Saralyn Mark Responds To Marsha Ivins' Gender Diversity Op Ed

Keith's note: Several weeks ago I posted some commentary "Marsha Ivins Opines On Gender Diversity At NASA: "Enough Already!" With regard to an opinion piece in Time magazine by former astronaut Marsha Ivins wherein she takes issue with comments by Dr. Saralyn Mark who testified before the National Space Council. Time magazine has declined to respond to her comments so I have offered to post them here.

Saralyn Mark: "As Ms. Ivins states in her TIME editorial ("I'm a Retired Female Astronaut and I Can't Understand the Obsession with 'Gender Diverse' Space Crews"), she did not fully listen to my 8/20/19 National Space Council testimony on sex/gender-inclusive design and innovation nor the related questions and comments from the Vice President and the Administrator which is unfortunate.

Please see the links to the actual C-SPAN coverage of this National Space Council meeting and to a Space.com article which accurately reflects my testimony. I've attached my written testimony (below) which had to be shortened in its delivery to 3 minutes due to time constraints.

Furthermore, it is important to emphasize that it is not about a "numbers" game when we discuss equity regarding women in professional positions. There is equity when everyone is given the tools, resources and opportunities to do their jobs well and safely on Earth and in space.

I hope that this discussion will continue in a constructive manner inspiring all of us to reach for our individual stars."

TESTIMONY BY SARALYN MARK, MD, NATIONAL SPACE COUNCIL, AUGUST 20, 2019

Mr. Vice President, Members of the National Space Council and distinguished guests, thank you for the invitation to speak to you today.

Gender and sex impact every aspect of our lives on Earth and in space. It is more than spacesuits not fitting female astronauts. We see the impact from the shoes and clothing we wear, the electronic devices we use, the cars we drive in, and even the medications we take. Modifying appearances or the "pink it or shrink it" approach for gendered innovation will never work in any environment including space, battlefields, hot zones and in our homes.

The National Academy of Medicine defines "gender" as a person's self-representation as male or female based upon social interactions and "sex" is based upon one's genes. We now know that the environment can modify gene expression, which is called epigenetics, thus, the definitions are more nuanced.

Today, I will predominately focus on the impact of gender and sex on space exploration. As NASA plans for long duration spaceflights to the moon and Mars, the health and safety considerations for astronauts grow increasingly complex.

Men and women adapt to space differently where even small differences significantly impact the quality and safety of life, including astronaut work performance. It is imperative that NASA and its commercial space partners address these differences in how they plan and conduct missions, how they develop products such as spacesuits, high performance clothing including liquid cooling and ventilation garments, tools, hardware and machine-human interfaces, and how they establish extravehicular activity or EVA training protocols and medical guidelines for countermeasures and precision medicine.

In several reports from The National Academy of Sciences, it was recommended that NASA fully evaluate the influence that gender and sex have on the physiological and psychological changes that occur during spaceflight. Many of these reports including "Exploring Biological Contributions to Health: Does Sex Matter?" published in 2001, followed that year by "Safe Passages: Astronaut Care for Exploration Mission" and the 2011 National Academy of Sciences' Decadal Survey, "Recapturing a Future for Space Exploration: Life and Physical Sciences for a New Era" emphasized the need to fully examine, understand and address this impact.

In response, NASA launched 2 decadal reviews assessing the impact of gender and sex on adaptation to space in 2002 and in 2012. In my capacity as the Senior Medical Advisor to NASA, I had the honor to co-chair and lead these reviews, working with many outstanding colleagues from NASA, the National Space Biomedical Research Institute, agencies and academia. In 2014, the second decadal review was published in the Journal of Women's Health. In this collection of manuscripts, six workgroups investigated and summarized human and animal research related to gender- and sex-based differences in the areas of cardiovascular, immunological, sensorimotor, musculoskeletal, reproductive and behavioral adaptations to human spaceflight.

Every system in the body changes in the microcosm of space. For example, it has been observed that some male and female astronauts experience spaceflight associated neuro- ocular syndrome, or SANS, in which there is visual impairment and increased intracranial pressure. Interestingly, the signs and symptoms are more severe in male astronauts. Orthostatic intolerance, or the inability to stand without fainting, is more prevalent upon landing in female astronauts than in their male counterparts. Additionally, radiation presents a major hazard for space travel. It has been reported that female subjects are more susceptible to radiation-induced cancer than male subjects, hence permissible exposure levels (PEL) for radiation are lower for women than men astronauts which could impact their ability to participate in long duration spaceflights.

In 2014, it was noted that there has been progress on several fronts including assessments of the design of new spacesuits based on anthropometric measurements and movement in which sex can have an impact. This was an optimistic development that spacesuit limitations, which astronauts, especially female astronauts, endured for over 40 years would finally be addressed.

In early 2017, NASA supported a challenge competition to assess the impact of gender and sex on innovation and technologies. Ironically, the winning submission by a NASA engineer focused on a modular space suit design which took into account sex differences as the body adapts in space. Unfortunately, leadership priorities, compounded by financial constraints, have hampered spacesuit development over many years. Perhaps, the recent heightened focus on spacesuit issues for female astronauts will finally catalyze efforts to advance new product design not only for the grandeur of space but for all environments.

During a roundtable hosted by my nonprofit, iGIANT® (impact of Gender/Sex on Innovation and Novel Technologies), which is an accelerator for gendered innovation, it was disheartening to hear from one of our nation's top female fighter pilots that she experienced physical, emotional and spiritual harm trying to do her job. She said that she wasted much time retrofitting her equipment to carry out her duties. In over 60 roundtables and summits since 2017, countless stories have been shared by women and men about how a "one-size-fits-all" approach for design elements such as products, programs, protocols and policies does not work.

I want to be crystal clear. This is not about who is faster, better or smarter, just different. We have the capability, such as using artificial intelligence, computational modeling and even 3 dimensional (3D) printing, to develop the tools and resources to ensure that everyone has the opportunity to live and work well and safely on Earth and in space.

Most of us in this room were influenced by the Apollo program. The Apollo effect changed the direction of our careers and the course of our lives. We need to ensure that there will be an Artemis effect. I want to believe that the next boots on the lunar surface will be worn by a woman. They will not only fit her, but will also inspire the next generation of explorers. It is time for NASA, as well as all agencies and organizations, to ensure that their programs and policies have a focus on human systems integration using a gender- and sex-based approach from research to operations. All offices within NASA, such as science, medicine, engineering, education, human resources and outreach, need to be involved. Therefore, there should be a centralized entity within NASA to coordinate these efforts.

It's time for the private sector to also evaluate their design elements to determine that they meet the needs of all customers and clients.

It is time to see the world through a gender/sex lens. When we achieve this goal, we are taking a major leap toward mission success for everyone that will enhance space exploration and our daily lives on Earth.

Thank you for your time and attention today.

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