10.1007/s11999-012-2377-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Anaesthesia Journal Editorial Board Diversity and Representation Study Group Trends in country and gender representation on editorial boards in anaesthesia journals: a pooled cross-sectional analysis. Anaesthesia. 2022;77(9):981–990. doi: 10.1111/anae.15733. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Beer Prydz, Espen, and Divyanshi Wadhwa. 2019. Classifying countries by income. World Bank, 9 September 2019. https://datatopics.worldbank.org/world-development-indicators/stories/the-classification-of-countries-by-income.html. Accessed 8 January 2023.
  6. Bhaumik S, Jagnoor J. Diversity in the editorial boards of global health journals. BMJ Global Health. 2019;4(5):e001909. doi: 10.1136/bmjgh-2019-001909. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bhujwalla ZM, Kakkad S, Chen Z, Jin J, Hapuarachchige S, Artemov D, et al. Theranostics and metabolotheranostics for precision medicine in oncology. Journal of Magnetic Resonance. 2018;291:141–151. doi: 10.1016/j.jmr.2018.03.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cascajares M, Alcayde A, Salmerón-Manzano E, Manzano-Agugliaro F. The bibliometric literature on Scopus and WoS: the medicine and environmental sciences categories as case of study. International Journal of Environmental Research and Public Health. 2021;18(11):5851. doi: 10.3390/ijerph18115851. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cochrane 2023. Cochrane training. https://training.cochrane.org/. Accessed 10 Jan 2023.
  10. Dandona, L., R. Dandona, G.A. Kumar, K. Cowling, P. Titus, V.M. Katoch, and S. Swaminathan. 2017. Mapping of health research funding in India. National Medical Journal of India 30 (6): 309–316. 10.4103/0970-258X.239069. [DOI] [PubMed]
  11. Dotson, B. 2012. Geographical composition of the editorial boards of leading pharmacy journals. American Journal of Pharmaceutical Education 76 (8): 160. 10.5688/ajpe768160. [DOI] [PMC free article] [PubMed]
  12. Eclampsia Trial Collaborative Group. 1995. Which anticonvulsant for women with eclampsia? Evidence from the eclampsia trial. Lancet 345: 1455–1463. 10.1016/S0140-6736(95)91034-4. [PubMed]
  13. Edelhauser, E., and L. Lupu-Dima. 2021. One year of online education in COVID-19 age, a challenge for the Romanian education system. International Journal of Environmental Research and Public Health 18 (15): 8129. 10.3390/ijerph18158129. [DOI] [PMC free article] [PubMed]
  14. Elmore, S.A., and E.H. Weston. 2020. Predatory Journals: what they are and how to avoid them. Toxicologic Pathology 48 (4): 607–610. 10.1177/0192623320920209. [DOI] [PMC free article] [PubMed]
  15. Falagas, M.E., V.D. Kouranos, R. Arencibia-Jorge, and D.E. Karageorgopoulos. 2008. Comparison of SCImago journal rank indicator with journal impact factor. FASEB Journal 22 (8): 2623–2628. 10.1096/fj.08-107938. [DOI] [PubMed]
  16. Fovet, T., M. Horn, C. Lancelevee, P. Thomas, and A. Amad. 2020. Language bias in forensic psychiatry research: the tower of Babel problem. Comment on “Potential language bias in systematic reviews on the use of coercion in psychiatry.” Acta Psychiatrica Scandinavica 142 (3): 257–258. 10.1111/acps.13227. [DOI] [PubMed]
  17. Ghosh, Kanjaksha, and Kinjalka Ghosh. 2019. Medical research in medical college in India: current scenario and ways to improve it. Journal of the Association of Physicians of India 67 (4): 71–73. [PubMed]
  18. Giuliani, M., J. Frambach, M. Broadhurst, J. Papadakos, R. Fazelad, E. Driessen, et al. 2020. A critical review of representation in the development of global oncology curricula and the influence of neocolonialism. BMC Medical Education 20 (1): 93. 10.1186/s12909-020-1989-9. [DOI] [PMC free article] [PubMed]
  19. Global Forum for Health Research. 2000. The 10/90 (‎ten ninety)‎ report on health research 2001-2002. Geneva: Global Forum for Health Research.
  20. Hamadeh, Nada, Catherine Van Rompaey, Eric Metreau, and Shwetha Grace Eapen. 2022. New World Bank country classifications by income level: 2022-2023. World Bank Blogs, 1 July 2022. https://blogs.worldbank.org/opendata/new-world-bank-country-classifications-income-level-2022-2023
  21. Harris CA, Banerjee T, Cramer M, Manz S, Ward ST, Dimick J, et al. Editorial (spring) board? Gender composition in high-impact general surgery journals over 20 years. Annals of Surgery. 2019;269(3):582–588. doi: 10.1097/SLA.0000000000002667. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hedt-Gauthier, B.L., R. Riviello, T. Nkurunziza, and F. Kateera. 2019. Growing research in global surgery with an eye towards equity. British Journal of Surgery 106 (2): e151–e155. 10.1002/bjs.11066. [DOI] [PubMed]
  23. Horton R. North and south: Bridging the information gap. Lancet. 2000;355:2231–2236. doi: 10.1016/S0140-6736(00)02414-4. [DOI] [PubMed] [Google Scholar]
  24. Igoumenou A, Ebmeier K, Roberts N. Fazel S (2014) Geographic trends of scientific output and citation practices in psychiatry. BMC Psychiatry. 2014;14:332. doi: 10.1186/s12888-014-0332-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Ioannidis, J.P. 2016. Why most clinical research is not useful. PLoS Medicine 13 (6): e1002049. 10.1371/journal.pmed.1002049. [DOI] [PMC free article] [PubMed]
  26. Kim JH, Scialli AR. Thalidomide: the tragedy of birth defects and the effective treatment of disease. Toxicological Sciences. 2011;122(1):1–6. doi: 10.1093/toxsci/kfr088. [DOI] [PubMed] [Google Scholar]
  27. Leung KK, Jawaid N, Bollegala N. Gender differences in gastroenterology and hepatology authorship and editorial boards. Gastrointestinal Endoscopy. 2021;94(4):713–723. doi: 10.1016/j.gie.2021.05.019. [DOI] [PubMed] [Google Scholar]
  28. Mari JJ, Patel V, Kieling C, Razzouk D, Tyrer P, Herrman H. The 5 ⁄ 95 gap in the indexation of psychiatric journals of low- and middle-income countries. Acta Psychiatrica Scandinavica. 2010;121(2):152–156. doi: 10.1111/j.1600-0447.2009.01476.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Meena S, Chowdhury B. How international are the leading orthopedic journals: a look at the composition of the editorial board members of the top orthopedic journals. Archives of Orthopaedic and Trauma Surgery. 2014;134(5):619–622. doi: 10.1007/s00402-014-1975-y. [DOI] [PubMed] [Google Scholar]
  30. Mendis S, Yach D, Bengoa R, Narvaez D, Zhang X. Research gap in cardiovascular disease in developing countries. Lancet. 2003;361(9376):2246–2247. doi: 10.1016/S0140-6736(03)13753-1. [DOI] [PubMed] [Google Scholar]
  31. Modlin CE, Deng Q, Benkeser D, Mulate YW, Aseffa A, Waller L, et al. Authorship trends in infectious diseases society of America affiliated journal articles conducted in low-income countries, 1998–2018. PLOS Global Public Health. 2022;2(6):e0000275. doi: 10.1371/journal.pgph.0000275. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Morton B, Vercueil A, Masekela R, Heinz E, Reimer L, Saleh S, et al. Consensus statement on measures to promote equitable authorship in the publication of research from international partnerships. Anaesthesia . 2022;77(3):264–276. doi: 10.1111/anae.15597. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Nafade, V., P. Sen, and M. Pai. 2019. Global health journals need to address equity, diversity and inclusion. BMJ Global Health 4 (5): e002018. 10.1136/bmjgh-2019-002018. [DOI] [PMC free article] [PubMed]
  34. Patel V, Sumathipala A. International representation in psychiatric literature: Survey of six leading journals. British Journal of Psychiatry. 2001;178(5):406–409. doi: 10.1192/bjp.178.5.406. [DOI] [PubMed] [Google Scholar]
  35. Pitman A, Underwood R, Hamilton A, Tyrer P, Yang M. Enhanced peer-review for optimising publication of biomedical papers submitted from low- and middle-income countries: feasibility study for a randomised controlled trial. BJPsych Open. 2019;5(2):e20. doi: 10.1192/bjo.2018.89. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Reichardt, J.K.V., G.P. Patrinos, P.S. Lai, and G. Novelli. 2022. J'Accuse….. or the plight of pro-bono volunteer scientists in academic publishing. Human Genomics 16: 44. 10.1186/s40246-022-00413-z. [DOI] [PMC free article] [PubMed]
  37. Rohra DK. Representation of less-developed countries in Pharmacology journals: an online survey of corresponding authors. BMC Medical Research Methodology. 2011;11:60. doi: 10.1186/1471-2288-11-60. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Sahoo S, Mohammed CA. Fostering critical thinking and collaborative learning skills among medical students through a research protocol writing activity in the curriculum. Korean Journal of Medical Education. 2018;30(2):109–118. doi: 10.3946/kjme.2018.86. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Samalik, J.M., C.S. Goldberg, Z.J. Modi, E.M. Fredericks, S.K. Gadepalli, S.J. Eder, et al. 2022. Discrepancies in race and ethnicity in the electronic health record compared to self-report. Journal of Racial and Ethnic Health Disparities, 23 November 2022. 10.1007/s40615-022-01445-w [DOI] [PubMed]
  40. Saxena, S., I. Levav, P. Maulik, and B. Saraceno. 2003. How international are the editorial boards of leading psychiatry journals? Lancet 361 (9357): 609. 10.1016/S0140-6736(03)12528-7. [DOI] [PubMed]
  41. Saxena S, Paraje G, Sharan P. The 10/90 divide in mental health research: Trends over a 10-year period. British Journal of Psychiatry. 2006;188(1):81–82. doi: 10.1192/bjp.bp.105.011221. [DOI] [PubMed] [Google Scholar]
  42. Šember, M., and J. Petrak. 2014. Radovi Doktorskih Kandidata S Medicinskog Fakulteta Sveučilišta U Zagrebu U Hrvatskim Časopisima [Publications in the Croatian medical journals by doctoral candidates at University of Zagreb School of Medicine]. Liječnički Vjesnik [Medical Journal] 136 (1–2): 18–21. [PubMed]
  43. Shlobin NA, Garba DL, Wang A. A call to include medical students on editorial boards of medical journals. Academic Medicine. 2022;97(2):168–170. doi: 10.1097/ACM.0000000000004492. [DOI] [PubMed] [Google Scholar]
  44. Shrestha S, Danekhu K, Sharma N, Khanal P, Ansari SR, Shrestha S, Piryani RM, Mohamed Ibrahim MI. Workshop on proposal writing on research for health care professionals: a brief report. Journal of Multidisciplinary Healthcare. 2019;22(12):565–572. doi: 10.2147/JMDH.S211257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Smyth, B., K. Trongtrakul, A. Haber, B. Talbot, C. Hawley, V. Perkovic, et al. 2019. Inequities in the global representation of sites participating in large, multicentre dialysis trials: a systematic review. BMJ Global Health 4 (6): e001940. 10.1136/bmjgh-2019-001940. [DOI] [PMC free article] [PubMed]
  46. Solomon D, Björk BC. Article processing charges for open access publication-the situation for research intensive universities in the USA and Canada. PeerJ. 2016;4:e2264. doi: 10.7717/peerj.2264. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Sumathipala, A., S. Siribaddana, and V. Patel. 2004. Under-representation of developing countries in the research literature: ethical issues arising from a survey of five leading medical journals. BMC Medical Ethics 5 (1): E5. 10.1186/1472-6939-5-5. [DOI] [PMC free article] [PubMed]
  48. Tegos, S., A. Mavridis, and S. Demetriadis. 2021. Agent-supported peer collaboration in MOOCs. Frontiers in Artificial Intelligence 4: 710856. 10.3389/frai.2021.710856. [DOI] [PMC free article] [PubMed]
  49. Teixeira da Silva JA. Handling ethics dumping and neo-colonial research: From the laboratory to the academic literature. Journal of Bioethical Inquiry. 2022;19(3):433–443. doi: 10.1007/s11673-022-10191-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Teixeira da Silva JA, Al-Khatib A. How are editors selected, recruited and approved? Science and Engineering Ethics. 2017;23(6):1801–1804. doi: 10.1007/s11948-016-9821-y. [DOI] [PubMed] [Google Scholar]
  51. Tutarel, Oktay. 2004. Composition of the editorial boards of leading medical education journals. BMC Medical Research Methodology 4: 3. 10.1186/1471-2288-4-3. [DOI] [PMC free article] [PubMed]
  52. Whelton, P.K., R.M. Carey, W.S. Aronow, D.E. Casey, K.J. Collins, C. Dennison Himmelfarb, et al. 2018. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/apha/ash/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive Summary: A report of the american college of cardiology/american heart association task force on clinical practice guidelines. Journal of the American College of Cardiology 71 (19): 2199–2269. 10.1016/j.jacc.2017.11.005.
  53. Yach D, Kenya P. Assessment of epidemiological and HIV/AIDS publications in Africa. International Journal of Epidemiology. 1992;21(3):557–560. doi: 10.1093/ije/21.3.557. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Data is available with the authors and can be made available upon request.

Articles from Asian Bioethics Review are provided here courtesy of Springer

RESOURCES