COVID-19 PPE Gender Divide: No One-Size-Fits-All?

Rachel Pugh

May 04, 2020

Female healthcare workers and those from ethnic minorities are being subjected to unacceptable levels of risk during the coronavirus pandemic because of 'thoughtless' procurement by the NHS, according to a leading expert on racism and inequality in the UK's health system.

Professor Aneez Esmail, professor of general practice at Manchester University and recognised nationally for his research on discrimination in the medical profession, is calling on those in charge of NHS procurement to take an urgent look at providing face masks suitable for women, who make up 75% of NHS staff. Many female healthcare workers find the personal protective equipment (PPE) provided does not fit them.

Professor Esmail told Medscape UK: "Most PPE we have in the NHS is designed for the male body, and it should be available too for women, given that they make up 75% of the workers in our NHS. It is not a new problem, but the current pandemic has made the situation acute - masks need to fit properly."

Ethnic Minorities

NHS staff from some black and minority ethnic (BAME) populations, particularly those from South Asia, have also found it difficult to achieve good seals on face masks because of their flatter face shapes. Even the smallest sizes are too big for some women.

"Most of this is thoughtlessness from NHS procurement services," said Professor Esmail. "But you can also argue that this is discrimination, since women and members of the ethnic minorities are overrepresented in lower positions. It's a power relationship and the lower in the hierarchy you are, the less likely you are to argue. Doctors and nurses are dying. Nobody in procurement has got around thinking differently. This has to change."

A 2016 survey conducted by the trade union Prospect, the Trades Union Congress (TUC), and others found that just 29% of female respondents were using PPE designed for women, and 57% said their PPE hampered their work.

Gender Concerns

Dr Julia Patterson, founder of the doctor-led campaigning organisation EveryDoctor, has picked up serious worries about the use of face masks during the current pandemic. She posted on the subject this week to the 5000 members of the EveryDoctor Facebook group.

She told Medcape UK: "There is definitely an issue about gender and PPE. Hospitals are very limited in the PPE they can order and there is serious concern that certain face masks just don't fit women because they have smaller faces. This also applies to South Asian faces, which are flatter."

In such cases female healthcare professionals are left with the choice of being consigned to non-COVID duties or to wear a reusable plastic hood equipped with a noisy electronic moisture-removing motor, which makes it difficult for wearers to hear instructions.

Anecdotal reports speak of women working in COVID-19 environments wearing only surgical masks.  An F2 junior doctor from the Midlands who did not want to be named said she had passed the 'fit test' on face masks herself but that many of her colleagues had not. Although rota coordinators tried not to put them on COVID-positive wards, they often felt pressured to work with COVID patients while wearing only a surgical mask for protection. She also said there was confusion among staff about risk categorisation of procedures, and whether or not they needed to be tackled with fully-fitted face protection. So colleagues had felt pressured to take risks and some had died.

She expressed anger and fear and said: "The whole environment is so unsafe that it's a joke."

Pressure Sores

One female nurse, working on both COVID and non-COVID wards in Manchester said her mask was so ill-fitting that she had pressure sores on her face and ears resulting from the tightness required to strap on her visor and surgical mask. Most of her female colleagues had similar problems. She said anxiety levels were also very high among colleagues because of a lack of clarity about what constituted the correct kit for managing specific procedures. She said: "It's one-size-fits-no-one, and that is really uncomfortable when you have to wear ill-fitting equipment for 12 hours, and it's also dangerous for some women who find their masks fall off and they have to fiddle with their faces. There should be more than one size available."

Procurement is part of the problem in Dr Patterson's view. Although some hospitals had worked hard to buy PPE in a range of sizes, most hospitals limited the masks on offer to one or two masks, modelled on the bodies of 6-foot males. But Dr Patterson believes the gender issue in PPE goes well beyond masks to equipment in general, from the design of protective lead aprons for radiographers to the shape of surgical instruments.

The current emergency had highlighted a wider problem of institutionalised power structures in hospitals. She said: "The pandemic is making it clear that in an unequal society where resources are scarce, the power structure comes into play and those people who are generally discriminated against - women and people from BAME communities - are being actively compromised with poorer equipment."


A procurement spokesperson was not available to speak on gendered PPE, but a Department of Health and Social Care representative underlined that whilst PPE is designed to be unisex, some products are available in different sizes to enable fitting to both small and larger frames. A spokesperson said: "The safety of our staff is paramount and we are working around the clock to ensure PPE is delivered as quickly as possible to those on the front line, and have delivered over 1 billion items since the outbreak began. PPE is designed to be unisex and offer protection for both genders."

Professor Raymond Agius, emeritus professor of occupational and environmental medicine at the University of Manchester, calls for an independent public inquiry in an editorial published this week in Occupational Medicine . He says it is vital to investigate employers who have failed to protect workers at risk of COVID-19 because of the kind of work that they do.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.