'No One Has Taught Us to Have It All': Reflections from Women on the Gender-Based Challenges in Surgical Careers in Africa.

Background: The surgical field in Africa has long grappled with a gender imbalance, with women being significantly underrepresented. Despite global efforts to foster gender diversity in healthcare practices, African women pursuing surgical careers still face substantial hurdles. This paper investigates these women's experiences and challenges, aiming to raise awareness of these issues and propose strategies for improving gender equity. Objective: To describe contextual aspects of barriers affecting women in surgery in Africa. Methods: A cross-sectional survey was conducted, targeting female medical students interested in surgical careers, interns, trainees, and surgical consultants across Africa. The survey was distributed in November-December 2021. Data were analysed using descriptive statistics for quantitative data and a simplified thematic analysis for qualitative data. Results: A total of 105 participants from 17 countries, aged 20 to 50 years and with various training levels, completed the survey. General surgery was the most common speciality among the respondents. Notably, 63% reported gender-based discrimination, with many (74%) attributing societal and familial discouragement and financial commitments as major barriers to pursuing surgical careers. Participants also shared experiences of gender-based inequity, underestimation of their skills, sexist comments, and even instances of sexual harassment during training or work. Conclusion: This study sheds light on the complex barriers African women face in pursuit of surgical careers. To enhance diversity in the field, fundamental change is required. This necessitates recognising the underlying causes hindering women's progress in surgery and the implementation of interventions to promote gender equity.