Podium: Are women better off for equality?

From the inaugural lecture by the head of health and social policy at the Policy Studies Institute, University of Westminster

I WOULD like to outline briefly some of the major developments over the past 30 years which have had far-reaching effects on the careers, aspirations and the lifestyle of women. The extent to which they have eventually changed women's lives for the better is something for debate.

In many ways, the opening up of opportunities, the legislation, the increase in choice and control which women have been able to exercise in their lives has been dramatic. But at the same time, it could be argued that all these things have contributed, perhaps paradoxically, to a situation in which many women find themselves worse off, perhaps not financially, but more stressed and more pulled in all directions than their counterparts 30 years ago.

Much of my own work has been about doctors and their careers. Up until the end of the 1960s there was an unofficial quota of women admitted to medical schools, which did not go above 25 per cent - couldn't spoil the rugby team. Back in 1966 women represented 25 per cent of those qualifying in medicine. The proportion gradually crept up through the 1970s to just under one-third in 1976, to 43 per cent in 1986, and now 53 per cent - with much higher proportions in some medical schools.

So more than half of the new entrants to medicine are women, and the proportion has been nearly 50 per cent for some time. For many years it has been argued that if women constitute a "critical mass" they can really make the breakthrough. How have they been getting on?

Women have accounted for over one-third of entrants to the profession for the last 20 years. Surely they should be making the breakthrough to the top jobs - the consultant posts.

Well, they just made it to 20 per cent in 1997 - up from 14 per cent in 1987 - which was a big improvement on 1967 - only 7 per cent - or even 1977, when they had crept up to 9 per cent.

But it is during their late twenties and early thirties that most women are likely to have children nowadays, and I would like to look at what happens to them when they do.

This is the time when men's careers have traditionally taken off, and when the big dip comes in women's careers, often because they have young children - and sometimes a parrot - and are trying to juggle work and family responsibilities. It is a time too when many women hit the glass ceiling - the point at which men of their generation are moving into top management and top jobs, and they find that old attitudes die hard.

One of the major constraints on women's careers has been the lack of opportunities for them to work less than full-time or flexibly during the years when they are bringing up children, with the opportunity of returning to senior positions after even a short break from full-time work. It is important in all careers but it is of particular importance in medicine with its longer undergraduate and postgraduate training, especially in hospital medicine, and has led to women in the past either delaying having children until they are well over 30 or not having them at all.

The general rule has been - in all professions and management - that if you step off the ladder, you fall out of the promotion race. This was identified clearly as a problem for women in our work back in 1968, but you would have thought that by 1999 things would have changed, particularly since women have accounted for such rapidly increasing proportions of the qualified workforce.

But the big problem in so many careers remains the linking of age to grade, the desirability of the straight full-time career path, the assumption that career breaks or working part-time for even a couple of years render competent, intelligent people completely useless and incapable of catching up.

Things are changing in medicine, but very slowly. The most recent statistics show that nearly one-fifth of women specialist registrars and a quarter of women consultants were working less than full time in 1997. So were over a quarter of women GP principals, compared with 16 per cent in 1990. I think that here we are perhaps beginning to see the effects of the critical mass and the difficulties in recruitment in some areas that result in women being able to work more flexibly and still have the status of GP principals.

Perhaps the main thing that has struck me in watching the impact of increasing numbers of highly qualified young women on the professions and management is how deeply entrenched traditional attitudes still are - and how difficult it has been to change hearts and minds.