Engineering leadership to advance women’s health

In this month's Not Alone newsletter, Dr John L Anderson, President of the National Academy of Engineering, writes about the need for systems thinking and diverse voices in engineering.

Engineers are playing an increasingly significant role in healthcare. In his Forbes article Engineers Are Unsung Heroes Of Global Health abre em uma nova guia/janela, Madhukar Pai abre em uma nova guia/janela showcases the many contributions engineers made during the COVID-19 pandemic, from building field hospitals to the development and distribution of the life-saving vaccines.

But not all health concerns are created equal. Throughout history, women’s health has been systemically neglected — perhaps because science and engineering have been male-dominated fields. Now, as women’s health options are critically limited in many places and even further curtailed, it is imperative that those with relevant expertise identify opportunities to advance the understanding and practice of healthcare, medicine and safety for women.

Obstacles to women’s health and safety

The historical absence of women from engineering disciplines has unintended consequences. A prime example is in the automotive industry. For decades, crash test dummies have been used in research to help the industry modify designs to ensure the safety of vehicle occupants. However, these dummies are designed to be representative of the 50th percentile male — 171 pounds, 5-foot-9-inches. Women’s bodies are different, not only in stature but in anatomy and physiology.

In his Consumer Reports article The Crash Test Bias: How Male-Focused Testing Puts Female Drivers at Risk abre em uma nova guia/janela, Keith Barry cites a 2013 study from the National Highway Traffic Safety Administration (NHTSA) abre em uma nova guia/janela that shows that the fatality risk for a female driver or front-seat passenger wearing her seat belt is 17% higher than a male driver of the same age. And he cites a 2019 study from the University of Virginia abre em uma nova guia/janela that shows that women have a 73% greater chance of being seriously injured in a frontal crash.

The automotive industry is not the sole culprit. Stanford University’s Gendered Innovations abre em uma nova guia/janela website features numerous case studies showing how sex and gender analysis in research can improve engineering design abre em uma nova guia/janela and medical outcomes abre em uma nova guia/janela — and the impacts when women are not included.

In her book Invisible Women: Data Bias in a World Designed for Men abre em uma nova guia/janela, Caroline Criado-Perez notes that everything from offices, research, medicine, policy, technology and urban planning is inclined toward men, mainly because the data don’t exist to include the other 50% of the population — women. The real problem, according to Criado-Perez, is the “gender data gap — a gap in our knowledge that is at the root of perpetual, systemic discrimination against women, and that has created a pervasive but invisible bias with a profound effect on women’s lives.”

Systems thinking for inclusive engineering

As engineers, we are taught a mathematical and technical set of skills. Until recently, social awareness was not an important part of an engineering curriculum. By integrating principles of inclusivity into the engineering curriculum, we can produce graduates who consider potential unintended consequences of an engineering project in the early stages of ideation and design rather than as an afterthought.

Equally important is diversity in engineering. From the founding of the National Academy of Engineering (NAE) abre em uma nova guia/janela in 1964 until 1985, 1,500 members were elected but only 12 were women. Over the past three years, 88 of the 301 members elected are women. This is not an excuse for our past, rather a reminder of how far we have come — and how much further we need to go for the good of the profession. A similar trend exists for people of color elected to the NAE.

Systems thinking is key to the engineering mindset. Optimal solutions to complex problems require input from a diversity of thought. Such input is critical for rational and effective decision-making and for an effective systems approach. Individuals of different backgrounds have different experiences and hence perspectives on a problem or creative project — and different ideas about the path forward. But diversity alone is not enough — we must seriously listen to diverse opinions. This is inclusion.

Engineering research to advance women’s health

Women are susceptible to particular health challenges not experienced by men that can benefit from engineering research and innovation in modeling, monitoring, screening and precision medicine. These and other opportunities and advances were illustrated in the spring 2022 issue of NAE’s flagship quarterly The Bridge, titled Engineering for Women’s Health abre em uma nova guia/janela.

In the realm of diagnostics, engineers are exploring screening alternatives for breast cancer abre em uma nova guia/janela, which accounts for about a third of all cancers in women. Regular screening can usually detect breast cancer in time for effective treatment. However, many women put off screening because of the discomfort and even pain caused by current screening methods, and by the prevalence of false positives and negatives. To address this potentially fatal shortcoming in a lifesaving tool, engineers are working to develop dedicated computer-aided tomography to detect breast masses — an alternative that promises to be both effective and painless.

Physical differences warrant specific attention to women’s health needs. Probably the most notable of these differences is women’s reproductive capacity. This feature places women in a unique but vulnerable position relative to men in terms of health.

Regular doctor visits and monitoring are needed throughout pregnancy to ensure the health and development of both mother and baby. During the pandemic, as much of the world went into lockdown, the need for remote monitoring of a pregnancy abre em uma nova guia/janela was evident. Even as medical facilities slowly reopened, many individuals skipped recommended checkups for fear of contagion.

Today, engineers are developing simple wireless wearables that enable pregnant people and their caregivers to remotely and easily monitor vital signs such as heart and respiratory rates, blood pressure, temperature and, when the time comes, contractions. Such devices can help bridge the gap, enabling quality accessible care for all women.

Complications from pregnancy can affect anyone — and often go unnoticed. One such complication is preterm delivery abre em uma nova guia/janela. It occurs in one in 10 births and can threaten a newborn’s ability to thrive or even survive. It also can create an emotional and financial toll for families. Why do some pregnancies require months of bed rest to prevent this? What methods work best, in what circumstances, to prevent preterm delivery? To find answers and solutions, clinicians, scientists and engineers need to work together. Clinicians can help identify the problems, scientists can help understand the biological underpinnings, and engineers can design robust solutions.

Other conditions specific to female physiology and anatomy can benefit from engineering approaches. The creation of a tissue database abre em uma nova guia/janela is helping with noninvasive diagnostics and monitoring of conditions such as endometriosis, fibroids and uterine cancer. It can also lead to the identification of biomarkers for the detection of ovarian and other cancers that affect women. An associated in-home tool eliminates the inconvenience and cost of a trip to the doctor’s office, as well as the discomfort of an invasive procedure such as a biopsy or laparoscopy. A novel method based on sampling via tampons is even more effective than in-clinic swabs and urine tests in the detection of certain diseases.

We are in this together

In her article The Role of Engineers in Women’s Health abre em uma nova guia/janela, Nicole Danos lists several obstacles to advancing women’s health, including: questions not being asked, healthcare professionals not listening to women, inadequate research and data, and culturally biased research. Danos’s solution is simple and within reach: collect data on women’s health, believe the data and believe women, encourage transdisciplinary collaboration and training, and actively include more women at all levels of the innovation process. She reminds us that “it is important for everyone to focus on this area given the role of women in society.”

Explicit acknowledgment of the unique health issues faced by women is the first step in improving healthcare for women. And improving healthcare for women should be a priority for all of us, especially in reproductive health given recent legislation in some states restricting a woman’s right to decide her course of action when pregnant. Effective prioritizing requires more resources and attention and an awareness of the medical complexities faced by women. It is time to not only invest more resources but also recruit more women into the disciplines of engineering, medicine and science to ensure that their voices are heard and their technical input is utilized. It is time to do the right thing.

References

• Engineers Are Unsung Heroes of Global Health abre em uma nova guia/janela, Madhukar Pai abre em uma nova guia/janela, Forbes, May 22, 2022

• The Crash Test Bias: How Male-Focused Testing Puts Female Drivers at Risk abre em uma nova guia/janela, Consumer Reports, October 23, 2019

• Invisible Women: Data Bias in a World Designed for Men abre em uma nova guia/janela, Caroline Criado-Perez, 2019

• Gendered Innovations website abre em uma nova guia/janela, Stanford University

• The Bridge: Engineering for Women’s Health abre em uma nova guia/janela, National Academy of Engineering, 2022

• Breast Cancer Screening: Opportunities and Challenges with Fully 3D Tomographic X-Ray Imaging abre em uma nova guia/janela, Srinivasan Vedantham and Andrew Karellas, The Bridge abre em uma nova guia/janela, NAE 2022

• The Future of Remote Monitoring for Pregnancy abre em uma nova guia/janela, Jessica R. Walter, Shuai Xu, Jeffrey S. Stringer, and John A. Rogers, The Bridge abre em uma nova guia/janela, NAE 2022

• Investigating Reproductive Biomechanics Using Physical Models abre em uma nova guia/janela, Alexa Baumer, Alexis Gimovsky, Michael Gallagher, and Megan C. Leftwich, The Bridge abre em uma nova guia/janela, NAE 2022

• The Menstrualome: Bringing Precision Medicine to Reproductive Care abre em uma nova guia/janela, Ridhi Tariyal and Stephen K. Gire, The Bridge abre em uma nova guia/janela, NAE 2022

• The Role of Engineers in Women’s Health abre em uma nova guia/janela, Nicole Danos, The Bridge abre em uma nova guia/janela, NAE 2022