The NIH needs to ensure that women are equally represented in grant funding decisions

For U.S. researchers, the room where it happens — “it” being decisions about funding — is National Institutes of Health study sections. These are the committees charged with reviewing applications for NIH grants and recommending which ones should be funded.

Despite decades of progress by women scientists, women are still underrepresented in study sections. As women who are physician-scientists funded by the NIH, each of us has had first-hand experiences of being the sole woman in the room.

Peer review of grant applications is the foundation of research in the U.S., and these reviews influence the course of scientific discovery for decades. Simply put, it matters who is in these rooms.

In research we published Monday in JAMA Network Open, we showed that women were less likely to be participants and chairs of NIH study sections than men. Women were also more likely to have temporary affiliations and serve on study sections with lower total funding or research grants awarded.

While some may argue that fewer women than men are scientists, and that only 33% of NIH research grants are awarded to women, it doesn’t change the fact that women make up half the U.S. population. Because NIH study section reviewers make decisions that affect the entire country’s health, they should reflect the U.S. population – both in terms of gender and race/ethnicity.

Diverse representation in the room is essential. Diverse membership is associated with teams that are smarter and make better decisions. People from diverse backgrounds keep biases in check and reduce group think, both of which are needed to challenge the status quo to ensure that advancements, including scientific advancements, benefit all. Women bring unique perspectives to discussions, and if they are not fully represented in study sections, their research questions aren’t either.

The consequences of not having equal representation to influence research are evident. For example, issues related to women’s health, such as maternal and perinatal health research, are chronically underfunded. Moreover, a recent analysis showing that nearly half of studies in 2019 included women — up from 28% a decade earlier — yet few of them analyzed results by sex, making it difficult to know if the effect of the treatments studied differs between men and women.

This could not be more salient given issues raised by Covid-19 vaccination. For instance, recommendations were lumped together for pregnant and breastfeeding individuals despite different biological considerations for them and babies.

To its credit, the NIH has internally applied a systems approach to change the institutional culture in favor of inclusion. It has also begun efforts to foster diversity by creating initiatives like the Early Career Reviewer Program and incorporating diversity in decisions about funding conferences. These actions are steps forward, yet further deliberate actions are paramount to ensure equal representation of women in study sections.

Our study provides merely a snapshot of diversity in NIH study sections. Due to limitations in the available data, our study did not examine race/ethnicity of grant reviewers, though there is no doubt that lack of racial/ethnicity diversity is also a pressing issue. Underrepresented groups must also have representation in the room that is equivalent to the US population.

A longitudinal analysis of study sections over the past 10 to 20 years would likely show that the inclusion of women in study sections, and possibly people of color, has improved over time, and we hope — and expect — that trend to continue in the years ahead.

We recommend that the NIH ask all study section reviewers to report their gender, race/ethnicity, work location, and other demographic information. These data should be regularly collected, analyzed, and publicly shared through a dashboard. Such real-time data sharing would support action as study sections are assembled, rather than looking at the data months or years later. Creating study sections with an open application process or the use of committees, rather than having reviewers selected by scientific review officers, could level the playing field. Implicit bias training will also be important for individuals selecting study sections participants.

The pandemic may have opened the door to some solutions toward equity in study section representation. The widespread adoption of virtual meetings, including those of NIH study sections, removes some barriers to participation for women, who take on the majority of household and care work. Studying the participation of women versus men during the pandemic may help elucidate barriers to participation in study sections. These data can help design solutions that overcome barriers women scientists face.

Deliberate efforts to ensure equal gender representation on study sections can help support scientific discovery that is most relevant to our nation and also ensure that more women remain in the biomedical workforce. Participation in NIH study sections is universally seen as significant and is often viewed as a metric for academic promotion. Individuals who are standing members — those who have positions on a study section rather than acting as ad-hoc participants — also have benefits such as the ability to submit grant proposals off cycle. Further, by participating in study sections, individuals gain real-life experience, learning more about effective research methods and grant writing. These experiences are foundational and, if not available equally, represent lost opportunities with broader workforce implications.

In the words of Ruth Bader Ginsburg, “Women belong in all places where decisions are being made.” It’s time that women have equal representation in rooms where decisions are made about our nation’s research.

Anna Volerman is an internal medicine and pediatric clinician-researcher and assistant professor of medicine and pediatrics at the University of Chicago, where Valerie Press is an internal medicine and pediatric clinician-researcher and associate professor of medicine and pediatrics, and Vineet Arora is a professor of medicine and clinician-researcher.