When Facebook COO Sheryl Sandberg got pregnant for the first time she was working at Google. ‘My pregnancy was not easy,’ she wrote in her bestselling book Lean In. She had morning sickness for the whole nine months. She didn’t just develop a bump, her whole body was swollen. Her feet went up two sizes ‘turning into odd-shaped lumps I could see only when they were propped up on a coffee table’.
It was 2014, and Google was already a huge company, with a huge car park – one that Sandberg found increasingly difficult to walk across in her swollen state. After months of struggling she finally went to one of Google’s founders, Sergey Brin, and ‘announced that we needed pregnancy parking [at the front of the building], preferably sooner rather than later’. Brin agreed immediately, ‘noting that he had never thought about it before’. Sandberg herself was ‘embarrassed’ she hadn’t realised ‘that pregnant women needed reserved parking until I experienced my own aching feet’.
What Google had suffered from until Sandberg became pregnant was a data gap: neither Google’s male founders nor Sandberg had ever been pregnant before. As soon as one of them did get pregnant, that data gap was filled. And all the women who got pregnant at the company after that would benefit from it.
It shouldn’t have taken a senior woman getting pregnant for Google to fill this data gap: there had been pregnant women working at the company before. Google could – and should – have been proactive in searching that data out. But the reality is that it usually does take a senior woman for problems like this to be fixed. And so, because business leadership is still so dominated by men, modern workplaces are riddled with these kind of gaps, from doors that are too heavy for the average woman to open with ease, to glass stairs and lobby floors that mean anyone below can see up your skirt, to paving that’s exactly the right size to catch your heels. Small, niggling issues that aren’t the end of the world, granted, but that nevertheless irritate.
Then there’s the standard office temperature. The formula to determine standard office temperature was developed in the 1960s around the metabolic resting rate of the average forty-year-old, 70 kg man.1 But a recent study found that ‘the metabolic rate of young adult females performing light office work is significantly lower’ than the standard values for men doing the same type of activity. In fact, the formula may overestimate female metabolic rate by as much as 35%, meaning that current offices are on average five degrees too cold for women. Which leads to the odd sight of female office workers wrapped up in blankets in the New York summer while their male colleagues wander around in summer clothes.2
These data gaps are all inequitable, not to mention being bad business sense – an uncomfortable workforce is an unproductive workforce. But workplace data gaps lead to a lot worse than simple discomfort and consequent inefficiency. Sometimes they lead to chronic illness. Sometimes, they mean women die.
Over the past hundred years workplaces have, on the whole, got considerably safer. In the early 1900s around 4,400 people in the UK died at work every year.3 By 2016, that figure had fallen to 137.4 In the US, around 23,000 people (out of a workforce of 38 million) died at work in 1913.5 In 2016, 5,190 people died out of a workforce of 163 million.6 This significant decrease in fatal accidents has largely been the result of unions pressuring employers and governments to improve safety standards; since the 1974 Health and Safety at Work Act, workplace fatalities in the UK have dropped by 85%. But there is a caveat to this good news story. While serious injuries at work have been decreasing for men, there is evidence that they have been increasing among women.7
The rise in serious injuries among female workers is linked to the gender data gap: with occupational research traditionally having been focused on male-dominated industries, our knowledge of how to prevent injuries in women is patchy to say the least. We know all about heavy lifting in construction – what the weight limits should be, how it can be done safely. But when it comes to heavy lifting in care work, well, that’s just women’s work, and who needs training for that?
Beatrice Boulanger didn’t get any training.8 As a home helper for older people, she ‘learned everything on the job’. But her duties included a lot of lifting, often of overweight people. One day, as she was helping a woman out of the bath, her shoulder gave way. ‘Everything around the joint was crumbling,’ she told occupational health magazine Hazards. ‘The doctors had to cut off the head of my humerus.’ Boulanger eventually needed a full shoulder replacement. And she can no longer do her job.
Boulanger is not a one-off. Women working as carers and cleaners can lift more in a shift than a construction worker or a miner.9 ‘We only got a sink upstairs three years ago,’ a cleaner at a cultural centre in France told the Equal Times.10 ‘Before that, we had to carry buckets of water upstairs, and down again when the water was dirty. Nobody realised.’ And unlike the construction workers and miners, these women often don’t go home to rest, but instead go home to a second unpaid shift where there is more lifting, more lugging, more crouching and scrubbing.
In her 2018 retrospective of a lifetime spent researching women’s occupational health, Karen Messing, a geneticist and professor of biological sciences at Montreal University, writes that ‘there has still been no biomechanics research on the effects of breast size on lifting techniques associated with back pain’11 despite that fact that engineer Angela Tate of Memorial University alerted scientists to male bias in biomechanical studies back in the 1990s. Messing also points to women’s reports of work-related musculoskeletal pain still being treated with scepticism despite accumulating reports that pain systems function differently among women and men.12 Meanwhile, we’ve only just noticed that nearly all pain studies have been done exclusively in male mice.
The gender data gap in occupational health is sometimes attributed to the fact that men are more likely than women to die on the job. But while it is true that the most dramatic accidents are still dominated by male workers this isn’t the full story, because an accident at work is by no means the only way your job can kill you. In fact, it’s not even the most common way your job can kill you – not by a long shot.
Every year, 8,000 people die from work-related cancers.13 And although most research in this area has been done on men,14 it’s far from clear that men are the most affected.15 Over the past fifty years, breast-cancer rates in the industrialised world have risen significantly16 – but a failure to research female bodies, occupations and environments means that the data for exactly what is behind this rise is lacking.17 ‘We know everything about dust disease in miners,’ Rory O’Neill, professor of occupational and environmental policy research at the University of Stirling, tells me. ‘You can’t say the same for exposures, physical or chemical, in ‘women’s’ work.’
This is partly a historical problem. ‘For many long-latency diseases, like cancer,’ explains O’Neill, ‘it can be decades before the pile of bodies gets big enough to reach a conclusion.’ We’ve been counting the bodies in traditional men’s jobs – mining, construction – for several generations. Specifically, we’ve been counting male bodies: when women did work in those industries, or had similar exposures, ‘they were often discounted from studies as “confounding factors”.’ Meanwhile, in most female-dominated industries, the studies simply weren’t done at all. So even if we started the studies now, says O’Neill, it would take a working generation before we had any usable data.
But we aren’t starting the studies now. Instead, we continue to rely on data from studies done on men as if they apply to women. Specifically, Caucasian men aged twenty-five to thirty, who weigh 70 kg. This is ‘Reference Man’ and his superpower is being able to represent humanity as a whole. Of course, he does not.
Men and women have different immune systems and different hormones, which can play a role in how chemicals are absorbed.18 Women tend to be smaller than men and have thinner skin, both of which can lower the level of toxins they can be safely exposed to. This lower tolerance threshold is compounded by women’s higher percentage of body fat, in which some chemicals can accumulate.
The result is that levels of radiation that are safe for Reference Man turn out to be anything but for women.19 Ditto for a whole range of commonly used chemicals.20 And yet the male-default one-level-to-rule-them-all approach persists.21 This is made worse by the way chemicals are tested. To start with, chemicals are still usually tested in isolation, and on the basis of a single exposure. But this is not how women tend to encounter them, either at home (in cleaning products and cosmetics), or in the workplace.
In nail salons, where the workforce is almost exclusively female (and often migrant), workers will be exposed on a daily basis to a huge range of chemicals that are ‘routinely found in the polishes, removers, gels, shellacs, disinfectants and adhesives that are staples of their work’.22 Many of these chemicals have been linked to cancer, miscarriages and lung diseases. Some may alter the body’s normal hormonal functions. After a shift of paid work many of these women will then go home and begin a second unpaid shift, where they will be exposed to different chemicals that are ubiquitous in common cleaning products.23 The effects of these chemicals mixing together are largely unknown,24 although research does indicate that exposure to a mixture of chemicals can be much more toxic than exposure to chemicals on an individual basis.25
Most of the research on chemicals has focused on their absorption through the skin.26 Leaving aside the problem that absorption through thicker male skin may not be the same as for women, skin is by no means the only way women working in nail salons will be absorbing these chemicals. Many of them are extremely volatile, which means that they evaporate into the air at room temperature and can be inhaled – along with the considerable amounts of dust produced when acrylic nails are filed. The research on how this may impact on workers is virtually non-existent.
But the data, although full of gaps, is mounting. Anne Rochon Ford, a women’s health researcher, tells me about how they started to realise there might be a problem in Canada. ‘One of the central Toronto community health centres that is very close to Chinatown was seeing a lot of women coming into their clinic who had a particular cluster of conditions that are traditionally associated with chemical exposure,’ she explains. It turned out they were all nail-salon workers. Several studies of air quality in nail salons have shown that they rarely exceed occupational exposure limits, but these limits are based on data that doesn’t account for the impact of chronic, long-term exposure. And this is particularly an issue when it comes to endocrine disrupting chemicals (EDCs) because, unlike most toxins, they can be harmful even at very low concentrations and they are found in a wide range of plastics, cosmetics and cleaners.27
EDCs mimic – and therefore can disrupt – reproductive hormones, ‘triggering changes in how cells and organs function, with an impact on a diverse array of metabolic, growth, and reproductive processes in the body’.28 The data on EDCs and their impact on women is limited.29 But what we do know is enough to give us pause, and should certainly be enough to trigger a full-scale data-collection programme.
EDCs are known to be linked to breast cancer, and several studies have found that cosmetologists are at a particularly elevated risk of Hodgkin’s disease, multiple myeloma and ovarian cancer.30 When occupational health researchers Jim and Margaret Brophy investigated the chemicals used in automotive plastics workplaces (where plastic parts for motorised vehicles are produced) ‘we could not find any substances that they were using that weren’t suspected’ to be either a mammary carcinogen, and/or an endocrine disruptor. ‘If you’re camping or around a campfire and somebody throws in a plastic bottle or a styrofoam cup people run away,’ Brophy points out. ‘The smell is enough to tell you it’s toxic. Well that’s what these women are doing on a daily basis. They’re working on moulding machines which heat up these plastic pellets which are full of all kinds of EDCs.’
After ten years working in a job where she is exposed either to mammary carcinogens or an EDC, a woman’s risk of developing breast cancer increases by 42%. But the Brophys found that after working for ten years in the auto-plastics industry a woman’s likelihood of developing breast cancer trebles. ‘And if you were under the age of fifty, so premenopausal breast cancer, it was a fivefold excess.’ Even a single year of working in this sector was estimated to increase the odds of developing breast cancer by 9%.31
The World Health Organization, the European Union and the Endocrine Society have all issued major reports on the dangers of EDCs, with the Endocrine Society in particular linking their use to the significant increase in breast-cancer rates in industrialised countries.32 And yet in many countries, regulation of EDCs is spotty at best. Phthalates, some of which have demonstrated endocrine-disrupting properties, are chemicals used to make plastics softer. They are found in ‘a wide range of products – from children’s toys to shower curtains. They are also used in nail polish, perfumes, and skin moisturizers, and can also be found in the outer coating on medicines and in the tubing used in medical devices’.
In Canada, they ‘are explicitly regulated only in soft vinyl articles for children; their use in the Canadian cosmetics industry is largely unregulated’. In the EU, as of 2015 EDCs can’t be produced unless authorised for a specific purpose – but they are allowed in products imported from abroad. In the US, there are no federal laws that require companies to list ingredients in their cleaning products (in the US women do 70% of household cleaning and make up 89% of home and hotel cleaners – most of whom are ethnic minorities), and a recent report found that even supposedly ‘green’ cleaning products contain EDCs.33 When Always menstrual pads were tested in 2014 they were found to include ‘a number of chemicals – including styrene, chloroform and acetone – that have been identified as either carcinogens or reproductive and developmental toxins’.34
It’s clear that we need more and better data about women’s exposure to chemicals. We need data that is separated and analysed by sex, and which includes reproductive status.35 And physical effects need to be measured for women themselves, rather than being restricted to foetuses and newborns, as is all too often currently the case.36 We need researchers to understand that because of their unpaid workload women often drop in and out of the workforce and work more than one job at a time (which can lead to, in Rory O’Neill’s words, ‘a cocktail of exposures’), and that this means that research which tracks only a single, current employment is likely to be sporting a significant gender data gap.37
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 rain’.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.