The need for an intersectional lens in health emergencies
Authors: Debora Diniz, Luciana Brito, Giselle Carino, Ilana Ambrogi
Journal: The Lancet Global Health (2021)

It was unsettling to read the Comment by Miguel Parra-Saavedra and Jezid Miranda (August, 2021).1Parra-Saavedra M Miranda J Maternal mental health is being affected by poverty and COVID-19.Lancet Glob Health. 2021; 9: e1031-e1032Google Scholar Their sense of alarm is focused on the next generation and anchored largely on the impact the COVID-19 pandemic might have on the unborn child and “the future of a society”. This theoretical framing is concerning; we know that public health emergencies have a gendered impact on the lives of women, and particularly on the most vulnerable among them.2Wenham C Smith J Morgan R COVID-19: the gendered impacts of the outbreak.Lancet. 2020; 395: 846-848Google Scholar Women are the most seriously affected,3Wenham C Smith J Davies SE et al.Women are most affected by pandemics—lessons from past outbreaks.Nature. 2020; 583: 194-198Google Scholar and global health policies continue to shift the focus away from women, even after substantial evidence has shown the importance of applying an intersectional gender lens to preparedness and response to health emergencies.2Wenham C Smith J Morgan R COVID-19: the gendered impacts of the outbreak.Lancet. 2020; 395: 846-848Google Scholar, 3Wenham C Smith J Davies SE et al.Women are most affected by pandemics—lessons from past outbreaks.Nature. 2020; 583: 194-198Google Scholar, 4Harman S Ebola, gender and conspicuously invisible women in global health governance.Third World Q. 2016; 37: 524-541Google Scholar For Parra-Saavedra and Miranda, gender is not an analytical category in evaluating the impact of the COVID-19 pandemic on women's mental health. They fail to offer a careful analysis of how the social determinants of inequalities contribute to the disproportional burden on women and their health or life projects. There is abundant evidence showing how COVID-19 has exacerbated gender-based violence, unsafe abortion, maternal mortality, and women's impoverishment.3Wenham C Smith J Davies SE et al.Women are most affected by pandemics—lessons from past outbreaks.Nature. 2020; 583: 194-198Google Scholar, 5Nakamura-Pereira M Knobel R Menezes MO Andreucci CB Takemoto MLS The impact of the COVID-19 pandemic on maternal mortality in Brazil: 523 maternal deaths by acute respiratory distress syndrome potentially associated with SARS-CoV-2.Int J Gynecol Obstet. 2021; 153: 360-362Google Scholar The reductionist frame of this Comment reinforces the medical patriarchy bias that “women are only made visible through motherhood”;4Harman S Ebola, gender and conspicuously invisible women in global health governance.Third World Q. 2016; 37: 524-541Google Scholar in fact, this concern with women's mental health seems more like a rhetorical means of speaking about the fetus. As researchers and health providers from the Global South, we were particularly surprised by the conclusion of the first paragraph of the Comment, in which women are reduced to mothers; their health matters insofar as it will impact “the unborn child” and their “probability of equal capabilities and opportunities as adults”. Pregnant women are under severe stress in countries where vaccines are not available for them, particularly those living in Latin America and the Caribbean. The fear and mental stress are caused by an external factor, which should be named: it is the medical science patriarchy that keeps ignoring women's rights and needs. We declare no competing interests. Maternal mental health is being affected by poverty and COVID-19Scientific efforts during the COVID-19 pandemic, in respect to pregnancy, have shown that COVID-19 infection is associated with a substantial increase in severe maternal morbidity and mortality,1 preterm birth, and low birthweight.2 In addition, preliminary data now suggest that vaccination in pregnant women is safe,3 and that there is an infrequent possibility of vertical transmission.4 Yet, less attention has been paid to the maternal health of uninfected women. Challenges that pregnant women face during the COVID-19 pandemic include fear of viral exposure, concerns about their health and of their unborn children, social isolation, childcare, and the increase of job, food, housing, and health-care insecurity. Full-Text PDF Open Access