Working Paper
Richardson, Sarah S.Sex Contextualism,” Working Paper.Abstract

This paper develops the conceptual framework of “sex contextualism” for the study of sex-related biological variables in basic, preclinical biomedical research. Sex contextualism offers an alternative to binary sex essentialist approaches to the study of sex as a biological variable. Specifically, sex contextualism recognizes the pluralism and context-specificity of operationalizations of ‘sex’ across bioscience research, particularly in a laboratory context. In light of recent policy mandates to consider sex as a biological variable, sex contextualism offers constructive guidance to bioscience research for attending to sex-related biological variation. As a constructive alternative to and critique of biological binary sex essentialism, sex contextualism contributes to current debates in philosophy of biology, feminist science studies, and social ontology on the construction of categories of gender/sex differences in scientific research.  (This paper is currently under review for publication; contact for manuscript.)

Shattuck-Heidorn, Heather, Ann Caroline Danielsen, Annika Gompers, Joseph Dov Bruch, Helen Zhao, Marion Boulicault, Jamie Marsella, and Sarah S. Richardson. “Matters Arising: A finding of sex differences or of similarities?Nature (Forthcoming).Abstract

The sex disparity in COVID-19 mortality varies widely and is of uncertain origin. In their recent Nature paper “Sex differences in immune responses that underlie COVID-19 disease outcomes,” Takahashi et al. assess immune phenotype in a sample of COVID-19 patients and conclude that the “immune landscape in COVID-19 patients is considerably different between the sexes,” warranting different vaccine and therapeutic regimes for men and women -- a claim widely disseminated following the publication. Here, we argue that these inferences are not supported by their findings: this study does not demonstrate that biological sex explains COVID-19 outcomes among patients. This study is diagnostic of an ongoing pattern in sex difference research of overstatement of findings and superficial treatment of factors beyond innate sex in analyzing the causes of gender/sex disparities in health outcomes.

The future of sperm: A biovariability framework for understanding global sperm count trends
Boulicault, Marion, Meg Perret, Jonathan Galka, Alex Borsa, Annika Gompers, Meredith Reiches, and Sarah S. Richardson. “The future of sperm: A biovariability framework for understanding global sperm count trends.” Human Fertility DOI 10.1080/14647273.2021.1917778 (Forthcoming). Publisher's VersionAbstract
The past 50 years have seen heated debate in the reproductive sciences about global trends in human sperm count. In 2017, Levine and colleagues published the most methodologically rigorous and largest meta-regression analysis to date and reported that average total sperm concentration among men from “Western” countries has decreased by 59.3% since 1973, with no sign of halting. These results reverberated in the scientific community and in public discussions about men and masculinity in the modern world, in part because of scientists’ public-facing claims about the societal implications of the decline of male fertility. We find that existing research follows a set of implicit and explicit assumptions about how to measure and interpret sperm counts, which collectively form what we term the Sperm Count Decline hypothesis (SCD). Using the study by Levine and colleagues, we identify weaknesses and inconsistencies in the SCD, and propose an alternative framework to guide research on sperm count trends, the Sperm Count Biovariability hypothesis (SCB). SCB asserts that sperm count varies within a wide range, much of which can be considered non-pathological and species-typical. Knowledge about the relationship between individual and population sperm count and life-historical and ecological factors is critical to interpreting trends in average sperm counts and their relationships to health and fertility.
The Maternal Imprint: The Contested Science of Maternal-Fetal Effects
Richardson, Sarah S. The Maternal Imprint: The Contested Science of Maternal-Fetal Effects. University of Chicago Press, Forthcoming.Abstract

Forthcoming September 2021. The Maternal Imprint charts the history of the idea that a woman’s health and behavior during pregnancy can have long-term effects on her descendants’ health and welfare.

The idea that a woman may leave a biological trace on her gestating offspring has long been a commonplace folk intuition and a matter of scientific intrigue, but the form of that idea—and its staggering implications for maternal well-being and reproductive autonomy—has changed dramatically over time. Beginning with the advent of modern genetics at the turn of the twentieth century, biomedical scientists dismissed any notion that a mother—except in cases of extreme deprivation or injury—could alter her offspring’s traits. Consensus asserted that a child’s fate was set by a combination of its genes and post-birth upbringing.  

Over the last fifty years, however, this consensus was dismantled, and today, research on the intrauterine environment and its effects on the fetus is emerging as a robust program of study in medicine, public health, psychology, evolutionary biology, and genomics. Collectively, these sciences argue that a woman’s experiences, behaviors, and physiology can have life-altering effects on offspring development. Tracing a genealogy of ideas about heredity and maternal-fetal effects, The Maternal Imprint offers a critical analysis of conceptual and ethical issues provoked by the striking rise of epigenetics and fetal origins science in postgenomic biology today.

Sex Disparities in COVID-19 Mortality Vary Across US Racial Groups
Rushovich, Tamara, Marion Boulicault, Jarvis T. Chen, Ann Caroline Danielsen, Amelia Tarrant, Sarah S. Richardson, and Heather Shattuck-Heidorn. “Sex Disparities in COVID-19 Mortality Vary Across US Racial Groups.” Journal of General Internal Medicine DOI 10.1007/s11606-021-06699-4 (2021). Publisher's VersionAbstract

This study shows that Black women are dying of COVID-19 at rates higher than men in other racial/ethnic groups. The study is the first to quantify the inequities in COVID-19 mortality looking at both race and sex group and analyzing the sex-disparity in COVID-19 mortality across racial groups. It shows that Black women are dying at significantly higher rates than white men, and that disparities in mortality rates among women of all races are greater than those between white women and white men, complicating the simple narrative that men are dying at greater rates of COVID-19 than women.

Results show that the common belief that men with COVID-19 fare more poorly than women varies in magnitude across social groups defined by race/ethnicity. Key findings of the study include:

  • Black women have COVID-19 mortality rates that are almost 4 times higher than that of white men and 3 times higher than that of Asian men, as well as higher than white and Asian women.
  • Black men have far higher mortality rates than any other sex and racial group, including over 6 times higher than the rate among white men.
  • The disparity in mortality rates between Black women and white women is over 3 times the disparity between white men and white women.
  • The disparity between Black men and Black women is larger than the disparity between white men and white women.

Study methods: This study used census data and publicly available data from Michigan and Georgia, the only two states reporting data disaggregated by age, race, and sex, to calculate and compare COVID-19 mortality rates.

Rushovich, Tamara, and Sarah S. Richardson. “The intersection of Black women, COVID, and death rates: The narrative about sex differences and COVID-19 overshadows alarming facts.” The Boston Globe, 2021, April 5. Publisher's VersionAbstract

Headlines like “Battle of the Sexes Against COVID-19” frame sex disparities in COVID-19 outcomes as a matter of essential biological differences between the sexes. Our findings support a contrary view, that biological factors at best play a small role. Rather, social factors influenced by structural gendered racism are key to the patterns of sex disparities revealed by the COVID-19 pandemic. These findings caution against public health messaging emphasizing a higher COVID-19 risk among men that does not also include social context.

Boulicault, M., A. C. Danielsen, J. Bruch, A. Tarrant, A. Borsa, and S. Richardson. “Socially Relevant Variables In US State COVID-19 Surveillance Reporting: A Report Card .” Health Affairs Blog, 2020, July 14. Publisher's VersionAbstract
The Harvard GenderSci Lab developed a scoring scheme and Report Card to evaluate the comprehensiveness of socially relevant, intersectional data publicly reported by each state.  We scored each state on their reporting of selected socially relevant variables (age, sex/gender, race/ethnicity, and comorbidity status), and on reporting of interactions between these variables.  The results document the paucity of comprehensive disaggregated COVID-19 surveillance reporting among states. Only three states received an “A”, while 30 states received a “D” grade or lower.
First Authorship Gender Gap in the Geosciences
Pico, Tamara, Paul Bierman, Kevin Doyle, and Sarah S. Richardson. “First Authorship Gender Gap in the Geosciences.” Earth and Space Science 7, no. 8 (2020): e2020EA001203. Publisher's VersionAbstract

Although gender parity has been reached at the graduate level in the geosciences, women remain a minority in faculty positions. First authorship of peer‐reviewed scholarship is a measure of academic success and is often used to project potential in the hiring process. Given the importance of first author publications for hiring and advancement, we sought to quantify whether women are underrepresented as first authors relative to their representation in the field of geoscience. We compiled first author names across 13 leading geoscience journals from January 2013 to April 2019 (n 1⁄4 35,183). Using a database of 216,286 names from 79 countries, across 89 languages, we classified the likely gender associated with each author's given (first) name. We also estimated the gender distribution of authors who publish using only initials, which may itself be a strategy employed by some women to preempt perceived (and actual) gender bias in the publication process. Female names represent 13–30% of all first authors in our database and are substantially underrepresented relative to the proportion of women in early career positions (30–50%). The proportion of female‐name first authors varies substantially by subfield, reflecting variation in representation of women across geoscience subdisciplines. In geoscience, the quantification of this first authorship gender gap supports the hypothesis that the publication process—namely, achievement or allocation of first authorship—is biased by social factors, which may modulate career success of women in the sciences.

Borsa, Alexander, Joseph Bruch, and Sarah S. Richardson. “When private equity firms invest in women’s health clinics, who benefits? .” STAT, 2020, Sep. 14. Publisher's VersionAbstract

The increasing influence of private equity in a range of health care delivery settings such as physician staffingnursing homes, and hospitals is not new. But our research reveals a precipitous rise of private equity activity in women’s health. The recent rise of private equity in this area marks a novel form of investor attention with unknown implications. To determine how the incentives of private equity firms interact with clinicians’ mission of caring for women, policymakers, researchers, and the general public need to stay vigilant. Deals between private equity firms and health care providers should be transparent, and ethical standards should be put in place to ensure that profits don’t get in the way of people, and that patients are able to access comprehensive, equitable, and affordable care.

Bruch, Joseph D., Alexander Borsa, Zirui Song, and Sarah S. Richardson. “Expansion of Private Equity Involvement in Women’s Health Care.” JAMA Internal Medicine 180, no. 11 (2020): 1542–1545. Publisher's VersionAbstract

We document formerly non–private equity women’s health care companies, including physician networks, practices, and fertility clinics, that gained a private equity affiliation between 2010 and 2019. This analysis shows a substantial increase in private equity affiliations in women’s health care since 2017. Private equity–affiliated OB/GYN offices are located in urban locations, with an average 2017 median household income 24% higher than the 2017 national average. How the incentives of private equity firms interact with the clinical mission of women’s health is a critical area of inquiry. Future debate about private equity in women’s health will likely be shaped by the associations between economic incentives and quality of care, elective or cosmetic procedures, and access to reproductive health services, especially among low-income, LGBTQIA, and other disadvantaged populations.

Commentary: Private Equity, Women’s Health, and the Corporate Transformation of American Medicine

Boulicault, Marion, and Sarah S. Richardson. “Analyzing COVID-19 Sex Difference Claims: The Harvard GenderSci Lab.” APA Newsletter on Feminism and Philosophy 20, no. 1 (2020): 3-7. Publisher's VersionAbstract
Since March 2020, our group at the Harvard GenderSci Lab has been critiquing sex essentialist explanations of COVID-19 outcome disparities. Using interdisciplinary tools from feminist philosophy, science studies, and critical public health, we work collaboratively to critically examine COVID-19 sex-difference research and to explore and elevate the role of social variables in driving biological disparities. We argue that, in public health research and messaging, data on sex disparities must be contextualized to avoid reinforcing harmful sex essentialist assumptions and to help the public understand how social factors influence these patterns. In the case of COVID-19, doing so can clarify risks and save lives. Here, we describe our methods and share some of our findings.
Shattuck-Heidorn, Heather, Meredith W. Reiches, and Sarah S. Richardson. “What’s Really Behind the Gender Gap in Covid-19 Deaths?The New York Times, 2020, June 24. Publisher's VersionAbstract
A few months into the first wave of the Covid-19 epidemic, men in aggregate appear to have higher fatality rates. But ascribing this outcome to biological sex-related variables, as some have rushed to do, is unlikely to lead to effective interventions. In past epidemics, what at first appeared to be a sex difference turned out to be largely a result of the difference in life experiences between women and men. Occupations, behaviors and pre-existing conditions mattered more than whether one was a woman or a man.
Reiches, Meredith, and Sarah S. Richardson. “We Dug Into Data to Disprove a Myth About Women in STEM.” Slate, 2020, Feb. 11. Publisher's VersionAbstract

The argument used to be that women were simply biologically less capable. Now it’s that they’re less interested. Both are wrong.

Richardson, Sarah S., Meredith W. Reiches, Joe Bruch, Marion Boulicault, Nicole E. Noll, and Heather Shattuck-Heidorn. “Is There a Gender-Equality Paradox in Science, Technology, Engineering, and Math (STEM)? Commentary on the Study by Stoet and Geary (2018).” Psychological Science (2020): 0956797619872762. Publisher's Version richardson_et_al_gender_equality_paradox.pdf
Richardson, S. S. Borsa, A. Boulicault M. Galka J. Ghosh N. Gompers A. Noll N. E. Perret M. Reiches M. W. Sandoval J. C.Genome studies must account for history.” Science 366, no. 6472 (2019): 1461. genome_studies_must_account_for_history.pdf
Shattuck-Heidorn, Heather, and Sarah S. Richardson. “Focusing on differences between the sexes is leading medical researchers astray.” The Washington Post, 2019, 30 May. Publisher's VersionAbstract
The sleep drug zolpidem (Ambien) is a leading example used by advocates of sex-based medicine. In this Op-Ed, Heather Shattuck-Heidorn and I argue that there is no evidence for sex differences in zolpidem dosing -- and that the paradigmatic example of zolpidem is actually a cautionary tale of the dangers of an overfocus on sex differences.
Time to cut the cord: recognizing and addressing the imbalance of DOHaD research towards the study of maternal pregnancy exposures
Sharp, G.C., L. Schellhas, S. S. Richardson, and D. A. Lawlor. “Time to cut the cord: recognizing and addressing the imbalance of DOHaD research towards the study of maternal pregnancy exposures.” Journal of Developmental Origins of Health and Disease DOI: 10.1017/S2040174419000072, no. Epub: 2019/03/08 (2019): 1-4. Publisher's VersionAbstract

Fifteen years ago, the society that produces this journal was established to advance research on the Developmental Origins of Health and Disease (DOHaD). But, as we show here, extending our previous work, DOHaD research has been more concerned with exposures in the fetal period than in any other window of development. This interest manifests as an abundance of studies on the potential effects of the health and lifestyle of mothers around the time of pregnancy on the health of their children. We argue that this focus reflects deeply-held assumptions, among researchers, clinicians, policy makers, the media and the public, that maternal pregnancy exposures are the most important, causal determinants of offspring health. We call for the DOHaD research community to recognize and challenge these assumptions.

Sex/Gender and the Biosocial Turn
Shattuck-Heidorn, Heather, and Sarah S. Richardson. “Sex/Gender and the Biosocial Turn.” The Scholar and Feminist Online 15, no. 2 (2019). Publisher's VersionAbstract

In this essay, we pose the biosocial turn as presenting an opportunity to creatively expand the range of empirical inquiries into gender as a biosocial variable and to newly articulate the importance of attending to gender in biological science. Feminist scientists and science theorists, we argue, would do well to engage the reservoir of innovative new biosocial research as a resource for developing methods and theories for the study of sex/gender. Similarly, we call on biosocial scientists to attend as assiduously to gender as they have to other intersecting foci of analysis, such as racial discrimination and socioeconomic disadvantage.

Richardson, Sarah S.Transphobia, Cloaked in Science.” Los Angeles Review of Books, 2018, Nov. 11. Publisher's VersionAbstract
Decades of research across scientific disciplines have built an understanding of human sex as a multidimensional trait with biological and social components that can vary over the life course. Against this scientific consensus, the proposed HHS definition marshals bits and pieces of biology in order to exclude millions of transgender citizens — whose sexual or gender identity often does not match their natal genitals — from civil rights protections.
It’s the Mother!: How Assumptions about the Causal Primacy of Maternal Effects Influence Research on the Developmental Origins of Health and Disease
Sharp, Gemma, Debbie Lawlor, and Sarah S. Richardson. “It’s the Mother!: How Assumptions about the Causal Primacy of Maternal Effects Influence Research on the Developmental Origins of Health and Disease.” Social Science and Medicine 213, no. September (2018): 20-27. Publisher's VersionAbstract
Research on the developmental origins of health and disease (DOHaD) has traditionally focused on how maternal exposures around the time of pregnancy might influence offspring health and risk of disease. We acknowledge that for some exposures this is likely to be correct, but argue that the focus on maternal pregnancy effects also reflects implicit and deeply-held assumptions that 1) causal early life exposures are primarily transmitted via maternal traits or exposures, 2) maternal exposures around the time of pregnancy and early infancy are particularly important, and 3) other factors, such as paternal factors and postnatal exposures in later life, have relatively little impact in comparison. These implicit assumptions about the “causal primacy” of maternal pregnancy effects set the agenda for DOHaD research and, through a looping effect, are reinforced rather than tested. We propose practical strategies to redress this imbalance through maintaining a critical perspective about these assumptions.