Sex ratios in healthcare occupations: population based study

BMJ 2004; 328 doi: (Published 15 January 2004) Cite this as: BMJ 2004;328:141
  1. Valerie J Grant, senior lecturer (vj.grant{at},
  2. Elizabeth Robinson, statistician2,
  3. Paul Muir, medical student3
  1. 1Department of Health Psychology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1, New Zealand
  2. 2Department of Community Health, Faculty of Medical and Health Sciences, University of Auckland
  3. 3Faculty of Medical and Health Sciences, University of Auckland
  1. Correspondence to: V J Grant
  • Accepted 8 December 2003


Thirty years ago a clear dichotomy existed between the healthcare occupations of men and women. If feminists' predictions were correct—that equal opportunities legislation would widen occupational choices for everyone1 —there should by now be a trend towards equal numbers of men and women in occupations that were formerly male or female dominated. We aimed to support or refute the feminists' predictions by comparing the sex ratio in healthcare occupations in 1971 with the ratio in 2001.

Methods and results

We used census data for 1971 and 2001 (obtained respectively from New Zealand Statistics2 and the New Zealand's government statistics website, to examine the situation before and after the introduction of legislation on equal opportunities for men and women in employment. We used data only for workers aged 18-44 years because this was the age group that would reflect any changes that might have occurred as a result of the legislation. We defined a healthcare worker as anyone working face to face with people who have health or disability problems.

If more than 90% of those employed in an occupation belonged to one sex, we considered the occupation to be “male dominated” or “female dominated.” If more than 70% belonged to one sex, we considered the occupation to be “mostly male” or “mostly female.” If the proportions of men and women were between 30% and 70%, we considered the occupation to be “balanced.” We used χ2 tests to test the significance of the differences in proportions between 1971 and 2001.

For healthcare workers aged 18-44 in 1971, there were 10 male dominated and 13 female dominated occupations; the table shows the numbers of staff in the 10 male dominated occupations and the top 10 female dominated occupations. Each of the 10 male dominated occupations showed a highly significant decrease (χ2 test, P < 0.0001) in the proportion of men in 2001 compared with 1971. The decrease ranged from 11 percentage points in surgeons to 62 percentage points in optometrists/dispensing opticians. Regardless of length of training or level of skill needed, none of these 10 occupations was male dominated in 2001. Moreover, in two occupations (optometrist/dispensing optician and obstetrician/gynaecologist) women became the majority.

Numbers (percentages) of men and women in top 10 male and female dominated healthcare occupations for age range 18-44 years, 1971 and 2001

View this table:

In contrast, eight of the top 10 female dominated occupations remained female dominated in 2001. The two that did not (occupational therapist and principal nurse) dipped only slightly below the category definition, with female proportions of 89.6% and 89.4% respectively. The decrease in the proportion of women in the top 10 female dominated occupations ranged from 0 to 10 percentage points. Two of the female dominated occupations showed no change in 2001 compared with 1971; both occupations were entirely female in both years.

For some occupations, the numbers in the workforce rose substantially. These increases are partly explained by a 36% rise in New Zealand's population, a change in definition of some jobs, and a rise in the number of part time general practitioners.


For workers aged 19-44, healthcare occupations that were male dominated 30 years ago are now balanced for the sexes, whereas occupations that used to be female dominated continue to be so. Our results therefore support the prediction that equal opportunities legislation would widen the choices for women. The same is not true for men, however, as women have retained their big majorities in the female dominated occupations; very few men have entered these occupations.

The reliability of these results is probably high. The data are from a small, developed country that has good quality census data. The extent to which these results might be atypical is unknown, although published results from other developed countries show a similar trend.3

Embedded ImageA figure showing the change in sex ratios in occupations is at


  • Contributors VJG conceived the idea and wrote the paper, ER did the statistical analysis, and PM collected and researched the data. VJG will act as guarantor

  • Funding No special funding

  • Competing interests None declared

  • Ethical approval Not needed


View Abstract