Daoxin Yin: Will the universal two-child policy in China exacerbate gender discrimination in the medical job market?

daoxin_yinWinter is the new doctor recruiting season for Chinese hospitals. Between the end of November and February, government-owned hospitals, who are major employers, interview job candidates. Most of these candidates are medical students who are about to graduate in June or July. As well as the traditionally male-dominated surgical sector and other departments doing interventional therapy such as cardiology and intervention, a preference for male doctors exists universally and is applied to hospital employment. Sometimes, the preference for a male doctor is clearly written in job posts, and more often than not, it tacitly plays a role in the decision-making process. 

Female doctors in China are usually questioned on their commitment to work after getting married and having babies. Many young female doctors have experienced being asked either implicitly or explicitly if they have got married or had babies, and sometimes, female job candidates need to justify that they can manage both work and their family life during the interview. These questions are rarely brought up to male job candidates.

Female doctors, like many other woman workers in China, are facing more challenges in getting job opportunities and career development. According to China Health Statistic Yearbook, female doctors account for 42.7% of the total registered doctors in 2012, although the sex ratio of female versus male clinical medicine students is balanced, in fact female students even slightly outnumber male students. Many factors contributed to the gender discrimination in employment, among which childbirth is prominent. Female labor protection regulations entitle women to at least 98 days of fully paid maternal leave across the country, and each province has its extension policy offering extra leave from 30 to 82 days. During the nursing period (1 year after birth), 1 hour of breastfeeding time should be counted as working time. Hiring female doctors means the working gap during their maternal leave and lactation period should be filled in by other employees.

At the end of 2015, the Chinese government decided to implement a universal two-child policy, replacing 36 years of a one-child policy. I am concerned that the two-child policy may exacerbate unfairness for women in the workplace. The new policy could put female doctors at higher risk of being unfairly treated in job hunting due to the second maternity leave that they may have. Female medical graduates about to join the job market are of childbearing age. Some of them have expressed their concerns and anxiety about gender discrimination they may encounter on social media.

I am not saying that the gender ratio should be 1:1 in each medical discipline (It is irrational and may generate new discrimination). On the contrary, a fair employment should respect and consider a job candidate’s capacity, aspiration, willingness, value, and mission instead of putting too much weight on gender. Like many social issues, gender inequity in healthcare employment is a systematic problem, and neither hospitals or males should be accused of the existence of the problem. Traditional culture has a tremendous impact on portraying women as the main caregivers for babies and family. This concept has been internalized and means that working women including female doctors take on the bulk of family responsibilities. And, current government-owned hospitals only recruit full-time doctors and offer little flexibility on working time. The workplace environment is not friendly to working mothers, and few hospitals have nursing rooms for preparing breast milk.

In the context of relaxing the one child policy, young female doctors are facing additional career barriers. It is hard to eliminate this discrimination in short-term. To empower young female doctors is part of raising the position for all the working women in China. We need to engage men to take on more within the family unit. The culture of praising women for sacrificing their career to support the family should transform to encouraging a balanced relationship in a family. Working couples should balance family and work commitments between both of them, particularly for those who plan to have two kids. Splitting housework and child care is also helpful to building a healthy relationship between family members and good for child education. Taking actions in a family is a starting point to change the stereotype of the family role of women and men. And, HR managers need to rethink their ways of managing and make the working environment and atmosphere more friendly to female employees. At a national level, laws of workplace gender equity employment should be enacted, and more importantly, enforced. At the very least, the gender preference in job posts should be stopped.

Daoxin Yin, China editor, The BMJ.

Competing interests: None.