Simi Mehta*, Anshula Mehta**
The COVID-19 Pandemic, apart from exposing the glaring gaps in our healthcare system, has also highlighted the need for a gender lens in policymaking. All over the country, women have been disproportionately affected by the Pandemic and the lockdowns. Women’s experiences and concerns during COVID-19 particularly with respect to women’s health, highlighted by Ms. Jashodhara Dasgupta, in a webinar, organised by the Gender Impact Studies Center (GISC) at Impact and Policy Research Institute, Delhi Post News, GenDev Centre for Research and Innovation on Women and Health: Concerns during COVID-19.
Ms. Dasgupta shed light on women’s hardships during COVID that often go unnoticed, analysed the underlying causes, shared insights on women and care work in the domestic as well as public spheres, and concluded with recommendations on policy approaches that could help change this unfortunate narrative.
During the onset of the pandemic, soon after nationwide lockdowns were imposed, there was panic-stricken exodus across the country. With a sudden halt in income from already precarious and unstable work and lockdown of public transport, millions of migrant workers began walking back home. This was most evident in urban India, which packs close to one third of our 1.4 billion population, living largely in poor housing conditions with crowded spaces, poor hygiene, and lack of private water connections and toilets. With such conditions, ‘stay home, stay safe’ was not an option for them.
With factories and workplaces shut down, millions had to deal with the loss of income, food shortages and enormous uncertainty about the future. Women, girls and children, accompanied by men, began their arduous journeys back to their villages, walking hundreds of kilometres. These also included the old, sick, malnourished, and pregnant. Many women lost their lives or their babies owing to unsafe deliveries on the highways.
An Adivasi woman was reported to have given birth on a highway in Maharashtra, rested for an hour or so and continued walking on with her baby and her luggage. Although the government announced policy support in response, it was inadequate and too late. For instance, pensions provided to old people were increased by a mere Rs.333 over the Rs.500 already provided per month, which often also reached too late. Although food security was also given priority in the government’s policy response, it was inadequate especially for migrants and the marginalized without documentation.
The situation was not easy for women that could afford to stay at home during the lockdowns either. With all family members at home, combined with decreased incomes and food security, women bore the brunt and were eating last and lesser. It was also significantly more difficult for women facing sexual assault or domestic and gender-based violence to reach out and seek help.
They were also unable to access reproductive health products and services such as menstrual hygiene products, contraceptives and abortion services as they were not included in the ‘essential services’ category. In fact, many women in labour who tried to access public as well as private hospitals were turned away. As a result, it is estimated that millions of women are currently dealing with unwanted pregnancies or risky abortions.
Furthermore, another issue the pandemic brought to light was women taking active care roles, both at the household and community levels, and how women’s forced voluntarism that is glorified all too often keeps families and our economy running. The closure of schools and child-care centres such as Anganwadis not only meant less food for the family without the support of school meals and Anganwadi rations, but also a greater burden of care roles on women with children at home.
A time use survey by the NSSO found that women spend 3 times as much time in unpaid domestic work for household members, with over 80% of women in India spending about 5 hours per day on such work. Women’s subordinate status at the household and societal levels implies that this unfair sharing of care work and burden is glorified as ‘maternalism’, ‘voluntarism’, ‘selfless service’, or love. Therefore, state investments must be substantially increased in childcare, elderly care and care of the sick or disabled, to reduce the burden on women and enable them to engage in other forms of productive work.
Similarly, in the health sector, only 17% of doctors are women. However, 85% of the total health sector workforce comprises of women. This shows that even in the formal healthcare sector, women mostly take up roles as nurses, assistants and allied workforce that are in closest contact with patients in clinical contexts including during the current pandemic.
At the community frontlines, women are mostly found in part-time low-paid informal care jobs that provide direct care for health, nutrition and child development – nearly a million rural women work as ASHA workers, with another 2.5 million working as Anganwadi workers and helpers (ANW/ANH). Particularly during the COVID Pandemic, nearly 3.5 million women healthcare workers working at the frontline – as nurses, assistants, sanitation workers etc – took up community surveillance, referral and tracking roles, spending long working hours in unsafe conditions without appropriate PPE, poor compensation, and even facing violence and hostility from communities.
The state, despite being the primary employer, takes no responsibility for their social protection or fair compensation, only perpetuating the notion of women’s ‘voluntarism’ and taking advantage of their desperate desire to engage in any sort of paid work. Over the past few years and recently in June and August 2020, several protests by ASHA, Anganwadi and other frontline workers have erupted, demanding their rights to fair compensation and decent working conditions. It is the need of the hour that more attention be given to women’s care roles at the policy level and to re-evaluate the budgets for health and ICDS.
While examining the intersectional disadvantages and social determinants, Ms Dasgupta highlighted, millions of Dalit, Adivasi, minority groups and resource-poor families are forced to migrate out of their villages as they face local discrimination and exclusion, lack resources and/or face sudden crises or unforeseeable displacement. When they reach cities, they are already deprived and desperate, willing to work for precarious, low paid or even unsafe jobs as they do not generally require documentation or qualifications.
Not surprisingly, such employment is exploitative and offers no social protection or health coverage. The employers or contractors also have no responsibility to pay the workers their due wages. Migrant women face even more hardships as they do not have bank accounts since it requires address proof and identity documents, and cannot avail State benefits since they are not registered with any ASHA/AWW/ANM to ensure their childbirth is safe.
Caste, class, sexual and communal divisions only exacerbate existing gender-based disadvantages and make women, girls and gender-diverse individuals more vulnerable. These situations make it clear that current policies and frameworks only benefit the privileged and those already at an advantage, like us.
While advising on policy response to such crises in particular simultaneously, undertaking a gendered lens, she emphasized on two points.
- Firstly, it is important to recognize that policymaking during crisis situations especially is generally influenced by the experiences of the relatively privileged, with access to internet and information, and documentation. In India, over 95% of working women are engaged in informal work such as agriculture, construction and domestic work, and therefore, cannot benefit from employer-based social protection without formal contracts and documents. Thus, it is necessary to move focus from employer-based social protection to universal social protection, and better understand and address the needs of such marginalized and vulnerable groups without demanding documents.
- Secondly, the vulnerable – such as pregnant women, breastfeeding women, the elderly, disabled and the destitute – could also benefit from additional support from the Union budget as we could consider steps such as emergency cash transfers for all women and gender-diverse individuals, pensions, and substantive maternity allowance equivalent to 50% of minimum wages. Enhancing food security in cereals and proteins, making sure community kitchens serve hot meals, and implementing effective systems that provide take-home-rations are also efforts in the right direction, ideally through local produce from local women farmers/SHGs. Enabling local women leadership when it comes to local implementation and monitoring is also crucial for us to actively view women as agents and not just victims.
With respect to the healthcare system, during the COVID Pandemic, as the unregulated and dominant private healthcare system continued to focus on maximizing profits out of panic, the PMJAY scheme was unable to serve its purpose and protect the poor from out-of-pocket health expenditures. Public health expenditure is extremely inequitable and ranges from Rs 10,000 per capita per year to Rs 600 per capita per year. This calls for more regulation of the private sector and reining in private insurance, increases in the public health budgets, and equitable per capita investment by the State for the provision of universal healthcare services.
In the healthcare domain, it is also necessary for state budgets to be increased for ICDS and public healthcare to pay fair wages to frontline workers like ASHA, AWW, AWH, along with social protection and formal recognition of their work. For women, state benefits should not be contingent on the number of pregnancies/children or the production of documents such as address proof, bank accounts etc.
All reproductive healthcare services must receive priority and all women, children and girls even without documentation must be registered with local providers like the ASHA,AWW,ANM. During emergencies and crises, violence response efforts and shelter services also ought to be included under essential services, and mental health services and stress-support care should be made available to women in community settings.
While concluding, she emphasised on to explore what gender-responsive policymaking could look like and how we can design relief packages that recognize intersectional disadvantages.
YouTube Video for Wavering women’s health amid COVID-19 pandemic
We acknowledge Paavani Pegatraju for assisting in making this event report. Paavani Pegatraju is a research intern at Impact and Policy Research Institute (IMPRI), New Delhi and is pursuing her Masters in Economics and Business at Sciences Po, Paris, France.
*CEO and Editorial Director, IMPRI; **Assistant Director, IMPRI
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