Journal of Scientific & Industrial Research Vol. 59, Dece mber 2000, pp 995- 100 I

Occupational Health for Women: A Current Need

A K Srivastava * and Vipin Bihari Epidemiology Di vis ion, Industri al Toxicology Research Centre , P B 80 , M G Marg,

Luckn ow 226 00 I, India Tel- (0522) 220 107 , 220207, 2 14 11 8; Fax- (0522) 228227

E- mail : ilrc @lw l .vsnl.ncl.in

Received: 2 June 2000; accepted: 24 August 2000

Women play diverse role in our society. Often they handle two or more tasks simultaneously. They are, therefore, prone to suffer from work related di seases which are furth er complicated by soc ial , psycho­logical , and physiological issues. Roughly one out of 300 females is suffering from some occupation related di seases and about same number of new cases add on to the ex isting cases each year. The lack of occupational health services result in thi s unwarranted sickness. Here we examine interpl ay of different related issues and outline a strategy for an action programme.

Introduction The proportion of employed women in the past

few decades has increased phenomenall y. These women are, therefore, exposed to di ffe rent types of work related hazards. The working cond iti ons of women in India are currently simil ar to those found in the early 19th century in industri ali sed countri es. Large numbers of women entered the job market during industri al revolution, and were exploited as a source of cheap labour and the working condi ­tions were riddled with grave occupational hazards l

.

Reports about exposure of fe male subject to silica, beryllium, benzene, and vinyl ch loride serve as past examples of indifference to women at the work-place. The lack of regulation fo r waste anes­thetic gases and antineoplast ic drugs to protect hea lth care workers indicates that the indi ffe rence contin ­ues even today2.

The Finance Minister, Government of India, has dec ided to set up a task force for rev iewing the ex­isting laws and government schemes on the role of women in national economy, thereby accepting the input of women in vari ous occupations and their

*Corresponding author

weak position in society. Further the Govern ment of India has also resolved to observe the year 200 I as "Women's Empowerment year").

There is a growing realisation that the occupa­tional health problems of women workers merit spe­cial attention for several interre lated reasons . The physiologica l, psychological, and health care needs of women are proportionately greater, as ·they are burdened with multiple responsibilities like: (i) Bulk of hOllsework 4

, (ii ) Care of young, aged , and sick; (iii ) Responsibilities of home; and (iv) The work at the place of employ ment. Child bearing and rearing (pregnancy and lactation) gives rise to a legitimate hea lth concern at work-p lace and requires safe guards spec iall y with reference to chemically in­duced teratogenicity. Table I briefly summari ses the hazards and adverse health effects in some of the occupations where women are chiefly empl oyed .

The objective of thi s arti cle is to outline the inter-face of different social , cultural, physio logi­ca l, and psychologica l issues which have a bearing on occupation related sickness among women and to suggest an action plan fo r the perusal of acade­micians , sc ienti sts , and policy makers. This wi ll re­sult in an informed discuss ion about desirabl e

996 ] SCI IND RES VOL. 59 DECEMBER 2000

Table 1- Occupati onal related hazards and their hea lt h outco mes*

Occupa ti ons

Househo ld wo rkers

Clerical workers

Health care workers

Hazards

Cleaning agent s

Infectious agents Heavy lifting Job insecuri ty

Ergonom ic hazard s VDUs , indoor air Indoor air r oll ut ants

VOCs Infect ious agents Ethy lene oxide

Possible health crfects

Dermatitis , mucous membrane and respirato ry irrita ti ons. Rubell a, va ri cella, inil uenza, etc. Musc uloske letal injuries Stress

Muscu loskeletal fa ti gue, Stress Eye stra in , RM Is Fat igue, eye, mucous, membrane, and respiratory irri tation H adache, fati gue Hepat itis B, AIDs, tuberculosis

Lifti ng pa tient s and eq uip ment Ioni zing rad iat ion

Suspected carcinogens. mlllagen Muscul oske leta l problems and injur ies Reprod ucti ve hazards . carcinogen, mutagen Injuries

Clothing/texti le workers

Retail sales workers

Haird ressers and re lated jobs

Rag pickers

*Reference 4 and 7

Slippery ilours Cotton dust Dyes, fabric Fabric treatment Repet it ive hand movements Noi se Pro longed standing Indoor air pollution

I-lair dyes Solvent. ae roso l propellant s Infectious agent s

Byssi nosis Dermatiti s, respiratory irrit ation , carcinogenesis Dermati tis, res piratory irritat ion, carcinogenesis Carpel tunnel syndrome Hearing loss Varicose veins, low hack st rain Eye, mucous membrane and respiratory irritation, headache, fati gue Dermatiti s, resp ira tory CNS depression . mucous mem brane irri ta tio n GnstrD-i ntestina l problems. dermatosis

- The hea lth effec ts arc app licab le to both the sexes but women represent a majori ty proport ion in these occupations

changes at di ffe rent levels of govern ance th at may lead to im proved health and safety fo r the working

women in India.

Burden of Occupational Disease Among Indian Women

Desp ite many s tudies regardi ng occ upat ional hea lth probl ems of women in Ind ia th e exact mag­nitude of occupat io n re lated di seases among Indi an women is not kn own. Recentl y Le igh et al.·'i have calcul ated bu rde n of occupati onal di seases in vari­ous countries and have reported th at 100.69 milli on new cases of occupational injuri es, and 1.85 mil ­li o n new cases of occupati onal di seases occur each year in India. B ased on th e ir va lues of global es ti ­mates regardi ng expected num ber of cases fo r d if­fe re nt occ up ati o na l di seases a mo ng wo me n th e li ke ly number of women suffering from occupational diseases in th e year 2000 AD in Indi a has been ca l-

cul ated taki ng (he popul ati on to be one billio n and sex rati o to be 927 fema les to 1000 males. Th is works out to 1. 65 mill ion wo men having occupa­

ti on re lated s ick ness . The nature and magnitude of specifi c occupati onal di seases are depicted in Table 2. As most of these disease have a chro ni c course and 1.85 m illion new cases w ill add on each year th e problem may become stupendous in the coming decade.

Social Issues Relating to Employed Women In quite a fe w occupati ons, wome n employees

are forced to lise a combinati on o f s ick leave, or leave with half pay/ without pay during mate rn ity

and onl y a ma ll percentage of em pl oyers are pro­viding any kin d of chil d ca re ass istance, s Ll ch as crec hes and day-care cente rs. Fac tori es Act6 in our country, lays down the statuto ry require me nts but

SRIVASTAVA & BIHARI : OCCUPATIONAL HEALTH FOR WOMEN 997

Table 2- Probab le magnitude of different occupational diseases among women

Di sease Expected numher of suffering wo men/million fema le world population "

Likely number of women suffering in India

Pneumoconioses Chronic respira tory diseases Muscul oskele tal diseases Cancer Menta l disorders Pesticide poisoning Other poisoni ngs Skin diseases Noi se induced hearing loss

126 76 1.1 I, 102

21 1l::3

24.4 46.3

1,011 166

the same may not be binding in all the occupations. Such a patch-work of protection is inadequate and a uniform national leg islation is definitel y call ed for to address thi s problem .

Female-intensive occupations are often plagued by requirements that contribute to specific health problems . Clerical and assembly jobs are repetitive and monotonous tasks, with LlIlvaried job require­ments, daily wage system and often oppress ive monitoring. Occupations like nursing, teach in g and soc ial servi ce demand responsibiliti es related to welfare which are in sharp contrast to role expecta­tions and grass root reality4. Jobs with competit ive requirements have their own hazards, 83 per cent of women respondents in such jobs compared to 53 per cent of men, reported that they always or often felt that they had to perform the best whatever they did. In physically demanding and ri sky situati ons , women may feel pressurized to attempt unsafe work as a way of proving their ab ilities and establi shing cred ibility with their male counterparts. Nurses and maids workin g in psych iatri c hospitals have to deal with violent patients in their day-to-day work . So­cial service workers are often victim ized by fru s­trated cl ients 7. Adequate securi ty systems and su f­ficient staff can so lve the issues of personal secu­rity.

Sexual harassment at workplace affects 36 to 88 per cent of worki ng women in both trad iti onal and non-traditional jobs7.

Sexual harassment inc lude~; any untoward ver­bal or physical advance, ranging from sex ual com-

60,606 366, 041 530,062 10,101 88, 023 11 , 736 22, 270

486,29 1 79, 846

ments , pressure for sexual favours accompanied by outri ght or subtle job threats and even physical as­sault. Besides loss of opportunity for career advance­ment, thi s is associated with psychological trauma and stress. Onl y 25 per cent of women reporting unwanted sexual advances seek medical or psycho­logical help7. Recently, guide lines have been issued by the Supreme Court prohibiting sexual harassment at work placeS.

Physical and Erogonomic Issues Ferro-luzi 9 have studi ed wo men from India,

Ethiopia and Benin fo r energy stress in marginall y nouri shed women and reported that body mass in­dex (BMI) of underprivileged Indian women was 18. 1 which was low and many of those women could be labeled as chronic energy deficient. The basal metabolic rate (BMR) values among Indian women were barely 65 per cent of that observed in women from other two countries. The low BMI and BMR raises question as regards to physical act ivity and ergonomic issues which have not been adequatel y addressed till date.

Although ergonomic concerns are not gender specific, women are particularly at risk because most tools, work stat ions, and personal protective equ ip­ments are designed to fit "the average male". Ma­chine designs suitable to men are, as a rule, not suited to women. Carpal Tunnel Syndrome (CTS), a dis­ab ling hand disorder resul ting from nerve compres­sion inside the wrist is associated with repetiti ve, hanel-intensive jobs li ke garment making, cash reg-

998 ] SCI IND RES VOL. 59 DECEMBER 2000

iste r operations and video display terminal (VDT) jobs where women are chiefly employedlO. More th an 25 per cent of 600 VDT operators were diag­

nosed with CTS or pre-CTS because of repetitive motion as a result of working at improperly located computer key-boards. Fatigue, headac he, visual di s­turbances , backstrain and other musculoskel eta l dis­orders are because of poorl y designed work stations, equipments and improper lighting which have also been reported by VDT users 10. Rao et (II. I I have re­

ported that 72.4 per cent of females suffered from asthenopia as compared to only 33 .8 per cent of male VOT users. They attributed this to higher prevalence

of anaemia detected among female subj ects. Assem­bly lines, work benches, chai rs, tool s, etc. in the case of women operators have to be designed as per their anthropometric needs. III fitting personal protective equipments are common and ofte n result in in­creased exposure to work-place hazards with adverse aifects on the health of working women I2.

Reproductive Hazards Vis-a-Vis Occupational Exposure

Occupational Safety Health Administration has regulated only four agents:(i) ioni zing radiati ons, (i i) lead , (iii ) dibromochloropropane, and (iv) e th y lene

oxide on the basis of their potent ia l to cause repro­ductive dysfunction 10 . Both paternal and mate rnal

exposures have been implicated in the adverse preg­nancy outcomes. These are broad ly infertility, spon­

taneous abortions, pre mature de livery, low birth -less weight babies and congenital anomalies. The factors responsible for these may be of physical , chemical or biol ogical nature. A positive re lat ion­ship between delivery of premature children and occupati o nal fat igue was reported in jobs that in ­vo lved standin g for 3 to 4 h a day work ing at tasks requiring little attention and working in a humid and noi sy environment u . Studies indicate that exposure to 85 dB or hi gher leve ls of noi se and shift work , espec ial ly rotating schedules, may have an indepen­dent and negative effect on birth weight and length of gestat ion. Exposure to no ise and shift work has also been reported to cause menstru a l d isturbances

and infertilityI :l .

Toxoplasma-rubella-cytomega lo and herpes virus (TORCH) infections acq uired durin g preg­

nancy may res ult in congenital abnormalities in the neonates. School teachers and day-care personnel have an increased risk of exposure to varicella, hu­man parvo virus, and mumps 14. Physicians, nurses,

and other health care personnel are susceptible to hepatiti s Band HIV infections which may adversely effect pregnancy out-comes in females.

Large proportions of women are engaged in ag­ricultura l work. Exposure to agroche micals includ­ing pesticides (insecticides, he rbicides, fumigants, and fungicides) a re kn ow n to be detrimenta l to hea lth. Increased prevalence of spontaneous abor­tions have been reported in India where both the parents had long - term chronic exposure to several pesticides 15.

Exposure to hi gh level s of so lvents in work en­vironment may increase the ri sk of spontaneous abortions I6. Association of spontaneous abortion

seems to be most evident in subjects exposed to tol u­ene, methy lene chloride, tetrachloroethyl ene, petro­leum ether, xy lene, and fo rm aldehyde or aliphati c hydrocarbons including paint thinners. Bihari etal. 17

while rev iew ing the health hazards of waste anes­thetic gases in su rg ical operation rooms commented that to date the exact number of persons exposed in India may be more than 150, 000 - a good propor­ti on of these are women. A policy of transferrin g pregnant workers ex posed to leve ls exceed ing 10 per cent of the thres hold limit value to other safe r jobs or sanct ion ing spec ial materni ty leave has been adopted in some countries. Table 3 depicts concen­tration limit of some chemicals vis-a-vis reproduc­ti ve hazards.

Respiratory Diseases Women 's resp ira to ry disorders in India are

linked with domestic exposure to cookin g smoke. In places where biomass fuel are commo nl y used , s imil ar rates fo r diseases such as chronic bronchiti s and cor-pulmonale are foun d fo r men and women. Occurrence of the onset of cor-pulmonale is , how­eve r, at an earl y age in the case of wo men IX.

SRIVASTAVA & BIHAR! : OCCUPATIONAL HEALTH FOR WOMEN 999

Table 3- Potenti ally hannful levels o f tox icants for pregnant women*

Agent

Anaesthetic gases

Inorganic lead Mercury Cytostati c drugs

Carbon monox ide Organic solvents

Carcinogens Ionizi ng rad iati on incl uding rad ionucl ides

* Ref. 24

Exposure level considered

harmful

Halo thane I ppm/8h, 3ppm/ 15 min Nitrous ox ide, 100 ppm/8h Nit rous ox ide, 100 ppm/8 h Isotlurane, entlurane, IOppm/8h B-Pb, 0.3 Il mo l/ l U- Hg, 50 nmol/ l Preparation of the d rug so luti on for therapeuti c adminis trati on 14 ppm/8h 10 per cent o f the Finni sh occupational hygenic va lue Any ex posure at a ll 2 mSv on the abdominal sk in ( I mSv in the foetus)

Silicosis among women from the deve loping countries is usually reported in potte ry industry and tends to progress more rapidly as compared to men IS.

Many women in our country are exposed to siliceous

dust in agate, pottery, construction , stone quarrying and grinding industries. Further, undetected pneu­

moconiosis in rural women may be caused by a com­bination of dust from grain grinding and smoke from biomass fuel. A majority of these women do not have access to adequate medical fac iliti es.

Skin Diseases and Allergy A good proportion of women are engaged in

jobs that involve continuous and prolonged contact with water, dete rgents and organic materi a l. These wome n are at a ri sk to infec ti ous skin di seases . Liden 19 has reported that contact a lle rgy to nicke l is found in 15 per cent fo r women and 2 pe r cent fo r men. Further, 40 per cent of those with contac t a l­lergy deve lop eczema of hand. The prob le m is spe­cia lly pertinent in the case of women because more women as compared to men are e ngaged in such jobs.

Occupational Cancers Occupati onal exposure to tetrachi o rethy le nc

used as a hai r d ress ing agent has been identi fied as

carc inoge nic in work environment. An assoc iat ion

between sali vary g land cancer among those em­ployed in hair dress ing shops, oesoph agea l cancer among those empl oyed in restaurants and bladder cancer in carpet manufac turin g need further re­search2o .

The high rate of lung cancer reported in Chi­nese women spec ia ll y from Xuan Wei county cou ld be attributed to the combined effects of passive smokin g and poor quality of coa l used as fuel IS.

Occupational Health Services in India At present , there is no comprehe nsive occupa­

tional hea lth serv ice in Ind ia. The re levant portions of the Directi ve Principles of State Po licy, in the Indian Constituti on state that (a) "The State sha ll , in parti cul ar, d irect its po li cy towards securi ng that the health and strength of the workers, men, women, and the tender age of children are not abused , and the c iti zens are not fo rced by economic necessity to enter avocati ons unsuited to the ir stre ngth , (b) The State shall make prov isions for securing j ust and human conditi ons of work". T he o rgani sation of

Directo rate General, Facto ry Inspec ti on and Adv i­sory Services deals w ith ques tio ns re lating to the admini strati on of the Factori es and othe r Acts and the rul es framed, bes ides the trai ning of factory in­spec tors, and fac tory medi ca l officers.

The State Departments of Health and Labour, through the ChiefIn spector of Factori es and hi s staff are responsible fo r enforc ing the lega l standards la ic! down in the vari ous Acts at the plant leve l. Other o rgani sati ons ac ti ve in the fie ld of occupati onal health are D irector General M ine Serv ices, at ional Institute of Occupati onal Health (ICMR), Industri al Tox ico logy Research Centre (CSIR) and certain non government orga ni sa ti on like Ind ian Assoc iati on of Occupati onal Hea lth , and E mployees State Insur­ance Scheme even then the de li very of occupational hea lth services are at best patchy. Whil e most of the large industri es have the ir own occupati onal hea lth set up, other industries and se lf-emp loyed peop le clo not have assess to spec ia li sed occupational hea lth services of any sort.

1000 J SCI IND RES VOL. 59 DECEMB ER 2000

The medical doctors are also not we ll equipped to deal with occupational health problems as onl y a few hours of teaching time is devoted to occupa­tional health and medicine in the under-graduate medical curriculum. Further, no medica l co ll ege or post graduate institute has a chair of occupational hea lth , though All Indi a Institute of Public Health and Hygiene, Calcutta is running a post graduate diploma course in Industrial Health , bes ides a few other institutions. Lack of coordinati on between those dealing with safety and those dealing with health further add to the confusion. Thus issues per­tain ing to women in the area of occupati onal health as a rul e get low priority.

Suggested Actions International Labour Organi sat ion (fLO) stati s­

tics indicate that women accoun t fo r 44 .5 per cent of labour force in thi s year, i.e., 2000 AD, which comes to roughl y 828 millions economica ll y acti ve women in worl d21. The demand fo r paid work is esca lating everywhere. Women are now entering labour fo rce in increas ing num bers either by choice or necess ity, often with lower recompense and rec­ognition. A large number of these women are em­ployed in informal sector and home based work , they are not even protected by an y leg islation. In the Tn ­dian contex t, while legislati on exists fo r monitor­ing working conditi ons and prov iding soc ial ben­efits the lack of abili ty to understand legal tex t means that women do not have the info rmat ion or skill s needed to benefit from these laws. Further the low proportion of women in trade unions means th at the women workers cannot lobby for their ri ghts.

The nature and mag nitude of occupat ional health problems of women workers are such that they need to be addressed urgent ly. Strategies for protecti on of health of the women workers have to be thought out, and coul d be on followin g lines:

(i) Articulation of a nat ional policy on occupa­tional safety and health, takin g cognizance of fe­male labour fo rce and the three key ro les of women , ie., housew ife , mother, and worker. The effect of each ro le on health should be criti ca ll y reviewed while rec ti fy ing th e pote ntia l confli cts and

contraindications. The aim of the policy should be to prevent accidents, injuries, and di seases which ari se or are linked with or occur during the course of work22 .

(ii ) ILO resolution on equal opportuni ty and equal treatment for men and women2.1 passed in 1985 should be recognised as the guiding principle fo r exi sting and future legislative acti on. These are: (a) Women and men should be protected from risk in­herent in the ir employment and occupation in the light of advances in scienti fic and technologica l knowledge; (b) Measures should be taken to rev iew all protective leg islations which are applied app ly­ing to women in the light of up-to-date sc ientific knowledge and technological changes and to rev ise, or repeal such legislati on, according to the national circumstances. These measures should be aimed to­wards improvement of the quality of li fe and at pro­moting equality in empl oyment between men and women; (c) Efforts should be made to extend spe­cial protecti on to women and men for type of wo rk known to be harmful fo r them, particul arly from the stand-point of their soc ia l fun ction of reproduction, and such measures shoul d be rev iewed and made up- to- date periodically in the light of advances in sc ienti fic and technological know ledge.

(iii ) National stat isti cs on occupational hea lth must be improved. Stati stics on occupational acc i­dents, injuri es, diseases , and compensation as we ll as sickness absence will he lp in the development of a national in fo rmation strategy wh ich include dis­seminati on of complete information on occupational safety and health of working women . Such action may assi st the deve lopment of national standa rds and guidelines regarding spec ific hazards faced by working women.

(iv) Occupational health has to be linked with related sectors and intersectori al co llaboration is es­sential fo r its development. Spec ificall y, there is a need to organize proper fun ctioning and competent occupational heal th services fo r all workers tak ing cogni zance of problems relat ing to women so as to ensure hea lthy and safe workplace. Such a service should be soc iall y and culturally oriented to care

SRIVASTAVA & BIHARI : OCCUPATIONAL HEALTH FOR WOM EN 100 1

for the special needs and health requirements of working women, specially those in agriculture and the informal sector. Such services should be com­prehensive and based on the primary health care approach, which is anchored on the principles of prevention, promotion and health protection.

On a short-term basis the medical officers posted in primary health centres need to be oriented towards occupational diseases and should be con­scious to the role of occupational factors and their clinical manifestations, including therapeutic aspects in day-to-day delivery of health care.

(v) Competent occupational health and safety activities require appropriate training. Efforts should be intensified to enroll more women in institutions imparting training for health and safety at work . Women should be encouraged to participate in na­tional and international seminars/workshops/confer­ences on occupational health. This platform would allow for exchange of ideas, broaden their knowl­edge and information , thereby creating awareness pertaining to occupational safety and health activi­ties resulting in increased demand for occupati onal

health services from women themselves.

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