Gender dimensions of the Covid-19 pandemic

The Covid-19 pandemic is raging through countries and affecting people from all walks of life.  

However, gendered analyses and sex disaggregated data of Covid-19 is important to understand its differential impact on women and men and hence prepare appropriate interventions.

The number of confirmed cases and deaths around the world are constantly evolving, and there have been millions of infections and hundreds of thousands of deaths.

Many countries, however, do not aggregate their data by sex, so it is difficult to portray a clear picture of the gendered dimension.

According to a report published by WHO, the ratio of men and women among the overall confirmed cases were 1.03:1 but women represented more infections among 20-29 years and 80 plus years age groups.

Interestingly, the ratio changed to 0.85:1 when it was calculated excluding USA, Germany and Italy, meaning that there were more women being infected in general.

However, it was observed that every country has different situations and that the gendered impact of Covid-19 is not so linear.

The trend shows that global infection rates are more or less balancing between men and women although there are some country specific variations, but death rate has been higher among men compared to women.

According to an article published in Nature Immunology, the average male death rate across 38 countries is 1.7 times higher than the average female death rate.

Even though data is still evolving, scientists and researchers have made a number of attempts to answer the causes of sex differentials from biological and socio-cultural point of view.

Information so far has largely revealed that men are more at risk of getting SARS-Cov-2 (Severe Acute Respiratory Syndrome Coronavirus-2) infection than women.

The reasons indicated for the sex-based differentials are pathobiology, immunology and life-style factors.

Various studies are supporting the hypothesis that higher expression of ACE 2 (Angiotensin-Converting Enzyme 2) which works as the receptor for SARS-Cov-2 are more common in men than women.

It is also hypothesised that androgens hormones, which are also more common among men, could increase expression of this spike protein.

Higher use of tobacco also makes men more vulnerable to being infected with Covid-19. In another study, the ACE2 expression was found to be significantly predominant in Asian men who smoke.

Hypertension, diabetes, cardiovascular disease, and respiratory diseases are comorbidities found in Covid-19 cases and these are also more common in men than women.

In Wuhan, during the early stages of the outbreak, it was found that even though there was an equal number of men and women patients, most of the critically ill patients (67 percent) were men.

Pre-existing medical complications make a person more vulnerable to this infection and men are more prone to have life-style related complications.

From an immuno-pathological perspective, pregnant women are also more vulnerable than the general population.

During pregnancy, women's weak immune responses can make them more susceptible to respiratory pathogens and contracting this disease can be fatal for both mother and baby.

Globally, health care frontliners have been hit hard by the coronavirus pandemic.

According to a report published in The New York Times, nearly 78 percent of healthcare workers in the US are women and in China's Hubei Province, where the Covid-19 outbreak originated, 90 percent of healthcare workers are women.

Limited access to treatment and care also make female health workers more vulnerable.

Even though most frontline health workers are women, they have less decision-making power due to hierarchical and patriarchal nature of workplaces.

Financially, women and men might suffer differently from the capitalist crash due to Covid-19. Data shows that women in general suffer more during disease outbreaks.

Globally, women represent 40 percent of full-time jobs and 57 percent of part-time jobs.

Part-time job holders lack the safety nets of formal contracts such as paid leave, maternity leave, or health insurance.

Another overlooked gendered dimension during this crisis is violence against women which is a pandemic on its own.

Domestic abuse and intimate partner violence are common forms of violence against women.

According to WHO, one out of every three women in the world face physical and/or sexual violence.    

During Covid-19 related lockdowns and quarantines, there are reported increase in the severity and frequency of domestic violence.

In France, reports of domestic abuse increased by 32-36 percent.

In the US, domestic violence reports increased by 25 percent, in Brazil it increased by 40-50 percent.

A surge in cases of gender-based violence was also seen in countries like Argentina, Peru, and Mexico.

In Colombia's capital Bogota, calls to police's 24/7 hotline to report violence against women had increased by a frightening 225 percent.

In one of their reports, Unicef expressed their worries about the rise of violence against women in the Rohingya camps in Cox's Bazar.

Many of the services provided to vulnerable women and survivors were temporarily discontinued during lockdowns which made these women even more helpless.

Often out of fear and shame, victims are unable to report their incidents. This means that the actual picture of violence against women during this pandemic might be even worse.

Evidence so far has shown that the gendered impact of Covid-19 is not linear as it is related to disease occurrence, mortality, and other social constructs including financial and psychological sufferings. 

These issues can be considered as opportunities for reforms to help pave the way for a more equal post-Covid world.

The response to pandemics like this one must be effective in terms of public health efforts and policies without gender bias.

Therefore, gender perspective in terms of vulnerability, exposure to pathogens, and access to healthcare and its availability, and impacts need to be addressed and integrated into public health approaches and policy.

The key actors are governments and global health institutions who need to own up to gender bias and incorporate the voices of activists and stakeholders in the frontline.

Only a concerted effort will strengthen the preparedness and response to fight this pandemic in a gender-balanced way.

Dr Nazmul Alam, is associate professor of public health, Asian University for Women. Leesa Leebang Subba and Jeba Anika Paula, are students majoring in public health, Asian University for Women