Since the beginning of the coronavirus pandemic there has been a lot of coverage about the way COVID-19 appears to discriminate against gender, and the fact that, as with previous coronavirus outbreaks like SARS and MERS, it appears to affect men worse than women.
Even though in most countries men are 50-80% more likely to die from the virus following diagnosis than women, this is not the only way COVID-19 impacts gender. The social, economic and long-term health consequences are in fact disproportionately impacting the lives of women and girls, in ways that could continue to exacerbate divides and inequalities within societies and impact the most marginalised, including migrant, disabled, HIV, and lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) communities.
Whilst the world tries to come to terms with the far-reaching impacts of COVID-19, gender and public health specialists have been advocating the need for a more feminist, people-centred response to COVID-19.
What can we learn from previous outbreaks?
Although the global impact and high transmission rate of COVID-19 is new territory, the global health community, including Gavi, the Vaccine Alliance, has responded to and can learn from similar outbreaks such as Ebola, Zika and SARS.
During the West Africa Ebola crisis, vaccination uptake for diseases like tuberculosis, measles and yellow fever decreased due to health system disruptions. Often pregnant women were scared or unable to attend health clinics to give birth during and after the epidemic, which resulted in a massive regional increase in maternal mortality and morbidity. Additionally, due to social and gendered norms, women tend to be family caregivers and frontline health workers, therefore more women were exposed to Ebola.
During the current pandemic, to get ahead of such challenges, gender-focussed preparation is needed. This can be achieved through a multi-sectoral response which includes targeted and protected funding for gender-focussed non-governmental organisations and programmes, and gender and sex-disaggregated data collection for real-time gender analysis of the situation.
Another way in which COVID-19 has affected gender is through lockdowns, which have led to a drastic increase in domestic violence in a number of countries.
With a quarter of all countries having no domestic violence protection laws, women and children can end up in extremely vulnerable situations and unable to reach much needed services and shelters. Often the social and economic support networks we see provided in Europe and the US are not available in low-income countries.
UN Women have coined this disturbing domestic violence trend the ‘shadow pandemic’. In countries, where women’s unequal decision-making status within households already impedes positive health choices, the imposed lockdown risks continuing to intensify some men’s control over women’s bodies and health choices.
Supporting and funding grass-root, frontline shelters and women support groups, expansion of helplines and technology-based solutions that include online and mobile platforms may serve to mitigate some of the immediate impact.
This can massively impact the rights of women and girls to bodily autonomy. School closures in West Africa are predicted to have far reaching and long-term consequences, including a spike in adolescent pregnancies and girls who are less likely to return to education.
During the Ebola crisis in Sierra Leone, it was estimated there was a 65% increase in adolescent pregnancies, and due to a recently revoked discriminatory policy not allowing pregnant school girls, a lost generation of girls did not return to school. Furthermore, COVID-19 could lead to increases in cervical cancer, which is already the leading cancer death for women in many Gavi-supported countries.
Human papillomavirus (HPV) vaccine programmes, aimed at preventing cervical cancer, are often implemented within schools which in many countries are now closed because of the pandemic. Sexual and reproductive health must be considered an essential service.
The global economic ramifications of COVID-19 are substantial and could exacerbate already present financial inequalities. Women represent a massive proportion of the unprotected informal economy, livelihoods that include agriculture, markets and domestic workers.
Women globally perform three times as much unpaid care labour than men, and with families working from home during widespread lockdowns, the pressures on women as both full-time workers and carers can be immense. Economic insecurity also underlies increases in domestic violence. Staying home is not an option for many who rely on a daily income to feed their families. This means there will be wide-reaching inequities and disparities in economic and health outcomes between high- and low-income countries.
Frontline female healthcare workers
There is a present shortfall of 18 million health care workers particularly in low- and middle-income countries meaning pressures on health systems will be immense. Women currently make up 70% of the global health and social workforce, therefore women are on the frontline of the COVID-19 response.
Already there is lack of attention given to female health worker needs such as menstrual hygiene and psychosocial support. Due to the high transmission rate and consequent fear and misinformation surrounding COVID-19, when combined with gender inequalities, women whose work brings them face-to-face with COVID-19 are more likely to be shunned by people within their households and communities.
There are further populations who are at higher risk to COVID-19. With 50% more smokers among the LGBTQI community compared to the general population and with systemic stigmatisation inhibiting their access to health services, they are potentially more vulnerable to COVID-19.
Additionally, with weaker immune systems and the risk of decreased access to vital antiretroviral therapy medication, the HIV community will potentially be more susceptible to the new coronavirus. The disability community who often require additional health support, are likely to be disproportionately impacted by weakened health systems and inaccessible healthcare services.
Finally, refugees, migrants and internally displaced people, with incredibly limited access to health services, over-congested camps and limited access to clean water, will require a specific response. Without inclusive and non-discriminatory policies and tailored responses, barriers to health care will be substantial for vulnerable populations which will increase the chance of virus transmission.
The COVID-19 response must be human rights centered. The global health community needs to learn from past outbreaks, and rather than only apply retrospective hindsight to COVID-19, instead try to get ahead of these gendered consequences to protect the most disadvantaged, discriminated and vulnerable communities.