Photo credit: GM Shimshali

Disasters and public health emergencies oftentimes compound gender inequalities in societies. They don’t have to, and in fact rather could present opportunities for change. We know that disasters and public health emergencies impact people differently based on factors such as gender, caste, class, ethnicity, age, health, (geographical) location, to name a few. This article focuses on gender because society assigns women and men differential roles, responsibilities, rights, and spaces. The gender impacts need to be understood so that we can respond in a way that at least will lessen hardships, and at best will facilitate transformation toward an equitable world. Here we lay out different kinds of gender impacts during this COVID-19 public health emergency in the HKH and provide actionable ideas.

Women’s contributions during health emergencies

Women all over the world in general and in the HKH region in particular play important roles in health care and social service sectors. As per the World Health Organization (WHO), women comprise 70% of the health care and social sector workforce. They are frontline responders as doctors, nurses, and paramedics. They lead community awareness programmes about pandemics and emergency response operations as teachers and social workers, identifying needs and providing food packages and health and hygiene kits. Likewise, a large number of women around the world work as mobilizers and volunteers engaged in emergency response and distribution of food and essential supplies. In their own homes and families, women and girls are the ones largely tasked with providing care to the sick, children, and elderly; managing food stocks and household chores; and provisioning water for domestic use.

Linkages between gender and the COVID-19 pandemic

On 11 March 2020, WHO declared the coronavirus disease (COVID-19) outbreak a global pandemic. Although research is very much still underway and data are constantly being reviewed and updated, it seems that a gendered pattern is emerging. A study looking back at the previous Severe Acute Respiratory Syndrome (SARS) epidemic and studies on mice, combined with a recent descriptive analysis made public by China’s Centre for Disease Control point towards a higher death rate among men. There are only 12 countries worldwide which publicly report sex-disaggregated data, and among those countries, analysis points towards men being 50%–80% more likely than women to die following COVID-19 diagnosis. Preliminary data also show that even where more women have been diagnosed with COVID-19, men have higher mortality rates. Different studies have pointed out that although a part of this is due to biology, a major reason is gender and its associated roles, norms, behaviours, attitudes, and expectations. For example, a higher percentage of men smoke; men tend to drink more as compared to women; and, men are more mobile because of their expected roles and responsibilities. Global Health 5050 states that as per the 2015 data, worldwide almost five times more men than women smoke, and men drink about five times more alcohol than women.  These have direct links to COVID-19 infection and fatality, given the current understanding of the nature of this virus and how it spreads. In the HKH region, except for China, gender-disaggregated COVID-19 data are not available, but we could speculate that gendered impacts may be similar.

Impacts of the pandemic on women in the HKH

In the HKH region, the gender division of labour is quite skewed with distinct roles, responsibilities, and spaces for women and men. Furthermore, the gender norms and practices are most often, if not always, discriminatory against women. In such a context, it’s clear this pandemic will have – and as we discuss below – is already having, relatively more negative impacts on women and the poor and marginalized.

Women at the frontline

The care economy is predominantly shouldered by women. As described in the International Labour Organization report Care work and care jobs for the future of decent work, in Asia and the Pacific, women do 80% of the unpaid care work. The HKH region, given its patriarchal systems, is no different, as women uphold the care economy and also engage in other “productive” work[i]. In the current situation, there are unprecedented risks for women while handling and dealing with the pandemic as first responders and family caregivers of the elderly, children, and the sick. In a region where unavailability of safety gear to protect health workers can be a problem, women health workers are particularly vulnerable.

Worldwide, the majority of nurses are women. This is also true in the HKH, where choosing a nursing profession may be a socially acceptable career choice for women and also a manifestation of the patriarchal norms and notions of masculinity and femininity in the region. Nurses are at the frontlines dealing with COVID-19 patients but are excluded from the decision making, and their particular concerns and safety are not considered. There are many anecdotal reports of women healthcare staff sending their children to grandparents to avoid possible transmission.

Water, social distancing, and cooking issues

Frequently washing hands with soap is a useful way to minimize the risk of contracting COVID-19. Yet, managing water to do so is easier said than done, especially for rural women in the HKH region who bear the brunt of the drudgery involved in retrieving water. Despite heavy investments and efforts by governments and non-governmental institutions to make water available to communities in the HKH region, the vast majority of people are still deprived of access to sufficient and clean water.

Water scarcity in the region due to climatic changes aggravates women’s work burden as they often have to fetch water from sources that are far off. This drudgery is particularly pronounced for women from poor households. Furthermore, women’s health can be compromised not only from this increased workload but also because of inadequate drinking water availability, particularly during the menstrual period.

Another safety measure, social distancing and isolation, is practically unrealistic for poor women (and men), particularly those inhabiting urban slums, given household responsibilities, large family sizes, and the unavailability of adequate living spaces. Further, under these circumstances, households need to ration food and yet ensure adequate food intake (however healthy). Here too, many women lose out, since social and gender norms and practices in many households dictate that women eat last and often what is left.

Indoor smoke and consequent respiratory vulnerability is another concern. Biomass is the main source of cooking fuel in the HKH region, and women are responsible for cooking (and heating) in most remote mountain villages. This means they spend long hours in smoke-filled kitchens that are often not well ventilated. Since pre-existing respiratory conditions appear to be factors that correlate with higher instances of fatality, this is one aspect that could make women from rural mountain villages more susceptible to severe consequences after contracting COVID-19.

Increase in gender-based domestic violence

Incidences of gender-based domestic violence against women (and children) rise during every emergency and disaster. The COVID-19 pandemic has been no different, with many reports and write-ups on a spike in such incidences from various countries that are highly affected. The problem is such that the United Nations called for urgent action to combat the worldwide surge in domestic violence. Emergency situations such as this one result in great stress among people because family members are cooped up in their household environment, and violence against women and children is an outlet for some men. This violence is fuelled by notions of masculinity and male superiority over women. As the lockdown of countries stretches for longer periods in an effort to flatten the curve of COVID-19 spread, it would not be far-fetched to say that incidences of gender-based violence against women and children may see a rise in the region. In this context, the closure of protection shelters for women and also of organisations working on these issues and the lockdown and restrictions on mobility, women will have nowhere to flee or go for help.

Reports from various countries of the region cite an increase in domestic abuse complaints since lockdown began. In China, the Lantianxia Women’s and Children’s Rights Protection Association of Hubei province reported a total of 175 domestic violence incidents in February 2020, twice the number compared to January and more than three times during the same period in 2019; in India, and the National Commission for Women (NCW) has reported a sharp rise in the number of distress calls during this time: from March 24 to April 1, the NCW received 69 calls on its helpline. Similar cases are being reported in Pakistan. As aptly put by Professor Ashwini Deshpande of Ashoka University, in a recent article, “… [as] one curve gets flattened, the other one [incidences of domestic violence] slopes upwards, perhaps not exponentially, but sharply, nevertheless”.

Integrating gender dimensions in emergency response

Studies on emergency responses indicate that emergency plans usually ignore or neglect women’s needs, experiences, and skills. In the current COVID-19 emergency, proper gender-disaggregated data which entail all gender-sensitive dimensions pertaining to social, economic, and psychological effects of the pandemic are vital for identifying needs and expertise to strategize and make immediate plans and policies. On the basis of these data, rehabilitation plans must consider women’s and men’s unique needs and experiences and accordingly create pathways for their psychological, social, and economic recovery. Unfortunately, as of now, most countries do not even have gender-disaggregated data of COVID-19 cases and deaths[ii], let alone other dimensions.

Safety and security equipment; child care facilities; protection shelters and cells for victims of gender-based violence; counselling; flexible working hours; equal pay and training; and involvement of women professionals, leaders, and frontline health workers in decision making need to be kept on priority during this pandemic. Women doctors who have been unable to continue their profession during this crisis because of restrictive socio-cultural norms and practices can be encouraged to resume their practice by developing a proper mechanism and by motivating their families.

Given that women are among the frontline responders during this pandemic, both within their households and in the community, it is crucial to leverage the expertise of women and girls while also appropriately addressing their safety and unique needs. The crucial role of women in emergency response as leaders at local, regional, provincial and national levels needs to be acknowledged. This can be done by involving women-owned, managed, and led organizations, women social activists, and gender experts at all levels of emergency response and recovery decision making.

Post-emergency response should integrate all gender-sensitive and responsive, and where possible gender transformative, dimensions by including economic, social, political, and physiological needs of poor, single, divorced, and widowed women; girls; differentially abled people; and the transgender community. As stated by Kyung- wha Kang UN Assistant Secretary-General and Deputy Emergency Relief Coordinator for Humanitarian Affairs “to be effective and responsible, humanitarian programming must aspire to meet [the] distinct needs [of the various groups]. This is not only the right thing to do, but the smart thing to do”.

In addition, to improve the health sector’s ability to integrate gender perspectives, social development investments must be prioritized in long-term planning, which includes macro public health programmes and ensuring access to safe housing, water, and sanitation facilities for poor and marginalized segments of society.

Finding opportunities for transformation

Emergencies, disasters, epidemics and pandemics bring a lot of issues for the most vulnerable segments of society especially women. However, they also allow for many opportunities if we are willing to learn and change. The well-known economist Amartya Sen states that “…the world before pandemic was full of inequalities, in the past, disasters have shaped some collective efforts among countries and masses to eradicate inequalities. Therefore this pandemic can be instrumental for such a desirable change”. The current pandemic has similarly posed some serious questions regarding contemporary economic models and GDPs which never recognized unpaid care work such as child care, care for the elderly and sick, nor the agricultural and livestock management activities carried out by women. Such activities in the current pandemic are becoming the only source of sustenance for many people around the world, showing clearly that these roles of women are vital for livelihoods and well-being. As we work together to create a more prosperous post-pandemic HKH, this is a great opportunity to bring about transformation, make “visible” and give long overdue value to the roles of women. What better way to do this than by including these activities in the post-pandemic economic models and development schemes for an inclusive and equitable development?

Chanda Gurung Goodrich

Kosar Bano

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