Janine Austin Clayton, M.D., FARVO, Associate Director for Research on Women’s Health and Director of the Office of Research on Women’s Health (ORWH) at the National Institutes of Health (NIH), works to strengthen NIH support for research on diseases, disorders, and conditions that affect women and helps lead NIH efforts to advance women in biomedical careers. In addition, she is a board-certified ophthalmologist whose research interests include autoimmune ocular diseases and the role of sex and gender in health. ORWH recently launched the NIH Prize for Enhancing Faculty Gender Diversity in Biomedical and Behavioral Science to increase the number of women faculty members in biomedical and behavioral science departments. We recently caught up with her to learn more about her background and advice for young women.

Q. What are some of the key challenges faced by women in science who aspire to leadership roles in their field?

In the United States, women enter graduate studies in the life sciences at about the same rate as men; it’s after their studies that women’s advancement runs into the steepest barriers. In biomedical sciences, women are underrepresented at the faculty level, particularly in mid- and senior-level positions. For example, women account for less than 20% of medical school deans and department chairs, despite constituting roughly half of medical school students. The situation is bleaker for women of color, who are at the intersection of gender and race/ethnicity. The National Center for Education Statistics reports that as of the fall of 2018, only 3% of total academic faculty members were Black women. Some attribute the problem to a “leaky pipeline.” Others say it is because women have constituted a smaller percentage of the biomedical research trainee pool for years. However, there has been adequate time for gender parity at the trainee level to percolate to more senior ranks, yet the underrepresentation of women at faculty levels remains persistent.

Women contend with gender and sexual harassment, negative stereotypes, a disproportionate burden of family responsibilities, and inequitable compensation and resource allocation. These barriers are almost always a part of the academic structure and culture and deeply rooted in institutional norms, so they are not always fully recognized, even by those who experience them.

COVID-19 appears to have compounded existing career challenges, resulting in an increase in the gender gap in scientific publishing across all disciplines and fewer early-career women contributing to COVID-19-related research compared with other topics, as evidenced by women’s authorship on COVID-19-related papers. These challenges have substantial ramifications on biomedical workforce projects and, without intervention, could foreshadow diminished promotion and tenure prospects.

The NIH Prize for Enhancing Faculty Gender Diversity in Biomedical and Behavioral Science  aims to address challenges and improve the existing career paradigm for many women in these fields through the recognition, dissemination, and adoption of replicable, evidence-based institutional approaches to increasing gender diversity.

Q. Why is it important for women to be in academic leadership roles in biomedical and behavioral health fields?

Advancing women into leadership roles in the sciences is critical to producing the best science. Diversity in the scientific workplace generates more innovative solutions; diverse teams are more productive and generate more substantial research. Perspectives can encompass a wide range of topics, including research on health disparities and the health of women. We also know that women scientists in senior and leadership roles are more likely to report the effects of sex on health and disease, which is essential to increasing the rigor and reproducibility of biomedical research. Additionally, fostering greater diversity encourages more people to pursue and remain in scientific careers, helping all to maximize personal potential and scientific contributions, increasing the prospects of science, and improving health for all people.

Increasing the number of women in scientific leadership roles will also help address a national labor shortage in many science, engineering, and medical professions, particularly in technical fields. Each time an employee is hired, an organization invests in human capital. The investment includes salary, benefits, training, onboarding, and myriad other resources, with the expectation that the individual will contribute to scientific discovery. With biomedical careers, the length of the initial investment can span over a decade. The loss of women at any point in this process reflects a lost opportunity—a loss to the scientific community in terms of the momentum of the research and potential contributions to science that the individual would have made. The loss is far greater than the initial investment.

Q. Who were some role models you looked up to, and how did they influence your path?

I’ve had many mentors and role models who have influenced my career in many substantive ways. I’d like to highlight just a few who are particularly relevant to the Challenge Prize.

Dr. LaSalle D. Leffall Jr. was fond of the saying, “Equanimity under duress.” A surgical oncologist, Dr. Leffall was the first African American to serve as national president of the American Cancer Society. He was also the first African American president of the Society of Surgical Oncology, the Society of Surgical Chairs, and the American College of Surgeons. He undoubtedly experienced challenges in many arenas. His calm presentation, steadfast commitment to excellence, caring demeanor as a physician, and honorable manner in all aspects impressed upon me the importance of these ideals—as a human being and as a physician. Knowing that Dr. Leffall maintained composure as he cleared hurdles and experienced many “firsts” instilled in me a sense that I, too, can remain calm no matter what challenges I face.

Dr. Vivian Pinn is another trailblazer. She was the only African American and the only woman in her class to graduate from the University of Virginia School of Medicine. Dr. Pinn, the first full-time director of ORWH, continues to be one of my most influential role models and mentors. Her creation of the first NIH-wide strategic plan for women’s health research set forth an enduring vision to build upon. Likewise, her leadership on women in biomedical careers is inspirational to me and many others who follow in her path. Dr. Pinn’s service to NIH is the standard of excellence that everyone working in public service should strive to replicate.

Dr. Bernadine Healy—the first and, to date, only woman director of NIH—was another great inspiration. She was a strong advocate for women’s health research, a visionary leader, and the architect of the Women’s Health Initiative (WHI), a long-term national study addressing the health of postmenopausal women. Prior to the initiative, health care professionals used clinical acumen—not rigorous scientific research—as a basis for the routine prescription of hormone therapy for older women. A 2014 study found that among its many contributions, WHI produced knowledge that helped save approximately $35.2 billion in direct medical costs in the U.S. and led to 126,000 fewer cases of breast cancer between 2003 and 2012.

And of course, there’s Dr. Francis Collins, the current director of NIH. He and I worked together to create and implement the NIH Policy on Sex as Biological Variable (SABV). It is a part of a national and international movement to integrate the study of sex into the research process. The study of SABV is key to better science and, ultimately, better health for everyone. As co-chairs of the NIH Working Group on Women in Biomedical Careers, Dr. Collins and I collaborate with representatives of NIH intramural and extramural staff and work to overcome institutional and environmental barriers to advancement at all career stages for women. In fact, this Challenge Prize sprang from the group’s efforts. Combine Dr. Collins’ commitment to women’s health, women’s health research, and the careers of women in science and you have a fierce advocate and an unwavering ally.

Notice any lack of pattern in my response? Mentorship is not the sole responsibility of women faculty and principal investigators. And women can find allies and mentors of any gender.  

Q. How do you envision the NIH Gender Equity Prize will help to change the landscape for women’s participation in science?

The Challenge Prize is a critical step in addressing some of the findings summarized by the National Academies of Sciences, Engineering, and Medicine to support research aiming to deepen the evidence base for programs, policies, and practices that will improve gender diversity in academia. NIH is crowdsourcing to learn about the most successful approaches used at institutions to bring about transformative, sustained gender diversity. Collecting and sharing these experiences is even more critical in the era of COVID-19, when the systemic issues disproportionately affecting women are greatly widening the gender gap. And these issues can be even more challenging for women from underrepresented groups. ORWH will disseminate the successful systems, programs, practices, and other approaches in a way that other institutions can adapt to their own environments or scale up across sites. In doing so, we will work to accelerate culture change—creating inclusive environments and conveying that this is a broadly shared responsibility. And the selected institutions will be rewarded and promoted for providing examples of their commitment to improving gender diversity.

 Q. What role would you like to see historically black colleges & universities (HBCUs) play in leveling the playing field for women in biomedical and behavioral sciences?

This Challenge Prize is an opportunity for NIH to pool its data and its approaches with institutions of various types across the country, allowing for an in-depth assessment. We’ll be able to look for what works, why it works, for whom it works, and with what disciplines, structures, and resources it works. Many HBCUs have had remarkable success in achieving and sustaining the participation and career advancement of diverse faculty. With stellar records of diversity, they have much to share—some of it translatable to other types of institutions. The strategies and approaches that have had the most success for women of color—as they represent a group that is one of the most underrepresented in any field of science—will be especially valuable.

Q. What is your advice for young women who are considering a career in biomedicine or behavioral science but may feel put off by the challenges that women disproportionately face in advancing their science careers?

Adaptability and persistence work in life and in the lab. Things won’t always go according to plan. Strategies need to be revised, and you need to keep moving forward. As I’ve learned from experience, unexpected detours can deliver great results. When I was a Harvard medical student, I needed to take a medical leave of absence. Initially, I thought my career was derailed, but I transferred to the Howard University College of Medicine to be near family and found a thriving and supportive academic environment.

Finding good mentorship and building your network are also essential to your career. Believe in yourself and look for mentors who believe in you. They are important, and you will need more than one. Whether it’s navigating new areas, making introductions and helping to open doors, or acting as a sounding board on big decisions, mentors and sponsors can help throughout your career. For networking and finding terrific resources on mentorship, check out the National Research Mentoring Network. Peers and colleagues are a great resource for ideas and advice, too.

Join or follow professional societies and scientific associations to meet more professionals outside of your school or workplace. The NIH Women of Color Network (WoCRN) on LinkedIn also provides a forum for networking and information sharing for women of color and their supporters. Be sure to follow ORWH on Twitter and Facebook, and check out our Facebook Live series, which offer insights on mentorship and leadership for women of color in STEMM. While online tools are great for networking, don’t underestimate the value of real conversations via phone calls, video chats, and safe in-person meetings.

When you are online, make certain to visit the Career Development & Interprofessional Education section of the ORWH website. Our “Pearls of Wisdom” videos (with new releases coming in 2021) showcase the career advice of successful researchers. Our quarterly publication, Women’s Health in Focus at NIH, provides insightful coverage of women’s careers in science. The ORWH website offers easily accessible ways to gain helpful information, insights, and inspiration. All of these resources are there to affirm that careers in science are achievable and rewarding and that science needs you.

Follow Dr. Clayton on Twitter @JanineClaytonMD