(Aruna Dewan)

Occupational and Environmental Health of Women

In 1973, WHO defined the Scope and Extent of Occupational Health Programmes as follows:

  1. To identify and bring under control at the workplace all chemical, physical, mechanical, biological and psychological agents that are known to be or suspected to be hazardous.
  2. To ensure that physical and mental demands imposed on people at work by their respective jobs are properly matched with their individual technical, physiological and psychological capabilities, needs and limitations.
  3. To provide effective measures to protect those who are especially vulnerable to adverse working conditions and also to raise their level of resistance.
  4. To discover and improve work situations that may contribute to the ill health of workers in order to ensure that burden of general illness in different occupational groups is not increased over the community level.
  5. To educate management and workers to fulfil their responsibilities relevant to health protection and promotion.
  6. To carry out in plant health programmes, dealing with man’s total health, which will assist public health authorities to raise the level of community health.

Even after 25 years, such programmes have benefited only a minuscule of women workers in developing countries. Approximately 2.5 billion persons work worldwide and only 15 percent ofthe workforce live in what may be called as rich or high income countries. The pattern of employment in different countries is vastly different. In poor countries, 61% of the labor force are in agriculture, 29% in middle income countries and 4% in rich countries.

Developed countries have almost stable populations, which enjoy good health, living and working environments. The occupational health services and legislation provide a wide safety network for their workers.On the other hand, in poor countries occupational health receives a low priority, due to various reasons such as : (a) failure to recognize occupational health as a need; (b) inadequate resources; and (c ) large unemployed work force which can replace persons afflicted with occupational/or other diseases. Under such circumstances, occupational health of women workers in poor countries becomes the last priority.

Women and work

It is a fact that all women work. They perform dual roles of production and reproduction. Their work goes unrecognized because they do a variety of jobs daily which does not fit into any specific ‘occupation’. Most of them are involved in arduous household work. Although women work for longer hours and contribute substantially to family income, they are not perceived as workers by either the women themselves or data collecting agencies and the government. To understand the issue of occupational health problems of women, it is necessary to make a detailed study of the women’s work in terms of the actual activity undertaken, the hours of work and the extent of remuneration received.

The so-called housewife is already doing a single shift. If a woman also works outside home, she is consistently working a double shift. When children or family members are ill, she does three shifts day after day. On an average, women work much longer hours than men. According to International Labour Organization (ILO), 2/3rd of the working hours around the world are worked by women because of the combination of various roles in the workplace, in the family and in the society. Most often, the women’s work remains invisible but it contributes a major portion to the world economy.

Pattern of employment for women

The pattern of employment of women is very different among different countries: In developed countries, most of the women are employed in white collar jobs or as semiskilled operatives in manufacturing industries. In USA in 1975, there were 37 million women workers (46.3% of all women) and in 1995 this figure is around 60%. In India on the other hand, according to 1981 census, workforce participation by females was barely 15% (main workers) as against 51.6% amongst males. According to the 1991 census, the participation of female workers has increased to 16.03 % (main workers) In addition, 6.24% of females have been shown as marginal workers and the remaining women (305.2 million) are shown as a non working population (Indian Labor Statistics, 1994, Labour Bureau, Ministry of Labour, Shimla (1996). The 1991 census also shows that of these 16.03% main women workers, 80.8% are employed in agriculture, 3.5 % in house hold industries, 4% in other industries, 0.3% in mining and quarrying, 0.6 % as construction workers and only 10.8% in other services.

However, there is gross underestimation of women’s work in this data. Almost 30-40% of non-working women are actually marginal workers. A large number of these marginal women workers are engaged in occupations in order to supplement family income in various ways such as, collection of firewood and cow dung, maintenance of kitchen gardens, tailoring, weaving and teaching. Moreover inadequate attention has been paid to ‘unpaid family labour’ and household work.

In India, most of the working women are employed in the unorganized sector, which includes agricultural labourers, workers in traditional village and cottage industries, migrants to the cities in domestic service, day labourers, street vendors,etc.In agriculture, the most important occupation in developing countries, women play an important role in agricultural production, animal husbandry and other related activities such as storage and marketing of produce, food processing etc. Apart from these activities, they spend almost 10-12 hours per day doing household chores.

Special problems affecting occupational health of women in developing countries.

Even in countries like Sweden, which is looked upon as a role model in nearly all aspects of the well-being of mankind, Monica Boethius, who heads the Swedish Work Environment Fund’s equality programme, writes: “Despite decades of campaigning for equality, women still earn less than men, have less chance of promotion, often given work not up to their qualifications and are more exposed to health
hazards than men.”

It is an unequal world, more so for the women workers in
developing countries who stand very little chance of equality.

A number of factors are intricately related which ultimately affect the total health of working women in developing countries.

Population: In developing and overpopulated countries like India, poor working women are at a great disadvantage as due to availability of excess labour, there is always job insecurity. Introduction of newer technologies often adversely affects unskilled women workers who are the first to suffer loss of job.

Poverty, illiteracy, malnutrition and infectious diseases: Women workers of many developing countries are caught in the vicious cycle of low productivity, low income, undernutrition and infectious diseases leading to lower work capacity. Low literacy level, poor sanitation and lack of public amenities further contribute to ill health.

Sociocultural beliefs: In many communities in India birth of a girl child is unwelcome and women submit to multiple pregnancies till a male child is born. This adversely affects the health of the mother and reduces her working capacity besides posing the extra load of caring for a large family. The status of women in a society is largely affected by its cultural beliefs. In India, obedience to and dependence on men (father, husband and son) is considered traditional and scared. This often culminates in the girl child getting minimum nutrition, poor education and poor access to health care facilities.

All factors mentioned above have a direct or indirect bearing on the occupational health of women. In India, it is not considered appropriate for women to work outside home for wages but past few decades have seen more and more women working outside home for economic necessities.

Occupational health problems of women as seen from a gender perspective

Basically hazards posed by physical, chemical and biological agents in work place are similar for male and female workers but the following factors have to be remembered for women workers.

Women on an average, have a smaller stature and have less physical strength; their vital capacity is 11% less; their hemoglobin is app. 20% less; their skin area is larger as compared to circulating volume; they have larger body fat content. They have lower heat tolerance and greater cold tolerance.

Woman’s unique reproductive function exposes her unborn child to workplace hazards. Women shoulder additional burden of house hold work, care of children and social responsibilities.

Occupational stress is one of the major problems from a gender perspective. Studies from developed countries show that sources of stress in women’s lives are more diverse and diffuse than those experienced by men. A number of factors cause stress among working women. These include:

  1. Multiple overlapping roles as housewives, mothers and workers especially when such roles are physically and mentally demanding with little satisfaction, monetary gain or social rewards;
  2. Types of job repetitive and monotonous jobs with little control over work pace and methods, piece rate system and job insecurity all lead to stress;
  3. Sexual harassment: This is often faced by women in almost all types of occupations except when they occupy top level jobs. It is widely believed that employers show a preference for women only when they are prepared to accept lower wages, are expected to be more docile and submissive;
  4. Shift work: In certain occupations, such as telephone operators who do different shifts including night shifts, interference with family responsibilities causes lot of stress.

Musculo-skeletal disorders and ergonomic issues: The heavy manual labour performed by malnourished women often under subhuman working and living conditions, cause a number of health problems of which musculoskeletal problems are one of the commonest problems of women in unorganized sector.. Repetitive trauma is often the cause of a variety of musculoskeletal and neurologic disorders in women. Work related musculoskeletal disorders of the neck and shoulders and upper limbs are also known as cumulative trauma disorders ( CTD). Evidences from a number of studies suggest that all these disorders principally result from; constrained working posture, monotonous and repetitive work and psychological stress.Even in mechanical jobs, most of the tools, machines and work stations have been designed for average male and are unsuitable for women from an ergonomic angle.

Reproductive health hazards

Many chemicals pose hazards to the embryo especially during organogenesis. This has led to restriction on the employment of women in various hazardous processes under various legislation (e.g. Factories act,1984.)Exposure to volatile organic solvents, dusts and pesticides and VDT (Video display terminal) nonionizing radiation has been found to be associated with increased risk of infertility in women. This could be due to interference with ovulation, fertilization or implantation.

Exposure to solvents increases the risk of spontaneous abortions and there is sufficient evidence of association between exposure to toluene, methylene chloride, tetrachloroethylene, petroleum ether, xylene, formaldehyde, paint thinners and reproductive disorders. Women exposed to toluene have reported a greater frequency of menstrual dysfunction including dysmennorhoea, irregular cycles and spontaneous abortions.

Occupational dust exposures (wood and agriculture based) have also been associated with adverse pregnancy outcome. It is not definite whether it is due to the preservatives such as pesticides or other agents like pentachlorophenol, creosote, formaldehyde, chromium,arsenic etc.Aflatoxins, one of the commonest mycotoxins found in agricultural grain dusts are known teratogens.

Pesticides: Maternal occupational pesticide exposures has been identified as a risk factor for still birth. Organochlorine pesticides, polyhalogenated biphenyls and chlorophenoxy herbicides such as 2,4-D have been found to be teratogenic. DDT has oestrogenic properties. Dioxins, polychlorinated biphenyls have been shown to create a variety of reproductive effects ranging from immune suppression, teratogenicity, hormonal disruptions and even endometriosis.

Important occupational health problems in women recognized
by National Institute of Occupational Health, India.

Acute poisonings: The Institute has started a Poison Information Centre with the technical collaboration of IPCS (International Programme on Chemical Safety). For the past 5 years, nearly 800 acute poisoning cases have been referred to this centre physicians.

Acute pesticide poisoning: The commonest type of acute poisoning reported in 70% of cases has been pesticide poisoning. So far 64% cases were males and 33% were females, with the largest number of poisonings occuring between 18-25 yrs in both sexes. The lesser number of poisonings reported in females may be due to poor accessibility of women to health care facilities. The data analysis reveals use of highly toxic agricultural pesticides (Organophosphates, Carbamates, Aluminium phosphide, Herbicides and Synthetic Pyrethroids) without adequate protective measures and safety precautions by illiterate farm labourers (both men and women). There is high morbidity and mortality in these cases. Even though majority of the poisonings are suicidal but access to highly toxic chemicals in the workplace has been classified as Category IV of Work related illness by WHO.

Acute methemoglobinemia in plastic scrap cleaners: Poor women often carry out washing of plastic bags and containers contaminated with a variety of chemicals used in dye industry which is one of the major industries in Ahmedabad region. Dermal absorption of these chemicals results in acute methemoglobinemia requiring hospitalization. Many such cases have been reported to NIOH Poison Centre and investigations have revealed these chemicals to be p-chloroaniline, p-nitrochlorobenzene (PNCB), o-tolidine, p-anisidine, nitrobezene etc.

Green Tobacco Sickness (GTS): This has been reported in a number of studies conducted by NIOH. During the process of tobacco cultivation, many agricultural women laboures have reported GTS (Green Tobacco Sickness) due to dermal absorption of nicotine manifesting as headache nausea, vomiting, giddiness associated with high levels of nicotine and its metabolite cotinine in urine of these women.

Chronic-occupational health problems of women studied by NIOH

Even though occupational health problems of women have been considered a thrust area for research in India, most of the studies carried out in the field of Occupational Health have not specifically focussed on women workers per se. In most of the studies, women have been included in the study as a part of the total sample.

Silicosis: Detailed studies have been carried out in many occupations involving exposure to silica dust. Among these, a high prevalence of silicosis in both males and female workers was found in slate-pencil workers and Agate workers. In the surface coal mines, the prevalence of silicosis was less.

Other studies: In many other studies such as workers exposed to cotton dust, dyes, metals and pesticides women workers have also been included.

Studies specific to women: In few studies, only women workers have been studied such as bidi (a type of smoking) workers, garment workers, agricultural workers etc. but these studies have focussed only on certain aspects of women’s health as workers .

It is now being planned to study the women workers health in total as Occupational health problems of women is a major thrust area for the institute and the country. A number of such occupations have been identified and studies have been initiated in collaboration with SEWA (Self Employed Women’s association). Examples are Agarbatti workers (incense stick makers), salt workers , scrap cleaners, screen printing workers and agricultural labourers exposed to pesticides.

Environmental health - a gender perspective

The environmental degradation and pollution due to industrialization and automobiles are a matter of urgent global concern for the communities at large but more specifically for vulnerable groups like very young, very old, disabled and pregnant women. Some aspects of environmental pollution are of special relevance to women’s health.

  1. Indoor air pollution including passive smoking (ETS)
  2. Environmental endocrine disrupters

Indoor air pollution: There are four principal sources of indoor air pollution viz. Combustion, building materials; ground under the building and biological agents such as moulds, fungi mites etc. Of all these, domestic cooking and passive smoking (Environmental Tobacco Smoke or ETS)are most important from women’s health point of virtue. More than half of world’s house-holds cook daily with unprocessed (Biomass) solid fuels that release 50 times more noxious pollutants that cooking gas. Biomass smoke is a complex mixture of aerosols which contain significant amounts of several important pollutants such as carbon monoxide, suspended particulate matter (SPM), hydrocarbons and oxides of nitrogen. Besides, the smoke also contains many organic compounds that are toxic, mutagenic and carcinogenic. In developing countries, most of the people in rural areas (nearly 70-80%) still depend on biomass fuels such as dried animal dung, agricultural wastes, wood or charcoal which are burnt in traditional stores (chullahs) without chimneys in poorly ventilated houses.

Domestic cooking is one of the major occupations of an average Indian housewife who spends around 6 hours in the kitchen everyday. Therefore, she is most likely to be affected by indoor air-pollution which can cause both respiratory and non-respiratory effects. Many studies have reported alterations in lung function, chronic cough and phlegm in women exposed to bio-mass smoke. Chronic obstructive pulmonary disease (COPD) though a disease of smokers can also be caused by indoor air pollution (a combination of domestic fuel smoke and passive smoking).

Adverse pregnancy outcome, such as still birth, early neonatal death, pre-term and term low birth weight have been found to be related to exposure to biomass smoke.

Environmental endocrine disruptors

In todays world, the society faces hazards that were neither imagined nor known a few decades ago. There is a risk of exposure to nearly 15,000 synthetic chemicals many of which are contained in house hold products or dispersed widely in the environment. More than, half have never been tested for their potential especially long-term toxicity. A great deal of concern is being shown towards the endocrine disrupting effects of these chemicals. These agents either mimic or inhibit natural hormones, or may alter the normal regulatory function of immune, nervous and endocrine systems. In women, breast cancer and endometriosis are some of the diseases suspected to be caused by environmental endocrine disrupters.

Some studies have provided evidence of a link between exposures to dioxins and endometriosis. In pregnant women, exposure of fetus in utero to many persistent chemicals such as chlorinated hydrocarbon compounds like DDT, polychlorinated biphenyls etc. can interfere with reproductive development at a later stage.

Studies related to such occupational and environmental exposure to persistent chemicals like DDT, Endosulfan, 2,4-D amd dioxins and their health effects on exposed workers and their families are now being undertaken by the National Institute of Occupational Health in India.

Needs for promotion of occupational health of women workers

WHO has identified three basic principles for the development of an occupational health service.

  1. It must be ensured that occupational health services are provided through the existing national health services by a process of integration.
  2. The service must provide for the total health of the workers and if necessary their families. The primary health care approach must be the chosen system for the delivery of such services.
  3. The occupational health problems of working women, especially those in the unorganized sector are a matter of urgent concern. There is also a definite need to develop a database on occupational health of women in developing countries. For primary health care approach to delivery of occupational health, it is essential to create awareness among the health personnel, NGO’s and Womens organizations. It is very important to understand that chronic occupational diseases are only preventable but rarely curable. Even though, in developing countries, health priorities focus more on infectious diseases, improving the health of workers (especially women ) will contribute tremendously to national growth and economy.