First detected in China’s Hubei Province in late December 2019, the novel coronavirus 2019 (COVID-19) has been declared a public health emergency of International Concern (PHEIC) and the virus has now spread to many countries and territories. In the last few months, Corona’s epicentre has been shifted from China to Europe to the United States. Till date, over 1.5 million people had been affected by COVID-19 and about 80,000 people had died worldwide.
Indirectly, billions of people have been suffering from the impact of this global pandemic. Needless to mention, the world is facing humanity’s biggest crisis since World War II. Almost every country has been affected by the devastating disease and India with 14,175 active cases (as on April 20) is one of those 184 affected countries of the world.
India, with 1.3 billion humans that are one-fifth of the population of the world and world’s fastest-growing major economy, can majorly affect the global dynamics economically; positively as well as negatively. Henceforth, the need to contain COVID-19 immediately is a national as well as a global concern.
India, unlike other nations, responded immediately to COVID-19. India has a notable history of developing an effective response mechanism for similar medical or natural emergencies; the early and immediate effective containment of Ebola is one such example.
As per the reports, even right now, India has successfully controlled the transmission of COVID-19 till today, thanks to the well-coordinated steps of the major stakeholders of the Indian ecosystem against this pandemic. India’s prowess in pharmaceuticals and health science; mass public awareness with the help of digital systems; and a central political command; among others, helped in containing the spread so far.
If we look at the global responses, the situation in India seems under control. The nation is trying to minimize the damage through the optimum allocation of the announced amount of US $24 million under the Stimulus Package.
The gender-blind framing of pandemic response policy measures, which in turn are the basis to direct and allocate funds, is an alarming threat. Globally, to frame the response of this pandemic, a language of security harnesses, resources and leadership are trying to tackle the virus from a human security standpoint. However, the women should be in their focal length too. Outbreaks such as COVID-19 are required to be tackled as more than just a health issue. The need is to understand that health issues inherently pose a risk to all levels of security– human, national, and international.
Economically, India was experiencing a historic slowdown over the past few quarters. The third quarter of the current fiscal year was expecting the economy to grow at a six-year low rate of 4.7%. In the third quarter of the current fiscal, the economy grew at a six-year low rate of 4.7%. The sources recorded a 6.1% unemployment rate much before this pandemic entered the land of India. Additionally, the announcement and implementation of new policies and bills starting early 2019, have led to the youth coming on streets, a complete lockdown of one state continuing for more than 6 months, a 100-day long protest, communal riots, increasing cases of discrimination based violence, forced section 144 in some areas and disturbance of law and order in some states.
India was yet to recover from the emergencies that happened in the last 12 months before it could have expected any challenge as big enough as the coronavirus. This mentioned history of violence and political instability will increase the complexities of the effect of this outbreak at the baseline population. This outbreak is an addition to the existing challenges, making the socio-disparities and discrimination across and within humans of India conspicuously more visible. This outbreak is no less than a producer of a movie showcasing “resolving global complexities by pushing the vulnerable to the lines of extinction drawn by selves with no options left”.
Its been almost a month of lockdown and the National Commission for Women has, over mail, received 123 complaints of domestic violence out total 370 complaints related to women issues. The data with respect to cases reported over telephone or helpline number has not been revealed. We can imagine how critical the situation would have been, had the cases reported via all means were released.
There is much more to state the condition of women other than these reports. The vulnerable state of an Indian woman is again reclaiming space in the evening news bulletins. Inequality is deep, intersectional and complex across the globe. The complexity of this social evil increases as it penetrates deep inside humankind branching itself within on the basis of gender first and then sex; the very fundamental biological distinction of humans becomes.
Scientifically, sex refers to biological differences between males and females whereas gender refers to differences between both determined by the societal and cultural constructs of male and female.
India recently slipped to the 112th spot, from its 108th position in 2018, in the World Economic Forum’s Global Gender Gap Index 2020. The Index includes the data of 153 economies and therefore is a significant indicator of how deep gender inequality in India. The report directly highlights the immediate need for more effort, a gender-centric and responsive approach to policies and measures in order to bridge the gap in the remaining two-third pie; which includes economy, health, and politics.
“Gender isn’t a priority right now,” an excuse, we as women rights advocates, leaders, and feminists have been listening to since long, as and when we question the leaders for their gender blind response measures to such pandemics. They assure us to take our asks into consideration once things calm down. However, there is no guarantee to those claims and assurance as well. The situation in India is no different, in fact, more vulnerable and is in an immediate need to address this humanitarian crisis – COVID-19 with a gender centric approach.
COVID-19 pandemics, like all public health crises, are inherently a gendered phenomenon. Until recently, the transmission of COVID-19 to developing countries has been posing particular challenges for infectious disease prevention and control. Limited or constrained access to public facilities, resources, and poor health and sanitation infrastructure are obstacles to disease prevention and treatment. Such existing circumstances when coupled with gender inequality and, in some cases insecurity, become a dominant factor for making public health inaccessible for all. Needless to mention, Each context is different, and each population within a context is also different—their needs and capabilities will vary as a result of circumstance and their unique, intersectional identities. Therefore it is required to be mindful that women, men and people with non-binary identities are not only affected differently by COVID-19, but the longer-term impact of the crisis will also continue to exacerbate and re-produce gendered inequalities.
India, a land with adherent inequalities across, more visible in the form of discrimination on the basis of gender and income, needs to invest the extra amount of effort in developing policies and measures that can help reduce the reproduction of the above-mentioned complexities.
WHO’s constitution states the Right to Health is a universal right. It defines health as “a state of complete physical, mental and social well-being”. The association between health and human rights has been mentioned and highlighted several times. The right to health is a medium to ensure and benefit humans with the access of all those wide ranges of socio-economic factors that promote conditions in which they can lead a healthy life. According to the UNC-CESCR General Comment 14, the underlying determinants of health are food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions, and a healthy environment.
In order to understand how well India will be able to perform and extend support every national in achieving health as a universal right, a deep analysis is required. Following is an attempt to build a framework for analyzing the performance and response mechanism of the concerned national authorities.
As per WHO Statistics 2019, in India, US $62 is invested per capita as Current Public Health Expenditure, which is only 3.6% of Gross Domestic Product.
Access to existing universal healthcare is very limited in India. The universal health coverage (UHC) service coverage index (SCI) of India is as low as 56%. Furthermore, a shortage of doctors has exacerbated the problem. The density of medical doctors (per 10 000 population) is only 8.57. The concern increases when we analyze these reports to check women’s access to this infrastructure. As per the report, 19% of Indian women still give birth without being attended by skilled health personnel. The density of nursing and midwifery personnel x (per 10 000 population) is only 21.1.
India is one of the few countries in the world where women and men have nearly the same life expectancy at birth while Indian women, on the other hand, have high mortality rates, particularly during childhood and in their reproductive years.
The health of Indian women is directly linked to their position or status in society. Various researches have time and again given evidence of the fact that contributions by women into families are often overlooked, and instead, they are viewed as economic burdens.
Typically, they have no or little autonomy, living under the great control of the male members of various generations of their family; to say rightly, first they being controlled by their fathers, then their husbands, and finally their sons. Because of the wide variation and diversity in cultures, religions, and levels of development in Indian states and union territories, it is not surprising that women’s health also varies greatly from state to state. All of these factors exert a negative impact on the health status of Indian women.
Experts like Ranjana Kumari, women’s rights activist and director of the Centre for Social Research in New Delhi, too have shared her views with a media channel DW in 2016. As per one of her statements, “There is a social aspect responsible for the skewed sex ratio in access to healthcare for women. The mental conditioning of Indian society has led to women having a very high threshold of patience and silence. The health of a woman is not a priority in our country. No one wants to invest in women’s health. It works both ways because most of the time women also keep silent about their health issues, adding that their upbringing often made them shy if they were young, or their low self-esteem came in the way of demanding access to a doctor”. A study conducted by experts in 2016 from India and Harvard University also reveals that Indian women suffer from gender bias while accessing health care.
The potential extent of disease morbidity and mortality among women can be forecasted through this complex health-care provision in an environment where health inequality is already so high and conspicuously visible even prior to this outbreak.
India’s mortality rate attributed to exposure to unsafe Water, Sanitation and Hygiene (WASH) services (per 1,00,000 population) in India is 21.6. However, it is 18.5 and 15.9 for women and men respectively (per 1,00,000 population) as per the WHO Global Health Report 2019. The quality and extent of water, sanitation, and hygiene (WASH) services to women in India during a pandemic can be anticipated.
Specifically, such situations make things more difficult for women and girls and hence, they often find their access to hygiene and sanitary materials is reduced and limited. The rationale behind this is the decreased household income or increased household competition for scarce hygiene resources, impeding their ability to practice disease prevention efforts at the household or community level in order to attend their own hygienic needs. The emergency situations make women and girls left with no option then complete reliance on government and its sensitivity to ensure continuous and regular flow of sanitary supplies and products to ensure sexual health. This includes condoms, contraceptive pills, menstrual hygiene goods, soap, and water treatment tabs, pregnancy testing kits, etc.
The seriousness of the concern and probability of these concerns increases when one acknowledges the latest data of the National Sample Survey Office (NSSO) which states that only 71.3% of rural households have their own toilets. This data leads to the addition of one more concern or threat for women in the existing long list. Women in rural India, semi-urban, semi-rural slums live with limited sanitation facilities, most reliable on community toilets may experience difficulty and attempts of sexual violence during such emergency situations when resources become scarcer, making them more vulnerable when travelling to collect water for household use or to use latrines.
Global Hunger Index (GHI) 2019, ranks India 103 among 119 countries in the world. Its a significant factor determining that India is still facing acute poverty. With a high prevalence of poverty, child labour, child marriages, dowry, violence, food riots, malnourishment highly likely to happen. Not only this, the early marriages, sexual violation of women child labourers at workplaces, part of the informal economy, leads to early reproduction and nutritional problems among young women later, according to NCBI.
About 40% of the women are mildly anaemic, 12% are moderately anaemic, and 1% are severely anaemic, as per The NFHS-4 (National Family Health Survey) conducted by the Ministry of Health and Family. It states that anaemia also varies by maternity status: 58% of women who are breastfeeding are anaemic, compared to 50% of the women who are pregnant and the other 52% who are neither pregnant nor breastfeeding.
Emergencies heighten the risk of food insecurity and malnourishment making it more grave for women and girls. Because of social norms dictating most of the contexts, women, and girls of the eat last and least, and one can imagine no food to eat if no food remains till they get their chance. It has been observed in past, that when food becomes scarce, women and girls the already malnourished women and girls are more prone to face additional health complications quickly, including increased susceptibility to COVID-19 infection.
India is experiencing a nationwide lockdown which means that it is likely that schools in the regions that will be worst hit by COVID-19 would close for an indefinite period to mitigate the spread of the outbreak. This will impede access to education for children, mostly in the areas which are in remote districts with no schools within their areas. And then, the school of the zone with a high density of population per sq.km will impede the spread at the community level.
Temporary school closures will directly affect the displaced or refugee children, and girls negatively. For most of them, the school supposedly provides a safe space for meaningful, violence-free interaction with peers, the opportunity to receive psychosocial support, and yes assured channel of food and nutritional security.
However, with virtual classes coming into the picture, the concern is around how to ensure maximum participation of girl students in those classes. The problem is twofold. Firstly, the girls who are in rural areas will lack access to these classes due to the huge gender digital divide and secondly, the increased pressure of care work, household chores may not allow girls to prioritize education. As UN Women also mentioned in its guidelines, please make sure your daughter study and does not loose on classes to make her brother attend the same.
According to the statistics of the Indian Census 2011, India’s female literacy rate is 65.46%, much lower than the global average 79.7%. So even if when schools were not closed, the education systems were not accessible to all and hence benefitted the privileged sections, socio-economic stable population of India. This also explains why the women and girls of low income, socio-economic insecure, unstable and backward communities found it increasingly difficult to balance their caregiving burdens with education, which led to increased absenteeism or to them leaving school completely. As mentioned above, the concern increases due to COVID-19 led lockdown will lead to long-term impacts on the girls’ educational, economic, and health outcomes.
India ranked 149 out of 153 countries in economic participation and opportunity for women in the World Economic Forum Global Gender Gap Index 2020. As per ILO Data, the workforce participation rate of women in India in 2020 is as low as 19.3%. More than 73% of the women workforce is unemployed. At present, the overall unemployment rate in India is 7%, but it is as high as 18% among women. If the trend continues, around 400 million jobs will be needed for women alone in the coming years, according to the World Economic Forum 2020.
A similar trend of gender inequality is visible in wealth distribution. Men title most of the wealth in India making the wealth distribution more asymmetric. Indian women between 20% and 30% of the $6 trillion (Rs73 lakh crore) overall household wealth in the country which is very less than the global share of 40% (Global Wealth Report 2018). Furthermore, female estimated earned income is a mere one-fifth of male income, which is also among the world’s lowest (144th). However, at present, the major concern is the pattern in which the existing employed women workforce allocated across formal and informal sectors of employment.
Out of the women employed, 94% are employed in the unorganized sector. The unorganized sector is a sector makes women take up work with lesser or no dignity, high wage gap or low wages, no social security, no assured date and time of payment, and sometimes no assurance to receive payment as there is no evidence of employment given to them. They are not offered and titled with the rights of an employee or worker as per the constitution of India. Not only this, it has been observed that job opportunities are highly influenced by gender. There is an irrational division of labour on the basis of gender making them inaccessible to better economic opportunities. Gender, or the so-called patriarchal and religious norms, restricts their mobility and reduce their decision-making capacity and ability. They end up doing so much labour and even then, they are not recognized or valued in the economy. And since domestic and care activities are specifically categorized as “woman’s work”, they are left to manage paid and unpaid work responsibilities on their own, on a daily basis.
As per NSSO data (2011-12), most of the women take employment in the primary sector that is agriculture and allied services. However, if we dive deep within the manufacturing sector, they are then again found to be employed in low paying, casual, home-based work or in unpaid work within family-run enterprises.
This 94% of employed women might have to bear the brunt of the economic crisis due to COVID-19 in terms of job losses and increased inability or an uncertain time period to bear this sudden financial shock. Moreover, as mentioned because the majority of employed women are part of the gig and informal economy, they are highly prone to disruption during this public health emergency.
Similarly, the other of the remaining employed women who have been engaged in agricultural activities will not be able to generate adequate or might be no revenue because of restricted movement and trade of goods to secondary or primary mandis or market operated via different private as well as government-led channels.
This increased instability and financial shock on the women who are either primary or secondary generator income will make them unable to pay back loans from village savings and loan associations and to pay rent of their houses. It is important to remember that due to poor credit history, most women borrow money from the informal financial market, therefore the government support in terms of financial loans will not be of many benefits to women associated and operating in the informal economy.
The history of such emergencies reveals that such a situation of financial instability makes women more vulnerable to sexual assaults done by money lenders or landowners as a trade-off for their inability to compensate monetarily. With higher travel restrictions associated with the outbreak, many women specifically female migrant workers, working in urban areas as domestic helpers, caregivers or industry labourers will have to experience grave economic consequences in terms of job loss, disconnect with livelihood generating support systems to them and their families.
Henceforth, the impact of COVID-19 on the economic well being of women will be huge and long term.
As per the medical studies done so far, women appear to be less likely to die from COVID-19 but we also need to acknowledge that the infectious prone disease may not affect women due to sex-based immunological or gendered differences, but because of their easy exposure to carriers of the virus which are men. Men are more prone to COVID-19 due to sex-related biological immunity and also their behaviour patterns and prevalence of smoking and alcohol consumption. Hence, women’s vulnerability exponentially increases due to their socially-ascribed caretaking roles, shaping women’s lived realities during times of conflict, emergencies, and peace.
Gender inﬂuences both patterns of exposure to infectious agents and the treatment of infectious diseases. The male and female existing in the same society, even though equal as per law, but experience differences in the provision of health care. Not only this, the accumulated scientiﬁc knowledge about the effects of treatments, inﬂuence the course and outcome of disease for those who have been infected also sometimes miss testing the same over a female body. Examples of common gender differences that inﬂuence exposure patterns and treatment include:
It is highly visible in the data-driven studies done by various development workers that men spend more time away from home than women. Since the virus is out in the air, these men are typically more exposed to these infectious agents. Whereas females tend to face greater exposure inside the home.
Women are more likely to take up the responsibility of providing care to children, sick family members both in-home and health care centres. In this capacity, women are more exposed than men to infectious agents. This is of particular importance for diseases that are transmitted by close contact, COVID-19 for example.
There are chances that during this national emergency situations, the majority of the health resources which were normally dedicated to reproductive health might go towards emergency response. Other than this, we are also required to acknowledge how gender plays a role in determining the access of women to health care. Health-seeking behaviour is also gender-biased in societies. A difference in the utilization and consumption pattern of healthcare benefits has been observed in a study conducted in Kolkata, India for example. A follow-up observational study found that boys with diarrhoea were more likely to be given oral rehydration ﬂuids than girls, and were more likely to be taken to qualiﬁ ed health professionals for treatment. Boys were also taken for care outside the home signiﬁcantly sooner than girls (Pandey et al., 2002).
30% of Indian women between 15 to 49 years of age, experience physical violence as per NFHS-4. These violence driven practices are influenced by patriarchal gender and social norms. These indicators are nothing more than a reflection of inequality rooted deep inside within India and are structural as well as institutional. India’s average rate of reported rape cases is about 6.3 per 100,000 of the population. With a public health emergency in hand, this can become a valid and potential reason to exacerbate age, gender, and disability inequalities enough to place women, girls, and other vulnerable populations at increased risk of gender-based violence (GBV) and intimate partner violence (IPV). Such violence leads to other health emergencies, physical and psychosocial harm.
An effective global response to public health emergencies must engage with the rights and needs of women.
Looking ahead, the necessary response is twofold. First, the measures should be inclusive enough to address the sexual and reproductive rights of women. The government should ensure clear and direct communication to all its institutions to assist women in realizing their rights; second, the financial policy measures, restrictions on trade, movement and mobility of individuals in current health emergency must address the social and economic conditions that restrict women’s ability to exercise those rights. Access to essential health services during complex emergencies is determined not solely by the provision of care, but also by the status of human rights and equity in Indian society.
The response mechanism should be prepared to underline the need for coordinated bolstered human rights violation related reporting systems, especially for COVID-19. This system should be easily accessible to all.