The second wave of the Covid-19 pandemic has exacerbated inequalities to a great extent, deeply affecting every sector of life. To understand the effect of Covid-19 on women, Gender Impact Studies Center (GISC), Impact and Policy Research Institute (IMPRI), New Delhi, organised a panel discussion on ‘Gendered Impact of the Catastrophic Second Wave of Covid-19 Pandemic: Way Forward towards Combating the Third Wave in India’ on June 15, 2021.
Professor Vibhuti Patel, Eminent Economist and Feminist, Former Professor, TISS, Mumbai, initiated the discussion as a moderator by stating that it is important to discuss the gender implications of the pandemic as the situation has been worse during the second wave. Covid-orphans and Covid-widows are the new terms added to our vocabulary due to the devastating impact of the pandemic.
She pointed to the naked profiteering by private enterprises amidst this pandemic that is pathetic to note. She said that we need to promote Universal Healthcare and 6% of our GDP should be devoted to the public health sector. The governments need to pay attention to:
- One crore girls who are at the verge of dropping out of schools,
- Food and nutrition safety,
- Job safety for unemployment,
- Recognition, reduction and redistribution of care work,
- Application of labour standards,
- Health insurance to ASHA and Anganwadi workers,
- Global minimum tax of 15% for corporate profits as talked in G7 summit 2021.
Gender responsive public policy for inter-sectional marginalities based on caste, class, religion, gender and ethnicity is the need of the hour. Professor Vibhuti Patel said:
“The thinking of profit before people needs to stop.”
Gender-based violence has taken varied forms in the form of sexual violence, online harassments, domestic abuse, forced child marriages etc. Corona Mata temples have been set up in villages as people believe that by worshipping Covid, they can get rid of it. Labour codes effect on women needs to be discussed promptly.
The focus in second wave has been on oxygen and hospital beds. We have lost precious lives to Covid-19 and 594 doctors have died within the first week of second wave. Thus, to discuss this multi-pronged issue, Prof Vibhuti Patel invited esteemed panelists to put forward their viewpoints.
Public Health Response
Ms Renu Khanna, Trustee SAHAJ, Vadodara; Member, Feminist Policy Collective, focused on the public health response of the pandemic. She presented the case study of maternal health to understand the topic well. There are social determinants affecting maternal health. Effective response is required to “build back better”. Food and livelihood security is crucial. Further, she presented data to make sense of the stark reality.
According to CSE-APU compilation of 76 food surveys reviewed by Dreze and Somanchi-Proportion, households eating less than before the lockdown was still 60% in Oct-Dec 2020, compared to 77% during the lockdown amid the second wave. Over 35- 66% migrants or informal workers were eating less than two meals a day and less nutritious food even in September-October 2020. Relief measures helped but their reachability is a question mark. Debt traps are increasing due to a depletion of physical and financial resources.
As per the UN Women Report in 2021, 118 women for every 100 men aged 25 to 34 are in extreme poverty; and this number is likely to increase to 130 women by 2030. According to a World Bank Report, more than 12 million people in India will be driven to poverty because of the pandemic.
According to the fourth National Family Health Survey, 55% women are not using the health services due to high out-of -pocket expenditure and gender-bias in the health insurance schemes.
There is reduced nutrition for lactating and pregnant women, increased workload, care work and violence for many women, and an increase in mental health problems, all contributing to compromising physical status.
What comes from being infected and what comes from being affected are two different things. According to a Centre for Disease Control study, there is 70% increased risk of death in pregnant women with Covid. The Lancet Global Health report of 2021, too, claimed that maternal deaths and still births rose by a third because of disruption of health services.
More women are getting infected during the second wave — 38.5% of total Covid cases as compared to 34% in July 2020 (Telangana). Women are generally admitted later, especially those from rural areas. Denial of services is a huge issue. There are heart tormenting stories of pregnant women.
Doctors are reporting dilemmas as doing a C-sec on a Covid-positive pregnant women will further reduce her oxygen level because of anaesthesia. Gender gap is widely increasing. Digital divide is further aggravating the situation as women in rural areas find it hard to register on COWIN app and there is vaccine hesitancy, too. The following measures should be taken to build back better:
- Increase financial resources
- Integrate the pandemic response
- Strengthen health wellness centres
- Strengthen mental health support — Talk Therapy
- Implement evidence-based protocols for vaccination for pregnant women with informed consent
- Data systems dis-aggregation- age, sex, co-morbidity
- Clearly classify deaths
- Disclose information
- Have women leaders in global health and social care as most organisations (WHO, WGH, GHWN) are led by men, but only delivered by women
Health systems have to remove structural barriers that prevent women in the health workforce from reaching leadership positions. Women have to be in leadership and decision-making roles.
Care Work
Ms Poonam Kathuria, Director, SWATI – Society for Women’s Action and Training Initiatives, Ahmedabad, Gujarat, highlighted that gender-based violence is a spectrum. There has to be a mitigation approach in policymaking amidst this unprecedented health calamity. There is a pattern regarding women’s issues and the onus is always on women to make them visible in the public domain. Only 1% of our GDP is allocated to health, which is really low. She presented case studies to understand the ground reality. She pointed that no Covid- related data is available on the LGBTQ+ community.
There are widely spread vaccine myths in rural areas. Caregiving of women is crucial as majority of them are responsible for caring even when they are ill.
In terms of reproductive health, there are unwanted pregnancies and more deaths. Women are losing jobs more than men due to additional family responsibilities. In rural areas, land is mainly registered in the name of males, but due to the death of males in the family because of Covid, women are facing problems related to inheritance of land. Thus, land rights need to be ensured.
Women Farmers
Ms Seema Kulkarni, Founding Member, Society for Promoting Participative Ecosystem Management (SOPPECOM), Pune, focused on women farmers. She pointed that the first wave was urban-centric and the lockdown was a major issue as access to markets was restricted.
There are a number of Covid-widows in rural areas and all public systems have failed them and women in general during the pandemic. There has been a deep economic impact on women. Stigmatised communities such as sugar cutters in many rural pockets are facing a greater brunt.
Subsistence agriculture is in a critical state. There are no opportunities for livestock and forest workers. To access the Public Distribution System (PDS) for ration, documents are needed. Therefore, food security is critical. Access to loans via microfinance institutions is leading to a mounting debt crisis. Women are subjected to sexual harassment for not paying loans. Online education has a cumulative effect on women.
Widows and orphans need our attention. Structural inequalities need to be looked into deeply. Further, community support needs to be strengthened. Seema Kulkarni said:
“We need to move from relief to reform, recognition and registration to ensure entitlements of women.”
Ecologically sound agriculture needs to be promoted and marginalised people needs to come at the fore.
Economic Care
Dr Soma K Parthasarathy, national facilitation team (NFT) MAKAAM, India, focused on the shadow pandemic and medicalisation of the whole process. There is an emergency of hunger as is becoming apparent on the streets. Incomes have reduced, and the worst-hit are sex and domestic workers.
Debt has become a vicious cycle. There is deepening poverty as no assets are left to survive. In Delhi, the first wave majorly affected migrants, but in the second wave, the upper class and middle class have been affected as well. The PDS and relief distribution systems are inadequate.
Meanwhile, the private sector is busy profiteering from the crisis. There is a myth that Covid is just another disease in the string of ailments such as TB and cancer. However, a big difference is that Covid is affecting everyone and as a result, has been declared a pandemic. Female-headed households are more vulnerable to the pandemic as the care burden has tripled.
A common question for the poor is: “Who can afford to stay indoors?”
There is a compounding situation in Delhi. Covid awareness and a resilient action needs to be taken. We need to focus on the following factors in hilly areas such as Uttarakhand:
- Traditional knowledge,
- Going back to the forests,
- Awareness for prevention,
- Care at community level.
Preventive health has to be adopted to boost immunity. We have to set care centres in villages and be prepared. People must be enabled to subsist in their locations. Dr Soma K Parthasarathy talked about:
Ecological subsistence living and economies of care. Resilience is embedded in the ecological processes.
Healthcare Workers
Dr Swati Rane, CEO, SevaShakti Healthcare Consultancy; VP Clinical Nursing Research Society; and Core Committee member, Jan Swasthya Abhiyan, Mumbai, asserted that every person who gives care professionally is a healthcare worker. Females are the primary care workers all across the world. Dr Swati Rane said:
“Definition of health care workers needs to be redefined.”
Violence against female healthcare workers is only the tip of the iceberg of gender power. Gender leadership gaps are driven by stereotypes, discrimination, power imbalance and privilege.
The leadership gap must be closed. There should be gender equity and leadership in the global health and care workforce, especially in the WHO, WGH and GHWN. She added:
“Disadvantaged women intersect with and are multiplied by other identities such as race and class.”
Women need to have an equal say in decision-making. In India, women are almost 50% of the healthcare workforce among different categories of healthcare workers, nurses and midwives dominated by women at 88% (68th National Sample Survey Organisation report).
Women are almost 70% of the global health workforce, but it is estimated that they hold only 25% are in senior roles. Sanitation workers mostly remain ignored. The states haven’t come up with uniform policies for their workers. Dr Rane said:
“No data is maintained in the Union Government about safai karmacharis (sanitation workers) who have died due to the Covid-19 pandemic.”
Nurses estimated to be around 50% of all health workers are significantly underrepresented in global and national health leadership. Over 76% nurses are overworked, according to the study conducted jointly with SATHI. In the first wave, there were 62 deaths in eight months and in the second wave, 62 deaths in three months.
Across Maharashtra, at least 570 ASHA workers have been infected with Covid-19. ASHA workers are underpaid and overworked. They have been confronted with physical abuse or violence during their home-home surveys. There is no system for ASHA workers, no proper job role of ASHA workers, as their duties include pre-natal and postnatal care, immunisation drives for children, and population-based screening for disease-based surveillance, among others. Our attention needs to be on:
- Working conditions
- Violence
- Harassment
- Fear
- Overload of work remains.
Last year, 748 doctors across India succumbed to Covid-19, while in the second wave, within a short period, 624 were doctors.
Recommendations
Ms Renu Khanna said that we need to invest more in healthcare, which is widely recognised now. Infrastructure and human resources have to expand. Health governance and transparency has to improve. Solidarity is required as private sector exploitation has to be stopped. She added:
“Decentralised local planning with coordination has to be learned from this pandemic.”
Resources have to come from the state for community mobilisation.
Ms Poonam Kathuria asserted that cash transfers need to be increased to Rs 2,000 for ASHA workers and their work should be regularised as they are the lifeline of this country. Targeted vaccination has to be implemented, and support services for women, such as creches and dabba services, need to be ensured. Ms Poonam Kathuria said:
“Data needs to be there for effective policy making.”
Ms Seema Kulkarni said that we need to restructure and reform. Recognition of women farmers is critical. Universalise and expand the activities of women. Look at diversity of crops and not be limited to wheat and rice. Reimagine MGNREGA, asset building, and ecology-centred agriculture. Land rights and community rights need to be strengthened. Ms Seema Kulkarni said:
“Right to land is critical.”
Every rural woman needs to be engaged in livelihood activities in a broader context. For instance, biosphere centres can be set up wherein organic manure can be provided by the community. Ms Soma K Parthasarathy asserted that the nature of policies needs to be oriented towards women. Dr Soma K Parthasarathy said:
“Food processing units, kitchen gardens needs institutional support.”
Subsistence and the concept of enough-ness need to be looked into. We need to invest in local resources. The CSR needs to invest in the caring sector as well. We need to promote local solutions, for example, the dabbawallas’ role in creating employment. Health infrastructure and the right to local resources is a priority. Professor Vibhuti Patel said:
“Door to door vaccination is the need of the hour.”
Dr Swati Rane concluded by saying that we need to invest in public health care as the private sector’s profiteering needs to be stopped. Diverse leadership roles need to be created like epidemiologists, nurses, architects and engineers as India is a diverse country with different needs. Health needs to have various actors. Healthcare workers working condition needs to be looked deep into. Tele-medicine should be adopted. The price of the drugs needs to be maintained. Dr Swati Rane said:
“Health should be related to food, sanitation and water.”
Primary health care centre have to be strong and a transformation of the health sector is required.
Prof Vibhuti Patel concluded by highlighting the statement of the WHO that global health is losing out on women’s talent due to gender discrimination. Women and girls’ futures need to be secure for equitable growth. Government should support childcare and maternal health. Challenge gender norms to create equal opportunities by adopting gender-responsive budgeting.
YouTube Video for Gendered Impact of the Catastrophic Second Wave of COVID-19 Pandemic: Way Forward towards Combating the Third Wave in India
Written by: Ritika Gupta, Ishika Chaudhary, Arjun Kumar