key: cord-274027-ovdhnajp
authors: Gyasi, Razak M.; Anderson, Eugenia A.
title: Rethinking the Gendered Dimensions in the Impacts and Response to COVID-19 Pandemic
date: 2020-06-11
journal: nan
DOI: 10.1016/j.puhip.2020.100019
sha: 
doc_id: 274027
cord_uid: ovdhnajp

Abstract The outbreak of the novel coronavirus disease 2019 (COVID-19) has demonstrated the urgency to rethink the health system quality to efficiently support and improve global health. Whilst efforts are now gathering pace in response to the deleterious impacts of COVID-19, gendered analysis of these impacts and response to the pandemic has been far too little. A critical consideration of gendered lenses and the respective brunt of health crises of the pandemic on men and women can improve our understanding and direction of efforts toward building robust and equitable public health response. Strategic plans for preparedness must be fully grounded in strong gender analysis in the remit of gender roles and norms, and strengthen the leadership and resourceful participation of women in the decision-making process toward addressing COVID-19 outbreak.

In almost all global regions and countries, COVID-19 caused by a novel coronavirus SARS-CoV-2 is causing exceptional health, societal behavior and socioeconomic crises. International and respective national endeavors are now gathering pace in response to the deleterious impacts of COVID-19. 1 ,2 Yet, the global effort to unravel the gendered impacts and perspectives in response to COVID-19 has been far too little.

There is currently a dearth of knowledge about the gendered dimension in the impact and response to COVID-19 particularly in sub-Saharan African countries.

International politics and health authorities charged to convey the information on COVID-19 such as the etiology, diffusion, and the susceptibility of different population cohorts could maximize efforts by gauging the gender implication of the pandemic.

Specifically, taking into account the gendered sensitivities and the respective brunt of health crises of the outbreak on men and women can improve our understanding and direction of efforts toward building robust and equitable public health response. Lessons learnt from past epidemics such as Ebola and Zika 3 suggest the need for critical gender analyses in response strategies to enhance the efficacy of health and policy interventions for COVID-19.

At the moment, COVID-19 is indiscriminately ravaging men and women of any age group. Some demographic data from various geographic regions depict certain diversities in the severity of the infection. However, the evidence on gender disparities of COVID-19 infections is highly mixed. What we do know, however, is that like adults 60 years or over, men are more likely to die from the pandemic. 4 COVID-19 thrives on people with comorbidities including older people with such conditions as cardiovascular disease, chronic respiratory and pulmonary disease, and active cancers. These chronic conditions are disproportionately prevalent in men compared to women. Key evidence also points to the sex-induced immunology. 5 Sex hormones differ between men and women and are involved in the way the immune system triggers an inflammatory response to pathogens. 6 Men have lower innate antiviral immune responses to a range of infections including hepatitis C and HIV. 7 Studies in mice suggest that this may also be true for coronaviruses, though specific evidence on COVID-19 is lacking. Lifestyle choices such as harmful drinking, excessive smoking 8 as well as sociocultural attitudes, masculine norms, and stoic-induced reluctance to seek help 9 could potentially predispose men to COVID-19-related vulnerabilities such as infection and mortality. It should be recognized that the curve of the outbreak is yet to be flattened. Hence, it is early days yet to propose a gender-based hypothesis for COVID-19 fatalities.

Estimates indicate that over 70% of health care workforce globally are women and are on the frontlines of the COVID-19 response, potentially placing them at a greater risk of the infection. 10 Crucially, an average gender pay gap of about 28% may aggravate the vulnerability of women in times of crises such as an outbreak of an epidemic. Many preventive protocols of COVID-19 including various levels of lockdown, physical and social distancing, market closure, and travel restrictions unleash a greater burden on women who predominantly provide informal familial caregiving and support.

This may limit their opportunities in resilience and economic empowerment. This is particularly problematic in low-income settings especially in Africa where women dominate the informal economic sector. In many African countries such as Ghana, Nigeria, and Kenya, there is a growing concern of heightened domestic violence against women as a result of lockdown. These may not only present serious psychological, wellbeing, and human rights implications for women but household management, support, and caregiving for older people and children could also be under siege.

Evidence from the Zika and Ebola outbreaks in East Africa and West Africa respectively indicate that women had limited decision making power for epidemics. 11, 12 It was also evident that most women experienced unmet care needs 3 because social and health resources were mostly diverted from routine health services such as reproductive health services and sanitary needs to emergency response deliveries. 13 Coupled with poor access to socio-economic resources, these circumstances deepened the inequalities and hardship for women. With previous experiences, would the COVID-19 outbreak further segregate the gender inequities in impacts and response strategies?

In the publication of the strengthening preparedness for health emergencies, the WHO Executive Board advocated for the inclusion and full representation of women in the decision making process at international and national levels during outbreaks. 14 However, not much has been done to involve women in preparedness and response to COVID-19 pandemic particularly sub-Saharan Africa countries which have been rated as vulnerable to exposing huge populations to COVID-19 and a moderate capacity to control the outbreak. 15 Indeed, the capacity of sub-Saharan African countries to provide sufficient infrastructure, personnel, and clinical care to support people with COVID-19 has been questioned vehemently 4 .

Global public health security is a shared responsibility that requires a collaborative and all-inclusive response. The effectiveness in the fight against the COVID-19 outbreak will largely depend upon gaining a deeper understanding of the gendered dynamics and the mechanisms that may correlate the diversity and susceptibility to the infection of the virus and management modalities among gender groups. We propose to the global health organizations, national political forces, and policymakers to conspicuously include gendered sensitivities in the analysis of impacts and response to COVID-19 pandemic. Strategic plans for preparedness must be fully grounded in strong gender analysis in the remit of gender roles and norms, and strengthen the leadership and resourceful participation of women in the decision-making process toward addressing COVID-19 outbreak.

There is no any funding source.

RMG and EAA developed the concept, wrote and revised the manuscript. All authors approved the final manuscript

None

Bearing the brunt of covid-19: older people in low and middle income countries: A global expert group on older people might be useful

Emergency Committee regarding the outbreak of novel coronavirus (COVID-19). The World Health Organization

Ebola, gender and conspicuously invisible women in global health governance

Fighting COVID-19: Fear and internal conflict among older adults in Ghana

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Sex Hormones and Gender Role Relate to Gray Matter Volumes in Sexually Dimorphic Brain Areas

Sex Drives Dimorphic Immune Responses to Viral Infections

Prevalence and patterns of tobacco smoking among Chinese adult men and women: findings of the 2010 national smoking survey

Explaining the gender gap in health services use in Ghanaian community-dwelling older cohorts

Gender equity in the health work force: Analysis of 104 countries

Serological evidence of Flavivirus circulation in human populations in Northern Kenya: an assessment of disease risk 2016-2017

A gendered human rights analysis of Ebola and Zika: locating gender in global health emergencies

Overcoming the 'tyranny of the urgent': integrating gender into disease outbreak preparedness and response

Executive Board EB146/Conf/17: strengthening preparedness for health emergencies; implementation of International Health Regulations

Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study

None