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Policy Brief Impact of COVID-19 on Women |
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POLICY BRIEF
2020 | JULY
THE IMPACT OF COVID-19
ON WOMEN
The COVID-19 pandemic has forced the world to
embrace a new normal, with self-isolation and physical
distancing being the global way of life today. And while
such preventive measures are critical, combating the
COVID-19 crisis necessitates a robust and inclusive
societal and health system response, bearing in mind the
specific needs of vulnerable populations.
cultural practices’. Yet evidence across sectors, including
economic planning and emergency response, continue
to lack a gender lens. Less than one percent of published
research papers on both Ebola and Zika outbreaks
focused on the gender dimensions of the emergencies.5
Research on the gendered implications of previous
health emergencies is even more scarce.
Policies and public health efforts have not addressed the
gendered impacts of disease outbreaks. The COVID-19
pandemic is deepening pre-existing inequalities,
exposing vulnerabilities in social, political and economic
systems, which are in turn amplifying the impacts of
the pandemic. Across every sphere, from health to the
economy, the impact of COVID-19 are exacerbated for
women and girls.
This policy brief explores the differential impact of COVID-19
and makes recommendations to ensure that women and
girls remain central to COVID-19 response planning and
recovery efforts.
Increased risk to women
Evidence from past epidemics, including Ebola (2014-16)
and Zika (2016) suggests that women and children are at
greater risk of exploitation and sexual violence.1 Increasing
the risks of violence for women were increased stress,
the disruption of social and protective networks, and
decreased access to services. Efforts to contain outbreaks
have in the past diverted resources from routine health
services including pre- and post-natal health care and
contraceptives,2 and exacerbated already limited access
to sexual and reproductive health services.3
The Report of the High-Level Panel on the Global
Response to Health Crises, set up by the United Nations
(UN) Secretary-General, submitted in 20164 underscored
in its recommendations ‘Focusing attention on the
gender dimensions of global health crises’. It noted the
need to incorporate gender analysis into responses,
as well as recognize the critical role played by women
in responding to health emergencies. It further stated
that ‘policy-makers and outbreak responders need to
pay attention to gender-related roles and social and
Economic Impact
Emerging evidence on the impact of COVID-19 suggests
that women’s economic and productive lives will be
affected disproportionately and differently from men.6
Across the globe, women earn less, save less, hold less
secure jobs, and are more likely to be employed in the
informal sector. In developing economies 70% of women
work in the informal sector with few protections against
dismissal or for paid sick leave and limited access to social
protection.7 The Ebola virus showed that quarantines can
significantly reduce women’s economic and livelihood
activities, increasing poverty rates, and exacerbating
food insecurity.8 In India, the nationwide lockdown
imposed by the government has left millions of migrant
women unemployed and starved for food, placing a
huge financial burden on these women, who contribute
substantially to their household income.
On an average, women spend two times as many hours
as men doing unpaid caregiving work as well as domestic
work. With health facilities being overburdened and
non- COVID-19 related health and social services being
scaled down, women will be primary, unpaid caregivers
to ailing family members, including children and old
people. Women’s greater involvement in the unpaid care
economy could also impact their already low workforce
participation rate. It is imperative to recognize women’s
caregiving responsibilities and include this work in
economic metrics and decision-making.
Health Impact
Restrictive social norms, gender stereotypes, home
quarantining and diversion of resources to respond to the
COVID-19 pandemic can limit women’s ability to access
health services as well as make them more susceptible
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PFI’s studies to assess the impact of COVID-19
To assess the impact of COVID-19 on young people,
girls and women and their access to health services,
Population Foundation of India (PFI) commissioned two
rapid telephonic surveys; first, with front line workers,
grassroots organizations and community members in
five states (Bihar, Jharkhand, Odisha, Rajasthan and
Uttar Pradesh), and second, with young people (15-24
years) in three states of Bihar, Rajasthan and Uttar
Pradesh. Key findings from the studies are shared
below:
Awareness and perceptions regarding Covid-19
•• Both front-line workers (FLWs) and community
members in five states were aware of the disease,
its symptoms, and preventive measures to be
followed.
•• There was a predominant perception of fear among
FLWs and community members often leading to
discriminatory behaviour and stigma.
•• Young people’s awareness on the symptoms of
COVID-19 in Rajasthan, UP and Bihar was high.
•• Sources of information- For community members,
media and family members were the major source.
FLWs received information from capacity building
sessions, colleagues and media while young people
received information from traditional media and
face-to-face interactions with FLWs.
Availability of and access to healthcare
•• While OPD services were functional, communities
were encouraged to access health care for deliveries
or medical emergencies only.
•• The fear of being infected kept many away from
accessing services at health facilities and led to
resistance in interacting with ASHAs and ANMs on
family planning during their home visits.
•• Consistent with national guidelines and state orders,
across states, Village and Health Nutrition Days
(VHNDs) were suspended during lockdown period.
•• In absence of VHND and service provision by ANMs
in villages, nearly 50 percent or more FLWs reported
that women were not accessing Ante-natal care
(ANC) services; and 70 percent or more reported
beneficiaries not accessing immunization services.
•• Young people in UP, Bihar and Rajasthan reported
an unmet need for reproductive health services,
sanitary pads and IFAs during the lockdown.
•• While contraceptives were available at the district
level, limited access to public transport prevented
FLWs to collect supplies from PHCs/CHCs.
•• Concerns were raised around complications arising
from limited availability of essential and emergency
health services,
•• Concerns were also raised around increase in
unwanted pregnancies and unsafe abortions due
to inadequate supply of contraceptives and limited
service provision.
•• Increase in domestic violence at home were only
reported by one-fourth of the participants, most of
which were women.
•• Young people expressed the need for mental health
care services, and those who have used these, have
found them to be positively influential.
to health risks. Global lockdowns have led to several
women being stuck at home with their perpetrators
and incidents and reports of violence against women
has been on a rise globally. Women’s access to sexual
and reproductive health services has also been severely
impacted due to the COVID-19 emergency response and
global lockdowns. Multiple responsibilities has also put
severe strain on their mental health.
1. Violence against women and girls
According to the WHO, violence against women remains
a major threat to global public health and women’s
health during emergencies. Although data are scarce,
reports from China, the United Kingdom, the United
States, and other countries suggest an increase in
domestic violence cases since the COVID-19 outbreak
began. The National Commission of Women in India has
also reported a surge in the reported cases of violence
in the country. Stress, the disruption of social and
protective networks, and decreased access to services
can all exacerbate the risk of violence for women. As
distancing measures are put in place and people are
encouraged to stay at home, the risk of intimate partner
violence is likely to increase.
In India, 1 in 4 girls get married by age of 18 years (27%
prevalence).9 One third (32 per cent) of women who
had married before the age of 18 had experienced
physical violence at the hands of their husbands. The
sex ratio at birth in India is 899 girls for every 1,000 boys
born.10 According to UNFPA’s recently released State of
the World Population (SWOP) report, COVID 19 may
exacerbate the already concerning numbers around
early marriage, violence and sex birth ratio at birth.11
UNFPA’s recent projections estimate that 31 million
additional cases of gender-based violence can be
expected to occur if the lockdown continues for at
least six months. For every three months the lockdown
continues, an additional 15 million extra cases of gender-
based violence are expected. The projections further
suggest that due to the disruption of programmes to
prevent female genital mutilation in response to
COVID-19, two million female genital mutilation cases
may occur over the next decade that could have been
averted. COVID-19 will disrupt efforts to end child
2 Population Foundation of India
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marriage, potentially resulting in an additional 13
million child marriages taking place between 2020 and
2030 that could otherwise have been averted.12
The health impacts of violence, particularly intimate
partner/domestic violence, on women and their
children, are significant. This can result in injuries and
serious physical, mental, sexual and reproductive health
problems, including sexually transmitted infections,
HIV, and unplanned pregnancies. Violence not only
negatively impacts women but also their families, the
community and the nation at large. It has tremendous
costs, from greater health care and legal expenses and
losses in productivity, impacting national budgets and
overall development.13
What can be done to address violence against women
during the COVID-19 response?
•• Inclusion of measures to address violence against
women in preparedness and response plans for
COVID-19 by Governments and policy makers.
•• Development of a public health response to
violence against women.
•• Ensuring preventive, curative and systematic
referral support to the survivors of violence and
early detection cases.
•• Training of healthcare providers to provide better
quality of care and counseling services to victims of
violence.
•• Facilitating hotlines, telemedicine services, shelters,
rape crisis centers, counselling for survivors of
violence must be ensured.
•• Emphasis on greater reporting on violence in
COVID-19 response plans.
2. Mental health
While there have been reports suggesting that men,
the elderly, and persons with compromised immune
systems may be at be greatest risk of fatality from
COVID-19, the greater caregiving role that women and
girls are expected to perform may compromise their
mental health and well-being. Results from a recent PFI
study to assess the knowledge and impact of COVID-19
on young people in three Indian states of Uttar Pradesh
(UP), Bihar and Rajasthan show that 51% female
adolescents experienced an increase in workload during
the nationwide lockdown, as compared to 23% male
adolescents. In UP 96% females experienced an increase
in workload, with 67% being below 18 years of age.14
Specific population groups are showing high degrees
of COVID-19-related psychological distress. Frontline
healthcare workers are facing backlash from
communities leading to stress. In the wake of the
lockdown, people across all strata and age groups
are finding it increasingly difficult to deal with social
isolation and stress at home, with some facing increased
abuse, disrupted education and uncertainty about their
futures.
In addition to the caregiving burden, social norms in
some contexts dictate that women and girls are the
last to receive medical attention when they become ill,
which could hinder their ability to receive timely care
for COVID-19. Furthermore, myths, misconceptions
and stigma surrounding COVID-19 can further drive
people, particularly vulnerable sections like women and
childrenparticularly vulnerable sections like women and
children to hide their illness to avoid discrimination.
This would prevent people from seeking health care
immediately as well as discourage them from adopting
healthy behaviours.
The caregiving responsibilities of women extend
beyond their homes, with women making up 70 percent
of the health workforce globally.15 In India, there are
1 million ASHAs (Accredited Social Health Activists)16,
0.9 million ANMs (Auxiliary Nurse Midwives)17 and 1.4
million nutrition workers called Anganwadi workers.18
During the ongoing crisis, these frontline health workers
are leading the health system’s response to COVID-19.
In Italy 66% of the total health workers infected with
COVID-19 are women while in Spain 72% of the total
infected health workers are female.19
Outbreaks could also result in disruptions to mental
health and psychosocial support services. Given the
increase in such cases during the COVID-19 outbreak,
frontline health workers, women and girls with caregiving
burdens, and community members fearful of becoming
infected or infecting others may all experience stress
and trauma relating to the outbreak.
What can be done to address mental health issues
stemming from the COVID-19 pandemic?
•• Inclusion of psychological support services for
women into primary health care.
•• Development of a comprehensive crisis prevention
and intervention system including epidemiological
monitoring, screening, referral and targeted
intervention to reduce psychological distress.
•• Awareness campaigns to ensure vulnerable
groups including women, are well informed about
the availability and accessibility of mental health
related services.
•• Increased investments in mental health research.
•• Building a cadre of trained professionals to
strengthen mental health services.
3. Access to Sexual and Reproductive Health Services
Evidence suggests that during past public health
emergencies, resources have been diverted from routine
health care services toward containing and responding
to the outbreak. These re-allocations constrain already
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limited access to sexual and reproductive health
(SRH) services, such as clean and safe deliveries,
contraceptives, and pre- and post-natal health care.20
What do projections tell us?
Guttmacher Institute recently released an estimate
of the potential impact of COVID-19 pandemic on
provision of sexual and reproductive health services
(SRH services) in low and middle income countries
(LMICs).21 The study takes into account data from 1.6
billion women of reproductive age across 132 LMICs
and makes the following projections:
•• A 10% decline in use of reversible contraceptive
methods in LMICs due to reduced access would
result in an additional 49 million women with an
unmet need for modern contraceptives and an
additional 15 million unintended pregnancies over
the course of a year.
•• A decline of 10% in coverage of pregnancy-related
care and newborn health care would result in an
additional 1.7 million women giving birth and 2.6
million newborns experiencing major complications
due to lack of care they need.
•• Countrywide lockdowns which are forcing clinics
to close or if abortion is considered a nonessential
service, an additional 3.3 million unsafe abortions
would occur in LMICs over the course of a year.
Recently released projections by the UNFPA suggest
that 47 million women in 114 low- and middle-
income countries may not be able to access modern
contraceptives and 7 million unintended pregnancies
are expected to occur if the lockdown carries on
for six months and there are major disruptions to
health services. For every three months the lockdown
continues, up to an additional two million women may
be unable to use modern contraceptives.
UNICEF has estimated that in the nine months span
dating from when COVID-19 was declared a pandemic,
the countries with the highest numbers of forecast
births are expected to be India (20.1 million), China
(13.5 million), Nigeria (6.4 million), Pakistan (5 million)
and Indonesia (4 million).22
An analysis of the projected demand for contraceptive
methods, based on previous year’s contraceptive
methods distribution and use of services, basis
Government of India’s Health Management Information
System (HMIS)23 indicates that approximately one
million women undergo sterilization or accept IUCD
or an injectable method in the month of March
alone. The data from HMIS further suggest that
approximately 2.8 million condoms and 4.3 million
pills are distributed monthly during the months of
April and May . With the country under extended
lockdown and a large number of migrants returning
to their villages, the demand for contraception
will likely be higher. This phenomenon, in normal
course, is witnessed during major festivals, and is
directly proportional to an increase in the number
of pregnancies in states like Bihar, which have a
huge migrant population.
What can be done to mitigate the risk to family
planning programs?
•• Social marketing organizations and FP service
delivery organizations could support the
government in ensuring uninterrupted supply
of reversible methods of contraception and
take some burden off the public health system.
•• The availability of self-care methods like
condoms, oral contraceptive pills, emergency
contraceptive pills, pregnancy test kits and
sanitary pads at the pharmacies should
be ensured. Furthermore, continuity of
contraceptive supply chain is imperative to rule
out stock outs in districts upto PHCs.
•• ASHAs and other community level health workers
should be supported to ensure continued access
to family planning services.
•• Counseling on family planning through
helplines, telemedicine services, community
radios, chatbots and mobile services should be
ensured.
•• The government should leverage partnerships
with NGOs to support information and service
delivery in this time of crisis. The government
has recognized the critical role of NGOs in
delivering services to vulnerable groups at this
time of crisis. Ensuring easy mobility and smooth
operations of NGOs providing health and family
planning services will be critical to many women
and children accessing essential non-COVID-19
healthcare services.
Way forward
Going forward, it is important for us to not view
COVID-19 as a standalone disaster impacting the
world. It is afterall, the third coronavirus outbreak
the world has witnessed in the past two decades.
The impact of COVID-19 has been, by far, the most
fatal and widespread, partly because of the severity
of the condition and partly because today the world
is way more connected making transmission quicker.
It is the need of the hour to develop a health systems
approach to disaster management, both natural or
manmade, where lessons identified from disasters
are effectively collated and used to enhance disaster
preparedness of the country.
First, we need effective solutions to ensure that
women’s health does not remain on the fringes in
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the post-COVID-19 era. Given the evidence, we must
apply an intentional gender lens while designing
programmes and prepare ourselves with adequate
knowledge, gender disaggregated data and evidence
to address the socio-economic impact of COVID-19.
Second, investing in our 3.3 million strong female
frontline workforce is the only solution for
combating the aftermath of COVID-19. Even in the
cases of HIV and polio eradication, it was the support
of the community, which proved to be effective.
Our community health workers need to be valued
prioritized and resourced.
Third, there is a need to step up investments in
family planning. Studies from across the globe have
revealed that investing in family planning is one
of the most cost-effective public health measures
and a development “best buy”. A study conducted
by Population Foundation of India for the period of
2015-2031 estimated that effective family planning
interventions can prevent 2.9 million infant deaths and
save 1.2 million maternal lives. Additionally, availability
of quality family planning services can prevent 206
million unsafe abortions in India during the same
period. In contrast, inaction in family planning can
have a disturbing influence on several fronts – it can
disrupt the growth equilibrium and result in loss to
individuals, households and the economy.
Fourth, as the pandemic and its ramifications on
the economy, social dynamics and health outcomes
continue to spread, health education and social
and behavior change communication (SBCC)
campaigns can help spread awareness on all aspects
of sudden disasters across all stratas of society and
dispel surrounding myths and misconceptions doing
the rounds. Changing mindsets is only possible by
adopting innovative SBCC strategies pertaining to
health, which enable people to observe and imbibe
healthy behaviours. For instance, Population
Foundation of India, is providing content support
to government of India to improve people’s access
to verified, reliable and updated information on
COVID 19. Vetted by leading public health experts and
epidemiologists, the information is being translated
into different languages to reach a wider audience. In
addition, as we prepare to embrace a ‘new normal’,
SBCC strategies will play a crucial role in promoting
self-care, fighting stigma and transforming regressive
social norms which have impacted the status of
women for centuries.
Fifth, given that routine health services are the first
to be impacted at the time of health disasters, such
as COVID-19, extra efforts are needed to revamp
and strengthen public health, especially primary
health care and increase health budget. It is crucial
to optimize service delivery settings and platforms
by mapping health facilities, maintaining supply
chains and establishing outreach mechanisms.
There is an urgent need for redistribution of health
workforce, capacity building of frontline workers and
strengthening paramedics and greater investment in
medical research. This will not only enable accurate
prognosis and subsequent referrals to specialists but
also ensure uninterrupted service provision with the
limited health workforce.
As researchers continue to study the coronavirus
and develop therapeutic strategies to prevent and
stop the spread of disease, the public health system
needs to simultaneously evolve and prepare itself to
combat severe health challenges, which is not at the
expense of other healthcare priorities.
How can we combat the aftermath of COVID-19?
•• Ensuring women’s equal representation in all
COVID-19 response planning and decision-
making.
•• Targeting women and girls in all efforts to
address the socioeconomic impact of COVID-19.
•• Integrating prevention efforts and services
to respond to violence against women into
COVID-19 response plans.
•• Partnerships between government and civil
society organizations to ensure uninterrupted
supply of sexual and reproductive health
services.
•• Extend basic social protection to informal
workers
•• Health systems strengthening and adequate/
increased health budget allocation.
•• Capacity building of community level health
workers to ensure continued access to family
planning services, improved quality of care and
counseling services to women.
•• Strengthening counseling services though
helplines, telemedicine services, community
radios, chatbots and mobile services.
•• Greater health awareness through behaviour
change communication campaigns- stepping up
advocacy and awareness campaigns, including
targeting men at home.
•• Ensuring psychosocial support for women
and girls combatting mental health issues and
stigma.
•• Developing a public health response to end
violence by providing preventive, curative and
systematic support to the survivors of violence
and early detection.
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PFI’s efforts to combat the COVID-19 crisis
•• Small grants to organizations in Bihar, Uttar Pradesh, West Bengal, Delhi and Jharkhand relief and rehabilitation work by way of
providing daily essentials, sanitizers, masks and livelihood support to approximately 18,000 beneficiaries since March 2020.
•• Content partner for Government of India’s citizen-centric platform for creating the content strategy, messaging and creatives
around COVID-19
•• Conceptualized and created a short film on female healthcare workers at the forefront of COVID-19. The video garnered 4.6
million views within 24 hours of being posted. [Hindi Version, English Version]
•• In collaboration with the renowned theatre and film director, Mr Feroz Abbas Khan, PFI has been working on a social and
behaviour change campaign to disseminate key messages, tackle misinformation and reinforce a sense of solidarity around the
fight against COVID-19. Hasya Kavi Potliwala is a short animation film featuring a poet who recites a short “kavita” addressing
stigma against COVID-19 patients. We have also conceived a five-episode animation series, titled Corona Ki Adalat (Court of
Corona) - the first film of the series addresses the issue of stigma and discrimination against healthcare workers.
•• Partnerships with State Governments and NGOs. PFI is working directly with state governments, Ministry of Health and Family
Welfare and civil society organizations to develop and disseminate materials on COVID-19 in Hindi, English and regional
languages for their use.
•• Generating evidence on the impact of COVID-19
•• PFI commissioned a study on impact of COVID-19 on availability of services and commodities in public health facilities and
outreach by front line workers in five Indian states (Bihar, Odisha, Jharkhand, UP, Rajasthan) – May, 2020,
•• PFI conducted a telephonic rapid assessment with adolescents and youths in three states (Rajasthan, UP and Bihar) to
understand the level of knowledge and impact of COVID-19 – May, 2020.
References
1. UNGA A/70/723. Protecting Humanity from Future Health Crises:
Report of the High Level Panel on the Global Response to Health
Crises; UNICEF Helpdesk, “GBV in Emergencies: Emergency
Responses to Public Health Outbreaks,” September 2018, p. 2.
2. UNGA A/70/723. Protecting Humanity from Future Health Crises:
Report of the High Level Panel on the Global Response to Health
Crises. Measure Evaluation (2017). The Importance of Gender in
Emerging Infectious Diseases Data. Smith, Julia (2019). Overcoming
the ‘tyranny of the urgent’: integrating gender into disease outbreak
preparedness and response, Gender and Development 27(2).
3. Smith, Julia (2019). Overcoming the ‘tyranny of the urgent’: integrating
gender into disease outbreak preparedness and response, Gender
and Development 27(2).
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impact_brief_for_UNFPA_24_April_2020_1.pdf
13. https://www.unwomen.org/en/what-we-do/ending-violence-
against-women
14. Population Foundation of India (2020). Rapid assessment on impact
of COVID-19 on young people in three states (Uttar Pradesh, Bihar
and Rajasthan)
15. WHO (2019). Gender equity in the health workforce: Analysis of 104
Countries.
16. https://pib.gov.in/newsite/PrintRelease.aspx?relid=200175
17. National Health Profile 2019
18. https://pib.gov.in/PressReleasePage.aspx?PRID=1578557
19. UN Policy Brief- Impact of COVID-19 on Women’s Health
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potential-impact-covid-19-pandemic-sexual-and-reproductive-health
22. h t t p s : / / n e w s . u n . o r g / e n / s t o r y / 2 0 2 0 / 0 5 / 1 0 6 3 4 2 2 ? u t m _
source=UN+News++Newsletter&utm_campaign=e90d7a9b3e
EMAIL_CAMPAIGN_2020_05_07_12_30&utm_medium =email&utm_
term=0_fdbf1af606e90d7a9b3e -107346842
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May 07, 2020 at 11:34 AM)
24. Analysis conducted by Population Council
Suggested citation:
Population Foundation of India. July 2020. Policy
Brief: The Impact of COVID-19 on Women. New Delhi:
Population Foundation of India.
6 Population Foundation of India
Population Foundation of India
B-28, Qutub Institutional Area,
New Delhi - 110 016, India T: +91 - 11- 4389 4100
populationfoundation.in