I have participated in a Cardiopulmonary Resuscitation (CPR) training program — a life-saving emergency procedure that aims to restore blood flow to vital organs — three times in the last five years. If you’ve participated in CPR training for certifications, you may recall that training for the procedure involves a short lecture on how the mechanics of blood flow work and how to externally pump the heart to keep the person alive before professionals can arrive. 

While kneeling beside the rubber manikins, I learned proper hand placement, posture, and rhythmic chest-pumping techniques to hopefully restore blood flow to the manikin’s ‘heart.’ I didn’t realize it then, but I never once came across a dummy or diagram that physically represented me, a woman, in all of my training sessions. While it’s true that breasts are not found two finger widths above the breastbone, in the centre of the chest — where CPR compressions are done — they do exist.

As a STEM student, I had absentmindedly dismissed the lack of representation of women’s bodies in scientific models and diagrams; it didn’t matter to me because I wasn’t going to become a doctor. 

However, by my third attempt to renew my CPR certification, I could no longer ignore the blatantly obvious bias in my training. Upon further research on CPR, I realized that my instructors were simply regurgitating what they had been taught: men’s anatomy and experiences were the default in teaching, administering, and understanding medicine and healthcare. 

How is CPR a gendered issue? 

The heart is responsible for pumping oxygen-rich blood throughout the body relying on a finely coordinated electrical system to maintain rhythmically timed heartbeats known medically as a sinus rhythm. 

When a person enters cardiac arrest, their sinus rhythm is disturbed, compromising the heart’s pumping ability. Chest compressions — a key technique in CPR — aim to restore this rhythm manually. No matter what sex the CPR recipient is, chest compressions are performed in the same area of the chest, with the same rhythm and pressure.

So why is CPR a gendered issue? 

Since their very inception, certain medical sciences have always used men’s anatomy, behaviour, and symptoms as the benchmark for what’s considered average and in the process, neglecting women’s bodies and experiences. 

A 2024 study in Health Promotion International looked into CPR training manikins and the representation of sexual differences in them. The study looked at several manufacturing companies and found that 95 per cent of manikins available globally did not represent sex-based physical characteristics — such as breasts — properly. 

This isn’t particularly a shock to me. Our scientific ethos has failed to give the same systematized attention, care, and funds to women’s health care as it has done for men — which naturally informs what manikins are in supply. The fact that 95 per cent of manikins that end up teaching millions of people CPR are flat-chested means that the majority of people that learn CPR have zero experience performing chest compressions on women. This includes me and everyone else I know who has received training. 

The bystander effect

In a 2024 study published in the Resuscitation — the official journal of the European Resuscitation Council — researchers found that anatomically, having breasts does not change the effectiveness or action of performing CPR techniques, but it does change whether a bystander will perform CPR in the first place. 

This plays off the bystander effect: a phenomenon that describes how individuals are less likely to offer help to victims in the presence of others. Bystanders may perceive women differently from men, for example, a fear of hurting the woman or a false perception of fragility, leading to weak compressions. 

The researchers from the study believe that one of the reasons women are less likely to receive CPR is because of concern some may have about touching the woman’s breasts in the process of administering CPR. In a recent casual conversation with a friend who is a man, I asked him if he would feel comfortable administering CPR to a woman. According to him, his hesitation stems from the paranoia that he would accidentally be violating — or sexually harassing — the woman by performing CPR. 

The 2024 study also discussed how people, especially men, expressed this irrational fear because of the lack of transparency, representation, and conversations surrounding women’s health. When a life is on the line, everyone should feel safe enough to provide help without hesitation or fear of being labelled a harasser. 

Incorporating both typical men’s and women’s anatomical representation into CPR training dummies is one step towards addressing the gendered difference in CPR practices. By manufacturing manikins that represent sex-based characteristics, teaching people how to be comfortable with them, and sharing our knowledge with others, we are not only chipping away at the insidious nature of medical misogyny but actively building a more equitable future for women, one chest compression at a time.