During the bleak early years of the Covid pandemic, if there was one thing we were all doing, it was “following the science”. This, we were repeatedly assured, was what was driving all the government’s tough decisions. We might not like all its policies but we shouldn’t, it was implied, argue. After all, it was – always – just “following the science”. But was it really?
In her evidence to the Covid inquiry, former civil servant Helen MacNamara revealed that in April 2020, the then prime minister, Boris Johnson, asked the former chief executive of the NHS in England, Simon Stevens, about reports that female frontline healthcare workers were struggling with PPE that had been designed for men. Stevens is said to have “reassured” the prime minister that there was “no problem”.
It is unclear what science Stevens was following here, but it’s certainly none that I’ve ever read. As I reported in my book Invisible Women, report after report over decades has found that while PPE is usually marketed as gender-neutral, the vast majority has in fact been designed around a male body, and therefore neither fits nor protects women. In fact, more often than not, it’s a hindrance: a 2017 TUC report found that only 5% of female emergency service workers said that their PPE never got in the way of their job.
When it comes to respiratory protective equipment specifically, that’s masks to you and me, the problem was highlighted as far back as 2010, when researchers at the National Institute for Occupational Safety and Health (NIOSH), the body that regulates masks in the US, found significant differences in facial dimensions between males and females and all ethnic groups; they even made a point of mentioning that this would be important information for designing and manufacturing masks. Since then, numerous studies have found that masks (all marketed as “standard” or “universal”) are much less likely to fit women than men, with women of east Asian origin particularly poorly served.
It did not surprise me, therefore, when, in the very early days of the pandemic, I started to hear from female healthcare workers telling me that their PPE was not fit for purpose. Their gloves were too big, their face shields caught on their breasts, they were tripping over their gowns and gloves, and their masks were giving them sores (from being pulled so tight to fit) and obscuring their vision (because they were so big on their face). These are people performing life-saving work, including tricky, time-sensitive procedures such as intubations. These are not the people we want being distracted by bad equipment. Worse, some healthcare workers told me they felt pressured to go into Covid wards even when they couldn’t get any mask to fit.
What I call “default male” PPE is a problem across many industries, but it is particularly egregious when it comes to healthcare, because this workforce is female-dominated (67% of healthcare workers globally are female). And in the context of a deadly pandemic, we should have been listening to that female-dominated workforce when they started raising the alarm.
But that is not what happened. From March 2020 I had been asking my newsletter readers to raise the issue with the then health secretary, Matt Hancock, on social media, and the following month I urged them to write to their MPs about it. But while many MPs did respond to say they had followed up with the Department of Health, the message came back very firmly that PPE was “designed to be unisex”. Which is all very well, but bodies aren’t unisex.
Having been blocked by politicians insisting there was no problem, I decided to get hold of some data to prove them wrong. Every time a healthcare worker uses a new model of mask, hospitals are meant to perform a “fit test” and record their results – so, in April 2020, I sent a freedom of information request to every NHS trust I could find. If I could show that women were failing their fit tests at a higher rate than men, surely the government would have to listen?
But here again I was met with, at best, a failure by trusts to collect disaggregated data by sex on fit-test outcomes; at worst, a strong implication that I was the one creating problems with my frivolous questions about worker safety (didn’t I know there was a pandemic on?). One of the trusts, Brighton and Sussex University Hospitals, which originally replied to say it did not disaggregate data by sex, went on to retrospectively do its own analysis and found that female staff were almost twice as likely as male staff to fail the mask-fit test. They have since committed to always collect sex-disaggregated data on fit tests.
More and better data is always to be welcomed, but the problem we have here is not really a lack of evidence: that PPE does not work for women has been clear for decades. The problem, as evidenced by MacNamara’s testimony, is of our systematic failure to listen to and, crucially, to believe women. And it’s a problem that continues to this day: female healthcare workers are still working with PPE that doesn’t fit them – and are still being told that there is no problem. But whatever manufacturers, politicians and career managers might have you believe, female healthcare workers are being left poorly protected. The only question that remains is: are we now going to follow the science and do something about it?
Caroline Criado Perez is the author of Invisible Women: Exposing Data Bias in a World Designed for Men
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