Introduction
The 1948 Universal Declaration of Human Rights recognizes the right of all people to just and favourable conditions of work. Unfortunately, work-related accidents and diseases continue to be a serious problem in both industrialized and developing countries. The ILO estimates that 250 million workplace accidents take place every year, with at least 335,000 fatalities. Further avoidable suffering is caused by 160 million cases of occupational diseases, and by an even higher number of threats to workers' physical and mental well-being. Taking accidents and diseases together, the global estimate of work-related deaths amounts to 1.1 million per year, and even this figure is considered to be a gross underestimate. The economic losses are enormous and, in terms of shattered families and communities, the damage is incalculable (1).
Although figures are not available for the gender breakdown of the above stated statistics, it is safe to assume that many women workers continue to suffer the worst abuses due to stress, manual handling, repetitive strain injuries as well as violence and sexual harassment at work. The situation is even more worrisome in this era of globalization, when companies and countries often start cutting hidden costs such as health and safety, and women often pay the greatest price.
Background
Participation of women in formal employment has increased quite significantly in addition to their traditional smallholder farming and informal sector employment activities. The majority in the female labour force are both mothers and housewives, hence they carry a heavy burden with serious repercussions on their health. Many of these women are in the lower echelons of their employment ranks, and consequently not in a position to influence policy decisions aimed at promoting their welfare. In addition, their numerical inferiority at work results in the neglect of the special health and safety needs of women.
ILO statistics indicate that in 1950 women accounted for 31.3 per cent of the world labour force; in 1975 they accounted for 35.0 per cent and in the year 2000 they are expected to account for about 44.5 per cent. The world total of economically active women now numbers 828 million and at least another 10 to 20 percent of the world's women are economically productive but not counted as part of the labour force because of inadequate measurement system. The reasons for this growing number of working women lies not only in the fact that women want remunerable jobs in order to support themselves and their families, but also that women all over the world want and indeed are beginning to demand active participation in every aspect of economic life. This trend has brought them a new sense of identity and a much valued network of relationships beyond the domestic field. The benefits include an improved standard of living and greater financial independence. Unfortunately, despite their increased number in the labour force, far less is known about women's occupational health than about men's (2).
Specific health problems and needs surround women at work, most especially in occupations where female employment is high, such as agriculture (where women produce 60-80 per cent of the supply of basic foodstuff in Sub-Saharan Africa); food and textile industries and in service sectors. Workers (both men and women) at these workplaces are exposed to hazards including noise, pesticides in the course of formulation and use and various chemicals which may have deleterious effects on their health, affecting fertility and pregnancy outcomes in women.
Cosmetologists (beauticians and hairdressers) tend to be mostly women. They are exposed to numerous reactive chemicals that may irritate and/or sensitize the skin and mucous membranes. Studies indicate an increased risk of asthma as well as eczema amongst hairdressers (3). Cosmetologists are also susceptible to a special kind of pulmonary disease called "thesaurosis" as a result of their frequent exposures to hair spray. Hospital workers including nurses and radiographers are continuously exposed to radioactive substances which are potentially hazardous especially to pregnant women, as they can cause either miscarriages or abnormal foetuses. All the problems highlighted above relate specifically to the occupational health of women workers worldwide.
Types and features of women's work
Women face a dual burden of household and productive work which is often heavy, monotonous, ergonomically inappropriate, and involves little control over the job. Women in rural areas spend most of their time meeting the basic needs of the family, such as fetching water and firewood, preparation of food and caring for dependants. They are usually the last to go to bed and the first to rise. Women also spend a significant amount of time engaging in informal trading, selling surplus produce and their own handicrafts to supplement the family income.
In Great Britain (an example of an industrialized country) the labour force survey for Spring 1995 indicates that the vast majority of women (85 per cent) work in service industries: health - where 81 per cent of workers are women, education has 69 per cent, hotels and catering has 61 per cent, and retail trade has 59 per cent. Only 13 per cent of women work in the manufacturing and construction industries compared with 36 per cent of men. But in clothing manufacturing 73 per cent of workers are women. Overall, 70 per cent of women work in non-manual occupations (4).
Women tend to be concentrated in low-paid, low-status jobs. In many of the developing countries, women are employed in industries as unskilled or semi-skilled workers, or as seasonal employees, particularly in the food, clothing and textile industries. They have little chance of promotion. Women are often the victims of the piece wage in agriculture, whereby they are brought in to supplement low family wages as contract labour and are sometimes not even recognized as working, but simply help their husbands complete piece tasks (5). They lack employment contracts, are not covered by any protective legislation in terms of working conditions/ environment and are not considered for employment or post employment benefits, such as pensions.
Hours of work
Working time is one of the most essential aspects of conditions of work. The level of hours of work and the way those hours are organized can influence, among others, occupational safety and health, the level of earnings, and the amount of time for rest and leisure. Various studies have shown that women work harder and longer. A woman's workday is long and arduous. Studies in Africa reveal that women work between 16 and 18 hours a day, especially in the rural areas where 65 to 70 per cent of women still reside. The women workers at the NOIDA Export Processing Zone outside Delhi, start their day at 5 a.m. and return from work to attend to household chores, which go on until 11 p.m. (6). This situation is not confined to the third world alone. A study in the United States of America found that the percentage of working women holding two or more paid jobs increased from 2.2 per cent in 1970 to 5.9 per cent in 1989, while that of men holding two jobs decreased by 0.6 per cent (7).
Some traditionally female professions such as nursing, often involve rotating shifts. Irregular working hours, especially rotating shifts, may disturb normal body functions. Moreover, women shift workers may have to face stressful living conditions in relation to the time pressures determined by the irregular work schedules and their additional domestic duties, particularly for those married with children. Some forms of shift work have also been associated with early foetal loss (8). It is evident therefore that while the entry of women into the labour force has changed traditional gender roles and has provided women with greater economic opportunities, it has unfortunately led to decreased rest time which could result in negative psychosocial impact.
Occupational/work-related hazards and health consequences
Reproductive hazards
Ionizing radiation from X-rays, to which health workers are exposed, can result in foetal deformity in the earliest weeks of pregnancy, sometimes before the woman herself realizes that she is pregnant. Exposure to biological hazards such as rubella and toxoplasma, which can be contacted through hospital and domestic work, endangers both the mother and child's health. Women workers are also exposed to myriad toxic substances during pregnancy with terrible health and pregnancy outcomes. Anaesthetic gases e.g halothane have been implicated in abortions in exposed health workers. Pesticides in the course of their formulation and use have been shown to produce abnormal foetal development, while lead, used in paint, battery, printing and welding industries, have also been implicated in mutations resulting in deformities in children.
Formaldehyde (used in textile, paper and ink industries and in laboratories), perchloroethylene (used as a dry cleaning agent) and metals such as mercury, copper and cadmium have all been found to be risk factors in a range of reproductive problems, from menstrual disorders, decreases in fertility, deformity and brain damage in children, miscarriage, still births and spontaneous abortion. Clearly the list of reproductive hazards is endless because many chemical effects have not been detected as several thousand new chemicals enter the market every year and the majority of them have not been tested for their health effects. In addition, the effects may take years to manifest themselves. For example, exposure to the drug diethylstilboestrol only produced its effects-cervical cancer, in the succeeding female generation about forty years later. Given poor screening for diseases such as cervical cancer in the developing countries, these health problems may remain undetected although commonly suffered (9).
Ergonomic hazards
Manual handling is one of the most common causes of injury (especially back injury) at work. It can be caused by carrying heavy weights such as boxes and equipment, and from lifting hospital patients (one of the daily duties of nurses), and any work that involves lowering, pushing, pulling, carrying or moving loads by hand or by bodily force. If these operations are not carried out safely they can result in injuries to the back, hands, arms and feet. Much of the equipment and machines in use at workplaces have been designed for men and are not readily adaptable to the physique and physiology of women, hence often results in musculoskeletal disorders for women. It is suggested that because of the perceived differences in physical capabilities between men and women, women employees are advised not to lift the same weight as their male counterparts without prior specific individual assessment being carried out.
Psychosocial hazards
A number of surveys and an ILO report on "Preventing Stress at Work" have indicated that stress affects working women more than men. Several factors seem to magnify the impact of stress on women, such as the fact that women are often less paid than men; and many organizations lack policies that allow for family responsibilities, and that the types of occupations performed by women may have characteristics which account for stress at work - high job demands and low worker control over the job and work organization. Teachers and nurses who have responsibilities for the health, welfare and well-being of others, have been identified as being particularly at risk of stress.
Sexual harassment has been described as the most common and least discussed occupational health hazard for women. It can cause depression, fatigue, headaches, sleeplessness, hostility, inability to concentrate and deterioration of personal relationships. Studies have shown that an estimated 50 per cent of women will experience sexual harassment at some time during their working lives (4). Women are far more likely to experience sexual harassment than men, partly because of the status and role of women in society, but also because of their status and role in the workplace. It thrives in an atmosphere where one individual has power or authority over another.
Other hazards or related factors
Nutrition is particularly important both generally and in relation to work: "good nutrition not only contributes to the greater welfare and happiness of mankind but also enables people to work and produce more. Acute or chronic under-nutrition has been found to be an insidious factor in the causes of occupational accidents, and has been classified among the factors which may cause fatigue and lessen concentration. Due to the multiple roles of women in society, they have special nutritional needs and health care requirements, but unfortunately they often have less of both. Nutritional anaemia, as a result of a poor economic situation coupled with repeated pregnancies, and abortions was the root cause of health problems of women workers at the NOIDA Export Processing Zone in India (6). Their own under-nutrition meant that their foetuses were inadequately nourished, producing low birth weight babies who were more at risk of death and diseases.
The role of climate in working conditions is often underestimated. This aspect is of particular importance in relation to working time and schedules, nutrition and occupational safety and health (10). In Africa, 60-80 per cent of all food farming is done by women (11). Many of them also work in commercial agricultural plantations. They perform physical work such as harvesting of sugar cane or weeding, in hot conditions which raises their body temperature. Working in such an environment could result in heat stress which places extra load on the heart, already stressed if the worker is pregnant, with disastrous health consequences.
It must be emphasized that the above description of exposure to occupational hazards by women workers does not mean that men do not suffer under the same conditions, nor that the special risks to women should be used as a means of excluding them from certain forms of labour. Indeed, many of these problems are faced by the working population as a whole, both male and female. However, the role of women in childbirth implies that these risks require attention for their additional effects on future generations. As explained earlier, because of women's common role as casual, unskilled labour, they are often exposed to the most risky working conditions, with the lowest levels of protection.
Strategies for enhancing women's health at work
The occupational health of women workers as presented indicates that it has not received the priority attention it deserves, hence a meaningful programme of action should be put in place. The following strategies are proposed for the improvement in the health of workers in general, and women workers in particular.
Occupational Safety and Health Policy
Health and safety at work are important matters that relate to the general health and well-being of working people and should be given an adequate consideration in policies at all levels, e.g. enterprise, national and international. Furthermore, articulation of a national policy on Occupational Safety and Health (OSH) is intended to reaffirm the government's commitment to the cause for a safe working environment for all workers in general and women workers in particular. It will also enable it to comply with its international as well as its moral obligation, and to promote action through a unified, coherent and purposeful statement of goals and strategies.
In order to be effective and equitable, the policy should take cognizance of the three key roles of women namely housewives, mothers and workers and the effect on health of each role should be critically reviewed separately with the view to examining and rectifying the potential conflicts and contradictions. A broad strategy for the improvement of women workers' health has to be built up within a national policy on OSH, with particular emphasis being placed on those areas of employment where women are concentrated e.g. nursing, education, garment and food industries. The aims of the policy should be the prevention of accidents and diseases and injury to health which arise or are linked with or occur during the course of work (12).
Policy and action should also be developed at enterprise level to ensure adequate adherence to the principles of national policy and to ensure its implementation. Specific programmes to ensure that the health and social welfare needs of women workers are taken into consideration should be reflected in the overall planning of the enterprise programme.
Protective legislation
The ILO Resolution on Equal Opportunities and Equal Treatment for Men and Women in Employment passed in Geneva in June 1985, discusses the protective legislation relating to working conditions, occupational safety and health amongst others and stated that:
women and men should be protected from risks inherent in their employment and occupation in the light of advances in scientific and technological knowledge;
measures should be taken to review all protective legislation applying to women in light of up-to-date scientific knowledge and technological changes and to revise, or repeal such legislation according to the national circumstances, these measures being aimed at the improvement of the quality of life and at promoting equality in employment between men and women;
measures should be taken to extend special protection to women and men for types of work proved to be harmful for them, particularly from the standpoint of their social function of reproduction, and such measures should be reviewed and brought up to date periodically in the light of advances in scientific and technological knowledge.
Individual countries have put in place protective legislation out of concern for women workers' health, safety and welfare and/or in compliance with an international treaty. Such measures include prohibition of night work, underground work and other activities which are considered harmful to women's reproductive health. For example, the labour law in China stipulates that "All units shall, in view of women's characteristics, protect women's safety and health during work or physical labour in accordance with the law, and shall not assign women to engage in work or physical labour that is not suitable to them. "(13).
Unfortunately, such measures have been called into question in the recent past because they have not only reduced women's opportunities/access to employment, but have also excluded women from hazardous occupations rather than eliminating the risk from the work environment for the protection of all workers. Protective legislation should therefore be monitored and enforced rigorously so as to avoid its misuse.
Occupational health services
There is a need to organize properly functioning and competent occupational health services for all workers to ensure healthy and safe workplaces as well as the requisite services for each individual worker (14). Such a service should take cognizance of the special needs and health requirements of women workers especially those in rural agriculture, the informal sector and other workplaces employing a large number of women e.g. Export Processing Zones. The service should be comprehensive and based on the primary health care approach, which is anchored on the principles of prevention, protection and health promotion.
Training, education and information
Competent occupational health and safety activities require appropriate training. The awareness, knowledge and skill of workers and the self-employed are key factors for appropriate safety and health behaviour and for adopting safe working practices. Women workers in the agricultural and informal sectors as well as the selfemployed could benefit from the ILO innovative training methodology, called Work Improvements in Small Enterprises (WISE), which is based on the concept of health linked to productivity. This approach is practical, voluntary and result-oriented, and employers and workers participate directly in improving the working conditions and environment. The WISE training programme will provide the basic principles of occupational health and safety for workers who need such knowledge in their every day work, and for employers who decide on the organization of work and other working conditions.
Efforts should be intensified to enrol more women in institutions for the training of health and safety officers, so as to empower women in such discipline. Women's participation at both national and international seminars/workshops and conferences on occupational health and safety should be encouraged. This forum allows for exchange of ideas, which could broaden their knowledge and information pertaining to occupational safety and health activities.
Improved data collection and statistics
One of the drawbacks to the improvement of occupational health and safety of women workers is inadequate or inaccurate statistics. One fifth of the world's women are economically productive but are not counted because of inadequate measurement. Therefore the method of data collection for national statistics on occupational health must be improved, especially the workplace coverage so as to highlight traditional areas of female employment. Other key areas that should be reflected include statistics of occupational accidents, injuries and diseases and compensation as well as sickness absence. This will help with the development of a national information strategy which would include dissemination of complete information on occupational safety and health of women workers. Such action could aid the development of national standards and guidelines regarding specific hazards faced by women workers.
The ILO global programme on safety, health and environment "SAFEWORK" devotes a section on the development of a major global statistical programme, particularly on hazardous occupations and sectors. This will develop methodologies for the collection and analysis of statistics on occupational accidents and diseases, which could overcome some of the existing problems regarding data on women workers.
Conclusion
This paper outlines the situation of women workers regarding occupational health. It presents an overwhelming evidence that women workers suffer from inaccurate statistics, inadequate health care, legislation and policy that could have protected them from adverse working conditions and environment in view of their reproductive role. This is not in consonant with the 1948 Universal Declaration of Human Rights which recognizes the right of all people to just and favourable conditions of work. The occupational health and safety situation of women workers therefore deserves an immediate attention.
In an effort to escape poverty and to make a living in conditions of rising inflation, many women workers especially those in the EPZ, give little importance to their health, especially reproductive health rights. For the poorest and most disenfranchised among them, sexual or reproductive or any other rights are meaningless without an enabling environment, e.g. protective legislation, implementable policy and programme, and political commitment. These conditions constitute social rights and involve social protection, personal security and political freedom. The provision of an enabling environment is also essential to the democratic transformation of societies in order to abolish gender or class injustice.
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Dr. Benjamin O. Alli
Senior Specialist, Occupational Health and Gender Focal Point
Occupational Safety and Health Branch
International Labour Organisation
Geneva, Switzerland
E-mail: alli@ilo.org
Asian-Pacific Newsletter 2/1999 p.29-33