Women and occupational health
Issues and policy paper prepared for the Global Commission on Women's Health.
Identifying issues and problems in the occupational health of women remains a challenge. Much of women's work remains unrecognised, uncounted and unpaid: work in the home, in agriculture, food production and the marketing of home-made products, for example. Within the paid labour force, women are disproportionately concentrated in the informal sector, beyond the scope of industrial regulations, trade unions, insurance or even data collection. Women may undertake paid work at home, or combine part or full time paid work with household work and the care of children, the sick and the elderly. They are likely to move in and out of the paid labour force during different life stages; within the paid labour force they may have a variety of different occupations in succession.
Women's occupations are thus fluid and multi-dimensional. The first problem is to learn what those activities really involve in different situations and cultures: a simple occupational category is seldom sufficient as a basis for establishing specific health risk. Agricultural workers may dig and hoe and apply fertilisers and pesticides, but not all the workers will perform all of those tasks and where the tasks are segregated by gender the health implications for men and women may be very different.
The tasks which men and women undertake vary from culture to culture, and at different times in different places. While most cultures assign particular tasks to women, and in some women's roles are more regulated and their economic activities restricted, there are in general very few activities which can universally be described as women's work. Occupational health risks are seldom confined to one sex alone. The risks are only likely to be fully understood, and confronted, in the context of a gender specific analysis of occupational health.
Research into women's and men's occupational health also requires a recognition of the extent of intra-sex variations and careful controls for biological and social characteristics which may affect health outcomes. Poor nutrition, for example, may be a more mportant factor in some types of occupational health impairment than simply being female.
The effects of potential occupational hazards on women's reproductive health have been, probably, the major focus of concern in the health of women workers. This concern has increased in recent years as more environmental hazards are identified and as more women enter the paid workforce. A range of occupational reproductive hazards has been documented but a large number of possible risks still require further examination.
Legislation to protect pregnant - or potentially pregnant workers has been a universal response. However, where such legislation ignores potential reproductive hazards to male workers it is not only scientifically unsound but fails to protect men while depriving women of an income.
Some countries cannot enforce their protective legislation because of the realities of economic pressures. If other policies such as training criteria exclude women from learning to minimise the hazards they in fact face, women may paradoxically be at greater risk than if there had been no attempt to protect them.
For millions of women today, as in the past, sex work is an occupation: often the only one available to them. While the occupational health of sex workers varies with the meanings, customs and context of sex work in their local environment, the degree of control they can exercise over their lives is the crucial determinant of their health status. Risks especially of violence and of sexually transmitted diseases, but also of infections and contagious conditions - are mediated not merely through customers but those who manage or orchestrate the circumstances of sex workers: brothel owners, pimps and police amongst them. Repressive legislation may drive the women away from health agencies and health interventions.
Only when there is a fuller recognition of what work women actually do and in what circumstances, will it be possible to examine their health profiles in the context of occupation. How much of the reported high level of respiratory disease among women in many developing countries is related to cooking practices, for instance? Where morbidity data are available, they may offer clues to potential occupational health hazards among women. However, in most third world countries mortality statistics alone offer an indirect and fragmentary indication of health status.
The limitations of mortality as an indicator of occupational health risk are well known. There may be considerable time gaps between exposure to the risk and any outcome in terms of disease and ultimately death. Early manifestations of illhealth may lead to a change of occupation. In the case of women, who move in and out of different occupations and the paid work force, the difficulty of identifying a causal relationship between occupation and health impairment is compounded. Longitudinal studies and record linkages are required for an improved understanding of any potentially fatal occupational health risks which women experience.
The effects on health of women's multiple roles are still poorly understood. Longitudinal studies could be valuable here too in disentangling the impact of different roles and responsibilities at different stages of the life-cycle. If much of the current literature on women and paid work, especially that concerned with mental health, is ambiguous or contradictory, it frequently reflects inadequate research design and an unjustifiable level of generalisation about women's lives.
Not all women undertake paid work, but few can escape household labour. What that labour involves varies with income, class and culture as well as across societies, but it is not immune from hazards. Because the home is such a basic feature of everybody's life the routine risks of homeworking are easily overlooked. They can be found, nevertheless, in such things as chemicals used for cleaning or the fuels for cooking. They can also be found in the isolation of many wives, especially those who have married into an unknown family or whose husbands leave home to find work. And they can be found in the domestic violence perpetrated by husbands or other family members - which many women face as they go about their daily tasks.
Those women whose husbands work away from home have been, additionally, at risk of introduced diseases especially sexually transmitted diseases. When women themselves migrate, it is often to badly-paid work in exploitative conditions; international migration may bring problems of isolation and stress, as well as difficulty in accessing health information in a new language.
Household labour also frequently involves caring for other family members: children, the sick and the elderly. Even where men share the caring function, it is usually the woman who is the primary carer, and she may suffer additional health risks. These may be physical (for instance, musculo-skeletal problems caused by lifting) or involve extreme tiredness, stress or depression. Women predominate, too, as paid carers healthworkers of different types - and encounter many of the same problems in that role.