Eloho Ese Basikoro
Current COVID-19 global trends show that men, compared to women, are at a higher risk of experiencing the disease’s severity and death. This trend may change if we consider gendered patterns in previous pandemics that are underpinned by inequalities which produce and increase vulnerability for women. Although the COVID-19 pandemic is still unraveling and with many unknowns, it is possible to predict gender trends and impact based on previous disease outbreaks like HIV/AIDS.
Like many global pandemics, COVID-19 amplifies existing structural inequities at the global and national levels, and at other scales of human existence. When pandemics occur, besides biological factors, risks and transmission move along class, socioeconomic and gender lines but with increased vulnerability for marginalized populations such as women. Although it is too early in the pandemic to produce a detailed assessment and analysis of gender as it shapes the risks and impact of COVID-19, already, there is a noticeable gendered pattern in COVID-19 mortality rates.
COVID-19 global trends show a deepening disparity along gender lines. Preliminary evidence for 36 countries shows that men are more than 50% more likely to die from COVID-19 compared to women. Men are also more likely to get severely sick from COVID-19 (Global Health 5050, 2020). Although there is no definitive explanation for this trend, preliminary analysis shows that biological and genetic factors, in addition to behavioral factors such as smoking increase men’s vulnerability and mortality given that COVID-19 is primarily a respiratory illness (Wenham et al., 2020). Ostensibly, at this time, women may have a comparative advantage in terms of the risks of morbidity and mortality from COVID-19 but this may change due to socioeconomic factors and other inequalities that place women at risk even when their biological susceptibility may be low. In Germany, for example, the Brookings Institute reports that most confirmed cases in the early phase of the COVID-19 outbreak were males but this changed in a short time, with females now comprising a majority of cases in the country (Ravi & Kapoor, 2020).
In taking a cue from history, at the beginning of the HIV/AIDS pandemic, men (albeit, gay and bisexual) were the face of the pandemic especially in the U.S. where testing capability facilitated the exposure of a large number of seropositive cases among this population. Overtime, the demographics of infected and at-risk persons metamorphosed with women increasingly impacted due to a plethora of socioeconomic, cultural, and political factors. The HIV/AIDS pandemic became feminized especially in societies where gender inequalities are rife. With the COVID-19 pandemic, we cannot afford to play catch-up like we did in the HIV/AIDS pandemic. We must proactively protect women and other vulnerable populations. Gender considerations must be mainstreamed early into the COVID-19 public health response to understand not only the current observed male-gendered pattern but also predict potential risks and impact on women, who by existing gender inequalities, are already a vulnerable population.
COVID-19 epidemiological trends, although indicate increased vulnerability for men, have implications for women; even though, biologically, women’s risk may be low. By default, women are usually at the forefront of pandemics whether as health care workers or as caregivers in the private domain of the household because the responsibility to care for the sick primarily falls on them. From historic to contemporary times, women have performed unpaid care labor, especially in the domestic or private realm, that has gone mostly unrecognized or devalued because the practice of care is perceived as natural or intrinsic to women’s being. Consequently, the dire conditions in which women sometimes perform care work are mostly unrecognized in both development and public health discourses (Basikoro, 2020).
Health care workers have been at the frontlines of the COVID-19 pandemic but the majority of health workers are women. A recent World Health Organization (WHO) report claims that women constitute 70% of workers in the health and social sector (Boniol et al., 2019). A common explanation for this is the normative association of caregiving with women in many spatial contexts. Like in every pandemic, caregiving is an intrinsic part of the COVID-19 medical response, whether this is in formal health care facilities, or in the homes of infected patients. However, public health measures usually fail to actively take into consideration, women’s caregiving roles through home-based care and formal health care work, and the ways these constitute risk for women and members of their household, as well as the implication for mitigation measures.
Presently, there are isolation centers in Nigeria where infected people may isolate or quarantine. However, global projections for COVID-19 may mean that these centers may get overwhelmed pretty quickly and infected individuals may be forced to quarantine at home like in other countries. In other words, a majority of COVID-19 cases will have to be treated at home. In both the public and private domains, therefore, the rising rates of COVID-19 will increase women’s caregiving burden. In the context of pandemics, women mediate care between their spouses and children at the household level, and this increases their risk of infection. In cases where a spouse or the head of a household is infected, the burden to care for the man is on the woman. This does not only place the woman at risk of infection but also the children.
Women’s care burdens are exacerbated when they are infected because they must care for themselves while they continue their caregiving roles. In the public domain, women who constitute the majority of health workers will face an increasing care burden. Already, some isolation centers in Nigeria request their health care staff to live in the facility to treat COVID-19 patients. What does this mean for female health care workers who must continue to cater for the families that they left at home?
Nigeria has been fortunate to lag behind other countries like the U.S. and Italy in the numbers of COVID-19 cases (excluding low-testing capability as a probable factor) but the country must leverage on this supposed advantage to plan proactively; taking into consideration, COVID-19 trends and patterns, and lessons from other countries, to formulate an effective gender response.
Current COVID-19 epidemiological trends may not show a direct impact for women but this may change if gender considerations are not centralized in potential interventions. It is well-documented that stress compromises immune systems and increases the susceptibility of people, who were otherwise, less prone to infections.
Women must thus be recognised as being on the frontlines of this pandemic not just because they make up a majority of the health workforce but because, even at the household level, they bear the burden of care. An effective COVID-19 response cannot exclude gender considerations if it must successfully mitigate transmission and the adverse impact of the disease at all levels.
While the inequities that circumscribe women’s caregiving must be challenged at all levels, if women must perform care to others at the private and public domains, they must be empowered to do so and in ways that not only reduce their exposure and risk of transmission but engender health equity for them.
The recent COVID-19 palliative care package that was rolled out by the Nigerian government, although lacked a gendered dimension, future plans and programs must mainstream gender because gender is pervasive and impacts everyday life including health. Looking at the COVID-19 pandemic from a feminist and care ethics lens will help in both prevention and treatment efforts, and promote health equity for women.
References
Basikoro, E. E. (2020). Pathologies of patriarchy: Death, suffering, care and coping in the gendered gaps
of HIV/AIDS interventions in Nigeria. London, UK: Rowman and Littlefield International.
Boniol, M., McIsaac, M., Xu, L., Wuliji, T., Diallo, K., & Campbell, J. (2019). Gender equity in the health
workforce: Analysis of 104 countries (Working Paper 1). Geneva, Switzerland: World Health Organization. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/311314/WHO-HIS-HWF-Gender-WP1-2019.1-eng.pdf
Global Health 5050. (2020). COVID-19 sex-disaggregated data tracker: Sex, gender and COVID-19.
Retrieved from http://globalhealth5050.org/covid19/
Ravi, S., & Kapoor, M. (2020). COVID-19 trends from Germany show different impacts by
gender and age. The Brookings Institute. Retrieved from https://www.brookings.edu/blog/techtank/2020/05/01/covid-19-trends-from-germany-show-different-impacts-by-gender-and-age/
Wenham, C., Smith, J., & Morgan, R., on behalf of the Gender and COVID-19 Working Group. (2020).
COVID-19: The gendered impacts of the outbreak. The Lancet, 395 (10227), 846-848.
About the contributor
Basikoro (PhD) is the author of Pathologies of patriarchy: Death, suffering, care and coping in the gendered gaps of HIV/AIDS interventions in Nigeria. She is a Research and International Development Consultant, and the Founder and President of BATOP Research and Consulting Services. Dr. Basikoro is based in Maryland, USA.
