A journalist explains the dangerous consequences of a world built for men

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 (out now from Abrams Books in the US, also available on Kindle). 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.

This interview has been lightly edited for clarity.

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?

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.

To be clear, when we talk about “women,” who are we talking about? Are we talking about white women specifically?

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.

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?

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.