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Occupational Exposures and Women’s Health in Low- and Middle-Income Countries: Risks, Realities, and Policy Imperatives

Abstract

Occupational health hazards are a silent determinant of women’s morbidity and mortality in the developing world. Women are increasingly participating in the workforce across sectors such as agriculture, manufacturing, health care, mining, and domestic labor—yet these environments often expose them to harmful chemicals, physical strain, infectious agents, and psychosocial stressors. In low- and middle-income countries (LMICs), where informal employment dominates and labor protections are weak, women face disproportionate health burdens linked to gendered divisions of labor, economic inequality, and limited access to healthcare. This paper critically examines occupational settings that expose women to poor health, analyses the biological and social determinants of vulnerability, and provides evidence-based policy recommendations to safeguard women’s health and productivity.

1. Introduction

Occupational safety and health (OSH) are core human rights and central to sustainable development. The World Health Organization (WHO, 2023) defines occupational health as the promotion and maintenance of the highest degree of physical, mental, and social well-being of workers in all occupations. However, the global occupational health framework has historically been male-centric, overlooking gender-specific risks and the complex intersections between work, reproductive health, and domestic responsibilities.

In Africa and South Asia, more than 70% of women are engaged in informal or vulnerable employment (ILO, 2022). This includes unpaid agricultural work, street vending, domestic work, small-scale manufacturing, and health care support services—occupations often lacking regulation, protective equipment, or access to occupational health services. The gendered nature of labor means that women are more likely to perform repetitive, low-paid, or hazardous tasks, often without formal contracts or social protection.

Moreover, the biological roles of pregnancy, lactation, and menstruation interact with workplace exposures, creating unique vulnerabilities to toxins, infections, and ergonomic stress. These exposures often lead to reproductive complications, chronic diseases, and psychosocial distress that perpetuate gender inequities and intergenerational poverty.

2. Occupational Settings Exposing Women to Poor Health

2.1 Agricultural Work

Agriculture remains the largest employer of women in Africa, with female labor accounting for 50–60% of total agricultural production (FAO, 2022). Women farmers and laborers are regularly exposed to pesticides, fertilizers, mycotoxins, and animal wastes, often without gloves, masks, or boots.

Pesticides such as paraquat, diazinon, and atrazine, widely used in African smallholder farming, are linked to:

  • Endocrine disruption and reproductive toxicity

  • Congenital anomalies and miscarriages

  • Neurological disorders such as tremors and memory loss

  • Dermal and respiratory irritation

Women also face ergonomic stress from bending, carrying heavy loads, and long exposure to sunlight. The cumulative strain contributes to musculoskeletal disorders and chronic back pain. In Kenya and Ghana, for example, studies have documented higher incidences of respiratory symptoms and skin irritation among female horticultural workers exposed to agrochemicals without adequate training or PPE.

Furthermore, postharvest processing exposes women to aflatoxins in stored grains, which are carcinogenic and linked to immune suppression and reproductive harm.

2.2 Manufacturing and Textile Industries

The expansion of light manufacturing and textile production in LMICs has drawn large numbers of women into factory labor. In countries such as Bangladesh, Ethiopia, and Kenya, female garment workers operate in poorly ventilated buildings, exposed to:

  • Textile dust and synthetic fibers causing chronic respiratory illness

  • Dyes and solvents containing formaldehyde, benzene, and azo compounds—known carcinogens

  • Poor lighting and ergonomically unsuitable workstations leading to eye strain, joint pain, and fatigue

Additionally, many female workers face verbal and sexual harassment, low wages, and lack of reproductive health rights such as maternity leave or breastfeeding breaks.

The 2013 Rana Plaza collapse in Bangladesh, which killed over 1,100 garment workers—mostly women—exposed how structural neglect of occupational safety intersects with gendered labor exploitation.

2.3 Domestic and Informal Work

Domestic workers, cleaners, and nannies—who constitute one of the most invisible and unregulated segments of the workforce—are exposed daily to chemical disinfectants, volatile organic compounds, detergents, and bleach. Chronic inhalation and skin contact lead to dermatitis, asthma, and allergic rhinitis.

Moreover, domestic work exposes women to psychosocial stress, violence, and sexual harassment, often without legal recourse. In Africa, most domestic workers lack written contracts and social insurance, leaving them economically and physically vulnerable.

Informal vendors and waste pickers also operate in polluted, unhygienic environments, often handling e-waste containing lead, mercury, and cadmium—elements associated with neurological and reproductive damage.

2.4 Health and Care Work

Globally, women comprise 70–80% of the health and social care workforce (ILO, 2022). This includes nurses, midwives, and community health volunteers who face multiple occupational hazards:

  • Exposure to infectious agents (HIV, TB, COVID-19, Ebola)

  • Handling cytotoxic drugs and sterilizing agents

  • Physical strain from lifting patients and long shifts

  • Psychological stress and burnout from moral injury, high workload, and emotional exhaustion

During the COVID-19 pandemic, women health workers bore a disproportionate burden of exposure risk while often lacking PPE and psychosocial support.

2.5 Mining and Extractive Industries

The participation of women in artisanal and small-scale mining (ASM) has increased across sub-Saharan Africa. These women frequently handle mercury and cyanide used in gold extraction, leading to chronic neurological impairment, renal dysfunction, and reproductive harm.

Informal mining sites are often unsanitary, with poor air quality and risk of respiratory silicosis due to dust inhalation. Pregnant women exposed to mercury have been shown to deliver infants with lower birth weights and cognitive deficits.

3. Gender-Specific Vulnerabilities and Social Determinants

Women’s occupational health risks are shaped by intersecting determinants:

  • Biological factors: Women’s hormonal cycles, pregnancy, and lactation modify toxicokinetics, making some exposures (like mercury and pesticides) more dangerous.

  • Socioeconomic inequality: Women are more likely to accept unsafe jobs due to poverty and lack of alternatives.

  • Cultural expectations: Social norms dictate that women continue unpaid domestic work after formal employment, leading to fatigue and chronic illness.

  • Limited representation: Few women participate in trade unions or safety committees, silencing their experiences and limiting advocacy for safer conditions.

These determinants produce structural inequities that perpetuate occupational health disparities between men and women.

4. Health Consequences of Hazardous Work Environments

  • Reproductive disorders: miscarriages, menstrual irregularities, infertility, and congenital anomalies due to pesticide and metal exposure.

  • Cancers: breast, cervical, and hematologic cancers linked to solvents and ionizing radiation.

  • Musculoskeletal disorders: chronic back pain and repetitive strain injuries from ergonomic challenges.

  • Respiratory and dermal illnesses: caused by dust, chemicals, and poor ventilation.

  • Psychological distress: depression, anxiety, and post-traumatic stress linked to exploitation and violence.

Long-term, these outcomes lead to reduced productivity, increased health costs, and perpetuation of intergenerational poverty.

5. Policy Gaps and Structural Challenges

Despite the existence of international labor conventions, most LMICs lack comprehensive, gender-responsive occupational health frameworks. Major policy gaps include:

  • Weak enforcement: Existing laws often exclude informal workers and domestic laborers.

  • Limited data: Lack of gender-disaggregated occupational health surveillance undermines targeted policy design.

  • Resource constraints: Few countries allocate sufficient budgets for OSH inspection or training.

  • Patriarchal bias: Policymaking often neglects women’s occupational risks due to entrenched gender norms.

6. Policy and Programmatic Recommendations

6.1 Strengthen Legislation and Enforcement

  • Extend occupational safety laws to informal and domestic sectors.

  • Ratify and implement ILO Conventions 155, 183, and 190, addressing occupational safety, maternity protection, and workplace harassment.

  • Empower labor inspectors with gender-sensitive training and resources.

6.2 Promote Gender-Responsive Workplace Design

  • Provide ergonomic equipment, adequate lighting, and ventilation.

  • Mandate maternity-friendly workplaces with breastfeeding spaces and flexible hours.

  • Ensure universal access to PPE and occupational health services, including reproductive risk assessment.

6.3 Expand Health Education and Training

  • Establish community-level occupational health education programs to raise awareness on pesticide handling, chemical use, and ergonomic safety.

  • Train women workers in toxic exposure management and safe chemical disposal.

6.4 Strengthen Data, Research, and Surveillance

  • Develop national registries on occupational diseases with sex-disaggregated data.

  • Fund research on reproductive and neurotoxic impacts of workplace exposures on women.

  • Collaborate with universities and public health agencies to monitor long-term effects.

6.5 Empowerment and Representation

  • Support women’s trade unions and cooperatives in advocating for safety and fair pay.

  • Include women’s voices in occupational safety boards and health policymaking.

6.6 Social Protection and Compensation

  • Extend health insurance, paid maternity leave, and injury compensation to all sectors, especially informal workers.

  • Develop microfinance and livelihood programs to reduce women’s dependence on hazardous jobs.

7. Case Studies

Kenya: Horticultural Workers in Naivasha

Studies among flower farm workers in Naivasha revealed that over 80% of female workers had symptoms of pesticide exposure, including dizziness, headaches, and menstrual irregularities. Lack of PPE and weak labor inspection exacerbated risks.

Ghana: Women in E-Waste Recycling

In Agbogbloshie, Accra, women involved in informal e-waste sorting are exposed to lead and cadmium, resulting in respiratory illness and reproductive harm. Absence of social protection means affected workers have no access to medical care or compensation.

South Africa: Nurses and Psychosocial Strain

Health care workers in under-resourced facilities experience chronic burnout and depression due to long shifts, inadequate staffing, and exposure to infectious diseases—highlighting the psychosocial dimension of occupational health neglect.

8. Conclusion

Occupational exposure remains a critical but neglected determinant of women’s health, especially in developing nations. Women’s growing participation in hazardous, informal, and underregulated sectors demands urgent, evidence-based interventions. Protecting women’s health in the workplace is not merely a welfare issue but a human rights and economic priority.

Gender-responsive occupational health policies—integrating biological, social, and economic considerations—will improve productivity, safeguard reproductive health, and advance gender equity. Governments, international organizations, and civil society must collaborate to ensure that no woman’s health is compromised by her occupation.

References

  • FAO. (2022). The State of Food and Agriculture: Women and Agrifood Systems.

  • International Labour Organization (ILO). (2022). Care at Work: Investing in Care Leave and Services for a More Gender Equal World of Work.

  • WHO. (2023). Occupational Health: Global Evidence and Policy Guidance.

  • UNDP. (2024). Gender Equality and Work in the Informal Economy.

  • World Bank. (2023). Gender, Jobs and Social Protection in Sub-Saharan Africa.

  • ILO Convention No. 190. (2019). Violence and Harassment in the World of Work.

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