When Janica Alvarez was trying to raise funds for her tech start-up Naya Health Inc. in 2013, she struggled to get investors to take her seriously. In one meeting, ‘investors Googled the product and ended up on a porn site. They lingered on the page and started cracking jokes’, leaving Alvarez feeling like she was ‘in the middle of a fraternity’.1 Other investors were ‘too grossed out to touch her product or pleaded ignorance’, with one male investor saying ‘I’m not touching that; that’s disgusting.’2 And what was this vile, ‘disgusting’ and incomprehensible product Alvarez was pitching? Reader, it was a breast pump.
The odd thing is, the breast-pump industry is one that is ripe for ‘disruption’, as Silicon Valley would have it. Breast-pumping is huge business in the US in particular: given the lack of legally mandated maternity leave, for most American women breast-pumping is the only option if they want to follow their doctors’ recommendations and breastfeed their babies for at least six months (in fact, the American Academy of Pediatrics recommends that women try to breastfeed for at least twelve months).3
And one company, Medela, has pretty much cornered the market. According to the New Yorker, ‘Eighty per cent of hospitals in the United States and the United Kingdom stock Medela’s pumps, and its sales increased thirty-four per cent in the two years after the passage of the Affordable Care Act, which mandated coverage of lactation services, including pumps.’ But the Medela pump is just not very good. Writing for the New Yorker4 Jessica Winter described it as a ‘hard, ill-fitting breast shield with a bottle dangling from it’, which, as it sucks milk out of a woman’s breast ‘pulls and stretches the breast like it’s taffy, except that taffy doesn’t have nerve endings’.5 And although some women manage to make it work hands-free most can’t because it doesn’t fit well enough. So they just have to sit and hold their personal milking contraptions to their breasts, for twenty minutes a time, several times a day.
So, to sum up: captive market (currently estimated at $700 million with room to grow)?6 Check. Products that aren’t serving consumer needs? Check. Why aren’t investors lapping it up?
Addressing the under-representation of women in positions of power and influence is often framed as a good in itself. And, of course, it is. It is a matter of justice that women have an equal chance of success as their equally qualified male colleagues. But female representation is about more than a specific woman who does or doesn’t get a job, because female representation is also about the gender data gap. As we saw with Sheryl Sandberg’s story about pregnancy parking, there will be certain female needs men won’t think to cater for because they relate to experiences that men simply won’t have. And it’s not always easy to convince someone a need exists if they don’t have that need themselves.
Dr Tania Boler, founder of women’s health tech company Chiaro, thinks that the reluctance to back female-led companies is partly a result of the ‘stereotype that men like great design and great tech and women don’t’. But is this stereotype based in reality, or is it possible that the problem isn’t tech-blind women so much as woman-blind tech, created by a woman-blind tech industry and funded by woman-blind investors?
A substantial chunk of tech start-ups are backed by venture capitalists (VCs) because they can take risks where banks can’t.7 The problem is that 93% of VCs are men,8 and, ‘men back men’, explains Debbie Woskow, co-founder of AllBright, a members’ club, academy, and fund that backs female-led business. ‘We need to have more women writing cheques. And men need to recognise that backing women is a great investment.’ Woskow tells me that when she was in the process of setting up AllBright with her friend Anna Jones, the former CEO of Hearst, ‘men who should know better, to be honest’ would ‘frequently’ tell them, ‘That’s lovely, it’s great that you and Anna have set up a charity.’ Woskow bristles at this. ‘We’re not a charity. We’re doing this because women deliver great economic returns.’
The data suggests she’s not wrong. Research published in 2018 by Boston Consulting Group found that although on average female business owners receive less than half the level of investment their male counterparts get, they produce more than twice the revenue.9 For every dollar of funding, female-owned start-ups generate seventy-eight cents, compared to male-owned start-ups which generate thirty-one cents. They also perform better over time, ‘generating 10% more in cumulative revenue over a five-year period’.
This may be partly because women are ‘better suited for leadership than men’.10 That was the conclusion of a study conducted by BI Norwegian Business School, which identified the five key traits (emotional stability, extraversion, openness to new experiences, agreeableness and conscientiousness) of a successful leader. Women scored higher than men in four out of the five. But it may also be because the women who do manage to make it through are filling a gender data gap: studies have repeatedly found that the more diverse a company’s leadership is, the more innovative they are.11 This could be because women are just innately more innovative – but more likely is that the presence of diverse perspectives makes businesses better informed about their customers. Certainly, innovation is strongly linked to financial performance.
And when it comes to consumer electronics for women, Boler says, innovation has been sorely lacking. ‘There’s never been much innovation in consumer electronics for women,’ she says. ‘It’s always focused on a very superficial aesthetic level: turn something pink, or turn something into a piece of jewellery, rather than taking account of the fact that technology can solve real problems for women.’ The result has been a chronic lack of investment, meaning that ‘the actual technology that’s used in medical devices for women is sort of a kickback from the 1980s’.
When I interview her early in 2018 Tania Boler is about to launch her own breast pump, and she is scathing about what is currently available on the market. ‘It’s just horrible,’ she says, bluntly. ‘It’s painful, it’s loud, it’s difficult to use. It’s quite humiliating.’ I think of trying to hold a conversation with my sister-in-law as she sits on the sofa with her top off, her breasts wired up to a machine. ‘It’s not even that complicated to get it right,’ Boler adds. The notion that ‘it would be nice to pump while you’re able to do something else, rather than having to spend hours a day sitting there chained to this noisy machine’ should, she says be ‘a basic requirement’. But somehow, it hasn’t been. When I ask her why she thinks this is, Boler muses that perhaps it’s different for her because she’s a woman. So ‘I just go in with: “As a woman what do I want from this?”’
But if the data gap of what women actually want is fairly easily fixed by, well, asking women, there’s another more chronic gap: data on the female body itself. Boler developed her first product – Elvie, a smart pelvic-floor trainer – after realising that poor pelvic-floor health in women was ‘a massively hidden epidemic’: 37% of women suffer from pelvic-floor issues; 10% of women will need to have an operation at some point because of prolapse (where your organs start dropping through your vagina). This rises to 50% of women over fifty.
‘There’s a sense of injustice,’ says Boler. ‘It’s a big issue for women and it should be a normal part of how women look after their bodies. But you need to have information and data in order to do that.’ And when Boler was first researching the issue, that data simply didn’t exist. ‘We were trying to design a product which fits in the vagina, and so we needed to answer simple questions like, what size, how does it vary by age, by race, after children – all the usual questions. And there just was no data there at all. [. . .] Fifty per cent of the population have a vagina,’ she continues, ‘and yet there’s hardly any journal articles about this part of anatomy. Three years ago I found about four articles done decades ago.’ One of them was ‘literally by a guy who basically made a kind of plaster cast, like a mould inside the vagina, and concluded that there were four shapes: a mushroom and a cone and a heart . . .’ she trails off laughing.
Problems with pelvic-floor health are often preventable, and the evidence base for pelvic-floor training is ‘very strong’, Boler tells me. ‘It’s the number-one line of defence and it’s recommended under the NICE [National Institute for Health and Case Excellence] guidelines in the UK.’ But when she started looking at the technology in hospitals, ‘there had been no investment. It was so outdated, it was very unreliable and not even very valid.’ The current treatment for prolapse (to insert a mesh into the vagina) is the subject of an ongoing scandal in the UK, as hundreds of women have been left in severe, debilitating pain, by what they describe as ‘barbaric’ treatment.12 In Scotland, a woman just died.
Ida Tin, founder of menstrual-tracking app Clue, encountered the same problem when she started trying to find an alternative to traditional contraception. ‘Menstruation is listed as one of the vital signs of the body,’ she tells me. ‘The same as: do you have a heart rate, are you breathing, what’s your body temperature. It’s a really strong indication of your health.’ And yet ‘it’s also an area where there is so much taboo and misinformation.’ As for family planning, Tin points out that ‘there’s been very little innovation since the pill came out in the 1950s. I mean, in the history of technology that’s a really long time.’
Tin set up Clue because she wanted to ‘enable women to take control of their own body and lives’, but the motivation was also personal. She’d tried the pill, but, like many women, she’d had side effects. ‘And I hadn’t had any children so an IUD wasn’t ideal. So I’d been using condoms for fifteen years.’ In frustration, Tin started looking at patent databases, but ‘everything was about putting hormones into the body’, she tells me. ‘And I felt it was a very non-data-driven approach to this problem. It made me a little bit provoked, like: why is it that nobody has given this some serious effort and consideration? It’s a pretty basic need for humankind.’
When she had the idea for the menstrual-tracking app there were only a couple of period-tracking apps available. ‘And they were very first-generation products – basically a calendar that can count to twenty-eight. And if only our biology were that simple’, she laughs. After a decade of being in the sector, Tin says, the science is still riddled with gaps. ‘There really is a lack of data,’ she tells me. Menstruation has been ‘not just overlooked, but borderline actively ignored. We do a lot of work together with science institutions because there are really a lot of blank areas on the academic map. Like, what’s even considered a normal bleeding pattern for an adolescent woman? That’s one of the things we’ve been working on with Stanford. Science just doesn’t know what’s normal.’
Given the male domination of VCs, data gaps are perhaps particularly problematic when it comes to tech aimed at women. ‘If you don’t have good data,’ explains Tin ‘it’s harder to open people’s minds that something might be an issue if they don’t encounter it themselves.’ Boler agrees. ‘We did talk to some VC investors who didn’t believe [Elvie] was an interesting proposition,’ she tells me.
The other problem women face when it comes to getting investment is ‘pattern recognition’.13 A corollary of ‘culture fit’, pattern recognition sounds data-driven, but it’s basically just a fancy term for looks-similar-to-something-that-has-worked-in-the-past – where ‘something’ could be white-male-founder-who-dropped-out-of-Harvard-and-wears-hoodies. Genuinely: I dated a guy who was working on a start-up and he referenced this uniform when he was talking about getting funding. Hoody-based pattern recognition is real. And this emphasis on recognising a typically male pattern may be exacerbated by the common belief that tech is a field where inborn ‘genius’ (which, as we’ve seen, is stereotypically associated with men14) is more important than working hard (hence fetishising Harvard dropouts).
It all feels rather catch-22ish. In a field where women are at a disadvantage specifically because they are women (and therefore can’t hope to fit a stereotypically male ‘pattern’), data will be particularly crucial for female entrepreneurs. And yet it’s the female entrepreneurs who are less likely to have it, because they are more likely to be trying to make products for women. For whom we lack data.
Still, some do manage tob break through. Tin and Boler got their funding (Boler in part from Woskow). And now these specific data gaps are starting to be filled. Before they launched, Chiaro had over 150 women test their pelvic-floor trainer, Boler tells me. ‘But we now have data on over a million workouts and we have a lot of measurements around pelvic-floor health which just haven’t existed before.’ This, she says, is the ‘exciting thing about wearable tech: giving people better information about their bodies so they can make more informed decisions’.
But while Boler’s and Tin’s products may give women better information about their bodies, the same can’t be said for all new tech, wearable or otherwise. In the tech world, the implicit assumption that men are the default human remains king. When Apple launched its health-monitoring system with much fanfare in 2014, it boasted a ‘comprehensive’ health tracker.15 It could track blood pressure; steps taken; blood alcohol level; even molybdenum (nope, me neither) and copper intake. But as many women pointed out at the time, they forgot one crucial detail: a period tracker.16
This was not to be the only time Apple completely forgot about at least 50% of their users. When Apple launched their AI, Siri, she (ironically) could find prostitutes and Viagra suppliers, but not abortion providers.17 Siri could help you if you’d had a heart attack, but if you told her you’d been raped, she replied ‘I don’t know what you mean by ‘I was raped.’18 These are basic errors that surely would have been caught by a team with enough women on it – that is, by a team without a gender data gap.
Products marketed as gender-neutral that are in fact biased towards men are rife across the (male-dominated) tech industry. From smartwatches that are too big for women’s wrists,19 to map apps that fail to account for women’s desire for ‘safest’ in addition to ‘fastest’ routes; to ‘measure how good you are at sex’ apps called ‘iThrust’20 and ‘iBang’21 (and yes the in-built assumptions of what constitutes good sex are exactly what the names imply), the tech industry is rife with examples of tech that forget about women. Virtual reality (VR) headsets that are too big for the average woman’s head; a ‘haptic jacket’ (a jacket that simulates touch) that fits snugly on a male body, but on a female reviewer’s body ‘could have fit over a puffy winter coat’; augmented-reality glasses whose lenses are too far apart for a woman to focus on the image, ‘or whose frames immediately fall off my face’. Or, as I know from my experience of going on TV and giving public lectures, mic packs that require either a waistband or substantial pockets to attach to. Out goes pretty much every dress ever designed.
Defaulting to male seems particularly endemic in sports tech. Starting with the most basic, the calorie count on treadmills is perfect for practically no one, but it will be more accurate for your average man because its calculations are based on the average male weight (the default setting for calorie count on most exercise machines is for a person who weighs eleven stone). And although you can change the weight setting, that still leaves a calculation based on an average male calorie burn. Women generally have a higher fat and lower muscle distribution than men as well as different ratios of various muscle fibres. What this means at a basic level is that even after accounting for weight difference, men on average will burn 8% more calories than a woman of the same weight. The treadmill does not account for this.
There’s no reason to think that things improved much with the advent of wearables, either. One study of twelve of the most common fitness monitors found that these underestimated steps during housework by up to 74% (that was the Omron, which was within 1% for normal walking or running) and underestimated calories burned during housework by as much as 34%.22 Anecdotally, Fitbits apparently fail to account for movement while doing the extremely common female activity of pushing a pram (yes of course men push prams too, but not as often as the women who do 75% of the world’s unpaid care). Another study, which unusually did manage to include almost 50% female participants, found that fitness devices were overestimating calorie burn by significant amounts.23 Unfortunately, they failed to disaggregate their data so it is impossible to know if there were any sex differences.
Tech developers even forget women when they form the potential majority of customers. In the US, women make up 59% of people over the age of sixty-five and 76% of those living alone, suggesting a potential greater need for assistive technology like fall-detection devices.24 The data we have suggests that not only do older women fall more often than men, they also injure themselves more when they do.25 Data analysis of a month’s worth of emergency department visits in the US found that of the 22,560 patients seen for fall injuries, 71%, were women. The rate of fracture was 2.2 times higher in women, and women had a hospitalisation rate 1.8 times that of men.26
And yet despite women’s arguably greater need (as well as research indicating that women tend to fall differently, for different reasons, and in different places), gender analysis is missing from the development of this technology. In one meta-analysis of fifty-three fall detection device studies, only half of them even described the sex of participants, let alone delivered sex-disaggregated data;27 another study noted that ‘Despite extensive literature on falls among seniors, little is known about gender-specific risk factors.’28
The Proceedings of the 2016 International Conference on Intelligent Data Engineering and Automated Learning points out that ‘a notable motivation for elders to reject fall-detection devices is their size’, suggesting mobile phones as a solution.29 Except this isn’t really a solution for women because as the authors themselves note, women tend to keep their phones in their handbags, ‘where fall-detection algorithms will likely fail because they are trained to detect falls through acceleration sensors close to the body trunk’.
In acknowledging this, the authors are unusual. Whitney Erin Boesel, a researcher at the Berkman Center for Internet and Society at Harvard, is a member of the ‘quantified self’ community, which promises ‘self-knowledge through numbers’. These numbers are often collected via passive tracking apps on your phone, the classic being how many steps you’ve taken that day. But there’s a pocket-sized problem with this promise: ‘Inevitably some dude gets up at a conference and [says] something about how your phone is always on you,’ Boesel told the Atlantic.30 ‘And every time I’ll stand up, and I’ll be like, “Hi, about this phone that is always on you. This is my phone. And these are my pants.”’
Designing passive tracking apps as if women have pockets big enough to hold their phones is a perennial problem with an easy solution: include proper pockets in women’s clothing (she types, furiously, having just had her phone fall out of her pocket and smash on the floor for the hundredth time). In the meantime, however, women use other solutions, and if tech developers don’t realise women are being forced into workarounds, they may fail in their development.
A Cape Town-based tech company fell into this trap when they developed an app to help community health workers monitor HIV-positive patients. The app ‘fulfilled all the usability requirements; it was easy to use, adaptable to local language’ and solved a very specific issue. More than this, the community health workers were ‘excited at the prospect of using it’.31 But when the service was launched, it proved to be a flop. Despite several attempts to solve it, the problem remained a mystery until a new design team took over the project. A team that happened to have a woman in it. And this woman ‘took only a day to discover the problem’. It turned out that in order to more safely complete their daily commute into the townships where their patients lived, female health workers were concealing their valuables in their underwear. And the phone was too big to fit in their bras.
Gender affects the kinds of questions we ask, says Margaret Mitchell, senior research scientist at Google. Limiting AI developers to one gender, she told Bloomberg News, puts companies ‘in a position of myopia’.32 Gayna Williams, ex-director of user experience at Microsoft, agrees.33 In a blogpost titled ‘Are you sure your software is gender-neutral?’ Williams explains that all product design begins by deciding which problem needs solving. And that is all a matter of perception: what problem were NASA scientists solving when they decided to give Valerie, their space-navigation robot, breasts?34
On the topic of sexy robots, even if men do identify a problem that affects us all, that doesn’t mean that without female input they will come up with the right solution. When, in ‘retaliation’ for women denying him the sex to which he believed he was entitled, Alek Minassian mowed down and killed ten people in Toronto with a rented van, the New York Times published a column headlined ‘The Redistribution of Sex’, which argued that sex robots could be the answer to the plight of men who can’t convince women to sleep with them. Feminists might argue that the solution is, instead, to challenge male sexual entitlement.
When it comes to the tech that ends up in our pockets (I’m ever hopeful), it all comes down to who is making the decisions. And like the world of venture capitalists, the tech industry is dominated by men. Margaret Mitchell calls this the ‘sea of dudes’ problem.35 Over the past five years she’s worked with around ten women and ‘hundreds’ of men. Across ‘professional computing’ as a whole in the US, 26% of jobs are held by women compared to the 57% of jobs women hold across the entire US workforce.36 In the UK, women make up 14% of the STEM workforce.37
As well as a rash of sexy robots, the sea of dudes leads to products like the ‘enormous robot research prototype called PR2’ that computer scientist and co-founder of a robotics company Tessa Lau encountered when she worked for robotics research lab Willow Garage. It weighed ‘hundreds of pounds – it’s much larger than a smaller woman – and it has two big arms. It looks really scary. I didn’t even want one of those things near me if it wasn’t being controlled properly.’ When I interviewed her a couple of years ago, roboticist Angelica Lim told me a similar story about the robot she encountered at a conference in Slovenia, which would come and shake your hand if you waved at it. When she waved at this 5’8’ robot on wheels (the average American woman is 5’4’) the robot slowly turned towards her, put out its hand, and then came ‘barrelling towards me, fast’, making her jump backwards and shriek.
Contrast these examples to the virtual-reality headset trialled by tech journalist Adi Robertson.38 The headset was meant to track her eyes, but it didn’t work for her – until an employee asked if she was wearing mascara. ‘When it got recalibrated perfectly a few minutes later, I was surprised – not by the fact that it worked, but by the fact that anyone had thought to troubleshoot make-up. Incidentally,’ she writes, ‘this was one of the only VR start-ups I’ve ever covered with a female founder.’
Most VR companies aren’t founded by women, however, and so the VR experience often comes with an in-built male bias. Like much of the online world, VR gaming seems to have a sexual harassment problem – and this problem is something VR’s mainly male developers are routinely forgetting to account for.39
When author and gamer Jordan Belamire tried the VR game QuiVr in multiplayer mode, she was sexually assaulted by another user called BigBro4 42.40 ‘Virtual’ makes it sound like it isn’t real – but it felt real to Belamire. And no wonder. VR is meant to feel real, and it can be so successful at tricking your brain that it is being explored as a treatment for PTSD, phobias, even phantom-limb syndrome.41
To be fair to the male designers of QuiVr, they had an excellent and proactive response to Belamire’s blog.42 They immediately redesigned their ‘Personal Bubble’ setting (in which other player’s hands disappear if they come close to your face) to cover the entire body and so make such groping impossible. But as they themselves noted, while they had thought ‘of the possibility of some silly person trying to block your view with their hands and ruining the game’, they hadn’t thought of extending the fading function to the rest of the body. How, they asked, ‘could we have overlooked something so obvious?’
Fairly simply, to be honest. Henry Jackson and Jonathan Schenker are clearly well-meaning men who don’t intend to shut women out. But it’s Sergey Brin and the pregnancy parking all over again: even the best of men can’t know what it’s like to go through the world as a person with a body which some other people treat as an access-all-areas amusement arcade. This just isn’t something that Jackson and Schenker have to face on a regular basis, and therefore it really isn’t all that surprising that they missed ‘something so obvious’.
Male violence is far from the only issue keeping women out of VR. From the oversized headsets, to research showing that VR causes motion sickness in women to a far larger degree than it does in men,43 to the fact that narrow computer displays favour men in tasks that require spatial awareness,44 you’re left with another platform that just doesn’t work well for women – and that is therefore likely to have fewer women on it.
We don’t know exactly why women are more likely to experience motion sickness while using VR, but Microsoft researcher danah boyd conducted a study that suggests a possible explanation.45 Human eyes use two basic cues to determine depth: ‘motion parallax’ and ‘shape-from-shading’. Motion parallax refers to how an object seems bigger or smaller depending on how close you are to it, while shape-from-shading refers to the way the shading of a point changes as you move. And while 3D VR is pretty good at rendering motion parallax, it still does ‘a terrible job’ of emulating shape-from-shading.
This discrepancy creates sex differences in how well VR works, because, as boyd discovered, men are ‘significantly more likely’ to rely on motion parallax for depth perception, while women rely on shape-from-shading. 3D environments are literally sending out information signals that benefit male over female depth perception. The question is: would we be so behind on recreating shape-from-shading if we had been testing 3D VR on equal numbers of men and women from the start?
Tom Stoffregen, professor of kinesiology at the University of Minnesota, has an entirely different theory for why women experience more motion sickness than men. The classic theories, he says, are ‘focused almost entirely on sensory stimulation’. The idea is that what you feel in your inner ear doesn’t match up with what you see with your eyes. And ‘that’s true,’ says Stoffregen, ‘but it’s not the only thing that changes. The big thing that traditional theories have not talked about,’ he says, ‘is changes in what you need to do to control your body.’
In the normal course of your day, your body is constantly making micro-adjustments in order to keep you stable. When you stand, when you sit, when you walk. But when you’re in a moving environment – say a car, or a ship – what you have to do to remain stable changes because your body is being destabilised. So, says Stoffregen, ‘You are being physically required to move in a different way and you haven’t learnt how to do it yet.’ And like cars and ships, he says, VR destabilises the body. Hence the motion sickness.
The VR industry has so far shown little interest in Stoffregen’s research. ‘They understand that it’s a serious problem,’ but they’re going the wrong way about fixing it, he says. ‘The people who design VR think it’s just an object that you put in front of your eyes, and the idea that it would have anything to do with anything other than your eyes is incoherent to them.’ But, he says, VR developers have to understand that they’re doing more than ‘simply placing screens in front of people’s eyes. Whether they like it or and whether they know it or not.’
VR developers also have to start collecting data systematically – and separating it by sex. ‘Most of the data on motion sickness in VR are anecdotal,’ explains Stoffregen, ‘and they come from the people who are working in these companies just using the systems themselves or trying them out at computer technology conferences or whatever. So they’re completely unsystematic – and most of these people are men.’
One of the most convincing aspects of Stoffregen’s theory is how it finally explains why I get car sick in every seat other than the driving seat: it’s all about control. When you’re walking, you are in control of your movements. You know what’s coming. On a ship, or in a car, someone else is in control – unless you’re the driver. ‘The driver knows what the motion of the car is going to be and so the driver is able to stabilise his or herself in what we call an anticipatory fashion,’ explains Stoffregen, ‘whereas the passenger cannot know in quantitative detail what the car is going to be doing. And so their control of their own body must be compensatory. And anticipatory control is just better than compensatory control. You know, that ain’t no rocket science.’
But where does the sex difference come in? ‘Everybody who studies motion sickness has known that women are more susceptible than men basically forever,’ says Stoffregen. ‘It’s just an utterly uncontroversial fact. It’s just there. But, and he includes himself in this group, ‘very few people did any research on it or made any effort to try and figure that out.’ Plus ça change.
But in 2010, Stoffregen made a discovery. ‘I was sort of fooling around in the literature and I came across some results that I didn’t know about,’ and which showed that there are sex differences in body sway. ‘These are small subtle differences. You can’t just watch somebody and see them, but in terms of the subtle quantitative details of how the body moves back and forth, there are in fact reliable sex differences. And as soon as I saw this, I mean, I’m talking the minute that I saw this I knew that oh, OK, now I have something to say about the sex difference in motion sickness. Because my whole story about motion sickness is that it’s related to the control of the body.’ Since then, Stoffregen has also discovered evidence that ‘women’s postural sway changes across the menstrual cycle’. And this is significant because ‘a woman’s susceptibility to motion sickness changes across the menstrual cycle. And those two things link up, believe it or not.’
A considerable gender data gap remains. We don’t yet know exactly how and when women’s body-sway changes. But as a woman who suffers from extreme car sickness, I am excited and enraged by Stoffregen’s findings, particularly because of how it ties into another gender data gap I’ve been looking into: car design.
When you’re sitting down, you’re still swaying. ‘If you’re sitting on a stool then you’re swaying around your hips,’ explains Stofcegen. ‘If your chair has a back, then your head is swaying on your neck. The only way to really get rid of that is to have a headrest and to use it,’ he adds. And I feel like one of those cartoon light bulbs has just gone off in my head. What if the headrest is at the wrong height, at the wrong angle, and the wrong shape to accommodate your body? Could women’s increased propensity to motion sickness in cars be exacerbated by cars being designed around the male body, I ask. ‘I think that’s quite possible, sure,’ Stoffregen replies. ‘The quality of the stabilisation, if it’s the wrong height or whatever . . . what you’re telling me is new to me, but it sounds perfectly plausible.’
But here I run into yet another data gap: the available research on whether car headrests have been designed to account for the female body is seemingly non-existent. This gap is hardly unexpected though: car design has a long and ignominious history of ignoring women.
Men are more likely than women to be involved in a car crash, which means they dominate the numbers of those seriously injured in car accidents. But when a woman is involved in a car crash, she is 47% more likely to be seriously injured than a man, and 71% more likely to be moderately injured,46 even when researchers control for factors such as height, weight, seat-belt usage, and crash intensity.47 She is also 17% more likely to die.48 And it’s all to do with how the car is designed – and for whom.
Women tend to sit further forward than men when driving. This is because we are on average shorter. Our legs need to be closer to reach the pedals, and we need to sit more upright to see clearly over the dashboard.49 This is not, however, the ‘standard seating position’. Women are ‘out of position’ drivers.50 And our wilful deviation from the norm means that we are at greater risk of internal injury on frontal collisions.51 The angle of our knees and hips as our shorter legs reach for the pedals also makes our legs more vulnerable.52 Essentially, we’re doing it all wrong.
Women are also at higher risk in rear-end collisions. Women have less muscle on our necks and upper torso than men, which make us more vulnerable to whiplash (by up to three times53), and car design has amplified this vulnerability. Swedish research has shown that modern seats are too firm to protect women against whiplash injuries: the seats throw women forward faster than men because the back of the seat doesn’t give way for women’s on average lighter bodies.54 The reason this has been allowed to happen is very simple: cars have been designed using car-crash test dummies based on the ‘average’ male.
Crash-test dummies were first introduced in the 1950s, and for decades they were based around the fiftieth percentile male. The most commonly used dummy is 1.77 cm tall and weighs 76 kg (significantly taller and heavier than an average woman), and the dummy also has male muscle-mass proportions and a male spinal column. In the early 1980s, researchers argued for the inclusion of a fiftieth percentile female in regulatory tests, but this advice was ignored.55 It wasn’t until 2011 that the US started using a female crash-test dummy,56 although, as we’ll see, just how ‘female’ these dummies are is questionable.
In 2018, Astrid Linder, research director of traffic safety at the Swedish National Road and Transport Research Institute, presented a paper at the Road Safety on Five Continents Conference in South Korea in which she ran through EU regulatory crash-test requirements.57 In the EU, there are five tests a car must pass before being allowed on the market: one safety-belt test, two frontal-collision tests, and two lateral-collision tests. In no test is an anthropometrically correct female crash-test dummy required. The seat-belt test, one of the frontal-collision tests, and both lateral-collision tests all specify that a fiftieth-percentile male dummy should be used. When Linder looked at regulatory tests worldwide, she found that while there are ‘several local differences’, regulatory tests are still using the fiftieth-percentile male ‘to represent the whole adult population’.
There is one EU regulatory test that requires what is called a fifth-percentile female dummy, which is meant to represent the female population. Only 5% of women will be shorter than this dummy. But there are a number of data gaps. For a start, this dummy is only tested in the passenger seat, so we have no data at all for how a female driver would be affected – something of an issue you would think, given women’s ‘out of position’ driving position. And secondly, this female dummy is not really female. It is just a scaled-down male dummy.
Consumer tests can be slightly more stringent. When I spoke to the EuroNCAP (a European organisation that provides car safety ratings for consumers) they informed me that since 2015 they have used male and female dummies in both front-crash tests and that they do base their female dummies on female anthropometric data – with the caveat that this is ‘where data is available’. And that, says Linder, is quite the caveat: ‘To my knowledge, little or even no such data is available,’ she tells me, adding that there is ‘currently no way EuroNCAP can identify the protective systems that protect both males and females the best way.’ In any case, EuroNCAP acknowledged that ‘sometimes’ they do just use scaled-down male dummies. But, as we’ll cover extensively in the next chapter, women are not scaled-down men. We have different muscle-mass distribution. We have lower bone density. There are sex differences in vertebrae spacing. As Stoffregen has noted, even our body sway is different. And these differences are all crucial when it comes to injury rates in car crashes.
The situation is even worse for pregnant women. Although a pregnant crash-test dummy was created back in 1996, testing with it is still not government-mandated either in the US or in the EU.58 In fact, even though car crashes are the number-one cause of foetal death related to maternal trauma,59 we haven’t even yet developed a seat belt that works for pregnant women. Research from 2004 suggests that pregnant women should use the standard seat belt,60 but 62% of third-trimester pregnant women don’t fit the standard seat-belt design.61 A three-point seat belt can also ride up on women who carry low, which a 1996 study found can treble or quadruple force transmission to the abdomen compared to when the belt is worn below the uterus, ‘with a corresponding increased risk of fetal injury’.62 Standard seat belts aren’t great for nonpregnant women either: apparently, in an effort to accommodate our breasts many of us are wearing seat belts ‘improperly’ which again, increases our risk of injury (another reason we should be designing explicitly female dummies rather than just smaller male dummies).63 And it’s not just a woman’s belly that changes in pregnancy: breast-size changes can also diminish seat-belt efficacy by affecting positioning. Here again, we find an example of a situation where we have the data on women, but are just ignoring it. Clearly what is needed is a wholesale redesign of cars using complete data, and this should be fairly simple since it’s not exactly hard to find women to model a test dummy on.
Even with all these gaps, the 2011 introduction of the female crash-test dummy in the US still sent cars’ star ratings plummeting. The Washington Post reported on the experience of Beth Milito and her husband, who bought a 2011 Toyota Sienna, based primarily on its four-star safety rating.64 But all was not as it seemed. The passenger seat, which Milito says she is likely to be sitting in when they are ‘out and about as a family’, had a two-star rating. In the previous year’s model, the front passenger seat (tested on a male dummy) had earned a top five-star rating. But the shift to female dummies revealed that in a front collision at 35 mph a female passenger had a 20-40% risk of being killed or seriously injured. The average risk of death for that class of vehicle, explains the Washington Post, is 15%.
A 2015 report by the Insurance Institute for Highway Safety is excitingly headlined ‘Improved vehicle designs bring down death rates’ – which sounds great. Perhaps this is the result of the new legislation? Unlikely. Buried in the report is the following telltale line: ‘The rates include only driver deaths because the presence of passengers is unknown.’ This is a huge gender data gap. When men and women are in a car together, the man is most likely to be driving.65 So not collecting data on passengers more or less translates as not collecting data on women.
The infuriating irony of all this is that the gendered passenger/driver norm is so prevalent that, as we’ve seen, the passenger seat is the only seat that is commonly tested with a female crash-test dummy anyway, with the male crash-test dummy still being the standard dummy for the driver’s seat. So stats that include only driver fatalities tell us precisely zero about the impact of introducing the female crash-test dummy. In conclusion, a more accurate headline for the report would be ‘Improved vehicle design brings down death rates in the seat most likely to be occupied by men, but who knows about death rates in the seat most likely to be occupied by women even though we already know women are 17% more likely to die in a car crash.’ Admittedly, this is less snappy.
When I speak to Dr David Lawrence, director of safety-literature database the SafetyLit Foundation, he tells me that ‘in most US states the quality of police crash reports is at best poor for use as a research tool’. Little data is gathered about anyone other than the driver. Written police reports have often been handed to ‘contract companies for data entry’, most of whom use prison labour for data entry. ‘Data-quality checks were rare and when quality was evaluated it was found wanting. For example, in Louisiana for most crashes in the 1980s most of the occupants were males who were born on January 1st, 1950. Almost all of the vehicles involved in crashes were the 1960 model year.’ Except they weren’t. These were just the default settings.
Lawrence tells me that even though this problem has been found in ‘many other states’, the data hasn’t improved ‘because no changes in the data-entry practices were made. The federal government required that states provide police crash-report data to NHTSA (The National Highway Traffic Safety Administration) but set no standards for data quality nor penalty for sending junk data.’
Astrid Linder has been working on what she says will be the first crash-test dummy to accurately represent female bodies. Currently, it’s just a prototype, but she is calling on the EU to make testing on anthropometrically correct female crash-test dummies a legal requirement. In fact, Linder argues that this technically already is a legal requirement. Article 8 of the legally binding Treaty of the Functioning of the European Union reads, ‘In all its activities, the Union shall aim to eliminate inequalities, and to promote equality, between men and women.’66 Clearly, women being 47% more likely to be seriously injured in a car crash is one hell of an inequality to be overlooking.
In some ways it’s hard to understand why a proper female crash-test dummy hasn’t been developed and made a legal requirement in car tests years ago. But on the other hand, and given all we know about how women and their bodies are routinely ignored in design and planning, it’s not surprising at all. From development initiatives to smartphones, from medical tech to stoves, tools (whether physical or financial) are developed without reference to women’s needs, and, as a result these tools are failing them on a grand scale. And this failure affects women’s lives on a similarly grand scale: it makes them poorer, it makes them sicker, and, when it comes to cars, it is killing them. Designers may believe they are making products for everyone, but in reality they are mainly making them for men. It’s time to start designing women in.