Every once in a while, I feel the urge to shout “women are not small men!” at inanimate objects. Today, that object is the flat-chested plastic torso typically used for CPR training. 

Breasts, it turns out, are really the bane of every woman’s existence — the back pain, the boob jail, the running. But here’s a new one: In a public cardiac arrest, they may be the reason nobody helps you.

Two years ago, an analysis of over 300,000 cardiac arrests showed that women are 14 percent less likely than men to receive CPR from a stranger if they have a cardiac arrest in public. Bystanders tend to be more hesitant and feel less comfortable providing CPR or using external defibrillator paddles, called AEDs, on people with breasts. Experts have time and again pointed, in part, to the fact that nearly everyone learns to perform CPR using the traditional, flat-chested dummies called “manikins,” which overwhelmingly represent the male anatomy. If the first time a stranger has to perform CPR on someone with breasts is in the middle of a high-stakes emergency — what else would you expect? 

For the last 20 years, not only has the survival rate for out-of-hospital cardiac arrests been around 10 percent, but also the chances of the victim surviving decrease by 10 percent every minute that interventions like CPR are not performed. It makes it all the more harrowing that women are not receiving the care they need when they experience cardiac arrests — especially in places where they are surrounded by people. 

Whether it is manikins used for CPR training, crash tests or medical care in combat, the default stand-in for what is “human” has long been male. 

But recently, researchers, advocates and governing bodies like the American Heart Association and European Resuscitation Council are pushing for better representation in CPR training and education. Increases in simulation-based research on the use of representative manikins, like ones that accurately represent female anatomy, are changing how people train to respond to cardiac arrest — and simultaneously exposing bigger gender gaps in design that systematically exclude women from experiencing the same level of safety and care as men. 

One size doesn’t fit all

The first CPR manikin was developed in 1960 by the Norwegian toy manufacturer Laerdal. The manikin, called Resusci Anne, which had the anatomy of a prepubescent teen, was ironically modeled off an unnamed girl who was thought to have drowned in the river Seine in Paris. Laerdal famously wanted a female face on the manikin since he thought men might hesitate to practice mouth-to-mouth resuscitation on a male manikin. It’s not surprising that women trainees didn’t factor into the equation at all back in the 1960s — they weren’t even included in clinical trials yet — but the norm of designing with the comfort of men at the forefront continues to this day. 

Since then, Resusci Anne has been reengineered many times over, and today’s manikins are surprisingly high-tech and interactive. However, as of 2022, about 95 percent of manikins on the market from mainstream manufacturers were still flat-chested and androgynous. 

So why does this matter?

In the past, research has hinted at three main reasons why bystanders don’t immediately rush to the aid of a woman in cardiac arrest. One, they are hesitant to expose or touch her in any way that could be misconstrued as inappropriate and are worried about sexual assault allegations after the fact. Two, they don’t want to accidentally hurt them, perceiving them as generally more fragile than the average man. And three — perhaps saddest of all: bystanders often don’t recognize that a woman is in cardiac arrest if, say, she collapses in public, misattributing it as overreacting, simply fainting or faking it. 

CPR training with female manikins would go a long way in teaching people to be comfortable with the female form.  

In one study, people at MassCPR — the free CPR certification program offered by Massachusetts Institute of Technology for the MIT community — were trained using standard manikins,  as well as a few which were retrofitted with a mold resembling breasts. At the end of the certification, participants who practiced on the manikin with breasts reported greater comfort performing CPR on women. 

If there was widespread adoption of manikins that looked and felt different, this could ultimately become the norm. 

It’s really only in the past five years or so that research on this disparity has sped up, offering some evidence for the need for more representative manikins. Even then, widespread adoption of female manikins is hindered by commercial availability of anatomically correct models and the cost of switching existing CPR training programs over to using them.   

Closing the design (gender) gap

There are two main ways to go about increasing the availability of female manikins: Either you retrofit existing standard manikins with breasts or you design completely new ones. 

When Christoph Veigl and colleagues at the Medical University of Vienna surveyed 133 training organizations across 43 countries from six continents, they found that of more than 5,000 manikins in use, only a fifth of organizations owned a female one. While that number is still low, adoption is triple what it was four years ago. The researchers acknowledge that just the availability of female manikins is not necessarily an indication of how much they are used in training — about a quarter of the organizations were also employing makeshift adaptations, like placing a bra on standard manikins, to simulate training on women. 

Dr. Pooja Nawathe, a resuscitation science researcher and pediatric critical care clinician at Cedars-Sinai Hospital, chose to focus her research on gender disparity in resuscitation for a specific reason. 

“Skin color is about implicit biases, but female breast tissue, which is a normal physical characteristic, is about the actual science of this,” she said, speaking about variations in care during cardiac arrests. “Are we teaching how to place the pads on the breast tissue?”  

She also stresses the importance of gathering good, granular data on how CPR performance changes when people are exposed to diverse populations.     

CPR manikins are just one example of the gender gap in design: Across fields like crash testing, the “human” body has long been modeled on men.

CPR manikins are just one example of the gender gap in design: Across fields like crash testing, the “human” body has long been modeled on men. But that’s starting to change, too. Last year, the National Highway Traffic Safety Administration (NHTSA) released the design details for THOR-05F, the first detailed female crash-test dummy.

Before this, the standard female crash-test dummy was a model called the Hybrid III 5th percentile female dummy — literally just a scaled-down version of the Hybrid III 50th percentile male dummy that represents the average male body dimensions. But the THOR-05F — every woman’s dream name, I’m sure — is a much more anatomically accurate female dummy, and includes a female pelvis, breasts, and a flexible spine. 

THOR-05F has arrived just as new research by the NHTSA affirmed the need for better crash-testing on women. Although the gap in vehicular accident fatality rates between the sexes has narrowed significantly in newer car models, women continue to experience a higher injury rate compared to men in multiple different types of vehicular accidents. The hope is that testing with the THOR-05F will provide a better understanding of this trend and help engineer safer vehicles and regulations for women.

Women are not small men!

Women are often referred to as the “invisible sex,” and the lack of female manikins really brings that to the forefront. It’s not like the manufacturers or policymakers intentionally excluded women from this area — they simply ignored them, accepting an androgynous body as the standard with an unchallenged assumption that what applies to it will undoubtedly apply to women too. 

In 2019, Joan Creative, the New York-based ad agency, launched the Womanikin, a universal attachment for CPR manikins, in partnership with United State of Women, a now-shuttered organization focused on gender equity. Launched during National CPR Week, the Womanikin is a neoprene vest with silicone breasts that can be zipped onto any standard manikin. Built as an awareness campaign, they open-sourced the design for the breasted vest and helped spark a broader conversation about the CPR gender gap. But we don’t have any detailed information about its success or adoption. 

More recently, other manufacturers like Prestan have come out with newly designed female manikins that can be purchased as is. They also sell “replacement female skin” that retrofits any existing Prestan adult manikins. Notably, these are now available on the American Red Cross store, increasing visibility for female manikins.

The fact that women account for 50 percent of the world’s population and yet have to mold themselves to standards not designed for them in the first place is atrocious. Not only is it frustrating to live in a world not built for you, but in cases like CPR training, the gender gap can quite literally be fatal. This is true whether it is for motor vehicle crash-test dummies or those used to train battlefield medics — another field where women injured in battle have a higher fatality rate than their counterparts.

The basic idea is that repeated exposure to female bodily characteristics during training or testing can significantly alleviate discomfort that causes dangerous hesitation. If people had more practice administering CPR to models that looked more feminine, they wouldn’t be thrown off by breasts, would understand how to cut away clothing like bras if needed, and learn how to efficiently place the pads of the external defibrillator on a female body. 

CPR techniques remain largely the same irrespective of sex. Chest compressions are performed on the sternum, which is the flat bone running down the center of your chest. For women, it lies between the breasts, so there are some additional considerations. That is what representation in training manikins is meant to address — not new skills, but familiarity. 

Ultimately, it really comes down to not feeling awkward about putting your hand in between two breasts, if it means you save a life.

LONDON, Ontario — President Donald Trump seems dead set on escalating his trade war with Canada. And no one is really sure why.

On Monday, Trump threatened another round of 50 percent tariffs on top of the ones he just implemented — this one targeting Canada’s auto industry, which is so deeply integrated with its American counterpart that large duties would do major damage on both sides of the border. By Tuesday morning, he had begun musing about renaming Lake Ontario “Lake America” to spite Canadians. And throughout all of this, he and Vice President JD Vance had renewed their “jokes” about absorbing Canada as the 51st state.

But who is this even for? While the White House’s behavior infuriates Canadians — it is palpable on the ground here in Canada — it’s unusual by Trump standards in that nobody seems to want this conflict but him. 

Even the most fringe, or unpopular, foreign policy ideas he’s pursued typically have think tanks devoted to pushing them, or a loyal ally to please, or a voting bloc to rile up before the midterms. But unlike, say, Trump’s conflicts with Iran, or Cuba, or China, it’s hard to find a highly visible corner of conservatism that’s the driving force behind a nationalist campaign against Canada. 

When I reached out to trade experts, political scientists, and in-the-know Republicans of the pro- and anti- Trump persuasion to try to trace the origins of Trump’s trade war, they had trouble pointing to anything solid. As one veteran GOP lobbyist put it, there doesn’t seem to be any ideological, business, or congressional coalition devoted to egging on the trade fight. 

Even people sympathetic to Trump’s economic nationalism seem confused: Michael Lind, a populist pundit who last year penned a piece titled “Why tariffs are good,” has just written a follow-up titled “The madness of Trump’s Canada trade war.” And while there are some affected industries — autos, steel — they don’t seem to be main characters: United Auto Workers, which backed some prior tariffs, came out strongly against the proposed auto tariffs.

The politics don’t make much sense either. American voters have long disapproved of Trump’s tariffs on Canadian-made goods, and the current escalation threatens to be the largest and most economically damaging yet. Republicans sound anxious about its impact on the midterms; several key Senate races are in states right on the Canadian border, and any tariff-related price spike there could supercharge Democrats’ core midterm message about affordability. 

“This has never been a particularly well-thought strategy. I think that the biggest, most coherent explanation is that this is about power.”

Kim Clausing, UCLA trade economist

“If I were [Senate Majority Leader] John Thune, I’d be very pissed at Trump right now,” says Adam Carlson, a Democratic pollster at Zenith Research.

So why are we at (economic) war?

The best answer is deceptively simple: because Trump, and Trump alone, wants to be. 

There is no good strategic rationale for the way Trump has gone about badgering America’s northern neighbor, even if you share his broadly nationalist view about trade. Rather, Trump has become fixated on dominating or even possessing Canada. And his top deputies are backfilling his fixation, including by offering terms of surrender the Canadians simply couldn’t accept. 

“This has never been a particularly well-thought strategy,” says Kim Clausing, a trade economist at UCLA. “I think that the biggest, most coherent explanation is that this is about power.”

It’s the latest example of the risks of governance by one man’s whims — one that could both damage America’s economy and burn its relationship with its staunchest ally before it resolves.

Trump’s northern power trip

Typically, when you try to explain the policy of any government, you look at two main factors: interests and ideology. In this case, neither is close to sufficient to explain the intensity of Trump’s war on Canada.

It is true that, for decades, the United States has had meaningful trade disputes with Canada over issues like lumber and dairy. But these issues never boiled over into a massive trade war, for the simple reason that they simply aren’t that large as a percentage of GDP. There’s a reason that every administration prior to this one — including Trump’s first — handled these issues through normal negotiating processes rather than loud bullying.

On the ideology front, it is true that Trump’s 2016 victory has revived conservative interest in economic nationalism — leading to the creation of groups like American Compass, a think tank dedicated to putting policy meat on the bones of the right’s nationalist spirit. But these nationalists largely converged on China as their principal economic enemy. While Trump trade adviser Peter Navarro is helping run Canada policy now, there was no sign in his essay in Project 2025 — or from other allies — that anyone was contemplating a full-on trade war with Canada beforehand. And American Compass does not appear to be involved in the current fight, offering no official comment on its press page or founder Oren Cass’s X feed.

“I really do think it is Trump’s idiosyncrasies that caused him to settle on Canada,” says Phil Magness, an economic historian who closely tracks intra-right economic disputes. “Others in the admin are going along with it.”

The timeline backs up Magness’s assessment.

In November 2024, shortly after winning the election, Trump began feuding with then-Prime Minister Justin Trudeau — calling him “governor” and beginning his talk of Canada as the 51st state. Less than two months after taking office, Trump targeted Canada with (at that point) historically high 25 percent across-the-board tariffs.

When the Washington Post investigated the rationale behind these tariffs at the time, they found a void. There was no policy paper behind the Canadian tariffs, nor any clear intellectual godfather or industry backer. People inside the administration put all the credit (or blame?) solely at the president’s feet. Within MAGA media, the closest to radical anti-Canada sentiment might have been Tucker Carlson’s trollish musing about “regime change” in 2023.

After Mark Carney replaced Trudeau as prime minister, and won the general election primarily on an anti-Trump platform, tensions cooled to a somewhat surprising degree, at least when it came to trade talks. Prior to this week, the 51st state rhetoric had declined dramatically; negotiations on trade looked like they had a real chance of success. Indeed, just this Tuesday, Trump himself declared they had reached a deal and postponed tariff implementation as a result. The Friday breakdown thus felt like a bit of a shock.

But reading detailed accounts of the negotiation collapse, including a brand-new ticktock from the New York Times, it’s clear that overweening American conditions were a major part of the failure. Most strikingly, and relevant, were US demands that it have control over Canada’s tariff rates with other countries and that it be able to reimpose American tariffs on Canada at will.

The key point here is that the Trump administration was not, and never has been, interested in a reciprocal trade deal between allies based on clear and cogent principles. Instead, they want to vassalize Canada — to bully it into surrendering elements of its sovereignty, or even its sovereign existence altogether. It is clear that this is the direct result of the president’s personal fixation.

Why exactly Trump has become so obsessed with controlling Canada is harder to say. Per the Post, there are theories ranging from bitterness around a legal battle over Trump Tower Toronto to his friendship with Kevin O’Leary, Canadian entrepreneur and host of the reality show Shark Tank. Certainly, his more recent rivalry with Carney hasn’t helped: “Canada lives because of the United States,” Trump declared, menacingly, after the prime minister delivered a critical foreign policy speech in January.

My own personal theory is that it’s of a piece with Trump’s desire to acquire Greenland, another cause that’s largely unique to him. He is looking toward his presidential legacy, and nothing makes a real estate developer think “legacy” more than literally enlarging the size of the United States on the map.

But in practical terms, the reason may be immaterial. Whatever the roots of Trump’s Canada fixation, we know that it is real and a major driver in US foreign policy — one so important, in fact, that he is willing to jeopardize his party’s all-important Senate majority in order to pursue it.