Documento(s) 7 de 13

The formal work force
The informal work force
The sexual division of labour
Women's work and associated health risks
Characteristics of women's work

Women constitute 50% of the world's population, do two-thirds of the world's work, and own one-tenth of the world's wealth. We are all raised in a culture that values men's work over women's work and men's lives over women's lives.

-- K. Soin, Member of Parliament, Singapore

Throughout the world, women work long and difficult hours in the formal and informal sectors, as well as in the household. However, in both industrialized and developing countries, the health implications of women's work is an area of study that has been relatively neglected (Messing 1991; Berr 1994; Haile 1994). According to Lee (1984, p. 15):

Even in the developed countries where the occupational health movements are more established, very few studies have been done that focus on women's health. Among these, the majority focus on the reproductive health effects rather than the health of the women themselves.

As an example of the dearth of research on the health implications of women's work, Messing (1994) reported that a 1975-91 search of the Medline data bank for English-language studies that used the key words "dysmenorrhoea," "menstrual disorders," and "premenstrual tension" associated with "industry" or "occupation" or "worker" or "women," yielded no references in French or English, and one reference to a study written in Chinese relating occupational risk factors to menstrual symptoms. In addition to the lack of information on health issues commonly encountered in women's activities outside the home, there is also limited information showing the direct health effects of women's heavy workloads in the household (Messing 1991; Koblinsky, Campbell et al. 1993; Hatcher Roberts and Law 1994). According to Lee (1984, p. 15), a Malaysian researcher, "this lack of priority and interest [is] linked to the lowly status that society has accorded to women's work, particularly housework, which is seldom seen as being potentially hazardous."

Various health-related issues associated with women's work are addressed. A broad definition of "work" has been adopted, which includes not only wage-earning activities, but all activities whereby economic goods and services are produced and sold. The health risks associated with women's work in subsistence and domestic activities are also discussed.

There is a need for more research by government and nongovernment bodies in the occupational health and safety area. Practical tools need to be developed for the incorporation of occupational health and safety principles into the implementation, monitoring, and evaluation of government and nongovernment policies and programs. There is much ignorance and a scarcity of gender disaggregated data about women's actual roles, their work, and their important contribution to development. This workshop provides an ideal environment for sharing knowledge and experiences so that avenues to encourage research in this area, and bring visibility to the concerns of working women, can be explored.

-- Ng Yen Yen, Senator to the Malaysian Parliament, Pahang, Malaysia

The formal work force

In most regions around the world, women are playing an increasingly important role in the formally measured work force. This change in women's economic roles is creating additional health risks for women (Paolisso and Leslie 1995). Between 1950 and 1985, the number of economically active women in developing countries increased from 344 million to 675 million (Sivard 1985). According to the International Labour Organisation (ILO 1993), women represented over one-third of the global work force in the formal sector in 1990: 41.4% in the industrialized nations and 34.3% in the developing world.

In Women's Lives and Women's Health, Leslie (1992, p. 11) states that "While there are important variations among countries and over time, it is clear that the trend in the developing world has been an overall increase in women's participation in the paid labor force (including both informal and formal sector work)." This rapid expansion in market work for women is associated with a number of economic and social changes. These include: "increased monetization of economies, urbanization, declines in standards of living, improving educational attainment for women, and changes in social attitudes regarding the acceptability of women's participation in a broader economic world" (Paolisso and Leslie 1995, p. 61).

There are significant regional variations in women's formal work force participation rates. Figures in industrialized countries tend to be higher than in developing countries. In Canada, for example, 58% of Canadian women over age 15 years are in the paid labour force and comprise 45% of the total labour force (Status of Women Canada 1994).

In sub-Saharan Africa, women's share of the formal labour force in 1990 was 37% (undiesa 1991). Because most public and wage employees are men, women are invariably left to work in subsistence agriculture or to create whatever opportunities they can in the informal sector (un 1991).

Female participation has increased in almost all Asian countries. According to official statistics, women's economic activity in southern and western Asia is very low (under 20%), but fairly high (35-40%) in eastern and southeastern Asia. In southeastern Asia, there has been significant expansion of economic opportunities for women. Female labour provides up to 80% of the work force of the export-producing zones (such as in the Republic of Korea and Thailand). However, women have usually been confined to repetitive assembly-line jobs in industries such as electronics, food processing, textiles, and footwear (ILO 1992a). Although more opportunities for women in the relatively advanced Asian economies reflect both women's higher educational status and growing labour shortages, in the low-income countries, increased women's participation, particularly in urban areas, is often related to poverty, and the need to increase household incomes (ILO 1994).

The changing social, political, and economic scenarios of many countries in the Asia-Pacific region has, and will continue to, radically change the role of women. As countries free themselves politically and economically and strive toward economic progress and development, an increasing number of women in the region will enter the work force.

-- Ng Yen Yen, Senator to the Malaysian Parliament, Pahang, Malaysia

In Latin America, increased economic participation of women has also been observed. In Chile, for example, between 1970 and 1990, there was an 83% increase in the participation of women in the paid work force (Berr 1994). Formal work force participation rates for women are currently 31% in urban areas of Latin America and 14% in rural areas. Opportunities for women in urban areas have been closely tied to the greater economic necessities arising from the ongoing economic crisis of the 1980s. Low-income working women constitute an "invisible adjustment" to the economic crisis (unicef 1987).

Increased opportunities for women in some Latin American countries have also been related to women's higher educational attainment. One of the highest participation rates for females in the labour force in this region is in Uruguay (40%), which perhaps has the most successful secondary school system in the region (ILO 1994).

Continued growth in the Chilean economy will depend on the increasing incorporation of women into the labour force. However, the occupational health of the female worker is an area of research, and policy, that has thus far received little attention.

-- Ximena Díaz Berr, Salaried Women in Industry and Fruitculture, Santiago, Chile

The service sector is particularly important in Latin America and employs about 70% of all economically active women, of which the highest proportion are in domestic service (ILO 1992a). In Brazil, for example, approximately one-third of the 15 million women who made up the female work force in 1985 were employed as domestic servants (Machado 1993).

The informal work force

Statistics focus only on the formally measured wage-earning participation of women in the labour force; they do not capture all the work done by women in the informal sector. When the health risks associated with women's work are addressed, it is crucial to recognize women's work in the informal sector, which is often missed by labour statistics. As described by Waring (1993, p. 109):

Consider Tendai, a young girl in the Lowveld in Zimbabwe. Her day starts at 4:00 am when, to fetch water, she carries a 30 litre tin to a bore hole about 11 kilometres from her home. She walks bare foot and is home by 9:00 am. She eats a little and proceeds to fetch firewood until midday. She cleans the utensils from the family's morning meal and sits preparing a lunch of sudsa for the family. After lunch and the cleaning of the dishes, she walks in the hot sun until early evening, fetching wild vegetables for supper before making the evening trip for water. Her day ends at 9:00 pm after she's prepared supper and put her younger brothers to sleep. Tendai is considered unproductive, unoccupied and economically inactive. According to the International Economic System, Tendai does not work and is not part of the labour force.

Poor women hustle to make a living and put food in their children's mouths by working as wayside vendors, hucksters, suitcase traders, domestic workers, sex workers, and drug mules.

-- Asha Kambon, Economic Commission for Latin America and the Caribbean, Port of Spain, Trinidad (see Kambon 1995)

Government statistics often omit much of the women's critical work that is useful to the continuing existence of the household, such as gathering fuel and water, raising a few animals, and keeping a kitchen garden (ILO 1985; Nuss 1989). The 1991 undiesa report, entitled The World's Women, states: "If women's unpaid work in subsistence agriculture and household and family care were fully counted in labour force statistics, their share of the labour force would be equal to or greater than men's."

In India, for example, official statistics suggest that 14% of the female population is working, compared with 52% of men. A special commission in 1988, however, found that more than 90% of working women in India were in the informal sector and unlikely to be recorded by the census-takers surveying the country's economy (Misch 1992).

Statistics overlook the increasing number of women worldwide who work as homeworkers and piece-workers, for example, weaving cloth, carpets, and baskets at home (Leslie 1992; Berr 1994; Haile 1994). Female street hawkers, such as the Andean peasants in Latin America who come from the country and from their indigenous communities to sell self-produced wares, food, and handicrafts in the cities, may also be ignored. According to Kambon (1995):

High unemployment rates have pushed large segments of the female labour force into the informal sector ... as women in the Caribbean devise strategies to survive. Estimates are that between 30 and 50% of all employment is in the informal sector. In Guyana, ... the informal sector provides income for approximately 60% of the economy and in Haiti it is as high as 93%.

Much of women's activities are related to family occupations such as agriculture, animal husbandry, and forestry. These contributions of women, working without wages on family farms, may get merged with the family and become invisible, or viewed as "secondary, marginal, and supplementary."¹¹ Women may not report their agricultural labour as work despite the fact that during harvest season they can labour as many as 16 hours each day in the field (Khan and Midhet 1991, cited in Koblinsky, Timyan et al. 1993).

Although the International Labour Organisation (ILO) widened the definition of productive work in 1982 to include "all work for pay or in anticipation of profit" and "all production and processing of primarily products, whether for the market, for barter or for home consumption," the application of the new standard is far form universal, and in most countries, only a small part of women's production is measured. Survey investigators, often male, may not identify what women do as "work," but as part of their domestic responsibilities (Greenhalgh 1991; Nayak-Mukherjee 1991). Potential problems associated with collecting statistics on women's work in the Philippines were described by Illo (1991, p. 4).

When collecting labor force or work data, census or statistics takers very often cursorily ask women what they do, to which countless women, particularly those in rural areas, respond "nothing." It should be noted that women's work, especially in the rural areas, consists of "small but many" enterprises .... The women consider all this as part and parcel of what being a good housewife ... means. The census taker, not trained to be sensitive to the nuances of people's own classificatory schemes, record countless women as "plain housewives" who, by definition, are "not working."

Women's work in the informal sector is repeatedly neglected despite the fact that it is frequently the only option for women and is crucial for their economic survival because they often cannot find work in the formal sector. As Greenhalgh (1991, p. 6) noted, "global processes of economic restructuring and labour deregulation have led to both an informalization and a feminization of the labour force in many parts of the world." Many women are in a situation where the husband -- if there is one -- is earning nothing, or not enough to guarantee a minimal basis of existence. The incomes of women in the informal sector become indispensable for the functioning of the household; as one women from Chad reported, "If I got a small scale trade, I could give my child what he needs; what his heart desires" (Wyss and Nandjingar 1995, p. 142).

The sexual division of labour

Throughout the world, there is a clear distinction between "women's work" and "men's work." According to Acevedo (1994), this differentiation originated in the sexual division of labour in the family and is perpetuated in the social organization of work outside the household. Men often have primary responsibility for tasks requiring heavy physical labour, such as cutting trees, hunting, the preparation of land for farming, and jobs that are specific to distant locations, such as livestock herding (Momsen 1991). In most cultures, the application of pesticides is considered a male task (Momsen 1991). Women, on the other hand, tend to be responsible for bearing children, caring for family members, and producing material goods that are directly consumed by the family, such as food and clothes (Acevedo 1994). In farming, "women carry out the repetitious, time consuming tasks like weeding, and those which are located close to home, such as the care of the kitchen garden" (Momsen 1991, p. 50).

In the work force, the sexual division of labour can be observed in the concentration of women in a narrow range of traditional or "female" occupations that tend to be poorly paid and lacking in status (ILO 1994). Women work in teaching, clerical work, sales, and domestic services, for example; whereas, men work in manufacturing, transportation, management, administration, and politics (undiesa 1991). This general pattern exists in industrialized countries, as well as developed nations. In Canada, in 1993, although women's participation in traditionally male-dominated professions had increased, 71% of all working women were employed in one of five occupational groups -- teaching, nursing or related health occupations, clerical, sales, and services (Status of Women Canada 1994).

The sexual division of labour continues even when women and men work within the same industry, occupation, or profession. Men tend to be represented in the higher-ranking jobs, whereas women frequently work in low-skilled jobs and have little opportunity for advancement. In the textiles industry, for example, women work primarily as production workers and operators; in the electronics industries, women work on assembly lines; and in the garment industry, women work as tailors, sewing-machine operators, and clothes pressers. Furthermore, when an occupation or profession becomes predominantly "female," its economic and social status diminishes (ILO 1985).

Women's work and associated health risks

Various types of women's work are examined along with selected health risks associated with these forms of work. Women's work in the agricultural sector, the service sector, and the industrial sector is examined first. Next, the health hazards linked to women's participation as homeworkers, a rapidly growing area, are reviewed. Finally, health risks associated with housework are explored in detail. Although these categories do not cover all varieties of women's work, they do encompass a major portion of the activities carried out by women in the developing world.

These categories of women's work are overlapping. For example, women's "housework" may include agricultural responsibilities. In addition, women employed in the industrial sector may perform their work at home and could, therefore, also be classified as homeworkers.

I am a worker, an organizer, a director, an administrator, an adviser, a doctor, a nurse, a cleaning woman, a gardener, a painter, a carpenter -- you name it! I am the handyman, the jack of all trades.

-- A black woman from northern KwaZulu-Natal, South Africa (quoted in Pagé 1995, p. 8)

The agricultural sector

In many parts of the developing world, most women work in the agricultural sector -- they work in both waged agricultural labour and subsistence agriculture. Their work can take the form of primary agriculture production, as well as processing, storage, and marketing of agricultural produce.

In sub-Saharan Africa, nearly 80% of economically active women are involved in agricultural labour (undiesa 1991). African women produce 80% of the food consumed domestically, and at least 50% of export crops (undiesa 1991). One study conducted by the Food and Agriculture Organization of the United Nations (FAO) reported that 80% of transporting and storing the harvest, 70% of the weeding and hoeing, and 50% of the sowing and planting are done by women (Haile 1994).

Although in many parts of Asia there has been a general shift in recent years to nonagricultural sectors of the economy (Nayak-Mukherjee 1991), the number of women involved in agriculture is still very high. Throughout southeastern Asia and the Indian subcontinent, at least 70% of the female labour force is engaged in agriculture (undiesa 1991). A study by ILO that detailed the way rural women spend their time indicated that up to 90% of rural women in central India participated in agriculture (Chatterjee 1990). More than 95% of economically active women work in agriculture in Bhutan and Nepal (un 1991).

Despite these high participation rates, and the important contribution that women farmers make to the world's food supply, there is a dearth of good research that addresses the potential health risks associated with women's work in agriculture. The work of women may even be systematically ignored in research. For example, in Canada, Messing (1991) reported that female agriculture workers were excluded from a large ongoing study of cancer among farm operators, the "Mortality Study of Canadian Male Farm Operators," because the definition of "operator" used by Statistics Canada included only the farm owner, and women constituted less than 4% of this category.

We do know that women's agricultural work is arduous and tiring. The type of tasks that women perform -- such as weeding, picking, and sorting -- means that they are at high risk of suffering injuries, backaches, severe arthritic pains, postural defects, and leg problems. The heavy and repetitive physical labour required in farm work is associated with musculoskeletal and soft tissue disorders and degenerative joint diseases of the hands, knees, and hips. Women agricultural workers in South India (Kerala and Tamil Nadu) who were involved in different stages of rice production reported that "they often made their children walk on their backs at night after a day's transplanting, in order to give them enough relief from pain so that they could go back and work the next day" (Mencher 1988, p. 104).

Women may have to work in the pouring rain as well as in the hot sun, with their feet deep in mud (Mencher 1988). Standing in water and mud all day while transplanting may lead to the splitting of the heels of the feet (Mencher 1988). Women may also be more readily exposed to a wide variety of infections and parasitic diseases (Mencher 1988; Chatterjee 1990).

Women's agricultural work is often carried out without the aid of labour-saving devices. Indeed, when agricultural technology -- such as machines for land clearing, plowing, harvesting, and threshing -- are introduced by development agencies, technology and related training may be exclusively provided to men (Butler et al. 1987, p. 20).

In the rice-growing industry [of Viet Nam], women have a number of responsibilities that are usually performed with rudimentary farm tools -- plowing, sowing, transplanting, tending, weeding, and harvesting. Women in Viet Nam often spend 16 to 18 hours a day at work; whereas, men spend only 12 to 14 hours.

-- Nguyen Thi Hoa Binh, Viet Nam Women's Union, Hanoi, Viet Nam (see Binh 1995)

In developing countries, pesticides are often misused, and health risks from excessive pesticide use may be increasing as women increasingly enter the growing agroexport sectors in many developing countries. Pesticides are absorbed through the skin, by inhalation, and by ingestion. Men, who are usually responsible for fumigating crops, may be exposed to high dosages of pesticides for short periods of time because of inadequate protection during application. Strengthening Women, a 1989 report from the International Center for Research on Women (ICRW), states:

Women ... do more of the hand labor (such as weeding, picking and sorting) in fields that have been sprayed, thus encountering prolonged exposure to pesticides, [and] yet they usually wear little or no protective clothing. The threat of pesticide exposure has implications not only for a woman's own health, but also for that of their unborn and breastfed infants.

Although men are usually responsible for the application of pesticides, on Malaysian oil palm and cocoa plantations, "the sprayers who go on foot and manually spray the pesticides are almost always women (the men most often handle the spray trucks and other more sophisticated equipment). The pesticides used, such as paraquat, are poisonous if consumed and produce noxious fumes when sprayed; women report impaired eyesight, including blindness" (apdc 1992, p. 67).

Depending on the specific pesticide, exposure can cause neurological and behavioural problems, dermatitis, reproductive disorders, pulmonary problems, liver damage, eye damage (including corneal abrasion), and certain types of cancer (Enberg 1993). Women who work on Malaysian plantations have cited other effects of pesticides, such as dizziness, muscular pain, itching, skin burns, blisters, difficulty in breathing, nausea, changing nail colour, and sore eyes (Labour Resource Centre 1995).

Some agrochemicals have been linked to genetic defects in offspring. Spontaneous abortions, stillbirths, and premature births have also been attributed to certain chemicals used in agriculture (Messing 1991). Tragically, sometimes chemicals that have been banned in countries of origin or manufacture because of known adverse health effects are dumped for use in the developing world (Puta 1994).

In a study conducted by the Health Research and Consultancy Centre, 40% of female farmers in Sigchos, Ecuador, were found to have high levels of toxins in their blood. Chemicals used in agriculture (pesticides and fertilizers) got into women's blood systems through breathing and through skin contact and caused cancer, miscarriages, kidney problems, and headaches (MacMillan 1995).

In Chile, about 200 000 temporary workers, mostly women from 20 to 29 years of age, pick and pack fruit in Chile's booming agroexport industry that ships fruit all over the world. However, there is a darker side to Chile's fruit boom. One study showed that three times as many children were born with birth defects between 1988 and 1990 at a hospital located in a Chilean agricultural area (Rancagua Regional Hospital) than at the University of Santiago Clinical Hospital. The levels of spontaneous abortion were also particularly high at Rancagua: 211 per 1 000 pregnancies compared with 120 per 1 000 in Santiago (reported in Diebel 1995). The researcher, Victoria Mella, began her study after observing that an exceptionally high number of young women were aborting grotesquely deformed fetuses. As described by Diebel (1995, p. A18):

The common denominator was that all had worked in the agricultural industry, often from the age of 12 .... [In Chile,] thousands of young women work away their childbearing years in pesticide-drenched fields, fearful that their babies will be born horribly deformed. They have no protective clothing, no union, no government health standards to protect them .... All [the women] talk about the lack of protective clothing and masks, the contaminated drinking water, the constant coughs, allergies, bronchial problems, muscular spasms and dizziness.

Workers invariably are not properly informed of the many ill-effects associated with agrochemicals, and they may not be provided with protective clothing. In the flower-export industry in Ecuador, women, under pressure to meet production quotas, reportedly entered fields that had just been chemically treated, wearing no protective clothing or masks (Paolisso and Blumberg 1989). Women farmers in Ecuador "didn't know that clothes had to be washed to get rid of agricultural chemicals [if pesticides had been used]" (MacMillan 1995, p. 11).

If on-site washing facilities are unavailable, agricultural workers may eat their meals when their hands are still covered with pesticides from the crop they have been working on (Messing 1991). Lack of knowledge about the dangers of pesticides means that unsuspecting workers often use discarded containers contaminated with pesticides to store drinking water (LaDou 1993).

The processing of agricultural products may also have harmful health effects. For example, in Brazil, Mozambique, and Sri Lanka, cashew nuts are produced for export and women process the crop. This involves removing the nut from its protective outer casting that contains an acid that can harm the skin if protective clothing is not worn (Momsen 1991). In the preparation of cassava, a major food crop throughout tropical Africa and in many Pacific countries, a deadly poison -- hydrogen cyanide -- is released. Women, predominantly responsible for processing cassava, may be exposed to hydrogen cyanide fumes during their work and suffer related health effects (Ferrar 1992).

Women make up a large part of the tobacco-growing work forces in many developing nations. They work in the fields and processing plants. In Indonesia, cigarette manufacturers employ about 15 million people, mostly women. In Brazil, women strip tobacco from its stems in warehouses where the humidity and smell from the tobacco can cause headaches, vomiting, dizziness, and shortness of breath (Greaves et al. 1994). Further research on the impact of tobacco growing on women's health is urgently required.

It should be noted that illnesses related to women's working environment, whether they result from women's participation in agriculture or from other types of women's work, may be exacerbated by a number of factors related to the general health and well-being of women. For example, poor nutrition and lack of sufficient rest, often associated with poverty, may increase the effects of workplace illness (Haile 1994; Puta 1994). As Messing (1991, p. 10) pointed out: "The healthy young body may resist damage from workplace chemicals better than the unhealthy or older body ... the poorly nourished body may be less able to tolerate polluted air."

Furthermore, infections and parasitic diseases that are not necessarily related to occupation, for example, malaria, hookworm, and AIDS, may aggravate the effects of illness or disease associated with women's work.

The service sector

Services form an important sector of employment for women. Service-sector employment includes work in nursing, secretarial, teaching, sales, and catering work. Women also work in restaurants and hotels and perform domestic labour. These types of activities are thought to be "typically female," because they are perceived to be an extension of women's traditional roles.

In Latin America and the Caribbean, 71% of economically active women are involved in the service sector. In Asia, 40% of women are employed in the service sector. However, in Africa, only 20% of women counted as economically active work in this sector (undiesa 1991).

Women [in Venezuela] are concentrated in the so-called "female ghettos." For example, twice as many women than men work in the service area, such as restaurants, hotels, and domestic labour.

-- Doris Acevedo, Carabodo University, Maracay, Venezuela

Characteristics of work in the service sector, one of the so-called "female ghettos" (Acevedo 1994), include minimal decision-making and working with the public. Although dealing with the public and responding to the needs of others can be rewarding, it can also be very demanding and difficult (Messing 1991) and lead to high stress levels, exhaustion, and a state of burnout. Excessive stress increases the risk of workplace accidents, as well as the chance of developing cardiovascular disease (Lowe 1989). These jobs involve monotonous tasks, minimal creativity, and little control over the external environment, all of which may contribute to mental health problems (Acevedo 1994).

An increased need for female domestic workers, to perform child care and other domestic responsibilities, has developed in some parts of the world as more and more women take full-time paid employment outside the home. As a result, a growing number of domestic workers from developing countries are migrating to industrialized countries.¹² These women may experience "emotional torment of leaving families behind, as well as difficult working conditions, job insecurity and potential employer abuse" (Grandea 1994, p. 13).

Women from Bangladesh, India, the Philippines, and Sri Lanka are lured to countries such as Kuwait, Saudi Arabia, and the United Arab Emirates to work as "virtual slave for prosperous Arab families" (Serrill 1995, p. 57). Serrill continues (p. 57):

It is common for the maids to be forced to work from dawn to midnight, seven days a week. Often they are fed scraps and lefovers, and beaten and verbally abused and, in the worst cases, raped and murdered. Only in the most egregious instances is the employer ever charged with sexual abuse or assault.

As well, as reported by Dickson (1995):

Domestic workers are exposed to the multiple risks of the home environment where most accidents occur. These include exposure to poisons in pesticides and cleaning materials, high risk of falls, long hours on their feet, frequent expectations to work overtime and on holidays, which deprives their own families. All this is often for inadequate remuneration. In this era of increasing opportunity, many women have opted out of being full-time housekeepers, but yet have not necessarily improved conditions for their proxies.

The health problems and working conditions of middle education teachers in the state of Maracay in Venezuela (about 75% of whom are women) were explored by Acevedo (1994). A review of medical records of the educators found that the most common health complaints were depression, arterial tension problems, and voice problems. The most frequent causes of absence from work were depression, anxiety, recurring headaches, functional diaphony, nodules on vocal cords, and high blood pressure. Acevedo pointed out that these disorders were related to the specific conditions of teaching: work with the public; an intensive working day; excessive use of the voice; low salary; and low social prestige.

In many countries, women constitute up to 75% of the labour force in the health sector (Jones and Catalan 1989; Strebel 1994; Lule and Ssembatya 1995). However, the majority of the better paid, more prestigious and authoritative positions as medical physicians and managers, continue to be held by men. Women, on the other hand, tend to fill the lower status, poorly paid (or unpaid), but nevertheless crucial, roles as nurses, midwives, auxiliaries and community health workers, and traditional birth attendants.

Women comprise the vast majority of volunteers in hospitals, self-help clinics, and other community health organizations despite their already significant workloads within the household (Lange et al. 1994). Indeed, the success of primary health-care programs and child-survival strategies has largely depended on women's involvement (Leslie et al. 1988; Kwawu 1994). Women perform vital and multiple tasks such as: providing health education to mothers about the importance of prenatal care, good diet during pregnancy, breastfeeding, proper weaning, immunizations, and management of diarrhea; monitoring the growth of infants and young children; distributing oral rehydration therapy; providing simple treatment and referrals; providing social and emotional support to community members; monitoring blood pressure; helping others to make decisions about when to go to health services and making appointments for those who need assistance; and participating in various prevention campaigns (World Bank 1993; Lange et al. 1994). Female traditional birth attendants deliver most of the babies in the developing world.

In Laos, for example (Boupha 1995):

Led by the Lao Women's Union members, Lao women, as grandmothers, mothers, daughters, nieces, aunts, and neighbours, play a great role in the family and in the community by providing health education .... They are bringing to the community an awareness of the importance of child immunization and knowledge about such things as sanitary activities, family planning, contraception, and methods of birth spacing.

The enthusiasm and willingness of women to work as volunteer health providers is consistent with prescribed gender expectations and stereotypes. According to socially defined duties and expectations, women are expected to serve, nurture, and understand others, to do so quietly without expecting praise, to never refuse requests made by others, and to be unconcerned with monetary compensation (Lange et al. 1994). Indeed, in the study by Lange et al. (1994) of female health providers in Santiago, Chile, over half of the women interviewed did not expect any economic compensation for their work. They emphasized that they were proud that their work was voluntary, and that payment would serve to lessen its value. Providers who indicated that they would like to be paid said that they would use the money to reduce the expenses incurred in performing their work or to buy implements necessary for their work.

We learned [in the program] that health is very important, that we have to learn many things, not learning how to treat illnesses, but how to prevent them. The program helped me a lot, because as a person, although I am still a little shy, I already speak to others and we deal with each other, we feel like equals. It is nice to deal with people of the community, to go and teach them. Sometimes we are welcomed, sometimes we are not, but at the end they understand what we are teaching them.

-- A participant in an education and development program in primary health care in Colombia, (quoted in Collazos V. 1994)

Although not the primary objective of health programs, women's involvement in primary health-care programs often contributes to the personal development of individual women and leads to immense satisfaction. In the study by Lange et al. (1994) of volunteer health-care workers in Chile, women were motivated to do this work because of the expectation of personal development, which could be attained through training, and the perception that the work represented an opportunity to do something useful for the community. Women said that their work allowed them to establish positive relationships with members of their community and gave them an opportunity to help others, which made them feel positive, helped them make good use of their time, and enriched their development as human beings. Training helped them feel more self-reliant and better able to face certain daily situations. For example, some women stated that, prior to being health-care workers, they did not feel confident to speak in public or to discuss issues with physicians or other health professionals. Training increased their self-esteem and their capacity to undertake important tasks (Lange et al. 1994).

Women's contribution [as health providers] is undervalued and women become discouraged by the lack of recognition they receive. Women risk being perceived and treated as resources that can be drawn on until exhausted.

-- Ilta Lange, School of Nursing, Universidad Católica de Chile, Santiago, Chile

Although women can gain much satisfaction from their role as health providers, women may also experience a sense of frustration and discouragement because the value of their contribution is not fully recognized. This lack of recognition can negatively affect the stability, continuity, and effectiveness of their work (Lange et al. 1994). In their study, when women were asked what they disliked most about their community "voluntary work," 75% pointed out elements related to the way other people reacted to their wish to help. They mentioned apathy, lack of cooperation, criticism, ungratefulness, and the fact that their work was not recognized by the community they were serving (Lange et al. 1994).

Likewise, in Bangladesh, traditional birth attendants or dai, reported that they did not receive sufficient recognition from families for their services. For example, even though dai are widely recognized as experienced women whose presence is desired at a birth, they sometimes did not receive a cash payment, or a suitable substitute for cash, such as a sari, after the child was delivered. The following comment was typical: "When in danger, they call you, but when the danger in over, get lost" (Rozario 1995, p. 95). In contrast, an attending doctor always received a substantial fee, even when it was the dai who actually delivered the baby while the doctor stood by. Despite this lack of gratitude, traditional birth attendants said they would continue to help families who asked for their assistance (Rozario 1995).

Because of the valuable, and largely voluntary role that female health providers play, there is a risk that health services may place onerous demands on women. Increased reductions in state-supported health-care programs mean further burdens for women. In addition, because of the way women have been socialized, they may not complain about such adverse conditions. Efforts are needed to ensure that female health providers are not exploited and that their work is fully acknowledged (Lange et al. 1994).

The industrial sector

Women's participation in the industrial labour force of many developing countries has risen over the past two decades. In newly industrialized economies such as Hong Kong, Singapore, South Korea, and Taiwan, and in others such as Malaysia, Mexico, the Philippines, Thailand, and some of the Caribbean countries, women have increasingly taken jobs in factories and, therefore, been exposed to new occupational risks (Vickers 1991; Jacobson 1993).

Some developing countries have set up economic production zones or free trade zones that offer various incentives, such as attractive tax packages and a cheap, well-disciplined, manually dextrous and highly productive work force, to encourage multinational corporations to set up production (Nayak-Mukherjee 1991; Vickers 1991). Some governments have attempted to increase their nations' comparative advantage by waiving worker-protection legislation that increases labour costs (LaDou 1993). The Malaysian government advertised "cheap, docile, highly trainable, non-unionized labour," to attract foreign investment (Lim 1988, p. 37). In the free-trade zones of Southeast and South Asia, the workers in the labour-intensive manufacturing of electronics, textiles, and footwear are predominantly female (75-90%), single, and young (15-29 years) (Nayak-Mukherjee 1991; Yen 1995). "Many authors have forcefully argued that the dynamism and economic growth witnessed in the economies of South-East Asian countries have been achieved largely due to the female-participation, as the sectors that have been crucial frontiers of growth have also been the sectors with female-dominated work force" (Nayak-Mukherjee 1991, p. 16).

Girls and young women are a particular target in a highly competitive climate where they are seen as a source of cheap, docile labour; easy to hire and easy to fire when they are no longer needed. Tens of thousands of young girls are working in factories, using tools designed for adults, carrying heavy loads, and working long hours with no breaks and few, if any, safety standards to protect them.

-- A. El Bindari Hammad, World Health Organization, Geneva, Switzerland

The working conditions in these factories are frequently abysmal. Women can usually only obtain the lowest-skilled, lowest-paid jobs because of lack of education and training opportunities (Vickers 1991) and systemic discrimination on the basis of sex. Women commonly work in unregulated industries that may be outside the scope of occupational health and safety legislation or trade unions (ILO 1985; World Bank 1993). Some firms reportedly restrict the number of years that they employ individual women to prevent the build up of senior workers who may demand higher wages (ILO 1985; Nayak-Mukherjee 1991). Other plants control the women's lives 24 hours a day by housing them in dormitory accommodations.

Considerable stress is associated with this type of factory employment. Female workers habitually face extremely high productivity targets, can work 7 days a week at monotonous tasks, and work odd shift hours. Factory employees working at piecework rates, or paid by the hour, are subject to extreme time pressures, which may result in anxiety and stress. A fast work pace may cause workers to neglect important safety precautions, which can increase the risk of accidents (Messing 1991).

An insecure employment situation, in which women can lose their jobs during production cutbacks or when firms relocate in search for new sources of cheap labour, further compounds stress levels. According to Nayak-Mukherjee (1991), a relocation of industries has been noticed from Singapore to Indonesia, Malaysia, Thailand and from there to Sri Lanka and very recently, to Bangladesh and even China. Not surprisingly, these stressful conditions may result in migraines, nervous breakdowns, and "burn-out" (Nayak-Mukherjee 1991).

Other unhealthy working conditions in the industrial sector include poor ventilation, inadequate lighting, heat, humidity, radiation, and overcrowding, which may affect physical health and decrease productivity (Soin 1995). Noise, an extremely frequent problem in factories (World Bank 1993; Puta 1994), can result in industrial deafness, and is also a major stress factor for workers (Messing 1991). Facilities for women, such as toilets, may be inadequate. For example, in one typical factory in Bangladesh, where over 200 women and 50 men were working, there was only one toilet for women and one for men (Hossain and Sobhan 1988).

Indoor air pollution may lead to discomfort, headaches, and respiratory problems (Messing 1991). The harmful effects of high dust concentrations on workers' health, especially on their respiratory systems, is a well-known fact in the field of occupational health (Carasco 1994; Haile 1994). As well as respiratory-tract difficulties, dust has been found to have significant associations with accidents, general illness, and absence (Meng et al. 1987).

Results from a study carried out at the National Institute of Occupational and Environmental Health in Hanoi, Viet Nam (Nga 1995), showed the following.

Women workers were exposed to hazardous agents in the workplace such as heat, toxic gases, noise, dust, and chemicals .... Characteristics of work in industries with new imported technologies included the monotonous motion of small muscle groups, poor air quality in working rooms ... and a significant difference in indoor and outdoor temperatures.

Women, stereotypically perceived as passive, predominate in jobs that require prolonged standing or sitting, often in uncomfortable positions, and in seats that are not ergonomically designed. Muscular pain, including back pain, and neck, shoulder, and leg problems, are health issues associated with static work (Acevedo 1994; Haile 1994). Prolonged standing, without moving, may strain the musculoskeletal system and interfere with blood circulation to and from the legs, which can lead to leg pain, cramps, numbness, and swelling in the lower legs and feet (Corlett and Bishop 1976; Waterfield 1981; Messing 1991).

Although some hazards are obvious, others are insidious and slow to manifest themselves. Workers may be exposed to dust- laden air, to fumes and gases in chemical extraction plants, to artificial humidification in cotton mills, to paints and solvents that can be absorbed through the skin. Their work on conveyor belt production may be boring and tedious.

-- Anne Kamoto Puta, Zambian Organization of Occupational Health and Safety, Zambia

More than half of the medical problems were of a respiratory nature. This was related to the high dust concentration in the textile factory.

-- Joseph Carasco, Centre for Basic Research, Kampala, Uganda

Textile workers

Among predominantly female textile and garment workers, byssinosis, or "brown lung," is a common occupational lung disease of workers who process cotton and are exposed to raw cotton dust. Its symptoms include breathlessness and tightness of the chest, and it can lead to chronic bronchitis or emphysema (Committee of Asian Women 1987; Labour Resource Centre 1995; Paolisso and Leslie 1995).

Textile workers may be exposed to harmful chemicals and may be unaware of the possible toxic effects of the chemical materials that they handle (Puta 1994). Exposure to chemicals used for dyeing, bleaching, and making fabrics shrink-resistant can lead to eye irritations, sore throat, allergic reactions, and skin rashes (Committee of Asian Women 1987).

The operation of a sewing machine requires repetitive movements of fingers, wrists, and elbows at high speeds (apdc 1990; Vézina et al. 1992), can cause extreme and persistent pain, and may eventually result in neurological and musculoskeletal problems such as bursitis, epicondylitis, carpal tunnel syndrome, and tenosynovitis of the wrist (Kurppa et al. 1979; Punnet 1985; Messing 1991). Garment workers are prone to accidents such as sewing needles piercing fingers, which tends to occur when fast work under stressful conditions is required (Committee of Asian Women 1987). Sewing machinists may also experience high levels of backache, neckache, and shoulder and elbow problems (Messing 1991; Rowbotham 1993). One women who had worked at a sewing machine for several years reported that "the consequences to my health cannot be compared. My hands were tired all the time. I could not use them for heavy work, and if I did, they would hurt" (Rowbotham 1993, p. 40).

This type of work, like much of women's work, is boring, repetitive, and monotonous. It also offers little opportunity for communication with others. The effects of these workplace conditions on the minds and general health of workers has not been well documented (Messing 1991; Acevedo 1994).

Textile workers may also be exposed to dangerous machinery (Berr 1994; Carasco 1994), have no protective devices, and not receive the training necessary for safe use. Women textile workers in Ethiopia, for instance, routinely work without protective devices (Haile 1994).

Electronics workers

Like the textiles industry, the electronics industry predominantly employs women. In the Malaysian electronics industry, for example, 85% of the employment is female -- and 92% of these jobs are unskilled. And, in Malaysia, "the concentration of women in electronics is no mere coincidence ... the presence of a large, low-wage, female work force is a well-documented reason for corporate decisions to locate [there]" (Labour Resource Centre 1995).

The main reported health hazard associated with women's work in electronics is related to eye damage. Female electronic workers on semiconductor assembly lines "using microscopes the whole day to join tiny wires to semiconductor chips" (apdc 1990, p. 18), often suffer from eyestrain that can result in conjunctivitis, nearsightedness, deteriorating eyesight, and double vision (apdc 1990; Nayak-Mukherjee 1991).

In addition, a range of potentially hazardous chemicals may be used in various stages of the electronics assembly process, including trichloroethylene (TCE), methyl ethyl ketone (MEK), xylene, acetone, solder flux, sulfuric acid, and hydrochloric acid. Exposure to these chemicals has been linked to skin and respiratory diseases and to spontaneous abortions (Labour Resource Centre 1995; Yen 1995).

Homeworkers

The specific health concerns of homeworkers warrant attention because nearly all homeworkers are women and homeworkers make up an integral part of the informal economy in most developing nations. "Homework," by definition, is the production of a good or the provision of a service, for an employer or contractor, at a place of the worker's own choosing, often the worker's own home, usually without direct supervision by the employer or the contractor. Homeworkers are also referred to as "outworkers," "home-based workers," or "piece-rate workers" (ILO 1992b, p. 3).

It is difficult to ascertain the actual numbers of homeworkers because they are unlikely to be recorded by statistics; however, the ILO has estimated that homeworkers account for between 5% and 35% of the gross domestic product in several developing countries for which it has gathered data (Misch 1992). Homeworkers are increasingly developing into a large international "shadow economy" in most industrialized and developing countries. As manufacturers respond to international competition by fragmenting their production process, they increasingly rely on routine work done by women in their own homes (Messing 1991). Homeworkers are "weaving carpets in Turkey, stitching shoes in Italy, making garments in the United States, laundering clothes in Ecuador, and assembling metal dishwashing sponges in Mexico" (Misch 1992, p. 18).

The types of work that homeworkers perform in developing countries is extremely wide-ranging: homeworkers are involved in the production of clothing, textiles, tobacco, carpets and rugs, and wicker and leather works (ILO 1992b); they perform ancillary tasks such as sorting, cleaning, packaging, and labelling; and they may engage is the subassembly of electrical and electronic products, as well as working in traditional industries associated with the preparation of food, handicrafts, and pottery (Haile 1994).

On the surface, home-based work offers some advantages to women. Because homeworkers tend to be married women who have children and only a primary education (ILO 1992b), homework provides these women, who are often living in poverty, with the opportunity to earn some income while they attend to their children and other household responsibilities (ILO 1992b, 1994).

Although little is known about the working conditions of homeworkers because of the lack of documentation, the available information suggests that conditions are typically very poor. Homework usually involves very long hours, which may lead to extreme fatigue. Extremely low pay for piece work encourages women to work extra long hours. In India, for example, women may role cigarettes from before dawn until long past dusk. According to one tobacco roller: "My days start at 5:30 in the morning and end at 11:30 at night. My life started with the rolling of beedis [cigarettes] and perhaps it will end that way too" (Misch 1992, p. 18).

Homeworkers face many of the same problems as women who work in other sectors. For example, like much of women's work, homework is typically repetitive, monotonous, and lacking in variety. Homeworkers, such as Indian bangel workers and lace-makers, may suffer from eye disorders because of the fine detail demanded by their handiwork (Misch 1992). Tobacco workers may experience "arms swollen from cutting, and asthma from breathing tobacco dust" (Misch 1992, p. 18). A survey of homeworkers in the garment industry carried out by the Self-Employed Women's Association (SENA) in Gujarat, India, in 1986 found that 90% of the women complained of pain in the feet and legs; 82% reported back pain; 31% suffered from pain in their hands. Headaches, abdominal pain, and eyestrain were other common complaints. Homeworkers can suffer from accidents related to their homework, such as injuries from knife cuts and the piercing of fingers by needles (ILO 1992b).

Factors that distinguish homework from other forms of work create additional hazards for the health and well-being of women. Because homeworkers are not registered as workers, and they do not work under fixed contracts, their employers generally take no responsibility for their health and security (Misch 1992). As Misch (1992, p. 19) stated, they are "beyond the reach of those laws and regulations that offer workers some measure of protection from exploitation." A Malaysian homeworker who worked until after midnight most evenings making paper "money" used in Chinese funeral ceremonies said, "I worry that I have no sickness or unemployment protection, and I often get backaches and sore eyes" (Mitter 1986, p. 119).

Being generally excluded from secure and bargainable jobs in the formal sector, women are willing to accept employment that offers them a livelihood, however insecure.

-- Swasti Mitter, Institute for New Technologies, United Nations University, Maastricht, Netherlands (see Mitter 1994)

Homeworkers are also isolated from fellow workers (Messing 1991) and have no access to channels such as trade unions for wage bargaining and the articulation of health-related concerns. In addition, because it is unlikely that their homes have been equipped or designed properly for the required task, homeworkers may, for example, work in highly uncomfortable working positions or have inadequate ventilation (Johnson 1982). Finally, Messing (1991, p. 13) pointed out that because "children may be present at the worksite, women may be required to divide their concentration between child care and the task at hand, thus increasing the risk of accidents for both themselves and their children" (Messing 1991, p. 13).

Housework

In addition to women's participation in the work process through their work in the formal and informal sectors, women also participate through their work at home (Acevedo 1994). Women in all societies tend to have significant responsibilities within the household. The numerous domestic tasks usually carried out by women include preparing food for the family over smoky fires in unventilated kitchens; caring for family members including children, the sick, and the elderly; providing food, firewood, and water for home consumption; carrying heavy loads over long distances; educating and supervising children; looking after the upkeep of the home; and tending the kitchen garden and livestock. It is clear, as Wyss and Nandjingar (1995, p. 142) pointed out, that "a housewife does not lack work." In the words of Cardaci (1992):

Nowhere is "housework" defined, so that it becomes the generic term for everything that women do in an unpaid capacity.

-- Waring (1993, p. 109).

As a provider, the woman is responsible for guaranteeing ... a safe atmosphere: a warm and clean house where family members are protected from illnesses and dangers, where children, young people, and adults are offered a balanced diet .... It is a woman's role to maintain family harmony inside a home and to diminish the anxieties and tensions that emerge when these relationships do not go well. Home as a refuge ... is "typically" a woman's responsibility.

Although women are increasingly entering the paid work force, this has not led to the lessening of household burdens. Instead, women feel responsible for doing both home and work-related jobs efficiently, and often this means that it is done at the expense of women's own health and well-being.

Household labour, central to the maintenance of social systems, is not compensated by society in monetary terms. Because "work" if often viewed as "paid activity," the important but unpaid work of women at home tends to be overshadowed and marginalized (Berr 1994). However, by their labour in the household, women are subsidizing the production and maintenance of the work force.

Because many women work in the home, they suffer disproportionately from the health risks in the household environment. Although many of the traditional responsibilities of women make them more susceptible to specific health effects, "very little research has been done to investigate the prevalence of these health conditions, their importance to women, their impact on productivity and well-being, or on how to alleviate them" (Vlassoff 1994, p. 1251).

National and international statistics about women's economic roles tend to completely ignore the work done by women within the household (Rathgeber 1994a). However, if housework is taken into account when measuring women's work, women work much longer hours than men in most parts of the world (ILO 1992a; Acevedo 1994) (Figure 4). Research must explicitly incorporate women's unpaid housework into the conceptualization and measurement of women's work activities.

Indoor air pollution

According to the World Bank (1993), indoor air pollution probably exposes more people worldwide to important air pollutants than does pollution in outdoor air. Women throughout the developing world are predominantly responsible for the cooking of food, and they, as well as their young children, suffer the greatest exposure.

Furthermore, the WHO estimates that about half of the world's population uses biomass (such as wood and cow dung) as cooking and heating fuel, often without proper ventilation. In India, for example, 99% of rural households and more than 50% of urban households use biomass cooking fuels (apdc 1990). Proximity to indoor household stoves that use biomass fuels has been linked to acute respiratory infections in young children and to chronic lung diseases and cancer in adults. Exposure during pregnancy may also lead to adverse pregnancy outcomes, such as stillbirths, right-side heart failure, and low birthweight (World Bank 1993; Haile 1994). Women may also suffer daily discomforts such as irritated eyes, running noses, and headaches.

Figure 4. Total amount of work time for women and men (including housework) in 1990 (source: undiesa 1991).

Because women are closely associated with domestic duties, they are more affected by pollutants in the household caused by the use of fuels such as kerosene and industrial byproducts such as rubber, canvas, leather, oil seed cakes, and fuelwood. These factors contribute to the high incidence of asthmatic and other respiratory diseases, as well as eye problems.

-- Fekerte Haile, International Labour Organisation, Addis Ababa, Ethiopia

Studies in China, India, Nepal, and Papua New Guinea have shown that up to half of adult women (few of whom smoke) suffer from chronic lung and heart disease because of the high levels of indoor smoke. Nonsmoking Chinese women exposed to indoor coal smoke (which is especially harmful) have a risk of lung cancer similar to that of men who smoke lightly (World Bank 1993).

A study of four villages in rural Gujarat, India, found that women who cooked in poorly ventilated huts were exposed, on average, to 100 times the level of suspended smoke particles deemed acceptable by the WHO, six times higher levels than other household members, and 15 times higher than a resident of Delhi (Chatterjee 1990). Another study in India estimated that while women were cooking they inhaled as much of the carcinogen benzopyrene as if they smoked 20 packs of cigarettes a day (WHO 1984). In the high-altitude mountain areas of Nepal, women often suffer from a disease similar to anemia. The illness is caused by carbon monoxide in the bloodstream, the result of long-term exposure to the pollutants from crude energy sources such as indoor cooking fires (Easterbrook 1994). Acute respiratory infections and chronic bronchitis are also very common in rural areas of India and Nepal as a result of exposure to kitchen smoke (un 1995).

Paolisso (1995) suggested that deforestation and fuelwood scarcity may increase health risks for women from smoke pollution because they are forced to use lower quality, quick-burning biomass fuels, which increase the time spent tending cooking fires. He pointed out, however, that there is little documentation of the extent to which fuel substitution is occurring, nor any reliable evidence of its health implications.

There is clearly an urgent need for more research on the health effects of this common activity. In addition, the extent to which modifications to home cooking and heating facilities -- such as stove design, ventilation design, and fuel type -- would reduce exposure to the detrimental effects of indoor air pollution needs to be explored. However, efforts to reduce indoor smoke levels may increase the biting activity of insect vectors in malaria-endemic communities because smoke repells the insects. Therefore, interventions aimed at reducing household smoke in malaria-endemic regions should be coupled with malaria-control interventions, such as pesticide-impregnated bednets.

Tropical diseases

Depending on the sexual division of labour, women's household responsibilities and culturally prescribed roles can also increase their exposure to water-borne diseases such as schistosomiasis. For example, in communities where women are responsible for washing clothes and laundry or cleaning kitchen utensils through immersion or partial immersion in infected waters, women may have higher infection rates than men during peak periods of cercarial shedding (Huang and Manderson 1992; Anyangwe et al. 1994). Furthermore, women who work or travel to get fuel and fodder from areas where open-field defecation is practiced risk exposure to diseases that can be spread via human excrement (such as typhoid, amoebic dysentery, parasitic infections, and hookworm).

Heavy weights

Many of the traditional responsibilities of women in the developing world are load-associated: women often carry, lift, and transport heavy loads in their daily activities. For example, the responsibility of obtaining fresh water for drinking, cooking, cleanliness, and hygiene, often from long distances in heavy containers, is almost exclusively that of women and girls (Carasco 1994; Hatcher Roberts and Law 1994). Small-scale studies in Asia and Africa indicate that women and girls spend an average of 5-17 hours per week collecting and carrying water (un 1991). However, Butler et al. (1987) reported that when the trip to a water source is facilitated by other means of transport (such as a bicycle, donkey, wheelbarrow, or oxcart), some men may become involved.

As well, Rosina Wiltshire remarked that "water pumps that have been installed in many communities have proven to be useless. Although women tend to be responsible for water collection, these pumps have primarily been designed and located for use by men."

Women are also responsible for obtaining fuelwood. Gurinder Shahi of the United Nations Development Programme (UNDP) estimated that, in Nepal, rural women spend 5 or 6 hours a day on foot searching for fuelwood and carrying it home (Easterbrook 1994). Young girls and women in Ethiopia frequently carry up to 77 kilograms of fuelwood and other produce, and travel an average of 11-12 kilometres daily (Haile 1985; Abegaz and Junge 1990). In Table 3, load data for fuelwood carriers in Ethiopia are compared with ILO weight limits.

Carrying heavy loads over long distances is physically demanding and exhausting work. In addition to fatigue, heavy weights can cause an increased incidence of back strains, lower-back pain, fractures, chronic and debilitating back and leg problems, damage to the knees, and other physical damage (ILO 1989; Haile 1994). In Viet Nam, for example, heavy physical work is common and "loads carried on the head were found to have a detrimental effect on the vertebrae of workers (especially in the neck region)" (Nga 1995).

Water is carried on the head, the back, the shoulder, or the hip, depending on the region of the world (apdc 1990), and each method may create health problems for women. Women who carry water on their back often walk in a stooped position. Asymmetric shoulder carrying may cause the body to develop more on one side. Hip damage can result from carrying water on the hip (apdc 1990), and the carrying of water on the back using a head strap may lead to severe headaches.

Table 3. ILO limits for loads to be lifted and carried by women
compared with loads commonly lifted and carried in Ethiopia.

Age (years)	Permissible loads (kg)					Average load (kg) lifted and carried by women in Ethiopia
	Occasionallya				Frequentlyb
15-18	15				10	46
19-45	15				10	64
Over 45	15				10	55

Source: ILO (1989), Haile (1994).

^a Limits that cannot be exceeded without health risk.

^b Values recommended from an ergonomic point of view.

Carrying heavy loads, such as large containers of water, can also lead to a prolapsed uterus (Labour Resource Centre 1995) and is associated with menstrual disorders, miscarriage, and stillbirth (ncsew 1988). Girls who begin carrying heavy loads of water at a young age are at risk for scoliosis (Chatterjee 1991).

The Asian and Pacific Development Centre (apdc 1990, p. 112) also points out that women are exposed to skeletal problems, which could lead to deformity and disability.

One of these is damage to the vertebral column (spine) which due to overwork can degenerate and lead to arthrosis, a degenerative rheumatism or cyphosis (a permanently bent back). Pain is constant and mobility becomes less until a stage may be reached where people cannot move at all.

In older working women in the developing world, researchers report that functional disability is most strongly related to years spent fetching water (Doty 1987). This type of physical damage can in turn increase the burden of women's work.

Environmental degradation and women's workloads

Because women are closely tied to natural resources, environmental degradation can have a immediate and dramatic impact on women's workloads and livelihoods, as well as on the health and living conditions of the family as a whole (Muntemba 1989; Soin 1995). Environmental degradation includes negative changes to the physical environment and the ecology, such as water pollution, receding vegetation, destroyed forests, and poor soils (Tsikata 1994).

If environmental degradation decreases the amount of food produced by the land and waters, or diminishes the availability of fuel to cook meals, women, who are largely responsible for feeding their families, become exhausted as they are forced to work longer hours to make ends meet (Jacobson 1992a). A study in rural Kenya found that agricultural marginalization and environmental deterioration were increasing the work burdens of women of reproductive age more than the work burdens of other members of the household (Ferguson 1986). In three communities in Nepal, a study showed that deforestation has resulted in a significant increase in the time needed for women to collect fuelwood. In highland communities, the time needed to collect fuelwood increased from just over 1 hour per day to 2.5 hours per day (Kumar and Hotchkiss 1988). In areas of India where the forests have been ravaged, women and children must now trek 8-10 kilometres every day to get sufficient wood to cook the evening meal. Seven or eight years ago, a short walk of 1 or 2 kilometres was required (apdc 1990). In the Jayawijaya District, Irian Jaya Province, Indonesia, people began to use the high slopes of hills as the amount of land suitable for cultivation decreased. This led to soil erosion. The soil became infertile and food production decreased. The ultimate result was the deterioration of the quality of life for all, but in particular, women and children.¹³

Women who are largely responsible for fetching water for their families may have to walk extra distances in the search for safe water because of environmental degradation. "The increasing run-off of agricultural chemicals and organic waste into rivers as well as siltation resulting from deforestation, [is] seriously affect[ing] the availability of clean, safe water for rural women" (apdc 1992, p. 56).

Researchers in a project in Burkino Faso examined the impact of fuelwood shortages on women's agricultural practices and on family nutritional intakes (Rathgeber 1990b, p. 500) and found that

As women are forced to spend longer periods of time searching for firewood, they have less time for agriculture. This in turn leads to lower crop yields and a reduced level of food for family consumption as well as a smaller surplus for sale in local markets. At the same time, women are cooking less frequently and serving their families cheap storebought foods or foods cooked several hours earlier and often stored under unhealthy and unsanitary conditions.

Women's double and triple burden

To understand women's occupational health, the combined burdens and hazards of the many roles of women, including paid work and family responsibilities must be appreciated (Timoteo and Llanos-Cuentas 1994). Unfortunately, little research has focused on the double work day: "The fact that [women] often combine domestic or family responsibilities with their paid work ha[s] also been insufficiently studied from a health perspective" (Messing 1991, p. 7).

Women who have responsibilities both in the home and in the formal work force are often said to be suffering from a "double burden" (Messing 1991; Acevedo 1994; Berr 1994). Breilh also coined the term "triple load" or "threefold burden" to refer to the triple responsibilities that women may have: that is, responsibility for reproduction, productive work in the formal work force, and domestic work (Breilh 1994).

Bearing and raising children, often at very short intervals, breastfeeding them, and, at the same time, continuing to perform energy-consuming work loads (Alilio 1994) is an onerous task for many women. Studies in Tanzania have shown that most women continue to carry out energy-consuming work, such as fetching firewood and fuel, farming, cooking and washing, and taking care of children, until their last days of pregnancy and that they often do so without adequate caloric intake (Mpanju 1992).

Women throughout the world maintain almost exclusive responsibility for childcare and housework, and they invariably receive little support from other family members, such as husbands (Chavkin 1984; Breilh 1994). There is also a lack of institutional support, such as childcare centres, nurseries, and other services, particularly for working-class mothers.

The double shift and double load of working both inside and outside the home creates considerable physical and mental stress (Berr 1994), and the roles commonly conflict. Household duties do not begin and end at set times. Rather, they dominate, in one way or another, the entire day. While working, women invariably are thinking of their home and making decisions that affect the household and their children.

Poor conditions in the household may negatively affect a woman's work in the formal sphere. Fatigue may lead to higher rates of absenteeism and to frustration and discontent, which may cause high rates of turnover (ILO 1994). Being overburdened by numerous responsibilities may cause cumulative detrimental health effects such as fatigue, stress, and diminished resistance to disease and chronic illness. The significant demands may lead to the deprivation of physiological necessities, such as sleep. Furthermore, "[a] body tired out from taking care of a baby or ill parent may be less able to resist a virus ... or to protect itself against the solvents in cleaning solutions" (Messing 1991, p. 12).

Characteristics of
women's work

Many characteristics of women's work activities may have adverse consequences for the health and well-being of women. The following characteristics are associated with the kinds of work that a large number of women in the developing world perform. These characteristics are not specific to women's jobs, but they are common to many women's jobs.

Long working hours and lack of leisure time

When all forms of women's work are considered, women in the developing world work longer hours per day than men (Jacobson 1993; Paolisso and Leslie 1995). Although there are differences from region to region, estimates vary from 16 to 20 hours per day in some areas (Commonwealth Secretariat 1990; Acevedo 1994; Handali, see footnote 13). In African countries, for example, women farmers regularly have to put in 16-hour days. In Burkina Faso, India, Kenya, Nepal, and Niger, fuelwood collection has been found to require 3-5 hours per day and involves traveling distances of 3-10 kilometres (Agarwal 1986). As an illustration of the time-consuming labour that women perform, a study carried out in Africa showed that where modern technology is not available it takes about 13 hours to pound enough maize to feed a family for between 4 and 5 days (Butler et al. 1987).

Women's responsibilities as health providers demand a great deal of time from women: "[w]hen a mother has a very sick child, she has no rest day and night" (Wyss and Nandjingar 1995, p. 142). According to Richters (1994, p. 41): "[a] baby sick with diarrhoea, vomiting and fretful with fever will require an enormous amount of time if oral rehydration fluid of sufficient quantity is to be coaxed into its mouth spoonful by spoonful," as will breast-feeding "completely on demand ... for 18 months or 2 years as recommended in primary health care programs in the developing world."

Women, therefore, have less leisure or discretionary time available than men, particularly during certain agricultural seasons (Holmboe-Ottesen et al. 1989; McGuire and Popkin 1989). Not only do women work long hours, they have little control over when they work at a particular task. "The timing of women's work in collecting water and fuelwood, preparing foods, feeding family members, bathing, caring and educating children, working in fields or factories is very much demand driven according to the daily needs of the household" (Paolisso and Leslie 1995, p. 60).

Such long working days often results in extreme fatigue. Lack of leisure time may also make it extremely difficult for women to find the opportunity to properly attend to a health problem (Berr 1994).

Poorly paid or unpaid

Sufficient wages are essential for health: "without assuring adequate wages, it is meaningless to discuss health or other measures to ensure health" (Misch 1992, p. 24). Sufficient wages are necessary to afford nutritious and adequate food, proper accommodations with healthier sources of water and environmentally safe power, as well as education. According to Messing (1991, p. 10): "a too-low income can ... worsen health by diminishing access to adequate nutrition and housing and by increasing stress levels."

However, much of women's work is underpaid and undervalued. The average salary received by women is always lower than that of their male counterparts (un 1991; Acevedo 1994). Worldwide, female wages are, on average, only two-thirds those of men. In parts of Africa and Asia, the wage gap in male-female earnings reaches 50% (undiesa 1991). Furthermore, women perform essential household roles that are not considered to be economically important and are not paid.

The observations of Gerelsuren and Erdenechimeg (1995), of the Mongolian Women's Federation, are all too familiar:

Although Mongolian law enshrines the principle of equal pay for work of equal value, women on average receive lower wages than men. This is related to the fact that women occupy most of the lower-paying and nonprofessional jobs. Although the government has issued some resolutions about flexible working hours for women, improved labour safety, and the creation of healthy working conditions for women, women continue to work in unhealthy environments.

Job segregation and discrimination contributes to wage differentials between women and men (ILO 1985). Women tend to work in jobs with little prestige and status (un 1991; Acevedo 1994). Furthermore, even when women do the same work as men and have the same educational qualifications, women typically receive less pay than men. The feminization of occupations traditionally carried out by men tends to devaluate them (Acevedo 1994).

Women's perceived role as secondary breadwinners is another major reason cited to explain unequal pay between the sexes for the same work (Grandea 1994).

Low-waged working women are more likely to suffer from a lack of nutritional energy, anemia, and high stress levels (Carasco 1994). Because women tend to use a high proportion of whatever income they do earn to meet family nutrition and basic amenity needs, low-wages translate into little or no remaining income for women to use for their own health needs (Paolisso and Leslie 1995).

Poor working women, with insufficient time to earn, care for their families, and conscientiously look after their health, are also unlikely to take time away from work to use health services: "sick leave may be unavailable or too costly for women with low incomes, [and] they may be forced to neglect their own health needs" (Messing 1991, p. 10).

Economic crisis further compounds health problems for women with low incomes. "When food prices rise and wages fall, a woman must spend more time finding ways to satisfy her family's hunger, travelling further to cheaper shops or markets, preparing cheaper food, and often eating less herself in order to feed her husband and children" (Vickers, 1991, p. 15).

There may also be a link between income levels and safety in the workplace. When incomes for women in a society are higher, and greater employment possibilities are available, women may have some degree of choice about whether or not they continue to work in a situation that poses hazards to their health and safety. In societies that offer fewer opportunities to women, the only choice available may be between a low-paying job with little or no occupational health and safety protection and no job at all.

If working wages are insufficient to meet basic needs, women may be forced to look for income from other sources. The extent to which women engage in secondary employment and the effects of this employment on health effects need more attention. Women with limited resources may also engage in prostitution to generate additional income (Standing and Kisekka 1989; Pauw 1993; Strebel 1994). According to the WHO (1994a, p. 59), "in hard times, some [women] find it necessary to trade sex for money, food, or shelter." Multiple sexual partnerships, without condom use, leads to an increased risk of stds, including AIDS.

Female-headed households

It is impossible to discuss women and their working environment without considering the fact that many women are the sole or primary source of family income. The increasing number of single women who have children and are heads of households worldwide is a result of a number of factors: national and international migration of men in the search for work; divorce; widowhood; wars; desertion; and the increasing number of births to unpartnered adolescent women. It is estimated that female-headed households make up one-quarter of households around the world (un 1995). In the Caribbean, women constitute up to 35% of all heads of households; in parts of sub-Saharan Africa, the figure is 40-45% (un 1995).

Female-headed households are particularly disadvantaged and economically vulnerable. As a result of the lack of educational opportunities that many women face and the difficulties of obtaining well-paid secure employment, a smaller amount of money often comes into the female-headed households than into male-headed households. In Canada, single-parent families headed by women are on the rise and most of them (57.2% in 1992) live in poverty (Status of Women Canada 1994). As stated by Richters (1994):

Women appear to be the only financial support for as many as a third of the world's families. Because such mothers are often poorly educated, without investment capital, and attempt to do two jobs at once (domestic and wage work), female-headed households tend to be poor.

In female-headed households, coping with limited living space and scarce resources has a high cost on the physical and mental health of these women (Acevedo 1994). The deterioration of public services particularly affects these women.

The transformation of subsistence-agricultural economies into income-generation economies may lead to an increased number of female-headed household and have negative impacts on health. Herrera and Lobo-Guerrera (1994) explained that some indigenous women in the Orinoco and Amazon basins faced significantly increased workloads when their husbands left the household for many months of the year in search of income-generation activities. Although the women had their agricultural produce from the conuco (small plot of land), they did not have the protein foods, such as meat and fish, that their husbands usually obtained.

Therefore, as stressed by Leslie (1992, p. 15),

Given the increasing prevalence of female-headed households, and differential findings in terms of the welfare of women and children living in female-headed households, local social science research is urgently needed to investigate factors that compound or mitigate poverty and poor health within such households.

Low positions

Throughout the world, women's subordinate position in society is reflected in the dearth of women in positions that involve the supervision and direction of others. In the majority of countries around the world, women hold only a small proportion (between 10 and 30%) of management positions, and even fewer (less than 5%) of the very highest posts (ILO 1993). In addition, women are poorly represented in the ranks of power, policy, and decision-making. Indeed, women make up less than 5% of the world's heads of state, the heads of major corporations, and the top positions in international organizations (un 1991).

Unemployment

In many developing countries, unemployment for females is much higher than for males. Women are particularly vulnerable to fluctuating economic conditions because they are least likely to benefit for job expansion and the first to suffer from job contraction. Unemployment, especially for poorer people, is associated with deteriorating physical and mental health.

In the English-speaking Caribbean, for example, women and young adults (under 25 years of age) are the most vulnerable groups in the labour force, and women are particularly disadvantaged. Of the 191 000 unemployed persons in Jamaica in 1989, 57.2% were 25 years old or younger, but 64.5% of the unemployed were women (Planning Institute of Jamaica 1989). In 1991, the unemployment rate for females in Jamaica (23.1%) was more than twice that for males (9.3%) (ILO 1994). Similar patterns were reported for Guyana in 1986 and Trinidad in 1988 (paho and WHO 1992).

Women may not look for work because there is no work suitable to them or they have become discouraged because they are victims of prejudice and discrimination (Nuss 1989). In addition to general discrimination on the basis of sex, women may experience discrimination if they do not measure up to a certain notion of feminine beauty (Acevedo 1994). Managers may hire or promote women on the basis of their attractiveness (Humphrey 1987). In Venezuela, for example, advertisements for secretaries and receptionists often require a "good appearance," an attribute that is not demanded of men (Acevedo 1994).

Part-time and voluntary work

Women are more likely to be part-time workers than men, in part because women try to fit their work around family responsibilities. Activities such as market trading and street vending offer this kind of flexibility. In West Africa, women dominate this type of work; for example, they make up 93% of the market traders in Accra, 87% in Lagos, and 60% in Dakar. However, significant portions of the world's women are engaged in involuntary temporary, part-time, or seasonal work. Part-time workers, usually excluded from trade-union membership, have no channels for negotiating better terms for work (Grandea 1994).

Voluntary social work is usually done by women, with little recognition and no remuneration. For example, women comprise most of the volunteers in hospitals, self-help clinics, and other community organizations. In Latin America, women have formed networks such as housewives associations and mothers' clubs to help them to meet their basic daily needs (Jacquette 1986). For example, in the settlements around the larger cities of Peru, many women have created and are running "Mothers' clubs" and "Milk glass committees," which are organizations aimed at providing effective relief from deteriorating economic and health conditions (Timoteo and Llanos-Cuentas 1994).

Women's lives, and women's workloads, are hit the hardest by economic crisis and adjustment policies because women must take on even greater responsibilities. Reductions in health, child-care, and education services mean that women are forced to provide, on a private or individual basis, social services that were formerly provided by the state (Commonwealth Secretariat 1990; Vickers 1991; Acevedo 1994).

Shift work

Shift work, which has become increasingly prevalent in the industrial sector as automated equipment is introduced, may lead to gastrointestinal disorders, nervous disorders, and sleep disturbances (such as fatigue, light sleep, and insomnia). Anxiety, confusion, irritability, nervousness, depression, and concentration difficulties have been linked to shift work (Labour Resource Centre 1995).

The conditions surrounding shift work, which often involves night work, may also decrease the amount of time that a woman has with her family in the home. For example, Haile (1994) reported that women night workers in Ethiopia are often forced to sleep in the factory after work because there is a lack of adequate transportation services to their homes. If a woman takes a service bus that lets her off at a central point, she will be exposed to the risk of both rape and robbery. Therefore, many women decide to spend the night at the work area and often get insufficient sleep.

Lack of occupational health and safety protection

Occupational health and safety standards and enforcement measures are necessary to ensure the promotion and maintenance of the highest degree of physical, mental, and social well-being of workers in all occupations (Puta 1994). To ensure the health and safety of workers, measures must be taken to establish and maintain a safe and healthy working environment and to prevent illness and injury related to working conditions.

Women often work in unregulated industries that may be outside the scope of occupational health and safety legislation (ILO 1985; World Bank 1993). In situations in which legislation is in place, it may not be enforced, which renders it useless.

The devastating implications of the absence of enforced safety standards were realized in Bangkok, Thailand, in May 1993, when a lack of fire-safety precautions led to the death of over 200 employees and to severe injuries to hundreds more, when a toy factory burned to the ground. Most of the victims were young Thai women who earned the equivalent of us $6 a day stuffing toy dolls. Fire alarms were not functioning and there were no smoke detectors, fire escapes, or fire drills. Because some exits were routinely locked shut, hundreds of workers were forced to jump from the third and fourth stories in an attempt to escape. The factory was owned by interests from Hong Kong, Taiwan, and Thailand and produced dolls for multinational toy companies in the United States.

According to Kittipak Thavisri, a labour specialist at Thammasat University in Bangkok (iht 1993, p. 15),

Public safety is costly ... to attract foreign investors .... You have to overlook some of the labor regulations .... Much the same situation prevails in thousand of other factories in Thailand .... Insufficient attention is paid in Asia to safe working conditions in an economic climate where the stress of manufacturers is often on keeping production costs as low as possible.

In fact, throughout Southeast Asia, labour safety laws have not kept pace with economic development. In some nations, there are no laws at all. In others that do have laws, there is practically no enforcement (Shenom 1993, p. 3).

Greater steps must be taken to ensure that adequate occupational health and safety standards, and enforcement measures, are put into place with regard to the risks associated with women's work.

In industrialized countries, attention to women's occupational safety has usually focused on safeguarding their reproductive capacity by protecting them from work environments deemed dangerous to fertility (Eines 1993) and on protecting the health of the fetus. The fact that reproductive damage may also be experienced by men has been largely neglected until recently.

Women must also be on guard for the possibility that protective legislation may be used against them. For example, protective legislation has been used to justify discriminatory labour practices and policies to keep women out of better paid jobs held mostly by men. In an American legal case, for example, the Supreme Court of the United States found that protective legislation excluding "women who are pregnant or who are capable of bearing children," was used to prevent women from obtaining high-paying jobs (Johnson Controls 1991, p. 1198).

Other types of legislation aimed at protecting women may also end up depressing their wages or discouraging their employment. For example, many countries have legislation that establishes standard periods of maternity leave and other special benefits for women. Such legislation usually requires employers to provide these benefits to female workers, effectively increasing the cost of hiring them. To avoid paying maternity benefits, some garment manufacturers in Bangledesh hire young women only on a daily or casual basis (World Bank 1995). Acevedo (1994) reported that, in Venezuela, changes to the employment law intended to benefit women¹⁴ have actually served to hurt some women. In response to the legislation, some employers in the industrial sector are actively recruiting only women who are beyond childbearing age or are replacing female employees with men. Some companies, before they hire a woman of childbearing age, are even demanding that women produce medical certificates attesting to their sterilization (Acevedo 1994).

Lack of union support

Women may suffer additional work stress in situations where they have no protective associations to support them when necessary. For example, workers in some export-producing free-trade zones, such as in Sri Lanka, are not permitted by law to form unions (apdc 1990).

Where unions do exist, they are often underrepresented by women. The Labour Resource Centre (1995) reported that, in Malaysia, legislation requires that a safety committee must be established in places of employment with more than 40 employees. Although the legislation specifies the number of employees and employers that must be on the committee, it does not specify representation on the basis of sex.

Interests of female workers -- such as childcare, sexual harrassment, lack of access to capital, social subordination, and health and safety issues -- are rarely the interests of traditional trade unions. In a study of male-dominated trade unions in female-dominated occupations (Rathgeber 1990a, p. 16), researchers found that

Women's concerns were usually not articulated by male trade union representatives ... but women themselves were reluctant to become involved in union activities because they felt that they lacked the necessary verbal skills or they were unable to combine time-consuming union activism with their domestic responsibilities .... Even when women have achieved high level qualifications or have become members of trade unions which supposedly protect their interests, gender still operates as a powerful intervening variable in the context of actual workplace experiences.

Strategies need to be developed to increase the representation of women in trade unions and to make trade unions more responsive to the needs of their membership, including females.

Lack of contracts

Many women in developing countries work in situations without contracts and therefore receive no health coverage or social security protection (Machado 1993; Berr 1994). Employers are also absolved from giving noncontractual workers, or temporary contract workers, maternity leave or rights to use company health clinics. For example, Zaini (unpublished)¹⁵ explained that, because a pregnant woman working for a contractor on a Malaysian plantation is not entitled to paid maternity leave, "[she] will be back in the plantation a week after her delivery for her income is vital to the family's survival."

A study of 300 women who pick grapes for export in Chile¹⁶ revealed that 65% of the women worked with a taskwork contract and another 14.3% worked without any contract (Medel and Riquelme 1992). In the best of cases, some of these women were protected against accidents and work-related diseases during the months in which they were employed. However, if the women later experienced health problems related to their hard work during the fruit-picking season, protection was not provided (Berr 1994).

Women are often involved in temporary or part-time work, and they are usually not eligible for insurance against accidents or disease, even if they have contracts. Women working in agriculture, as domestic servants, and in fisheries and fruit picking, often work in noncontractual relationships (Berr 1994). In Brazil, approximately one-third of the 15 million women who made up with female work force in 1985 were employed as domestic workers. These women, who usually earn below minimum wage, often do not have employment contracts and are not covered by the social welfare system, which provides such benefits as health insurance, pension, and retirement benefits (ILO 1985; Machado 1993). The percentage of women without contracts is highest among low-income groups and rural women.

There has been an increase in the use of homeworkers in many parts of the world to reduce labour costs. Companies that use homeworkers usually have a long subcontracting chain. The last and most precarious link is the work performed predominantly by women in their homes. These women have no formal work contracts, no social security, and no coverage against accidents and diseases (Berr 1994). If a homeworker is ill, she cannot take medical leave. In the case of injury or illness during work, the cost of medical treatment is borne by the worker or their families. It is not the responsibility of the employer (Prompunthum and Kerdpol 1985; ILO 1992b).

Lack of information on health and safety risks

Women often lack information on the extent to which detrimental working conditions can lead to negative health effects. For example, women may be unaware of the toxic effects of chemical materials that they handle. Although this may sometimes be because information is unavailable, in other cases, it is because they have not been properly informed of the hazards. LaDou (1993) reported that lack of knowledge about the dangers of pesticides is pervasive among workers, employers, and even pesticide sellers. Workers -- and all others who are in contact with harmful agents -- have a right to know about suspected hazards, and training programs should be instituted.

The Labour Resource Centre (1995) pointed out, however, that it is a constant struggle to educate workers about health and safety concerns. Many workers, primarily concerned with having work and receiving better wages, do not consider workplace health and safety issues to be a priority. Indeed, some workers may even agree to carry out hazardous jobs or use hazardous chemicals if they are paid an extra allowance for the job.

Sexual harassment

There is a growing recognition of the extent to which women may be subjected to sexual harassment on the job (Ahikirie 1991). Employers may demand sex in return for access to, or continuance in, a job, promotions, or salary increases. A woman who desperately needs the work may find herself unable to refuse the demands for sexual favours. A woman who is subjected to sexual harassment may suffer mental and psychological damage as well as adverse physiological reactions, such as gastritis and dizziness (Acevedo 1994).

As described by Humphrey (1987, p. 140),

They [women] can be sacked by foremen and managers for rejecting advances, sacked if a relationship comes to an end, and in many cases sacked if they denounce the offender .... Possibly more pervasive and generalized are the public humiliations and demeaning of women through bullying, shouting, abuse and disciplinary warnings ... such practices seemed quite common in Brazilian factories.

Stress

Increased attention is being given to the extent to which stress affects the health and well-being of individuals. There are a number of psychosocial factors found in the workplace that are related to stress levels: the number of hours worked; the level of job satisfaction; the complexity of tasks; the degree of supervision; and the organizational structure. Stress can by provoked by other workplace conditions such as noise, chemicals, and sexual harassment (Messing 1991). Stress has also been linked with few rest periods, constant demands, inability to talk with co-workers, and repetitive work (Messing 1991).

Stress is an important hazard associated with work for many women. The competing demands on women from their work and family can be a significant source of stress in both developing and industrialized countries. Several studies in industrialized countries have demonstrated that the stress associated with balancing paid work outside the home with childrearing and household management responsibilities can lead to decreased productivity, tardiness, absenteeism, turnover, poor morale, reduced life satisfaction, and poorer mental health (Lee et al. 1994). Furthermore, women often have higher levels of stress than men because of the social conditions under which they live, conditions of economic inequality, poverty, and marginality.

In some industries that predominantly employ females, the fast pace of the work regime and the domination of women's lives by production targets may lead to a chronic state of ill-health. Workers, under the constant threat of dismissal if quotas are not met, may experience headaches, fatigue, stomach ulcers, constant colds, sleeping problems, high blood pressure, and palpations of the heart (apdc 1990). However, there have been few systematic studies of stress in female-dominated industries.

Some research has been conducted in Latin America on stress among women in the paid work force. Berr (1994) reported results from a study conducted by the Centre for Women's Studies in Chile on risk factors associated with stress among females who work in the fruit and garment industries. A stress index was developed based on the presence of three stress-related diseases (neurosis, ulcers, and gastritis) reported by working women. This was followed by an analysis of factors associated with the stress index. From these control values (women who have never suffered from any of the three diseases), an analysis was undertaken to identify risk factors associated with stress.

In the garment industry, women who reported that they suffered from stress-related illnesses were 3.7 times more likely to be economically responsible for the household; 2.0 times more likely to be exposed to environmental noise; and 2.8 times more likely to have suffered some type of accident at the workplace. In the case of female fruit pickers, women were more likely to suffer from a stress-related illness if they devoted more than 2 hours a day to household work (8.5 times more); feared dismissal (3.5 times more); and worked in a forced physical position (2.1 times more). In packing plants, stressful working conditions were related to the rigorousness of the work and the long working hours. Women working in packing plants were more susceptible to stress when they feared dismissal (3.4 times more) and worked in a noisy environment (3.9 times more).

Breilh (1994) presented survey results with regard to stress among women in the civil service in Ecuador. A high proportion of the women surveyed were in a state of stress. He reported that high stress levels among female civil servants were associated with repetitive and dull work, poor organization, and too much work. It was also shown that women who stood a great deal during their work were most affected by stress.

High stress levels were also linked to lack of support with domestic responsibilities. Over 50% of the working women surveyed by Breilh (1994) carried out a large amount of domestic work with no support of any kind. Among the workers with a husband or partner, a very small percentage reported that they received help in the home from their partners. Only 10% of partners helped out with domestic labour, and 27% of the men participated in tasks involving family care and attention.

Breilh reported that there was a significant decrease of severe stress in workers with the highest levels of recreation. However, because of cultural restrictions and lack of time, recreation time for female workers was minimal, and the full protective effect of recreation was therefore not realized. Women invariably have little time for themselves, for personal projects, leisure, or recreational activities.

Breilh also established a relationship between a stressful working environment and the presence of a menstruation disturbance. The percentage of women with polymenorrhea (increased menstruation) almost tripled in workers with a high level of stress. Women who were experiencing high stress levels were also found to be most likely to suffer from other ailments, such as intercurrent infections. Psychological stress can also result in amenorrhea among women (rcnrt 1993).

Possible detrimental effects on reproduction

Women's work activities may also lead to reproductive difficulties. Heavy loads, for example, may lead to a prolapsed uterus and are associated with menstrual disorders, miscarriage, and stillbirth (ncsew 1988). A study in Maharashtna, India, which addressed heavy agricultural work, found that there was a high incidence of stillbirths and premature births during the peak season for rice cultivation season when everyone, including women whose pregnancy is almost full-term, are in the fields the whole day. "The work involves squatting and bending for hours. Such physical strain and pressure in the uterus can lead to premature labour as well as births" (Batliwala 1988, p. 33).

Other potential reproductive problems for farm women may include the following (Engberg 1993, p. 873):

• Disruption of the menstrual cycle;
• Infertility;
• Fetal malformation;
• Cancer among offspring;
• Growth retardation; and
• Abnormal postnatal development of infants because of chemicals passed to breastmilk.

Certain working conditions, such as shift work, irregular schedules, and temperature variations, may change the menstrual cycle of a woman (Acevedo 1994). Some studies have shown that cold, exposure to solvents, or lifting weights at a fast pace can produce menstrual pain (dysmenorrhoea) (Messing 1991).

Prolonged standing, shift work, long working days, radiation, and exposure to certain chemicals may contribute to the number of spontaneous abortions among working women (Patrick 1991, cited in Koblinsky, Timyan et al. 1993; Acevedo 1994). Borges (1993) noted that high-stress jobs, and low task control, increased the risk that a woman would experience a premature birth (Acevedo 1994).

A study carried out in La Victoria, Venezuela, assessed the health status of a group of female textile workers and compared them with women from the same neighbourhood who did not work outside the home (Borges and Acevedo 1994). Generally, the textile workers tended to have poorer living conditions and lower levels of schooling and to be significantly more likely to be the financial head of the household than the women who did not work outside the home. The textile workers also had significantly more spontaneous abortions and significantly lower birthweights of their newborns than women who worked exclusively in the home.¹⁷ The characteristics of work in the textile factory, including long working hours at an assembly line, the intense working pace, and prolonged standing, combined with poor living conditions and the burden of caring for a family, may have contributed to these reproductive difficulties.

Positive aspects of women's work

Work may also have many positive health benefits for women. In industrialized countries, evidence suggests that, at least for women who have a positive attitude toward work, there is a strong positive association between women's employment and women's health (Repetti et al. 1989; Rodin and Ickovics 1990). As well, it appears that the mental and physical health of employed women is significantly better than the health of women who stay at home (McDaniel 1987).

Women working in the formal work force may experience heightened self-esteem and confidence in their abilities and decisions. The workplace environment also offers the opportunity to obtain social support from co-workers (Leslie 1992; Debert-Ribeiro 1993). Juggling multiple roles (such as in the household and in the paid work force) can result in higher self-esteem and greater happiness and may act as a shield against depression (Ayers et al. 1993). Employment's protective effect has been found to be greater for women who hold professional and managerial positions than for those in blue-collar occupations (Hazuda et al. 1986).

Because working conditions in developing countries are quite different from industrialized countries, it is difficult to generalize from data obtained in industrialized countries. It is therefore important that the health consequences of women's increased participation in the work force of developing countries be systematically and fully explored.

¹¹ See Mirdha, B.R., "The female client and the health provider." Unpublished paper submitted to the 1994-1995 TDR/IDRC competition.

¹² Such as from the Philippines and Caribbean countries to Canada and from the Philippines to Hong Kong and Singapore.

¹³ See Handali, S., "Gender and women's health issues in Jayawijaya District, Irian Jaya, Indonesia." Unpublished paper submitted to the 1994-95 TDR/IDRC competition.

¹⁴ Such as lengthening the time for pregnancy leave from 12 to 16 weeks and prohibiting job dismissal during the year following the birth of a child.

¹⁵ See Zaini, J., "Women in Malaysian plantations: health and medicines." Cited in apdc (1990).

¹⁶ Grape picking is one of the most important sources of female employment within Chile's productive sector.

¹⁷ See Borges, A.; Acevedo, D. Salud reproductiva en textileras y amas de casa, La Victoria, Aragua, Venezuela. Unpublished.

Documento(s) 7 de 13