Exposing Data Bias in a World Designed for Men
by Karen Boyle / /  March 22, 2019

“Feminist campaigner Caroline Criado Perez’s latest book is an essential if enraging read. It might seem ironic that the central figure in Invisible Women: Exposing Data Bias in a World Designed for Men is a man, but Perez argues convincingly that the “default male” is the figure our world is designed around. Unfortunately, the default male is also a stand-in for “human”, with consequences for women that range from the annoying (longer loo queues, phones that don’t fit our hands) to potentially lethal (protective clothing that fails to protect, misdiagnosis of heart attacks). Perez’s analysis is wide-ranging and compelling, and no matter how familiar you think you are with the distorting effects of default male thinking, there will be examples in here that enrage you anew.

Did you know (I didn’t), that worldwide, indoor air pollution is the single largest environmental risk factor for female mortality and the leading killer of children under the age of five? And that toxic fumes from stoves are one of the main contributors? As women typically take on the bulk of domestic work and child care, this means gender roles are literally killing them. The beauty of the book is that it makes you wonder how it is possible that you didn’t know this. This is a book about how knowledge is created, shared and reproduced, challenging readers to think about the limits of our own, and seek out new ways of knowing.

It should perhaps come as no surprise that Perez’s own authority is continually under attack from blokes who’ve done a quick Google search to trump her years of research. Safiya Umoja Noble’s work on algorithms of oppression could have alerted them to the folly of using Google as the authority on these things. Perez’s experiences as a feminist in the public eye point to the double-edged nature of visibility for women: this is the woman who received death and rape threats for suggesting the Bank of England should have a woman on a banknote. At one level, it is encouraging that the costs of visibility for women in public life are themselves increasingly visible, as in Amnesty’s recent research on the toxicity of Twitter. But it is hard to be encouraged when the abuse continues.

The default male pollutes the very language we use to talk about these things. Feminist legal scholar Catharine MacKinnon made this point brilliantly in the New York Times. She declared that the #MeToo campaign had done what the law could not: sexually assaulted women who had once been disbelieved and denigrated were being believed and valued. But MacKinnon noted too that the courts are “hidebound and less nimble than culture”, and there is still a long way to go: “Legal standards for retaliation – one of the biggest fears behind non-reporting – need to change to protect [women reporting crimes]. Culturally, it is still said “women allege” or “claim” they were sexually assaulted. Those accused “deny what was alleged”. What if we changed the emphasis and said that survivors “report” and the accused “alleges” or “claims” it didn’t happen?” MacKinnon’s point is that the very way we talk about these things is skewed – privileging the male accused while framing women’s reports as suspect. Her suggested change in emphasis still makes it clear that these reports are contested, but it no longer privileges the male point of view.

Writing about men’s violence against women is particularly pernicious in this respect. For instance, in the UK recently, Level Up – an organisation that campaigns to end sexism against women – successfully lobbied the Independent Press Standards Organisation to launch guidelines on the reporting of domestic homicide to avoid the hideous clichés which typically pepper reports of men who murder the women they are in relationships with. We are all familiar with it: the “kind” men who just “snapped” in the face of some perceived infraction, whose histories of domestic abuse are mentioned only in passing. As feminist organisations including Zero Tolerance forcefully argue, journalists can and should do better.

But one of the most powerful takeaways from Perez’s book is the extent to which so much of this bias is unconscious, such that we are all infected by it. Feminism is the process of unlearning this, but it’s an ongoing process, for all of us. So while I learned a huge amount from Perez’s book, I also winced when I read that urban planning “fails to account for women’s risk of being sexually assaulted”. I heard within this echoes of a victim-blaming narrative which asks what we should do to avoid being sexually assaulted, rather than what men should do to avoid sexually assaulting others. At the same time, the book itself is built on a wealth of only partially visible gendered labour.

Perez is rigorous in referencing her claims throughout, but her end notes often direct us to web links rather than full citations (which reference a published source in an effort to specifically acknowledge the work of others). Do citation practices really matter? Well, yes, according to Perez’s chapter, The Myth of Meritocracy. Here she notes both that women are systematically cited less than men and that female academics are more likely than men to challenge male-default thinking in their work. In light of this, not to name so many of the researchers who conducted the work her book relies on risks perpetuating the problem. Because that’s the thing about the default male: he’s in all our heads.”

Journalist explains dangerous consequences of world built for men
by Angela Chen /  Mar 5, 2019

“In college, Caroline Criado Perez picked up a book on linguistic theory that pointed out that when women hear the word “he” — the default pronoun that is often used to mean “he or she” — they picture a man. “It blew my mind because I realized that I do that, but I had never realized that that’s what I do,” says Criado Perez. “I never realized that I had been going through life blithely picturing men all the time when the gender of the person was not specified.”

Years later, the same idea would resurface when Criado Perez learned that women are more likely to die from heart attacks due to unequal treatment because it’s not well-publicized that female heart attacks have different symptoms than male heart attacks. She became interested in (and horrified by) all of the ways that the world is built for the “default male” that doesn’t take women into account, and the result is her book Invisible Women: Data Bias in a World Designed for Men. Throughout the book, Criado Perez reflects on how women are harmed because everything from crash-test dummies to voice technologies are modeled and trained on men. She learned that Viagra showed promising results in treating period pain, but this potential use was not pursued because it was not considered worthy of funding. The Verge spoke to Criado Perez about gender-neutral snow clearing, which women are invisible, and the steps governments can take to promote change.

V: You cover so many different examples of data bias in this book, from urinal designs to refugee camps. After doing all of that research, what surprised you the most?
C: I really found it shocking that women’s care work isn’t included in economic data, and that the workplace and economy and travel is designed around typical male lives. But I still remain the most shocked by the medical data because I still, despite all of the research I’ve done showing that it is not actually nearly as objective as we’d like to think, really would like to think that the medical world is just trying to do its best for men and women.

In some ways, it is — I’m not saying anyone is evil — but we’ve known about the difference between male and female heart attacks for a long time, and those stats have not gotten better. In other areas, it feels like people just haven’t really noticed it yet. But with medical research, we’ve known for a long time. I find it absolutely shocking when papers are published that don’t include women at all and don’t include any sort of apology for not including women. One study I saw, on something about baths for lowering blood pressure, included as its only caveat that it was a small sample size and didn’t mention that they only studied men.

When it comes to drugs, for example, we’ve found sex differences in every single organ in the body and sex differences down to a cellular level. We just don’t know the extent to which those sex differences are interacting with the medical treatments we receive, which, to me, is an absolute scandal. I found it very shocking and worrying in one study that looked at male and female cells and exposed them both to estrogen and to a virus. The female cell was able to use the estrogen to fight off the virus, and the male cell wasn’t able to use the estrogen and the virus took over.

That was so tantalizing and also so infuriating because the vast majority of human cell studies are still done on male cells. When you look at a study like that, you can’t help thinking about how many more treatments we have ruled out at the cell stage because we only tested it on male cells. That virus study is very suggestive of what could be, especially if we take that together with the fact that a huge problem with drugs for women is when the drug simply doesn’t work. There’s potentially so much to be discovered that we have not found out.

V: To be clear, when we talk about “women,” who are we talking about? Are we talking about white women specifically?
C: That is a whole other book in that there is very little data for women at all, but there’s a double data gap when it comes to data for women of color. Frequently, if you get data sex-disaggregated, you don’t get it race-disaggregated and vice versa. I have not come across any data that disaggregates by both race and sex, though that’s not to say there’s none out there. It’s a perfect example of Kimberlé Crenshaw’s essay where she talks about the lawsuits where women had to choose whether they were black or women when going for their discrimination employment tribunals, and they were saying, “No, we’re black women.” Basically, the various groups of people who are not white men get broken down from that, but not any further than that.

V: What type of change is necessary to get rid of this data bias on a large scale? Do you have any numbers on how expensive these types of changes would be?
C; Well, one example from my book is the snowplow example from Karlskoga in Sweden [which instituted a gender-neutral snow clearing initiative that prioritized public transit areas like bike paths instead of major traffic roads]. This prioritized the paths that pedestrians and women took instead of just men, and it actually ended up saving money because of fewer injuries. That was an example of being smart about budgeting. Essentially, what needs to be done as a first step is to collect the data because without the data, it’s impossible to know what is needed and how much it’s going to cost.

For a lot of things, like subways, there’s no doubt that that would be expensive, but there are much cheaper forms of transport that you can deal with, like buses. Buses are much more likely to be used by women because they’re the low-cost option, and it would be very easy to collect the data on where women need the buses to be and what they need for safety. One thing I find very interesting is that women form the majority of bus users in London during the day, but that switches over at night. We don’t have data on why that is, but I think it’s fairly easy to guess. So if women were using the bus at night, the bus companies would perhaps be making more money, and that could pay for anything they did to try and get more women on the bus, like making sure the stops are in well-lit areas. The other thing to bear in mind is that the way we’ve set up transport and child care and the world of work doesn’t take into account women’s unpaid care responsibilities.

At the same time, you have all of these countries wanting to get women into the workplace because they know that women working at their full capacity would be a massive boon to GDP [gross domestic product], and so there are these conflicting ideas. If they were to actually count the amount of women’s unpaid care work and see how much it contributes and invest accordingly by making it easier for women to actually carry it out, that would, in many ways, recoup its costs down the line. But, of course, all of this requires governments to be both willing to collect the data and also willing to think long term, and those are both quite difficult propositions.”

“Solar exposure enhances energy intake
+ metabolic profile
of men compared to women”

COVID-19 studies should provide sex-disaggregated data
by Sally Robertson, B.Sc.  /  Jun 21 2021  /  reviewed by Emily Henderson, B.Sc.

“Researchers in Greece have warned that studies examining sex-specific responses to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) must provide sex-disaggregated data to help improve understanding of the pathology involved in coronavirus disease 2019 (COVID-19). The team – from the Aristotle University of Thessaloniki – conducted a literature review exploring the pathophysiologic and behavioral basis of the disproportionate male morbidity and mortality that occurs in COVID-19.

As reported in the journal Microbes and Infection, the researchers found that the data support the existence of sex-specific responses to SARS-CoV-2. However, not all studies include a sex-based distinction regarding the data used to monitor the pandemic, says Kalliopi Kotsa and colleagues. “Interpreting intersex differences in immune response to SARS-CoV-2 could lead to a deeper understanding of COVID-19 pathophysiology and enable healthcare professionals to conduct a more accurate patient risk assessment and better predict clinical outcomes of the disease…”

Epidemiologic monitoring of the COVID-19 pandemic has shown that males are more susceptible to morbidity and mortality than females, despite a similar infection rate between the sexes. Differences in comorbidities, hormonal profiles, chromosomal composition, and behavior have all been proposed as potential factors underlying this sexual dimorphism in susceptibility to SARS-CoV-2. Kotsa and colleagues say that an in-depth analysis of this sexual dimorphism is essential to understanding COVID-19 pathophysiology. The researchers set out to review literature covering the pathophysiological and behavioral basis underlying the disproportionate male morbidity and mortality observed in COVID-19. They searched PubMed, Embase, and Google Scholar databases for relevant articles, with the last search performed in April 2021.

According to a systematic review of seven studies, patients with severe COVID-19 are more likely to have hypertension or cardiovascular disease, says the team. Multiple studies have also shown that hypertension occurs more commonly in males than among age-matched females throughout middle age, potentially rendering males more susceptible to severe COVID-19. Rates of mortality due to cardiovascular disease have also been shown to be higher among males than females, says Kotsa and colleagues. “It could be argued that the sex-bias regarding COVID-19 morbidity and mortality could be partly attributed to the fact that, overall, males begin at a less favorable health standpoint, presenting with more risk factors for severe COVID-19…” However, according to some sex-disaggregated data, the difference in case fatality rate between males and females is too large to be accounted for by differences in comorbidity alone, they add.

Immune cells such as natural killer cells, neutrophils, B-cells, and T cells are directly affected by circulating estrogen levels, depending on the type of estrogen receptors they express. For example, in the case of T cells, the expression ratio of the estrogen receptors Erα and Erβ determines the cell’s course of action. Erβ signaling is involved in the differentiation of T regulatory cells and immunosuppression, while Erα signaling stimulates the immune response. “As estrogen levels fluctuate throughout the menstrual cycle, women may undergo phases of altered immune reactivity,” says the team.

“In this context, females may elicit stronger immune responses than their male counterparts.” The researchers also suggest that estrogen signaling may affect immune responses via induction of endothelial nitric oxide synthase in the presence of inflammation. This increases the production of nitric oxide, which exerts strong vasodilatory effects and increases blood circulation at sites of inflammation. The activation of estrogen receptors also impedes the formation of reactive oxygen species, thereby exerting another anti-inflammatory benefit.

Other factors that the team says may contribute to the sexual dimorphism seen in the response to SARS-CoV-2 include the sex chromosomes, differences in behavior between men and women, and a sex bias in vaccination. The X chromosome contains more immune-related genes than the Y chromosome and since females possess two X chromosomes, they have twice the quantity of immune genes that men do. Studies of gender behavior have shown that women are more likely than men to adhere to preventive measures such as mask-wearing, hand washing, and social distancing. Women have also been shown to be more likely to comply with social distancing practices. In addition, women have been shown to have a stronger immune response to vaccination than men and to produce higher levels of neutralizing antibodies against viruses.

“It is evident that many factors play a role in the sexual dimorphism related to SARS-CoV-2 infection,” says Kotsa and colleagues. Comorbidities, estrogen levels, sex chromosomes, and behaviors during the pandemic all appear to play a part in making men more vulnerable to infection and less likely to survive. “However, clinical trials and animal model experiments are not always sex-balanced and tend to include fewer female subjects.

In addition, not all countries include a sex-based distinction regarding their epidemiological data used to monitor the course of the pandemic,” writes the team. The researchers say such a lack of information hinders scientific conclusions. “Thus, it is of utmost importance that henceforward, sex-disaggregated data stand at the epicenter of the research field, thereby shedding more light on COVID-19 pathogenesis and enabling the drawing of more accurate scientific conclusions…”

Journal reference:

Kotsa K, et al. The role of sexual dimorphism in susceptibility to SARS-CoV-2 infection, disease severity, and mortality: facts, controversies, and future perspectives. Microbes and Infection, 2021.



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