In 2003, the World Health Organization called road crashes a neglected pandemic. Two decades later, road crashes still kill 1.16 million people every year and injure tens of millions more. But those risks are not distributed equally.

Men are three times more likely to be involved in a car crash than women and are more likely to be killed as drivers or motorcyclists. They drive more, drive faster, and take more risks behind the wheel. The European Transport Safety Council once modelled a hypothetical scenario in which every driver in the EU was a woman. Road mortality dropped by 20 percent. 

Women’s risk shows up elsewhere. They are more likely to be killed as pedestrians and passengers than as drivers. And when a frontal crash does happen, research shows that women are 73 percent more likely to be seriously injured and 17 percent more likely to die than men in the same seat, wearing the same seatbelt. Since the 1970s, crash-test dummies have been modelled on a 77 kg, 177 cm male body, overlooking anatomical differences in areas such as the hips, arms and head, as well as differences in soft tissue and fat distribution.

Bringing a gender lens to the Safe System

The Gender and Road Safety Framework, developed by ICLEI through the TRANS-SAFE project, looks at how gender can be integrated across the Safe System approach. It merges the Safe System approach and the gender effectiveness scale.

Endorsed by the UN Decade of Action for Road Safety 2021–2030, the Safe System approach recognizes that road deaths result from systemic issues and therefore require action across the system. The framework considers five pillars: safe roads, safe vehicles, safe road users, multi-modal mobility and land use, and post-crash care. 

In terms of gender interventions, it provides a way to think about how far action can go. Gender-sensitive measures recognize different gender roles and experiences. Gender-responsive measures address specific needs and inequalities. Gender-transformative approaches seek to change the norms and power relations that produce those inequalities. 

What does this mean in practice?

Who are our roads and vehicles designed for?

In Africa, 53 percent of road deaths are vulnerable road users, and pedestrians alone account for 31 percent of all fatalities. Road design standards in most African cities were inherited from colonial-era or internationally derived frameworks built around motor vehicles. Footpaths are discontinuous or absent, crossings unmarked, and street lighting concentrated along commercial arterials rather than the residential and peri-urban roads where women walk, often after dark, often carrying something or someone. 

Gender-sensitive road safety audits can examine infrastructure against women’s actual usage patterns, including nighttime pedestrian routes, informal market access points and routes to health facilities. This helps identify where interventions such as better lighting, raised crossings, speed humps or continuous footpaths are needed.

But whether a road serves the people who walk, it is largely decided before construction begins, in feasibility studies and procurement documents. The Philippines’ Department of Public Works and Highways started to address this stage directly, through a toolkit that integrates a gender action checklist into early feasibility studies and procurement. The value lies in the timing: gender analysis shapes the project from the outset rather than as a retrofit. The checklists and analyses were designed to be transferable across road infrastructure projects in the Global South.

A gender-transformative approach goes further, changing who builds and maintains roads in the first place. CARE International’s rural road maintenance programme, which ran from 1983 to 2006 in Bangladesh, employed around 42,000 women annually, targeting those who were divorced, separated, widowed or otherwise excluded from economic opportunity. Road work was paired with training in human rights, health, business, and income generation. Roughly 20% of participants went on to run their own enterprises, and around 60% remained economically active after graduating. The outcomes extended well beyond income: some 90% of community members acknowledged the improved road quality these women delivered, and participants reported greater acceptance at social events and community functions.

The same design question applies to what travels on those roads. Crash-test standards have historically been based on male bodies. Female bodies face a 73 percent higher risk of serious injury and a 17 percent higher risk of death in equivalent frontal collisions, even when wearing a seatbelt. Differences in weight, height, bone anatomy and soft-tissue distribution are among the factors that vehicle safety design has historically failed to account for adequately. In the African context, this is compounded by the import of second-hand vehicles built to outdated or unregulated safety standards.

From protection to participation

In 1989, Cairo, Egypt introduced women-only metro wagons. They still carry millions of women daily, who reported greater safety using the women-only wagons. However, a 2013 UN Women study found that 99 percent of Egyptian women surveyed had experienced sexual harassment in public spaces, and 86.5 percent did not feel safe on public transport. Women-only carriages reduce exposure to harassment in public transport, but don’t address the behaviour causing it. Looking at gender-responsive and gender-transformative interventions can inspire more profound change.

In Quito, Ecuador, “Bájale al Acoso” allows passengers to report sexual harassment on public transport by SMS. A report activates a response mechanism involving the driver, a voice alarm in the bus to alert the passengers, and a support team contacting the victim, all while police are sent to the next station where appropriate. 

In Kenya, the Usalama Wa Umma program provided certified training for transport operators on addressing gender-based violence and sexual harassment, reaching 554 drivers and transport workers by 2018. 

And in Dakar, Senegal, the Bus Rapid Transit project connects passenger safety with women’s participation in the transport sector itself. The project targeted increasing the share of female employees from 6 percent to 25 percent, while measures including female drivers and controllers and CCTV aim to increase female passengers’ trust in the service. 

What happens after a crash?

Fewer than half of sub-Saharan African countries have formal pre-hospital care systems. For women, barriers in accessibility, awareness and medical bias stack up before medical care is granted.

Research from Nigeria found women less likely to know about or have used emergency medical services. Studies from Gambia, Kenya and Nigeria have also identified situations in which women’s access to healthcare depends on decisions by male relatives, mothers-in-law or village elders. Economic inequalities can create another barrier, including lower access to health insurance and greater exposure to informal employment without employer-sponsored coverage. 

Bias can continue once care is available. The report points to research on gender disparities in pain assessment and treatment, as well as differences in the likelihood of receiving bystander CPR. It notes that 95 percent of CPR training manikins examined in one study were flat-chested, with only one in 20 including breasts or a breast overlay. Misogyny in healthcare facilities can also be a barrier to post-crash responses. Women’s reported pain is frequently read as exaggerated and unserious, leading to longer waiting times of 30 minutes longer than men in emergency departments to receive pain relief for identical complaints, regardless of the clinician’s gender.

TRANS-SAFE provides one example of how this gap can be addressed locally. In South Africa and Rwanda, the project provided community-level post-crash care training in areas where ambulance reach can be limited. Most participants were women and received training on witness protocols, Stop the Bleed, and CPR techniques. This expands the road safety conversation from preventing collisions to ensuring that people can access appropriate care when crashes happen.

What can cities do now?

The Gender and Road Safety Framework translates these challenges into actions for different actors, from national road safety agencies and health ministries to vehicle regulators, transport operators, donors and cities.

For city and transport authorities, three actions stand out:

• Commission gender-sensitive road safety audits, looking at infrastructure against women’s actual mobility patterns, including pedestrian routes, market access points and nighttime lighting.
• Prioritize traffic calming around schools, markets, clinics and childcare facilities, connecting road safety interventions with the places people use in their everyday lives.
• Make women’s trip chains visible in mobility planning by ensuring diagnostics and origin-destination surveys capture complete, multi-stop journeys. 

The wider recommendations show that cities cannot address every part of the road safety system alone. National agencies can improve sex-disaggregated crash and health data. Health and emergency services can address gender disparities in post-crash care. Transport operators can strengthen reporting mechanisms and open more opportunities for women in the workforce. Development finance institutions can incorporate gender equity into transport funding requirements. 

The starting point, however, is straightforward: Look at who moves through the transport system, how they move and where different risks emerge.

Road safety is not gender-neutral. Making those differences visible can help cities design streets, services and systems that are safer for everyone.

Explore the full Gender and Road Safety Framework to see the recommendations and practical examples across all five pillars of the Safe System approach. Download here.