The novel Coronavirus pandemic (COVID-19) is exhibiting catastrophic secondary impacts on women and girls' health across the world. Particularly, the COVID-19 lockdown has inequitably affected the women due to the pre-existing gender inequalities, which are exacerbating many gender-based disparities within common populations. These include access to resources, access to information, coping capacities and socio-economic impact. During the previous outbreaks as well, such as Ebola, the needs of women were deemed largely unmet. They were less likely to exercise their individual agency in the planning, policy make-up and overall decision-making. The resources for sexual and reproductive health were diverted towards the outbreak response thus leading to rise in maternal mortality. The current COVID-19 situation, particularly the lockdown, is said to increase the caregiving, household and childbearing responsibilities for women. This may result in their limited access to crucial health services and access to education, thereby making them more vulnerable. It may also result in their increased risk to gender-based violence due to limited involvement and power in the household decision-making. Additionally, girls from marginalized spaces such as 'with disabilities', 'urban informal settlements' and 'religious minorities' may be particularly affected by the outbreak and the crisis it has lashed on the communities. It is therefore crucial to consider a gender-lens for the current COVID-19 pandemic and the impacts inflicting on the communities.
Essential Health services
Women and girls often face delays in getting the services they need due to the gender and social norms pre-existing in the society. Experiences from past pandemic situations reveal that they could also be outright denied access to basic health services. The World Bank reports more than three-quarters of countries having faced disruptions in supplies of basic and key medicine for mothers and babies. These include antibiotics and oxytocin-an important drug to prevent excessive haemorrhage after delivery. The resources are also being diverted from key areas such as maternal, neonatal and child health (MNCH), family planning and over all sexual and reproductive health. In lower- and middle-income contexts, the beneficiaries of these services are largely women. Additionally, lack or disrupted access to safe toilets and sanitation facilities for women and girls, especially during pandemics which ignite infectious environments, could result in physical, psychological and environmental risk factors which may hinder their overall development. In such situations, the World Health Organization predicts alleviation in infectious conditions such as cholera, diarrhoea, hepatitis, typhoid and an exacerbation in malnutrition, food security and stress among the youth. This is a very common phenomenon for females residing in lower- and middle-income countries.
The female labour force participation rate is much lower compared to the male counterparts. Even though, women account for 70% of the health workforce, but at low paying positions and little to no job security. The low pay means decreased capacity to buy essential supplies. In lieu of this, the economic challenges during the pandemic, resulting in disruption of economies across the world, may pose serious threats to women's work and economic security. Girls and women who face potentially catastrophic economic impacts end up taking high-risk work for their survival, often resulting in low-paid or/and un-paid work. As per World Bank data, globally, the gender pay gap in the health workforce is at 11% thus undervaluing women's contribution. This result in under-investment affecting the preparedness in the times of crisis. As per the International Labour Organization, due to COVID-19, 195 million jobs could be eliminated, majority of which are being held by women. Due to social norms, women are performing 76% of total hours of unpaid care work which is supposed to increase in COVID-19 crisis, thus reducing their time to generate income and operate economic activities. On average 43% of the agricultural workforce in developing countries are women, accounting for two thirds of world's 600 million poor livestock keepers. This may also result in limited global food supply as countries are focusing on domestic production thereby putting women on economic disadvantages. This is supposedly said to lead to a reduction of $160 trillion USD in global wealth due to exacerbated gender earning gaps.
The gender-based violence (GBV) is prevalent in almost all the societies and is evidenced to exacerbate during COVID-19 crisis. GBV, during emergencies, increases due to a number of reasons; pre-existing social norms, gender inequalities, economic stress on families and constant friction within families. This surge in GBV has elucidated the gender inequality and discrepancies in the policy make-up ensuring safety of women and girls. It is quite clear that measures enforced to contain the spread of COVID-19 disease; mobility restrictions, home quarantine and closure of businesses, are limiting the GBV survivors' ability to distance themselves from their abusers. As a result, many women at home during lockdown are still living with their abusers and totally cut-off from supportive services. This also results in negative coping strategies adopted by populations such as child marriage and leads to alleviation in rapes as well. According to global literature, GBV prevents women and girls from engaging into productive activities and cedes their control over earnings to their abusers thereby impeding their economic independence. Additionally, insignificant representation of women in leadership roles, particularly at local levels, in outbreak response to COVID-19 results in gender insensitive approaches. As a result, available services fall short of addressing the barriers and gaps in helping women and girls facing GBV during quarantine.
Sexual and Reproductive Health
Amid emergencies, sexual and reproductive health services are often neglected. However, the governments and ministries of health were forced to make tougher choices in prioritising the services which are most important. This led to women and girls being further cut off from access to sexual and reproductive health services. India is at the 1st rank among the countries with expected higher number of births for the period of 9 months from start of the pandemic, with an estimated 20.1 million births. With the current health system being overwhelmed with patients, supply-chain shortages and task shifting of MNCH workers to cater COVID-19 services, there is a strong opinion that maternal mortality may rise further. Although, access to safe delivery is deemed as an essential health service but global literature suggests that pregnant mothers during COVID-19 found themselves with fever options for care. Also, with the drastic psychological impact of COVID-19 crisis, pregnant women have become more vulnerable given that estimated 50% of them remain undiagnosed with pregnancy related and post-partum depression. In lieu of this WHO, in march, issued guidance to prioritise services related to sexual and reproductive health and make continued efforts to evert maternal and child mortality and morbidity.
It is crucial that all Covid-19 actors take a gender lens into account within their programme planning and implementation. Quarantine measure need to be coupled with supportive economic, medical and information packages for women which address their daily needs. Governments should include measures to address and intervene in GBV and child protection during outbreak response to COVID-19. Pregnant women need to be of prime focus. Antenatal check-ups, provision of skilled delivery, Post-natal care and access to basic medicine needs to be ensured and prioritised. While the mother to child transmission of COVID-19 is largely unknown, UNICEF has recommended pregnant mother to closely monitor their symptoms and stay in touch with nearest facilities. Thus, government also needs to ensure presence of female doctors and nurses at every hospital. Vending machines for sanitary pads should be considered in service sector including hospitals and schools, to ensure better health of Women and girls. Lastly, Menstruation hygiene management training during COVID-19 should be introduced in all service sectors to ensure continuity of female workforce.
Ateeb Ahmad Parray is Public Health Researcher, The Center of Excellence for Gender, Sexual and Reproductive Health and Rights (CGSRHR)