There is no doubt that women are dying as a result of the gender data gap in occupational health research. And there is no doubt that we urgently need to start systematically collecting data on female bodies in the workplace. But there is a second strand to this story because, as the stickiness of the myth of meritocracy shows, closing the gender data gap is only step one. The next, and crucial step, is for governments and organisations to actually use that data to shape policy around it. This isn’t happening.
In Canada, even where sex-disaggregated data on chemical exposure exists, the government ‘continues to apply a mean allperson daily intake for many substances’.38 In the UK, where around 2,000 women develop shiftwork-related breast cancer every year, ‘breast cancer caused by shiftwork isn’t on the state-prescribed disease list’.39 Neither is asbestos related to ovarian cancer, even though it has the International Agency Research on Cancer’s top cancer risk ranking and is the most common gynaecological cancer in UK women. In fact, asbestos-related ovarian cancer cases aren’t even tracked and counted by the UK’s Health and Safety Executive.
Part of the failure to see the risks in traditionally female-dominated industries is because often these jobs are an extension of what women do in the home (although at a larger and therefore more onerous scale). But the data gap when it comes to women in the workplace doesn’t only arise in female-dominated industries. As we’ve seen, even when women worked in male-dominated industries, they were treated as ‘confounding factors’, and data on female workers went uncollected.
The result is that even in industries with a good historical health and safety record women are still being failed. In the US, where by 2007 there were nearly 1 million female farm operators, ‘virtually all tools and equipment on the US market have been designed either for men or for some “average” user whose size, weight, strength etc. were heavily influenced by the average man’.40 This has led to tools that are too heavy or long; hand tools that are not appropriately balanced; handles and grips that are not appropriately sized or placed (women’s hands are on average 0.8 inches shorter than men’s); and mechanised equipment that is too heavy or that is difficult to control (for example pedals on tractors being placed too far from the seat).
Little data exists on injuries to women in construction, but the New York Committee for Occupational Safety & Health (NYCOSH) points to a US study of union carpenters which found that women had higher rates of sprains/strains and nerve conditions of the wrist and forearm than men. Given the lack of data it’s hard to be sure exactly why this is, but it’s a safe bet to put at least some if not all of the higher injury rates amongst women down to ‘standard’ construction site equipment being designed around the male body.
Wendy Davis, ex-director of the Women’s Design Service in the UK, questions the standard size of a bag of cement. It’s a comfortable weight for a man to lift – but it doesn’t actually have to be that size, she points out. ‘If they were a bit smaller then women could lift them.’ Davis also takes issue with the standard brick size. ‘I’ve got photographs of my [adult] daughter holding a brick. She can’t get her hand round it. But [her husband] Danny’s hand fits perfectly comfortably. Why does a brick have to be that size? It doesn’t have to be that size.’ She also notes that the typical A1 architect’s portfolio fits nicely under most men’s arms while most women’s arms don’t reach round it – and again has photos of her daughter and her husband to prove it. NYCOSH similarly notes that ‘standard hand tools like wrenches tend to be too large for women’s hands to grip tightly’.41
Women in the military are also affected by equipment designed around the male body. In the course of my research I came across the impressively named tactile situation awareness system (TSAS): a vest designed for airforce pilots and fitted with thirty-two sensors that vibrate if the pilot needs to correct her position; pilots can sometimes lose track of where they are in space and cannot tell if they are heading up or down. I say her, because a review of ‘Tactile Sensitivity and Human Tactile Interfaces’ explained that ‘The TSAS allows the pilot to always know his orientation with respect to the ground’.42 The pronoun choice seems relevant given that the review later casually mentions that ‘[v]ibration is detected best on hairy, bony skin and is more difficult to detect on soft, fleshy areas of the body.’ Women make up 20% of the US airforce and given women have breasts and don’t tend to have particularly hairy chests, this sounds like it might be something of a problem for them.43
Failing to account for female bodies in the military doesn’t just result in equipment that doesn’t work for women: it can injure them too. Women in the British Army have been found to be up to seven times more likely than men to suffer from musculoskeletal injuries, even if they have ‘the same aerobic fitness and strength’. They are ten times more likely than men to suffer from hip and pelvic stress fractures.44
The higher rate of female pelvic stress fractures has been related to what I have christened the ‘Henry Higgins effect’. In the 1956 musical My Fair Lady, phoneticist Henry Higgins is baffled when, after enduring months of his hectoring put-downs, his protegee-cum-victim Eliza Doolittle finally bites back. ‘Why can’t a woman be more like a man?’ he grumbles. It’s a common complaint – and one for which the common solution is to fix the women. This is unsurprising in a world where what is male is seen as universal and what is female is seen as ‘atypical’.
And the leadership of the British armed forces have historically been a right bunch of Henry Higginses. Until 2013, when three RAF recruits (one of whom had been medically discharged after suffering four pelvic fractures45), challenged the practice in court, women in the British armed forces were forced to match male stride length (the average man’s stride is 9-10% longer than the average woman’s).46 Since the Australian Army reduced the required stride length for women from thirty inches to twenty-eight inches, pelvic stress fractures in women have fallen in number. And as an added bonus, not forcing women to march in time with men has not, as yet, led to the apocalypse.
The heavy loads soldiers are required to carry may be aggravating the situation, as women’s stride length decreases as loads increase, while men’s stride length doesn’t show ‘significant change’.47 This may go some way towards explaining US research which found that a women’s risk of injury increases fivefold if she is carrying more than 25% of her body weight.48 If packs were created for women’s bodies, heavy loads might not be such a problem, but they haven’t been. Women are more likely to find that rucksacks (which ‘have been designed primarily based on the anthropometry of men’) are unstable, that pistol belts fit poorly, and that pack straps are uncomfortable.49 Studies suggest that a ‘well-padded hip belt allows a better transfer of the load to the hips’ so women can use their stronger leg muscles to carry the load50 – while men’s upper body strength is on average 50% higher than women’s, the average gap in lower body strength is about half that. Instead, women compensate for packs built around typically male upper body strength by hyperextending their necks and bringing their shoulders farther forward, leading to injury – and a shorter stride length.
It’s not just packs that aren’t created to accommodate women’s bodies. It wasn’t until 2011, thirty-five years after women were first admitted to US military academies, that the first uniforms were designed that accounted for women’s hips and breasts.51 The uniforms also included repositioned knee pads to account for women’s generally shorter legs, and, perhaps most exciting of all for a general audience, a redesigned crotch: these uniforms reportedly abandoned the ‘universal’ zippered fly, instead being designed in such a way that women can pee without pulling down their trousers. But even though the existence of female bodies has finally been recognised by the US military, gaps remain: boots designed to accommodate women’s typically narrower feet and higher arches were not included in the uniform changes. According to the Washington Times, the US Army buys ‘different boot styles for hot and cold weather, mountain and desert warfare and the ra
in’.52 Just not for the atypical sex.
The peeing issue is a recurring one for women who have to spend any length of time outdoors. In the UK all coastguards are issued with a set of one-piece overalls which they are meant to put on underneath various other pieces of personal protective equipment (PPE) such as foul-weather clothing, life jackets and climbing harnesses. The double zip at the front of the overalls is great if you are a man, but, explained one woman in a 2017 Trades Union Congress (TUC) report, peeing becomes a ‘major operation’ for women as all the PPE must be stripped off, followed by the overalls themselves.53 ‘As the type of incidents which we are called to regularly involve long searches which can last for many hours,’ she explains, ‘you can imagine the discomfort which female coastguards end up having to experience as a result. It has been suggested to management that the current overalls should be replaced with a two-piece garment which would allow the trousers to be pulled down without having to remove the top section, and while management have acknowledged the advantage of this idea nothing has so far been done to implement it.’
A female scientist studying climate change in Alaska was also plagued by overalls designed for the male body.54 The extreme cold means that overalls are the most sensible thing to wear – but, again, these come with a zip. Where there are indoor toilets, this would be inconvenient and require additional time spent taking off clothes from jacket downwards just for a pee. But when there is no indoor toilet, the problem is much more serious as frostbite becomes a concern. The woman in question bought a rubber funnelled approximation of a penis to deal with the problem – and ended up peeing all over herself. Why can’t a woman be more like a man?
In the UK, employers are legally required to provide well-maintained PPE to workers free of charge. But most PPE is based on the sizes and characteristics of male populations from Europe and the US. The TUC found that employers often think that when it comes to female workers all they need to do to comply with this legal requirement is to buy smaller sizes.55 A 2009 survey by the Women’s Engineering Society found 74% of PPE was designed for men.56 A 2016 Prospect Union survey of women working in sectors ranging from the emergency services, to construction, via the energy industry, found that just 29% wore PPE designed for women,57 while a 2016 TUC report found that ‘less than 10% of women working in the energy sector and just 17% in construction currently wear PPE designed for women’.58 One rail-industry worker summed it up: ‘Size small is a) a rarity, b) men’s small only.’
This ‘unisex approach’ to PPE can lead to ‘significant problems’, cautions the TUC. Differences in chests, hips and thighs can affect the way the straps fit on safety harnesses. The use of a ‘standard’ US male face shape for dust, hazard and eye masks means they don’t fit most women (as well as a lot of black and minority ethnic men). Safety boots can also be a problem. One female police officer told the TUC about trying to get boots designed for female crime scene investigators. ‘The PPE boots supplied are the same as those for males,’ she explains, ‘and the females find them uncomfortable, too heavy, and causing pressure on the Achilles tendons. Our uniform stores refused to address the matter.’
This isn’t just about comfort. Ill-fitting PPE hampers women’s work – and can, ironically, sometimes itself be a safety hazard. NYCOSH points out that loose clothing and gloves can get caught in machinery, while overly large boots can cause tripping.59 Of those surveyed for the 2016 Prospect survey, 57% reported that their PPE ‘sometimes or significantly hampered their work’;60 over 60% said the same in the Women’s Engineering Society survey. One rail-industry worker explained that the ‘regular’ size thirteen gloves she was issued were ‘dangerous for climbing on/off locos’ and she had complained to her manager. She doesn’t reveal how long it took for management to order her gloves that fit, but another woman who had been issued with the standard size thirteens told Prospect that it took her two years to convince her manager to order gloves in her size.
A 2017 TUC report found that the problem with ill-fitting PPE was worst in the emergency services, where only 5% of women said that their PPE never hampered their work, with body armour, stab vests, hi-vis vest and jackets all highlighted as unsuitable.61 This problem seems to be a global one: in 2018 a female police officer in Spain faced disciplinary action for wearing the women’s bulletproof jacket she had bought for herself (at a cost of€500), because the standard-issue men’s jacket did not fit her.62 Pilar Villacorta, women’s secretary for the United Association of Civil Guards explained to the Guardian that the overly large jackets leave female police officers doubly unprotected: they don’t cover them properly and they ‘make it hard for female officers to reach their guns, handcuffs and telescopic batons’.63
When it comes to front-line workers, poorly fitting PPE can prove fatal. In 1997 a British female police officer was stabbed and killed while using a hydraulic ram to enter a flat. She had removed her body armour because it was too difficult to use the ram while wearing it. Two years later a female police officer revealed that she had to have breast-reduction surgery because of the health effects of wearing her body armour. After this case was reported another 700 officers in the same force came forward to complain about the standard-issue protective vest.64 But although the complaints have been coming regularly over the past twenty years, little seems to have been done. British female police officers report being bruised by their kit belts; a number have had to have physiotherapy as a result of the way stab vests sit on their female body; many complain there is no space for their breasts. This is not only uncomfortable, it also results in stab vests coming up too short, leaving women unprotected. Which rather negates the whole point of wearing one.
CHAPTER 6
Being Worth Less Than a Shoe
It was in 2008 that the big bisphenol A (BPA) scare got serious. Since the 1950s, this synthetic chemical had been used in the production of clear, durable plastics, and it was to be found in millions of consumer items from baby bottles to food cans to main water pipes.1 By 2008, 2.7 million tons of BPA was being produced globally every year, and it was so ubiquitous that it had been detected in the urine of 93% of Americans over the age of six.2 And then a US federal health agency came out and said that this compound that we were all interacting with on a daily basis may cause cancer, chromosomal abnormalities, brain and behavioural abnormalities and metabolic disorders. Crucially, it could cause all these medical problems at levels below the regulatory standard for exposure. Naturally, all hell broke loose.
The story of BPA is in some ways a cautionary tale about what happens when we ignore female medical health data. We have known that BPA can mimic the female hormone oestrogen since the mid-1930s. And since at least the 1970s we have known that synthetic oestrogen can be carcinogenic in women: in 1971 diethylstilbestrol (DES) – another synthetic oestrogen which had been prescribed to millions of pregnant women for thirty years – was banned following reports of rare vaginal cancers in young women exposed to DES while in their mothers’ wombs.3 But BPA carried on being used in hundreds of thousands of tons of consumer plastics: by the late 1980s, production of BPA in the United States ‘soared to close to a billion pounds per year as polycarbonates found new markets in compact discs, digital versatile discs (DVDs), water and baby bottles, and laboratory and hospital equipment’.4
But the story of BPA is not just about gender: it’s also about class. Or at least it’s about gendered class. Fearing a major consumer boycott, most baby-bottle manufacturers voluntarily removed BPA from their products, and while the official US line on BPA is that it is not toxic, the EU and Canada are on their way to banning its use altogether. But the legislation that we have exclusively concerns consumers: no regulatory standard has ever been set for workplace exposure.5 ‘It was ironic to me,’ says occupational health researcher Jim Brophy, ‘that all this talk about the danger for pregnant women and women who had just given birth never extended to the women who were producing these bottles. Those women whose exposures far exceeded an
ything that you would have in the general environment. There was no talk about the pregnant worker who is on the machine that’s producing this thing.’
This is a mistake, says Brophy. Worker health should be a public health priority if only because ‘workers are acting as a canary for society as a whole’. If women’s breast-cancer rates in the plastics industry were documented and recognised, ‘if we cared enough to look at what’s going on in the health of workers that use these substances every day’, it would have a ‘tremendous effect on these substances being allowed to enter into the mainstream commerce’. It would have a ‘tremendous effect on public health’.
But we don’t care enough. In Canada, where women’s health researcher Anne Rochon Ford is based, five women’s health research centres that had been operating since the 1990s, including Ford’s own, had their funding cut in 2013. It’s a similar story in the UK, where ‘public research budgets have been decimated’, says Rory O’Neill. And so the ‘far better resourced’ chemicals industry and its offshoots have successfully resisted regulation for years. They have fought government bans and restrictions. They have claimed that certain chemicals have been removed voluntarily when random testing has shown that they are still present. They have dismissed studies and other evidence of the negative health impacts of their products.6 between 1997 and 2005, 115 studies were conducted on BPA in labs all over the world; 90% of those funded by government found the BPA had effects at exposures at or below the reference dose. Of the eleven studies funded by industry, none reported any effects.7
The result is that workplaces remain unsafe. Brophy tells me that the ventilation he found in most auto-plastics factories was limited to ‘fans in the ceiling. So the fumes literally pass the breathing zone and head to the roof and in the summertime when it’s really hot in there and the fumes become visible, they will open the doors.’ It’s the same story in Canadian nail salons, says Rochon Ford. ‘It’s a Wild West here. Anyone can open a nail salon. It’s only recently that you even needed a licence.’ But even this is ‘pretty lax’. There are no ventilation requirements, there are no training requirements. There is no legislation around wearing gloves and masks. And there is nobody following up on the requirements that do exist – unless someone makes a complaint.
Invisible Women: Exposing Data Bias in a World Designed for Men Page 13