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Health Effects and Environmental Issues

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Health Problems and Disease Patterns

Garment production workers are at risk for the development of WRMDs; occupational asthma; contact and irritative dermatitis; eye, nose and throat irritative symptoms; lung, nasopharyngeal and bladder cancers; and noise-induced hearing loss. Additionally, as some processes in this industry involve exposure to heated plastic fumes, metal dust and fumes (especially lead), leather dust, wool dust and hazardous solvents such as dimethyl formamide, the illnesses associated with these exposures may also be seen among garment workers. Electromagnetic field exposures generated by sewing machine motors are an area of increasing concern. Associations have been reported between maternal employment in apparel production and adverse reproductive outcomes.

Table 1 summarizes the spectrum of occupational diseases which may be seen in the clothing and finished textile industry.

Table 1. Examples of occupational diseases which may be seen in garment workers



Musculoskeletal disorders

Carpal tunnel syndrome, forearm tendinitis,
DeQuervains tendinitis, epicondylitis, bicipital tendinitis,
rotator cuff tears and tendinitis, trapezius spasm,
cervical radiculopathy, low-back syndrome, sciatica,
disc herniation, osteoarthritis of the knees

Non-neutral postures
Prolonged sitting


Other fabric treatments
Heated plastics


Bladder cancer


Lung, nasopharyngeal cancer


Hearing loss



Contact and irritative dermatitis

Formaldehyde, textile dyes

Lead poisoning



Musculoskeletal disorders. Garment production involves the performance of monotonous, highly repetitive and high-speed tasks, often requiring non-neutral and awkward joint postures. These exposures place garment workers at risk of developing WRMDs of the neck, upper extremities, back and lower extremities (Andersen and Gaardboe 1993; Schibye et al. 1995). It is not uncommon for garment workers to develop multiple WRMDs, often with both soft-tissue disorders, such as tendinitis, and concomitant nerve entrapment syndromes, such as carpal tunnel syndrome (Punnett et al. 1985; Schibye et al. 1995).

Sewing machine operators and hand sewers (sample-makers and finishers) perform work which requires repetitive hand and wrist movements, typically performed with non-neutral postures of the fingers, wrist, elbows, shoulders and neck. Therefore, they are at risk for developing carpal tunnel syndrome, ganglion cysts, forearm tendinitis, epicondylitis, shoulder disorders including bicipital and rotator cuff tendinitis, rotator cuff tears and neck disorders. Additionally, sewing machine operation typically requires prolonged sitting (often in seats without backrests and in workstations that necessitate leaning forward from the waist), intermittent lifting and repetitive use of foot pedals. Thus, sewing machine operators may develop WRMDs of the low back and lower extremities.

Cutters, whose work requires lifting and carrying of fabric rolls as well as operation of hand-held or computer-operated cutting machines, are also at risk for development of musculoskeletal disorders of the neck, shoulder, elbow, forearm/wrist and low back. Pressers are at risk for developing tendinitis and related disorders of the shoulder, elbow and forearm, and may also be at risk for developing related nerve entrapment disorders.

In addition to ergonomic/biomechanical factors, rapid piece-rate production systems and work organizational factors described more fully in the previous section may contribute to musculoskeletal disorders among workers in the clothing industry. In one study of garment workers, duration of employment in piece-work was found to be associated with an increased prevalence of severe disability (Brisson et al. 1989). Consequently, prevention of work-related musculoskeletal disorders may require both workplace ergonomic modifications and attention to work organization issues, including piece-work.

Chemical hazards. Resin-treated fabrics used in permanent press clothing may release formaldehyde. Exposures are greatest during cutting, because off-gassing is greatest when fabric bolts are first unrolled; during pressing, as heating promotes the liberation of formaldehyde from residual amounts of resins; in production areas in which large quantities of fabric are being used; and in warehouse and retail areas. Many garment shops are poorly ventilated and afford poor control of ambient temperatures. With increased temperature, off-gassing is greater; with poor ventilation, increasing ambient concentrations of formaldehyde can accumulate. Formaldehyde is a well-recognized acute irritant of the eyes, nose, throat and upper and lower airways. Formaldehyde may be a cause of occupational asthma due to either irritative effects or allergic sensitization (Friedman-Jimenez 1994; Ng et al. 1994).

Formaldehyde exposure has been associated in a number of studies with the development of lung and nasopharyngeal cancers (Alderson 1986). Additionally, formaldehyde exposure can result in both allergic contact and irritative dermatitis. Garment workers may develop a chronic, eczema-like dermatitis of the hands and arms which is likely related to sensitization to formaldehyde. The irritative and other non-allergic health effects of formaldehyde can be minimized by the implementation of proper ventilation systems and product substitution where feasible. Allergic sensitization, however, can occur at lower levels of exposure. Once a garment worker has developed allergic sensitization, removal from exposure may be necessary.

Workers in the finished textile industry may sustain exposure to organic solvents. Solvents such as perchlorethylene, trichlorethylene and 1,1,1-trichlorethane are frequently used in finishing departments for stain removal. Health effects due to such exposures may include central nervous system depression, peripheral neuropathy, dermatitis and, less commonly, liver toxicity. Dimethyl formamide (DMF) is a particularly hazardous solvent which has been employed to waterproof fabric. Its use in one such setting resulted in an outbreak of occupational hepatitis among exposed garment workers (Redlich et al. 1988). DMF use should be avoided both due to its hepatotoxicity and because it has been found to be associated with testicular cancer in two distinct occupational settings. Similarly, benzene may still be used in some clothing industry settings. Its use should be scrupulously avoided.

Physical hazards; electromagnetic fields. Recent reports have indicated that operation of a sewing machine may result in high exposures to electromagnetic fields (EMFs). The health effects of EMFs are not yet well understood and are the subject of current debate. However, one case-control study, which utilized three separate data sets from two countries (United States and Finland), found a strong association in all three data sets between occupational EMF exposure and Alzheimer’s disease among sewing machine operators and others classified as having sustained medium and high EMF exposures (Sobel et al. 1995). A case-control study of maternal occupation and acute lymphoblastic leukaemia (ALL) in Spain found an increased risk of ALL in offspring of mothers working at home during pregnancy, with most performing sewing machine operation. Although the authors of the study initially speculated that maternal exposure to organic dust and synthetic fibres might be responsible for the observed increase, the possibility of EMF exposure as a possible aetiological agent was raised (Infante-Rivard et al. 1991). (See the chapter Radiation, non-ionizing  for further discussion.)

Other occupational illnesses and hazards. Garment workers have been shown in a number of studies to be at increased risk for the development of asthma (Friedman-Jimenez et al. 1994; Ng et al. 1994). In addition to potentially increased risk of lung and nasopharyngeal cancer due to formaldehyde exposure, garment workers have been found to have an increased risk of bladder cancer (Alderson 1986). Lead poisoning has been observed among clothing workers involved in production of metallic buttons. Warehouse and distribution workers may be at risk of developing the illnesses associated with exposure to diesel exhaust.

Worldwide, the high proportion of women and children employed in the garment industry, combined with the predominance of sub-contracting and industrial home work, has created an ideal field for exploitation. Sexual harassment, including non-consensual sexual activity with its attendant health problems, is a serious problem in the clothing industry worldwide. Child workers are particularly vulnerable to the health effects of toxic exposures and to the effects of poor workplace ergonomics due to their developing bodies. Working children are also highly vulnerable to workplace accidents. Lastly, two recent studies have found associations between work in the apparel industry during pregnancy and adverse reproductive outcomes, suggesting the need for further investigation in this area (Eskenazi et al. 1993; Decouflé et al. 1993).

Public Health and Environmental Issues

The apparel and other finished textile products industry is, generally, an industry which yields relatively little environmental contamination via discharges into air, soil or water. However, off-gassing of formaldehyde can persist at the retail level in this industry, creating the potential for development of formaldehyde-related allergic, irritative and respiratory symptomatology among both sales people and customers. Additionally, some of the special processes utilized in the garment industry, such as rubberizing and production of lead-based adornments, can pose more serious threats of environmental contamination.

In recent years, growing concerns about the potential adverse health effects associated with exposure to formaldehyde and other fabric treatments has lead to development of a “green” industry. Apparel and other finished textile products are typically sewn from natural rather than synthetic fibre-based materials. Additionally, these natural products are generally not treated with crease-resistant and other finishing agents.

The crowded, often squalid, conditions in the garment industry create ideal conditions for transmission of infectious diseases. In particular, tuberculosis has been a recurrent public health issue among workers in the garment industry.



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Clothing and Finished Textile Products References

Alderson, M. 1986. Occupational Cancer. London: Butterworths.

Anderson, JH and O Gaardboe 1993. Musculoskeletal disorders of the neck and upper limb among sewing machine operators: A clinical investigation. Am J Ind Med 24:689–700.

Brisson, CB, A Vinet, N Vezina, and S Gingras. 1989. Effect of duration of employment in piecework on severe disability among female garment workers. Scand J Work Environ Health 15:329–334.

Decouflé, P, CC Murphy, CD Drews, and M Yeargin-Allsopp. 1993. Mental retardation in ten-year-old children in relation to their mothers’ occupations during pregnancy. Am J Ind Med 24:567–586.

Eskenazi, B, S Guendelman, EP Elkin, and M Jasis. 1993. A preliminary study of reproductive outcomes of female maquiladora workers in Tijuana, Mexico. Am J Ind Med 24:667–676.

Friedman-Jimenez, G. 1994. Adult onset asthma in women garment workers from the Bellevue Asthma Clinic. PA855. Am J Resp Crit Care Med 4:149.

Infante-Rivard, C, D Mur, B Armstrong, C Alvarez-Dardet, and F Bolumar. 1991. Acute lymphoblastic leukemia among Spanish children and mothers’ occupation: A case-control study. J Epidemiol Community Health 45:11-15.

Ng, TP, CY Hong, LG Goh, ML Wang, KT Koh, and SL Ling. 1994. Risks of asthma associated with occupations in a community-based case control study. Am J Ind Med 25:709–718.

Punnett, L, JM Robins, DH Wegman, and WM Keyserling. 1985. Soft tissue disorders in the upper limbs of female garment workers. Scand J Work Environ Health 11:417–425.

Redlich, CA, WS Beckett, J Sparer, KW Barwick, CA Reily, H Miller, SL Sigal, SL Shalat, and MR Cullen. 1988. Liver disease associated with occupational exposure to the solvent dimethyl fornamide. Ann Intern Med 108:680-686.

Schibye, B, T Skor, D Ekner, JU Christiansen, and G Sjogaard. 1995. Musculoskeletal symptoms among sewing machine operators. Scand J Work Environ Health 21:427–434.

Sobel, E, Z Davanipour, R Sulkava, T Erkinjuntti, J Wikström, VW Henderson, G Buckwalter, JD Bowman, and PJ Lee. 1995. Occupations with exposure to electromagnetic fields: A possible risk factor for Alzheimer’s disease. Am J Epidemiol 142:515–524.