We cannot talk about health without talking about gender. Gender inequity and its underlying causes influence health-seeking behaviors, access to care, and potential exposure to disease. We see gender inequity play out in all our work at PATH.
COVID-19 has highlighted the inequalities of the world's health systems and epidemic preparedness. To respond to COVID-19, we must understand what puts some people more at risk than others. Women are affected by the pandemic in specific ways, including caregiving burdens, economic impacts, risk of intimate partner violence, and reduced access to sexual and reproductive health services. As PATH is supporting countries to deploy testing, surveillance, mitigation strategies, and solutions to improve health system capacities to respond to urgent needs, we must maintain a focus on gender equity.
“Health emergencies amplify existing inequalities,” explained Elizabeth Rowley, a gender expert at PATH. “The COVID-19 pandemic is still unfolding in many parts of the world, but we already know that there are critical sex- and gender-related differences in the way that people are experiencing the disease and how it impacts the lives of women, men, and individuals with other gender identities and expressions.”
“Health emergencies amplify existing inequalities.”— Elizabeth Rowley, Global Advisor, Gender Programs and Research, PATH
In COVID-19, the numbers are clear. Where data include information on sex, we see that more men than women suffer severe outcomes of COVID-19. Research indicates that there are likely some biological reasons for this related to hormonal, genetic, and immunological differences between males and females.
But there is an important distinction between sex and gender—one is biological, the other a social construct. Unlike sex distinctions that are based on anatomical differences between women, men, and intersex individuals, gender has to do with social expectations. Gender inequity stems from the ways in which society values people differently depending on their sex, gender identity, and/or gender expression.
For example, in many countries, traditional gender norms place the heaviest caregiving burdens on women, both within the home and in the health workforce. At the same time, common notions about physical strength and masculinity prevent many men from seeking care. Unhealthy behaviors are often more acceptable among men. These and other gender-related norms drive differences in many disease risks and burdens that women and men face, including COVID-19.
Gender-related norms drive differences in many disease risks and burdens that women and men face, including COVID-19.
“We can learn a lot about the gendered implications of COVID-19 from HIV and TB,” said Rowley. “PATH’s long history of HIV and TB programming shows that there are clear differences between males and females in their use of health services, including testing for infections.” COVID-19 data from the United States indicate that men are less likely to get tested and seek medical care, and this trend is likely happening around the world.
As the COVID-19 pandemic unfolds in the countries where we work, we want to track how the gendered dimensions of health care and social norms influence progress against the pandemic—and find ways to remove any gender-related barriers to care.
The gendered impact of pandemics
In outbreak and pandemic situations, women play an important role caring for the sick and elderly, conducting contact tracing activities, and providing testing services. This increases their own risk of infection as they find themselves on the frontlines of deadly outbreaks—from COVID-19 to Ebola—that are further exacerbated by shortages of personal protective equipment, testing, and treatment options.
At the same time, women in many countries where COVID-19 social distancing measures are in place are doing double duty by homeschooling and parenting around their work responsibilities, and often shouldering the emotional burden of these uncertain times.
COVID-19 lockdowns, and the accompanying economic and social stresses, have also created conditions that may increase the rate of violence against women, especially intimate partner violence (IPV). Physical distancing measures, coupled with the mental, financial, and physical stress of the virus, have led to a surge in IPV. Women facing IPV often use social or work-related activities to leave the domestic environment and protect themselves. With physical restrictions in place, many of these outlets and resources have been reduced, cut off, or diverted elsewhere.
Gender at the intersection of inequity
Gender is not the only social dimension that influences health outcomes or responses to pandemics. No individual can be described by a single characteristic, but rather is described by a full, complex, and dynamic set of characteristics that influence how that individual is able to access health and other services.
Data on COVID-19 and other health areas often do not fully account for an individual’s intersectional identity because they are often not disaggregated by sex, race, and other dimensions of inequity. To protect those who are most vulnerable, we need as much information as we can obtain about the full spectrum of possible inequity in order to understand the unique impact COVID-19 has on different cross sections of the global population.
The data we have demonstrate the inequitable impact of COVID-19 on Black communities in the United States, and similar trends have been seen in marginalized communities in other countries. Women of color face significant barriers because of both their gender and their skin color—so we must consider how our pandemic responses address these barriers together, rather than seeing them as separate challenges to be overcome.
We need as much information as we can obtain about the full spectrum of possible inequity.
In COVID-19 and other pandemics, poor socioeconomic status can also increase vulnerability to both disease and its economic impacts. Research suggests that many types of essential work have low hourly wages and limited access to health benefits and sick leave. Furthermore, without the option to social distance, “essential workers” are required to interact with others face-to-face, heightening their risk of exposure.
Equity must be incorporated into decision-making bodies, task forces, medical and social research on new preventative measures, and the development and dissemination of testing and treatment. When equity is at the core of our work, we drive progress against pandemics and other challenges facing our global community.