If you are designing seat-belts, who do you design them for? Or if teaching aspiring doctors the symptoms of heart disease and the presentation of heart attacks, whose symptoms do you describe? Clearly the correct answer to both questions should be men and women, but that hasn’t always been the answer assumed, sometimes with fatal results. Once it is pointed out that if you market a drug that has only been tested on men it may have bad consequences for women, it becomes rather obvious, but for years there have been very limited requirements for drug trials to factor this in (despite the much publicised horrors of the action of thalidomide when prescribed to pregnant women in the 1950’s). I first heard Londa Schiebinger from Stanford talk about this topic a year ago when I met her at a meeting in Austria on Science and Gender described here, when she talked about Gender in Knowledge. At the time she was developing a new project in conjunction with the EU which has now come to fruition in the form of an extensive website entitled Gendered Innovations. This site identifies why it is crucial, in setting out to solve many science, healthcare and engineering problems, that sex and gender are appropriately factored in.
For the non-social scientists reading this let me stress the difference between sex and gender, helpfully defined on the website:
“Sex” is a biological quality or classification of sexually-reproducing organisms, generally female or male, according to functions that derive from the chromosomal complement, reproductive organs, and/or specific hormones or environmental factors which affect the expression of phenotypic traits that are strongly associated with females or males within a given species.
Gender—a socio-cultural process—refers to cultural and social attitudes that together shape and sanction “feminine” and “masculine” behaviors, products, technologies, environments, and knowledges.
Thus pink is (rightly or wrongly) associated with the female gender, whereas breast-feeding is associated with the female sex.
When bringing new products to market it is important to recognize that both sex and gender may play a role both in how the design team formulate the product and how the consumer receives it. Failing to recognize this may lead to anything from death of a product to death of a patient. It matters to get these things right!
Now I am not a social scientist, I don’t research gender, nor am I even an engineer, but you don’t have to be any of these things to realise that we all make assumptions that, if not spotted and left to lurk in experimental design may lead to systematic errors, or worse, in the outcomes. So, if using a dummy to test a seatbelt on in mock-up car crashes and all tests are carried out on male shape and weight models then, a child or woman may end up unprotected by the design. The U.S. Federal Motor Vehicle Safety Standard specified a 50% percentile (for body weight) male dummy for use in compliance testing from 1973 to 1997. Some tests were carried out on child-sized dummies only from the 80’s. The idea that a pregnant woman might get into a car doesn’t seem to have occurred to anyone until the 1990’s when a dummy of a pregnant woman was created. Even so its use is still not yet a federal or EU requirement in car-safety tests, despite the fact that car crashes involving pregnant women lead to significant numbers of fetal deaths.
Readers of this blog will know that I do feel rather strongly about gender assumptions imposed on children, as I wrote about quite recently. We impose the equation of pink = girl quite arbitrarily, and really rather recently, for cynical marketing reasons I’m sure. As the Gendered Innovation website points out, when software developers produce “pink” games (such as Barbie Fashion Designer) for girls (of course that in itself is an assumption, but I’m guessing boys aren’t going to display much interest), they tend to reinforce gendered stereotypes about girls’ and women’s interests. Creating separate “blue” and “pink” games for boys and girls reinforces this gender separation, and turns out not necessarily to be a productive strategy. Girls and women are not homogeneous and making stereotype assumptions may not maximise market impact, even if that is what the marketing teams believe they are doing. In producing anything both sex and gender may play a part, interrelating in potentially complex ways, so that although the average male is clearly taller than the average female, some 6% of men are shorter and that value may also be affected by nutrition and hence socio-economic class; many factors must be considered in innovation.
The emphasis of the website is to encourage reflection about strategies of design, be it of clinical trials or engineering products, with the message that thinking about these issues may actually open up new fields for innovation, to fill niches that have been overlooked, and to find novel solutions to age-old problems. Scrolling through the website I was intrigued to find that stem cells have a sex. Maybe I shouldn’t have been, but it had never occurred to me that such cells might differ according to their source. But I learnt that research using animal models has shown that the sex of stem cells may influence therapeutically-relevant cell traits, such as proliferation and differentiation rates. Clearly, by exploring this factor there is yet another control parameter that can be brought into play in therapeutic design, offering new opportunities. I learnt that around a third of all osteoporotic fractures are in men, although the disease is frequently portrayed as a problem of post-menopausal women; consequently men are much less likely to be tested or treated for it.
There are a number of quite detailed case studies given on the website, elements of which I’ve given here to give a flavour for the sorts of things covered. The case studies cover pure science (such as the stem cell example), healthcare (heart disease and osteoporosis for instance) and engineering (including the crash dummy example). But over and above these case studies it is clear a major aim of the website is to ensure that scientists and design teams of any sort think much harder about sex and gender as they proceed with their experimental programmes and development work. Furthermore, it is clear that grant-giving organisations are increasingly demanding thought be given to the issues, so that grantees may be asked to address whether, and in what sense, sex and gender are relevant in the objectives and methodology of their proposed research. Clearly this makes sense if the innovations produced, of whatever kind, are going to be relevant to the whole population and not simply to some stereotypical construct of a bygone age.