Beyond COVID-19: How to navigate women’s health

Hidden Pandemics in Women’s Health

The ongoing Covid-19 crisis has caused insurmountable devastation globally. This once in a century kind of global health crisis has been a social “un-equalizer”. This “Inequality Virus” has impacted the women health to an unfathomable magnitude, yet it is least talked about during the pandemic. Let us unfold and dissect the overt as well as covert effects of the pandemic on various aspects of women’s health.

By Dr. Trupti Gilada, 29 Sep 2021

Sexual and reproductive health

The oft repeated lockdowns hampered emergency as well as routine access to all health services including those that the young women need the most but hardly discuss. That includes contraceptives, menstrual health supplies, pregnancy-related and other reproductive care and managing sexually transmitted infections.

Being pregnant during the lockdown was a challenge in itself. Not enough was known about effect of Covid-19 on pregnancy. The fear of any harm that could be caused to the foetus was pervasive.

To add to this plight was the limited availability of child delivery services even in major hospitals of large cities. If women tested positive right around their delivery, this challenge got compounded manifold. Added to that was non-eligibility of pregnant women to take the Covid vaccine.

Eventually, we have realized that pregnant women are not at higher risk of acquiring COVID-19 infection but once they have a symptomatic infection, they do experience more adverse outcomes compared to others. This of course means that they needed additional care and counselling during pregnancy.

Unfortunately, an analysis by the Population Foundation of India showed that during the 2020 lockdown, there was a 28% drop in women receiving requisite antenatal check-ups and institutional deliveries, leading to a 33% increase in maternal deaths and 28% increase stillbirths globally.

Then there are the unmeasured yet grave effects on mental health due to the worry of Covid effects on the foetus, limited social support and varied delivery and breastfeeding guidelines for Covid positive patients.

On the other hand, millions of women were forced to either continue with an unwanted pregnancy or undergo unsafe abortion due to disruption of reproductive health services. According to a policy brief by a Delhi-based NGO, India’s Covid-19 lockdown was to result in more than 8 lakh unsafe abortions by September 2020 and an additional 1.94 million unintended pregnancies in 2020.

Gender based violence Being ‘locked down with the abuser’

Disasters and violence have an established correlation. Lockdowns resulted in an increase in domestic violence by more than 47% from March to July 2020.
Studies revealed that the major impetus to perpetrators were alcoholism and unemployment.

Both alcohol withdrawal (seen early in the lockdown) and alcohol consumption subsequently contributed to the domestic violence. In times of monetary recession, human behavior tends to be impulsive, reckless, and aggressive, and the brunt usually goes down the patriarchal power-hierarchy. The ineffectiveness of the law wherein marital rape is still not considered a criminal act adds to the injury.

While domestic violence increased across urban and rural India, NGOs actually saw a 50% decline in helpline calls. For 60% of such married women, their first go-to people to seek help would be parents followed by neighbors, who now became inaccessible during lockdowns.

Being constantly in close proximity with the perpetrator(s) restricted their access to phones, while the overburdening of the police force and travel restrictions prevented the victim from reaching out for help. This ‘Shadow Pandemic’ of domestic violence growing amidst the crisis will leave permanent scars on innumerable women.

School drop-outs

India had made substantial progress in the field of children’s education in the last decade; so much so that the dropout rate for females was lower than males in 2018. The pandemic came as a big jolt to this laudable achievement.

As digitalization took over education, many children missed out on schools because of limited access to a device and even a quiet place to attend school. Increased poverty, reverse migration, job losses, lack of school infrastructure (both online and offline) and disruption in the mid-day meal program are obvious reasons for drop-outs across both genders.

But girls were expectedly at greater risk of being deprived of their education by the already prevalent gender based discriminatory practices, often being pushed towards paid and unpaid labor, including sibling care and household chores.

The Right to Education Forum policy brief released this January stated that 10 million girls in India could drop out of secondary school due to the COVID-19 pandemic. Schools have been closed for over 18 months and re-registering those who dropped out, especially in rural areas, is set to become a major challenge.

Parents who have become used to having their daughters home may not want to send them back. The positive association between school discontinuation and marriage is well known, putting girls at risk of early marriage, unwanted pregnancies, poverty, trafficking and violence.

Covid-19 Child Brides

One of the lesser documented consequence of the pandemic is perhaps the spurt in child and early marriage. Poverty and uncertainty with employment were the key drivers of child marriage. Smaller dowries demanded for younger girls and the restrictions placed during the pandemic on the number of guests made child marriage all the more attractive as a cost-saving measure.

Another likely factor responsible was the absence of available support systems at the local level that wrestle pressures to marry off young girls. In the second wave, anecdotal reports suggested that girls orphaned were being married off early as well.

Consequently, reports of child marriage and sexual abuse have risen by up to 52% in some states in India. And this too is probably just the tip of the iceberg. The consequences of child marriage are grave and will likely impede if not overturn the progress made during the recent past and further widen inequities.

Work overload, career disruptions and unemployment

Working women faced enormous challenges during the lockdown with children being at home 24×7 and absence of domestic helps. The onus of childcare and home-schooling kids disproportionately fell on the women, negatively impacting their career.

For instance, about 7% men lost employment during the lockdown, compared with 47% women. With increasing number of organizations opening up physical offices, employers are also unable to offer flexible working options to their female staff, leading to a disproportionate attrition rate in women.

A survey showed that 77% women quit work in India due to lack of flexible work options. Women and families, especially in low-income households, will find it very difficult to cope and recover from these job losses.

Mental Health

Prolonged lockdowns and the devastating second wave along with all the issues discussed above have led to a surge in mental distress and resultant increase in suicides, with little in the way of social safety nets. According to a survey among the Indian urban youth about life in lockdown, 42% females stated that their well-being was strongly affected at that time.

Although we do not have real numbers from India yet, other countries have seen a 40-55% rise in the suicide cases in women, mostly the 15-49 years age group. Psychiatrists and psychologists have seen a 2-3 time rise in the number of patients with depression and anxiety during Covid times.

The other downstream effects of poor mental health are becoming evident as well, with an increase in domestic violence against children, marital separation and divorce. This unfathomed pandemic of mental ill-health will have long-lasting repercussions on society.

Strangely, all these issues aren’t even part of “long-Covid”! It is time that we un-pack the complex implications of COVID-19 on women and girls in its entirety. This requires not only the scientists and physicians, but also policy-makers, community organizations, and most importantly a strong political will to work in coordination towards a common mission.

There is an emergent need for political and other opinion leaders to discuss these issues more openly on public foray to create a wider awareness. Looking beyond Covid-19, community programs that are at a stand-still and the altered roles of frontline workers at the grassroot level will need to be streamlined once again to address these dire issues.

We will need innovative strategies and solid policies to bring back our girls to school, stop child marriages and prevent women from losing their jobs.

We need to start seeing hidden realities, listen to their stories, and help amplify their real-life experiences so that when we strategize to re-build, we put women and girls right in the centre. Like Nelson Mandela said “If you want to change the world, help the women.”