Interim Guidance: Gender alert for COVID-19 outbreak, March 2020

Manual and Guideline
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On March 11, 2020, the WHO declared that the COVID-19 outbreak is a pandemic. 1 Particular concern, in humanitarian terms, must be for populations in high-risk settings, such as camps, poor high-density population areas and contexts with weak health care service provision, WASH facilities, and social protection settings.

Recognizing the extent to which the COVID-19 outbreaks affects women and men differently is hugely important. Some preliminary data suggested that more men than women are dying, potentially due to sex-based immunological differences, higher rates of cardiovascular disease for men and lifestyle choices, such as smoking. However, the experiences and lessons learned from the Zika and Ebola outbreaks and the HIV pandemic demonstrate that robust gender analysis and informed, gender-integrated response are vital to strengthen the access and acceptability of the humanitarian services needed to meet the distinct needs of women and girls, as well as men and boy and LGBTI people.

Gender norms and pre-existing inequalities disproportionately impact women and girls in emergencies, including health emergencies. Gender, together with other factors including age, sexual orientation and gender identity, ethnicity, disability, education, employment, and geographical location may intersect to further compound individual experiences in emergencies. In the COVID-19 health emergency, a number of gendered impacts have emerged, including:

  • Women are more likely to be front-line health workers (globally, 70% of workers in the health sector are women2 ) or health facility service-staff (e.g. cleaners, laundry) and as such they are more likely to be exposed to the virus and dealing with enormous stress balancing paid and unpaid work roles.
  • Women may have limited access to accurate, official information and public service announcements, due to limited access to public spaces, and group gatherings (e.g. through safe spaces) and outreach activities. This can contribute to increased risk of infection, as well as increased stress and protection risks.
  • In most locations, norms dictate that women and girls are the main caretakers of the household. This can mean giving up work to care for children out of school and/or sick household members, impacting their levels of income and heightening exposure to the virus.
  • Women are also more likely to be engaged in short-term, part-time and other precarious employments/ contracts, which offer poorer social insurance, pension, and health insurance schemes, and are particularly at risk in an economic downturn. This can lead to women engaging in risky coping strategies, such as transactional sex and/or heighten their exposure to risks of sexual exploitation and abuse and other forms of gender-based violence (GBV).
  • Overwhelmed health services, reduced mobility and diverted funding will likely hamper women and girl’s access to health services, including sexual and reproductive health, GBV survivor care, HIV/AIDS treatment and attended childbirth and other natal services, exacerbating preventable maternal deaths, 507 of which occur every day from complications of pregnancy and childbirth in emergencies.
  • Given that pregnant women are more likely to have contact with health services (antenatal care and delivery), they experience greater exposure to infections in health facilities, which may discourage attendance.
  • This also applies to older women and men who will continue to access health facilities for their pre-existing conditions, adding to their virus exposure risk.
  • Furthermore, disruptions in the supply chain and overwhelmed health services may limit access to family planning services and to modern contraceptives, potentially leading to a rise in unwanted pregnancies and unsafe abortions, leading causes of maternal mortality, and the socio-economic impact that they have on individuals, households and communities.
  • During the COVID-19 outbreak, strategies such as ‘shelter-in-place’ and other movement restrictions, combined with fear, tension and stress, may place women and girls and LGBTI people, especially in non-accepting households, at heightened risk as they are confined with their abusers.
  • School closures, social distancing and containment strategies will impact girls and boys differently, especially adolescent girls who due to gender roles may be expected to take on care duties, limiting their access to remote learning programmes. As such, the provision of remote learning must be designed to meet the needs of all children and youth and take into account and overcome the digital gender divide.
  • Livelihood concerns will also present new, gendered risks of exploitation, abuse and violence for women and children, as well as exacerbate existing ones.
  • Health crises can trigger economic crises and as the majority of rural women work in the informal economy – i.e. in low-paying, insecure jobs – they can face dramatic declines in incomes and livelihoods security. Rural women lack access to information and may be more affected, in places with more female health workers and where women are the primary care providers within households.
  • Rural women are often excluded from decision-making and leadership roles in preparing response and mitigation strategies.
  • Travel restrictions and closures of small agricultural enterprises may reduce the availability of employment opportunities for millions of small-scale traders, who are often predominantly women.
  • Travel restrictions and self-isolation may also impact migrant workers, predominantly women, often without passports/identity documents, and/or financially dependent on jobs which may put them at particular risks. Due to the power imbalance, women migrant domestic workers may be demanded by their employers to do tasks outside of the house, including shopping and running errands, that puts them at particular risk of infection. The impact on remittances of women domestic migrant workers, on which their families rely, will also likely be impacted, with far-reaching implications.

In addition, there is also a clear preponderance of cases and fatalities amongst the older sections of affected populations, and as with women and girls, the needs, rights and contributions of older people in emergencies are often neglected. Their susceptibility to the virus is exasperated by pre-existing conditions, more prevalent in older people, which compromise patients’ immune systems. Reduction in the mobility of older people can potentially lead to their isolation and neglect due to their lack of visibility. Moreover, older women are more likely to have lower or no pensions and live in poverty, a manifestation of life-long inequality and discrimination. This may in turn exacerbate the impact of the virus, their meaningful participation and access to protective items, food, water, information and health services, as well as measures taken in response to the virus such as self-isolation.