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Infectious disease outbreaks highlight gender inequity

In COVID-19, the world faces its biggest global crisis for decades. Gender may not be at the forefront of people’s minds, but it should not be ignored. Pandemics are not gender-neutral and gender-informed responses can improve how infectious disease outbreaks are tackled.

The measures put in place to combat COVID-19 in many parts of the globe are unprecedented. They include the closure of schools, childcare facilities and businesses, travel restrictions, self-isolation, and quarantine in many states. These actions will affect women and men, girls and boys, differently1. Governments should bear these differences in mind in their response strategies, including in public messaging and reporting protocols. This could help to increase resilience and aid recovery from the pandemic.

In a 2019 research report, we argued that applying a gender lens to biosecurity threats can contribute to States’ preparedness for, and rapid recovery from, biological incidents. Our paper was focused on the gendered impacts of biological weapons – and there is no credible evidence to suggest that COVID-19 is a biological weapon. Nonetheless, as part of the study, we analyzed past Ebola, SARS and other natural disease outbreaks to better understand their gendered impacts. As we grapple with the spread of COVID-19, it’s worth revisiting those research findings.

Understanding how gender norms structure societies can help to uncover different patterns of exposure between men and women, boys and girls. For example, in many parts of the world women operate as the primary caregivers in both domestic settings and professionally, where women make up more than 80 percent of the nursing and midwifery global workforce. This can leave women at greater risk of exposure to pathogens. This was evident during the 2014-2016 Ebola outbreak in West Africa. Women there were in many cases primarily responsible for caring for the sick and performing burial practices. This trend, in part, explains the disproportionate number of female Ebola cases in countries, such as Guinea and Liberia.

Uneven access to information can compound gendered differences in patterns of exposure. Research into Ebola suggests that, in some cultures, differences in opportunities for formal education were among the causes of the deadly disease’s spread. So was the exclusion of women from meetings at which Ebola responses were considered. This can create a situation in which those most at risk of exposure to infectious disease are denied access to critical information on good practices to minimize the risk of infection. Addressing this challenge requires consideration of cultural factors, specifically how to overcome gendered communication barriers to get health messages through to key actors, such as primary caregivers.

Our findings are backed by wider research highlighting gendered patterns of engagement with health care8 across different cultures. Various factors affect health care engagement, such as the distribution of power and resources at different levels of society. The perceived stigma of having a disease is another, under-appreciated factor, and something which is also gendered in certain societies. For example, with Tuberculosis evidence from South Asia, Africa, and Vietnam suggests that the potential for stigmatization affects women’s help-seeking more than men and is linked to fears of contagion and social isolation”. As recent articles on COVID-19 demonstrate, the fear of stigmatization can dissuade people from seeking medical assistance and reporting cases of infection. In turn, this can affect monitoring and response strategies. As such, means to counter and minimize stigma need to be considered, particularly through public health messaging.

Disease outbreaks can have serious psychological effects. COVID-19 will be no exception. For example, one study of Ebola reported “profound psychosocial implications at individual, community and international levels”. Research into the long-term impact of the outbreak of Middle East respiratory syndrome (MERS), which is from the same family of coronaviruses as COVID-19 and SARS, suggested that MERS survivors have a high chance of adverse psychiatric consequences, even after their recovery. Indeed, almost two-thirds of survivors suffered from significant psychiatric problems, including post-traumatic symptoms, sleep problems, anxiety, and depression. Post-traumatic stress disorder (PTSD) affects women and men, boys and girls – but not necessarily equally. Responding to gendered differences in coping style, might, therefore, aid societal recovery in the long term.

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