Dr Varthani Kirupanandan MBChB, for the Commonwealth Medical Trust (Commat)
The COVID-19 pandemic has imposed limitations on not only trade, economic growth and society; but also on progression of work towards meeting sustainable development goals [1], particularly gender equality and women’s health. As a result of the pandemic, the 64th session of the Commission on the Status of Women was held in a scaled down format with limited international participation, involving only New York based delegations.
On the 23rd of September 2020, the UN will hold a high-level meeting in New York of the General Assembly, with the theme of ‘Accelerating the realization of gender equality and empowerment of all women and girls.’ [2] In preparation for this meeting, UN Women convened a virtual multi-stakeholder hearing on Tuesday 21st of July 2020, which I attended for the Commonwealth Medical Trust, a NGO focused on health promotion, disease prevention and advancement of human rights.
From a global health perspective, the COVID-19 pandemic inexplicably exacerbates pre-existing inequalities. Multiple states have made advancements towards women’s health. H.E. David Sengeh, the Minister of Primary and Secondary Education in Sierra Lorne, emphasized the state's efforts in reducing teenage pregnancy and increasing education rates. The Sierra Lorne government earlier this year overturned a five year law, inhibiting pregnant girls attending school, which was initially introduced in 2015. Subsequently following school closure due to the covid-19 pandemic, the government launched a campaign to engage communities, and a radio-teaching programme which includes sexual and reproductive health as part of their curriculum. This adaptability to the new constraints imposed in the time of covid-19 highlights the importance, and furthermore the ability, to include women’s health in covid-19 mitigation and recovery plans.
During the Ebola outbreak in Sierra Lorne there was an increase in teenage pregnancy rates and COVID-19 is likely to mirror this pattern. Statistics suggest that reductions in health services of 10% during lockdown could result globally in 15 million unintended pregnancies. It is vital that work is made to compound soaring teenage pregnancy rates. The biggest cause of death in girls aged 15-19 in Sierra Leone is pregnancy complications.[3] Indeed, this work has been supported by civic society and NGOs. Save the Children has launched an app for teenagers to provide sexual health advice, support, and information on coronavirus. The app was designed in conjunction with young people in Sierra Leone, ensuring relevance to the target demographic.[4]
The call for sexual and reproductive health education and access to services has been echoed by Restless Development in Tanzania, emphasizing the importance of youth as not only beneficiaries in reproductive health policies, but stakeholders.
Sexual and reproductive health is an issue that not only affects the youth. Nino Lomjaria, Public Defender of Georgia, described the efforts to address sexual health in different demographics of society. Awareness of sexual and reproductive rights of women, particularly those with disabilities, LGBT+, in ethnic minorities, rural areas, conflict affected areas and victims of domestic violence, needs to be addressed. Monitoring conducted by the Public Defender’s office in psychiatric institutions found that whilst mental health was addressed, women’s reproductive health needs have largely been ignored. However, the government of Georgia has made significant progress. Following recommendations from the Public Defender’s office, the Ministry of Healthcare of Georgia elaborated guidelines to integrate women’s reproductive health issues into medical protocols for treatment of women with mental health issues.
Despite advances made in global women’s health, this multi-stakeholder meeting stressed that much progress still needs to be made, and significant issues persist. Of these, period poverty is an issue that is still present. African Union’s Envoy on Youth noted that ‘menstruation is not on quarantine’ - there is still a lack of access to free sanitary pads, access to contraceptives and access to antiretroviral therapy for HIV.
There was particular focus on social care, and unpaid work. The unpaid care economy is vastly supported by women. Public policy, and true gender responsive budgeting, will need to impact not only paid work but also unpaid work. Mary-Ann Stephenson, Director of the Women’s Budget Group noted the change in UK government policy to encourage return to work - despite the childcare system being in crisis, impacting women’s ability to return to work. Her description of economic revival highlighted that often policies to stimulate the economy are based on traditional infrastructure, such as construction, railways and telecoms. However, the Women’s Budget Group modelling has found that investment in social infrastructure, such as health, education and social care, can also create multiple jobs whilst also addressing care needs.
Argentina has been at the forefront of addressing issues of the social organization of care. Gómez Alcorta, the first to hold the office of Minister of Women, Genders and Diversity, described the introduction of an inter-ministerial commission to address the care needs of its citizens. This commission will bring together multiple ministries, including the Ministry of Health and Social Development and Ministry of Economy. This is an important acknowledgement of the need for a joint responsibility policy when addressing care of the elderly - a responsibility that extends beyond genders, but also to the states, private sector and community.
Of course, inequality issues extend beyond health and social care. Frankie Campbell, Minister of Social Services and Development in the Bahamas, emphasized the distinct impact of the climate change crisis on small island developing states. The 2019 “Hurricane Dorain” in the Bahamas resulted in a massive 3.4 billion dollars’ worth of damage.
Moreover, gender equality, particularly in the time of COVID-19, cannot be advanced without male involvement. Dismantling social constructs and shifting gender norms is vital for change in gender relationships, whether it be between women and men, men and men, or non-normative genders. This could be through changes in families, for example men taking responsibility for care work, as highlighted by Dr Hearn, Professor of Gender Studies in Orebro University; or through widespread national measures such as advertisements. The World Federation of Advertisers described the ’Unstereotype Alliance’, an initiative launched by UN Women, to portray parity in roles by both genders at home and in the community.
Furthermore, for true gender equality, there needs to be intersectionality. Active and meaningful participation of women who have historically marginalized - those of ethnic minorities, LGBTQ+ groups, rural women, and women in poverty, is essential for true gender parity. As Salam Al-Nukta, founder and CEO of Changemakers described, when it comes to policy making, “it is naive to think one size fits all. Needs vary depending on context, communities, demographics.”
Ultimately, the COVID-19 pandemic has the opportunity to have potential profound impacts on advancements made towards meeting the Beijing Declaration. This multi-stakeholder meeting has demonstrated global acknowledgement for the importance of protecting, preserving and advancing strides made. However, whilst naming inequalities is important, it is not transformative enough if it is not followed by implementation of policy, legislation and accountability. Gender is an important conversation - and I am hopeful this conversation will move beyond this virtual platform, and we will see the implementation of real and meaningful change.
References
[1] United Nations. Sustainable Development Goals. Available from: https://www.un.org/sustainabledevelopment/sustainable-development-goals/
[2] General Assembly of the United Nations. Accelerating the Realization of Gender Equality and the Empowerment of all Women and Girls. Available from: https://www.un.org/pga/74/event/accelerating-the-realization-of-gender-equality-and-the-empowerment-of-all-women-and-girls/
[3] Maternal disorders are the primary cause of death for girls age 15-19 in Sierra Leone, accounting for 24.8% of deaths in this age group (Institute for Health Metrics and Evaluation. Global Burden of Disease 2017)
[4] Save the Children. Sierra Leone: Innovative Sexual Health App to help prevent surge in teenage pregnancy due to COVID-19. Available from: https://www.savethechildren.net/news/sierra-leone-innovative-sexual-health-app-help-prevent-surge-teenage-pregnancy-due-covid-19