Paper:A call for a gender-responsive, intersectional approach to address COVID-19
https://www.tandfonline.com/doi/full/10.1080/17441692.2020.1791214
A call for a gender-responsive, intersectional approach to address COVID-19
ABSTRACT
The COVID-19 pandemic exacerbates existing health inequities, including gender disparities, and we must learn from previous global public health threats to build a gender-responsive, intersectional approach to address immediate and long-term consequences. While a narrow gender focus alone can reinforce binary and competing understandings of disease burden by gender, an intersectionality approach encourages understanding of the dimensions of power, historical structural inequalities, and the role of social determinants and lived experience to inform a multidimensional, gender-informed response to this and future emerging infectious diseases. We provide specific, actionable recommendations for critical healthcare, public health, and policy to use an intersectional approach to COVID-19 pandemic preparedness, response and resiliency.
Recommendations
Global and public health policy and programs too frequently overlook the differences between gender equity, the variable needs of women and men, versus gender equality, women's unequal social position compared to men. COVID-19 emphasises the critical need for equity-informed evidence and an evidence-based rather than values-based response. Although the concept of gender mainstreaming has existed for decades (Ravindran & Kelkar-Khambete, 2008), only recent examples of gender guidance resources, analyses, and guidelines for a global public health threat exist, namely for the recent Ebola epidemic (Inter-Agency Standing Committee, 2020) but we are also beginning to see this for COVID-19 as well (CARE, 2020; CARE & IRC, 2020; PAHO, 2020; UN Women, 2020). We must incorporate and expand upon the lessons learned from previous global public health threats, including HIV, SARS, Ebola and other emergencies, to implement a gender-responsive, intersectional approach to contain the COVID-19 pandemic, mitigate the immediate and long-term consequences, and build resiliency. Critical healthcare, public health and policy needs include:
Prioritise protecting and supporting essential workers, including frontline responders in the healthcare sector, with PPE, paid time off, equitable compensation, and psychosocial support
Ensure availability, equitable access, acceptability and quality of healthcare, including safe and respectful maternity care, sexual and reproductive health services, including infertility services (Inhorn & Patrizio, 2015), and mental health care
Innovate service delivery rather than interrupt support services, such as transitioning to mHealth provision for critical services like essential sexual and reproductive health care and case management for gender-based violence
Include equity-based surveillance with appropriate data disaggregation, as well as explicit inclusion and sub-group assessment within clinical trials of therapeutics and vaccines, including but not limited to gender, race, age, health status, disability, occupation and socioeconomic status
Collect diverse data from multiple sources, including governments, but also practitioners and civil society (even more so in lower resource settings where surveillance systems are not strong or reliable), and with multiple methodologies, including qualitative and mixed methods to capture lived experiences, health needs and voices of those affected
Contextualise data within systems of power, including how social forces (i.e. socioeconomic and political context, policy, and cultural and societal values and norms) influence one's social location within household, community and the wider health system, as well as how COVID-19 is exacerbated by globalisation, capitalism, urbanisation, war, conflict, climate change, racism and xenophobia. This will allow us to map the pathways through which gender roles, norms and relations are reinforced or disrupted throughout the pandemic and the response
Support disaggregated surveillance, research, and programming (including both accommodating and transformative gender-integrated programs) (Schriver et al., 2017) through gender-based budgeting. Accommodating interventions acknowledge and work around existing gender differences and inequalities to achieve impact, while transformative interventions actively seek to transform gender relations to promote equalities and achieve health objectives
Mainstream intersectionality through research design, program delivery, and evaluation
Foster community participation and include the lived experiences of women who live at the intersections of oppressions and inequalities to ensure we address the needs of women, and allow for tailoring and adaptation of evidence-based interventions at the national, subnational, and community levels to ensure disparities are explicitly addressed
Utilise an assets-based approach in programs and capitalise on existing community strengths and resources
Ensure remote education reaches girls, not just boys, whose schooling may be challenged by concurrent domestic labor or caregiving responsibilities
Provide COVID-19 guidance on gender mainstreaming by global public health organisations like the WHO to encourage assessment of policy implications based on gender in all areas and at multiple levels
Ensure gender parity in COVID-19 working groups and support women representing diverse experiences in leadership positions (across government, industry, non-profit sectors) to promote gender-informed decision making.
Indeed, some progress was made at the May 2020 World Health Assembly meeting, in integrating provisions for a gender-responsive approach to the resolution developed: to include women at all stages of the decision-making process, to appropriately identify women who are the majority of frontline health workers as at highest risk of COVID-19, to call on WHO member states to implement national action plans that are explicitly gender-responsive as a way of ensuring respect for human rights and fundamental freedoms, and to take necessary measures to ensure social protection, protection from financial hardship, and the prevention of gender-based violence (World Health Assembly, 2020). However, much work remains to be done, as the resolution does not include policies for fair compensation for health and social workers, does not require member states to report sex-disaggregated COVID-19 data, and does not ensure that COVID-19 funding is inclusive of women-centred organisations, especially those in the Global South, so that women have the resources they need to better ingrain gender-responsiveness into our health systems. Additionally, women continue to be under-represented in the WHA decision-making process, as only 23% of delegations are female-led (Dhatt, 2020).
As we learned with previous pandemics, the collateral damage can be worse than the direct impact, and this should be kept in mind as we develop and manage our public health response. Gender, along with other complex, intersecting, and overlapping power differentials shape risk and experiences. Gender should be integrated within an intersectional approach to guide the global response to the COVID-19 pandemic and ensure promotion and adoption of equity-responsive policies and programming designed to reduce impacts to all. This will ultimately produce a more equitable and effective response within and between resource-poor and resource-rich nations within an interacting, global system.
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