are wearing seat belts ‘improperly’ which again, increases our risk of injury (another reason we should be designing explicitly female dummies rather than just smaller male dummies).63 And it’s not just a woman’s belly that changes in pregnancy: breast-size changes can also diminish seat-belt efficacy by affecting positioning. Here again, we find an example of a situation where we have the data on women, but are just ignoring it. Clearly what is needed is a wholesale redesign of cars using complete data, and this should be fairly simple since it’s not exactly hard to find women to model a test dummy on.

Even with all these gaps, the 2011 introduction of the female crash-test dummy in the US still sent cars’ star ratings plummeting. The Washington Post reported on the experience of Beth Milito and her husband, who bought a 2011 Toyota Sienna, based primarily on its four-star safety rating.64 But all was not as it seemed. The passenger seat, which Milito says she is likely to be sitting in when they are ‘out and about as a family’, had a two-star rating. In the previous year’s model, the front passenger seat (tested on a male dummy) had earned a top five-star rating. But the shift to female dummies revealed that in a front collision at 35 mph a female passenger had a 20-40% risk of being killed or seriously injured. The average risk of death for that class of vehicle, explains the Washington Post, is 15%.

A 2015 report by the Insurance Institute for Highway Safety is excitingly headlined ‘Improved vehicle designs bring down death rates’ – which sounds great. Perhaps this is the result of the new legislation? Unlikely. Buried in the report is the following telltale line: ‘The rates include only driver deaths because the presence of passengers is unknown.’ This is a huge gender data gap. When men and women are in a car together, the man is most likely to be driving.65 So not collecting data on passengers more or less translates as not collecting data on women.

The infuriating irony of all this is that the gendered passenger/driver norm is so prevalent that, as we’ve seen, the passenger seat is the only seat that is commonly tested with a female crash-test dummy anyway, with the male crash-test dummy still being the standard dummy for the driver’s seat. So stats that include only driver fatalities tell us precisely zero about the impact of introducing the female crash-test dummy. In conclusion, a more accurate headline for the report would be ‘Improved vehicle design brings down death rates in the seat most likely to be occupied by men, but who knows about death rates in the seat most likely to be occupied by women even though we already know women are 17% more likely to die in a car crash.’ Admittedly, this is less snappy.

When I speak to Dr David Lawrence, director of safety-literature database the SafetyLit Foundation, he tells me that ‘in most US states the quality of police crash reports is at best poor for use as a research tool’. Little data is gathered about anyone other than the driver. Written police reports have often been handed to ‘contract companies for data entry’, most of whom use prison labour for data entry. ‘Data-quality checks were rare and when quality was evaluated it was found wanting. For example, in Louisiana for most crashes in the 1980s most of the occupants were males who were born on January 1st, 1950. Almost all of the vehicles involved in crashes were the 1960 model year.’ Except they weren’t. These were just the default settings.

Lawrence tells me that even though this problem has been found in ‘many other states’, the data hasn’t improved ‘because no changes in the data-entry practices were made. The federal government required that states provide police crash-report data to NHTSA (The National Highway Traffic Safety Administration) but set no standards for data quality nor penalty for sending junk data.’

Astrid Linder has been working on what she says will be the first crash-test dummy to accurately represent female bodies. Currently, it’s just a prototype, but she is calling on the EU to make testing on anthropometrically correct female crash-test dummies a legal requirement. In fact, Linder argues that this technically already is a legal requirement. Article 8 of the legally binding Treaty of the Functioning of the European Union reads, ‘In all its activities, the Union shall aim to eliminate inequalities, and to promote equality, between men and women.’66 Clearly, women being 47% more likely to be seriously injured in a car crash is one hell of an inequality to be overlooking.

In some ways it’s hard to understand why a proper female crash-test dummy hasn’t been developed and made a legal requirement in car tests years ago. But on the other hand, and given all we know about how women and their bodies are routinely ignored in design and planning, it’s not surprising at all. From development initiatives to smartphones, from medical tech to stoves, tools (whether physical or financial) are developed without reference to women’s needs, and, as a result these tools are failing them on a grand scale. And this failure affects women’s lives on a similarly grand scale: it makes them poorer, it makes them sicker, and, when it comes to cars, it is killing them. Designers may believe they are making products for everyone, but in reality they are mainly making them for men. It’s time to start designing women in.

PART IV

Going to the Doctor

CHAPTER 10

The Drugs Don’t Work

It took twelve years for Michelle to receive a diagnosis. ‘I was about fourteen when I first started having symptoms,’ she tells me. ‘I was too ashamed to go to a doctor for it.’ She kept her urgent, painful, frequent, sometimes bloody bowel movements a secret for two years, until one night, it hurt too much to hide anymore. ‘I couldn’t move from the foetal position on my bathroom floor. I

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