Don't Just "Shrink It and Pink It"
Common PPE Challenges for Women
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Editor’s note: The mention of specific products or companies in this article does not constitute endorsement by the authors, AIHA®, or The Synergist®. Personal protective equipment is an integral part of every organization’s safety program. PPE should be supplied to workers when hazards cannot be mitigated through other control options. When selected and worn properly, PPE can be a valuable solution. Within an organization, PPE should never be an afterthought; in many circumstances, it is the last line of defense for protection against a hazard. Challenges arise when PPE solutions are not available for a certain group or when the PPE offered does not adequately account for the physical attributes of the individuals expected to wear it. Women in the workforce routinely face some of those challenges, but OEHS professionals can help by considering key questions when identifying, selecting, and offering PPE solutions for employees.
In honor of Women’s History Month, this article reflects on women in the workforce and their use of PPE. According to the U.S. Bureau of Labor Statistics, as of January 2022, women made up nearly half (47 percent) of employed workers over the age of 16, but they still appear to be underrepresented in many industries where safety and PPE are critical elements, such as manufacturing (29 percent), construction (11 percent), transportation (25 percent), and mining/quarrying/oil and gas (15 percent). Because of the relatively low percentages of women in these industries, resources for PPE may be lacking. Industries such as healthcare and retail that employ a relatively high percentage of women—78 percent and 49 percent, respectively—also require the use of PPE. Healthcare workers need respirators, lab coats, and gloves, and retail workers require foot protection. Proper selection and fit for employees in these industries is imperative for a safe working environment. The COVID-19 pandemic greatly increased the need for and importance of the use of PPE in the healthcare setting. When PPE does not fit the wearer correctly, it does not provide the protection it was designed to afford. But the need for additional PPE options was identified long before the pandemic. As one example, Saralyn Mark, MD, founder and president of iGIANT and the COVID-19 lead for the American Medical Women’s Association, observed during the 2014 Ebola outbreak that women were at risk of infection when the PPE did not fit them properly. WHY "SHRINK IT AND PINK IT" IS INEFFECTIVE At first, many PPE options targeted to women were merely smaller versions of men’s PPE or were offered in pink or purple, the stereotypical colors for women. Conversations with members of AIHA’s Women in IH volunteer group verified that the “shrink it and pink it” approach appeared to be a seemingly standard practice among many suppliers, vendors, and employers. What women in industry really want is safe, properly fitting protective equipment. To produce properly fitting PPE, manufacturers must recognize that the male and female bodies are anthropometrically different, says Anuja Patil, CPE, CSP, the risk control product consulting director for ergonomics at CNA Insurance. “When considering how to accommodate different body types for adjustments to PPE, one cannot just assume that a larger or smaller size will work,” Patil says. “Anthropometric data must be considered. For example, in the space of exoskeletons, designing a product that is larger in the chest-strap area will not solve for all women’s bodies. While women may need extra space to accommodate breast tissue, adjustments in torso length and width are also necessary.” These valuable insights should inform considerations of proper fit and functionality for all PPE solutions. Research shows that anthropometric data of the 50th percentile for men and the 50th percentile for women vary significantly for many body parts (see Table 1). In many instances, a woman’s body measurements may be different than the measurements in the table. Simply put, PPE is not, nor has it ever been, a one-size-fits-all solution. Advancements both in product selection and in program management are necessary to ensure a safe workplace for all.
Table 1. Selected Anthropometric Data for U.S. Adults, 50th Percentile. (Click or tap on the table to open a larger version in your browser.)
COMMON PPE CHALLENGES FOR WOMEN As explained below, different types of PPE represent different challenges for women. Clothing The Ebola outbreak illustrated that when protective clothing such as gowns does not fit properly, the result may be unintended exposures to hazards that the PPE was designed to protect against. This risk increased during the COVID-19 pandemic when more healthcare workers needed to wear protective clothing. Improperly-fitting protective clothing can also cause safety issues. Clothing that is too large can get caught in machinery or knock over hazardous chemicals. An accident in a lab is what motivated the chemist Beau Wangtrakuldee, who suffered a serious burn from a chemical spill, to found AmorSui, a company that designs and sells PPE for both women and men. Safety risks are also present in construction, manufacturing, and other industries where employees regularly interact with machinery while wearing protective clothing such as high-visibility vests. The need for protective undergarments for women is often overlooked. Some companies offer work bras that help protect from flying scraps and embers that could get under clothing.
Fire-Resistant Gear
NFPA 652, Standard on the Fundamentals of Combustible Dust, stipulates the use of flame-resistant or non-melting undergarments, when required by a formal risk assessment. While this standard notes that incidental elastic may be used, caution is necessary when elastic is a main component of the material. Due to the limited availability of FR-rated undergarments in the marketplace, it is possible that this requirement is not properly adhered to. Similar requirements are outlined in NFPA 70E, Electrical Workplace Safety, which states that arc-rated underwear or undergarments generally provide a higher system arc rating than non-melting, flammable fiber underwear or undergarments used as underlayers. According to NFPA 70E, clothing fibers such as acetate, nylon, polyester, and other fibers are not permitted in the fabric underlayers. This requirement can make it difficult to find undergarments such as bras that will offer support for the woman and protection against potential hazards. Footwear The differences in bone structure between women and men are particularly pronounced in their feet. Safety shoes that are too large can lead to tripping hazards, and those that don’t fit properly can lead to health issues such as blisters and back problems. According to one PPE provider, thirty percent of safety shoe wearers have one or more foot-related health problems. Most women confront limited options when purchasing safety shoes, especially those in smaller sizes.
Your organization's PPE policy is a good starting point to ensure adequate options have been provided for all employees.
Respirators The challenges with improperly fitted respiratory protection for women were exacerbated at the height of the pandemic, when shortages of N95 respirators left many healthcare providers with limited sizing selections. As reported in the April 17, 2020, edition of CDC’s Morbidity and Mortality Weekly Report, the vast majority (73 percent) of healthcare providers who contracted COVID-19 in the early stages of the pandemic were women, reflecting the high percentage of women in this industry. While a direct correlation between PPE fit and likelihood of contracting COVID-19 is difficult to determine, it remains that proper fit of respirators is necessary for protection from inhalation hazards.
Exoskeletons As the ergonomist Anuja Patil mentioned, proper fit is an element to consider when selecting exoskeletons. Proper fit is necessary for the exoskeleton to function, and its weight must be appropriate in relation to the strength of the individual donning the gear. Broadly speaking, women have less upper arm strength than men. Additionally, chest straps that restrict proper movement in the breast area may increase risks.
When evaluating and selecting PPE gear such as exoskeletons and personal fall arrest systems such as harnesses, full-body design principles should be considered.
Gloves Proper hand protection is critical for safety, especially when precision work is performed. Workers rely on properly fitted gloves to protect them from cuts, lacerations, and chemical contact with the skin. Gloves that fit too loosely may increase the risk of injuries resulting from material getting caught in machinery. Work quality may decrease when improper gloves are worn during work tasks.
Our research revealed a need for peer-reviewed articles about the effectiveness, including proper fit, of PPE for women. We also found that general consensus standards often do not acknowledge gender as part of their design process requirements. But despite the limits of research and available guidance, employers still have a duty to ensure PPE fit is acceptable for all users, according to OSHA’s PPE standard.
As manufacturers continue to expand their offerings to be more inclusive of women in the workforce, it is imperative that employers also take the opportunity to ensure their policies and practices accommodate the needs of all genders. Reviewing your organization’s PPE policy is a good starting point to ensure adequate options have been considered, reviewed, and provided for all current and prospective employees.
CONSIDERATIONS FOR YOUR PPE PROGRAM We’ve noted the relatively low percentage of women in industries such as oil and gas, construction, and manufacturing. However, many associations in these industries are attempting to shift the perception that these are male-only fields. One key element to attracting new talent, especially from traditionally underrepresented groups, is to ensure that your workplace strives toward equity and inclusion in all aspects of its operations, including the structure and implementation of safety programs. Employers with traditionally low employment of women may feel limited pressure to review and enhance policies, but this effort is important to attract and retain talent.
The following questions are intended to help you determine if your company or PPE program could be enhanced to accommodate all individuals.
Has your company identified the need for inclusive PPE selection options? Conduct an evaluation of your current PPE program to determine what you currently offer. Does it include a variety of options and sizes? If not, why not? Consider not only the needs of your current workforce but those of visitors and guests. Also consider what PPE is needed to attract prospective employees.
Has your company reviewed the PPE items required and ensured there are options for both men and women? In addition to evaluating your company’s current PPE options, also evaluate the process of identifying and selecting PPE. Has your company recognized the need to select and offer a broad range of size or fit options for workers? Do the sizes and options offered include selections for both men and women?
Does your company allow employees to try on different sizes of PPE before making a selection? Fit testing is standard practice for respiratory protection, but it is not commonly part of an overall PPE program. When working with suppliers, ask them for sample sizes, which will allow employees to choose the option that provides the best fit and comfort for their respective needs. You may need to utilize more than one manufacturer for a specified PPE item.
How do employees suggest improvements for PPE offerings? Employees may be hesitant to offer feedback on the PPE provided for fear of retaliation or concern that they will be perceived as difficult to manage. But receiving suggestions on PPE, including when the fit is not proper, should be an acceptable practice within all organizations. Management needs to be informed when PPE is not performing as intended, just as they are informed about unmanaged hazards.
Do your suppliers offer products for both men and women? Once you have evaluated your PPE needs and current offerings, check with your suppliers to learn what options are available. They should provide a variety of sizes, including selections for all genders. If they don’t, investigate other suppliers.
Have you asked your manufacturers for more inclusive options? While options for women-focused PPE solutions have increased over time, they still lag far behind the options offered for men. As purchasers, the more we can encourage manufacturers to offer PPE in various sizes, the better. Manufacturers will not make a product if there is no demand for it. A disservice is done when we don’t request the products we need. Inclusivity efforts put an onus on everyone to do their part, and employers should hold manufacturers accountable to provide those options.
Understanding the hazards unique to women in the industry and vendors who supply PPE modeled for women is only part of the equation. Employers, standards, and manufacturers of equipment, PPE, and other solution-based programs must continue to pave the way to a more inclusive environment that keeps all individuals safe, regardless of their gender, race, religion, or ability.
DIANA PERONI, CIH, is a senior environmental health, safety, and sustainability manager at BioMarin Pharmaceutical.
KATIE STRYKER, CIH, MS, is an assistant vice president of risk control at CNA Insurance.
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Disclaimer: The information, examples, and suggestions presented in this material have been developed from sources believed to be reliable, but they should not be construed as legal or other professional advice. CNA accepts no responsibility for the accuracy or completeness of this material and recommends the consultation with competent legal counsel and/or other professional advisors before applying this material in any particular factual situations. This material is for illustrative purposes only.
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More Choices in PPE
Some women-founded companies are paving the way toward accessibility in protective gear. A few of these companies include AmorSui, SeeHerWork, Seraphina Safety Apparel, and Xena Workwear.
In addition, many large suppliers such as KEEN Footwear and Bulwark continue to make headway in offering PPE solutions specifically for women in the workplace. A list of PPE providers is available from the AIHA Vendor Directory for OEHS Professionals.
American Medical Association: “Ill-Fitting PPE Contributes to Added Stress for Women Physicians” (September 2021).
Bureau of Labor Statistics: “Labor Force Statistics from the Current Population Survey” (January 2020).
CDC: Morbidity and Mortality Weekly Report, “Characteristics of Health Care Personnel with COVID-19—United States, February 12–April 9, 2020” (April 2020).
International Workplace: “Women Put at Risk by Ill-Fitting Safety Gear.”
La Medicina del Lavoro: “Personal Protective Equipment (PPE) Use and Its Relation to Accidents Among Construction Workers” (PDF, August 2020).
North Carolina State University: “Anthropometric Data for U.S. Adults (all dimensions in inches)” (PDF, 2020).
OSHA: Occupational Safety and Health Standards, Personal Protective Equipment.
Safety+Health: “Fitting PPE to Female Workers: How Are Women Represented When It Comes to PPE?” (March 2022).