Ritika Gupta, Ishika Chaudhary, Arjun Kumar

The second wave of COVID-19 pandemic has exacerbated inequalities to a great extent affecting every aspect of life deeply. To understand the effect of COVID-19 on women, Gender Impact Studies Center (GISC), IMPRI Impact and Policy Research Institute, New Delhi, organized 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.

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Freedom cannot be achieved unless women have been emancipated from all kinds of oppression- Nelson Mandela

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Prof Vibhuti Patel speaking at IMPRI #WebPolicyTalk

Prof Vibhuti Patel, eminent economist and feminist, former professor, TISS, Mumbai, initiated the discussion as the moderator by stating that it is important to discuss the gendered implications of the pandemic as the situation was worst in the second wave. COVID orphans and COVID widows are the new terms added to our vocabulary due to the devastating impact of COVID-19.

She pointed to the naked profiteering by private enterprises amidst this pandemic, which is pathetic to note. She said that we need to promote universal healthcare and 6% of our Gross Domestic Product (GDP) should be devoted to the public health sector. The Government needs to pay attention to:

  • 1 crore girls who are at the verge of dropping-out of schools
  • Food and nutrition safety
  • Job security for unemployment
  • Recognition, reduction and redistribution of care work
  • Application of labour standards
  • Health insurance to ASHA & Anganwadi workers
  • Global minimum tax of 15% for corporate profits as mentioned in G7 summit 2021

She pointed out that gender responsive public policy for inter-sectional marginalities based on caste, class, religion, gender and ethnicity is the need of the hour.

The thinking of profit before people needs to stop- Prof Vibhuti Patel

Gender based violence has taken varied forms in the form of sexual violence, online harassments, domestic abuse, forced child marriages, etc. Mata corona temples have been set up in villages as people believe that by worshipping corona, they can get rid of it. The effects of Labour Codes on women needs to be discussed promptly.

The focus in the 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 the esteemed panelists to put forward their viewpoints.

Public Health Response

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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 of households eating less than after the lockdown was still 60% in Oct- Dec 2020 compared to 77% during the lockdown period. Around 35-66% of the migrants and informal workers ate less than two meals a day and less nutritious food during September- October 2020. Relief measures helped but was patchy and their reach remains a question mark. Debt traps are increasing due to depletion of physical and financial resources.

According to the UN Women report in 2021, 118 women for every 100 men aged 25 to 34 years were under extreme poverty, which is expected to increase to 130 women by 2030. According to World Bank report, in India more than 12 million people 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, violence, and mental health problems, contribute to compromising their physical status.

Ms Khanna pointed that what comes from being infected and what comes from being affected are two different things. According to Centre for Disease Control study, there is 70% increased risk of deaths in pregnant women with COVID infections. Lancet Global Health report 2021 also claimed that maternal deaths and still births rose by a third around the world because of disruption of health services.

In the second wave, more women are getting infected. For example, in Telangana, 38.5% of total cases as compared to 34% in July 2020. 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-section on a COVID positive pregnant woman will further reduce her oxygen levels because of anaesthesia.

Further, Ms Khanna pointed out that the gender gap is increasing widely. Digital divide is aggravating the situation as women in rural areas find it hard to register on CoWIN app and there is a lot of vaccine hesitancy too. Following measures should be taken to “build back better“:

  • Increase financial resources
  • Integrated pandemic response
  • Strengthen health wellness centers
  • Strong mental health support, like the WHO proposed “Talk Therapy”
  • Evidence based protocols for vaccination for pregnant women with informed consent
  • Data systems disaggregation- age, sex, comorbidity
  • Clear classification of deaths
  • Transparent disclosure of information

Global health and social care are delivered by women but led by men, for instance, the World Health Organization.

Health systems have to remove structural barriers that prevent women in health workforce from reaching leadership positions. Women have to be in the leadership and decision making roles.

Care Work

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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.

No data on LGBTQ+ community.

There are widely spread vaccine myths in rural areas. Care giving work 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, the land is mainly registered in the name of males but due to the death of males in the family because of Coronavirus, women are facing problems related to the inheritance of land. Thus, land rights need to be ensured.

Women Farmers

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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-centered and the lockdown was a major issue as access to markets was restricted.

The bargaining power of Dalit women is low. Thus, distress sales are happening in COVID. There are numerous COVID widows in rural areas. All public systems have failed the women. There is a deep economic impact on women. Stigmatized communities like sugar cutters 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), documents are needed to access food. 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 negative effect on girls and women.

Widows and orphans need our attention. Structural inequalities need to be looked into deeply. Further, community support needs to be strengthened.

We need to move from ‘relief to reform’. Recognition and registration to ensure entitlements of women- Ms Seema Kulkarni

Ecologically sound agriculture needs to be promoted and marginalized people needs to come at the fore.

Economic Care

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Dr Soma K Parthasarathy, national facilitation team (NFT) MAKAAM, India focused on the shadow pandemic and medicalization of the whole process. There is an emergency of hunger as is becoming apparent on the streets. Incomes have reduced. Worst hit are sex and domestic workers.

Debt has become a vicious cycle. There is deepening poverty as there are no assets left to survive. In Delhi, the first wave of the pandemic majorly affected migrants, but in the second wave, the upper class and middle class have been affected. PDS and relief distribution systems are inadequate. Profiteering is going on by the private sector. There is a myth that COVID is just another disease in the string of ailments like TB and cancer, the only difference is that COVID is affecting everyone, as a result, it has been declared a pandemic. Female-headed households are more vulnerable. She pointed out that the care burden has tripled.

A common question among the poor is, “Who can afford to stay indoors?”

There is a compounding situation in Delhi. COVID awareness and resilient action need to be taken. We need to focus on the following factors in hilly areas like Uttarakhand:

  • Traditional knowledge,
  • 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 centers in the villages and be prepared. People need to be enabled to subsist in their locations.

Ecological subsistence living and economies of care need more emphasis. Resilience is embedded in the ecological processes- Dr Soma K Parthasarathy

Healthcare Workers

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Dr Swati Rane, CEO, SevaShakti Healthcare Consultancy; VP Clinical Nursing Research Society; Core Committee member, Jan Swasthya Abhiyan, Mumbai, asserted that every person who gives care professionally is a health care worker. Females are the primary care workers all across the world.

Definition of health care workers needs to be redefined- Dr Swati Rane

The violence against female health care workers is tip of iceberg of gender power. Gender leadership gaps are driven by stereotypes, discrimination, power imbalance and privilege.

We need to closing the leadership gap and ensure gender equity and leadership in the global health and care workforce.

Women’s disadvantages intersects with and is 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 health care workers, nurses, and midwives dominated by women at 88% (68th National Sample Survey Organisation (NSSO) 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 remain mostly ignored. The states do not have uniform policies for their workers.

No data is maintained in the Union Government about Safai Karmacharis who died due to COVID-19 pandemic.

Nurses estimated to be around 50% of all health workers are significantly underrepresented in global and national health leadership. Dr Rane pointed out that 76% nurses are overworked. In the first wave, there were 62 deaths in 8 months and in the second wave, 62 deaths in 3 months.

Across Maharashtra, at least 570 ASHA workers were infected with COVID-19. ASHA workers are underpaid and overworked. They have been confronted with physical abuse or violence during their home surveys. There is no system for ASHA workers, for instance, there is no proper job role, as their duties include pre-natal and post-natal care, immunization drives for children, population-based screening for disease based surveillance among others. Therefore, our attention needs to be on:

  • Working conditions
  • Violence
  • Harassment
  • Fear
  • Overload of work.

624 and 748 doctors died in the first and second wave of COVID-19, respectively- Indian Medical Association.

Recommendations

Ms Renu Khanna said that we need to invest more in healthcare which is widely recognized now. Infrastructure and human resources have to expand. Health governance and transparency have to improve. Solidarity against private sector exploitation is required. Resources have to come from the state for community mobilization.

Decentralized local planning with coordination has to be learned from this pandemic- Ms Renu Khanna

Ms Poonam Kathuria asserted that cash transfers need to be increased to Rs 2,000 for ASHA workers and their work must be regularized as they are the lifeline of this country. There has to be targeted vaccination. Support services for women like creches and dabba services needs to be ensured.

There needs to be accurate data needs for effective policy making- Ms Poonam Kathuria

Ms Seema Kulkarni said that we need to restructure and reform. Recognition of women farmers is critical. We need to universalize and expand the agricultural activities of women. We also need to look at diversity of crops and not be limited to wheat and rice. She emphasized on the importance of reimagining MGNREGA, asset building and ecologically centered agriculture. Land rights and Community rights to be strengthened.

Right to land is critical- Ms Seema Kulkarni

Every rural woman needs to be engaged in livelihood activities in a broader context. For instance, biosphere centers can be set up wherein organic manure can be provided by the community.

Ms Soma K Parthasarathy asserted that nature of policies need to be oriented towards women. Subsistence and the concept of enough-ness needs to be looked into. We need to invest in local resources. CSR needs to invest in the caring sector. We need to promote local solutions ex-dabbavallas role in creating employment. Health infrastructure and right to local resources is a priority.

Food processing units, kitchen gardens needs institutional support- Dr Soma K Parthasarathy

Door to door vaccination is the need of the hour- Prof Vibhuti Patel

Dr Swati Rane concluded by saying that we need to invest in public health care as private sector’s profiteering needs to be stopped. Diverse leadership roles need to be created like epidemiologists, nurses, architects, engineers as India is a diverse country with different needs. Health needs to have various actors. The working conditions of the health care workers needs to be improved. Tele-medicine should be adopted. Price of the drugs needs to be maintained.

Health should be related to food, sanitation and water- Dr Swati Rane

Primary health care centres have to be straightened. Transformation of health sector is required.

Prof Vibhuti Patel concluded by highlighting the statement of WHO that global health is losing out on women’s talents due to gender discrimination. Women and girls’ futures need to be secured for equitable growth. Government should support childcare and maternal health. We need to challenge gender norms to create equal opportunities by adopting gender-responsive budgeting.

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