Dr. Magee on the implications of conference location in light of Roe v Wade reversal

In this interview, Diana Magee, MD, MPH, MSc, FRCSC, highlights the recent Journal of Urology editorial, “Taking a stand: No conferences in anti-abortion states,” for which she served as the lead author.¹ Magee is a urologic oncologist at Humber River Hospital in Toronto, Canada.

Diana Magee, MD, MPH, MSc, FRCSC

Could you describe the background of this publication?

This all came to a head when Roe v Wade was overturned, and suddenly all the states had their own rights to make laws regarding abortion. In the past, conferences could be held from anywhere and it was irrelevant from reproductive health care perspective where they were held. You were guaranteed access to appropriate care if you were pregnant or a woman. With the fall of that and then the mosaic of state regulations, this became more problematic, as a female practicing in urology, where these conferences are held.

The tipping point, I would argue, is that 2 of our major meetings—the AUA [American Urological Association Annual Meeting] and the SUO [Society of Urologic Oncology Annual Meeting]—are scheduled to be held in Texas next year. When I was at the AUA [this year], there was discussion among women in their 30s and 40s about how we felt going to that state, particularly if you were potentially pregnant next year, and how you were going to balance your professional responsibilities with the need to be safe from a health care perspective. That was the impetus to write this. It has been written about in other spheres, but certainly because urology still is a male-dominated field, it felt important to bring this to the forefront and engage people in a conversation about how we choose our meeting sites and where they are.

What were some of the key points that you highlighted in this publication?

I think the most important thing to recognize is that female surgeons have a higher risk of pregnancy complications. That's the most compelling thing to me. Any female surgeon has a higher risk of pregnancy complications, and it's not just any type of pregnancy complications; you have a much higher rate of miscarriage. This risk of miscarriage carries on far beyond what we think of as standard risk; it extends beyond 10 weeks, and it's about a 3% risk of miscarriage after I think 20 weeks, which was cited in the paper. So, you could go to the meeting, assuming everything is great, and then have a catastrophic medical issue in a state that doesn't necessarily allow you appropriate care. That's the most important thing to recognize. [Although] abortion and abortion politics are very political, this is [about] are we asking people to go to conferences in states where they're not going to be able to get appropriate health care.

The other things that we outlined was about the money that we pour into these organizations to host conferences in states that have policies that are in some people's opinions, quite regressive and oppressive to the people both in the state and visiting the state, and whether we should be using that money to support places that have more open and progressive leanings. Voting with our wallet, so to speak.

The last part is in keeping with the risk of pregnancy loss for these women attending a conference, it has to be traded against this balance of the vast majority of women in urology are under the age of 45. The percentage of women in urology has grown between the censuses, up to 11% as of the last census. But the vast majority are under the age of 45, so they're of childbearing age. They're more likely to be younger in their careers, and therefore the conferences and cementing professional relationships is far more important from a career development perspective. It's a very tricky situation to ask women who potentially could be pregnant to [not] go to these meetings and to sacrifice that professional development to protect their own health care. That's how gender inequities in any realm of professional work continue to grow. A lot of urologic associations have committed a lot of work to diversity, equity, and inclusion, and this just seems like a step backward compared with the policies that they've been working toward in diversifying the urologic work force.

Could you touch a little bit more on why this is of particular interest for urology or urology-based conferences?

I think it's important for all conferences, but I think within urology, it hasn't been talked about. It is a male-dominated field, so even though 11% of the urologic work force are now women, that still represents a very small percentage of it. As women, and especially as a woman in her 30s, we need to make our voices heard about what's also important to us. This is in no way, shape, or form a blame; it just wouldn't have crossed someone's mind during their later years if they’ve never had a kid. So, why would you think about the safety of having a conference in one state or another? It's important because we represent a smaller proportion to make sure that our opinions and what matters to us is voiced and advocated for.

Have you noticed or heard about any changes in practice volume or patient concerns as a result of the Supreme Court ruling?

There are some studies that have said the number of vasectomies since Roe v Wade has increased because of the concern about reliability and access to access to abortion care. There was also a paper that was published in Urology recently that looked at female medical students and where they would pick their residencies, and a lot of them have ruled out certain states in the US because when you're a resident, you’re in your 20s and 30s, which are prime childbearing years. If [they] want to have kids, they just don't want to be there.

So, it is affecting both the patients we take care of from a vasectomy perspective, and then it's also affecting the distribution of our work force and where people are trained. This may come to light down the road if we look at female urologists 15 years from now and there’s none in Mississippi because no one trained there. It'll be interesting to see how these policies [affect] us in a very small microcosm years from now.

Is there anything else that you’d like to add?

The biggest thing is that the authors of this paper and I recognize that conferences are chosen years in advance and [lots] of money are invested in them. We're not suggesting that just because these conferences are in Texas next year, that they cancel them right now and reschedule them. That's an unrealistic expectation to make. From my perspective, I have no idea as to how these venues are chosen, what the decision-making process is, and what factors lead to an event. So, the most important call to action is that these bodies need to open the selection criteria with transparency to their selection and allow for voicing of the members' concerns about different places. There's certainly a lot of issues that are not just about reproductive rights that are important to people and may [affect] where they go or how safe they feel going to a certain state. It’s important to increase transparency and let people have a voice about where they want their dues and registration money spent.

Reference

1. Magee DE, Bukavina L, Correa A. Taking a stand: No conferences in anti-abortion states. J Urol. Accessed September 15, 2023. 2023 Aug 29;101097JU0000000000003686. doi:10.1097/JU.0000000000003686