Are we looking through the wrong end of the microscope?
This week I have had several conversations with friends working in education that have shocked me.
They told me numerous stories of the hardships they are observing in their roles during the pandemic: families increasingly reliant on food vouchers to survive, heightened financial pressures on households, and worryingly, a surge in domestic violence (DV).
In previous posts, we learnt that disasters happen when a community or society is unable to deal with a hazard using their current resources. Disasters are, at least in part, socially constructed through the needs created by, and the values inherent in, our society. This is why disaster can disproportionately affect those in marginalised social groups, who have less access to resources.
In this post, we will be taking a look how the pandemic has exacerbated inequalities for one such group – women and girls.
This isn’t to say that other groups do not suffer disparately in disasters because of social inequality. It is also important to say that all women do not experience the effects of disaster in the same way, but gender can certainly shape this experience.
What do we know about gender and disasters already?
There has been surprisingly – or maybe unsurprisingly – little gender analysis of biological disasters until recently.
For this reason, we’ll focus mainly on the Ebola virus outbreak in West Africa, and the Zika virus outbreak in Central & South America.
Ebola Outbreak (2014-2016):
- Increased maternal mortality: MSF chose to stop providing maternal and child healthcare during the outbreak to help redirect scarce resources to the disaster response (Stockholm Evaluation Unit, 2016). In countries affected by Ebola, maternal mortality increased by 75% during the outbreak (Davies & Bennett, 2016).
- Women as caregivers: Due to local gender norms, the sick were cared for largely by women, increasing the risk of acquiring Ebola (Smith, 2019).
- Exclusion of female perspectives from health advice: Official MSF health promotion material overlooked how isolation advice applied to many women, who were informally caring for sick family members (Stockholm Evaluation Unit, 2016).
Zika Outbreak (2015-2016):
- Physical experience: Zika can cause severe birth defects if contracted during pregnancy. Pregnant women therefore experienced a more physical embodiment of the disease (Smith, 2019).
- Poor access to healthcare: Women with fewer financial resources, especially those living in rural areas, had less access to emergency contraception and healthcare services (Harris, Silverman & Marshall, 2016).
- Reduced economic opportunities: Children with Zika-related birth defects are more commonly born to women with fewer socioeconomic resources because of the above (Lowe, et al., 2018). Many of these women gave up their studies or employment to provide their child with the care that they require (Diniz, 2017).
- Legality of abortion: The Zika outbreak affected several countries where abortion practices are restrictive or illegal. Many women therefore turned to DIY abortion procedures, which carry a high risk of serious complications (Wenham, et al., 2019).
These cases demonstrate how women and girls can have significantly different experiences of disaster because of gender.
In many of the examples, the role of the social context is evident – weak healthcare systems, poverty, poor governance. It is vital to understand that these root causes contribute to heightened adversity for women when the dynamic pressure of disaster is applied.
How are women and girls being affected during the COVID-19 pandemic?
Women specifically play a crucial role in disasters, often assuming the role of caregiver as already discussed. This doesn’t just apply to West African countries facing Ebola, or Central and South American countries facing Zika.
In the UK, women not only take on the bulk of unpaid, informal care, looking after sick children or relatives (Smith, 2019), but also represent 9/10 nurses and 77% of the NHS workforce (NHS Digital, 2018).
Women may encounter tensions between their paid formal work and their responsibilities at home – what Hochschild (1989) calls a second shift. With the large number women being employed in caring roles, like nursing, some scholars believe that these women bear a triple burden.
As my friends had alluded to, there has been a disturbing rise in reports of DV across the UK, with charities such as Refuge reporting a 25% increase in requests for help and 150% increase in the National Domestic Abuse website’s traffic (Kelly & Morgan, 2020).
DV is a gendered act. Although both men and women suffer DV, women are significantly more likely to suffer repeated victimisation, and abuse that leads to serious harm or death (Women’s Aid, 2018).
During lockdown, DV survivors may be stuck in close proximity to their abuser at a time of increased tension, with reduced access to support and refuge. In the context of women enduring on average 50 incidents of abuse prior to receiving effective support (SafeLives, 2015), this sharp rise is deeply concerning.
The Counting Dead Women project records women and girls who have been killed through DV in the UK. Analysis of data during the last few weeks has shown a concerning spike in these deaths (Grierson, 2020).
However, no emergency funds have been released to help DV services to cope during this period of increased need, as the government continues to signpost to generic funds (Grierson, 2020).
Why is this happening?
The importance of gendered perspectives in disaster management has long been recognised. The Global Health Crises Task Force (2017) report acknowledges ‘systemic gender biases’ in pandemic preparedness and response. However, progress has not materialised to the degree that it was hoped.
The International Health Regulations, which aim to promote national capacities for disease outbreak management, fail to recognise informal care and how the majority of this is provided by women (Smith, 2019). This is symptomatic of the poor representation of female voices in COVID-19 policy at both national and global levels (Wenham, et al., 2020), which perpetuates gender inequality. The Global Health 50/50 (2020) report analyses the extent of gender equality in global organisations participating in health policy. It finds that poor gender parity remains an issue across these bodies.
This obscuration of female voices at policy level contributes to structural inequality. Structural inequality is the idea that inequalities are deeply rooted into social machinery, producing and reproducing ideas and relationships that maintain social inequality.
So, are we looking through the wrong end of the microscope?
Julia Smith writes about the ‘tyranny of the urgent’ during disease outbreaks. In disasters, urgent biomedical needs are prioritised, and important structural issues can be neglected.
Much of the focus in the current COVID-19 pandemic is on biomedical needs – the medicines, the vaccines, the ventilators. However, crises like COVID-19 give us a vital opportunity to think about the wider structural and systemic problems that contribute to how disasters entrench long-standing inequalities.
One of the first texts I read on disaster theory pointed to the origin of the term ‘crisis’. In Greek, krisis means ‘decision’. This pandemic is a crossroads at which we must make important changes that extend beyond the urgent.
In this day and age, it is easy to think that inequalities are insignificant because we have come such a long way. However, COVID-19 has reinforced that disparities remain, and we must consider how we can prevent all marginalised social groups, not just women, from falling victim to the tyranny of the urgent.
Next time: Some Interesting Lockdown Reads…
An update on my situation:
Yesterday I received an email confirming my graduation from medical school. It is not quite the graduation I expected, as our ceremonies have been postponed for the foreseeable future for safety reasons. However, I am incredibly proud of what myself and my friends have achieved, and look forward to putting what I know into practice as part of an interim junior doctor role!
For information about support available for domestic violence or to donate to Refuge as part of their COVID-19 appeal, please click on the buttons below to take you to their website:
An update on some of the issues raised in this article:
2nd May 2020:
The UK government has announced £76 million funding to help support domestic violence survivors and at risk children (BBC News, 2020). The Communities Secretary, Robert Jenrick, has also issued further guidance for these individuals, clarifying that leaving the home to access support will not be criminalised (BBC News, 2020).
This tangible recognition of gender based issues within the political sphere is a significant and positive step. After chronic underfunding of vital services for these individuals, we can only hope that this awareness will lead to longer term, sustainable financing.
BBC News (2020, May 2nd). Coronavirus: Government pledges £76m for abuse victims. Retrieved from BBC News: https://www.bbc.co.uk/news/uk-52516433?intlink_from_url=https://www.bbc.co.uk/news/topics/c008ql15dvgt/domestic-abuse&link_location=live-reporting-story
Brewer, K. (2020). Birth in a pandemic: ‘You are stronger than you think’. Retrieved April 7, 2020, from BBC News: https://www.bbc.co.uk/news/stories-52098036
Davies, S., & Bennett, B. (2016). A gendered human rights analysis of Ebola and Zika: locating gender in global health emergencies. International Affairs, 92(5), 1041-60.
Diniz, D. (2017). Zika: From the Brazilian Backlands to Global Threat. London: Zed Publishing.
Farrar, J., & Gupta, G. (2020). Why we need women’s leadership in the COVID-19 response. Retrieved April 7, 2020, from World Economic Forum: https://www.weforum.org/agenda/2020/04/women-female-leadership-gender-coronavirus-covid19-response/
Fielding, S. (2020). In quarantine with an abuser: surge in domestic violence reports linked to coronavirus. Retrieved April 7, 2020, from The Guardian: https://www.theguardian.com/us-news/2020/apr/03/coronavirus-quarantine-abuse-domestic-violence
Global Health 50/50. (2020). The Global Health 50/50 Report 2020: Power, Privilege and Priorities. London: Global Health 50/50.
Global Health Crises Task Force (2017). Final Report. Geneva: United Nations.
Grierson, J. (2020). Calls for funds to house domestic violence victims during Covid-19 outbreak. Retrieved April 7, 2020, from The Guardian: https://www.theguardian.com/society/2020/mar/31/call-for-uk-domestic-violence-refuges-to-get-coronavirus-funding
Harris, L., Silverman, N., & Marshall, M. (2016). The Paradigm of the Paradox: Women, Pregnant Women, and the Unequal Burdens of the Zika Virus Pandemic. The American Journal of Bioethics, 16(5), 1-4.
Hochschild, A. (1989). The Second Shift: Working Parents and the Revolution at Home. New York: Viking Penguin.
Kelly, J., & Morgan, T. (2020). Coronavirus: Domestic abuse calls up 25% since lockdown, charity says. Retrieved April 7, 2020, from BBC News: https://www.bbc.co.uk/news/uk-52157620
Lowe, R., Barcellos, C., Brasil, P., Cruz, O., Honorio, N., Kuper, H., & Carvalho, M. (2018). The Zika Virus Epidemic in Brazil: From Discovery to Future Implications. International Journal of Environmental Research and Public Health, 15(1), 96.
NHS Digital. (2018, March 8). Narrowing of NHS gender divide but men still the majority in senior roles. Retrieved April 7, 2020, from NHS Digital: https://digital.nhs.uk/news-and-events/latest-news/narrowing-of-nhs-gender-divide-but-men-still-the-majority-in-senior-roles
SafeLives. (2015). Insights Idva National Dataset 2013-14. Bristol: SafeLives.
Smith, J. (2019). Overcoming the ‘tyranny of the urgent’: integrating gender into disease outbreak preparedness and response. Gender & Development, 27(2), 355-69.
Stockholm Evaluation Unit, MSF. (2016). OCB Ebola Review. Guinea: MSF.
Wenham, C., Arevalo, A., Coast, E., Correa, S., Cuellar, K., & Leone, T. (2019). Zika, abortion and health emergencies: a review of contemporary debates. Global Health, 15(1), 49.
Wenham, C., Smith, J., & Morgan, R. (2020). COVID-19: the gendered impacts of the outbreak. The Lancet, 395(10227), 846-848.
Women’s Aid. (2018). Domestic abuse is a gendered crime. Retrieved April 7, 2020, from Women’s Aid: https://www.womensaid.org.uk/information-support/what-is-domestic-abuse/domestic-abuse-is-a-gendered-crime/