To protect herself from contracting the coronavirus, Dr. Adele Teodoro, a gynecologist in private practice in Milan, could have chosen to cancel her patients’ appointments and go into quarantine like most people in Italy. Instead, she has continued to work. “I haven’t had the courage to abandon my pregnant patients,” she says. “We have to do check-ups every month. I follow all the necessary protective measures to ensure continuous care.”
But this decision has had very painful consequences: Teodoro cannot visit her dying father in a village in southern Italy. “Although it is now against the law to leave your town of residence, I could have left Milan for something this serious,” she says. “But, as a doctor, my sense of responsibility has prevailed. How could I travel from a city that has been so badly hit by the virus, without running the risk of spreading it to my family and my hometown?”
Another Italian doctor, Federica Brena, posted a heartbreaking observation in a Facebook message that has been shared by more than 55,000 people. “This picture [of my face mask] portrays the end of my guard yesterday, when after 12 hours spent breathing in that mask, I stripped of the war armor. Yeah cause it feels like war. I’ve never experienced it, but I imagine a little like this, a war against a new and unknown enemy. ”
Brena is an oncologist in Bergamo, the northern Italian city that is being devastated by the virus – in mid-March the whole country was moved by the images of the army taking the coffins of the victims out of the town because there was no longer space at the local cemetery. “The hospitals have been reduced to lazarettos [isolation hospitals for highly infectious patients], the health system is on the verge of collapse,” Brena’s post continues. “What will happen to the other sick people?”
Although Covid-19 appears to kill more men than women – the Italian Higher Institute of Health has observed a mortality rate of 7.2% for men compared to 4.1% for women – it is women who are on the frontline of the fight against the disease. According to the World Health Organization (WHO), women represent 70% of workers in the health and social sector, though in the Chinese province of Hubei – the epicenter of the outbreak – that figure stands at 90%. Women are also primarily responsible for caring for children and the elderly. And they are in a more financially vulnerable position than men – in Europe, the employment rate for women is 65% compared to 78% for men – an issue that will be exacerbated by the economic fallout of the crisis. And yet, still no political or health authority has analyzed the impact of the coronavirus from a gender perspective.
The issue has been tackled, however, in an article published in The Lancet medical journal, titled “Covid-19: The Gendered Impacts of the Outbreak.” “Recognizing the extent to which disease outbreaks affect women and men differently is a fundamental step to understanding the primary and secondary effects of a health emergency on different individuals and communities, and for creating effective, equitable policies and interventions,” say the authors.
It is hard not to link the lack of interest in this issue to the fact that healthcare organizations are largely run by men. According to the latest report from Global Health 50/50, a non-profit organization that promotes equal opportunities in the sector, more than 70% of the directors of health organizations in the world are men. The researchers of The Lancet article also highlight that there is a lack of female representation in the institutions responsible for making decisions on how to tackle Covid-19, from the WHO, to the White House’s special committee. And they launch this appeal: “We call on governments and global health institutions to consider the sex and gender effects of the Covid-19 outbreak, both direct and indirect, and conduct an analysis of the gendered impacts of the multiple outbreaks, incorporating the voices of women on the frontline of the response to Covid-19 and of those most affected by the disease within preparedness and response policies or practices going forward,” they write.
Past epidemics have shown that a gender-blind approach in such crises, coupled with the almost non-existent presence of women in the higher echelons of power, not only highlights gender inequality, but puts women at greater risk. For example, during the Ebola outbreak in West Africa between 2014 and 2016, women were subjected to far greater exposure to infection because of their predominant role as family caregivers and health workers.
Past epidemics have shown that a gender-blind approach puts women at greater risk
During the same outbreak, Sierra Leone diverted resources from sexual and reproductive healthcare to address the Ebola crisis, resulting in increased female mortality during childbirth and pregnancy in a country that already had the highest rates of this in the world. The Lancet article also recalls that during the spread of the mosquito-borne Zika virus in the Americas between 2015 and 2016, “differences in power between men and women meant that women did not have autonomy over their sexual and reproductive lives, which was compounded by their inadequate access to healthcare and insufficient financial resources to travel to hospitals for check-ups for their children.”
According to the head of UN Women, Phumzile Mlambo-Ngcukai, the economic issue will soon develop into another acute problem: “Majority of women work in the informal economy, where health insurance is likely to be non-existent or inadequate, and income is not secure. Because they are not well targeted for bailouts, they are financially on their own. This is not simply a health issue for many women; it goes to the heart of gender equality.”
The closure of schools in countries affected by the coronavirus certainly does not help women, many of whom are forced to combine the stress of teleworking – often for the first time – with childcare, which in most countries is still the women’s exclusive domain. This is compounded by mental health issues such as depression and anxiety, which in Europe are predominantly suffered by women.
The Lancet’s analysis also looks at how travel restrictions cause economic hardship and uncertainty among foreign domestic workers, many of whom travel in Southeast Asia between Indonesia, Hong Kong, the Philippines and Singapore. Meanwhile, in Italy, the €25 billion package to save the economy fails to take into account the two million domestic workers, most of whom are women and foreign nationals. At a time when wages are plummeting, many families are having to lay off cleaners, carers and nannies, who will not be eligible for government subsidies.
Women are more financially vulnerable than men – in Europe, the employment rate for women is 65% compared to 78% for men
Lastly, according to Claire Barnett, the executive director of UN Women UK, there is “evident proof” that domestic violence increases in times of economic precariousness and social instability. Wan Fei, the founder of an anti-domestic violence nonprofit in Jingzhou in the Chinese province of Hubei, told the online magazine Sixth Tone, “The epidemic has had a huge impact on domestic violence.” The former police officer said that the police station in Jianli County had received three times as many reports of domestic violence in February this year than in the same month the previous year. “According to our statistics, 90% of the causes of violence are related to the Covid-19 epidemic,” he explained.
In Italy, where one woman in three is abused and 81% of femicides take place in the home, centers for victims are seeing a fall in requests for help. According to one of the country’s longest established centers, the Casa delle Donne in Bologna, confinement means that abusive partners are able to exercise even greater control over their victims who have far less freedom to call for help. With their capacity to leave the home strictly limited due to the lockdown rules, many choose to endure the abuse in silence, while those who are on the way to escaping the abuse with the help of meetings, therapy or activities in safe houses, are abruptly left to cope by themselves.
Milan Judge Maria Letizia Mannella is all too aware that the number of reports of abuse has fallen since the coronavirus outbreak. “It is still too early to have precise data,” she says. “But what we can say is that enforced cohabitation with abusive partners, husbands and children during this period makes women refrain from calling or going in person to the law.”
By the end of the year, more complete information could be available on how health crises affect both the health and lives of women. Diah Saminarsih, a WHO gender counselor, has announced that a study is already underway. Meanwhile, Soumya Swaminathan, WHO chief scientist, hopes that at least one positive will emerge from these challenging times. “It may be the chance to finally shed light on women’s role as the caregivers in the home, one that is seldom recognized, appreciated or paid for,” she says.
English version by Heather Galloway.