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#FitForWomen: Improving Personal Protective Equipment (PPE) for women health & care workers

One of the many gender inequities in the health and care workforce that COVID-19 has exposed is around the fit and design of Personal Protective Equipment (PPE). The rapid onset and scale of COVID-19 led to shortages of PPE in most countries, causing preventable infection and mortality among healthcare workers and others on the front lines. Even though most health workers are women, manufacturing specifications for medical PPE are usually drawn up based on the male body and there have been many reports of PPE not designed for women's bodies. WGH undertook a global research project to document the challenges women health workers have faced.

 

We thank Johnson & Johnson Foundation for their sponsorship and support throughout the creation of this report.

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Executive Summary

Personal Protective Equipment (PPE) has become one of the defining issues of the COVID-19 pandemic.  In the first quarter of 2020 as the COVID-19 virus spread and patient numbers surged, reports appeared in the media of women health and care workers unable to access PPE working in garbage bags, forced to wear adult diapers, suffering cut and bruised faces from long shifts in PPE and even going on strike.  

Shortages of PPE for health workers, especially in low-and middle-income countries are not new. The pandemic, however, exposed the particular problems faced by women health workers using PPE. WHO reports that 115,000 health and care workers (HCWs) have died due to COVID-19, almost certainly an underestimate, and millions will suffer longer term health impacts from having been infected. Health workers need to be protected from the health-related risks they face at work.

The World Health Assembly designated 2021 as the International Year of Health and Care Workers (YHCW) with the themes -Protect. Invest. Together-.  YHCW highlights the urgent need to ensure that health and care workers - 70% of whom are women - are supported, protected, motivated and equipped to deliver safe health care at all times, not only during COVID-19. PPE is a critical line of defense for the protection of health workers, and that was especially so at the start of the pandemic, in the absence of vaccines or therapeutics  for COVID-19.

Also in 2021 the Government of France, the World Health Organization and Women in Global Health have partnered on the Gender Equal Health and Care Workforce Initiative (GEHCWI) which aims to inspire action in the health and care sectors on safe and decent work for women, ending informal work, which is often unpaid and under paid, equal opportunities in health and care occupations, an end to violence and harassment and equal participation of men and women in the sector in leadership and decision making. One of the four pillars of the Initiative is ensuring safe and decent working conditions for all health workers everywhere, including provision of PPE designed to fit women. 

As a response to women's feedback on deficient PPE during the pandemic, Women in Global Health launched a research project in 2021 to document and better understand gendered challenges around PPE in the health sector, including an online survey and interviews with women HCWs in over 50 countries. Our objective was to elevate the voices of women to enable health sector policy makers, employers, standards bodies, and industry to better understand the challenges women have been facing during COVID-19 with access, fit and design of PPE.  By documenting women's experiences and suggestions, we aim to inform global initiatives to make PPE manufacturing standards gender responsive and increase safety and dignity at work for women HCWs.

Whilst some of the challenges around PPE (for example, shortages and poor quality) affect HCWs of all genders, women are 90% of nurses and have been the vast majority of HCWs in patient facing roles in the pandemic. Therefore, if medical PPE is not fit for women, it is not fit for the majority of the health workforce. Our findings show that PPE manufacturing standards pay too little attention to the needs of women and our research has confirmed what many women HCWs already knew: PPE is not fit for women.

Although PPE is a universal challenge for women HCWs, it does not manifest equally across regions and health worker cadres. HCWs in high income countries have generally had access to PPE, while many HCWs in low-income countries have had and still have limited access to PPE. PPE is an equity issue. Within all health systems, because women tend to be clustered in lower status roles, our data finds women have often been less able than their male counterparts to access PPE. There is also anecdotal evidence that women from racial and ethnic minorities have been less protected, highlighting the intersectionality of gender inequities in the health workforce.

After almost two years of a global pandemic, millions of HCWs around the world, especially women, are burnt out and planning to leave the profession.  This report therefore lands at a critical time. When the pandemic began, the world had a severe shortage of HCWs, with an additional 18 million alone needed in low-and middle-income countries to achieve UHC. We cannot afford to lose one more health worker. The failure to protect women HCWs is a moral failure and it is also a failure of accountability. Governments have made numerous commitments in global fora to protect HCWs and the Year of Health and Care Worker 2021 is an opportunity to reinforce existing obligations. Finally, failure to protect women HCWs is a failure to protect ourselves. Women in the health sector want the means - decent work, fair pay, equal leadership, dignity and safety - to do their jobs and deliver stronger health outcomes for everyone.

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Contact ana.gutierrez@womeningh.org if you would like to further spread the word!