It all started with a mysterious disease, and soon the new coronavirus was identified as SARS-CoV-2. The crisis has turned into a global recession as countries around the world shut down their economies to slow the spread of the virus. By April, the United Nations had warned of a spin-off crisis triggered by the outbreak: violence against women was taking place behind closed doors, becoming a “ghost plague”.
By Melinda Gates
History has shown that outbreaks of disease, from AIDS and Zika to Ebola, have a certain frightening predictability: in the course of transmission, the disease is exposed and increases the level of marginalization of vulnerable groups that have been neglected because of gender, race, caste and class. It’s no coincidence, for example, that african-Americans in the United States have disproportionately high mortality from new crown infections, whether it’s a cytokine storm in the lungs or a police officer’s knee that is crushed around his neck, and the root cause is systemic racism.
Every day, new examples show that women are lagging behind in the world’s response to pandemics. Some women who are giving birth are turned away from overburdened hospitals; household workers lose income that cannot be covered by stimulus money; and girls cannot continue to receive online education because their communities frown when they see women holding mobile phones in their hands.
Female health care workers take to the streets to protest / Redux
“Gender blindness is not gender neutral” is the slogan of women’s rights advocates. At this critical juncture, this slogan must also become an initiative for action. Policymakers are at risk of prolonging the crisis and slowing economic recovery if they ignore the outbreak and its differential impact on both men and women. But if they use this opportunity to make changes that replace the old systemwith with new, better systems, countries can rebuild prosperity, be more prepared and more equal.
By almost all indicators, February 2014 was the safest pregnancy in Sierra Leone’s history. The country’s health system has been one of the worst in the world, but since 1990 maternal mortality has fallen by more than 50 per cent and some level of antenatal care has reached almost the entire country. In March of that year, the World Health Organization declared an Ebola outbreak in the region, and previous progress began to unravel. By November, you can respond to the disaster with two terrible mirror-mirror curves: one showing an exponential increase in Ebola cases, and the other showing a significant drop in the number of pregnant women in care.
By the end of the outbreak, the number of uncounted female and newborn deaths was higher than the official figure: 3,589 people in Sierra Leone died directly from the Ebola virus, and the number of new newborns and mothers dying during childbirth was between 3,593 and 4936.
This is the destructive power of infectious diseases, which not only destroy the immune system, but also destroy the health system. Because the sectors used in the care of women in the health system are often the most vulnerable and least financially funded, they will collapse the first fastest. Early data show that in low- and middle-income countries, as many as 113,000 women will be killed as a result of the decline in maternal care during the new crown outbreak.
Maternal and reproductive health must be considered a “necessary” service for every woman in every country.
Fortunately, there is still time to avoid such an outcome. Maternal and reproductive health must be considered a “necessary” service for every woman in every country. Even during an epidemic, we don’t say to a heart attack person that you don’t have to go to the emergency department. However, the message to millions of mothers in the crisis is that you can give birth at home alone. This is not right. During the 2014 Ebola outbreak, the biggest driver of maternal deaths was the increasing number of women giving birth without medical assistance. Health ministers need to find ways to ensure that safe maternity care is available even in an outbreak. In some countries, this may mean the provision of independent health facilities, especially for mothers and newborns who are not infected with the new crown, and specifically for the treatment of patients with new crowns. Elsewhere, it may be easier and safer to pass on the expertise of the clinic to mothers.
Protecting the contraceptive supply chain is also crucial. Preliminary estimates suggest that the outbreak will result in an additional 49 million women without access to contraceptives and, as a result, 15 million women from unwanted pregnancies. The international community should bear part of the responsibility for addressing this problem. A small number of countries produce the main active ingredients in most common contraceptives, which they have been stocking up on since the outbreak — even if there is no evidence of a shortage. This is not only a ruthless trade policy, but also meaningless.
Health systems are more than just a supply chain network or a package of basic services. It is a system of people. Front-line health workers need tools to keep themselves safe. Ultimately, make sure they get the new crown vaccine first. However, for the time being, they need to be provided with appropriate personal protective equipment. Although 70 per cent of the world’s health workers are women, personal protective equipment sent to hospitals and clinics is usually designed for men. Manufacturers should ensure that they produce enough personal protective equipment to meet people’s needs, while health systems should ensure adequate procurement.
Leaders should also use the outbreak as a mandatory mechanism to integrate women’s health care. In many low-income countries, how women receive care is still determined by a random schedule: Monday, vaccination; Tuesday, prenatal care. Wednesday, Planned Parenthood. Instead of seeing an appointment, the woman goes to the clinic at the same time as other people who need service, spends the day waiting for her turn to see the clinic, and then repeats the process the next morning. This time-phased approach has never made sense. And during a pandemic, no one should spend unnecessary time in a crowded waiting area, which is even less feasible.
Women at work
If health policy makers had to choose a place that best reflected the disproportionate impact of the 2014 Ebola outbreak on women, they might all point to – maternity wards. Economists, however, may give a very different answer: food stalls.
A few weeks after the Ebola outbreak subsided, Oxfam International and UN Women investigated the economic impact of the outbreak on the region. They found that the virus has nearly tripled unemployment rates for both men and women in Liberia. However, men’s incometends to rebound quickly, while women’s income takes longer to recover. Most women are self-employed, many of them selling food on the street, and when a deadly virus spreads, no one wants to “eat on the street”.
The impact of the new crown outbreak on women’s livelihoods is also far greater than on men. Early estimates suggest that women are 1.8 times more likely to be cut jobs worldwide during the recession than men. In addition, women’s rights to paid work are disappearing, while the burden of unpaid work, such as child-care and family members, is rising sharply. Before the outbreak, unpaid work was a major obstacle to women’s economic equality. Now, as many schools close and the health system is overwhelmed, more women may be forced to leave their jobs altogether.
If the pandemic hinders the progress of gender equality, the cost will be trillions of dollars: it will take even four years to take new initiatives such as women’s digital finance and inclusive finance to improve gender equality, which will cost $5 trillion in global GDP by 2030. As policymakers strive to protect and rebuild the economy, their responses must take into account the disproportionate impact of the new crown epidemic on women and the unique role that women must play in mitigating the effects of the pandemic.
Take the food system, for example. This year, more than 100 million people may need emergency food aid as a result of a series of disasters: global warming, locust plagues, pandemics and so on. (The core problem is not food shortages, but the family’s ability to pay.) This is particularly true for women. First, many women depend on food systems for their livelihoods. Second, cultural norms in some places require women to be the last to eat at home. As a result, food shortages often affect women first. Social security schemes should therefore ensure that women can afford enough nutritious food to feed their entire family. Policymakers can also support women farmers by expanding insurance, savings and other financial instruments to protect them from the worst effects of the outbreak, while empowering them to withstand the next shock that is inevitable.
Economically marginalized women are often overlooked by the government
Another way to ensure that the basic needs of the family are met is to design the distribution of emergency cash assistance tailored to the reality of women. Although measures to slow the spread of the epidemic have hampered the flow of goods and services around the world, the World Bank estimates that more than 1 billion people have received new crown-related cash subsidies from their governments since the crisis began to help them meet their basic needs. The most economically marginalized women are often overlooked by the government: they are less likely to be on tax lists, may lack identification, have no mobile phone, and therefore may miss out on these benefits. Studies have shown that gender-sensitive social security schemes exacerbate existing inequalities. However, cleverly designed cash transfers can yield significant benefits. A 2019 study in India found that by depositing cash benefits into a woman’s account, rather than her husband’s, and telling her how to use it, women’s labour force participation rate increased.
A Cambodian woman / IIE supported by a women’s livelihood bond
Policymakers can also direct money from stimulus packages to women-run businesses. Sometimes sexism is hidden in obscure terms. “For example, because women tend to be small and immature in their businesses, they may not be able to obtain government loans or procurement plans that require companies to meet certain capitalization requirements.” Governments could follow Canada’s lead in ensuring that women business owners enjoyed specific preferences. Others have wisely directed more money to industries with a high proportion of women, Argentina is buying masks from family workshops, and Burkina Faso has eliminated utility fees for fruit and vegetable vendors.
The preferential policies for women also depend on their equal access to mobile phones. Mobile phones are increasingly becoming the main tools for commodity trading, information interaction, discussion of important issues and mobile banking. But in low- and middle-income countries, women have 10 percent less mobile phone ownership than men, and 313 million fewer women use the mobile Internet than men. The result is a vicious circle: gender inequality leads to digital inequality, which in turn exacerbates gender inequality. To break this vicious cycle, Governments can refer to the practices of Kenya and Bangladesh, which provide mobile phones and mobile mobile bags with special pricing and outreach programmes for women’s needs.
Finally, we must recognize, reduce and redistribute women’s unpaid work. There is a worldwide view that women should spend hours a day cooking, cleaning and caring for their families in order to keep their families running without being paid. The unequal distribution of unpaid work deprives women of their rights, hurts the economy and slows the post-epidemic economic recovery. Globally, every two hours of extra unpaid care for women leads to a 10 per cent reduction in female labour force participation. Governments can ensure that this work is valued through policies that include paid leave for working parents and investment in infrastructure that reduces the length of unpaid work, such as electricity and running water. Employers can also help, such as providing flexible working hours for employees, providing remote work opportunities whenever possible, and providing childcare for employees who must work on site. All of these policies should apply to both men and women in order to subvert, rather than reinforce, gender bias.
Listen to the experts.
“Listen to the experts” – that’s a phrase that has been said since the outbreak. Whether wearing a mask or closing a restaurant, the outbreak is under control when people follow the advice of the public health department. And scientists are not the only group we need to listen to. Looking back at the recommendations mentioned in this article, almost all of them are about recognizing our blind spots and asking new questions: Who would have their original responsibilities if health workers were to be deployed to treat new patients? Does the economic data that drives our nation’s anti-epidemic decisions also reflect a woman’s perspective? Should domestic violence shelters be kept open as “basic services” during the outbreak? Questions like this are more likely to be asked only when women are present.
Most countries have men in their leaders. About three-quarters of national legislators are also men. Some of these male leaders are indeed advocates for gender equality (such as South Africa’s president, Cyril Ramaphosa, who, even during the outbreak, has been calling attention to gender-based violence). All of these leaders must now ensure that women are able to participate in decision-making related to the response to the outbreak.
The new crown outbreak has triggered a surge in blue ribbon committees, “kitchen cabinets” and other ad hoc bodies. These agencies are helping to make decisions ranging from when to restart the economy to how vaccines will be distributed. Women, especially those from different backgrounds, need to be represented equally in all these dialogues. Governments should work with grass-roots organizations that focus on women’s rights outside traditional decision-making channels. The deep understanding of marginalized groups by these organizations helps the Government’s anti-epidemic measures to leave no woman behind. Some governments have realized that these groups are important partners in the fight against the epidemic. In India, thousands of members of women’s grassroots organizations had produced more than 100 million masks, 200,000 protective clothing and 300,000 litres of sanitized hand sanitizer by early May.
This will be the key to our complete exit from the epidemic: the recognition that women are not only victims of a broken world, they can also be the builders of a better world.