The world is far away from building more equal and resilient societies and creating equitable policies and interventions
The Indian economy’s downhill journey was all over the media, but the news about 88.17 per cent women workers surviving with a reduced number of meals in the 26 districts of Madhya Pradesh (MP) and the 52.46 per cent dip in women’s participation, the lowest in eight years in the National Rural Employment Guarantee Act, received very little media attention.
When the pandemic struck the world, Maria Holtsberg, United Nation (UN) Women, Humanitarian and Disaster Risk Advisor, Asia and Pacific, rued that a “crisis always exacerbates gender inequality.” In 2016, a high-level UN panel called for incorporating gender dimensions in any public health emergency response. Unfortunately, Coronavirus Aid, Relief, and Economic Security Act’s appraisal of 73 policy statements, guidance documents and response strategies, laid bare a shocking revelation that nearly half or 46 per cent ignored the gendered effects of the pandemic and hunger crises and only seven per cent proposed any concrete action.
“The pandemic-containment public policies and health strategies so far haven’t looked through the gender lens… and now the pre-existing gender inequalities, in every sphere, from health to the economy…are likely to be further amplified,” lamented Poonam Muttreja, Executive Director, Population Foundation of India (PFI).
In the light of the past adverse health consequences of epidemics, the World Health Organisation’s (WHO’s) early advisory urged prioritising sexual and reproductive health services as “essential services.” Nevertheless, a survey in 103 countries found large-scale disruptions in 67 per cent. A Guttmacher Institute’s projection, on the basis of data from 1.6 billion women of reproductive age from 132 low and middle income countries, envisaged that a “10 per cent decline in use of reversible contraceptive methods, would hit 49 million more women, cause 15 million additional unintended pregnancies and 3.3 million unsafe abortions over the course of a year.” Going by official figures, the health deficit (April-June) in India amounts to a drop in immunisation by 27 per cent, institutional deliveries by 28 per cent and major surgeries by 60 per cent in comparison to last year.
Despite abortions being enlisted as “emergency services,” very few in reality could reach the clinics due to inadequate transport and lack of information. Ipas Development Foundation (IDF), India, collating data from eight States, evaluated that “from March 25 to June 24, about 1.85 million Indian women could not terminate unwanted pregnancies. About 80 per cent for absence of medical abortion drugs at pharmacy stores, another 20 per cent, due to reduced access to health facilities.”
However, women play a lead role in care-giving within families or as healthcare workers. “Women’s social conditioning makes them take charge of a sick family member. And as professional care-givers, nursing continues to be seen as a women’s domain. But the risks of being with patients for longer hours than the doctors are often undermined. We tend to fall into gendered hierarchies in recognising the services of a nurse contracting the disease and succumbing, as against the doctors falling prey to the disease,” says Padmini Ghosh, country co-ordinator, Women’s Regional Network.
The recent agitation of the ASHA workers against underpayment and increased workload, without the minimum protective gear, further exposed the inadequacies of the public health system. PFI’s Muttreja was categorical that “we must invest in our 3.3 million strong female frontline workforce for combating COVID-19 by valuing and resourcing their needs.”
A PFI study in Uttar Pradesh (UP), Bihar and Rajasthan, disclosed that an increasing care-giving role within the household has led to high degrees of psychological distress among girls/women. Ghosh says that women’s mental health problems are often ignored as “figments of imagination” and receive no medical interventions. In this regard, the launch of a toll-free helpline “Kiran” to address the rising number of pandemic-induced mental health problems is a welcome step.
Furthermore, the economic slump has also created ripple effects on food security in India, which experts apprehend, would reinforce inequalities in food distribution within the household, making structural inequities more visible in food systems.
Dr Shweta Khandelwal, Head, Nutrition Research, Public Health Foundation of India, asserted that “women tend to remain vulnerable to multiple forms of malnutrition due to various socio-economic, demographic and cultural factors. Undernutrition enhances their susceptibility to infection, including respiratory infections and immuno-deficiency, making them more vulnerable to COVID-19.”
Plus, with less than a quarter being present in the labour force in the pre-pandemic era, Indian women are now likely to be further pushed out of gainful employment. The Centre for Monitoring Indian Economy’s Consumer Pyramids Household Survey data confirmed that, at least, four out of ten women in India lost their jobs. In rural India, the huge influx of migrants workers to hometowns and villages generated a downswing of about 2.24 per cent in the rate of women’s work participation. William Joe, Professor, Population Research Centre, Indian Institute of Economic Growth, alerted that, “Women being hardly present in the core sector labour force are less likely to benefit from macro-support programmes. There is a need for direct wage support programmes like MNREGA, rural and urban. These should be redesigned to fit into gender needs and work preferences as unskilled labour work may not find many takers in urban areas.”
Many experts also fear that “about 23.5 percentage points less women than men employed in the pre-Corona phase are likely to be re-employed later.”
Besides, the lockdowns have turned homes into a place for physical, sexual and psychological abuse for many women. During the first four phases of the lockdown, Indian women filed more domestic violence complaints than in the last ten years during the same period.
Now, while assessing women’s COVID-19 disease burden and health outcomes from the biological perspective, many researchers affirmed that “women tend to mount a stronger immune response,” while some contended that “sex patterns are not universal among all viruses.” How sex and gender are influencing clinical care cannot be fully explained for lack of comprehensive sex-disaggregated data, as the WHO in its 2007 guidelines emphasised. Nevertheless, in the past too, WHO guidelines have been overlooked which seriously affected women’s health needs.
“The pandemic’s imagery in public consciousness and reportage has been dominated by a male doctor, a policeman, a male migrant labourer. While a nurse, the policewoman who has to go back home to an infant, a jobless migrant domestic help or a trafficked sex-worker with no income, rarely feature in public imagination,” laments Ghosh. Sadly, this rings true.
The UN Secretary-General’s call for focussing on women’s interests in the pandemic remains largely unheeded. The world is far away from building more equal and resilient societies and creating equitable policies and interventions.
(The writer is a retired Indian Information Service Officer and a media educator.)