Thinking about Gender While Responding to an Epidemic: Must Have or Nice to Have?
By Gloria Twesigye, MTaPS Senior Technical Advisor for Research and Reporting
In December 2019, WHO identified COVID-19, a novel coronavirus disease. COVID-19 has now reached pandemic status, disproportionately affecting millions globally. Lessons learned from previous disease outbreaks of other coronaviruses (MERS and SARS), Ebola, and Zika, have highlighted the lack of gender considerations in epidemic preparedness and response and its consequences. Julia Smith, Research Associate at Simon Fraser University, writes “the gender dimensions of outbreaks are both physical and socially constructed”—physical in that diseases may affect people differently based on their sex. For example, Zika infections can be passed to fetuses during pregnancy, and traces of Ebola have been found in men’s semen long after they have recovered from the disease. Gendered social constructions refer to different roles, behaviors, and attributes associated with being male or female. This can be seen in the Ebola outbreak’s effect on women who, as frequent caregivers both at home and in the health care setting, were at greater risk of exposure to the virus.
“Tyranny of the urgent” vs resilient health systems strengthening
Gender, as described in The Lancet’s series on gender inequities and health, is an underlying factor in health system functions and components (i.e., laws, policies, and guidelines; human resources; data collection; service delivery), all of which have an effect on health outcomes. However, gender considerations are often not prioritized in disease outbreaks and fall to what Davies and Bennett call the “tyranny of the urgent,” which defers “structural issues in favour of addressing immediate biomedical needs.”
After the Ebola outbreak, global health stakeholders prioritized investments in building resilient health systems—systems with the “capacity of health actors, institutions, and populations to prepare for and effectively respond to crises; maintain core functions when a crisis hits; and, [are] informed by lessons learned during the crisis.” While gender considerations have historically not been prioritized in health systems strengthening, there is growing recognition of the need to use a gender lens when thinking of the who, what, when, where, why, and how in interventions to strengthen health systems and a country’s ability to effectively respond to health crises.
Using lessons from previous outbreaks to protect health care workers today
The global and national responses to the COVID-19 pandemic may already have fallen into similar patterns as previous disease outbreaks. Smith and Wenham of the Gender and COVID-19 Working Group note that as of early March 2020, global and national COVID-19 policies had yet to reflect gender analyses or considerations. Rather than wait for another report written at the end of this pandemic, offering us what will likely be all too familiar insights into the gender aspects of COVID-19, let’s glean what we can from the current, albeit rapidly changing, epidemiology of COVID-19 and current social dynamics to apply previous lessons to the present situation.
As in previous infectious disease outbreaks, particularly Ebola, formal and informal health care workers are the first line of defense against further disease spread. Globally, women comprise 67% of health- and social-sector employment, although they are underrepresented in leadership positions, and they are the main contributors to the unpaid and informal health workforce. Even among health care workers, the risk of contact with infected patients depends on their occupation; for example, male health care workers make up the majority of physicians, dentists, and pharmacists, while females are the vast majority of nurses and midwives. Close, personal care of sick patients relies heavily on nurses and nursing assistants, thus leaving them at even higher risk among the health care workforce, particularly if there’s not enough protective equipment (i.e., masks, gloves). Furthermore, in most contexts women are the caregivers at home, contributing to further exposure during disease outbreaks. Consequently, the intersection of gender and the health care workforce must be considered to effectively respond to an epidemic.
Global health programs such as the USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program are supporting countries in strengthening their infection prevention and control (IPC) capacity to improve epidemic preparedness and response. IPC activities include patient placement, hand hygiene, and use of personal protective equipment. These activities are focused on ensuring that health care workers adhere to guidelines and procedures and prevent the spread of hospital-acquired infections that may contribute to antimicrobial resistance and the spread of disease. Implementing partners and other stakeholders assisting countries to prepare for and manage the COVID-19 outbreak should resist the tendency towards the “tyranny of the urgent” and instead integrate gender considerations into COVID-19 responses to avoid exacerbating the effects of structural gender inequalities.
Gender considerations for health care workers
The following are suggestions on how health care leaders and implementing partners can increase gender awareness in preparing for and responding to COVID-19.
Sex disaggregated data. At a minimum, programs and health facilities should collect, analyze, and report sex-disaggregated data for COVID-19-infected patients and health care workers.
Disaggregate data for COVID-19-infected health care workers by occupation. It is important to track these data, knowing that staff who provide close, personal care, such as nurses and nursing assistants, may be at higher risk of exposure and, therefore, IPC activities may need to be tailored to those roles.
Contact tracing for infected health care workers. Investigate whether a health care worker was infected at home or in a health facility. Women who are health care workers tend to be primary caregivers at home, so knowing whether infections are acquired at home or in the health care setting is key to understanding transmission patterns.
Planning to protect high-risk health care workers. Health care workers can be in the high-risk category—older than 65 years, have asthma or HIV, or be pregnant. Health facilities and implementing partners offering technical assistance should have plans in place that reduce potential exposure to high-risk health care workers while also ensuring the privacy of workers’ health information.
Nonpunitive leave for health care workers. Challenges in human resources for health vary significantly by context, particularly in low- and middle-income countries where there often is uneven capacity and high rates of absenteeism. Ideally, health care workers have paid sick leave and family leave, but that is not always the reality. At a minimum, health care workers who must take a leave of absence due to COVID-19 exposure or infection should not be punished, as this disincentive may result in people coming to work when they should stay home.
Encourage upward communication within health care settings. Clear and consistent communication with decision makers and health care leaders is essential during a crisis. Health facilities should have focal points by occupation to represent staff concerns, including issues around patient care and resource management, which should increase the voices of women and provide leaders with timely information.
Ensure that community-based best-practice communication and outreach strategies reach household caregivers. This may include going house to house to inform caregivers and their households about best practices; ensuring that information provided is in both local languages and diagram form; and, where possible, providing households with soap, clean water, and protective gear.
We are still learning, and we should expect to keep learning for the long term. Weekly and even daily, our global response to COVID-19 is adapting as new data and lessons emerge. These suggestions represent only some of the ways that COVID-19 response efforts can begin using a gender lens during times of epidemic preparation and response. It is essential that we not only recognize the need to increase gender considerations for health care workers but apply them going forward.
Useful commentaries on gender and COVID-19
● How Will COVID-19 Affect Women and Girls in Low- and Middle-Income Countries? Center for Global Development.
● The COVID-19 Outbreak: Potential Fallout for Sexual and Reproductive Health and Rights.Guttmacher Institute.
● The Coronavirus Is a Disaster for Feminism. The Atlantic.
● Coronavirus: Five ways virus upheaval is hitting women in Asia. BBC News.
This blog was written by Gloria Twesigye, Senior Technical Advisor for Research and Reporting, MTaPS, with contributions from Carol Tyroler (Senior Gender and Research Advisor for Overseas Strategic Consulting, Ltd.), Luis Ortiz Echevarria (MSH), and Tamara Hafner (MSH). The blog was adapted from a version previously published on MSH’s LeaderNet platform.