Comment on: Key factors contributing to gender inequity in global rheumatology awards: a global survey analysis

Dear Editor, We read with interest the article by Day et al. on key factors contributing to gender inequity in global rheumatology awards, researched through a 13-item global survey that identified competing domestic responsibilities, lack of female nominees, limited visibility, and fewer leadership opportunities as major barriers to women receiving prestigious career awards in rheumatology [1]. Although this survey included 227 respondents (66% female) from 40 countries, the majority of the participants were White and Hispanic/Latino (73.5%), and were from a relatively low proportion (12.9%) of countries of origin categorized as either low or medium by the human development index (HDI). Therefore, the specific context of women in rheumatology in countries such as India warrants further emphasis. In India, female representation in medical colleges, starting from undergraduation, is close to 50%, achieving a numerical parity, yet leadership positions in health care and academic medicine are predominantly held by males, forming an ‘inverse pyramid’ of women’s representation in senior roles [2]. Career advancement continues to be largely judged using traditional metrics such as promotions, prizes, awards, and financial appraisals, with less explicit recognition of the structural and cultural barriers that disproportionately affect women. Cultural factors are particularly pertinent in India, where the double burden of the second unpaid shift at home and the resultant divided attention markedly erode women’s discretionary time. This makes sustained research and leadership-building activities beyond clinical work only remotely possible for many.