Why women are being left out of Covid-19 fight

Discrimination at its worst in pandemic with doctors, NGOs trying to address post-recovery partiality and gender gap in vaccination

As director of Population First, a social impact organisation that works for women empowerment, gender equality and community mobilisation, Dr AL Sharada is fully aware of the life-changing impact of education on women. But, as India battled two devastating Coronavirus waves, she admits that education and entitlement, played little or no role in easing the burden off women in households afflicted by the infection. Hers is the best example, she tells us over a call. “In April, my husband, 28-year-old son and I got infected with COVID-19. While my son was home quarantined, the two of us had to be hospitalised. We returned home 10 days later, but my husband, who had more severe symptoms, had not completely recovered. My son was also unable to help because of a bad back. Our home was in a mess; there was no food, as we stay in the outskirts of the city [Hyderabad],” recalls Sharada. Though the disease had taken a toll on all, Sharada, says she had no option, but to turn caregiver, as the other two were in no position to do anything. “During this time, I worked more than I ever had in my entire life—cleaning, cooking and washing, I did everything possible. Though I cooked protein-rich food, I never consumed it because I was tired and had no sense of taste or smell.”

Lack of adequate rest and nutrition in the early days of her recovery period, impacted Sharada’s health to such an extent that till date, “I don’t feel normal. I 
have extreme fatigue, joint pains and weakness.” 

Dr Ruma Bhargava, Lead Healthcare, World Economic Forum and founder of Mumbai NGO Samarpann and Nitika Kakkar, Senior programme manager with SMART

Sharada says that in India “men often get better post-recovery care, compared to women”. To make a case, she points to a recent study, published in medical journal Lancet, which stated that the long-term consequences of COVID-19 were greater in women than men. In the year-long study, reported by mid-day earlier this week, women were shown to have 1.4 times significantly higher risk of fatigue or muscle weakness, two times significantly higher anxiety or depression, and three times significantly higher lung diffusion impairment.

What’s worse, despite being the biggest sufferers, women continue to be left behind in India’s vaccination programme. As per data available on the CoWin dashboard on September 2, a total of 66,97,75,627 doses were administered across the country. Of these, 35,09,24,237 doses were given to men, and 31,52,63,511 to women. Chennai-based data journalist Rukmini S says this gender disparity in India’s vaccination drive is worrying, because of mounting evidence of the toll that COVID-19 is taking on women. The results of the second round of Delhi’s SARS-CoV2 seroprevalence (the level of a pathogen in a population, as measured in blood serum) survey released recently showed that the prevalence of infections was higher among women than among men. The Mumbai and Ahmedabad sero-surveys, she says, had similar findings, with the gap being higher in Mumbai. “I first noticed the gap this May. It was of concern then, because the initial vaccination drive focused on frontline and health workers, so we should have expected to see women outnumber men. That was at least the case in most parts of the world. India also saw a similar trend for a couple of days, but that quickly changed,” she says, adding that the gap as of this week has widened further and is now, at its widest yet. The highest gap is currently seen in Delhi, Jammu and Kashmir, and Odisha, while Andhra Pradesh, Karnataka and Tamil Nadu have the lowest, Rukmini shares.

Dr AL Sharada, director of Population First says that in India, men often get better post-recovery care, when compared to women

The reasons for the gender disparity in vaccine distribution are varied. Sriram Haridass, United Nations Population Fund (UNPFA), Representative India and Country Director Bhutan a.i. says that the issue cannot be understood, without understanding the gendered impact of COVID-19. “We have seen a surge in incidents of violence against girls and women—it’s what we have described as the shadow pandemic. Female health workers are also at a higher risk of contracting the disease, as they constitute a large part of the health work force, thus compromising their jobs and livelihoods. There has been a disruption of sexual and reproductive health services, including access to contraceptives. Mental health issues have also gone up due to loss of income and poverty. Even among women, the needs of the marginalised, like the elderly and sex workers, have been completely ignored,” he adds.

The problem that India is seeing with its vaccination programme, he says, is an extension of these issues. “Due to the prevalent gender norms and social conditioning, there has been an increased burden in caregiving and household chores, since everyone is now at home. This means that women don’t have the time to spare to even get the vaccine.”

Archana Kapoor, founder and director of Radio Mewat, on-air with reporter Imran Khan. The community radio airs fresh COVID-related shows daily

Making it worse is the fact that in many households, women are still not decision makers on issues related to health. “In the case of vaccination too, many women are dependent on men to take them to vaccination centres,” he says.

Sharada adds that there’s generally there’s a little tardiness on part of families to get their women vaccinated. “It’s assumed that men go out more and are at a greater risk and need protection.” She feels that since most men are breadwinners, there’s a tendency to invest more in their healthcare. “Women’s health issues, on the other hand, are rarely prioritised, with treatment often being delayed.”

Sriram Haridass, United Nations Population Fund (UNFPA), Representative India and Country Director Bhutan a.i. says the prevalent gender norms and social conditioning, has led to increased burden in caregiving and household chores, since everyone is now at home. 'This means that women don’t have the time to spare to even get the vaccine'

Poonam Muttreja, executive director of national non-profit Population Foundation of India, echoes Sharada’s sentiment. Most women, Muttreja says, receive medical attention only when they are pregnant. Logistical issues of having to register on a mobile phone, taking time off home duties, and waiting in long queues for the vaccine, are also proving to be a huge deterrent for many women, says Sharada. 

Mumbai is no stranger to this problem. Suresh Kakani, additional municipal commissioner, BMC, says that of the total vaccinated population in the city currently, men constitute 55 per cent, while women comprise 45 per cent. “This gap was most likely due to the over-crowding at vaccination centres, especially in the initial months, when the vaccine registration process was still not decentralised. At the time, we noticed that fewer women were getting vaccinated,” he says, adding, that women usually prefer to go to a vaccination camp that’s being held closer to their home, or where the process is more streamlined, so that they don’t have to wait for “long hours”.

Poonam Muttreja and Suresh Kakani

Dr Ruma Bhargava, Lead Healthcare, World Economic Forum and the founder of Samarpann, a Mumbai-based non-profit, established in 2016, to help people across the country gain better access to healthcare, education, sanitation, and hygiene, says that she is not at all surprised by the fact that women are being left behind in the immunisation programme. The gender gap in India, she says, has always been skewed, with most indicators related to health, literacy and employment, favouring men. Having worked in public health as Immunisation Technical Support to the Government of India, Bhargava has travelled across the country, witnessing first-hand the existing lacunae in women’s health.   

Her NGO predominantly focuses on education in the rural and tribal areas of Maharashtra, Uttarakhand, Rajasthan, Arunachal Pradesh, Delhi, and Madhya Pradesh. When COVID-19 struck, the team at Samarpann repurposed itself to provide relief and aid. While working with government schools in an around the villages near Kota, Rajasthan, where Bhargava had briefly moved, she realised the need for vaccination advocacy. “Most of the people are daily-wage labourers, and they cannot afford missing a day’s work to get the vaccine, especially for a disease they haven’t contracted yet,” she says. Moreover, in rural vaccine centres, paracetamol is rarely given. This means that if they did get a fever after the vaccine, they couldn’t treat it, and wouldn’t be able to contribute at home or even earn their wages. “Many of the women also wanted to know whether taking the vaccine would affect their menstrual cycles, pregnancy or ability to conceive.”  

Dr Ruma Bhargava, Lead Healthcare, World Economic Forum and the founder of Samarpann, a Mumbai-based non-profit, has been travelling to villages across Rajasthan for vaccination advocacy among women

The other issue was that of accessibility, with many not having a phone, or being tech-savvy. “This was not just a challenge for women, but also for men. Only when the government was holding camps, could they go and get the vaccine,” adds Bhargava. 

Over the last two months, Samarpann along with panchayats, local school teachers and community leaders, have been travelling from one village to another, organising sessions to address fears and hesitancy among women. The men of the family are also being co-opted in the discussions to instill confidence.  Bhargava’s team has covered around 15 villages. “Inter-personal communication is key, and this information needs to come from someone you trust,” she adds. The UNPFA, for instance, has been roping in Accredited Social Health Activist (ASHA) and community health workers to counsel many of these women.

Technology, both rudimentary and the Internet, have also played an instrumental role in disseminating information.    

Rukmini S, data journalist

Population Foundation of India, which promotes and advocates for the effective formulation and implementation of gender sensitive population, health and development strategies and policies, launched phase two of its Himmat Hai Toh Jeet Hai campaign in April this year, to promote awareness on the COVID-19 vaccine. The campaign focused on women both in urban and rural areas, says Muttreja. “Using videos, static posts and GIFs, the campaign promoted awareness, simplified the vaccine registration process and encouraged women to get themselves and their loved ones vaccinated as soon as they were eligible.” Rolled out in partnership with Facebook India across their social media platforms, it has been disseminated widely through Population Foundation of India’s own network of Civil Society Organisations (CSOs) and state governments.  “It culminated in a new video that celebrated the fortitude of women and girls in the face of the COVID -19 crisis,” Muttreja adds.   

Another key effort in this direction was led by Seeking Modern Applications for Real Transformation (SMART). The non-profit worked with the UNESCO New Delhi and UN Women to provide timely information on pressing issues through creative community radio programming. The programmes, aimed at creating awareness related to COVID-19 information, gender-related violence and women health and nutrition, is being broadcasted daily on the SMART supported community radio station Radio Mewat. Radio Mewat is heard by approximately 0.7 million people across 180 villages in Haryana’s Nuh district. As reported by en.unesco.org, Nuh in Mewat has been categorised by the government of India as the most backward district in the country.

Apart from this, SMART has also been working on the issue of vaccine hesitancy with nearly 150 community radio stations across the country. Archana Kapoor, founder SMART and Radio Mewat, says it’s only now that pregnant women and lactating mothers are being allowed to take vaccines. “But enough of mistrust has been created around the issue. Only the literate, and those who have enough access to information, are taking the vaccines, but it has really damaged the confidence of women in rural areas, where people are not very sure if they should go ahead with it.”  Nitika Kakkar, senior programming manager with SMART, adds that a lot of women who have taken the vaccine have noticed a change in their menstrual cycles. “Nobody is talking about this side-effect as much, and it has been barely written about in one or two reports or studies. When a woman experiences it on her own, it leads to more apprehension and confusion.”  

Rukmini feels that there’s a paucity of women-focused COVID-19 research, due to which there are still a lot of unanswered questions, which need to be addressed. “Personally, I feel very strongly about the delay in offering the vaccine to pregnant women, because I know of a pregnant friend who died of COVID-19. I think it’s an unforgivable delay.” Kapoor says these efforts don’t bring immediate changes, but it does help mobilise the community. “I am not saying that women are rushing to get the vaccine after listening to our radio. We must remember that we are trying to influence behaviour, which is not just influenced by science, but by traditions, beliefs, past experiences, faith in the government, among other things. But I think, it will at least sow the thought of change in them.”

45 per cent
Percentage of women vaccinated so far in Mumbai, as compared to 55 per cent men

31.5
Crore women have been vaccinated across India, as per CoWin data on September 2

Her story convinced other women

At 23, Farheen Khan who hails from the village Kherla in Mewat, has her priorities clear. The young reporter at Radio Mewat wants to get married and have children soon. So, when her mother told her not to take the vaccine, because it would make her “infertile,” she immediately decided against it. It took participating in the awareness programme held by SMART to convince her to get the jab. “I finally took the vaccine on July 18, and though, I had arm pain and mild fever for about two days, I was good by the end of it,” she adds. Today, Farheen along with station manager Sohrab Khan have been curating programmes to help tackle the vaccine hesitancy in the region.  Sohrab, for instance, has a daily COVID-update show, where he discusses fresh government guidelines and protocols that need to be followed. “After listening to my story, more women from my village are coming forward to get the vaccine,” says Farheen.

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