Injuries among female army recruits: a conflict of legislation.

In the final decade of the 20th century, the British Armed Forces came under intense pressure to open up traditionally male roles to female recruits. For training, women were initially given lower entry and exit standards, but it became apparent that many did not possess the strength necessary for their work. This 'gender fair' policy was therefore changed to a 'gender free' policy, whereby identical physical fitness tests were used for selection of male and female recruits and the training programme made no allowances for gender differences. To determine the effects of this policy change, data from medical discharges were examined for the periods before and after implementation, with reference to musculoskeletal injuries of the lower limbs. In the first cohort there were 5697 men and 791 women, in the second 6228 men and 592 women. The cross-gender (F/M) odds ratio for discharges because of overuse injury rose from 4.0 (95% CI 2.8 to 5.7) under the gender-fair system to 7.5 (5.8 to 9.7) under the gender-free system (P=0.001). Despite reducing the number of women selected, the gender-free policy led to higher losses from overuse injuries. This study confirms and quantifies the excess risk for women when they undertake the same arduous training as male recruits, and highlights the conflict between health and safety legislation and equal opportunities legislation.