87. Clothing and Finished Textile Products
Chapter Editors: Robin Herbert and Rebecca Plattus
Major Sectors and Processes
Rebecca Plattus and Robin Herbert
Accidents in Clothing Manufacture
Health Effects and Environmental Issues
Robin Herbert and Rebecca Plattus
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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. Examples of occupational diseases which may be seen in garment workers
Carpal tunnel syndrome, forearm tendinitis,
Lung, nasopharyngeal cancer
Contact and irritative dermatitis
Formaldehyde, textile dyes
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.
Adapted from 3rd edition, Encyclopaedia of Occupational Health and Safety
Small enterprises in unsuitable domestic premises used for clothing manufacture often present a serious fire hazard. In any workroom, large or small, there is much combustible material, and combustible waste will accumulate unless very strict control is exercised. Some of the materials used are particularly flammable (e.g., foam resins used for lining and padding and fine particulate coir). Adequate means of escape, adequate fire extinguishers and training in procedures in case of fire are necessary. Maintenance and good housekeeping not only assist in preventing fires and limiting their spread, but are essential where goods are transported mechanically.
In general, the accident frequency and severity rates are low, but the trade produces a multiplicity of minor injuries that can be prevented from becoming more serious by immediate first aid. Band knives can cause serious wounds unless effectively protected; only that part of the knife necessarily exposed for cutting should be left unguarded; the circular knives of portable cutting machines should be similarly protected. If power presses are used, adequate machinery guarding, preferably fixed, is necessary to keep hands out of the danger area. The sewing machine presents two main hazards—the driving mechanisms and the needle. In many places, long lines of machines are still driven by underbench shafting. It is essential that this shafting be effectively guarded by enclosure or close railing; many entanglement accidents have occurred when workers stooped under benches to retrieve materials or to replace belts. Several different types of needle guard, which keep fingers out of the area of risk, are available.
The use of garment presses involves a serious risk of crushing and burning. Two-handed controls are widely used but are not entirely satisfactory: they may be subject to misuse (e.g., operation by the knee). They should always be set to make this impossible and to prevent operation by one hand. Guards which prevent the pressure head from closing on the buck if anything (most importantly, the hand) comes within the area are to be used. All presses, with their steam and pneumatic supplies, require frequent inspection.
All portable electrical power tools require careful maintenance of the earthing arrangements.
Recent developments in plastics welding (to replace seaming and so on) and in the making of foam backs usually involve the use of an electric press, sometimes operated by treadle, sometimes by compressed air. There is a risk of physical trapping between the electrodes and also of electrical burns from high-frequency current. The only sure safety measure is to enclose the dangerous parts so that the electrode cannot operate when the hand is in the danger area: double-handed control has not proved satisfactory. Seaming machines must incorporate built-in safety designs.
In general, the processes involved in the production of clothing and other finished textile products have changed little since the inception of the industry. Although the organization of the production process has changed, and continues to change, and some technological advances have upgraded machinery, many of the safety and health hazards in this industry remain the same as those facing the earliest apparel workers.
The major health and safety concerns in the apparel industry are related to general conditions of the work environment. Poorly designed workstations, tools and equipment, combined with piece-rate compensation systems and the progressive bundle system of production, pose serious risks of musculoskeletal injury and stress-related conditions. Garment shops are often housed in buildings that are poorly maintained and inadequately ventilated, cooled, heated and lit. Overcrowding, together with improper storage of flammable materials, frequently creates serious fire hazards. Poor sanitation and lack of proper housekeeping measures contribute to these conditions.
Major advances have been made in the design and production of well-designed, ergonomic sewing workstations that include adjustable sewing tables and chairs and take into consideration proper positioning of equipment and tools. These workstations are widely available and are in use in some facilities, mostly large manufacturing establishments. However, only the largest, best-capitalized facilities are able to afford these amenities. Ergonomic redesign is also possible in other clothing manufacturing operations (see figure 1).The majority of apparel production, however, still takes place in small, ill-equipped contracting operations where, in general, little attention is paid to workplace design, working conditions and health and safety hazards.
Figure 1. A sequin-manufacturing facility
Source: Michael McCann
Product design and sample-making. The design of clothing and other textile products is overseen by apparel manufacturers, retailers or “jobbers”, with the design process performed by skilled designers. Apparel jobbers, manufacturers or retailers are frequently responsible only for the design, sample production and marketing of the product. While the jobber or manufacturer takes responsibility for specifying all details of the garment’s production, purchases the fabric and trims items to be used, the actual large-scale production work is typically performed by independent contracting shops.
Sample-making, in which small numbers of sample garments are made to be used to market the product and to be sent to contracting shops as examples of the finished product, also takes place on the jobber’s premises. Samples are produced by highly skilled sewing machine operators, sample-makers, who sew the entire garment.
Pattern-making and cutting. Garment design must be broken down into pattern parts for cutting and sewing. Traditionally, cardboard patterns are made up for each piece of the garment; these patterns are graded by the sizes to be made. From these patterns, paper-cutting markers are created, which are used by the garment cutter to cut out the pattern pieces. In more modern plants, cutting markers are made up and graded for size on a computer screen, then printed on a computerized plotter.
In the cutting phase, fabric is first spread into multiple piles on a cutting table, the length and width of which is determined by production demands. This is most often performed by an automatic or semi-automatic spreading machine which unrolls the bolts of fabric along the length of the table. Plaid or print fabrics may be laid out by hand and pinned to assure that plaids for prints will match. Markers are then laid down on the fabric to be cut.
Fabric for apparel production is usually cut using hand-held band saw cutting tools (see figure 2). Small parts may be cut using a die press. Advanced cutting technology includes robotic cutting, which automatically follows patterns made on a computer.
Figure 2. A clothing factory in the Philippines
There are several hazards associated with fabric cutting. Although the blade on the cutting tool is guarded, this guard must be correctly set in order to afford the necessary protection to the hand positioning the material. Guards should always be used and correctly positioned. As an additional protection it is recommended that cutting machine operators wear a protective glove, preferably of metal mesh. Besides posing the risk of accidental cuts, cutting fabric also presents ergonomic risks. Supporting and manoeuvering a cutting machine, while stretching across the cutting table, can present a risk of neck, upper-extremity and back disorders. Finally, many cutters have a tendency to work with the cutting machine at ear level, often exposing themselves to excessive noise with the attendant risk of noise-induced hearing loss.
Handling rolls of fabric, which can weigh up to 32 kg and must be lifted above the head onto a rack for spreading, also poses an ergonomic hazard. Proper material-handling equipment can eliminate or reduce these risks.
Sewing machine operation. Typically, cut fabric pieces are sewn together on sewing machines operated by hand. The traditional “progressive bundle system”, in which bundles of cut pieces progress from one sewing machine operator to the next, with each operator performing a different single operation, continues to prevail in the industry, despite significant changes in work organization in many shops. This type of work organization breaks the production process down into many different operations, each consisting of a very short cycle repeated hundreds of times by one operator during the course of a workday. This system, combined with piece-rate pay compensation that rewards speed above all else and affords workers very little control over the production process, creates a potentially very stressful work environment.
The majority of the sewing machine workstations currently in use are designed without the comfort, health or convenience of the sewing machine operator in mind (see figure 3). Because sewing machine operators generally work in a seated position at poorly designed workstations, performing the same operation during the entire course of the workday, the risk of developing musculoskeletal disorders is high. The poor postures resulting from the conditions described above, combined with highly repetitive, time-pressured work, has resulted in high rates of work-related musculoskeletal disorders (WRMDs) among sewing machine operators and other workers in the industry.
Figure 3. Woman using a sewing machine without a needle guard
Advances in sewing workstation design, such as adjustable chairs and worktables, create the potential for reduction of some of the risks associated with sewing machine operation. However, while these workstations and chairs are widely available, their price often places them out of reach of all but the most profitable enterprises. Additionally, even with better-designed workstations, the risk factor of repetition remains.
Changes in the organization of work and the introduction of teamwork, in the form of modular or flexible manufacturing, offer an alternative to the traditional, Taylorist production process and may serve to alleviate some of the health risks involved in the traditional system. In a teamwork system sewing machine operators work in a group to produce an entire garment, often shifting frequently between machines and jobs.
In one of the most popular team systems, workers work standing up, rather than seated, and move frequently from machine to machine. Cross-training for a variety of jobs enhances workers’ skills, and workers are given more control over production. Changes from an individual piece-rate system of pay to hourly pay or to a group incentive system, as well as increased emphasis on monitoring quality throughout the production process, may help to eliminate some factors that put workers at risk of developing WRMDs.
Some newer manufacturing systems, while technologically advanced, may actually contribute to increased risk of WRMD. So-called unit production systems, for example, are designed to mechanically convey cut goods on an overhead conveyor from worker to worker, thus speeding up the progress of the goods and eliminating much of the material handling previously performed by the sewing machine operators or by floor workers. While these systems often increase production by speeding up the line, they eliminate the already small rest time that was afforded to the operator between cycles, resulting in increased fatigue and repetition.
When instituting any alternative production system, care should be taken to evaluate risk factors and design the new system with ergonomics in mind. For example, when workers will be trained to do a variety of jobs, jobs should be combined to stress differing parts of the body and not overtax any one muscle or joint. Care should be taken to ensure that equipment and machinery can be adapted to fit all the workers in the team.
Whenever any new equipment is purchased, it should be easily adjustable by the workers themselves, and training should be provided on how to make adjustments. This is particularly important in the apparel industry, where mechanics are often not readily available to adjust equipment to properly fit workers.
Recent studies have raised concerns about sewing machine operators’ exposure to high levels of electromagnetic fields (EMFs) generated by sewing machine motors. These studies have indicated that there may be an association between increased levels of Alzheimer’s disease (Sobel et al. 1995) and other chronic diseases found among sewing machine operators and the operators’ exposure to high levels of EMFs.
Finishing and pressing. Once sewn, the completed garment is ironed by pressers and checked for loose threads, stains and other defects by finishers. Finishers perform a variety of hand work, including clipping loose threads, hand sewing, turning and hand pressing. Ergonomic hazards are a problem for workers who finish, ticket, pack and distribute apparel. They often perform highly repetitive tasks, frequently involving working with the hands and arms in awkward and unhealthy postures. Seating and workstations for these workers are rarely adjustable or designed for comfort or health. Finishing workers, including pressers, often work standing and in static positions, despite the fact that many of the jobs could be equipped with chairs, stools or sit-stand chairs, and workers could alternate between standing and sitting. Table tops could be adjusted to the proper height for the operator and could be tilted to enable the operator to work in a more comfortable position. Padded table edges and properly designed and sized tools could eliminate some stresses on hands, wrists and arms.
Pressing the sewn product is performed either using a hand iron or a buck press. Sewn products may also be steamed using a hand steamer or a steam tunnel. Presses and irons may present risks of burns, as well as ergonomic hazards. While most presses are designed with two-handed controls, eliminating the possibility of getting the hand stuck in the press, some old machines still exist which do not have these safety features. Working a pressing machine also presents the risks of shoulder, neck and back injury caused by frequent overhead reaching and by constant standing and operating the foot pedals. While the job can be made safer by a more highly automated machine and by proper positioning of the worker at the machine, the current machinery makes it difficult to eliminate the high stress.
Ticketers, who use ticketing guns to place tags on finished garments, are at risk of hand and wrist injury from this highly repetitive operation. Automatic, as opposed to manual, ticketing guns can help decrease the force needed to perform the operation, greatly reducing stress and strain on the fingers and hands.
Distribution. Workers in apparel distribution centres are exposed to all the hazards of other warehouse workers. Manual material handling accounts for many of the injuries in warehouse operations. Particular hazards include lifting and overhead work. Designing the distribution workplace with the proper handling of materials in mind, such as placement of conveyors and worktables at appropriate heights, can help prevent many injuries. Mechanical material-handling equipment, such as fork-lifts and hoists, can help prevent injuries caused by having to perform awkward or heavy lifts.
Chemical exposure. Workers at every stage of apparel production may be exposed to the chemicals used in fabric finishing; the most common of these is formaldehyde. Used to make fabric permanent press and colour-fast, formaldehyde is released into the air from fabric in the form of a gas. Workers may also have skin exposure to formaldehyde as they handle the fabric. The amount of formaldehyde released from fabric depends on a variety of factors, including the amount used in finishing, the finishing process used and the ambient heat and humidity. Exposure to formaldehyde can be prevented by allowing the fabric to off-gas in a well-ventilated area before it is handled and by providing good ventilation in the work areas, particularly where fabric is exposed to high heat and humidity (e.g., in pressing operations). Workers who experience skin problems from handling formaldehyde-treated fabric can wear gloves or protective cream. Finally, textile manufacturers should be encouraged to develop safer alternative fabric treatments.
Pleating. The pleating process is used to place creases or pleats into fabric or garments. This process uses high temperatures and high humidity to put folds into various types of fabric. Pleaters are exposed to these conditions of high heat and humidity, which may cause the release of greater quantities of substances used to finish the fabric than may otherwise be released under conditions of normal temperature and humidity. Stiffening agents may be added to fabrics that are to be pleated to facilitate the fabric’s ability to hold the crease. Steam boxes and steam chambers expose the pleated fabric to steam under pressure.
Rubberizing/waterproofing. To create a rubberized or waterproof finish, fabrics may be coated with a waterproof substance. These various coatings, which may be a type of rubber, are often thinned with solvents, including those that pose serious health risks to exposed workers. These coatings may include benzene or dimethylformamide, as well as other solvents. Workers are exposed to these chemicals when they are mixed or poured, often by hand, or in large vats in poorly ventilated areas. Workers can also be exposed as they pour the mixtures on the fabric to coat it. Hazardous exposures should be minimized by substitution of less toxic substances and by providing adequate ventilation at the point of use. In addition, mixing and pouring operations should be contained and automated, where possible.
Computer use. Computers are increasingly used in the apparel industry, from computer-aided design/computer-aided manufacturing (CAD/CAM) systems in the design, marking and cutting processes to the tracking of goods in the warehousing and shipping operations. Hazards associated with computer usage are discussed elsewhere in this Encyclopaedia.
Buttons, buckles and other adornments. Buttons, buckles and other fasteners on apparel or sewn products are most often manufactured in facilities separate from those that produce apparel. Buttons may be manufactured from a variety of materials, and the material used will determine the production process. Most commonly, buttons and buckles are made from moulded plastic or metals, including lead. During the production process, the heated raw materials are poured into moulds and then cooled. Workers may be exposed to toxic chemicals or metals during this moulding process. After cooling, workers may be exposed to the dust generated when the products are polished or ground. These exposures can be prevented by providing adequate ventilation during this finishing process or by containment of these operations. Other adornments, such as sequins, beads and so on, are produced from plastics and metals, either stamped or moulded, and may expose the production workers to the hazards of their components.
Sewn plastic products and plastic accessories. Various items such as shower curtains, tablecloths and protective raingear are made of sewn, or joined, plastics. Where goods are sewn from sheet plastic, the hazards are similar to those of other sewn items. However, working with large stores of plastic material creates a unique fire safety hazard, since the heating and burning of plastic creates a release of toxic materials that can be very dangerous. Extreme care should be taken in the area of fire prevention and protection where large amounts of plastic materials are used or stored.
In addition to being sewn, plastics can also be joined together by heat or electromagnetic radiation. When plastics are heated they release their components and they may expose workers to these toxics. When electromagnetic radiation is used to join or seal plastics, care must be taken not to expose workers to dangerous levels of this radiation.
The piece-rate system, where workers are paid according to the number of units they produce, is one which is still widely used in the production of apparel and sewn products. The continued use of the piece-work system of compensation poses both stress-related and musculoskeletal health risks to workers in the apparel industry. As discussed above, alternative compensation systems, as well as alternative production systems, may make apparel production a more attractive, less stressful and less hazardous option for workers entering the workforce.
A teamwork system, which gives workers more control over the production process, as well as the opportunity to work with others, may be less stressful than the traditional progressive bundle system. However, these team systems may also cause additional stress if they are set up so that workers are responsible for enforcing work rules against their co-workers. Some types of group compensation systems which penalize an entire team for the slowness or absenteeism of any of its members may create tension and stress within the group.
Home work is the system of sending out work to be done in the home of a worker. It is very common in the apparel industry. Work may be sent home with a factory worker at the end of the workday to be done in the evening or the weekend; or, work may be sent directly into the worker’s home, bypassing the factory altogether.
The home-work system is often synonymous with exploitation of workers. Home work cannot easily be regulated by agencies that enforce labour standards, including laws governing child labour, health and safety, minimum wage and so on. In many instances home workers are paid substandard wages and forced to furnish, at their own expense, equipment and tools needed for production. Children in the home may be drawn into doing home work, regardless of their age or ability to work safely, or at a detriment to their schooling or leisure time. Health and safety hazards may abound in homeworking situations, including exposure to dangerous chemicals, fire and electrical hazards. Industrial machinery may present hazards to small children in the home.