As health organizations and national governments seek to stem the spread of COVID-19, it is critical that they understand the gender dynamics in their societies. Efforts to combat the pandemic will only go so far if women and girls are left behind in the process. For example, how can a woman experiencing domestic violence quarantine at home safely? Thankfully, global efforts to integrate women as equal partners in peace and security can provide key lessons in responding to health epidemics more inclusively and effectively.

Josephine Finda Sellu, deputy nurse matron at a government hospital, before going into the isolation area for Ebola patients, in Kenema, Sierra Leone, Aug. 20, 2014. (Samuel Aranda/The New York Times)
Josephine Finda Sellu, deputy nurse matron at a government hospital, before going into the isolation area for Ebola patients, in Kenema, Sierra Leone, Aug. 20, 2014. (Samuel Aranda/The New York Times)

The global Women, Peace and Security agenda emerged in 2000 with the adoption of U.N. Security Council Resolution 1325. It argues two main points: Responses to violent conflict must address the particular needs of women and girls and women must be equal partners in all efforts to build peace. These same principles must be applied to efforts to combat COVID-19.

Previous responses to health epidemics, like that of Ebola (2014-2016) and Zika (2015-2016) have shown that women and girls are often left out in how we both understand and respond to these crises. Because such outbreaks impact men and women differently, it is critical that the responses and the analysis after the fact take gender dynamics into consideration. Thinking through how the diversion of equipment, medications, or other resources impacts men and women differently can help prevent unnecessary deaths. In Sierra Leone, the redistribution of resources translated into 3,600 additional maternal, neonatal, and stillbirth deaths. In her book, “Invisible Women,” Caroline Criado Perez shows that in the 29 million peer-reviewed papers that were published around the time of the Ebola and Zika outbreaks, less than 1 percent discussed gender issues.

Whether it is in health epidemics or peace processes, addressing the needs of women and girls in crises is often sidelined for what are deemed “more immediate” concerns. The majority of peace agreements since 1990 failed to reference women or gender issues and the number of women who serve as negotiators, mediators, or signatories to peace processes is still staggeringly low. But, when civil society organizations, including women-led organizations, are involved in peace processes, they are 64 percent less likely to fail. Without addressing and responding to the experiences of women and girls in violent conflict, peace is not possible. The same can be said for societies seeking to successfully recover from health epidemics.

Prevention

Gender-blind responses by health organizations create potential harm or stall progress during health crises. In the 2015 Zika outbreak, WHO health professionals recommended that women practice safer sex, including the correct and consistent use of condoms, or abstain from sex for at least three months after the last possible exposure to prevent contracting the Zika virus. However, this assumes women have access to resources and agency to adopt these recommendations. Health organizations and policymakers need to account for the legal, cultural, and social factors that limit women’s autonomy in health care decisions like inadequate access to health services or insufficient financial resources. Experts note that gender-blind recommendations impede prevention and shift the burden of responding to the crisis to individuals.

As guidance evolves in response to COVID-19, governments must understand and respond to the potential harm of social distancing or self-quarantining guidance, especially for women living in unsafe environments like those exposed to domestic violence. Violence against women must be considered a critical security issue in government responses—shelters and service providers should maintain operations as essential businesses and emergency funds should be made available for organizations responding to the increased need. Beyond these measures, the French government has also established local resource centers in businesses women are still likely to frequent under national lockdown orders, like grocery stores and pharmacies.

Understanding Exposure and Treatment

Sex-disaggregated data and analyzing how the spread of a disease differs between men and women is key to understanding who is at increased exposure risk and how they respond to the disease. In the 2014 Ebola outbreak, West African women were at greater risk of contracting the disease than men because they are typically the primary caregivers, community health workers, and oversee burial practices, all of which increased risk of contracting the virus.

National governments and health organizations must consider how gender roles will contribute to the spread of COVID-19 to prepare properly. Many have cited that women make up 70 percent of the global health and social care workforce, often filling “frontline” roles such as nurses, midwives, and community health workers. Nurses and other such workers tend to be in closer, more prolonged contact with patients especially as they draw blood or take fluid samples.

Beyond exposure rates, national governments have failed to consistently collect sex-disaggregated data of infection and fatality rates. Emerging evidence suggests that more men than women are dying from COVID-19 but it is unclear why. Collecting this data is key to understanding how to respond.

Gender-Sensitive Responses

The sidelining of gender issues and women’s voices in responses to health epidemics can leave long-lasting damage. Following the Ebola epidemic, men’s income rebounded faster than women’s. Targeted gender responses can also perpetuate harmful inequalities. In Sierra Leone, a ban was enacted prohibiting pregnant girls from attending mainstream education in reaction to the crisis. This ban was put into place after a stark spike in pregnancies among school-age girls appeared toward the end of the Ebola crisis, likely due to increased vulnerability to sexual exploitation, sexual assault, and rape among teenage girls. The ban was only lifted this past March, nearly five years after the end of the crisis. This response did not address the spread of the disease nor the root drivers of increased pregnancy, rather it limited girls’ chance for education.

Moving Forward, Listen to Women

National governments and health organizations must learn from the lessons of the Women, Peace and Security agenda and integrate women into the global response against COVID-19. As discussed, women often occupy frontline positions in the healthcare workforce, making them particularly keen to identify and detect local-level trends in disease spread and response. However, only 20 percent of global health organizations have gender parity on their boards and only 25 percent have gender parity at senior management levels. While women may be best positioned to understanding the dynamics of a health epidemic, they do not hold decision-making positions. A WHO report entitled, “Delivered by Women, Led by Men” notes that health systems would be stronger if the women who deliver the services have an equal say in the design of national health plans, policies, and systems.

The lessons of the Women, Peace and Security agenda cannot be ignored. If the response to COVID-19 is to be effective, the particular vulnerabilities and experiences of women and girls need to be addressed and women must be integrated as decision-makers in the process.

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