The novel coronavirus (COVID-19) has had a devastating impact globally. Governments across East, Central and Southern Africa (ECSA) are imposing lockdowns and other restrictions, which although critical in slowing the spread of the disease, can themselves impose significant social and economic costs on millions of people, especially those living in informal settlements or overcrowded refugee and internally displaced person (IDP) camps. Most countries in ECSA have little to no prior experience in responding to such a pandemic.
The impacts – direct and indirect – of public health emergencies fall disproportionally on the most vulnerable and marginalized groups in society. Interconnected social, economic, and political factors pose complex challenges for the ECSA region’s ability to respond to COVID-19. The region already faces significant health challenges that would exacerbate the severity of COVID-19, such as high levels of malnutrition, malaria, anemia, HIV/AIDS, and tuberculosis. Access to healthcare in the region is the lowest in the world, thus there is limited capacity to absorb the pandemic.
Gender-based inequality is extensive in the region. Women are at a higher risk for exposure to infection due to the fact that they are often the primary caregivers in the family and constitute 70% of frontline healthcare responders. Most women already face limited access to sexual and reproductive health and rights (SRHR) services, and the region struggles with high levels of maternal mortality. For example, mother mortality rates recorded in South Sudan were 1150 per 100 000 live births. COVID-19 will only increase women’s safety risks and care burdens as health services become stretched and resources shift to COVID-19 responses.
Women and girls are at increased risk of violence during the COVID-19 period. Current rates of violence against women and girls combined with the prevalence of harmful traditional practices leads to increased vulnerability. Income loss and limited mobility, compounded with existing gender role expectations, may contribute to increases in intimate partner violence and other forms of gender-based violence.
Further, women are more likely to lose income as many are in the informal sector and engaging in activities that are highly sensitive to economic downturn and market disruption(such as petty trade or primary production).
With COVID-19, existing food crises will be exacerbated in the ECSA region, resulting in worsening food security and nutritional outcomes for the most vulnerable households. Given expected trajectories and historical knowledge, already high levels of hunger and malnutrition will further increase. Preparedness for the possibility of increasing food and nutrition insecurity, particularly among women, is imperative, given the likely effects of this pandemic on livelihoods, markets, and the delivery of basic health services such as maternal and child health.
The region has limited access to water and sanitation services and varying levels of knowledge, attitudes and practices with regards to environmental health and hygiene. This creates challenges and burdens for women who have the primary responsibility around water, sanitation and hygiene (WASH) at the household and community level. Furthermore, the region is host to more than five million refugees and IDPs that are living in temporary and cramped shelters. These facilities do not have adequate WASH facilities. These socioeconomic and health contexts, combined with high population densities and dependency on fresh food marketing in urban areas, makes policy recommendations such as physical distancing and quarantine difficult to implement.
Women’s care burden is likely to increase due to the closures of schools and as health systems become less accessible in the shift to COVID-19 responses.
Women are at the frontline of the response as community health workers and nurses, which places them at increased risk and exposure to infection. Risks may be exacerbated by limited access to personal protective equipment (PPE).
Access to gender-based violence (GBV)support and sexual and reproductive health services will be reduced due to restrictions in movement and resources being diverted to fight COVID-19, potentially resulting in an increase in maternal mortality and intimate partner violence.
Women’s economic and productive lives will be affected due to restriction in movement as most are engaged in informal trade, where they earn less and have no social safety nets.
Data reflects an increase in GBV. Use of the military and service personnel to enforce restrictions is likely to expose women to sexual harassment and exploitation.
Women have limited decision making in governance and policy making bodies. There has been limited engagement of women in COVID-19 decision making processes.
Gender gap in the use of technology and literacy may influence prevention, awareness and resource access.