Disease outbreaks affect women and men differently, and epidemics make existing inequalities for women and girls and discrimination of other marginalised groups such as persons with disabilities and those in extreme poverty, worse. This needs to be considered, given the different impacts surrounding detection and access to treatment for women and men as well as for their overall well-being.
Women can be less likely than men to have power in decision making around the outbreak, and as a consequence their general and sexual and reproductive health needs may go largely unmet. Drawing lessons from the Zika virus outbreak, differences in power between men and women meant that women did not have autonomy over their sexual and reproductive decisions, which was compounded by their inadequate access to health care and insufficient financial resources to travel to hospitals and health care facilities for check-ups for their children, despite women doing most of the community spread control activities.
Many times, there is also an inadequate level of women’s representation in pandemic planning and response, which can already be seen in some of the national and global Covid-19 responses.
In terms of other risks, men may exhibit less health seeking behaviour as a result of rigid gender norms, wanting to be viewed as tough rather than weak, implying a delay in detection and access to treatment for the virus. Within the context of such norms, men may also feel pressure in the face of economic hardship resulting from the outbreak and the inability to work, causing tensions and conflict in the household. During quarantine, women and men’s experiences and needs will also vary because of their different physical, cultural, security, and sanitary needs.
Seventy per cent of the global health workforce are women, emphasising the gendered nature of the health workforce and the risk of infection that female health workers face. Given that women provide the main part of primary health care interventions including front-line interaction at the community level, it is concerning that they are not fully engaged into decision-making and planning of interventions, security surveillance, detection, and prevention mechanisms.
Experience shows that women’s roles within communities often puts them in a good position to identify trends at the local level, including those that might signal the start of an outbreak and overall health situation.
Experience from past outbreaks shows the importance of incorporating a gender analysis into preparedness and response efforts to improve the effectiveness of health interventions and promote gender equality and health equity. During the 2014–16 West African outbreak of Ebola, women were more likely to be infected by the virus, given their predominant roles as caregivers within families and as front-line health-care workers.
The closure of schools to control Covid-19 transmission has a differential effect on women economically, given their role in providing most of the informal care within families, with consequences that limit their work and economic opportunities. In general, the outbreak experience means that women’s domestic burden becomes exacerbated as well, making their share of household responsibilities even heavier, and for many while they also work full time. Additionally, travel restrictions cause financial challenges and uncertainty for mostly female foreign domestic workers or those in service related industries impacted by travel limitations.
Pandemics compound existing gender inequalities and vulnerabilities, increasing risks of abuse. In times of crisis such as an outbreak, women and girls may be at higher risk, for example, of intimate partner violence and other forms of domestic violence due to heightened tensions in the household.
They also face increased risks of other forms of gender based violence including sexual exploitation and abuse in these situations. For example, the economic impacts of the 2013-2016 Ebola outbreak in West Africa, placed women and children at greater risk of exploitation and sexual violence.
In addition, life-saving care and support to gender based violence survivors (i.e. clinical management of rape and mental health and psycho-social support) may be cut off in the health care response when health service providers are overburdened and preoccupied with handling Covid-19 cases. Systems must ensure that health workers have the necessary skills and resources to deal with sensitive gender-based violence related information, that any disclosure of gender based violence be met with respect, sympathy and confidentiality and that services are provided with a survivor centered approach.
All vulnerable populations will experience Covid-19 outbreaks differently. For vulnerable and marginalised women, the dangers that Covid-19 outbreaks pose will be magnified. Conflict, poor conditions in displacement sites, and constrained resources are likely to amplify the need for additional support and funding. Containing the rapidly spreading Covid-19 is even more daunting in countries and communities already facing long-running crises, conflict, natural disasters, displacement and other health emergencies.
Countries affected by conflict or considered to be fragile often have some of the weakest health systems which makes them vulnerable to Covid-19 in terms of their capacity to detect, confirm, and manage the public health component, and equally to manage the clinical and health impact of the disease in a population.
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Dr Wanjawa teaches in the School of Humanities and Social Sciences, Pwani University.