WHO Library Cataloguing-in-Publication Data         boundaries. Dotted lines on maps represent                            ...
Acknowledgments     Acknowledgements                                ii   The project was led by the following WHO experts:...
Figure 1: Types of WorkAround the world, women are at adisadvantage compared to men in the variousspheres of society and, ...
Gender differences in paid work                   are, therefore, more likely to be victims of       exposed during applic...
domestic, unpaid work such as cooking,             particularly problematic when income is low         countries, girl chi...
Globalization                                    Informal and flexible                             (HPV), the cause of nea...
insecurity, isolation, racism, and physical and    Cultural norms – for instance, those that value   instance in Cambodia,...
Governments, employers and researchers            workers’ compensation benefits for                     on the basis of o...
Employers may want to:                                   designated spaces for breastfeeding or breast           women an...
ReferencesThis information sheet highlights key issues       1.   Messing K. One-eyed science:                       31-09...
Commission on Sustainable Development              indoor smoke. European Respiratory                 Medicine, 1999, 14:4...
Labour Office, 2010.                                 Self-reports of stress in Asian immigrants:         2005, 55:515–522....
Gender, work & health
Gender, work & health
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Gender, work & health

  1. 1. WHO Library Cataloguing-in-Publication Data boundaries. Dotted lines on maps represent approximate border lines for which there mayGender, work and health. not yet be full agreement.1.Women, Working. 2.Womens rights. The mention of specific companies or of certain3.Womens health. 4.Occupational health. manufacturers’ products does not imply thatI.World Health Organization. they are endorsed or recommended by the World Health Organization in preference toISBN 978 92 4 150172 9 others of a similar nature that are not mentioned. Errors and omissions excepted, the(NLM classification: WA 491) names of proprietary products are distinguished by initial capital letters.© World Health Organization 2011 All reasonable precautions have been taken byAll rights reserved. Publications of the World the World Health Organization to verify theHealth Organization are available on the WHO information contained in this publication.web site (www.who.int) or can be purchased However, the published material is beingfrom WHO Press, World Health Organization, 20 distributed without warranty of any kind, eitherAvenue Appia, 1211 Geneva 27, Switzerland (tel.: expressed or implied. The responsibility for the+41 22 791 3264; fax: +41 22 791 4857; e-mail: interpretation and use of the material lies withbookorders@who.int). the reader. In no event shall the World Health Organization be liable for damages arising fromRequests for permission to reproduce or its use.translate WHO publications – whether for sale orfor noncommercial distribution – should be Printed in Switzerland.addressed to WHO Press through the WHO website (http://www.who.int/about/licensing/copyright_form/en/index.html).The designations employed and the presentationof the material in this publication do not imply (INSIDE) COVER IMAGEthe expression of any opinion whatsoever on the Young woman on her way to the well,part of the World Health Organization Rwanda © ILOconcerning the legal status of any country,territory, city or area or of its authorities, or IMAGE(S), pp. 5-6, pp. 9-10, pp. 13-14, p.15concerning the delimitation of its frontiers or All Images © ILO
  2. 2. Acknowledgments Acknowledgements ii The project was led by the following WHO experts: Evelyn Kortum, Technical Officer, Occupational Health, Public Health & Environment, WHO, Geneva, Switzerland Introduction 01 Adepeju Olukoya, MD, Department of Gender, Women and Health, WHO, Geneva, Switzerland WHO would like to acknowledge the writer of this document, Stephanie Premji, Interdisciplinary Centre for the01 What do we know? 03 study of Biology, Health, Society and the Environment (CINBIOSE). Gender differences in paid work 03 Gender differences in unpaid work 04 We wish to thank the following reviewers: Child labour 05 Narimah Awin, Regional Adviser, Making Pregnancy Safer and Gender, Women and Reproductive Health, WHO Multiple social disadvantage 06 Western Pacific Region Biological differences between women and men 06 Leonor Alicia Cedillo B., Occupational and Environmental Health Consultant, Coyoacan, Mexico Valentina Forastieri, Coordinator, Health Promotion and Training Unit, SafeWork Programme, International Labour Organization, Geneva, Switzerland02 Changing work patterns 07 Monika Gehner, Public Relations Officer, Department of Gender, Women and Health, WHO, Geneva, Switzerland Lilia M. Jara, Adviser on Women in Health And Development, WHO Regional Office for the Americas, Globalization 07 Washington, USA Informal and flexible employment 07 Jatinder, Kishtwaria, Professor and Head, Family Resource Management, Faculty of Home Science, HP Migration 08 Agricultural University, Palampur, India Leon Matagi, Makerere University, Institute of Psychology, Kampala, Uganda, Africa Global economic crisis 09 Dingani Moyo, MD, Midlands Occupational & Travel Health Centre, Zimbabwe, Africa Hisashi Ogawa, Regional Adviser, Occupational Health, WHO Regional Office for the Western Pacific Region,03 Suggestions for action 11 Manila, Philippines Rita Ohene-Adjei, MD, Department of Occupational and Environmental Medicine, Yale University Occupational What governments can do 11 and Environmental Medicine, USA What employers can do 12 Elena Villalobos Prats, Associate Professional Officer, Department of Gender, Women and Health, WHO, Geneva, Switzerland What workers can do 13 Joanna Vogel, Technical Officer, Women in Health and Development, WHO Regional Office for the Eastern What researchers can do 14 Mediterranean Region, Cairo, Egypt. The National Institute for Occupational Safety and Health (NIOSH), United States of America, has part-funded Conclusion 15 this project. References 16
  3. 3. Figure 1: Types of WorkAround the world, women are at adisadvantage compared to men in the variousspheres of society and, as a result, their issueshave traditionally lacked visibility. Women’swork is no exception. Women’s workingconditions are less often researched, and their Unpaid Workassociated health problems less often For example, domesticdiagnosed and compensated for than men’s work, voluntary work in(1). This information sheet provides an the family or privateoverview of the differences and inequalities in businesses, often forcedwork and health between women and men, work. Informal Sectorand highlights issues of particular importance Work not usuallyto women. monitored by a government. Paid Work Child Labour IMAGE, RIGHT What constitutes child labour depends on the age of the Man and woman working in construction, child, the type of labour and the hours worked. Nepal © ILO
  4. 4. Gender differences in paid work are, therefore, more likely to be victims of exposed during application (13). Women and machine operators, for example, manipulate work-related accidents and death (6,7). Men men who have identical job titles may also light objects many thousand times a day, but are also more likely to be exposed to noise (8) perform different tasks exposing them to the fact that the objects are light often givesGlobally women make up 40% of the paid and, especially in developing countries, to different risks. For example, in some garment the false impression that the work is harmless.workforce (2). In developed countries, such as heat and solar radiation (9). Women are over- factories women cutters use scissors while In addition, in many countries data on work-the United States of America (USA), women represented in service sector jobs (e.g. as men cutters use cutting machines (14). related accidents and diseases are notnow account for nearly half of all workers (3) teachers, retail clerks and nurses) where they disaggregated by sex, making it difficult tobut, in many developing countries that face risks from violence and biological Women and men also face different assess priority areas of concern for womenproportion is much smaller. In Pakistan, for materials, and in low-wage manufacturing jobs psychological health risks in paid employment. and men.instance, women represent 21% of paid (e.g. as garment workers) where they are A study of over 10 000 employees in six Frenchworkers (4). This gender gap is gradually exposed to repetitive tasks, among others businesses between 2000 and 2007 showedshrinking as the share of women in paid work (10). that, partly because of differences in workingincreases and the share of men in paid work conditions, women were almost twice as likelydecreases (2). to report stress as men (15). Women’s jobs, often at the lowest hierarchical levels,Despite women’s increasing presence in paid commonly involve little decision-makingemployment, they continue to be under- autonomy and high psychological demands.represented in high-level and decision-making Women also face violence and harassment –positions and often face barriers to their including newer forms such as cyber-advancement (the “glass ceiling”). In addition, harassment – in their jobs, in education, andwomen on average continue to earn less than across social services and health care (16).men, even for the same job (5). Nevertheless, Even within the same sectors and jobs, Gender differences in unpaidwomen are progressively entering jobs thathave traditionally been done by men (e.g. in prevailing gender roles (e.g. women’s work In developing countries, women and men are expected subservience) make women morethe construction industry) but, despite this largely employed in agriculture where they are vulnerable to violence and harassment than Due to the gender division of labour, womentrend, women and men are still largely exposed to various risks including chemical men (17,18). and men play different roles in relation tosegregated into different types of work, with (e.g. pesticides) and biological hazards. Femaleimplications for their health. children, families and communities and this and male agricultural workers have different The nature of women’s work contributes to its also has implications for their health. Even patterns of pesticide use: women are more invisibility. The risks that women face at workMen are more likely than women to work with though women are increasingly joining the often exposed indirectly during planting and tend to be less dramatic than men’s but theyheavy equipment in sectors such as paid workforce, in most societies, they harvesting, whereas men are more often can be just as harmful to their health. Sewingconstruction, mining and transport, and they continue to be mainly responsible for
  5. 5. domestic, unpaid work such as cooking, particularly problematic when income is low countries, girl children are discriminated Biological differences betweencleaning and caring for children. They are also and there are no social services or child-care against from early on in life, for example, bylargely responsible for unpaid work as health support. In some cases, the lack of child care being denied an education, which leaves them women and mencarers of their elderly, disabled and ill means that women must take their children to more vulnerable to unemployment, low wagesrelatives. In African rural settings, as in many work where they too may be exposed to and hazardous working conditions. In addition to gender differences in workingparts of the world, women perform all hazardous environments (26). and living conditions, certain biologicaldomestic and care tasks while many also differences between the sexes can influence Multiple social disadvantage the responses to work-related risks. Men areassume men’s traditional role in paid Even though unpaid work is crucial foremployment. Women also comprise a large societies’ economic and social development, it on average taller, larger, heavier and stronger Depending on characteristics, such as age,proportion of unpaid family workers in is not well recognized and, therefore, not than women (32). Work equipment and tools ethnicity, socioeconomic status and sexualbusiness establishments owned by relatives included in labour statistics or public policies. that are designed for men’s bodies are often orientation, women and men face differentwho live in the same household as they do In addition, occupational health research has, unsuitable for women (33), resulting in injuries forms of social stigma and difficulties in life(20). up to now, largely focused on paid and illnesses amongst women who use them (28, 29). The co-existence of conditions of employment. This has limited our knowledge (34). This is particularly the case with work social disadvantage (i.e. multipleUnpaid work, just like paid work, is of the risks and health problems associated that has traditionally been done by men. Men disadvantage) is associated with moreaccompanied by health risks (e.g. respiratory with unpaid work. and women also have different reproductive hazardous working conditions, fewerproblems from biomass burning, systems that can be affected differently by opportunities for training and education,musculoskeletal or reproductive health workplace hazards. For example, exposure to Child labour reduced access to health services, exclusion chemicals and radiation may be related to aproblems from carrying heavy loads) (21). In from prevention and protection schemes, andmany developing countries water and fuel decline in fertility and to negative birth Worldwide, 246 million girls and boys are greater obstacles in defending their rights atcollection for domestic purposes represents a outcomes, such as stillbirths and birth defects involved in child labour, some 179 million of work. Multiple disadvantage is also associatedhuge burden for women. In Gujurat, India, (35, 36, 37). Additionally, there may be whom are exposed to conditions that with stressful life experiences, less favourablewomen spend, on average, from three to four differences in the metabolism of toxins by endanger their physical, mental or social well- living conditions (at home and in thehours every day collecting water (22). The women and men that may be modulated by being (27). Gender is an important community) and fewer opportunities forcombination of paid and unpaid work means sex differences in hormones (38). determinant of the risks and health problems positive health behaviours, all of which canthat work days are generally longer for women facing child labourers. Girls tend to perform combine with working conditions to affectthan men, especially in developing countries paid work in agriculture and personal services workers’ health (30,31).(23). Also, the very act of balancing while boys tend to work in manufacturing,responsibilities for paid and unpaid work often trade, hospitality and transport. Girls inleads to stress, depression and fatigue (24, developing countries also tend to perform25). This balancing of responsibilities is more household chores than boys. In many
  6. 6. Globalization Informal and flexible (HPV), the cause of nearly all cases of cervical Migration cancer (45,46), and human immunodeficiency employment virus (HIV) (47).Globalization, the process by which societies In the past few decades, conditions such asand economies are increasingly becoming labour market shortages in developing The globalization of production and the need Flexible employment arrangements areconnected and interdependent, has resulted countries have contributed to an increase in for cheap and flexible labour has led to an alternatives to the conventional working hoursin a shift in the production of industrial the migration of workers from countries with increase in workloads and to a rise in informal of 9:00–17:00 or a 40-hour working week.products from developed to developing limited economic opportunities to developed and flexible employment. These forms of work They are becoming more common andcountries. While this process has at times countries. In equal proportions, workers are are generally associated with a lack of job therefore increasingly regarded asbrought with it economic and social benefits, also migrating within developing or developed security and benefits; unhealthy working conventional. While some forms of flexibleit has also resulted in adverse working and countries (internal migration). Migration can conditions; a lack of training and information working arrangements can benefit workersliving conditions that negatively impact also be forced, such as in the trafficking of about work-related risks, health problems and when it is their choice, for instance, in the caseworkers, families and communities (39, 40, women and girls. Migrant workers tend to be opportunities for action; exclusion from legal of women choosing to work part-time in order41). Women make up the majority of workers employed in high-risk sectors; receive little protection; and greater difficulties balancing to better balance work and familyin many export processing zones (EPZs), areas work-related training and information; face paid and unpaid work. responsibilities, in most cases flexiblewhere trade barriers are eliminated and language and cultural barriers; lack protection arrangements benefit employers. Womenbureaucratic requirements are few. In these under the destination country’s labour laws; Governments do not generally monitor worldwide are over-represented in certainfactories, they often face low wages, poor and experience difficulties in adequately informal employment, which includes unpaid forms of unconventional employment, such asworking conditions and abusive labour accessing and using health services. Women work and most child labour. In developing part-time work (48), whereas men are over-relations. In northern Thailand and Uganda, as migrants represent nearly half of the total countries, the informal economy is generally a represented among own-account and shiftin many other countries, the social context of migrants in the world and their proportion is greater source of employment for women. workers (2).factory work in EPZs (e.g. sexual harassment, growing, especially in Asia (52). However, within the informal economy,family separation) has led to workers engaging women and men tend to perform different Specific health risks are associated within risky behaviours, such as substance abuse Men migrants often work as agricultural or work, exposing them to different risks. specific forms of employment. For example,and unprotected sex (42,43). In Honduras, the construction workers (53) while women often Outside of agriculture, men tend to work shift work has been linked to an increased risksocioeconomic precariousness experienced by work as domestic workers or caregivers. informally in the construction and transport of sleep disruption, gastrointestinal disorders,women sweatshop workers in the garment Agricultural workers face injury from industries, while women tend to participate in psychological health problems, breast andindustry has forced some of them to leave machinery, poisoning from chemicals, home-based work or street vending (44). colorectal cancer, and preterm delivery (49,their children unsupervised as they work 15 inadequate rest and abuse (e.g. discrimination Women are also predominantly involved in 50). Temporary employment has beenhours a day, seven days a week (26). from crew leaders, substandard housing, sex work which places them at risk of various associated with increased deaths among both violence, etc.). Domestic workers experience health problems such as sexually transmitted female and male employees caused by alcohol lack of control over their conditions, job infections, including human papillomavirus consumption and smoking (51).
  7. 7. insecurity, isolation, racism, and physical and Cultural norms – for instance, those that value instance in Cambodia, in the garment industry an expansion of the informal sector resultingpsychological abuse (54–59). There are also a subordinate role for women – and family where 90% of workers are women, 30 000 in increased work-related accidents andother health impacts of economic migration. responsibilities can hinder women’s access to jobs have been lost since the crisis began in diseases.Migration has been associated with women’s language and professional training, thus 2008 (66). There are growing concerns thatreliance on risky survivalist activities such as limiting their possibilities for social and the economic slowdown will lead to ansex work (60), as reflected in the increase in economic integration. Cultural norms relating increase in job insecurity and workHIV infection among migrant workers in to how women communicate in the workplace intensification (i.e. enterprises employingvarious countries (52). The impact of with superiors can also result in women not fewer workers to do the same amount ofmigration on health can also reach beyond the standing up against poor conditions or other work); compromises in health and safety; andworker. Currently, the increasing migration of difficulties (28). They are vulnerable to thenurses (the large majority of whom are whims of employers, especially where therewomen) leaving their home countries in are no protective laws in place. Lack ofsearch of better conditions for themselves and knowledge of the language of the host countrytheir families has given rise to concerns about compounds these problems. IMAGE, BELOWthe negative impact of this trend on health Workers in an office meeting, Egypt © ILOsystems in the home countries (61). Global economic crisisInternational migration is on the rise. Both The recent global economic crisis has resultedwomen and men experience a worsening of in a slowing down of migration (includingworking conditions and health status following emigration or immigration) and has had aimmigration (62, 63). However, immigrant devastating impact on workers causing highwomen are often relegated to jobs at the levels of unemployment, underemploymentlower end of the social scale (e.g. as cleaners and job insecurity. Examples of theand garment workers). There they are consequences include an increase in theexposed to hazardous physical and number of working poor and a decrease inpsychological working conditions, lack work- remittances sent to home countries, especiallyrelated training and protective equipment, to developing countries (65). Job lossesand are discouraged from defending their initially affected traditional male domains inrights, for example, by dissuasive actions such developed countries in the financial,as being coerced into undergoing illegal drug manufacturing and construction sectors andtesting (64). later women’s domains around the world. For
  8. 8. Governments, employers and researchers workers’ compensation benefits for on the basis of occupation, migration through policies that favour the recognitionneed to consider the differential pattern of psychological problems or musculoskeletal (including emigration or immigration) status, of previously acquired qualifications and theoccupational risk exposure of women and men disorders (more common among women) are employment relationship or nature of the acquisition of the destination country’sin order to address their specific work-related sometimes excluded from the purview of the health problem; official language, and promote and ensureissues. Because of the nature of the work- law causing systemic discrimination (69).  extend labour laws to informal male and their access to health services;related risks women face – often less dramatic female workers and ensure their enforcement  ensure that legislation, programmes and– they should ensure that they do not In some contexts, labour laws have been in both the formal and informal sectors, policies identify the different vulnerabilities including in private homes; and needs of women and men workersoverlook the hazards and health problems extended to protect certain categories of  value unpaid work by assessing the through gender-based analysis and ensurethat are common in women’s jobs. workers such as migrant workers, domestic contribution of women’s and men’s unpaid that those needs are addressed (70). workers and informal workers, but there are labour, including health-care work in theWhat governments can do considerable gaps worldwide. Even when context of the broader health system, while workers benefit from the protection of the What employers can do developing policies to support unpaid law, enforcement (e.g. labour inspections) caregivers;Occupational health policy and legislation that may be problematic for work that is informal Employers may overlook the risks and healthexplicitly relate to gender equality are in two  adopt or expand legislation on maternity, or performed in private homes. Lack of paternity and child-care leave (including problems associated with women’s jobs sincebroad categories: (1) the treatment of legislative protection is often made worse by occasional leave for emergencies and health- they are often less obvious than men’s. Indifferences due to sex/biology, such as in the gaps in health and social services (e.g. child- care seeking), and leave due to the prolonged many workplaces, workers’ education andprotection of pregnant and breastfeeding care services), especially in developing illness of a family member; training programmes on occupational healthworkers; and (2) the mechanisms for handling countries, in rural areas, and among minorities  facilitate work-family balance through public and safety are lacking or inadequate,discrimination, including sexual harassment. and other vulnerable groups. programmes (e.g. provide affordable child- especially among women (71), and inAlthough many countries have legislation in care services in and out of the workplace, developing countries (72). Also, women oftenplace to protect pregnant or breastfeeding Accordingly, governments may opt to: open clinics after working hours to allow lack the control and authority to positivelywomen (67) and to protect women from workers to seek medical care for themselves impact their working conditions since they aresexual harassment (68), many still lack such or their children);  extend labour legislation to all female and less likely to be in decision-making positions aslegislation. For instance, in a number of  while addressing the economic realities that male workers and guarantee minimum labour supervisors or managers. For instance, womenmaquiladoras (export assembly plants) in perpetuate child labour, ensure that working standards, anti-discrimination, occupational cashiers in North America are often reluctantMexico, pregnant workers are required to girls and boys have their different health safety and health (including protection from to ask for a seat as it could threaten theirobtain permission to use the restroom, which vulnerabilities addressed and avenues for occupational reproductive health hazards employment relationship (73, 74).can be refused. The application of seemingly without restricting women’s access to jobs), their schooling pursued;gender-neutral labour legislation may have compensation in the case of injury or illness,  with particular focus on women workers,unintentional discriminatory effects. For and access to and quality of care; promote the economic and social integrationexample, in many countries, claims for  such legislation should be without exclusion of immigrant workers in the host society
  9. 9. Employers may want to: designated spaces for breastfeeding or breast  women and men should develop and Researchers may wish to focus on: -milk pumping; participate in capacity-building initiatives (in ensure that legislation covering labour, health  provide health/medical and counseling the workplace or community) that aim to  the health and safety issues present in and equity is respected; services at the workplace that are gender- ameliorate their working and living conditions informal and flexible employment and in identify and alleviate the risks in jobs sensitive; through education as well as advocacy for domestic (paid and unpaid) work; traditionally reserved for women and men  ensure that workplace initiatives involve the policy/legislative change.  the physical and mental health of unpaid including known or suspected risks to male participation of both women and men in health caregivers in diverse levels of intensive and female reproductive health while order to address their concerns in a manner care; What researchers can do ensuring that women’s access to jobs is not that is equitable and promotes equality (77–  the role of migration and emigration or restricted; 79); immigration in shaping women’s and men’s Although researchers have paid increasing increase proactive initiatives, for instance, in  build relationships with governments, occupational health experiences; attention to women workers’ experiences in ergonomic design and in the use of workers’ compensation boards, physicians,  the role of socio-demographic characteristics unions, community organizations and recent years, given the importance of ergonomically sound implements, without (e.g. gender, ethnicity, income, etc.) as workers having to ask for modifications; researchers in order to develop or introduce differences in women’s and men’s determinants of occupational health tackle workplace violence while taking all health and safety programmes into the occupational health, there is a need for experiences; incidents of violence and injury seriously, workplace. additional research on the risks and health  the impact of new technologies on health, including when the assault is verbal and when problems facing women workers within and including on reproductive health; the injury is psychological; What workers can do across occupations, and for more gender-  the role of cumulative exposures at work, at increase the systematic education and sensitive occupational health research in home and in the community in determining training of workers on specific occupational general. There is a particular need for high- the health outcomes for women and men of In many parts of the world, workers, especially risks (75), and of managers and supervisors quality research to be conducted in different social groups; women, have limited power to improve their on work-family balance, workplace violence, developing countries. The research should  the impact of occupational health problems working and living conditions. Unions or, more and other health and safety issues from a have strong epidemiological, biological and (e.g. health, social, economic, etc.) on men gender perspective; generally, collective action, have been and women. social components since these are essential to establish work arrangements that facilitate important guarantors of health and safety, the understanding of gender issues in work-family balance (e.g. formal variable and access to compensation. Access to occupational health. Workers should be given work schedule arrangements (flexitime), self- unionization should therefore be regulated. In an active role in the research, through a scheduling, options for periodic unscheduled addition: participatory research process (80), to ensure leave, etc.) and foster a work culture that is that it is being undertaken in accordance with supportive of family responsibilities (76);  unions should ensure that women participate their needs and interests. set up workplace day care for children during meaningfully at all levels in health and safety working hours and after school as well as activities and should create structures to facilitate their participation in union activities;
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