Grace is a second year medical student at King’s with a passion for medical humanities, closing the gender data gap, and perfecting the chocolate chip cookie. When not out walking she can usually be found in front of a sewing machine, behind a computer, or inside a book.
[Featured Image: shows five doctors in Personal Protective Equipment standing side by side. Source]
Why PPE isn’t designed for female bodies and the negative impact this has on women’s health and safety at work.
For millennia, medicine, industry, and indeed most of society, has functioned on the theory that men and male bodies are the norm, and that they can and do represent humanity as a whole. Female anatomy and physiology is in turn thought of as abnormal, and as such difficult or unnecessary to study. The result of this is a gender data gap and a world where personal protective equipment (PPE) is, like most things, designed around an average male body, leaving women ill-protected and at greater risk of injury than their male counterparts.
For thousands of years, women and the female body have been viewed as men….but smaller, men…..but lesser, or men…..but gentler. Aristotle believed (as explained by feminist philosopher Cynthia Freeland) that “a female is an incomplete male or ‘as it were, a deformity’” – a woman, according to Aristotle, was just a man who had not generated enough vital heat in the process of conception. Galen too theorised that men and women were complimentary, differing in that the man’s genitalia were on the outside and the woman’s on the inside. Indeed, it was not until the 17th century that ovaries were given their own name rather than ‘female testicles’.
The result of this is that – especially in traditionally male industries, professions, and environments where historically the presence of women has been the exception and not the rule, (for example in agriculture, heavy industry, and the armed forces) – the assumption has always been that women can and will wear and use exactly what men do, because physically all that do the job are essentially the same: one size fits all.
Except it doesn’t.
Under Regulation 4 of the Personal Protective Equipment at Work Regulations 1992, UK employers are legally required to provide necessary PPE to workers free of charge, and to make sure that such PPE is well maintained. However, most PPE is designed around the average size and characteristics of predominantly male populations from the US and Western Europe. The result of this is that most women (and many men) experience severe problems finding suitable PPE because they do not conform to this standard male model. A 2016 study conducted by the Trades Union Congress (TUC) showed that overall, 57% of women stated that their PPE ‘sometimes or significantly’ hampered their work, with only 5% of women in emergency services saying that their PPE never caused difficulties in carrying out their duties.
Often, employers think that they only thing they need to do to accommodate women is buy PPE in smaller sizes, but this unisex approach still causes problems and can, ironically, increase risk of injury. Items such as fall arrest harnesses, protective overalls, and utility belts need to fit well but differences in hip and chest sizes change the fit, leading to issues ranging from consistent rubbing and blisters from ill-fitting items to long term back pain and musculoskeletal problems. Another key example is safety boots: a typical woman’s foot is both shorter and narrower than a typical man’s foot, so a smaller boot may be the right length but not the right width. Inappropriate shoes result in increased likelihood of tripping, as well as calluses, bunions, foot deformities, and back pain, over and above the risk that the boots are supposed to mediate that of foot injury caused by the work environment.
Even if the issue is logistical rather than actively dangerous, women are still being inconvenienced significantly more than their male colleagues. In occupations where foul weather gear is required, or where workwear or PPE consists of overalls, for example coastguards, these garments are designed for male anatomy and hence typical male urination. This in turn makes even the relatively simple act of relieving oneself, not to mention potentially needing to change pads or tampons, infinitely more complex for people without penises.
Even more topically, an Independent article from 21st of April this year warned that female NHS staff were at risk of not being able to “access protective gear correctly sized for women”, due to the fact that medical PPE items “tend to be designed to the size and shape of male bodies”. This despite the fact that, according to NHS digital statistics published in International Women’s Day 2018, 77% of NHS employees are female. Quoting Dr Helen Fidler (deputy chair of the BMA Consultants Committee and member of the BMA council), “female doctors and other NHS staff are having issues with filtering face-piece (FFP) masks and other [one-size-fits-all] PPE not being available in smaller sizes as they tend to be designed to the size and shape of male bodies.”
Worse, when PPE doesn’t fit, is uncomfortable, causes health problems, or actively hampers a woman’s work, she is less likely to wear it, leaving her vulnerable to potentially devastating consequences. In 1997, a 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.
It is especially galling that problems like these keep arising time and time again when the solutions are so simple. In their 2016 study, the TUC outline a number of suggestions as to what employers and union representatives can do, including:
“Avoid[ing] suppliers who do not provide a range of sizes, and seek[ing] to ensure that all suppliers have properly assessed the appropriateness of their equipment to both men and women.”
“Where the need for separate PPE for men and women is identified, mak[ing] sure that they provide for the same range of sizes for women as for men.”
“Provid[ing] mechanisms of feedback to ensure the suitability of PPE either to safety committees or occupational health providers … [including] both reporting mechanisms and anonymous surveys.”
The long term effects of a lack of safe, adequate PPE, beyond the fact that women are being injured and put at risk, is that it becomes harder for women to work on an equal footing with men, contributing yet another hurdle that must be overcome before true equality can be reached and, perhaps, yet another factor in why so many industries are still dominated by men.
- Caroline Criado Perez Invisible Women: Exposing Data Bias in a World Designed for Men (2019)
- Angela Saini Inferior: How Science Got Women Wrong and the New Research That’s Rewriting the Story (2017)
- David James Elliott, Marissa Silverman, Wayne D. Bowman: Artistic Citizenship: Artisty, Social Responsibility, and Ethical Praxis (2016)
- Witt, Charlotte and Lisa Shapiro, ‘Feminist History of Philosophy’, The Stanford Encyclopaedia of Philosophy (Fall 2018 Edition), Edward N. Zalta (ed.), URL = <https://plato.stanford.edu/archives/fall2018/entries/feminism-femhist/>.
- Connell, Sophia M (2000) ‘Aristotle and Galen on Sex Difference and Reproduction: A New Approach to an Ancient Rivalry’ Stud. Hist. Phil. Sci. Vol. 31, No. 3, pp. 405–427