# Invisible Women by Caroline Criado Perez >[!Abstract] Description > Data is fundamental to the modern world. From economic development, to healthcare, to education and public policy, we rely on numbers to allocate resources and make crucial decisions. But because so much data fails to take into account gender, because it treats men as the default and women as atypical, bias and discrimination are baked into our systems. And women pay tremendous costs for this bias, in time, money, and often with their lives. Celebrated feminist advocate Caroline Criado Perez investigates the shocking root cause of gender inequality and research in Invisible Women​, diving into women's lives at home, the workplace, the public square, the doctor's office, and more. Built on hundreds of studies in the US, the UK, and around the world, and written with energy, wit, and sparkling intelligence, this is a groundbreaking, unforgettable expos that will change the way you look at the world. After recommendation, I finally got round to reading Invisible Women by Caroline Criado Perez, all about exposing gender data bias. And it’s fascinating. I want to be angry at the bias that still exists (and at times I am) but as Caroline Criado Perez points out… > “One of the most important things to say about the gender data gap is that it is not generally malicious, or even deliberate. Quite the opposite. It is simply the product of a way of thinking that has been around for millennia and is therefore a kind of *not* thinking. A double not thinking, even: men go without saying, and women don't get said at all. Because when we say human, on the whole, we mean man.” I appreciate that there is not a lot that I can do about something that has been around since the start of time. But what I am doing is teaching my sons about the unconscious bias towards the female species in the hope that when they become men they will be part of the change, that they will listen to women and will involve them in decision making processes that impact them. I’m also trying to help others understand that, although I specialise in Women’s Health…it’s NOT niche! Women make up half of the population with all of them (with a few exceptions) having a menstrual cycle, having female anatomy, many of whom will experience pregnancy and childbirth and all (with a few exceptions) will go through menopause. So how the fuck can working in women’s health be Niche? Anyway, rant over. ## Notes - we continue to rely on data from studies done on men as if they apply to women - why is there always a queue for the women's toilet? article - women waiting in a long line for the bathroom is a common occurrence - the number of people who can relieve themselves at once is far higher per square foot of floor space in the male bathroom than in the female bathroom - women take up to 2.3 times as long as men to use the toilet - women require more trips to the bathroo - even in language itself, male dominance permeates - men are seen as the default - even non-humans default as male - half of the global population are still seen as niche - male dominance has led to a gender data gap - women are invisible - the question of whether snow-clearing can be sexist started out as a joke - women are far more likely than men to walk and utilise public transport - men are more likely to drive a car and if a household owns a car, men have the dominant access - women have more complicated travel patterns - women do 75% of the world’s unpaid care work and this affects their travel needs - while men travel on their own women travel encumbered - women experience time poverty - women are paid less than men - a third of the world’s population lack adequate toilet provision - women are at risk of sexual assault when finding or using a toilet - women are often scared in public spaces - women and men respond to similar environmental conditions differently - fear of crime is particularly high among low-income women - viagra was originally created to treat heart-disease %% ## Introduction: The Default Male ### [[men are seen as the default]] >Seeing men as the default is fundamental to the structure of human society. ^y71lk - anthropology - history - biology - even language itself ### [[even in language itself, male dominance permeates]] >The generic masculine is also used when referring to groups of people: when the gender is unknown, or if it’s a mixed group the generic masculine is used. ^w0aor ### [[even non-humans default as male]] > A 2007 international study of 25,439 children’s TV characters found that only 13% of non-human characters are female (the figure for female human characters was slightly better, although still low at 32%). ^i8m4l ### [[half of the global population are still seen as niche]] > The result of this deeply male-dominated culture is that the male experience, the male perspective, has come to be seen as universal, while the female experience – that of half the global population, after all – is seen as, well, niche. ^qmykt ### [[male dominance has led to a gender data gap]] >But male universality is also a cause of the gender data gap: because women aren’t seen and aren’t remembered, because male data makes up the majority of what we know, what is male comes to be seen as universal. It leads to the positioning of women, half the global population, as a minority. ^2vcpr > ### [[women are invisible]] >With a niche identity and a subjective point of view. In such a framing, women are set up to be forgettable. Ignorable. Dispensable – from culture, from history, from data. And so, women become invisible. ^4egfz ## Chapter 1: Can Snow-Clearing be Sexist? ### [[the question of whether snow-clearing can be sexist started out as a joke]] >It all started with a joke. It was 2011 and officials in the town of Karlskoga, in Sweden, were being hit with a gender-equality initiative that meant they had to re-evaluate all their policies through a gendered lens. As one after another of their policies were subjected to this harsh glare, one unfortunate official laughed that at least snow-clearing was something the ‘gender people’ would keep their noses out of. Unfortunately for him, his comment got the gender people thinking: is snow-clearing sexist? ^beat3 - Unplowed roadways have a significant negative impact on women due to differences in travel - So yes, snow plowing can be sexist - See following notes ### [[women are far more likely than men to walk and utilise public transport]] > We lack consistent, sex-disaggregated data from every country, but the data we do have makes it clear that women are invariably more likely than men to walk and take public transport. In France, two-thirds of public transport passengers are women; in Philadelphia and Chicago in the US, the figure is 64% and 62% respectively. ^w0afw ### [[men are more likely to drive a car and if a household owns a car, men have the dominant access]] > Meanwhile, men around the world are more likely to drive and if a household owns a car, it is the men who dominate access to it – even in the feminist utopia that is Sweden. And the differences don’t stop at the mode of transport. ^bmaq1 ### [[women have more complicated travel patterns]] > Men are most likely to have a fairly simple travel pattern: a twice-daily commute in and out of town. But women’s travel patterns tend to be more complicated. ^4d4qv men tend to have simple travel patterns (to and from work), whereas women have more complicated travel patterns *this stems from the fact that women do 75% of the world's unpaid care work and this affects their travel needs ### [[women do 75% of the world’s unpaid care work and this affects their travel needs]] > Women do 75% of the world’s unpaid care work and this affects their travel needs. A typical female travel pattern involves, for example, dropping children off at school before going to work; taking an elderly relative to the doctor and doing the grocery shopping on the way home. This is called ‘trip-chaining’, a travel pattern of several small interconnected trips that has been observed in women around the world. ^85fxe ### [[while men travel on their own women travel encumbered]] > Men tend to travel on their own, but women travel encumbered – by shopping, by buggies, by children or elderly relatives they are caring for. ^xgk6g > In London women are three times more likely than men to take a child to school and 25% more likely to trip-chain; this figure rises to 39% if there is a child older than nine in the household > a working woman with a child under the age of five will increase her trip-chaining by 54%; a working man in the same position will only increase his by 19%. ### [[women experience time poverty]] >women’s time poverty (women’s paid and unpaid work combines into a longer working day than men’s) ^n42xo > Globally women do three times the amount of unpaid care work men do; according to the IMF, this can be further subdivided into twice as much childcare and four times as much housework. ### [[women are paid less than men]] > the global gender pay gap currently stands at 37.8% (it varies hugely from country to country, being 18.1% in the UK; 23% in Australia; and 59.6% in Angola) ^7hxw5 ## Chapter 2: Gender Neutral With Urinals ### [[women waiting in a long line for the bathroom is a common occurrence]] >Women are used to queueing when they go out. It’s frustrating and puts a dampener on their evening. No nice interval chit-chat about the show with friends over a drink, just dull, tedious lining up, occasionally leavened by the knowing eye rolls they share with their fellow waiting women. [[Caroline Criado Perez]] ^tw0o5 *why is this? See below... ### [[the number of people who can relieve themselves at once is far higher per square foot of floor space in the male bathroom than in the female bathroom]] >On the face of it, it may seem fair and equitable to accord male and female public toilets the same amount of floor space – and historically, this is the way it has been done. 50/50 division of floor space has even been formalised in plumbing codes. However, if a male toilet has both cubicles and urinals, the number of people who can relieve themselves at once is far higher per square foot of floor space in the male bathroom than in the female bathroom. Suddenly equal floor space isn’t so equal. ^t0hdd ### [[women take up to 2.3 times as long as men to use the toilet]] > women take up to 2.3 times as long as men to use the toilet. Women make up the majority of the elderly and disabled, two groups that will tend to need more time in the toilet. Women are also more likely to be accompanied by children, as well as disabled and older people. Then there’s the 20-25% of women of childbearing age who may be on their period at any one time, and therefore needing to change a tampon or a sanitary pad. ^xaw7d ### [[women require more trips to the bathroom]] > Women may also in any case require more trips to the bathroom than men: pregnancy significantly reduces bladder capacity, and women are eight times more likely to suffer from urinary-tract infections than men which again increases the frequency with which a toilet visit is needed. ^itxvi ### [[a third of the world’s population lack adequate toilet provision]] > A third of the world’s population lack adequate toilet provision at all. According to the UN, one in three women lack access to safe toilets, and WaterAid reports that girls and women collectively spend 97 billion hours a year finding a safe place to relieve themselves. ^qht4t > A typical Mumbai slum might have six bathrooms for 8,000 women, and government figures from 2014 revealed that the city as a whole has ‘3,536 public restrooms that women share with men, but not a single women’s-only facility – not even in some police stations and courts’. > More than half of Mumbai’s 5 million women do not have an indoor toilet and there are no free public toilets for women. ### [[women are at risk of sexual assault when finding or using a toilet]] > A 2016 study found that Indian women who use fields to relieve themselves are twice as likely to face non-partner sexual violence as women with a household toilet. ^rd8g8 ### [[women are often scared in public spaces]] > Women are often scared in public spaces. In fact, they are around twice as likely to be scared as men. ^ypzdn > finding that 62% of women are scared walking in multistorey car parks, 60% are scared waiting on train platforms, 49% are scared waiting at the bus stop, and 59% are scared walking home from a bus stop or station. The figures for men are 31%, 25%, 20% and 25%, respectively. ^oxpnz ### [[women and men respond to similar environmental conditions differently]] > women and men respond to similar environmental conditions differently, with women tending to be ‘more sensitive than men to signs of danger and social disorder, graffiti, and unkempt and abandoned buildings’. ^dcwu5 ### [[ Fear of crime is particularly high among low-income women]] > Fear of crime is particularly high among low-income women, partly because they tend to live in areas with higher crime rates, but also because they are likely to be working odd hours and often come home from work in the dark. ^0fqdu # CLAIM!!! > Ranging from catcalling, to being leered at, to the use of ‘sexualised slurs and requests for someone’s name’, none of these behaviours is criminal exactly, but they all add up to a feeling of sexual menace. A feeling of being watched. Of being in danger – and in fact these behaviours can easily escalate > As women navigate public spaces, they are also navigating a slew of threatening sexual behaviours. Before we even get to the more serious offences like being assaulted, women are dealing on a daily basis with behaviours from men that make – and are often calculated to make – them feel uncomfortable > But women don’t report these behaviours, because who could they report them to? > in London, where a fifth of women have reportedly been physically assaulted while using public transport, a 2017 study found that ‘around 90% of people who experience unwanted sexual behaviour would not report it’. ### public spaces become male spaces by default >When planners fail to account for gender, public spaces become male spaces by default. The reality is that half the global population has a female body. Half the global population has to deal on a daily basis with the sexualised menace that is visited on that body. The entire global population needs the care that, currently, is mainly carried out, unpaid, by women. These are not niche concerns, and if public spaces are truly to be for everyone, we have to start accounting for the lives of the other half of the world. --- ## Chapter 3: The Long Friday ### 24th October 1975, known as ‘The Long Friday was when 90% of Icelandic women took part in a strike where they did no work (paid and unpaid) to let the men see how they coped without the invisible work they do every day to keep the country moving > 1975 had been declared by the UN as a Women’s Year, and in Iceland women were determined to make it count. A committee was set up with representatives from Iceland’s five biggest women’s organisations. After some discussion they came up with the idea of a strike. On 24 October, no woman in Iceland would do a lick of work. No paid work, but also no cooking, no cleaning, no child care. Let the men of Iceland see how they coped without the invisible work women did every day to keep the country moving. > Ninety per cent of Icelandic women took part in the strike. Twenty-five thousand women gathered for a rally (the largest of more than twenty to take place throughout the country) in Reykjavík’s Downtown Square – a staggering figure in a country of then only 220,000 people. > A year later, in 1976, Iceland passed the Gender Equality Act, which outlawed sex discrimination in workplaces and schools. Five years later, Vigdís Finnbogadòttir beat three men to become the world’s first democratically elected female head of state. And today, Iceland has the most gender-equal parliament in the world without a quota system. In 2017 the country topped the World Economic Forum’s Global Gender Gap Index for the eighth year running. ### there is no such thing as a woman who doesn’t work. There is only a woman who isn’t paid for her work > There is no such thing as a woman who doesn’t work. There is only a woman who isn’t paid for her work. ### 75% of unpaid work is done by women, who spend between three and six hours per day on it compared to men’s average thirty minutes to two hours > Globally, 75% of unpaid work is done by women, who spend between three and six hours per day on it compared to men’s average of thirty minutes to two hours. > In the UK up to 70% of all unpaid dementia carers are women, and female carers are more likely to help with bathing, dressing, using the toilet and managing incontinence. Women are more than twice as likely as men to be providing intensive on-duty care for someone twenty-four hours a day, and to have been caring for someone with dementia for more than five years. Female carers also tend to receive less support than male carers so they end up feeling more isolated and being more likely to suffer from depression – in itself a risk factor for dementia. > On average, 61% of housework is undertaken by women. ### men enjoy five hours more leisure time per week than women > in the UK, the Office for National Statistics found that men enjoy five hours more leisure time per week than women. ### the imbalance of work has a negative impact on women’s health > All this extra work is affecting women’s health. We have long known that women (in particular women under fifty-five) have worse outcomes than men following heart surgery. But it wasn’t until a Canadian study came out in 2016 that researchers were able to isolate women’s care burden as one of the factors behind this discrepancy. ‘We have noticed that women who have bypass surgery tend to go right back into their caregiver roles, while men were more likely to have someone to look after them,’ explained lead researcher Colleen Norris. > This observation may go some way to explaining why a Finnish study found that single women recovered better from heart attacks than married women – particularly when put alongside a University of Michigan study which found that husbands create an extra seven hours of housework a week for women > In 2017 the UK’s Health and Safety Executive (HSE) released a report on stress in the workplace which revealed that, in every age range, women had higher rates of work-related stress, anxiety and depression than men. Overall, women were 53% more stressed than men, but the difference was particularly dramatic in the age range thirty-five to forty-four: for men the rate was 1,270 cases per 100,000 workers; for women it was nearly double that, at 2,250 cases per 100,000 workers. > The HSE concluded that this disparity was a result of the sectors women work in (stress is more prevalent in public service industries, such as education, health and social care), as well as ‘cultural differences in attitudes and beliefs between males and females around the subject of stress’ ### studies show that it’s unhealthy for women to work more than forty hours a week > A 2011 analysis of data collected on British civil servants between 1997 and 2004 found that working more than fifty-five hours per week significantly increased women’s risk of developing depression and anxiety – but did not have a statistically significant impact on men. > This was in line with a 1999 Canadian study and a 2017 analysis of six years of data from the Household Income Labour Dynamics of Australia Survey, both of which found that women had to work far fewer paid hours than men before their mental health started to deteriorate. ### over time affects women’s mental health, hospitalisation and mortality rates > Even working forty-one to fifty-five hours seemed to increase the probability of mental health problems in women. > Swedish studies have found that moderate overtime work increases women’s hospitalisation and mortality rate, but has a protective effect for men. > A 2016 US paper on the impact of long work hours over a thirty-two-year period found a similar gender disparity. Working moderately long hours (forty-one to fifty hours per week) was ‘associated with less risk of contracting heart disease, chronic lung disease, or depression’ in men. By contrast, such hours for female workers led to consistent and ‘alarming increases’ in life-threatening diseases, including heart disease and cancer. > Women’s risk of developing these diseases started to rise when they worked more than forty hours per week. If they worked for an average of sixty hours per week for over thirty years, their risk of developing one of these diseases tripled. ### women aren’t the weaker sex, it’s just that the work they do is invisible > Is this all proof that women are in fact the weaker sex? Not exactly. In fact, the Australian study found that although the average man could work substantially longer hours than the average woman before his mental health was negatively impacted, there was one group of workers for whom the gender gap was much narrower. These workers are called the ‘unencumbered’, that is, workers with little to no care responsibilities. For the unencumbered, both men’s and women’s work-hour thresholds were much closer to the forty-eight hours stipulated by the ILO. The problem is, women aren’t unencumbered. It’s just that the work they do is invisible. ### women are often forced to accept a lower job than they are qualified for because of the more accessible hours a part-time job offers > Of course most male bosses in heterosexual relationships won’t have a full-time wife at home, because most women can’t afford to quit work entirely. Instead, women accommodate their care responsibilities by going part-time. In the UK, 42% of women compared to 11% of men work part-time, and women make up 75% of part-time workers. And part-time work is paid less per hour than full-time work – in part because it’s rare that a high-level post is offered as a job-share or with flexible working hours. Women end up working in jobs below their skill level that offer them the flexibility they need – but not the pay they deserve. ### women earn between 31% and 75% less than men over their lifetimes > Over time, these pay gaps add up. In Germany a woman who has given birth to one child can expect to earn up to $285,000 less by the time she’s forty-five than a woman who has worked fulltime without interruption. > Data from France, Germany, Sweden and Turkey shows that even after accounting for social transfers that some countries employ to recognise the contribution women make through their unpaid care work, women earn between 31% and 75% less than men over their lifetimes. ### 90% of single parents are women > yes, men can be single parents, but they are a rare beast. In the UK, 90% of single parents are women. ### nothing and nobody could function without the invisible, unpaid work women do > It is abundantly clear that the culture of paid work as a whole needs a radical overhaul. It needs to take into account that women are not the unencumbered workers the traditional workplace has been designed to suit, and that while men are more likely to fit into this automaton ideal, increasing numbers of them no longer want to. After all, it is simply a fact that none of us, including businesses, could do without the invisible, unpaid work carers do. So it is time to stop penalising them for doing it. Instead, we must start recognising it, valuing it, and designing the paid workplace to account for it. --- ## Chapter 4: The Myth of Meritocracy ### women receive negative personality criticism that men simply don’t > An analysis of 248 performance reviews collected from a variety of US-based tech companies found that women receive negative personality criticism that men simply don’t. Women are told to watch their tone, to step back. They are called bossy, abrasive, strident, aggressive, emotional and irrational. Out of all these words, only aggressive appeared in men’s reviews at all – ‘twice with an exhortation to be more of it’. ### white men are rewarded at a higher rate than equally performing women and ethnic minorities > More damningly, several studies of performance-related bonuses or salary increases have found that white men are rewarded at a higher rate than equally performing women and ethnic minorities, with one study of a financial corporation uncovering a 25% difference in performance-based bonuses between women and men in the same job. ### women leave companies due to inequality > More than 40% of women leave tech companies after ten years compared to 17% of men. A report by the Center for Talent Innovation found that women didn’t leave for family reasons or because they didn’t enjoy the work. They left because of ‘workplace conditions’, ‘undermining behaviour from managers’, and ‘a sense of feeling stalled in one’s career’. ### female students are less likely to get the job > Numerous studies from around the world have found that female students and academics are significantly less likely than comparable male candidates to receive funding, be granted meetings with professors, be offered mentoring, or even to get the job. ### where mothers are seen as less competent and often paid less, being a father can work in a man’s favour > Where mothers are seen as less competent and often paid less, being a father can work in a man’s favour (a gendered bias that is by no means restricted to academia). ### there is a citations gap within research with women systematically cited less than men > Citation is often a key metric in determining research impact, which in turn determines career progression, and several studies have found that women are systematically cited less than men. Over the past twenty years, men have self-cited 70% more than women – and women tend to cite other women more than men do, meaning that the publication gap is something of a vicious circle: fewer women getting published leads to a citations gap, which in turn means fewer women progress as they should in their careers, and around again we go. > The citations gap is further compounded by male-default thinking: as a result of the widespread academic practice of using initials rather than full names, the gender of academics is often not immediately obvious, leading female academics to be assumed to be male. One analysis found that female scholars are cited as if they are male (by colleagues who have assumed the P stands for Paul rather than Pauline) more than ten times more often than vice versa. ### female academics have more unpaid workload > When students have an emotional problem, it is their female professors, not their male professors they turn to. Students are also more likely to request extensions, grade boosts, and rule-bending of female academics. In isolation, a request of this kind isn’t likely to take up much time or mental energy – but they add up, and they constitute a cost on female academics’ time that male academics mostly aren’t even aware of, and that universities don’t account for. *I think the same can be {mostly} applied to home too ### women are asked to do more undervalued admin work than their male colleagues > Women are also asked to do more undervalued admin work than their male colleagues – and they say yes, because they are penalised for being ‘unlikeable’ if they say no. (This is a problem across a range of workplaces: women, and in particular ethnic minority women, do the ‘housekeeping’ – taking notes, getting the coffee, cleaning up after everyone – in the office as well as at home. ### the association of brilliance as a male trait > Think of a genius. Chances are, you pictured a man. It’s OK – we all have these unconscious biases. I pictured Einstein – that famous one of him sticking his tongue out, his hair all over the place. And the reality is that this bias (that I like to call ‘brilliance bias’) means that male professors are routinely considered more knowledgeable, more objective, more innately talented. And career progression that rests on teaching evaluations completely fails to account for it. > Brilliance bias is in no small part a result of a data gap: we have written so many female geniuses out of history, they just don’t come to mind as easily. The result is that when ‘brilliance’ is considered a requirement for a job, what is really meant is ‘a penis’. Several studies have found that the more a field is culturally understood to require ‘brilliance’ or ‘raw talent’ to succeed – think philosophy, maths, physics, music composition, computer science – the fewer women there will be studying and working in it.41 We just don’t see women as naturally brilliant. In fact, we seem to see femininity as inversely associated with brilliance. ### we seem to see femininity as inversely associated with brilliance > a recent study where participants were shown photos of male and female science faculty at elite US universities also found that appearance had no impact on how likely it was that a man would be judged to be a scientist. When it came to women, however, the more stereotypically feminine they looked, the less likely it was that people would think they were a scientist. ### a girl’s beliefs about her ability become obvious at the age of six > A recent US study found that when girls start primary school at the age of five, they are as likely as five-year-old boys to think women could be ‘really really smart’. But by the time they turn six, something changes. They start doubting their gender. So much so, in fact, that they start limiting themselves: if a game is presented to them as intended for ‘children who are really, really smart’, five-year-old girls are as likely to want to play it as boys – but six-year-old girls are suddenly uninterested. ### despite the fact that a ‘scientist’ is often thought of as a male occupation, women actually outnumber men in a huge range of science degrees > following decades of ‘draw a scientist’ studies where children overwhelmingly drew men, a recent ‘draw a scientist’ meta-analysis was celebrated across the media as showing that finally we were becoming less sexist. Where in the 1960s only 1% of children drew female scientists, 28% do now. This is of course an improvement, but it is still far off reality. In the UK, women actually outnumber men in a huge range of science degrees: 86% of those studying polymers, 57% of those studying genetics, and 56% of those studying microbiology are female. > There was also a significant gender difference in the change. Between 1985-2016, the average percentage of female scientists drawn by girls rose from 33% to 58%. The respective figures for boys were 2.4% and 13%. This discrepancy may shed some light on the finding of a 2016 study which found that while female students ranked their peers according to actual ability, male biology students consistently ranked their fellow male students as more intelligent than better-performing female students. ### women don't’t nominate themselves for promotion at the same rate as men > Employment procedures that are unwittingly biased towards men are an issue in promotion as well as hiring. A classic example comes from Google, where women weren’t nominating themselves for promotion at the same rate as men. This is unsurprising: women are conditioned to be modest, and are penalised when they step outside of this prescribed gender norm. > But Google was surprised. And, to do them credit, they set about trying to fix it. Unfortunately the way they went about fixing it was quintessential male- default thinking. It’s not clear whether Google didn’t have or didn’t care about the data on the cultural expectations that are imposed on women, but either way, their solution was not to fix the male-biased system: it was to fix the women. > Senior women at Google started hosting workshops ‘to encourage women to nominate themselves’, Laszlo Bock, head of people operations, told the New York Times in 2012. In other words, they held workshops to encourage women to be more like men. But why should we accept that the way men do things, the way men see themselves, is the correct way? ### while women tend to assess their intelligence accurately, men of average intelligence think they are more intelligent than two-thirds of people > Recent research has emerged showing that while women tend to assess their intelligence accurately, men of average intelligence think they are more intelligent than two-thirds of people. This being the case, perhaps it wasn’t that women’s rates of putting themselves up for promotion were too low. Perhaps it was that men’s were too high. --- ## Chapter 5: The Henry Higgins Effect ### current offices are on average five degrees too cold for women > current offices are on average five degrees too cold for women. Which leads to the odd sight of female office workers wrapped up in blankets in the New York summer while their male colleagues wander around in summer clothes. ### while serious injuries at work have been decreasing for men, there is evidence that they have been increasing among women > an uncomfortable workforce is an unproductive workforce. But workplace data gaps lead to a lot worse than simple discomfort and consequent inefficiency. Sometimes they lead to chronic illness. Sometimes, they mean women die. > While serious injuries at work have been decreasing for men, there is evidence that they have been increasing among women. > We know all about heavy lifting in construction – what the weight limits should be, how it can be done safely. But when it comes to heavy lifting in care work, well, that’s just women’s work, and who needs training for that? > Beatrice Boulanger didn’t get any training. As a home helper for older people, she ‘learned everything on the job’. But her duties included a lot of lifting, often of overweight people. One day, as she was helping a woman out of the bath, her shoulder gave way. ‘Everything around the joint was crumbling,’ she told occupational health magazine Hazards. ‘The doctors had to cut off the head of my humerus.’ Boulanger eventually needed a full shoulder replacement. And she can no longer do her job. ### women working as carers and cleaners can lift more in a shift than a construction worker or a mine > Women working as carers and cleaners can lift more in a shift than a construction worker or a miner. > And unlike the construction workers and miners, these women often don’t go home to rest, but instead go home to a second unpaid shift where there is more lifting, more lugging, more crouching and scrubbing. ### [[we continue to rely on data from studies done on men as if they apply to women]] > we continue to rely on data from studies done on men as if they apply to women. Specifically, Caucasian men aged twenty-five to thirty, who weigh 70 kg. This is ‘Reference Man’ and his superpower is being able to represent humanity as a whole. Of course, he does not. ^b8e66 ### levels of chemicals that are safe for Reference Man turn out to be anything but for women > Men and women have different immune systems and different hormones, which can play a role in how chemicals are absorbed. Women tend to be smaller than men and have thinner skin, both of which can lower the level of toxins they can be safely exposed to. This lower tolerance threshold is compounded by women’s higher percentage of body fat, in which some chemicals can accumulate. > The result is that levels of radiation that are safe for Reference Man turn out to be anything but for women. Ditto for a whole range of commonly used chemicals. And yet the male-default one-level-to-rule-them-all approach persists. ### chemicals are usually tested in isolation but that’s not how women use them > This is made worse by the way chemicals are tested. To start with, chemicals are still usually tested in isolation, and on the basis of a single exposure. But this is not how women tend to encounter them, either at home (in cleaning products and cosmetics), or in the workplace. ### endocrine disrupting chemicals (EDCs) > endocrine disrupting chemicals (EDCs) because, unlike most toxins, they can be harmful even at very low concentrations and they are found in a wide range of plastics, cosmetics and cleaners. > EDCs mimic – and therefore can disrupt – reproductive hormones, ‘triggering changes in how cells and organs function, with an impact on a diverse array of metabolic, growth, and reproductive processes in the body’. > The data on EDCs and their impact on women is limited. But what we do know is enough to give us pause, and should certainly be enough to trigger a full-scale data-collection programme. > EDCs are known to be linked to breast cancer, and several studies have found that cosmetologists are at a particularly elevated risk of Hodgkin’s disease, multiple myeloma and ovarian cancer. ### failing to account for female bodies doesn’t just result in equipment that doesn’t work for women: it can injure them too > Failing to account for female bodies in the military doesn’t just result in equipment that doesn’t work for women: it can injure them too. Women in the British Army have been found to be up to seven times more likely than men to suffer from musculoskeletal injuries, even if they have ‘the same aerobic fitness and strength’. They are ten times more likely than men to suffer from hip and pelvic stress fractures. > Until 2013, when three RAF recruits (one of whom had been medically discharged after suffering four pelvic fractures), challenged the practice in court, women in the British armed forces were forced to match male stride length (the average man’s stride is 9-10% longer than the average woman’s). > Since the Australian Army reduced the required stride length for women from thirty inches to twenty-eight inches, pelvic stress fractures in women have fallen in number. ### rucksacks designed primarily on the anthropometry of men may lead to injury > US research which found that a women’s risk of injury increases fivefold if she is carrying more than 25% of her body weight. > If packs were created for women’s bodies, heavy loads might not be such a problem, but they haven’t been. Women are more likely to find that rucksacks (which ‘have been designed primarily based on the anthropometry of men’) are unstable, that pistol belts fit poorly, and that pack straps are uncomfortable. ### a well-padded hip belt may be better for female bodies (in the police) > Studies suggest that a ‘well-padded hip belt allows a better transfer of the load to the hips’ so women can use their stronger leg muscles to carry the load – while men’s upper body strength is on average 50% higher than women’s, the average gap in lower body strength is about half that. Instead, women compensate for packs built around typically male upper body strength by hyperextending their necks and bringing their shoulders farther forward, leading to injury – and a shorter stride length. ### poorly fitting PPE can prove fatal for female police officers > When it comes to front-line workers, poorly fitting PPE can prove fatal. In 1997 a British female police officer was stabbed and killed while using a hydraulic ram to enter a flat. She had removed her body armour because it was too difficult to use the ram while wearing it. Two years later a female police officer revealed that she had to have breast-reduction surgery because of the health effects of wearing her body armour. After this case was reported another 700 officers in the same force came forward to complain about the standard-issue protective vest. But although the complaints have been coming regularly over the past twenty years, little seems to have been done. British female police officers report being bruised by their kit belts; a number have had to have physiotherapy as a result of the way stab vests sit on their female body; many complain there is no space for their breasts. This is not only uncomfortable, it also results in stab vests coming up too short, leaving women unprotected. Which rather negates the whole point of wearing one. ## Chapter 6: Being Worth Less Than a Shoe ### nurses are subjected to more acts of violence than police officers or prison guards > Research has found that nurses are subjected to ‘more acts of violence than police officers or prison guards’. ### women don't report acts of violence > Women don’t report because they fear reprisals and because they fear nothing will be done – both of which are reasonable expectations in many industries. ### women have always worked > Women have always worked. They have worked unpaid, underpaid, underappreciated, and invisibly, but they have always worked. But the modern workplace does not work for women. From its location, to its hours, to its regulatory standards, it has been designed around the lives of men and it is no longer fit for purpose. The world of work needs a wholesale redesign – of its regulations, of its equipment, of its culture – and this redesign must be led by data on female bodies and female lives. We have to start recognising that the work women do is not an added extra, a bonus that we could do without: women’s work, paid and unpaid, is the backbone of our society and our economy. It’s about time we started valuing it. ## Chapter 7: The Plough Hypothesis ### The plough, like many other devices, was built without women in mind. > Upper-body mass is approximately 75% greater in men because women’s lean body mass tends to be less concentrated in their upper body, and, as a result, men’s upper body strength is on average between 40-60%5 higher than women’s (compared to lower-body strength which is on average only 25% higher in men). Women also have on average a 41% lower grip strength than men, and this is not a sex difference that changes with age: the typical seventy-year-old man has a stronger handgrip than the average twenty-five-year-old woman. - it's not that women aren't involved in labour - but rather their involvement looks different from men's - and it has to be ### women naturally have a weaker grip strength than men > It’s also not a sex difference that can be significantly trained away: a study which compared ‘highly trained female athletes’ to men who were ‘untrained or not specifically trained’ found that their grip strength ‘rarely’ surpassed the fiftieth percentile of male subjects. Overall, 90% of the women (this time including untrained women) in the study had a weaker grip than 95% of their male counterparts ## Chapter 8: One-Size-Fits-Men ### equipment is designed around the average male hand > There is plenty of data showing that women have, on average, smaller hands than men, and yet we continue to design equipment around the average male hand as if one-size-fits-men is the same as one-size-fits-all. ### 87% of adult female pianists are at a disadvantage when it comes to a standard keyboard > The average female handspan is between seven and eight inches, which makes the standard forty-eight-inch keyboard something of a challenge. Octaves on a standard keyboard are 7.4 inches wide, and one study found that this keyboard disadvantages 87% of adult female pianists. ### female musicians suffered ‘disproportionately’ from work-related injuries > A range of studies carried out on instrumentalists during the 1980s and 90s found that female musicians suffered ‘disproportionately’ from work-related injuries, and that keyboard players were among those ‘most at risk’. Several studies have found that female pianists run an approximately 50% higher risk of pain and injury than male pianists; in one study 78% of women compared to 47% of men had developed RSI. ### iphones are too big for women's hands - Apple iPhones are too big for women’s hands - even though research shows women are more likely to own an iPhone than men - Apple developers justify that women like bigger phones because they put them in their handbags - but handbags are only used because women’s clothes lack adequate pockets ## Chapter 9: A Sea of Dudes ### although there is potentially a greater need for assistive technology for women as they age, gender analysis is missing from the development of this technology > In the US, women make up 59% of people over the age of sixty-five and 76% of those living alone, suggesting a potential greater need for assistive technology like fall-detection devices. The data we have suggests that not only do older women fall more often than men, they also injure themselves more when they do. Data analysis of a month’s worth of emergency department visits in the US found that of the 22,560 patients seen for fall injuries, 71%, were women. The rate of fracture was 2.2 times higher in women, and women had a hospitalisation rate 1.8 times that of men. > And yet despite women’s arguably greater need (as well as research indicating that women tend to fall differently, for different reasons, and in different places), gender analysis is missing from the development of this technology ### women experience more motion sickness than men but we still don't know why > Stoffregen has also discovered evidence that ‘women’s postural sway changes across the menstrual cycle’. And this is significant because ‘a woman’s susceptibility to motion sickness changes across the menstrual cycle. And those two things link up, believe it or not.’ > A considerable gender data gap remains. We don’t yet know exactly how and when women’s body-sway changes. But as a woman who suffers from extreme car sickness, I am excited and enraged by Stoffregen’s findings, particularly because of how it ties into another gender data gap I’ve been looking into: car design. > When you’re sitting down, you’re still swaying. ‘If you’re sitting on a stool then you’re swaying around your hips,’ explains Stofcegen. ‘If your chair has a back, then your head is swaying on your neck. The only way to really get rid of that is to have a headrest and to use it, ### cars are designed for men, not women > Men are more likely than women to be involved in a car crash, which means they dominate the numbers of those seriously injured in car accidents. But when a woman is involved in a car crash, she is 47% more likely to be seriously injured than a man, and 71% more likely to be moderately injured, even when researchers control for factors such as height, weight, seat-belt usage, and crash intensity. She is also 17% more likely to die. And it’s all to do with how the car is designed – and for whom. > Women have less muscle on our necks and upper torso than men, which make us more vulnerable to whiplash (by up to three times), and car design has amplified this vulnerability > women are not scaled-down men. We have different muscle-mass distribution. We have lower bone density. There are sex differences in vertebrae spacing. As Stoffregen has noted, even our body sway is different. And these differences are all crucial when it comes to injury rates in car crashes. - Cars are even more dangerous for pregnant women because seatbelts are not properly designed for them ### when men and women are in a car together, the man is most likely to be driving so not collecting data on passengers more or less translates as not collecting data on women > A 2015 report by the Insurance Institute for Highway Safety is excitingly headlined ‘Improved vehicle designs bring down death rates’ – which sounds great. Perhaps this is the result of the new legislation? Unlikely. Buried in the report is the following telltale line: ‘The rates include only driver deaths because the presence of passengers is unknown.’ This is a huge gender data gap. When men and women are in a car together, the man is most likely to be driving. So not collecting data on passengers more or less translates as not collecting data on women. ### the passenger seat is the only seat that is commonly tested with a female crash-test dummy anyway, with the male crash-test dummy still being the standard dummy for the driver’s seat > The infuriating irony of all this is that the gendered passenger/driver norm is so prevalent that, as we’ve seen, the passenger seat is the only seat that is commonly tested with a female crash-test dummy anyway, with the male crash-test dummy still being the standard dummy for the driver’s seat. So stats that include only driver fatalities tell us precisely zero about the impact of introducing the female crash-test dummy. In conclusion, a more accurate headline for the report would be ‘Improved vehicle design brings down death rates in the seat most likely to be occupied by men, but who knows about death rates in the seat most likely to be occupied by women even though we already know women are 17% more likely to die in a car crash.’ Admittedly, this is less snappy. ### designers may believe they are making products for everyone, but in reality they are mainly making them for men > From development initiatives to smartphones, from medical tech to stoves, tools (whether physical or financial) are developed without reference to women’s needs, and, as a result these tools are failing them on a grand scale. And this failure affects women’s lives on a similarly grand scale: it makes them poorer, it makes them sicker, and, when it comes to cars, it is killing them. Designers may believe they are making products for everyone, but in reality they are mainly making them for men. It’s time to start designing women in. ## Chapter 10: The Drugs Don’t Work > Isometric exercises fatigue women less (which is relevant for post-injury rehabilitation) because men and women have different ratios of types of muscle fibre, but we have ‘a limited understanding of the differences’ because there are ‘an inadequate number of published studies’.97 When even something as simple as ice-pack application is sex-sensitive, it’s clear that women should be included in sports-medicine research at the same rates as men.98 But they aren’t.99 And researchers continue to research men and act as if their findings apply to women. > It’s hard to read an account like this and not feel angry with the doctors who let Michelle down so badly. But the truth is that these are not isolated rogue doctors, bad apples who should be struck off. They are the products of a medical system which, from root to tip, is systematically discriminating against women, leaving them chronically misunderstood, mistreated and misdiagnosed. > Historically it’s been assumed that there wasn’t anything fundamentally different between male and female bodies other than size and reproductive function, and so for years medical education has been focused on a male ‘norm’, with everything that falls outside that designated ‘atypical’ or even ‘abnormal’.1 References to the ‘typical 70 kg man’2 abound, as if he covers both sexes (as one doctor pointed out to me, he doesn’t even represent men very well). When women are mentioned, they are presented as if they are a variation on standard humanity. Students learn about physiology, and female physiology. Anatomy, and female anatomy. ‘The male body’, concluded social psychologist Carol Tavris in her 1992 book The Mismeasure of Woman, ‘is anatomy itself.’3 > the representation of the male body as the human body persists. A 2008 analysis of a range of textbooks recommended by twenty of the ‘most prestigious universities in Europe, the United States and Canada’ revealed that across 16,329 images, male bodies were used three times as often as female bodies to illustrate ‘neutral body parts’.4 > contrary to what we’ve assumed for millennia, sex differences can be substantial. Researchers have found sex differences in every tissue and organ system in the human body,10 as well as in the ‘prevalence, course and severity’ of the majority of common human diseases.11 There are sex differences in the fundamental mechanical workings of the heart.12 There are sex differences in lung capacity,13 even when these values are normalised to height (perhaps related is the fact that among men and women who smoke the same number of cigarettes, women are 20-70% more likely to develop lung cancer14). > Autoimmune diseases affect about 8% of the population,15 but women are three times more likely to develop one, making up about 80% of those affected.16 > researchers think it might be down to women being the child-bearing sex: the theory is that females ‘evolved a particularly fast and strong immune response to protect developing fetuses and newborn babies’,17 meaning that sometimes it overreacts and attacks the body.18 > There are still vast medical gender data gaps to be filled in, but the past twenty years have demonstrably proven that women are not just smaller men: male and female bodies differ down to a cellular level. So why aren’t we teaching this? > Because of their routine exclusion from clinical trials we lack solid data on how to treat pregnant women for pretty much anything. We may not know how a disease will take hold or what the likely outcome may be, although the WHO warns that many diseases can have ‘particularly serious consequences for pregnant women, or can harm the foetus’.34 > Alongside insisting that sex differences don’t matter, some researchers advocate against the inclusion of women in research on the basis that while biological sex may matter, the lack of comparable data arising from the historical data gap makes including women inadvisable (talk about adding insult to injury).44 Female bodies (both the human and animal variety) are, it is argued, too complex, too variable,45 too costly to be tested on. Integrating sex and gender into research is seen as ‘burdensome’.46 It is seen as possible for there to be ‘too much gender’,47 and for its exclusion to be acceptable on the basis of ‘simplification’48 > According to the FDA, the second most common adverse drug reaction in women is that the drug simply doesn’t work, even though it clearly works in men. So with that substantial sex difference in mind: how many drugs that would work for women are we ruling out at phase one trials just because they don’t work in men? > The idea is to ‘minimise the possible impacts oestradiol and progesterone may have on the study outcomes’.57 > menstrual-cycle impacts have been found for antipsychotics, antihistamines and antibiotic treatments as well as heart medication.58 Some antidepressants have been found to affect women differently at different times of their cycle, meaning that dosage may be too high at some points and too low at others.59 > Women are also more likely to experience drug-induced heart-rhythm abnormalities60 and the risk is highest during the first half of a woman’s cycle.61 This can, of course, be fatal. > another issue the authors completely failed to address is whether or not the drugs were tested in women at different stages in their menstrual cycles. The likelihood is that they weren’t, because most drugs aren’t. When women are included in trials at all, they tend to be tested in the early follicular phase of their menstrual cycle, when hormone levels are at their lowest – i.e. when they are superficially most like men > Women are 70% more likely to suffer depression than men, for instance, but animal studies on brain disorders are five times as likely to be done on male animals.64 > A 2014 paper found that of studies on female-prevalent diseases that specified sex (44%), only 12% studied female animals.65 > Dr Tami Martino researches the impact of circadian rhythms on heart disease, and during a 2016 lecture to the Physiology Society she recounted a recent shock discovery. Together with her team, she conducted a study which found that the time of day you have a heart attack affects your chances of survival. A heart attack that hits during the day triggers, among other things, a greater immune response. In particular, it triggers a greater neutrophil response (neutrophils are a type of white blood cell that are usually first on the scene in response to any injury), and this response correlates with a better chance of survival. This finding has been replicated many times over many years with many different animals, becoming, explained Martino, the ‘gold standard for survivorship in the literature’. > Martino and her team were ‘quite surprised’ when in 2016 another group of researchers released a paper which also found that daytime heart attacks triggered a greater neutrophil response – but that this correlated with a worse chance of survival. After a substantial amount of head-scratching, they realised there was one basic difference between the historic studies and this one new study: the old studies had all used male mice, while this new paper had used female mice. Different sex: totally opposite result. > When the ‘female Viagra’74 that was released with much fanfare in 2015 was found to potentially interact negatively with alcohol (as most readers will know, the absorption of alcohol differs between men and women75), its manufacturer, Sprout Pharmaceuticals, quite rightly decided to run a trial – for which they recruited twenty-three men and two women.76 They did not sex-disaggregate the data. > Even something as basic as advice on how to exercise to keep disease at bay is based on male-biased research. If you run a general search for whether resistance training is good for reducing heart disease, you’ll come across a series of papers warning against resistance training if you have high blood pressure.90 This is in large part because of the concerns that it doesn’t have as beneficial an effect on lowering blood pressure as aerobic exercise, and also because it causes an increase in artery stiffness. > Which is all true. In men. Who, as ever, form the majority of research participants. The research that has been done on women suggests that this advice is not gender-neutral. A 2008 paper, for example, found that not only does resistance training lower blood pressure to a greater extent in women, women don’t suffer from the same increase in artery stiffness.91 And this matters, because as women get older, their blood pressure gets higher compared to men of the same age, and elevated blood pressure is more directly linked to cardiovascular mortality in women than in men. In fact, the risk of death from coronary artery disease for women is twice that for men for every 20 mm Hg increase in blood pressure above normal levels. ### drugs work different for men & women → [[the majority of research in fitness is done on men and then just applied to women]] >It also matters because commonly used antihypertensive drugs have been shown to be less beneficial in lowering blood pressure in women than in men. > So to sum up: for women, the blood-pressure drugs (developed using male subjects) don’t work as effectively, but resistance training just might do the trick. Except we haven’t known that because all the studies have been done on men. And this is before we account for the benefits to women in doing resistance training to counteract osteopenia and osteoporosis, both of which they are at high risk for post-menopause. > There have been some attempts to force researchers to properly represent females in medical research. Since 1993, when the US passed the National Institute of Health Revitalization Act, it has been illegal not to include women in federally funded clinical trials. Australia’s main funding body made similar rules for the research it funds,104 as has the EU, which in fact went even further, also requiring both sexes to be studied in pre-clinical animal studies. This requirement did not come into effect in the US until January 2016,105 which is also when the NIH introduced the requirement that the data in trials it funded be disaggregated and analysed by sex (unless there is a compelling reason not to).106 > Other positive developments include the German Society of Epidemiology which has for more than a decade required researchers to justify including only one sex in any study where the results could potentially affect both sexes;107 and the introduction of the same by the Canadian Institutes of Health in 2012, as well as mandatory questions about the consideration of sex and gender in the study design. Some academic journals also now insist that papers submitted for publication should provide information about the gender of participants in clinical trials, for example.108 > Trailing behind everyone is the UK, whose main funders ‘make no substantive reference to, or requirements regarding, the consideration of gender in research design and analysis’,109 and despite the at-risk population of women suffering more morbidity and mortality,110 UK research funding for coronary artery disease in men is far greater than for women. Indeed, such is the dearth of gender-based clinical research from within the UK, that Anita Holdcroft, emeritus professor at Imperial College London, has written that for cardiovascular treatment, ‘it is pertinent to use studies from North America and Europe where these issues have been investigated’.111 ## Chapter 11: Yentl Syndrome > But what if the trial had included women? The outcome of the 2013 study is suggestive. The trial had to be stopped because the funding ran out, meaning the researchers did not meet their sample size and therefore could not confirm the primary hypothesis. They called for ‘larger studies of longer duration, likely multi-center’ to confirm their findings. These studies have not happened. Dr Richard Legro, who led the study, told me he applied twice to the NIH for funding ‘to do a longer and larger study and also to compare sildenafil to the standard of care, a non-steroidal anti-inflammatory agent’. He was rejected both times. In each case, the grant ‘was deemed to be in the lower half of grants submitted’. It wasn’t even reviewed. Legro tells me that the comments he received ‘indicated that the reviewers did not see dysmenorrhea as a priority public health issue’. They also didn’t ‘fully understand clinical trial design of dysmenorrhea trials’. When I ask him if he thinks he will ever get funding, he says, ‘No. Men don’t care or understand dysmenorrhea. Give me an all-female review panel!’ > endometriosis, a disease where womb tissue grows elsewhere in the body, causing extreme pain and sometimes infertility. It takes an average of eight years to diagnose in the UK,56 an average of ten years to diagnose in the US,57 and there is currently no cure. And although the disease is thought to affect one in ten women (176 million worldwide58) it took until 2017 for England’s National Institute for Health and Care Excellence to release its first ever guidance to doctors for dealing with it. The main recommendation? ‘Listen to women.’59 > PMS affects 90% of women, but is chronically under-studied: one research round-up found five times as many studies on erectile dysfunction than on PMS.88 And yet while a range of medication exists to treat erectile dysfunction89 there is very little available for women, to the extent that over 40% of women who have PMS don’t respond to treatments currently available. Sufferers are still sometimes treated with hysterectomies; in extreme cases, women have tried to kill themselves.90 But researchers are still being turned down for research grants on the basis that ‘PMS does not actually exist’.91 > Period pain – dysmenorrhea – similarly affects up to 90% of women,92 and according to the American Academy of Family Physicians it affects the daily life of around one in five women.93The level of pain women experience on a monthly basis has been described as ‘almost as bad as a heart attack’.94 But despite how common it is and how bad the pain can be, there is precious little that doctors can or will do for you. A rare 2007 grant application for research into primary dysmenorrhea described its causes as ‘poorly understood’ and treatment options as ‘limited’.95 The prescription medications which are available have serious possible side effects and are by no means universally effective. > 2013 study that seemed to have found a cure. The ‘primary outcome’ of a double-blind, randomised, controlled trial of sildenafil citrate, was, ladies, you may want to sit down for this: ‘total pain relief over 4 consecutive hours’, with ‘no observed adverse effects’.96 Imagine. ### [[viagra was originally created to treat heart-disease]] > Created in 1989, sildenafil citrate is the medical name for Viagra. In the early 1990s, the drug was being tested as a heart-disease medication. It turned out not to be great at that, but one thing participants did report was an increase in erections (yes, all the trial participants were men). ^4zrxw > Total erectile dysfunction affects between 5-15% of men depending on age,98 with about 40% of men experiencing it to some degree – and so naturally the researchers were keen to explore this alternative use for their drug. By 1996, sildenafil citrate had been patented in the US and by March 1998 it was approved by the FDA.99 A happy ending for men, then. > In 2016 Susan Wray, a professor of cellular and molecular physiology at the University of Liverpool, gave a lecture to the Physiological Society.103 Wray is also the director of the Centre of Better Births in Liverpool Women’s Hospital and she explained that recent research revealed that women with contractions that were too weak to give birth had more acid in their myometrial blood (the blood in the part of the uterus that causes contractions). The higher the levels of acid were, the higher the likelihood a woman would end up needing a caesarean, because oxytocin isn’t, it turns out, that effective on women with an acidic blood pH. > But Wray didn’t simply want to be able to predict the need for a caesarean. She wanted to be able to avoid it. Together with her fellow researcher Eva Wiberg-Itzel, Wray conducted a randomised control trial on women with weak contractions. Half of them were given the usual oxytocin; half were given bicarbonate of soda, and then given the usual oxytocin an hour later. The change was dramatic: 67% of women given just oxytocin went on to give birth vaginally, but this rose to 84% if they were given bicarbonate of soda an hour before. As Wray pointed out, the bicarb dose wasn’t tailored to body weight, it wasn’t tailored to the amount of acid in the blood, and the women weren’t given repeated doses. So the efficacy could turn out to be even higher. > But it looks like we aren’t going to see the fruits of her labour any time soon. When Wray discovered that the British Medical Research Council was offering funding for research that would benefit low- and middle-income countries, she decided to apply. And yet, despite all the data about how dangerous weak contractions can be, she was turned down. The research was ‘not a high enough priority’. So currently we have only one treatment for women with weak contractions, and it doesn’t work half the time > The evidence that women are being let down by the medical establishment is overwhelming. The bodies, symptoms and diseases that affect half the world’s population are being dismissed, disbelieved and ignored. And it’s all a result of the data gap combined with the still prevalent belief, in the face of all the evidence that we do have, that men are the default humans. They are not. They are, to state the obvious, just men. And data collected on them does not, cannot, and should not, apply to women. We need a revolution in the research and the practice of medicine, and we need it yesterday. We need to train doctors to listen to women, and to recognise that their inability to diagnose a woman may not be because she is lying or being hysterical: the problem may be the gender data gaps in their knowledge. It’s time to stop dismissing women, and start saving them. ## Afterword > Routinely forgetting to accommodate the female body in design – whether medical, technological or architectural – has led to a world that is less hospitable and more dangerous for women to navigate. It leads to us injuring ourselves in jobs and cars that weren’t designed for our bodies. It leads to us dying from drugs that don’t work. It has led to the creation of a world where women just don’t fit very well. > male sexual violence against women – how we don’t measure it, don’t design our world to account for it, and in so doing, allow it to limit women’s liberty. Female biology is not the reason women are raped. It is not the reason women are intimidated and violated as they navigate public spaces. This happens not because of sex, but because of gender: the social meanings we have imposed on male and female bodies. In order for gender to work, it must be obvious which bodies elicit which treatment. And, clearly, it is: as we’ve seen, ‘the mere sight of a woman’ is enough for the viewer to ‘immediately elicit a specific set of associated traits and attributions’.8 To immediately class her as someone to speak over. Someone to cat call. Someone to follow. Someone to rape > Women are doing far and away more than our fair share of this work – this necessary work without which our lives would all fall apart. And, as with male violence against women, female biology is not the reason women are the bum-wiping class. But recognising a child as female is the reason she will be brought up to expect and accept that as her role. Recognising a woman as female is the reason she will be seen as the appropriate person to clear up after everyone in the office. To write the Christmas and birthday cards to her husband’s family – and look after them when they get sick. To be paid less. To go part-time when they have kids. > The solution to the sex and gender data gap is clear: we have to close the female representation gap. When women are involved in decision-making, in research, in knowledge production, women do not get forgotten. Female lives and perspectives are brought out of the shadows. This is to the benefit of women everywhere