Personal protective equipment is often designed for men, and that is leaving female health workers further exposed to infection amid the pandemic, global health professionals say.
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“This is a universal issue as most PPE is designed for U.S. and European males and are too big for many females and Asian health care workers,” Dr. Michelle Acorn, chief nurse at the International Council of Nurses, said. This is despite women making up close to 70% of the global health workforce.
Research conducted last year in the United Kingdom revealed respiratory equipment “poorly fit” 16.7% of female health workers compared to 7.6% of men. PPE — including gloves, goggles, face masks, visors, or protective suits — that doesn’t fit properly leaves users exposed to harmful substances or chemicals as well as infections.
Despite long being an issue, COVID-19 has shone “a harsh light on it,” Ann Keeling, senior fellow at Women in Global Health, said.
According to research conducted in May 2020 in 195 countries, while there were more COVID-19 deaths among male health care workers, about 70% of infections occurred in women.
“Because women are 70% of the health workforce, therefore the women’s sizes get used up first,” Keeling explained. “Then what’s available in a shortage is the very large PPE, which basically is swimming on women’s bodies.”
“At this point, we want to get the design right and then, through WHO and others, make sure that design is adopted by governments and that governments purchasing PPE are aware of the issue.”
— Ann Keeling, senior fellow, Women in Global Health“Personally, I need smaller medical masks so I have to improvise and make them smaller by tying the loops,” Irene Atuhairwe, nursing adviser and deputy country director at Seed Global Health Uganda, told Devex.
Despite the increased attention over the last year, Keeling said many governments are likely unaware this is even an issue. Through a survey, WGH has crowdsourced women’s experience of PPE to be consolidated into a report later this year.
For many women community health workers, it’s a choice between refusing to work or risk becoming disease vectors themselves, said Dr. Madeleine Ballard, executive director at the Community Health Impact Coalition. Large masks that don’t sit tight or gloves that don’t seal because they’re too big mean many are left worrying about the risks they’re exposing themselves, their patients, and their families too.
This brings higher stress levels and anxiety for female health workers, Keeling said. “Because of this a number of women health workers have chosen to live separately from their families during the pandemic,” she said.
There are additional practical issues when using PPE designed for men. While males may be able to simply undo the zip of a hazmat suit for a toilet break, women would need to remove and discard the suit to urinate or manage menstruation, something many don’t have time to do during a long shift, Keeling said. A new suit may also not be available given a shortage of PPE.
WGH in Zambia reported incidents where women have restricted their liquid intake to avoid urination. This can be harmful. At the start of the pandemic, United Nations Population Fund sent large consignments of adult diapers and sanitary towels to help nurses in China get through their long shifts.
The problem is that women hold only 25% of leadership roles in global health, Keeling said, which means gender issues can be overlooked. “I am absolutely sure that if you had equal numbers of women in decision-making that they would have been asking this question [on PPE fit] because they would know this is an issue women are facing,” she said.
Listen to the people providing care and what they need, Ballard recommended. “So often that voice is not necessarily present at the table,” she said.
Earlier this year, the government of France, the World Health Organization, and WGH launched the Gender Equal Health and Care Workforce Initiative with a view to increasing “visibility, dialogue, and commitment to action on gender equity in the health and care workforce.” A part of this involves ensuring more representative leadership by building a legal foundation for equality in the workplace; addressing social norms and stereotypes; and addressing workplace systems and culture.
Keeling said WGH is talking to medical PPE manufacturing standards organizations — which produce the technical manufacturing guidelines — about having women sit on some of their technical committees to ensure standards are tailored to different needs.
Opinion: Build back better — invest in women community health workers
Building gender-transformative health systems — to prevent the next pandemic, advance universal health coverage, and achieve greater gender equality — starts with investing in women as paid community health workers.
UN Women and United Nations Economic Commission for Europe have encouraged all standards bodies to sign a Gender Responsive Standards and Standards Development Declaration to ensure any standards developed are gender-responsive and that a gender action plan for their organization is implemented.
“At this point, we want to get the design right and then, through WHO and others, make sure that design is adopted by governments and that governments purchasing PPE are aware of the issue,” Keeling said.
On a practical level, Acorn recommended fit-testing be made a part of official hospital occupational health and safety programs and that PPE must stop being produced as “one size fits all.” “From an occupational health perspective, employers have a legal duty to provide suitable and correctly fitting PPE for safe working conditions.”
Hospital administrators and employers also need to ensure that staff are fitted for N95 masks so they know how many need a smaller and medium fit, Atuhairwe said. “This will ensure that the right amounts of masks and other supplies are procured.”
While tailored PPE might be more expensive, Ballard said pooling demand among districts and NGOs could help cut costs.
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