Gender Based Inequalities Amplified by COVID-19 Pandemic

By Professor Father Michael J. Kelly
Guest Writer Contributing to the Key Correspondent Programme
Luwisha House, Lusaka, Zambia: May 18, 2020

Article Summary: COVID and Gender

The United Nations has reminded us that a pandemic amplifies and heightens all inequalities. The circumstances of the current COVID-19 pandemic bear it out that this is very true of gender-based inequalities. This article examines the most outstanding of these male-female differences and in particular the unbalanced way the pandemic increases the burdens placed on women and adds new ones. It looks first at some of the biological considerations that could account for more pandemic-related deaths among men than women. From there it moves to more strictly gender-based understandings, examining the way COVID-19 and the response measures magnify the burdens women must carry in maintaining a home and caring for children, the sick and the elderly; the impact on women of the closure of schools; the possibility of a large increase in violence against women; limitations on the provision of healthcare; the vulnerability of healthcare workers, so many of whom are women; the impacts on employment, with some consideration of telecommuting and its challenges for women; the vulnerability of female migrant workers; the way that the pandemic increases the levels of stress, anxiety and worry for women; the ubiquitous and evil presence of COVID-19-related stigma, discrimination and xenophobia; and the importance of ensuring that women have an equal voice on all pandemic response teams.

Having noted that COVID-19 has reversed the Beijing aspirations for the empowerment of women and full equality between women and men, the article leaves the reader with the question whether, despite all its negative impacts on women and girls, the COVID-19 pandemic might actually contribute to accelerating the changes needed to transform this world into one where gender-equality is more manifest.

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COVID-19 and Gender

The COVID-19 pandemic that we are currently experiencing has radically changed our normal ways of living and interacting. Schools, shops, businesses, bars, cafes, and fast-food outlets have closed. Large gatherings of people have been prohibited. Churches that want to offer services need a licence to do so. Sporting fixtures have been cancelled. Hospitals and medical centres are preoccupied more with responding to the pandemic than with the other ailments that affect people. Visiting one another in our homes is discouraged and visiting the sick in hospitals is not permitted. Funerals no longer constitute great social occasions but have been reduced to small, almost private, gatherings of mourners with just a few key well-wishers.

But throughout all this social and economic turmoil, the pandemic marches on, leading by mid-May to more than four and a half million infections and over 300,000 deaths worldwide. And one thing that has become very apparent is that this pandemic is far from being gender-neutral. The disease itself and the measures being taken against it are affecting men and women in different ways. Data from different parts of the world show that men are more likely than women to experience a serious COVID-19 illness and to die from it. On the other hand, the pandemic and the measures adopted to prevent the transmission of the virus are affecting women much more extensively and deeply than men. This article examines the most outstanding of these male-female differences and in particular the unbalanced way the pandemic increases the burdens placed on women and adds new ones.

Men’s Health Vulnerability: Sex Differences

Unfortunately not all countries give sex-disaggregated data on the disease, but in those that do two things are emerging. First, there is no clear pattern as to which sex is more likely to become infected with COVID-19. In 25 out of 56 countries from all over the globe for which sex-disaggregated data was available in mid-May, there were more confirmed COVID-19 cases among men than women; in 27 of the countries, however, the reverse obtained, with more COVID-19 cases among women than men (and in the remaining four countries the number of infections was the same among men as among women)[i]. Second, this sex-ambivalence in the numbers infected is not reflected in death patterns. Instead the data show that once they become infected with COVID-19 men are dying at a higher rate than women; thus in 46 out of 50 countries the COVID-19 fatality rate (the percentage of deaths in confirmed COVID-19 cases) was higher among men than among women, with men in a number of countries being over 50% more likely than women to die of the disease – for every two women dying from COVID-19 there were three or more men. Very clearly the “mortality disadvantage” for men is quite large.

While it is not fully clear why this should be so, two very different lines of inquiry are being pursued. The first, drawing on biological sex considerations, is examining the hormonal and genetic factors that strengthen the female immune response system and thereby improve a woman’s ability to fight off disease. Basically, a woman’s sex hormones, and in particular oestrogen, equip her with an immune system that is considerably stronger than a man’s. This contributes to women having less severe COVID-19 infections than men and less risk of death. On the other hand, the male hormone testosterone, which is immuno-suppressive, may increase health risks for men, including the mortality risk from COVID-19 infection. Moreover, genetically women have two X chromosomes while men have only one. Because the X-chromosome contains a large number of immune-related genes women’s additional X-chromosome may also have a part to play in giving them an advantage over men by strengthening their response to COVID-19 infection and in enabling them to survive even severe infections. These sex-differentiated hormonal and genetic factors are among the reasons why women can expect to live longer lives than men, with female life expectancy in many parts of the world being several years more than that of men. Further research in this area is important, because it might point to the way to build genetic and hormonal considerations into the development of medication to fight off disease, especially a new disease like COVID-19.

Gender Differences in Vulnerability to COVID-19

The second line of inquiry rests more squarely on gender considerations – how social and cultural norms and roles that are considered appropriate for women and men shape the ways people behave and the choices they make. Gender consists in the whole complex of these norms, roles, relationships, attitudes and expectations. From the time of birth, people learn these socially constructed and culturally produced characteristics in the society in which they live and experience them as very powerful, sometimes irresistible, forces in the way they influence behaviour, social interactions and sense of self.

In relation to COVID-19, gender norms, or expectations of behaviour appropriate to their manifest biological sex, may lead women to adopt behaviour that affords them some protection against the virus, whereas the norms for male behaviour may lead men in the opposite direction, to behave in ways that put them at higher risk of infection or to more serious consequences if an infection is incurred. Thus, women take greater care of their health than men and are more likely to visit a doctor. This is borne out in a major survey of the health profile of American men, carried out in 2000 by the Commonwealth Fund; this found that one in three men had no regular doctor compared with one in five women, that three times as many men as women had not seen a doctor in the previous year, and that one in four men who might have a health concern would wait as long as possible before going to see a doctor[ii].

Among the factors driving this kind of health-related male behaviour is the macho image of the male as strong, active, invulnerable, a John Wayne type who has no need to take the simple steps that could lessen his vulnerability to COVID-19. Apart from his reluctance to visit a healthcare provider, a man may also be disinclined to protect himself and others by wearing a face mask or by washing his hands frequently in the recommended way. Many men, regarding such practices as “cissy” or “not cool”, do not let them become part of their lives. Perceived masculine role discrepancy, that is, the perception of being less masculine than the typical ‘man’, can also cause significant strains and tensions which in turn may be associated with harmful social practices such as binge drinking[iii]. Moreover, in most parts of the world men also smoke more, drink more alcohol than women and are more likely than women to be drug-abusers, all of which are habits that can lead to negative health conditions such as chronic heart or lung disease. Worldwide, because of their lifestyle these underlying medical conditions are found to be more common among men than women, a factor that contributes to men experiencing more severe COVID-19 infections and higher fatality rates than women. In addition men travel more, both locally and internationally, and thereby increase their exposure both to polluted air and to risks of infection. These culturally determined factors help to bring it about that health-wise men constitute the weaker sex, with lower life expectancy than women, and that COVID-19 leads to a higher proportion of deaths among men than among women.

COVID-19 Increases Gender Inequalities

In concluding its policy brief, The Impact of COVID-19 on Women, the United Nations draws attention to the fact that a “pandemic amplifies and heightens all existing inequalities. These inequalities in turn shape who is affected, the severity of that impact, and our efforts at recovery.” The sections that follow examine a number of the inequalities that confront women and girls in various areas of their domestic, working and personal lives and the way many of these are made more pronounced by COVID-19. Essentially the pandemic enlarges many of the inequalities that women experience simply by virtue of their sex. The global crisis that it has created calls for a radical social change that sets out to address these gender inequalities that belie the first article of the Universal Declaration of Human Rights, that “all human beings are born free and equal in dignity and rights”.

As can be seen from the pages that follow, the pandemic has highlighted, expanded and given further expression to the pervasiveness and magnitude of the gender inequalities that characterise the international, national and local scenes. Becoming more aware of these inequalities reinforces the need to safeguard the equal participation of women in all decision-making related to the pandemic and to ensure that response plans and budgets always take account of the gender dimensions.

COVID-19 and Domestic Responsibilities:

Traditionally women have borne most of the burden of daily domestic work in such areas as cooking, laundry, caring for clothes andbedding, house cleaning, and shopping for household items. In addition to their almost perpetual labour in these areas women are also the principal providers of care in the home, looking after the young during their years of childhood and adolescence, caring for household members who are ill or living with disabilities, and caring for the elderly. It is estimated that globally all of these tasks lead to women doing three times as much unpaid work in the home as men[iv]. Regardless of the COVID-19 pandemic they must continue with these tasks, responding to the wide-ranging and almost never-ending demands of the various members of the household.

COVID-19 has aggravated for women this heavy dependence on their almost perpetual and unpaid labour. For many of them shopping has become an arduous chore, because of  COVID-dictated restrictions on going out of one’s house, advice against stopping to talk to other people, panic-buying leading to difficulties in getting various household and food items, empty shelves and long queues. Pandemic-related job losses, whether for themselves or their partners, and the non-availability of piece work for many in the informal sector, with the consequent income reductions, have increased the difficulty of living within a limited budget and given rise to anxiety and worry about where the next meal is to come from. These negative experiences are occurring against a background in which the woman of the house feels a personal responsibility for the health and well-being of its members and tends to blame herself if anything untoward happens to them within her domestic domain, including infection by COVID-19.

In normal circumstances the domestic responsibilities of women would become lighter when children would go to school and for several hours in the day would not be “under the feet” of their mothers or older female home-carers. The closure of schools as a response measure to the COVID-19 pandemic has changed this. Children are remaining at home and must be cared for throughout the day. This has greatly increased the domestic care-burden that women, including working mothers, must carry. The demands of caring for a household with several children who have no functioning school that they can attend are such that several women, particularly single mothers, have had to give up paid employment so that they can attend to these domestic responsibilities.

All over the world women are the predominant providers of informal home-based care for sick, elderly and disabled family members. These health-care demands on women are increasing as health systems become over-stretched with responding to the pandemic, making it necessary that many people with COVID-19 and other illnesses be cared for at home. Home care is also needed for the many who are infected but have not been diagnosed as such and also for those who have been discharged after COVID-19-necessitated hospitalisation, particularly those who are elderly. All of these factors add to women’s overall burden and in many cases put them at greater risk of becoming infected themselves.

Care for the elderly may involve providing meals, personal and cleanliness care, help with dressing, washing clothes and bedding, toileting and continence care, mobility assistance, administering medications, and simple companionship – being there with the older person or within call for him or her. COVID-19 hits older people the most, with the confirmed infection and fatality rates being much higher in people aged 70 and above than among younger people. With older people, it is not always so obvious that they are infected, as it may seem that they are just more tired than usual, less hungry, more confused, disoriented and off-balance. As a result it could happen that some of the elderly people for whom women provide care in the home are carrying the infection, though nobody is aware of this. This can put everybody belonging to the household, but especially the women who are providing the care, at risk of infection. Many of the tasks mentioned above that care for the elderly may entail are very intimate and require a great deal of person-to-person contact. This increases the risk of COVID-19 transmission in both directions, from the older person to the carer and from the carer to the one being cared for, thereby yet again increasing the challenge that COVID-19 represents for women.

Not everything, however, is negative. Research in Asia and the Pacific has shown that with the spread of COVID-19 men and boys are helping more at home. Of approximately 12,000 women surveyed in Bangladesh, Maldives, Pakistan and the Philippines, more than half noted that since the onset of the pandemic their partners had increased the help they had been giving them at home; in three of the countries the women respondents also noted that their sons were now helping with domestic chores more than ever before. All noted, however, that women and girls continue to do most of the domestic work[v].

The Closure of Educational Institutions

Global efforts to stop the transmission of COVID-19 have led to the majority of countries closing their schools, universities and other educational institutions. UNESCO has estimated that by mid-May there had been 162 country-wide school closures, affecting more than 1.23 billion children and youth; this means that more than 69% of the total population of students enrolled in educational institutions worldwide were out of school[vi]. In addition, various examination authorities have cancelled their end-of-year school examinations, thereby throwing a number of assessment programmes as well as university and college admissions systems into disarray.

These closures of schools and other educational institutions have negative impacts on women and girls which are not borne in the same way by men and boys. Getting into school in the face of local cultural norms has already proved a struggle for a large number of girls in many of the world’s least developed countries. School closures have undermined the hopes and aspirations of millions of these girls, causing them severe mental stress and anxieties about their future education and life prospects.

Further, in addition to their traditional domestic concerns women must now take on not just the added care of children whose schools have been closed in response to COVID-19, but also some responsibility to ensure that these children continue to learn. In many households, “home-schooling” is now the in-thing. Where e-learning facilities are available in the home, this may help the young ones to be occupied for some hours in learning activities, but in a great many households this may not be an option, leaving many women with no recourse but to assume, however tentatively and inadequately, the role of surrogate teacher, thereby increasing their burden of child and adolescent care. This is a process in which both the woman and the child or young person may suffer: the woman from the increase in the burden of child and adolescent care and the learner from the woman’s lack of knowledge and skill as a teacher of formal school subjects. The situation for women is aggravated by COVID-19-dictated requirements that people remain within their homes, avoid large gatherings and observe social distancing. In effect, these measures seriously curtail the possibilities that the young people might otherwise have grasped, to spend time with their age-mates or in the rough-and-tumble of play and sporting activities, thereby reducing the burden of care that women must assume.

A further gender difference lies in the different opportunities and encouragement for continuing with their learning programmes likely to be available to girls and boys during the period of school closures. Better-off families may be able to provide for some continuing learning opportunities for their children, but this is not the case with poorer families and with many in rural areas. While this affects both boys and girls, the negative consequences for poorer girls may be more serious. Going by the priority that historically has been given to boys’ education, it can be expected that, for as long as the schools remain closed, families will give more attention to ensuring that boys maintain contact with their “lessons and books”, while there will be less concern about this in relation to girls.

In addition, there is strong evidence that following circumstances which have led to their education being disrupted, girls are less likely than boys to resume school participation when eventually the schools do re-open. When schools in West Africa re-opened after the Ebola emergency, many girls did not want to return. In addition, during the time when schools were closed in West Africa there was a significant rise in the number of adolescent pregnancies and early marriages, with girls reporting that these increases were a direct result of being outside the protective environment provided by their school. The same could happen with the COVID-19-dictated closures: when schools are allowed to re-open, it seems probable that girls will be less likely than boys to go back to attending class and that there will have been a rise in teenage and enforced pregnancies and in early marriages. In this way, a measure designed to contain the COVID-19 pandemic seems set to increase the educational disadvantages experienced by women and girls.

Increased Possibility of Violence against Women

The lockdown measures imposed in many countries as a way of preventing the transmission of the COVID-19 virus are having the unintended consequence of increasing the likelihood of gender-based violence (GBV) and intimate partner violence (IPV). Restrictions on movement and stay-at-home measures result in domestic partners having to be in one another’s company for extended periods of time, living together in what amounts to a forced level of coexistence. The domestic tensions to which this can give rise are aggravated by COVID-19-induced fears about job-security, income and the possibility of infection, as well as by an increased use of alcohol. In an abusive environment these situations translate into a woman or girl being trapped in her home with her potential abuser and finding it very difficult to escape. Family stresses related to the pandemic also heighten the risk of violence by caregivers against children. Some countries report that since the onset of anti-COVID-19 measures emergency calls to domestic violence hotlines, support services and police have doubled, while the United Nations Secretary-General has warned that because of the pandemic the world is seeing a “horrifying global surge in domestic violence”[vii].

On the other hand, in some countries, these emergency calls have decreased, possibly because COVID-19 movement restrictions prevent the abused woman from leaving her house in order to seek help or because she fears that her ever-present abusive partner may overhear if she reports by telephone. At the same time, the pandemic has limited the ability of civil society organizations and government bodies to respond to the increase in domestic violence, partly because the safe shelters for those affected by domestic violence have been converted into health facilities and partly because new victims of violence are being denied access for fear they would bring the virus with them. Looking to the future in this context UNFPA has made the stark projection that “31 million additional cases of gender-based violence can be expected to occur if the lockdown continues for at least 6 months. For every 3 months the lockdown continues, an additional 15 million extra cases of gender-based violence are expected”.

The Provision of Healthcare

The accelerating incidence of new COVID-19 cases is placing a very heavy burden on health systems. Evidence from past epidemics shows that healthcare resources are often diverted from routine health services to the newly emerging health crisis. This is now happening with COVID-19. Many of these health systems, in their response to the pandemic, are concentrating their services on dealing with COVID-19 illnesses which are making such demands that facilities are no longer as freely available as they used be for people with other illnesses. This has resulted in somewhat limited or hurried services remaining available for the general public, including women and girls, a factor that discourages the access of women, especially those from lower income and rural households. More specifically, these over-stretched health services may no longer be able to provide women with the pre-and post-natal care that they require. Also, uncertainty surrounding maternity services is causing pregnant women increased stress and anxiety and has reduced the possibility of home births[viii]. The congested facilities and the longer than usual waiting-time also lead some women not to keep appointments or to postpone important health check-ups. In communities where COVID-19 is spreading at a fairly rapid rate, the fear of infection is also leading women and girls to stay away from clinics and health centres and thereby miss out on some required health treatment.

The pressure on health systems may also lead to confirmed COVID-19 cases not being given hospital accommodation, especially where the symptoms are mild, but being sent back to their homes for care, a development that can greatly increase the household care burden of women. Women’s burden of care may also be increased in looking after children with measles or other infectious disease whose numbers are sure to increase because of the way COVID-19 has disrupted routine vaccination and immunization services. The World Health Organization predictions are that “more than 117 million children in 37 countries, many of whom live in regions with ongoing measles outbreaks, could be impacted by the suspension of scheduled immunization activities”[ix] In addition there are the numerous infants who may not receive other vaccinations or necessary medical treatment because of the impacts of COVID-19 on routine medical services. Caring at home for these infants and children, should they fall ill, will greatly extend the already large care burden of women.

The global disruption that COVID-19 has brought about in trade and transport may also lead to significant shortages of various medical supplies, including contraceptives. UNFPA has projected that if the COVID-19-dictated lockdowns continue for six months, 47 million women in low and middle income countries may not be able to access modern contraceptives and 7 million unintended pregnancies may be expected to occur[x].

A further COVID-19-related health impact on women is that in some countries screenings for breast and cervical cancer have been suspended. Thus during April this year no mammograms were carried out in Ireland compared to more than 13,000 in the same month last year[xi]. Similarly, whereas in April 2019 more than 21,000 samples were collected for sending to laboratories to check on signs for cervical cancer, none were collected this year. A similar dramatic fall in cancer screenings has been observed in the United States where these breast and cervical cancer screenings fell by 94% in March 2020 compared to the 2017-2019 averages[xii]. The situation is much the same in a number of other countries. These screenings can detect the cancer in the early stages, before any symptoms show and when the treatment is more likely to be effective. But because of the COVID-19 epidemic hundreds of thousands of women across the world are being denied these services (or are not accessing them where they remain available), thereby placing themselves at risk of serious cancer disorders later in their lives.

The pandemic would also have significant adverse impacts for persons living with HIV if it led to interruptions in HIV services and supplies. The World Health Organization has warned that the disruption over an extended period of antiretroviral therapy could lead to a mushrooming of AIDS-related illnesses, including tuberculosis, and increase the number of deaths. One significant gender-related aspect of such a curtailment of HIV services is that it would reverse the gains that have been made in recent years in preventing mother-to-child transmission of HIV[xiii]. A resurgence of this condition would again increase the vulnerability of women in the entire HIV and AIDS setting.

COVID-19 and Healthcare Workers

“Globally, there are 136 million workers in human health and social work activities, including nurses, doctors and other health workers, workers in residential care facilities and social workers, as well as support workers, such as laundry and cleaning staff”[xiv]. The great majority of these – approximately 70% – are women. The frequent and close contact that their work necessitates with COVID-19-infected patients puts these women, especially nurses and cleaners in hospitals and residential healthcare facilities, at increased risk of contracting the COVID-19 virus and dying from it. Healthcare workers are also experiencing increased stress and mental health risks, aggravated by their anxiety lest they become personally infected. Because the majority of healthcare workers are women, their increased risk of infection translates into more female than male health workers (and related allied workers) becoming infected. This is borne out by data from the United States and some European countries which shows that up to 75% of the confirmed cases of COVID-19 infections among healthcare workers are female[xv]. The rate of infection can be lowered with the use of personal protective equipment (PPE – gowns, aprons, masks, gloves), provided adequate training is given to ensure that workers make proper use of these items. In addition, the specific needs of women healthcare workers and care-givers should also be catered for by the inclusion of menstrual hygiene products for female workers, though currently this is being done in very few countries..

COVID-19 Impacts on Employment

COVID-19 has seen the world’s major economies experiencing massive declines which in turn are pulling down employment levels. The International Labour Organization (ILO) has quantified this in its statement that the rapidly worsening economic effects of COVID-19 on the world of work are proving to be far worse than were experienced during the global financial crisis of 2007-2008 – and worse is still to come, with the equivalent of nearly 200 million job losses expected in the next three months alone[xvi]. The agency further estimates that as of early April full or partial lockdown measures had affected almost 2.7 billion workers, representing around 81% of the world’s workforce.

The ILO has also stated that “The majority of job losses and declining working hours … occur in hardest-hit sectors. (It) estimates that 1.25 billion workers, representing almost 38 per cent of the global workforce, are employed in sectors that are now facing a severe decline in output and a high risk of workforce displacement.” More women than men are employed in many of these ‘hardest hit sectors’, such as education; human health and social work areas; accommodation and food services; arts, entertainment, tourism and recreation; and other services sectors. With the exception of the health sector, all of these have incurred highly significant reductions in their active workforce, with the biggest losses being incurred by accommodation, food services and tourism, and therefore in the employment of women. An illustration of this comes from Canada where more than six in ten jobs lost in mass lay-offs caused by the COVID-19 pandemic had been held by women[xvii].

Contributing to the female job losses is the fact that many of the jobs held by women are in ‘must-show’ areas which demand the personal presence of the employee. This is the case with restaurant, travel, hair and beauty treatment and other occupations. Many of the jobs in these areas cannot be done remotely but require the personal interaction between the client and the employee. Although men work in these concerns, women tend to dominate. However, COVID-required social distancing strategies, restrictions on movement and stay-at-home measures have resulted in a significant loss of jobs in these person-to-person contact areas, with women being the ones most affected.

In response to the social distancing strategy for preventing the transmission of COVID-19 some industries, especially those that are office-based (including government offices), have established telecommuting arrangements. This is a work arrangement where the employee works from home or from a location close to home, but away from the place of work (frequently an office), and uses such technology as a computer and smartphone to carry out work-related duties. Even though these arrangements may enable a business to survive the economic upheaval brought about by COVID they are not feasible in the ‘must show’ areas mentioned in the preceding paragraph. Moreover, they can present difficult challenges to women and girls because of the almost inevitable way domestic and child-care responsibilities may interfere with and tend to crowd out activities related to paid employment that are undertaken in the home. Further, in some countries women are up to 31% less likely than men to have access to the internet and worldwide are less likely than men to have a smartphone; hence for many women telecommuting would not be a viable option that would enable them to keep their job[xviii].

All of these factors conspire to bring it about that in many parts of the world women are the majority of the newly unemployed. Thus, data from the United States shows that in March women shouldered nearly 60% of job losses, outnumbering men in all sectors of the economy[xix]. Hence one gender-related outcome of the COVID-19 pandemic is the impact the disease has on the economic status of women, showing itself in the inability of millions of women to access their former source of income-generating employment – even female commercial sex-workers have bewailed the negative effect of the pandemic on their business![xx]

Moreover, globally a very high proportion of workers are self-employed, are in informal employment or are under-employed. ILO estimates that across the globe about two billion people work in the informal economy which plays a major economic role in many low- and middle-income countries. In developing economies 70% of women’s employment is in this informal sector with few protections against the loss of employment and with many of the women living close to poverty[xxi]. In urban areas very many informal-sector workers, such as transport providers, street vendors and food servers, tend to work in economic sectors that not only carry a high risk of COVID-19 infection but are also directly impacted by lockdown measures. A very high proportion of these workers are women with very limited access to health services and social protection.

COVID-19 and Women Migrant Workers

In 2019, half the estimated 272 million migrants who live and work outside their countries of origin were women[xxii]. Of these approximately 67 million were female migrants, working in lowly-paid and vulnerable jobs, such as domestic workers, workers in health and care areas, nurses, cleaners and laundry workers. COVID-19 gives rise to multiple risks for these women migrant workers: they are in danger of becoming infected by the virus; COVID-19 impacts on the labour market put their jobs in jeopardy; because they tend to work in the informal economy, especially as domestic workers; they lack access to health care and to such social protection measures and unemployment benefits as may be available; language barriers make it difficult for them to present their case or to make it known that they may have COVID-19 symptoms; the pandemic exacerbates their risk of sexual and gender-based violence, particularly those with irregular migration status and those who must deal with public officials, including officials at border crossings. A further COVID-19 impact occurs when the pandemic leads to the loss of jobs and therefore to a decline in the remittances that these women can send back to their countries of origin; in many cases, the result is that their families back home can no longer meet their livelihood, health and educational needs, something that exacerbates the migrants’ sense of loneliness and isolation. Moreover, travel restrictions and border controls, imposed in response to COVID-19, may make it impossible for them to return to their countries of origin.

COVID-19 Increases Anxiety, Stress and Worry

As is shown by the way it is sometimes referred to as the novel COVID-19 pandemic, COVID-19 is a new disease about which there is still much to learn. This means that there is still a great deal of uncertainty about it, while at the same time it is being given almost overwhelming media coverage. Its silent, virtually anonymous transmission route has thrown the whole world into disarray and disrupted social and economic life to an extent never before experienced by humanity. These aspects of the disease come to the surface in the way it is giving rise to a wide range of emotional reactions: anxiety, worry, panic; anger; feeling helpless or confused; a sense of hopelessness, inadequacy, isolation; fear of the future; worries about job security and possible loss of income; worries about older people and loved ones; worries about being shunned and stigmatised if it became known that one was infected or had had dealings with persons infected with the virus. While worries about health and safety are normal during a pandemic, serious anxiety is more likely to develop when the situation is less familiar. For many people the uncertainty surrounding COVID-19 is very hard to handle – not knowing where it will strike next, not knowing how bad things will get and not knowing when it all may end. Many individuals find that struggling in the face of the pandemic to stay positive about the future is a real challenge.

Although this entire anxiety-provoking situation is being experienced differently by women and men, there has been little explicit reporting about the extent to which COVID-19 anxiety-provoking situations are affecting men and women in different ways. What is noteworthy, though, is that the media reports on the psychological and emotional challenges to which COVID-19 is giving rise focus predominantly on women’s reactions to the pandemic but give less prominence to the impacts on the mental health of men. This may be because research has shown that women tend to have consistently higher levels of anxiety conditions than men[xxiii]. There are some biological reasons for this, with the male hormone testosterone helping to calm down the activity of the brain’s emotional response nerve centre, thereby giving men some protection from higher levels of anxiety. But there are also gender-related social factors, such as women’s domestic responsibility overload, the harassment and discrimination they can experience at work, and family and social expectations of what is appropriate for a woman. It is also a cultural expectation that men should be ‘in control’ of their emotions and hence in given situations display less anxiety than women. In keeping with these biological and cultural understandings a poll in the United Kingdom has found that women currently at work were substantially more anxious than men about the impacts of COVID-19 on their economic prospects: 46% of female workers said that money concerns prompted by the economic turmoil resulting from the pandemic were having a direct impact on their mental health, but only 37% of men said the same; also, while 55% of women were concerned lest they be at risk of contracting the disease at their work, only 45% of men said the same[xxiv].

In addition, women are finding their worries being exacerbated by some of the various measures being taken in response to COVID-19. They are experiencing social isolation. They are concerned about the risks and lack of educational opportunities for their children, especially their girl-children, who are out of school. They are troubled by the more limited availability of medical services. Despite reassurances to the contrary, they are concerned that the virus may affect any pregnancy they may be carrying and be detrimental to their unborn child. And even if they do not experience any outright domestic violence, they know that with its lockdowns and stay-at-home policies the pandemic is exposing them to the possibility of an increase of this. In other words, COVID-19 is making women ever more worried than before. It is increasing the rational for women’s anxiety. It is making life more stressful for them.

COVID, Stigma and Xenophobia

From time immemorial infectious diseases have given rise to stigma. COVID-19 is no exception. Having originated in China, the disease has provoked social stigma against people of Asian, especially Chinese, origin, Also, being highly contagious, it has given rise to stigma against people known to have been in contact with individuals infected with the disease or who have come from areas affected by the pandemic. It needs however to be emphasised that while the virus first appeared in the Wuhan region of China, its spread cannot be attributed to any single racial or ethnic group. Likewise, although healthcare workers may have to come into contact with people who are infected, their role in transmitting the disease is minimal compared with that of the unknown millions of individuals who have interacted with the millions of others who have been diagnosed with the infection and the possibly larger number who are infected but are asymptomatic.

Unfortunately, reports abound that COVID-related stigma and xenophobia, leading to discrimination, continue to make their ugly presence felt. Thus Wuhan residents are reported to have been turned away from hotels in other provinces in China; signs saying “No Chinese allowed” have appeared outside shops and restaurants in various parts of the world; within three months of the onset of the pandemic, Chinese restaurants in Australia saw business drop by 70%; in February, a French newspaper carried an editorial entitled “A new Yellow Peril”; in Oxford, a National Health Service doctor was asked to leave his rented room because his landlady was worried lest he bring the coronavirus into her property; in Egypt many of those who have recovered from the infection are refusing to admit that they have had the virus, lest they and their families be shunned[xxv]; a medical practitioner in Lusaka who was diagnosed as being infected with the virus said that one of the challenges she faced after receiving her diagnosis was the stigma from society which extended not only to her but also to her relatives[xxvi].

There is no evidence that women have suffered more than men in these and other discriminatory and xenophobic cases. But since women already suffer from a generalised systemic discrimination it is very likely that many of them interpret any COVID-19 stigma or discrimination that they experience as a further instance of bias against them because of their sex. Also, since women comprise 70% of healthcare workers and so many of these have considerable dealings with people infected by the disease, the fear of infection on the part of  the general public, and their anxiety lest they become infected, may show itself in much reserve towards female healthcare workers, very pointed exaggerations of the social distancing strategy, and a tendency to avoid them.

COVID-19 also gives rise to self-stigma – feelings of guilt and shame at being infected, feeling bad about the way other people will perceive the situation, self-condemnation at having inadvertently passed the disease on to others, self-blame because of perceptions that the infection was one’s own fault and could have been avoided if more precautions had been taken or the public prevention guidance measures had been observed. For many individuals, this stigma that they experience within themselves is more upsetting and disturbing than anything that might come from an outside source. Although there is no evidence that women experience more of this self-stigma than men, the possibility is deserving of further examination, especially in the light of the extensive caring roles played by women and girls, their adopting a more intuitive approach to situations, and the large part that anxiety and stress play in their lives.

COVID-19 Response Teams

On 29^th January President Trump established the White House Coronavirus Task Force, with Vice-President Mike Spence being named in late February as Chair. On varying dates between late January and early March, twenty-one other members were appointed to this Task Force. Only two of these were women while the remaining nineteen were men[xxvii]. Similarly, in late March the Australian Prime Minister announced the membership of the Executive Board of Australia’s newly-formed National COVID-19 Coordination Commission – two women and six men[xxviii]. These male-dominated national response bodies epitomise much that has been taking place in efforts to understand COVID-19 and to organise, coordinate and deliver appropriate responses – heavily male-dominated response teams with inadequate representation of women. But as the foregoing pages have made clear, the COVID-19 epidemic is strongly biased against women and girls, a bias which cries out for greater female participation in the response teams at all levels – local, national, regional and international.

The COVID-19 global crisis exacerbates women’s vulnerability and gender inequality. Responding to it will be doomed to failure if the response strategies at country, regional and international levels fail to take into account the gender-differentials of the pandemic. To achieve this gender-sensitivity in the entire response framework it is necessary that women should have at least an equal voice in decision-making in relation to the pandemic and its prevention and in long-term planning to deal with its social, medical and economic impacts. It is therefore fundamentally important to ensure the meaningful engagement of women in all COVID-19 decision-making in responding to the pandemic and preventing the further transmission of the virus. This is something that the world has not yet achieved.

COVID-19 Underlines the Need to Eliminate Gender Inequalities

The foregoing pages have highlighted how the COVID-19 pandemic is currently magnifying existing gender inequalities and opening doors to new ones. Across every sphere impacted by the pandemic, from family care to employment, from health provision to gender-based violence, from education to migration, women and girls are experiencing increased COVID-related inequalities and vulnerabilities, simply because of their sex. It is essential that these situations be changed and that all responses to the pandemic take account of its gender impacts. This entails ensuring that gender dimensions are factored into every analysis, response plan and related budgetary measure. A prerequisite for this is to ensure the availability of sex-disaggregated data on rates of infection and fatality, on employment and economic impacts, on the domestic care burden, on the incidence of domestic violence and sexual abuse, and on the provision of health care and education. It will also be necessary to ensure the equal participation of women in decision-making in evaluating the impacts of the pandemic, determining the immediate response measures, and developing the long-term plans that will protect societies and the world from possible future occurrences of a similar pandemic.

Gender inequalities constitute a major weakness in current social, political and economic systems and, as has been seen, in many of the areas impacted by COVID-19. Eliminating these kinds of inequality was a task that the world set for itself twenty-five years ago at Beijing when it looked to the empowerment of women and equality between women and men as prerequisites for achieving political, social, economic, cultural and environmental security among all peoples. COVID-19 has set that agenda back. The time has surely come to rectify this situation and to place gender issues at the heart of the global and local understanding of the pandemic and of the response to it. Gender equality is a must which currently is more conspicuous by its absence than by its presence. But possibly, in an unforeseen twist of circumstances, the COVID-19 pandemic may serve as a catalyst to accelerate the changes needed to bring it about.

Footnotes

[i] Global Health 50/50, 14 May 2020: COVID-19 sex-disaggregated data tracker.

[ii] Commonwealth Fund. 1 March, 2000: Out of touch: American men and the health care system.

[iii] “Role discrepancy prevalence of binge drinking and relationships between masculine role discrepancy and binge drinking via discrepancy stress among Chinese men”. Xue Yang et al., Drug and Alcohol Dependence, Vol. 196, March 2019.

[iv] UN Women Arab States, 18 March 2020: Paying attention to women’s needs and leadership will strengthen COVID-19 response.

[v]UN Women, 29 April 2020: Surveys show that COVID-19 has gendered effects in Asia and the Pacific.

[vi] United Nations Educational, Scientific and Cultural Organization (UNESCO), 13 May 2020: COVID-19, Educational disruption and response.

[vii] UN News, 6 April. 2020: UN Chief calls for ‘domestic violence ceasefire’ amid ‘horrifying global surge’.

[viii] ITV Report, 17 May 2020: Coronavirus crisis causing stress for pregnant women as pandemic disrupts maternity services.

[ix] World Health Organization (WHO), April 2020: More than 117 million children at risk of missing out on measles vaccinations, as COVID-19 surges.

[x] United Nations Fund for Population Activities (UNFPA), April 2020: New UNFPA projections predict calamitous impact on women’s health as COVID-19 pandemic continues.

[xi] Radio Telefís Eireann (RTE) News, 11 May 2020: Aisling Kenny. COVID-19 stalls breast cervical cancer screenings.

[xii] STAT, May 2020: Rebecca Robins. Routine cancer screenings have plummeted during the pandemic, medical records show.

[xiii] World Health Organization (WHO), 11 May 2020: The cost of inaction: COVID-19-related service disruptions.

[xiv] International Labour Organization (ILO). 7 April, 2020: ILO Monitor: COVID-19 and the world of work.

[xv] US News, 14 April, 2020: Gaby Galvin, Nearly 10,000 health care workers had coronavirus – but there’s probably more.

[xvi] UN News, 8 April 2020: COVID 19: Impact could cause equivalent of 195 million job losses, says ILO chief.

[xvii] iPolitics, 9 April, 2020: Youth, women, precarious workers bear brunt of COVID-19 job losses, Statistics Canada finds.

[xviii] Human Rights Watch, 19 March 2020: Human rights dimensions of COVID-19 response.

[xix] Working Economics Blog, 15 April, 2020: Elise Gould et al., Women have been hit hard by the coronavirus labor market.

[xx] Lusaka Times, 3 April 2020: Chipata sex workers urge Government to contain COVID-19 soon, it has affected their business.

[xxi] United Nations, 9 April 2020.:Policy Brief: The impact of COVID-19 on women.

[xxii] UN Women, 2020: Guidance Note: Addressing the impacts of the COVID-19 pandemic on women migrant workers.

[xxiii] Journal of Psychiatric Research, Aug. 2011:. C. P. McClean et al, Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness.

[xxiv] Independent, 26 March 2020: Maya Oppenheim, Coronavirus: Why women are being hit hardest by the economic fallout.

[xxv] Wikipedia, retrieved 13 May 2020: List of incidents of xenophobia and racism linked to the COVID-19 pandemic.

[xxvi] Lusaka Times, 16 May 2020: COVID-19 survivor urges Zambia to take disease seriously and bemoan stigmatisation.

[xxvii] (1) Wikipedia, retrieved 13 May 2020: White House coronavirus task force. (2) Independent, 15 April 2020, Ahmed Aboudouh. In Egypt, the social stigma of COVID-19 is spreading faster than the virus.

[xxviii] Prime Minister of Australia, 25 March 2020: Media Release, National COVID-19 Coordination Commission.

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