Women’s cognitive bandwidth is consumed by constant workarounds that men rarely have to consider.
Adapted from the new book Man-Made: How We Designed a World That Leaves Women Out, and How We Can Make It Right. Copyright © 2026 by Karen Korellis Reuther. Reprinted here with permission from Harper Business, an imprint of HarperCollins Publishers.
There’s an episode in the first season of the Netflix series The Diplomat, a political thriller starring Keri Russell as the U.S. ambassador to the U.K., in which her character, Kate Wyler, arrives at a meeting where she is the only woman at the table. She takes her seat with confidence, yet struggles to get settled into the oversized boardroom chair. She sits and looks to her left and right, realizing she is sitting much lower than her male colleagues, needing to raise her elbows to rest them on the table. She’s trying not to call attention to herself but as she scoots the chair in closer, it causes a loud screech on the hardwood floors. Cue the glances from the men at the table. She makes a second attempt, this time standing up to lift the chair while discreetly tucking her purse under her. Efficient. Nevertheless, this only calls more attention to her, what I am sure she was trying to avoid at all costs.
She replies, “I’m fine,” not wanting to be seen as needy. But a much older gentleman at the table answers for her: “She’s not fine! … It’s structural inequity in the plainest sense,” explaining to his colleagues that the furniture in the conference room is designed for a man’s build. He asserts, if they want to have women at that table, it’s incumbent upon them to pull up a chair that fits. “Can we get Ambassador Wyler a suitable chair?” another man at the table calls out to no one in particular.
Kate just wants the entire nightmare to end. She pleads, “I love my chair!” She’s offered a cushion which she accepts with grace and a grin and they finally move on. Well, sort of. When she brings up an issue she would like to discuss, she is told there isn’t time; due to the “the structural inequity of the furniture,” they are running behind schedule.
Kate Wyler in The Diplomat is thinking about how to elevate her chair, not bring attention to herself, and raise a policy issue—all at the same time.
This is a reality we seldom notice: the physical contortion that is constantly required and tolerated by women to get through the day. It’s everywhere if you pay attention; the woman struggling to reach and hold on to the strap on the moving subway car; the corporate attorney changing her gait to avoid blisters from her heels; any woman choreographing her every move inside a public restroom stall, accommodating a space designed to be barely sufficient.
We fail to scrutinize these daily discomforts and instead accept them as more of life’s subtle disappointments. However they whisper to us in tenuous ways.
Maybe the corporate attorney packs a pair of sneakers for the commute to work, resulting in a heavier bag that gives her shoulder pain. Maybe the woman at the door holds her cell phone in her teeth as she searches through her bag for her keys. (She has no pockets!)
This is all without mentioning what is perhaps the most insidious side effect of discomfort in the built world: distraction. Instead of mentally preparing for work, the corporate attorney is using her headspace to plan for a day without blisters. The woman with her hands full at the door is spending extra time to take in her surroundings, acutely aware of her vulnerability alone on the urban streets as she searches for her keys. Kate Wyler in The Diplomat is thinking about how to elevate her chair, not bring attention to herself, and raise a policy issue—all at the same time.
There are many such examples.
… It is no longer the case that our labor market is predominantly male, and design should reflect that.
Mind the Gap
The distraction caused by an ill-fitting built world has a tangible consequence: Headspace that would otherwise be focused on a goal or fulfilling one’s potential is wasted on silly workarounds. (And we know these workarounds cost money too.) This is headspace that our male counterparts have available to them. I call this the headspace gap. It perpetuates patriarchy, operating as a product by design.
I want to reiterate the prevalence of design in our built world. The built world is not only the physical environment in which we exist; it’s the products and tools we hold and use, it’s what we wear at home, to work and to play, it’s the equipment that allows us to do our jobs and engage with our hobbies. Specialty professions such as doctors, athletes and military personnel offer rigorous case studies of the headspace gap due to their high reliance on equipment and their historical exclusion of women.
To write Man-Made, I interviewed women across the professional spectrum on their experiences with their unique built world, and in nearly every case it was undeniably ill-equipped to serve them. It’s not difficult to understand why. After all, designing for the “traditional” doctor, athlete or military personnel has historically meant designing for the average man.
Yet, it is no longer the case that our labor market is predominantly male, and design should reflect that. In a century characterized by the emergence of some of the most frivolous comforts, to ignore gender bias in design is to convey indifference toward the health, safety, performance and comfort of our women.
In addition to the ill-fitting uniform, the operating room is an obstacle course of equipment too large, too heavy or too tall. … She wonders how long she’ll be able to last in this profession.
Take Ashley, for example.
It’s another gray Tuesday as Ashley preps to remove a tumor from a patient’s brain. It’s a delicate surgery along the brain stem, siding the hearing and balance nerves. It’s a surgery in which one misstep as slight as a shiver, as imperceptible as a quiet jitter, a twitch of mere micromillimeters in the wrong direction, could result in the loss of the patient’s senses, movement or life.
Ashley has done this 1,000 times before. Indeed, she has been successfully removing cancer from people’s brains four to five days per week for the past 10 years, allowing her to remain unnerved as she commutes to work that day for the 1,001st time.
She begins by changing out of her day clothes into her scrubs. She reviews the patient’s chart with her colleagues. She washes her hands and puts on a pair of surgical gloves. And then she puts on another.
Since she was a young medical student, Ashley has always worn two pairs of gloves in her practice. Ashley has average-sized hands for a woman, and, like most hospitals, hers keeps two sizes of gloves in stock: large and small. The large size is baggy on her hands and makes her feel unfit to hold the small blades, dissectors and forceps required for delicate, high-stakes microsurgeries. But if she opts for the tighter, shorter pair, she limits her range of motion. Early in her career, she figured out that by wearing two pairs of the baggy gloves, she reinstates some tactile feedback—although not nearly as much as she would with a single, properly fitting pair.
Fitted with two pairs of gloves, Ashley finishes her surgery prep routine by putting on her surgical gown. Standing at a humble 5’3″, she feels as though she is drowning in a sea of blue hospital-issued synthetic fabric. The gown piles on the floor, and she wills herself not to trip. It’s not much different from the baggy scrubs she wears to see her patients outside the OR, which make her look even smaller than she is. It is not lost on her that her own professional clothing does nothing to inspire confidence in her patients. She wears these garments 12 hours per day.
In addition to the ill-fitting uniform, the operating room is an obstacle course of equipment too large, too heavy or too tall. As part of a male-dominated team, Ashley is cognizant not to come across as high-maintenance, so she accommodates. She overextends. The bed is too high, but she doesn’t speak up. Even if she did, the bed mechanism isn’t designed to go any lower. Instead, she holds an arabesque for hours on end atop a footstool. When it’s appropriate for her to sit, she raises the surgery chair. Her feet dangle and the seat is too deep to reach her back, so she goes without support. In practice, it’s no better than standing. She develops back and neck pain that her male colleagues do not.
Through her two layers of gloves, Ashley uses a needle driver to suture an incision. The drivers are too large for her ring finger and for the following two weeks, she develops “trigger finger,” where her ring finger locks up when she tries to bend it, causing her pain. She buys disability insurance just in case. She’s reminded of everything she knows about herniated discs, frozen shoulder and carpal tunnel, and how these ailments arise from repeated engagement in ergonomically uncomfortable positions. She wonders how long she’ll be able to last in this profession.
When it’s time to use the laser, Ashley adjusts her goggles. They normally sit low on her nose, slipping down throughout the procedure because the only ones available are too large for her slim face. But she’s concerned about the impact of the lasers on her eyesight. She feels justified in asking her colleagues to push her goggles back up on her face to protect her eyes because she’s waited until now to ask for help. She knows that wearing safety goggles that don’t fit her properly increases her potential of eye infection. In fact, her fellow female physicians seem to have higher incidences of eye infections than their male counterparts. She thinks to herself, “How much of my day do I spend negotiating between helping myself and helping my patients, making calculations, planning workarounds?”
How much of her day indeed? In 2021, more than one-third of active physicians in the United States were female. That means up to one in three physicians are expected to perform in gowns, gloves, safety goggles and masks that don’t fit. Nurses endure the same bias multiplied, given that women make up a supermajority of the profession—around 86 percent in the U.S., and close to 90 percent globally.
Ultimately, around three-quarters of healthcare professionals are expending energy forcing the built world to work for them rather than working seamlessly in the built world. That is the headspace gap in action.
Not in Her Head
Healthcare equipment provides an additional level of complexity due to its need to serve both practitioners and patients. In many cases, two bodies are interacting with a single piece of equipment at once. And just as this equipment is ill-fitted to female practitioners, it is also ill-fitted to female patients.
On a lazy morning in June 2023, I woke up to the sun shining in anticipation for my Sunday morning ritual. I made my coffee, downloaded that day’s issue of The Boston Globe, and prepared to settle into my favorite Adirondack looking out over the saltwater marsh at my home in Rye, N.H. Before I could turn off the news to focus on the paper, I was reminded that it was nearly a year to the day of the Supreme Court’s decision to overturn Roe v. Wade. What a tragic turn of events I thought, to have lived through the landmark decision as well as its reversal; to have been promised autonomy over my own body and to have had it taken away.
When I opened my paper to the opinion section, I realized I wasn’t the only one spending my time reflecting on healthcare’s neglect of women. While I was ruminating on once-progressive policy now moving backward, a writer meditated on a lack of progress altogether in women’s healthcare—progress so lethargic it can only be characterized as stagnant—for the past 200 years.
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