Global health policy Opinion - 15/March/2021

Reflecting on Women and NCDs in COVID-19 Times

Before the pandemic crisis, women’s lives were already heavily affected by non-communicable diseases (NCDs), as women constitute the majority of the workforce in the healthcare sector and also function as main caregivers for family members at home. The pandemic has only exacerbated the disproportionate care burdens on women. If we are to build a more equitable world, we must start by addressing such imbalances.

The views expressed are those of the author and do not necessarily reflect the position of FORESIGHT Global Health.


 

COVID-19 has laid bare many inequities and fault lines in society, not least for women.  Even before the pandemic crisis, women’s lives were badly affected by non-communicable diseases (NCDs), as women constitute the majority of the workforce in the healthcare sector and also function as main caregivers for family members at home. The pandemic has only exacerbated the disproportionate care burdens on women. If we are to build a more equitable world, we must start by addressing such imbalances. Inaction and ignorance are not options.

Research has shown that people with underlying non-communicable diseases (NCDs) – including  heart disease, cancers, hypertension, obesity and diabetes – who are infected with COVID-19 are at higher risk for becoming severely ill or dying from the coronavirus. They are more likely to require hospitalization, ICU admission and the use of ventilators.  Moreover, the long-term consequences of COVID-19 for the four billion people living with NCDs is worsening disease tomorrow, as they skip doctor visits today out of fear of contracting the virus. Preventing NCDs now is more urgent and important than ever before, and women have a key role to play.

Women are in a key position to set the direction for healthy lifestyles. According to the World Health Organisation (WHO), 80% of heart disease, 80% of type 2 diabetes and 40% of cancers can be prevented with three lifestyle changes – healthy diets, exercise and avoidance of tobacco. Women, who are often at the centre of family decisions about healthy lifestyles, are critical to making the world stronger in the future.

NCDs affect women as patients; they are at risk of breast cancer, cervical cancer, heart disease (the #1 killer of women), gestational diabetes, and Chronic Obstructive Pulmonary Disease (COPD) from cooking on unclean cookstoves. But what may not be so obvious is that women are also affected by NCDs as caregivers.

Women care. They really do. Women make up 70% of the healthcare workforce, as nurses, midwives, doctors, and frontline staff in hospitals, and have been at the forefront of caring for people during the long ordeal of the pandemic. Women also bear a lot of the burden of care for those living with NCDs around the world.

 

COVID-19 HIGHLIGHTS WOMEN’S CARE BURDEN

As we mark the most recent International Women’s Day, Arogya World’s 10,000 women’s survey, completed in 2013, still has a number of lessons to teach us. The massive study, the largest grassroots effort of its kind at the time, unearthed important data about the impact of NCDs on women and their everyday lives.  It showed that two out of three women globally have someone in their home with an NCD, that half of them provide care for that person and one in five have had to quit their job to do so.

Unpaid care work is the foundation of our families, but also an increasing burden for women as they are disproportionality shouldering the responsibilities of increased domestic work stemming from the pandemic. Before the pandemic, women already spent about three times as many hours on unpaid domestic work and care work as men. COVID-19 has therefore only exacerbated the unpaid care burden on women.

We welcome the attention The Gates Foundation, and Melinda Gates in particular, continue to bring to the issue of unequal distribution of unpaid care work, even as recently as in their 2021 Annual Letter. What many do not realize is that NCDs are one of the big reasons behind the unfair burden placed on women by unpaid care.  A quarter of the women in the Arogya study said they spend 25% of their household income caring for family members with NCDs; one in ten of those surveyed said this expenditure accounted for as much as half of their household income. This is completely unsustainable.

 

CALLING FOR ACTION ON HEALTH INEQUALITIES

The World Bank estimates that COVID-19 is pushing people faster into poverty than at any other time in modern history.  Some two-thirds of the 70-100 million newly poor are women.  UN Women estimates that the total number of women and girls in extreme poverty is now 450 million. How will these poor women and their families pay for healthcare, including management of NCDs? These factors add to the growing evidence that Universal Health Coverage (UHC) is absolutely essential as we think through how to make our world resilient and sustainable after the pandemic.

Women’s access to healthcare for themselves remains inadequate; a third of the women in the Arogya study had never even had their blood pressure checked.  Surely, we can do better than that and take steps to improve women’s healthcare in general as we move into a post-pandemic world. Arogya World has interviewed women from around the world, who tell us in their own voices how they have coped with these serious diseases for decades.  One especially poignant story is that of Amelia from Mexico, who had diabetes and hypertension herself and was the principal caregiver to her aged parents, who also had NCDs.  In a video interview, she tells us over and over again  how tired she became from the caregiving work. I still wonder all these years later – who took care of Amelia?

We have an opportunity now to support women, who make up the fabric of society. It would be a shame if the world simply went back to what it was, if we didn’t put the learnings from the pandemic to some use and make every effort to create a more equal environment for all of those living with NCDs.

We call on governments to use tools like UN Women’s Gender Tracker and follow their sound policy recommendations. Governments should put women first as they continue to provide COVID-related economic relief, food assistance and cash transfers. They should extend assistance to informal workers, many of whom are women, to prevent them from falling deep into the abyss of poverty.

We would like to see more countries provide childcare services and commit to addressing unpaid care.  We call on companies to be aware of the pressures on women as they work from home during the pandemic lockdown, often doing the lion’s share of household chores, homeschooling, childcare and eldercare, on top of showing up at work meetings (for those who have work!). And we call on each and every one of us.  We ask concerned global citizens  to commit to lead healthy lives as individuals.  We ask women, in particular, to step up and steer their own families to eat right, to boost immunity, to find ways to exercise every day.  Even as we ask the world to deliver for women, we ask women to step up and deliver for the world.  The future of our world depends on this.  •

 

TEXT Nalini Saligram & Deepa Prahalad. Nalini Saligram is an Ashoka Fellow. Both authors are board members of Arogya World.

 


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