Frontline health workers in all countries have faced exceptional physical and mental challenges responding to the covid-19 pandemic. Many millions have contracted the virus and more than 100 000 health workers have died. As 70% of the health workforce, women have been the majority in patient facing roles during the pandemic, and are therefore most in need of personal protective equipment (PPE) to protect their health. Yet throughout the pandemic, stories have come from all regions of women working in garbage bags, forced to wear adult diapers, and suffering bruised faces from ill fitting respirators. Strikes by health workers in many countries were linked to PPE shortages, including in India where around one million women ASHA (accredited social health activist) community health workers demanded better PPE. PPE matters to women. However, there has been little research into the gender differences in PPE needs or effectiveness.
In response to the problems raised by women, Women in Global Health undertook research to document and better understand gendered challenges around PPE in the health sector. Common themes emerged from women in different contexts around PPE fit, design, and access.
PPE designed for men
Like many products, PPE is designed on a reference man.6 As a result, the average sizes of PPE are too big for most women. Masks are too big, leaving gaps in the sides, increasing stress and infection risk for women health workers. In the Women in Global Health survey, only 14% of women wore PPE fitted exclusively to them. Gowns and other body coverings are not modelled for women’s physique and although PPE may be manufactured in a range of sizes, large will often be the only size procured on the assumption that it will fit. Guidance from the World Health Organization (WHO) on PPE has been notably gender blind, as has donor support for procurement in low and middle income countries.
Women health workers know what they need but their views have not been included in PPE design. Women have also been marginalised in pandemic decision making7 and women’s needs, especially during menstruation, pregnancy, and menopause, have not been accommodated. Women health workers have reported intentionally disrupting their menstrual cycles so that they can cope at work, while pregnant and menopausal women have overheated in unsuitable PPE. Women in Global Health’s research found only around 10% of women health workers could use the bathroom as needed while working, leading to dehydration, infections, and fainting.5
While many of the gendered issues around PPE are universal, women health workers are not homogenous, and the current “one size fits all” approach to PPE fails to account for diversity, including conventions on hair styling, body and face shapes, and climactic and working conditions. Women from ethnic minorities seem to disproportionately report having PPE that does not fit them. Lack of diversity in PPE design is exacerbated by inequities in access within health systems. Globally, the pandemic has also exposed inequities between countries, especially at the start of 2020 when surging PPE prices hit low and middle income countries particularly hard. The health workers in these countries, the majority of whom were women, have also had least access to covid-19 vaccines.
Change means listening to women
PPE will not be fit for women unless underlying gender inequities in the health workforce are tackled. Women health workers are often clustered into low status jobs and have often been a lower priority for PPE than male colleagues. Although women are the majority of health workers, they hold only 25% of senior leadership roles.2 Women’s anxiety around inadequate PPE is compounded by their “double burden” of care: their common role as the primary care giver within the family means they also have to worry about transmitting covid-19 to family members. Women health workers have considered workplace policies and practices unsafe—for example, the reuse of PPE—but have felt powerless to leverage change. When PPE has not been provided, women health workers have had to buy their own, a last resort that is particularly challenging for women working unpaid or earning less than their male counterparts, especially in low income countries.
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Source: BMJ
Daye: 12 April