Research specifically focused on female firefighters has greatly increased over the past two decades. An online search of peer-reviewed scientific articles revealed zero such articles published on female firefighters prior to 1981. Between 1981 and 1991, nine articles included female firefighters. In 2002, seven articles were published focused on women. From there, we start to see the increased focus on the health and wellness of female firefighters. This coincides with federal funding being allocated to projects focused specifically on the health of female firefighters. In the most recent time period review – between 2014 and 2024 – there have been 183 articles focused on female firefighters published in scientific journals, thus far. While that is certainly worth celebrating, more research is needed.
From that collection of research, here’s what we know about the experiences of female firefighters on the job and the impact of firefighting on women’s health.
General health
From the available literature, we know that female firefighters tend to be healthier than their male counterparts. For example, a recent study from Dr. Sara Jahnke and colleagues found rates of obesity for both career (15.4%) and volunteer (31.6%) female firefighters were not only lower than men in the fire service (33.5% career and 43.2% volunteer) but also were lower than the general population (41.1%).
A recent study by Dr. Denise Smith and colleagues found that female firefighters also tend to have more favorable cardiovascular health measures (Smith et al., 2020). Specifically, female firefighters had higher HDL (“good”) and lower LDL (“bad”) cholesterol, lower blood glucose, lower blood pressure, and lower use of hypertensive medication compared to men.
When it comes to alcohol, the prevalence of alcohol consumption among female firefighters is lower compared to their male counterparts. In a study of 1,913 female firefighters, about 17% reported abstaining from alcohol, while over 60% averaged two or more drinks per day on days they consumed alcohol. Among those who drank, 39.5% reported binge drinking in the past month (Haddock et al., 2017). In contrast, 14.7% of 950 male firefighters reported abstinence, with around 85% of them consuming alcohol, half of whom reported excessive drinking (Haddock et al., 2015).
Bullying, harassment and workplace incivility
Despite being successful in overcoming several occupational risk factors, female firefighters are at risk for bullying, harassment and workplace incivility. In a recent study of 1,773 female firefighters, women reported experiencing verbal (37.5%) and written (12.9%) harassment, hazing (16.9%), sexual advances (37.4%) and assaults (5.1%) in the fire service (Jahnke et al., 2019).
Further, Jahnke and colleagues found that discrimination and harassment impacted physical and mental health. Firefighters who experienced the most severe work discrimination/harassment reported over 40% more poor health days in the last 30 days. Women who experienced moderate and severe discrimination/harassment had negative mental health outcomes including higher prevalence of depressive symptoms, anxiety and PTSD symptoms. Those who experienced high rates of discrimination and/or harassment also were more likely to report issues with alcohol consumption (Jahnke et al., 2019). This goes to show how we treat our brothers and sisters directly impacts our health.
Cancer risks
All firefighters are at greater risk of cancer compared to the general population. The International Agency for Research on Cancer (IARC) recently classified the occupation of firefighting as carcinogenic to humans (Group 1) based on sufficient evidence for cancer in humans. This applies to men and women, career and volunteer firefighters.
Occupational exposure as a firefighter causes mesothelioma and cancer of the bladder. There was limited evidence in humans for cancers of the colon, prostate and testis, and for melanoma of the skin and non-Hodgkin lymphoma. There was also strong mechanistic evidence that occupational exposure as a firefighter exhibits multiple key characteristics of carcinogens in exposed humans (Demers et al., 2022).
Little is known specifically about the prevalence of cancer among female firefighters, as women represent a small proportion of the fire service, and they also have represented small proportions of mechanistic cancer studies. More research is needed. Enter the National Firefighter Registry (NFR) for Cancer. In 2018, Congress passed the Firefighter Cancer Registry Act, which directed NIOSH to develop a registry to study cancer among all firefighters: career, volunteer, probationary, current, retired, etc. The NFR is open to all U.S. firefighters, not just those with a previous diagnosis of cancer. Having many types of firefighters join the NFR is crucial to examining relationships between firefighting and cancer. Join the NFR here.
Reproductive health
Firefighter exposures are increasingly being linked to adverse reproductive health outcomes for both male and female firefighters and their offspring – infertility, miscarriage, pre-term labor, offspring heart defects, atrial/septal defects and facial and limb deficiencies, low fetal birth weight, labor and delivery complications, and puerperium outcomes. Recent research from Samantha Davidson and colleagues found anti-müllerian hormone (AMH), a clinical marker of ovarian reserve (which can indicate fertility), is approximately 33% lower among firefighters compared to women of the same age in the general population.
Jahnke and colleagues found miscarriage rates among women firefighters were approximately 2.3 times higher than the national average (Jahnke et al., 2018). Following up on this study, Alesia Jung and colleagues found that miscarriage rates among volunteer women firefighters were at least 1.42 times higher compared to career firefighters (Jung et al., 2021). And among volunteer wildland/wildland-urban interface (WUI) firefighters, women had 2.53 times higher the risk of miscarriage compared to career firefighters.
The excretion of toxicants accumulated from firefighter exposures through breastmilk poses a potential hazard. Jung and colleagues (2023) investigated the impact of firefighting operations on the concentration of polybrominated diphenyl ethers (PBDEs) and aryl hydrocarbon receptor (AhR) activation in breastmilk. Both firefighters and non-firefighters collected breastmilk samples before any firefighting responses (baseline) and at 2, 8, 24, 48, and 72 hours after a structural fire (firefighters only). The researchers found no statistically significant difference in the levels of these chemicals between firefighter and non-firefighter breastmilk, nor did the levels differ after fire exposure or based on interior or exterior job assignments. Due to the small sample size and the focus on only two classes of chemicals, further research is necessary before providing definitive guidance on forgoing breastfeeding after fire exposure. However, given the study’s limitations and the potential hazard of accumulated toxicants from firefighter exposures excreted through breastfeeding, future studies should consider additional contaminants and measures of toxicity to better understand how firefighting may impact maternal and child health.
PPE problems
Considering the risk of exposure related to cancer and adverse reproductive health outcomes, it is imperative all firefighters have appropriately fitting PPE. Not to mention one should have appropriately fitting uniform and equipment to feel a part of the team.
Though gear fit can be an issue for all firefighters, women in particular have struggled with properly fitting PPE for decades. As early as 1990, FEMA and the U.S. Fire Administration indicated the lack of appropriately sized clothing and equipment as an ongoing issue for women in the fire service. At least 80% of women at that time reported experiencing issues with ill-fitting gear.
In 2019, Meredith McQuerry and colleagues emphasized that PPE has traditionally been designed for the male human form and this leads to a lack of fit and protection, including an increased risk of injury, reduced mobility and poorer comfort for women firefighters. Additionally, qualitative work in 2023 found that 82.9% of structural and 52.1% of wildland firefighters who are women indicated having issues with one or more pieces of ill-fitting equipment.
Issues of policy
One glaring issue is the lack of fire department policies that address women’s health issues. Take reproductive health for example. A study by Jahnke and colleagues in 2018 found that nearly a quarter of women reported their fire department did not have a pregnancy policy. Also, 20% reported their department did not have a maternity leave policy. By implementing and maintaining diverse policies, fire departments can create a more equitable, supportive and effective work environment, leading to improved recruitment, higher retention rates and better service to the community.
What’s next
Over the past two decades, there has been a significant increase in research focused on female firefighters, highlighting various aspects of their health, wellbeing and occupational challenges.
As we answer some research questions, we continue to uncover new questions in need of answers. One critical area that requires immediate attention is the provision of appropriately fitting PPE for female firefighters. Despite longstanding recognition of this issue, many women still struggle with ill-fitting gear, which can compromise their safety and effectiveness. Additionally, the lack of fire department policies addressing women’s health issues, such as pregnancy and maternity leave, highlights the need for more inclusive and supportive workplace practices.
To create a more equitable and effective work environment, it is imperative that fire departments implement and maintain diverse policies that address the specific needs of female firefighters. This will not only improve recruitment and retention rates but also ensure that all firefighters can perform their duties safely and efficiently, ultimately enhancing the quality of service to the community.
As we celebrate the progress made, it is clear that more research and policy development are needed to fully support the health and wellbeing of women in the fire service.
RESOURCES
- Davidson, S., Jahnke, S., Jung, A. M., et al. (2022). Anti-Müllerian hormone levels among female firefighters. International Journal of Environmental Research and Public Health, 19(10), 5981.
- Demers, P. A., DeMarini, D. M., Fent, K. W., et al. (2022). Carcinogenicity of occupational exposure as a firefighter. The Lancet Oncology, 23(8), 985-986.
- Haddock, C. K., Day, R. S., Poston, W. S., et al. (2015). Alcohol use and caloric intake from alcohol in a national cohort of US career firefighters. Journal of Studies on Alcohol and Drugs, 76(3), 360-366.
- Haddock, C. K., Poston, W. S., Jahnke, S. A., et al. (2017). Alcohol use and problem drinking among women firefighters. Women’s Health Issues, 27(6), 632-638.
- Jahnke, S. A., Haddock, C. K., Jitnarin, N., et al. (2019). The prevalence and health impacts of frequent work discrimination and harassment among women firefighters in the US fire service. BioMed research international, 2019(1), 6740207.
- Jahnke, S. A., Kaipust, C., Jitnarin, N., et al. (2022). Prevalence and predictors of obesity among women in the fire service. Occupational and Environmental Medicine, 79(5), 289-294.
- Jahnke, S. A., Poston, W. S., Jitnarin, N., et al. (2018). Maternal and child health among female firefighters in the US. Maternal and child health journal, 22, 922-931.
- Jung, A. M., Beitel, S. C., Gutenkunst, S. L., et al. (2023). Excretion of polybrominated diphenyl ethers and AhR activation in breastmilk among firefighters. Toxicological Sciences, 192(2), 223-232.
- Jung, A. M., Jahnke, S. A., Dennis, L. K., et al. (2021). Occupational factors and miscarriages in the US fire service: a cross-sectional analysis of women firefighters. Environmental Health, 20, 1-13.
- McQuerry, M., Kwon, C., & Johnson, H. (2019). A critical review of female firefighter protective clothing and equipment workplace challenges. Research Journal of Textile and Apparel, 23(2), 94-110.
- McQuerry, M., Kwon, C., & Poley-Bogan, M. (2023). Female firefighters’ increased risk of occupational exposure due to ill-fitting personal protective clothing. Frontiers in Materials, 10, 1175559.
- Park, J., Ahn, Y. S., & Kim, M. G. (2020). Pregnancy, childbirth, and puerperium outcomes in female firefighters in Korea. Annals of Occupational and Environmental Medicine, 32(1).
- Siegel, M. R., Rocheleau, C. M., Hollerbach, B. S., et al. National Birth Defects Prevention Study. (2023). Birth defects associated with paternal firefighting in the National Birth Defects Prevention Study. American journal of industrial medicine, 66(1), 30-40.
- Smith, D. L., Graham, E., Stewart, D., & Mathias, K. C. (2020). Cardiovascular disease risk factor changes over 5 years among male and female US firefighters. Journal of occupational and environmental medicine, 62(6), 398-402.
- Armstrong, D. S., Berkman, B., Floren, T. M. (1993). A Handbook on Women in Firefighting: The Changing Face of the Fire Service. USFA/FEMA/Women in the Fire Service.
