Invisible Women: women at work, text-pesting and sex disaggregating anaesthesia

the percentage of US women in the paid workforce with young children is significantly higher than it's ever been

Good morning and Happy Monday, GFPs! This week we’re starting the newsletter with a word from data.org, who are kindly sponsoring this month’s missives:

When I wrote Invisible Women, I wanted to clearly highlight the gender data gap, the systematic biases behind the data and assumptions impacting our everyday lives. Identifying those gaps is a start, but addressing them takes a community. That’s why the work of data.org is so critical. 

Through its campaign under / over, data.org is showing what it means when people find power and change lives through collecting, analyzing, and applying data to gendered inequity. 

People like Temie-Giwa Tubosun, CEO of LifeBank. 

After the difficult birth of her son, Temie vowed to dedicate the rest of her career to maternal health. LifeBank leverages data to improve maternal outcomes, serving over 160,000 patients across Nigeria, Kenya, and Ethiopia.

Watch her story, and learn more about data.org’s under / over movement.

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In other news, GFPs, I need your help! I am working on something that requires me to read the annual reports from NHS Resolutions, the body that handles medical negligence claims for the NHS. I have some questions about how certain figures are presented, for example the difference between "claims by value" versus "total clinical negligence cost of harm." I also have some other questions about how costs specifically related to maternity care seem to have risen exponentially over the past decade. I’ve tried contacting NHS Resolutions directly, but have not received a response, so if anyone who subscribes to this newsletter happens to be an expert in claims against the NHS (even better, if you’re an expert in claims against the NHS for maternity care!) please hit reply, with many thanks in advance!

Moving on, this week I read with much interest this post by the always interesting Emily Peck of Axios. In brief, it turns out that, in the US, “the percentage of women in the workforce with young children is significantly higher than it's ever been.” This is particularly noteworthy given the significant setbacks suffered by women and in particular mothers in the workplace at the peak of the pandemic. Remember the “Shecession”?

The report on which Peck’s post is based includes this telling graph, which highlights both the sharp loss of jobs experienced by women in 2020, followed by an impressive bounce-back — with the most pronounced bounce being seen in women with the children under five.

Source: Hamilton Project

But what, you might ask, could possibly explain this bounce? Well, the jury’s still out on that one, but this report highlights increased workplace flexibility, especially around working from home as a potential driver and that would certainly seem to make sense given everything we know about how a world designed for men makes it extremely difficult for women to combine their paid and unpaid work responsibilities (for more details there’s a really good book that covers just this kind of thing, oh what’s it called now….)

Meanwhile it feels like there’s a new article every day reporting on an increasingly shrill boss-class ordering their gender-neutral employees back into their gender-neutral office, because who cares that decades of feminist analysis has been proven right on the impact of flexible working on the female paid labour force participation rate.

Never one to be outdone, the US government is similarly failing to learn the lessons of the pandemic and sunsetting the childcare provider aid programmes it set up during the peak of the pandemic. It’s estimated that this could result in the closure of more than 70,000 childcare programmes, translating into the loss of childcare for more than 3 million children. This is not only bad for the (mainly) women who rely on those spots to enable their participation in paid employment, it’s also bad for the (again mainly) women for whom childcare is their paid employment. And therefore it is overall very bad for women’s paid labour force participation, which is in turn bad for the economy. I don’t know, I sometimes think we don’t actually want to close the gender pay gap or something???

Talking of gender neutrality masking a whole host of sins, loads of GFPs pointed me towards this ICO poll on the subject of “text pests,” that is, “individuals who use personal information, such as a phone number or email address, given to them in a business context for “romantic” or sexual propositions – for example, asking a customer out on a date after they ordered a takeaway.” Or, you know, when the government ordered us to give our numbers to bar staff a few years ago as if nothing could ever possibly go wrong with that idea.

The ICO found that “29% of 18-34-year-olds received unwanted contact after giving their personal information to a business” which is certainly interesting, but I can’t help thinking it would be more informative if the ICO had, you know, sex disaggregated the data. Without the data it’s not possible for me to conclusively state that there aren’t gangs of marauding women out harassing innocent young men who only wanted a new spider fern from patch plants, but based on my own experience, not to mention that of friends and acquaintances, along with everything we know about who tends to perpetrate sexual harassment and who tends to be a victim of it, it’s not really very likely is it? Indeed, given that the poll was apparently “weighted to be representative by […]gender,” it might transpire that this 29% figure both overstates the issue for men and understates it for women.

The frustrating thing here is that they did sex-disaggregate some of the data, specifically, data on how men versus women view this behaviour, with men being more than twice as likely as women to both believe that text-pesting is legal and to think it’s morally right.

In conclusion: SEX DISAGGREGATE YOUR DATA. Hi, it’s me, I’m the stuck record it’s me.

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Gender data gap of the week

Continuing on the theme of why you should always — ALWAYS — sex disaggregate your data, GFP Tamsin sent me a fascinating study looking at sex differences in how male and female bodies respond to anaesthesia. This discrepancy is, writes Tamsin, “often commented on in the anaesthetic community but never properly looked at.” Until now, that is.

The discrepancy that Tamsin is referring to is that women seem to be more likely to regain some form of consciousness during an operation, ie, when they are meant to be fully out for the count. This is naturally incredibly frightening for the patient, and according to this study, “reported rates of post-traumatic stress disorder in [people who regain some level of consciousness during an operation are] as high as 71%.”

There is more than anecdotal evidence to back up Tamsin’s observation that men and women may respond differently to anaesthesia. As I reported in Invisible Women (see chapter 10, The Drugs Don’t Work) there are all sorts of sex differences, from body composition to enzyme activity, that may affect drug metabolism.

This particular study also refers to data suggesting that sex hormones, in particular progesterone, may have an impact on how the female body processes certain drugs, which further complicates the matter since this means we should, for premenopausal women, be considering where she is in her menstrual cycle when determining dosage levels. It also has implications for the use of anaesthesia in obstetrics, and as GFPs will be aware from previous newsletters, if we’re bad at researching the female body in general, this gendered data gap goes into overdrive when it comes to pregnancy, making this a problem that goes well beyond the correct dosage for anaesthesia.

The study authors also refer to their “recent multicentre cohort study of connected consciousness during intended anaesthesia (defined by response to command during intended general anaesthesia)” which “suggested that females may be three times more likely than males to respond to command after intubation during general anaesthesia.” Emphasis mine because that’s one hell of a discrepancy — and yet, the authors note, the fact that dose is not differentiated by sex does rather imply “a lack of consideration that female sex is a risk factor for awareness,” a view, they write, that is “supported by a 2015 review of anaesthetic awareness that did not mention sex as a risk factor.” A data gap that is, of course, entirely unprecedented.

Noting that only small differences in dosing “may result in ineffective anaesthesia,” the authors of this new study decided to perform a systematic review of the published research, to see if they could nail down if there were indeed any sex differences and immediately they ran into difficulties because OF COURSE the vast majority of studies (78% of them to be precise) did not sex disaggregate their data, a data gap that elicited this plaintive plea from the study authors:

To address equity, diversity, and inclusion in clinical trials, sex stratified data needs to be transparently available for core reported outcomes. Ideally these data could be provided to facilitate individual participant meta-analysis, supporting improved integration of research.

Yes, that would in fact be quite nice.

Thankfully, some researchers had bothered to both include women AND sex disaggregate their data, for which we are all truly grateful. (Aside: I was very interested to note that while male participants dominated in randomised control studies, aka the gold standard, female participants represented the majority on observational studies and non-randomised interventional studies another gendered discrepancy that really tells its on story doesn’t it…). Anyway, these sex disaggregated studies demonstrated that women are indeed “experiencing more ‘failures of anaesthesia’ than males” a finding which “may suggest that inadequate consideration is given to sex differences as an important factor in anaesthetic titration.”

So let’s maybe consider fixing that…

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Default male of the week

I enjoyed this baffling submission from GFP Liz

I guess we should be grateful to netballuk.co.uk for being so explicit about men being the default and yes I am noting the irony of netball being, last time I checked, one of the few female-dominated sports in existence.

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Poppy pic of the week

That’s it! Until next time, my dear GFPs….xoxoxo