Here we are, in the Northern Hemisphere, heading into yet another COVID-affected winter … and I feel for health workers everywhere. COVID has impacted women disproportionately since the very beginning of the pandemic. This impact has been especially acute in the field of health, where women health workers have provided care on the frontlines from day one. The World Health Organization (WHO) estimates that at least 115,000 health and care workers have died of COVID-19. In countries like Guinea and Liberia, this was their second deadly epidemic in a decade, on the heels of Ebola.
I’ve been following the brilliant work of the feminist activists at Women in Global Health (shout out to WGH!), who have, since 2015, put the concerns of the female health workforce on the political map worldwide. From the get go, WGH identified the leadership gap in healthcare as the critical factor behind the poor and often dangerous working conditions for women and the significant gender pay gap across all job categories in healthcare, from surgeons on down.
Women comprise almost 70% of the global health and social care workforce, but hold only 25% of senior leadership positions. What percentage of national ministers of health are women, do you think? WHO says: only 30%. Deans of top medical and public health schools? 28%. CEOs and board chairs of global health organizations and agencies? 27%. Nurses—90% of whom are women—are significantly underrepresented in health leadership at any level.
Even in the context of the COVID pandemic—where women heads of government such as Prime Minister Jacinda Ahern of New Zealand, or then Chancellor Angela Merkel of Germany, demonstrated superior stewardship—national COVID task forces have been majority male in 97 out of 115 countries.
The result: decisions that affect this largely female workforce continue to be made by the men in leadership. This has particular impact on the women of color and migrant women who make up a significant portion of healthcare and social care workers in many health systems.
Perhaps nothing illustrates the impact of the leadership gap more clearly than the issue of personal protective equipment (PPE): the goggles, respirators, masks, face shields, gloves, shoe covers, gowns and coveralls that health workers need to wear to protect themselves and their patients from infection.
Did you know that, to this day, health PPE is designed for men’s bodies? In fact, health PPE is based on that mythical, “standard” European and American 1950s white man, as so much design still is, from crash test dummies to public bathrooms. A brand new report by WGH, entitled Fit for Women? Safe and Decent PPE for Women Health and Care Workers, documents the effects of this absurd situation. It makes for shocking reading.
At the outset, the WGH researchers make clear that chronic PPE shortages are a constant across many countries in the global South, endangering the health of all frontline health workers of all genders daily. Pictures of nurses in garbage bags shocked Americans last year, but health workers treating patients in improvised equipment, or re-using single-use PPE, is standard in many places. It is very dangerous.
A psychologist in Malawi explains: “Mostly, it’s the men who are at the top. And so, they’re the first priority… The [gender] dynamics have been playing out, where women are expected to do the dirty work, but without getting any protection… I’m hearing it from female friends in different fields—nurses, pharmacists, physiotherapists—and when we complain about being sent out into the field without proper protection, we get labelled as being stubborn.”
But even when PPE is on hand, it rarely fits women. There is no such thing as unisex PPE. Women of color fare even worse. Remember the photos of women health workers with deep marks on their faces from wearing N95 respirators? They had to tighten the straps to ensure a proper seal, because respirators are designed for men’s faces.
Breasts, hips and pregnancy bumps are not taken into account in the design of coveralls, nor long, braided or curly hair in the design of masks and head covers.
This situation is not new, obviously, and women health workers have been told to accept this as the status quo. A nurse in the UK reports that “[she] ha [s] been told by the mask fit testers that most South and Southeast Asian female staff have failed mask fit tests due to our smaller than average (which average??) faces.”
To make matters worse, the standard size for equipment ordered by health facilities is an XL. One Australian nurse noted: “The gowns were way too big, sometimes I even slipped on them because they were so long, I couldn’t walk properly. The goggles always slid down the nose, so sometimes out of reflex, I pushed them up when my gloves were already possibly contaminated.” Another nurse makes the blindingly obvious point that gloves that are too large make it hard to handle medications and give injections, leading her to sometimes remove them … which endangers her and her patients. As WGH notes, “if PPE doesn’t fit, it doesn’t protect.”
The good news is that feminist activists are fiercely advocating for policy changes, and that these longstanding and structural issues are finally being reported and discussed more broadly. Activists have enlisted WHO, the International Finance Corporation (part of the World Bank Group) and ASTM International (the technical standards organization) to seek change in standards for equipment and in purchasing patterns. But the ultimate change they want is at the leadership level: more women in top positions in health.
Women health workers deserve more than our gratitude or folks banging pots and pans out of their windows. They deserve to be in charge.