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Dr. Tori Hudson, Portland, Oregon, Blog Healthline Blog

I read an article recently that I thought made a very profound point:  “When you are thinking about a pandemic, you have to differentiate between what comes from being infected and what comes from being affected”.  (Quote from Clare Wenham, Assistant Professor of Global Health Policy, London School of Economics and Political Science).  As of this writing in August 2020, 12,552,765 cases of COVID-19 had been confirmed throughout the world, with 561,617 deaths, predominantly  in Europe and the Americas.

image of scales of justice - inequality ideaOne thing that has emerged is that mortality rates appear to be higher for men than for women; However, it is women who are more likely to bear the brunt of the social and economic consequences, with lockdown measures and school closures affecting girls and women differently throughout the world, and some have long term quite negative consequences.

The UN Secretary-General António Guterres noted that “COVID-19 could reverse the limited progress that has been made on gender equality and women’s rights”.

Globally, there does not seem to be a sex or gender bias in diagnosis of COVID-19, although there may be some variations from country to country.   But regarding the progression of the disease to severe cases and death, men seem to account for 57% of deaths from COVID-19 and 70% of admission to intensive care units, which is the case in the European regions.  In the Netherlands, men constitute 38% of the cases but 55% of the deaths.   A study of some 44,600 people with COVID-19 from the Chinese Center for Disease Control showed the death rate among men was 2.8%, compared with 1.7% for women.

Overall, throughout the world from the data we have, men show higher death rates from confirmed cases.

What is going on?  Honestly, it’s still unclear, but we do know that in general, men die earlier than women so we may be seeing that COVID-19 is worsening these underlying differences in mortality.  It’s also possible that via a combination of biology and social determinants of health, women have a more robust immune response than men do.   It has been noted that it is possible that the men who are dying from COVID-19 have higher rates of obesity, high blood pressure, diabetes and lung disease.  Also, men tend to go to the doctor less or later, than do women.   This is more of a gender/social issue than an infection issue related to the SARS-2 coronavirus .

To expand the perspective further, there is the issue of poverty and how the pandemic deepens inequalities in the social, political and economic systems in which people live.  Globally, women earn less, save less, hold less secure jobs, and are more likely to be employed in jobs in which they are paid informally, or “under the table” so to speak.  Women also have less governmental and cultural social protections in most societies. Women are also the majority of single-parent households creating an extra layer of economic fragility and then home security.  Because of these economic disadvantages, women cannot as easily absorb economic shocks and tragedies as can men.  A report by the Institute for Fiscal Studies found that mothers in the UK were 1.5 times more likely than fathers to have either quit their job or lost it during the lockdown.

It is estimated that 740 million women worldwide are employed in the informal economy.  More than two thirds of female employment is a part of this informal economy in developing nations.   According to the International Labour Organization, globally, women perform 76.2% of total hours of unpaid care work, more than three times as much as men.  In Asia and the Pacific, it rises to 80%.

With lockdowns—these jobs disappear quickly- think housecleaning and home childcare as two examples.  A sudden job loss such as this means an immediate unstable household in terms of food, shelter and clothing.   Foreign domestic workers have faced travel restrictions which also puts them out of work.

As the health care system gets stretched, more sick people will be cared for at home, and this falls more to women as well, which then can also put them at increased risk of getting sick themselves.   Women are also more anxious about getting sick.  In a study done in March, from the Kaiser Family Foundation, more women than men worry that they or a family member will get sick from the coronavirus (68% vs. 56%); and more women than men worry about losing income due to closure or reduced hours of their workplace due to COVID-19 (50% vs. 42%).  And more women compared to men worry they would put themselves at risk of exposure to the virus because they can’t afford to miss work (39% vs 31%).

Again, a survey from the Kaiser Family Foundation, more women (16%) compared to men (11%) reported that they feel that anxiety or stress related to COVID-19 has had a major negative impact on their mental health. Nearly four in ten women (36%) and three in ten men (27%) feel that worry or stress related to coronavirus has had some impact on their mental health.  This is on top of what we already know that more women than men are diagnosed with anxiety and depression.


Let’s look at one example, Liberia during the Ebola outbreak of 2013-2016, and how challenging recovering from the pandemic was, for women.  The  majority of workers in local trading markets in Liberia  are female. During the Ebola outbreak, they endured higher levels of unemployment than men and as a result, it took significantly longer for women to re-enter the labor market.  And these women who survive these kind of tough times, their risk of falling back into poverty is extremely high.

Let’s not forget another heart wrenching issue associated with this current pandemic and the response to it.  About 243 million women are thought to have experienced sexual or physical abuse by their intimate partner at some point over the last 12 months.   Women are often trapped in the home with their abuser.   In France, it was reported that within 1 week of their lockdown, reports of domestic violence had surged by 30%.  Dozens of other countries reported the same kind of findings.

UNESCO estimated that the pandemic was preventing 1.52 billion children from attending school as of March 2020.  It is predicted that some of them will never return.  In certain parts of the world, girls who are not in school face a higher risk of female genital mutilation and early marriage.  Schools for girls provide feminine hygiene products, protection from abuse, and offers a better chance of prevention of teenage pregnancy and sexually transmitted infections.   When not working at a job, women also face an increase in all of the unpaid domestic duties of looking after more children (who are not in school), increased food preparation, caring for sick family members and other tasks that fall more to women than to men.

Contraception and safe abortion are also under the influence of the pandemic.  An international organization estimated that 9.5 million girls and women around the world will lose access to these services during the pandemic.  Other health care impacts for impoverished nations/people is less access to health care in general and thus more malnutrition in children, less vaccinations, less prenatal care, and more.  Even in the developed world, there is an increased concern about less children getting their vaccinations during the pandemic.

While there are people, men, women and children worldwide who are facing a particularly fragile uncertain future, gender inequality is something that will require more attention and strategic plans so that the pandemic does not affect women even longer.


Other issues related to COVID-19 and women:


Risks during pregnancy (reprinted from the Mayo Clinic)

The overall risk of COVID-19 to pregnant women is low. However, pregnant women who have COVID-19 appear more likely to develop respiratory complications requiring intensive care than women who aren’t pregnant, according to the Centers for Disease Control and Prevention. Pregnant women are also more likely to be placed on a ventilator. In addition, pregnant women who are Black or Hispanic appear to be disproportionately affected by infection with the COVID-19 virus.

It isn’t yet known how frequently COVID-19 causes problems during pregnancy or affects the health of the baby after birth. There have been a small number of reported problems, such as premature birth, in babies born to mothers who tested positive for COVID-19 during pregnancy. But these problems might not be related to the mother’s infection.

Health workers

Women comprise the majority of health and social care workers and are on the front lines of the fight against COVID-19.

More than half of the doctors and 90% of the nurses in Hubei, China are women, according to the Shanghai Women’s Federation, a government body.

More broadly, women make up the majority of workers in the health and social care sector – 70% in 104 countries analyzed by the World Health Organization (WHO).

Primary Resources for this article:

1) Burki T. The indirect impact of COVID-19 on women.  The LANCET; Infectious Diseases. 2020; 20(8): 904-905

2) Wenham C, Smith J, Morgan R. COVID-10: the gendered impacts of the outbreak. The Lancet 2020; 395(10227): 846-848

3) Mayo Clinic

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