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Acta Obstet Gynecol Scand 2005: 84: 48--53 Copyright # Acta Obstet Gynecol Scand 2005
Printed in Denmark. All rights reserved
Acta Obstetricia et
Gynecologica Scandinavica

ORIGINAL ARTICLE

Determinants of women’s choice of their

obstetrician and gynecologist provider in
the UAE
DIAA E. E. RIZK1, MARGARET A. EL-ZUBEIR2, ALIA M. AL-DHAHERI3, FATIMA R. AL-MANSOURI1 AND HOUDA S. AL-JENAIBI2

From the 1Department of Obstetrics and Gynecology, 2Department of Medical Education, Faculty of Medicine
and Health Sciences, United Arab Emirates University,and 3Department of Family Medicine, Al-Ain Medical District,
Al-Ain, UAE

Acta Obstet Gynecol Scand 2005; 84: 48–53. # Acta Obstet Gynecol Scand 84 2005

Background. The objective of this study is to evaluate women’s priorities and preferences
in selecting their obstetrician and gynecologist in a non-Western society.
Methods. Consecutive sample of 508 patients attending the obstetric and gynecologic
services of AL-Ain Hospital; AL-Ain; United Arab Emirates during 4 months was
recruited. Participants were interviewed by using a structured 26-item questionnaire
administered by means of face-to-face interview within 24 h of admission in the ward or
before consultation in the outpatient clinic. Respondents were asked about their prefer-
ences, priorities, determinants of choice of their obstetrician and gynecologist, their view
of his/her role as a medical provider, and their perception of importance of each of
provider’s characteristics and roles on a five-point Likert scale.
Results. Four hundred thirty-nine (86.4%) participants preferred female physicians. Sixty-
one (12%) had no preference and eight (1.6%) preferred male physicians. Reasons for
female selection were privacy during intimate examination (89.1%) or counseling (68.8%),
religious beliefs (74.3%), and cultural traditions (45.3%). Female preference was
significantly associated with higher parity (P ¼ 0.002), religion (P ¼ 0.005), nationality
(P ¼ 0.01), occupation (P ¼ 0.02), education (P ¼ 0.04), and poor recognition of
physician’s role as professional/expert (P < 0.00001). Male preference was significantly
associated with experience at previous encounter (P ¼ 0.03), obstetric consultation
(P ¼ 0.04), and perceiving physician’s role as skilled communicator (P ¼ 0.01) or health
educator (P ¼ 0.04). Other physician characteristics affecting choice were professionalism,
bedside manners, empathy, communication, competence, availability, and religion.
Conclusions. Physician’s attitude, professional profile, sex, and religious faith determine
women’s choice of obstetricians and gynecologists. Most women prefer female providers
because of embarrassment during pelvic examination and reproductive counseling,
religious beliefs, and sociocultural values.

Key words: obstetrics and gynecology; physician characteristics; sex; UAE; women

Submitted 6 June, 2004

Accepted 13 August, 2004

Many studies have investigated the importance of
physician characteristics particularly sex to
patients in primary health care settings (1–7)
and obstetric and gynecologic services (8–16).
Abbreviations:
UAE: United Arab Emirates.
# Acta Obstet Gynecol Scand 84 (2005)
The results revealed a weak preference for
physicians of the same sex as patients when the
presenting complaint is not sex-specific (1–7). A
preference for the same-sex medical provider,
nevertheless, was significant when women
are seeking care for reproductive disorders
(4–8, 12–16). The importance of other determinants

Women’s choice of obstetrician–gynecologist
of patient’s choice of their obstetrician and
gynecologist provider has also been described in
Western communities (8–16). Ethnic and cross-
cultural differences in women’s attitudes to phy-
sician’s sex and other attributes in reproductive
health care, however, have not been adequately
reported (15–21).
The intimate and sensitive nature of obstetric
and gynecologic practice in a predominantly
Islamic socioreligious environment, such as the
UAE, would be expected to significantly influ-
ence a preference for a female physician among
women (15,18,19,21). We have previously
reported that this finding adversely affects the
involvement of male medical students and clinical
tutors in outpatient obstetric and gynecologic
care and consequently in teaching and acquisition
of clinical skills (19). It is also anticipated that
our female patients will have similar perceptions
and preferences for the sex of medical providers
involved in intimate procedures and examin-
ations of non-reproductive diseases (1–7).
The aims of this study, therefore, are to (i)
evaluate the priorities and preferences of women
attending the obstetric and gynecologic services
of our hospital when selecting their physician, (ii)
identify the physician’s attributes, particularly
sex, that are most important to women in this
process, (iii) ascertain whether there are any asso-
ciations between determinants of patients’
choices and sociodemographic or clinical vari-
ables, and (iv) investigate the women’s prefer-
ences for sex of medical providers involved in
other intimate health problems that do not
include obstetric and gynecologic conditions.
This work may have an important impact on
the future structure of the medical workforce,
service delivery, and undergraduate teaching
and postgraduate training in obstetrics and gyne-
cology in our community.
Patients and methods
A cross-sectional survey was performed at Al-Ain Hospital,
one of the two main teaching facilities affiliated with the
Faculty of Medicine and Health Sciences, United Arab
Emirates University, Al-Ain, UAE, for undergraduate and
postgraduate medical education. The hospital provides
tertiary medical services for a multiethnic patient population
domicile in the Al-Ain city. In the Obstetrics and Gyne-
cology Department, both academic faculty and clinicians/
preceptors participate in teaching and clinical service and
all patient population have access to free reproductive health
care. The departmental staff consists of four consultants
(all women), six clinical faculty (five men, including the
chairman, and one woman), and 17 residents/registrars (all
women). The Research Ethics Committee of the faculty
approved the study protocol.
All women, who attended the Obstetrics and Gynecology
Clinic or who were admitted to the Obstetrics and Gyne-
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49
cology wards at Al-Ain Hospital over a 4-month period
(between 1 January, 2003 and 30 April, 2003) were recruited
into the survey. This sample size was conveniently selected in
line with previous studies designated in order to evaluate
women’s attitudes toward sex and other characteristics of
obstetrician and gynecologist providers (8–16). It was also
calculated that this population of women was equivalent to
17.4% of the expected annual clinic and inpatient volume in
Obstetrics and Gynecology (2800–3200) and would thus
provide an adequate and representative sample of our
institutional database (19). Women, who were staff at the
hospital, women whose babies died in the perinatal period,
and those with a history of psychiatric illness were excluded.
Of the eligible 522 women, 14 refused enrollment and
the remaining 508 women gave their informed consent to
participate in the study.
A resident in family medicine (A.M.A.) and an intern
(F.R.A.) collected the data during their consecutive
2-month rotations in Obstetrics and Gynecology by using a
structured questionnaire, modified from those described
elsewhere (1,3,5,6,8,10,12,14–16). The questionnaire was
administered by means of face-to-face interview within 24 h
of admission in the ward or before consultation in the
outpatient clinic. The questionnaire was also pretested on
20 randomly selected women from the clerical staff working
at the hospital in order to validate the survey instrument and
assess suitability for the target population. Questions were
amended according to responses of this pilot study and the
final questionnaire consisted of 26 items that included a
number of demographic and reproductive variables.
Respondents were asked about their preferences, priorities,
determinants of choice of their obstetrician and gyne-
cologist, and their view of his/her role as a medical provider
by using a set of predetermined characteristics identified in
previous studies (1,3,5–7,10,12,14–16). Women were also
requested to rate their perception of the importance of
each of provider’s characteristics and roles on a five-point
Likert scale (1 ¼ not important, 2 ¼ slightly important,
3 ¼ moderately important, 4 ¼ very important, and
5 ¼ extremely important). Finally, the study participants
were interviewed about their overall preference for the sex
of physician providers in other medical specialties that may
involve discussion of personal problems and/or intimate
examination (4,5). The questionnaire answers were kept
anonymous and confidential.
Statistical analysis was performed by means of the Statistical
Package for the Social Sciences, Ill.- version 11 (SPSS Inc.,
Chicago, Illinois, USA). Differences between proportions
were examined by means of w2 test or Fisher’s exact test when
the class size was small (2
2 or 2
3,4 tests, as appropriate).
Differences between means were compared with the help
of Student’s t-test. A P < 0.05 was considered a significant
difference.
Results
The study sample comprised 508 (97.3% response
rate) of the 522 eligible women, who were
admitted to the hospital (n ¼ 255; 50.2%) or who
attended the clinic (n ¼ 253; 49.8%) during the
study period. Four hundred thirty-nine (86.4%)
women preferred the involvement of a female
physician in their obstetric and gynecologic care,
whereas the remaining women expressed no pre-
ference (n ¼ 61; 12%) or preferred the involvement
of a male physician (n ¼ 8; 1.6%). All participants
were married.
# Acta Obstet Gynecol Scand 84 (2005)
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50 D. E. E. Rizk et al.
Table I. Demographic and clinical characteristics of study population according to sex preference of their obstetrician and gynecologist provider (n ¼ 508)

Female physician No preference Male physician Difference*

(n ¼ 439) (n ¼ 61) (n ¼ 8) (P-value)

Age (years) 29.3  7.1† 29.2  6.4 29.3  4.4 Not significant‡
Parity 2.9  2.7 2.1  1.7 2.1  1.8 0.002‡
Nationality 0.01§
Other Arabs 241 (54.9){ 37 (60.6) 6 (75)
UAE 145 (33) 10 (16.4) 0
Indian/Pakistani 42 (9.6) 12 (19.7) 1 (12.5)
Filipino 11 (2.5) 2 (3.3) 1 (12.5)
Religion 0.005§
Moslem 420 (95.6) 52 (85.2) 6 (75)
Christian 13 (3) 7 (11.5) 1 (12.5)
Hindu 6 (1.4) 2 (3.3) 1 (12.5)
Monthly income (Dirhams)** Not significant §
<5000 211 (48.1) 30 (49.2) 4 (50)
5000–15 000 191 (43.5) 27 (44.3) 4 (50)
>15 000 37 (8.4) 4 (6.5) 0
Occupation 0.02§,††
Housewife 218 (79.6) 19 (31.1) 3 (37.5)
Manual 105 (23.9) 14 (23) 2 (25)
Professional 116 (26) 28 (45.9) 3 (37.5)
Education 0.04§
Illiterate 38 (8.7) 1 (1.6) 0
Secondary school 210 (47.8) 25 (41) 2 (25)
University 191 (43.5) 35 (57.4) 6 (75)
Clinical encounter Not significant §,††
Outpatient clinic 217 (49.4) 31 (50.8) 5 (62.5)
Hospital inpatient 222 (50.6) 30 (49.2) 3 (37.5)
Clinical presentation 0.04§,††,‡‡
Obstetric problems 295 (67.2) 31 (50.1) 7 (87.5)
Gynecologic problems 144 (32.8) 30 (49.9) 1 (12.5)

*Differences were analyzed by using no preference as the reference group, compared to female-preference and male-preference groups. Statistical analysis of
the difference between two groups was performed by means of Student’s t-test‡, Fisher’s exact test § or w2 test††.
†Mean  SD.
{Number (percentage)
**1 US $ ¼ 3.68 Dirhams
‡‡Significant difference between the no-preference and male-preference groups.

The demographic and clinical characteristics of
the study population have been presented in
Table I. More women attended the clinic for peri-
natal care (n ¼ 135; 53.3%) than for gynecologic
problems (n ¼ 118; 46.7%) and most were admitted
because of obstetric (n ¼ 198; 77.6%) than of gyne-
cologic (n ¼ 57; 22.4%) reasons. Of the perinatal
clinic visits, 71 (52.6%) were booking, 56 (41.5%)
were antenatal follow-up, and eight (5.9%) were
postnatal visits. Gynecologic reasons for out-
patient consultation included infertility (n ¼ 31;
26.3%), abnormal uterine bleeding (n ¼ 29;
24.6%), hirsutism (n ¼ 20; 16.9%), vaginitis
(n ¼ 19; 16.1%), chronic pelvic pain (n ¼ 17;
14.4%), and sensation of genital prolapse and/or
urinary incontinence (n ¼ 2; 1.7%). In the inpatient
obstetric population, 112 (56.6%) had various
antenatal problems and 86 (43.4%) were inter-
viewed during their routine postpartum hospital
stay. The gynecologic indications for admission
were miscarriage (n ¼ 25; 43.8%), abnormal uterine
bleeding (n ¼ 13; 22.8%), hyperemesis gravidarum
(n ¼ 7; 12.3%), ectopic pregnancy (n ¼ 4; 7%),
# Acta Obstet Gynecol Scand 84 (2005)
acute pelvic pain (n ¼ 3; 5.3%), infertility (n ¼ 3;
5.3%), and pelvic organ prolapse (n ¼ 2; 3.5%).
There were significant differences between
women, who expressed preference for sex of their
obstetricians and gynecologists and those who had
no preference (Table I). The female-preference group
was of significantly higher parity with a significant
trend for having lower education and being UAE
national, housewife, and Moslem. Male-sex prefer-
ence was significantly more common in women with
obstetric conditions. Reasons given for same-sex
preference were embarrassment during intimate
examination (n ¼ 391; 89.1%), religious beliefs
(n ¼ 326; 74.3%), reluctance to discuss sensitive and
confidential issues (n ¼ 302; 68.8%), and
cultural objections (n ¼ 199; 45.3%). Female obste-
tricians and gynecologists were also considered
having greater awareness for female reproductive
problems (n ¼ 301; 68.6%), more compassionate
(n ¼ 146; 33.3%), and better listeners (n ¼ 80;
18.2%) than male obstetricians. Two hundred
twenty-seven of these women (51.7%), however,
agreed that participation of a male obstetrician
 16000412, 2005, 1, Downloaded from https://obgyn.onlinelibrary.wiley.com/doi/10.1111/j.0001-6349.2005.00705.x by Jordan Hinari NPL, Wiley Online Library on [16/01/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Women’s choice of obstetrician–gynecologist 51

and gynecologist is acceptable in emergency or (n ¼ 8; 100%) than with no preference (n ¼ 39;

complicated cases, but all would consult a male
physician only if he was accompanied by a female
chaperone.
Reasons given by women, who wished to
consult a male obstetrician and gynecologist
only, were greater technical competence of male
physicians (n ¼ 5; 62.5%) and opportunity to gain
more information about management (n ¼ 2; 25%)
and ability to communicate more freely about
reproductive problems (n ¼ 1; 12.5%) when the
physician is a man. Only two (33.3%) and 30
(57.7%) of the Moslem women in this group and
in the no-sex-preference group, respectively, were,
however, prepared to have a male obstetrician and
gynecologist involved in their care during the holy
month of Ramadan for religious reasons.
Physician’s attributes and their relative import-
ance in choosing an obstetrician and gynecologist
provider in descending order of mean total scores
achieved in all groups have been shown in
Table II. Women with sex preference, particularly
for female physicians, rated sex significantly
higher than those who had no preference. Those
who had male-sex preference rated physician
availability, postgraduate qualifications, medical
educational background, bedside manners, and
experience significantly higher than the no-
preference group. Positive experience at previous
clinical encounter was also significantly asso-
ciated (P ¼ 0.03) more with male-sex preference
63.9%).
Perceptions of study participants about the role
of their obstetrician and gynecologist provider in
descending order of total mean scores achieved in
all groups have been presented in Table III. The
mean perception score for expert/professional was
significantly lower in the female-physician-preference
group and that for skilled communicator or teacher/
health educator was significantly higher in the
male-physician-preference group, compared to the
no-preference group.
Views of the study cohort about physician sex
in other disciplines that might include intimate
examinations were entirely different. Most
women, thus, accepted consultations by a male
ophthalmologist (n ¼ 396; 80%), ear, nose, and
throat surgeon (n ¼ 383; 75.4%), general surgeon
(n ¼ 270; 53.1%), cardiologist (n ¼ 259; 51%),
internal medicine physician (n ¼ 256; 50.4%),
chest physician (n ¼ 217; 42.7%), and breast
surgeon (n ¼ 163; 32.1%). Female-physician-
preference rate in obstetric and gynecologic care
(86.4%) was significantly higher (P < 0.00001)
than that in other clinical specialties, including
breast disorders (67.9%).
Discussion
This survey provides new information to the
world literature on the factors involved in the

Table II. Physician characteristics considered important by the study population in selecting their obstetrician and gynecologist providers*

Female physician No preference Male physician

(n ¼ 439) (n ¼ 61) (n ¼ 8)

Responsiveness/caring/empathy 4.6  0.8† 4.6  1 4.9  0.4

Knowledge 4.6  0.9 4.6  1 4.9  0.4
Bedside manners 4.6  1 4.5  1‡ 4.9  0.4‡
Experience 4.6  1 4.5  1‡ 4.9  0.4‡
Professionalism 4.7  0.8 4.6  1 4.7  0.8
Technical skills and competence 4.7  0.7 4.7  0.6 4.6  1.1
Availability 4.4  1 4.4  1‡ 5  0‡
Communication proficiency 4.6  0.7 4.4  1 4.7  0.5
Reputation 4.5  1 4.5  1 4.6  0.8
Confidence 4.5  1 4.3  1.2 4.7  0.5
Sex 4.5  1‡ 2.2  1.6‡ 3.7  1.6‡
Institutional rank 3.6  1.6 3.3  1.6 4  1.5
Postgraduate qualifications 2.9  1.6 2.9  1.6‡ 4  0.5‡
Medical educational background 2.3  1.6 2.5  1.6‡ 4  1.4‡
Religious faith 3  1.7 2.9  1.7 2.9  1.5
Cost of service 2.9  1.5 2.9  1.4 2.6  1.6
Academic affiliation 2.2  1.6 2.4  1.6 2.6  1.9
Age 1.7  1.3 1.8  1.2 2.1  1.4
Nationality 1.6  1.2 1.7  1.3 2  1.5

*Response is rated on a five-point scale (see text).

†Mean response score  SD.
‡Differences were significant between the no-preference and both the female-preference group (P < 0.00001) and male-preference group (P ¼ 0.03) for
physician sex. Differences were significant between the no-preference and male-preference groups for physician availability (P < 0.00001), postgraduate
qualifications (P ¼ 0.02), medical educational background (P ¼ 0.02), bedside manners (P ¼ 0.04), and experience (P ¼ 0.04). Statistical analysis of the
difference between two groups was performed by means of Student’s t-test.

# Acta Obstet Gynecol Scand 84 (2005)


52 D. E. E. Rizk et al.
Table III. Perceptions of study population about the role expected from their obstetrician and gynecologist providers*
Female physician†
(n ¼ 439)
Expert/professional 4.4  0.1†,‡
Skilled communicator 4.6  0.8
Teacher/health educator 3.9  1.5
Scholar/researcher 3.2  1.5
Patient advocate 3.1  1.7
Team/resource manager 2.2  1.6
*Response is rated on a five-point scale (see text).
†Differences were significant between the no-preference and female-preference groups for professional/expert (P < 0.00001) and between the no-preference
and male-preference groups for skilled communicator (P ¼ 0.01) and teacher/health educator (P ¼ 0.04). Statistical analysis of the difference between two
groups was performed by means of Student’s t-test.
‡Mean response score  SD.
selection of obstetrician and gynecologist pro-
viders, particularly sex, and their relative import-
ance from the clientele’s perspective in a
Middle Eastern population (4). Our results
showed that physician’s technical competence
and expertise, personal attitude and behavior,
communication skills, professional profile, and
accessibility – besides female sex – are the most
important determinants of women’s choice. This
finding is similar to most Western studies
(1,2,5–10,12,14–16). However, our study was unique
in showing that physician’s sex was ranked as one
of the important factors for selection and that
his/her religious conviction was also influential
(8,10,12,14–16). Preference rates for same-sex
physician–patient dyad in obstetric and gynecologic
care are, therefore, significantly lower in Western
studies (11–75%) than those observed in our study
(5–10,12,14–16).
Women perceive female physicians as more
caring, empathetic, and compassionate and male
physicians as more curing, knowledgeable, and
experienced mainly because of socialization of
sex role stereotypes (1,5,13,21,22). Although
obstetricians and gynecologists usually have
lower psychometric empathy ratings than primary
care physicians (22), some (8,10,21,22) but not all
(2,4,11,13) studies indicate that female obstetri-
cians and gynecologists also have better commu-
nication skills than male obstetricians and
gynecologists. Furthermore, women prefer to
have female physicians for obstetric and gyne-
cologic consultations, because these are perceived
as embarrassing, physically invasive, and difficult
to endure (1–9,13,16,19,21,23). Our study confirms
all of these observations and highlights the fact that
women place a high value on the communication
proficiency, empathetic behavior, and personal
conduct of their obstetrician and gynecologist
providers (1,3,5,8,12,14,21,23,24).
Similar to the present survey, patients’ educa-
tional level (1,6,9), ethnicity (7,9,16), religious
# Acta Obstet Gynecol Scand 84 (2005)
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No preference† Male physician†
(n ¼ 61) (n ¼ 8)
4.9  0.3† 4.8  0.6
4.4  1† 4.9  0.4†
3.8  1.5† 4.6  0.8†
3.3  1.4 3.2  1.5
3.2  1.7 3.3  2.1
2.3  1.6 2.3  1.9
faith (15,19,21), socioeconomic status (7,9), and
parity (24) and type of clinical encounter (11)
affect sex preference for obstetrician and gyne-
cologist providers. Having encountered male
physicians during common clinical conditions in
Obstetrics and Gynecology, such as perinatal
care and labor, may account for the association
between male-sex preference and obstetric con-
sultations in our patients (6,9,11,14,15,19,24). It
is also likely that when expertise is perceived as
required during emergency or complicated obstet-
ric conditions, these women may have less con-
cern about provider’s sex. Patients’ experience
with physician involvement and their perception
and knowledge of his/her role and responsibility
as a medical provider acquired from previous
obstetric and gynecologic encounters also signifi-
cantly affect their subsequent preferences for
physician sex (1,3,5–7,9,15,19,20,23). This finding
was seen in our study in women, who had male-
sex preference. The majority of Moslem women,
however, did not accept obstetric and gynecologic
consultations by a male physician even in the
presence of a female chaperone and particularly
during Ramadan, compared to other ethnic and
non-Moslem groups (15,16,19,21). Encouraging a
multiethnic female patient population, like our
own, to seek reproductive health care, thus,
requires formal teaching of these religiocultural
issues during undergraduate, postgraduate, and
continuing medical education (17,18,20).
Respondents of patient questionnaires tend to
be more positive about their choices and assess-
ments of clinical services, because their cognitive
evaluation is influenced by their affective reaction
(15,19,23). Therefore, polarization to same-sex
preference in the present series is legitimate
particularly because expressed by the majority of
women (8,9,15,18–21). This necessitates alternative
recruitment and planning strategies for delivering
reproductive health care in our community
(2,4,5,7,9,10,11,22). Decreased opportunities for

Women’s choice of obstetrician–gynecologist
teaching and training of male students and resi-
dents in Obstetrics and Gynecology might be
further important consequences in academic
health centers (8,19,20,25). Most study partici-
pants were, nevertheless, comfortable with inti-
mate and sensitive examinations performed by
male physicians from other clinical disciplines in
contrast to Obstetrics and Gynecology, as reported
in Western women (1–7). This finding has import-
ant ethical implications for women’s acceptance
of intimate pelvic examinations and participation
in medical education with potentially harmful
effects on reproductive health (23,25).
Surveys are subject to sampling and response
biases (12,19,23). In order to reduce the sampling
bias, we chose to recruit all eligible women during a
specific time frame (7,8,10,12,14,16,23). We also
used an interview-based instrument rather than
self-completion (1,6–9,15,16,23) or telephone-
based questionnaires (20) in order to increase the
response rate through direct personal contact and
interaction with participants (13,19). However,
there was no further information to assess the char-
acteristics of non-respondents. This could bias the
results, because motivated participants may differ
from non-respondents (1,8,14). Response bias is
also possible, because the interviewer approached
women as a service provider and not as an inde-
pendent researcher (2,4,8,10,12,21). We did not ask
patients directly what criteria they use in choosing
their obstetrician and gynecologist and it is possible
that those studied in our survey are not what drive
this choice (3,10,14,16). Our survey did not also
include qualitative analysis of responses (10). A
further qualitative study might seek suggestions
from interviewees about how best to manage situ-
ations where an obstetrician or a gynecologist of
the less-preferred sex is the only physician available
(e.g., what alternatives they would be prepared to
accept).
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Address for correspondence:
Diaa E. E. Rizk
Department of Obstetrics and Gynecology
Faculty of Medicine and Health Sciences
United Arab Emirates University
P O Box 17666
Al-Ain Medical District
Al-Ain
UAE
e-mail: rizk.diaa@uaeu.ac.ae
# Acta Obstet Gynecol Scand 84 (2005)