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Gender inequalities in healthcare: The impact of COVID-19 on global inequalities

The COVID-19 pandemic has gravely impacted the livelihoods and resilience of large vulnerable populations across the world. As the crisis raged on, organisations and researchers sought to understand exactly how the pandemic was impacting women and gender minorities in different parts of the world. Research pointed to the fact that, as disasters impact societies along pre-existing lines of vulnerabilities, COVID-19 was particularly severe for marginalised groups. This concept of intersectionality is key to understanding how inequalities of race, gender, class, caste, and ethnicity determine experiences of the pandemic as well as the connected disruptions to employment, healthcare, food security, and more.


The pandemic crippled global healthcare systems. At a time when production and supply chains were massively impacted by varying lockdown measures around the world, non-COVID healthcare services took a back seat. This was a result of several factors, including a general shortage of medical practitioners and resources, high levels of anxiety around medical services, and the large contraction of employment and income levels among marginalised groups. Populations reliant on informal sources of employment or those where work could not be shifted to virtual modes were adversely affected by these lockdown measures. Research studies frequently noted the financial burden of healthcare amidst job loss and the subsequent depletion of savings deterred low-income households from pursuing healthcare services. This was further exacerbated as low-income households had to prioritise allocation of money, which often meant that women’s needs were put on the backburner. Social and cultural norms play a big role in how finances are allocated in the family, and a reduction in a family’s disposable income is often closely linked to the de-prioritisation of women’s health needs, fulfilling the needs of the family at the expense of the woman’s [1]. This was often observed in India’s low-income families, where women’s health and nutrition needs were sidelined in order to fulfil the needs of older family members, men, or children. One of the insights from a pre-COVID study [2] which presents a set of multivariate regressions illustrates how access to healthcare services is inherently gendered and unequal. According to this study, women were less likely to be vaccinated and more likely to report disruptions in accessing medication and other routine healthcare measures as compared to men. It reflects that gatekeeping of resources from minorities and disadvantaged groups puts their access to healthcare during crisis on the backburner and makes them further vulnerable to the crisis.


Evidence from India reflects this disparity among low-income households and women engaged in informal means of employment. With the reduction of out-patient services offered by several clinics and hospitals as well as stringent social distancing measures, many women reported having to forgo doctor visits, post-surgery care and, in some cases, indefinitely postpone planned surgeries and treatments [3]. Access to sexual and reproductive health services is also greatly determined by women’s economic and socio-cultural position, especially in developing countries [4]. Social distancing norms, cut-backs on employees, and funding shortages meant that the availability and accessibility of these services was hampered during COVID-19. Marie Stopes International (MSI) released a report that projected the drastic impact that disruptions to these services could have on vulnerable populations across 37 countries [5]. The organisation launched an online survey in the UK, India, and South Africa which showed significant disruptions including: inaccessibility of contraception due to lockdown measures; shutdown of local clinics that provided medical services; and perceived reduced availability of services. As compared to MSI’s forecast for January-June 2020, it reported that 1.9 million fewer women were served in this period due to COVID related disruptions. This could imply over a million unsafe abortions, about 900,000 unintended pregnancies, and also several avoidable maternal deaths. The evidence from various countries points to the fact that the pandemic significantly impacted women in their ability to access healthcare services as per pre-COVID times, some due to increased restrictions, and some due to shortages and problems within the healthcare industry.


Accurately quantifying the impact of COVID-19 has been tremendously difficult, due to the prolonged and evolving nature of the crisis as well as the interwoven inequalities that interacted with it to further disrupt livelihoods. Women have often been at the forefront of inequalities and discriminations, making them susceptible to such systemic crises. As witnessed during the pandemic, problems of access, exclusion, and discrimination that were part of the social fabric pre-COVID had a significant influence on how medical and non-medical services were disseminated during COVID-19. These experiences shed light on the larger issue of systematic exclusion and barriers to access for gender minorities among other vulnerable groups. It facilitates discussions on how policymaking and cultural mores must evolve to be more inclusive and address the intersectional needs of minorities in an ever-evolving society and globalised world. At a time when large populations lack access to robust healthcare, employers and businesses need to respond to this need by ensuring that all employees have equal and affordable access to healthcare and implement policies that support employees during medical crises. Lastly, businesses in the healthcare sector need to focus on reducing health inequalities and ensuring equitable distribution of services.


Written by Bhuvan Majmudar, Thrive Research Hub Member

References

[1] Bhat et al., 2021, p.147

[2] Flor et al., 2022, p. 2387

[3] Sumalatha et al., 2021, p. 455

[4] Sanneving et al., 2013; Thapa et al., 2021

[5] Marie Stopes International, 2020


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