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Health Needs of Women in Ag Overlooked

Despite the fact that 31% of all American farmers are women, health and safety education for the agricultural population is most often aimed at men.

Women on the farm fill more roles than ever before – or are at least being publicly recognized for filling these roles – including primary operator, mother, wife, ag implement salesperson, and large animal veterinarian, to name a few. However, despite the fact that 31% of all American farmers are women, according to USDA, their safety and health needs are being overlooked.

As part of last week’s National Farm Safety and Health Week, AgriSafe Network partnered with the National Education Center for Agricultural Safety to offer several free webinars for ag producers, health-care professionals, educators, trainers, and safety professionals. One of those webinars, “Optimizing the Health of the Female Agricultural Producer,” was hosted by AgriSafe’s Linda Emanuel, RN, and Knesha Rose-Davison, MPH.

“Safety education for the agricultural population is often aimed at the men in farming operations,” Emanuel said in the webinar, which means women may be less prepared to prevent injuries, illnesses, and chronic conditions related to agricultural work.

Third-Shift Phenomenon

Many women work off the farm in order to provide a steady income and health insurance for the family, but their workday doesn’t end at 5:00. Like other women who work outside the home, they return to a “second shift” of housework and childcare.

The difference between rural and urban women is that on the farm, there is another shift: providing farm labor. Of course, this varies depending on the type of operation, other help available, and the season. This is referred to as the third-shift phenomenon, which has long been recognized as contributing to the stress felt by many women in agriculture.

“Each farm has its own set of values that influence the division of labor on farms, and women’s potential exposure to multiple roles,” Emanuel said. “As women, we tend to take on too much and we are expected to fill multiple roles. We rarely get to sit down – especially during the child-rearing years – which increases our mental and physical stress and contributes to fatigue.”

Rose-Davison pointed out that the toll isn’t purely physical. “The increased risk of stress and agricultural injury are due to both exhaustion and women having their minds on multiple things at the same time,” she said.

Gender-Specific Risks

While women are perfectly capable of performing as well as men in any role on the farm, there are some health and safety risks that either apply specifically to women, or which are more pronounced for female farmers.

The National Institute for Occupational Safety and Health (NIOSH) lists numerous women’s safety and health issues in agriculture, including pesticide exposures, chronic bronchitis, pregnancy-related risks, work-related injuries, exposures to inhaled substances, livestock-related injuries, fatigue, cancer risks, depression, and risk factors for infertility.

The combination of these risks and living in a rural location means farm women are experiencing health disparities when compared with the population as a whole. “In general, women who live in rural health areas have poorer health outcomes and have less access to care than urban women,” Rose-Davison said in the webinar. “There’s also a marked lack of rural health resources for female and reproductive health, which leads to fewer preventive screens for breast and cervical cancer for rural women.”

Specific areas of risk include:

Heart Disease: Women in rural areas are at a higher risk of death from ischemic heart disease than those in urban areas. “The primary culprit is a lack of vigorous physical activity,” Rose-Davison said. “Women who work in ag are doing physical work, but the length of time engaged in physical activity needs to be long enough to increase the heart rate.” Increased use of alcohol is also a contributing factor.

Diabetes: Rural women, especially those in the South and Southeast, have an increased risk of diabetes, due in part to cultural influences. “Everything is a festival and is centered around food and alcohol,” Rose-Davison noted.

Breast cancer: In 2018, 266,000 women will develop breast cancer, the webinar reported. While the death rate isn’t necessarily increased for rural women, Rose-Davison said, “It’s a great concern for all women, so those screening opportunities are very important for rural women to be able to catch cancer early.”

Broken bones: Emanuel noted that farm women are likely to work past the typical retirement age, and past the age of menopause, when bone strength may be compromised. “As we age, we have an increased risk for falls because our peripheral vision decreases, and muscle flexibility and balance change,” she said. “In agriculture, the environment we work in puts us at an increased risk for falls from climbing fences, working on uneven or slippery surfaces, and working around livestock that moves quickly. It’s important to monitor bone strength and make sure it’s where it needs to be to meet the critical demands of working in agriculture.”

Chronic pain: Overall, Emanuel said, women have an increased frequency of lower back pain over men, and this can be exacerbated by farmwork. “Work on the farm requires strength, flexibility, and balance,” she said. “We are caught off-guard in awkward body positioning while working on equipment, we have extended reaches, quick unexpected movements especially when working with livestock, falls, repetitive motions, working with vibrating tools, and sitting on tractor seats that are continuously vibrating. We also take minimal regard for good use of ergonomics, and at the end of the day, we are driven to get the task done, which sometimes means working through the pain.” Emanuel warned that ongoing pain can lead to opioid addiction.

Mental health: Besides addiction concerns, Emanuel pointed out that women are more likely than men to suffer from depression, anxiety, feelings of isolation, and overall mental illness, although men are more likely to commit suicide. “With steadily dropping incomes, patchy access to mental health care, and things beyond our control, mental stress has increased,” she said. “Finding a behavioral health specialist who specifically understands agriculture is so important, but not always feasible because of the shortage of mental health caregivers in rural areas.” Also, she said stress is often listed by farm women as a top health issue they are facing. This worry often leads to a lack of sleep, and therefore fatigue.

Pregnancy risks from working with livestock: Contact with the infected blood or aborted tissue of livestock with brucellosis can cause miscarriage, as can unintended needle sticks when administering oxytocin or prostaglandin. Women working in swine barns may be exposed to dangerously high carbon monoxide levels, which can lead to fetal brain damage or death. Zoonotic infections like brucellosis, Q fever, and listeria are also dangerous for pregnant women and fetuses, as are exposure to salmonella, toxoplasmosis, and insect-borne diseases. When working with livestock, Rose-Davison said women should choose the appropriate protective equipment, designate specific clothes for farmwork, constantly wash hands with soap and dry with paper towels, and disinfect work areas.

Respiratory illness: “Farm women have been overlooked in the evaluation of respiratory hazards of agriculture, although they commonly perform tasks that are similar to those done by men,” Rose-Davison said. Protective gear may not be the right fit for women. Grain and dust exposures and pesticides often lead to chronic bronchitis among nonsmoking farm women, she said, and this is often misdiagnosed if doctors don't know their patients do that type of work. She recommends using the respirator guide at agrisafe.org.

Chemical Concerns

In addition to respiratory issues, exposure to chemicals can cause a range of other problems for women, and can affect both mother and baby when it occurs before, during, or after pregnancy.  “Oftentimes, we aren't even thinking about preconception. We only think about exposure once you become pregnant, but with some kinds of work, exposure can have lingering effects.”

The Environmental Protection Agency offers a free manual that explains pesticide exposures. Rose-Davison recommended providing a copy of Recognition and Management of Pesticide Poisonings to all women on the farm who are exposed to pesticides. “Even if a woman isn't mixing or handling pesticides herself, she can still be exposed by doing laundry,” she said. “It can get on them and affect them and anyone in the household.”

Rose-Davison said before using or exposing themselves to pesticides, women should take time to read the label and wear the appropriate protective gear, including gloves, goggles, clothing protection, and a respirator. “Know the right items for your task and make sure they fit correctly so they properly protect you,” she said.

Risks for Babies

The No. 1 cause of death for babies under the age of one is congenital malformations, or birth defects, according to the Centers for Disease Control’s National Center for Health Statistics. In urban counties, 108.91 deaths occur for this reason per 1,000 live births. In rural counties, that number jumps to 146.79 deaths. Rose-Davison said this disparity may be due to genetic issues, specialty care, lack of adequate prenatal care, lack of folic acid, or a number of other things. “This is rather alarming,” she said.

Also, babies in rural counties are more likely to die than babies in small towns or urban communities. “That is not necessarily because women are working in agriculture,” Rose-Davison said. “It’s more due to access to care and a number of other factors.”

In addition to the chemical exposure risks listed above, water sources are a concern for newborns. “Think about what’s actually in your soil if you get your water from a well and you mix that water to make formula,” Rose-Davison said. “Nitrates are really dangerous because exposure can lead to blue baby syndrome, and infants under 4 months of age lack the enzyme necessary to correct the condition.”

Get Fit to Farm

Emanuel said yoga and Pilates can help farm women both physically and mentally. AgriSafe has created free downloadable instructional posters that demonstrate proper yoga techniques that can help protect joints and prevent muscle strain or sprain, and Pilates moves that increase core strength to protect the back and provide overall conditioning. “Yoga works for me in my work here on our farm,” she said. “It provides flexibility and strength – and a dose of sanity.” She recommends hanging these posters in barns, shops, and other areas where they can be seen by all workers.

AgriSafe also offers an online health risk assessment tool, which takes a look at physical and mental issues and helps develop an individualized plan based on each person’s circumstances. See all of AgriSafe’s resources for women’s health at agrisafe.org.

To view a recording of this webinar or any of the other National Farm Safety and Health Week presentations offered by AgriSafe, visit agrisafe.org/nfshweek2018.

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