COVID-19: the turning point for gender equality
Authors: Senait Fisseha, Gita Sen, Tedros Adhanom Ghebreyesus, Winnie Byanyima, Debora Diniz, Henrietta H Fore, Natalia Kanem, Ulrika Karlsson, Rajat Khosla, Laura Laski, Dina Mired, Phumzile Mlambo-Ngcuka, Tlaleng Mofokeng, Geeta Rao Gupta, Achim Steiner, Michelle Remme, Pascale Allotey
Journal: The Lancet (2021)

The impacts of the COVID-19 pandemic have gone far beyond the disease itself. In addition to the increasing number of COVID-19 deaths,1WHOWHO Coronavirus (COVID-19) Dashboard.https://covid19.who.int/Date: July 12, 2021Date accessed: July 14, 2021Google Scholar the pandemic has deepened social and economic inequalities.2UNThe Sustainable Development Goals Report 2021. United Nations Department of Economic and Social Affairs, New York2021Google Scholar These indirect impacts have been compounded by pervasive gender inequalities, with profound consequences, especially for women, girls, and people of diverse gender identities.2UNThe Sustainable Development Goals Report 2021. United Nations Department of Economic and Social Affairs, New York2021Google Scholar There has been an escalation in gender-based violence within households,3Bourgault S Peterman A O'Donnell M Violence against women and children during COVID-19—one year on and 100 papers in. Center for Global Development, Washington, DC2021https://www.cgdev.org/sites/default/files/vawc-fourth-roundup.pdfDate accessed: July 4, 2021Google Scholar increasing risk of child marriages and female genital mutilation,4UNICEFCOVID-19: a threat to progress against child marriage. UNICEF, Washington, DC2021https://data.unicef.org/resources/covid-19-a-threat-to-progress-against-child-marriage/Date accessed: July 14, 2021Google Scholar and an increased burden of unpaid care work,5Power K The COVID-19 pandemic has increased the care burden of women and families.Sustainability Sci Pract Policy. 2020; 16: 67-73Crossref Scopus (674) Google Scholar with impacts on mental health.6Almeida M Shrestha AD Stojanac D Miller LJ The impact of the COVID-19 pandemic on women's mental health.Arch Womens Ment Health. 2020; 23: 741-748Crossref PubMed Scopus (295) Google Scholar Communities of people affected by HIV are, again, at the crossroads of injustice and targeted discrimination.7UNAIDSRights in a pandemic—lockdowns, rights and lessons from HIV in the early response to COVID-19. UNAIDS, Geneva, Switzerland2020https://www.unaids.org/sites/default/files/media_asset/rights-in-a-pandemic_en.pdfDate accessed: July 14, 2021Google Scholar Measures to control the pandemic have reduced access to essential health and social welfare services, including sexual and reproductive health services, reduced employment and labour force participation, and decimated many household incomes.8Azcona G Bhatt A Encarnacion J et al.From insights to action: gender equality in the wake of COVID-19. UN Women, New York2020Google Scholar, 9WHOSecond round of the national pulse survey on continuity of essential health services during the COVID-19 pandemic. World Health Organization, Geneva, Switzerland2021https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-EHS-continuity-survey-2021.1Date accessed: July 4, 2021Google Scholar, 10International Labour OrganizationILO Monitor: COVID-19 and the world of work. Seventh edition.https://www.ilo.org/wcmsp5/groups/public/@dgreports/@dcomm/documents/briefingnote/wcms_767028.pdfDate: 2021Date accessed: July 14, 2021Google Scholar Here again, women have borne the brunt of marginalisation, particularly those working in the informal sector. Intersectionality analyses have highlighted the inextricable effects of poverty, racial discrimination, harmful gender norms, and limited agency and opportunities for women, especially already marginalised women, even when they represent most of the front-line health workers.11Morgan R Baker P Griffith DM et al.Beyond a zero-sum game: how does the impact of COVID-19 vary by gender?.Front Sociol. 2021; (published online June 15.)https://doi.org/10.3389/fsoc.2021.650729Crossref PubMed Google Scholar The diversion of funds from other health and development programmes into economic recovery means that the pandemic is further eroding health gains made over decades, stalling progress on tackling gender inequalities.9WHOSecond round of the national pulse survey on continuity of essential health services during the COVID-19 pandemic. World Health Organization, Geneva, Switzerland2021https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-EHS-continuity-survey-2021.1Date accessed: July 4, 2021Google Scholar There are, however, glimmers of hope. The gendered impacts of power, intersectionality, social, legal, and commercial determinants on health are foregrounded in public forums and can no longer be ignored. The pandemic has catalysed a need for concrete action on gender inequality. There is growing acknowledgment by governments that political leadership is required for key decisions about investments in health to ensure social protection and financial recovery, targeting of disadvantaged populations to ensure equity, and engaging with broader geopolitical challenges that impact on health.12Kickbusch I Kirton J Health a political choice: act now, together. 2020http://repository.graduateinstitute.ch/record/298752/files/HPC-ActNowTogether.pdfDate accessed: July 14, 2021Google Scholar With commitments by governments to strengthen health systems and the health workforce, and to enhance the quality of care and self-managed care, there are opportunities to learn from previous efforts to address gender inequalities. Although there are still evidence gaps, our institutions, experts, and practitioners have decades of practice-based knowledge of strategies that work to drive gender equality impacts in health, including an understanding of the political and policy levers that are crucial drivers of change.13Lopes CA Allotey P Vijayasingham L Ghani F Ippolito AR Remme M What works in gender and health? Setting the agenda. UNU-IIGH, Kuala Lumpur, Malaysia2019Google Scholar For example, the progress made in advancing sexual and reproductive health and rights and tackling gender-based violence has consistently been realised through the strong leadership and engagement of feminist civil society and women's rights movements.14Htun M Weldon SL The civic origins of progressive policy change: combating violence against women in global perspective, 1975–2005.Am Political Sci Rev. 2012; 106: 548-569Crossref Scopus (359) Google Scholar The global health community is equipped now more than ever before to drive the gender equality agenda forward in pandemic responses and other health areas.15Wenham C Smith J Davies SE et al.Women are most affected by pandemics— lessons from past outbreaks.Nature. 2020; 583: 194-198Crossref PubMed Scopus (166) Google Scholar There is considerable evidence on the technical solutions that promote gender equality,16Levy JK Darmstadt GL Ashby C et al.Characteristics of successful programmes targeting gender inequality and restrictive gender norms for the health and wellbeing of children, adolescents, and young adults: a systematic review.Lancet Glob Health. 2020; 8: e225-e236Summary Full Text Full Text PDF PubMed Scopus (125) Google Scholar and many of these solutions provide transferable lessons. For example, gender-balanced community health worker teams can achieve increased service coverage.17Viswanathan K Hansen PM Rahman MH et al.Can community health workers increase coverage of reproductive health services?.J Epidemiol Community Health. 2012; 66: 894-900Crossref PubMed Scopus (43) Google Scholar Group-based education interventions that tackle gendered power dynamics in relationships, communities, schools, and health-care settings can reduce intimate partner violence, HIV risk, and disrespectful maternity care.16Levy JK Darmstadt GL Ashby C et al.Characteristics of successful programmes targeting gender inequality and restrictive gender norms for the health and wellbeing of children, adolescents, and young adults: a systematic review.Lancet Glob Health. 2020; 8: e225-e236Summary Full Text Full Text PDF PubMed Scopus (125) Google Scholar, 18UNESCOEmerging evidence, lessons and practice in comprehensive sexuality education: a global review. United Nations Educational, Scientific and Cultural Organization, Paris2015Google Scholar, 19Grilo Diniz CS Rattner D Lucas d'Oliveira AFP de Aguiar JM Niy DY Disrespect and abuse in childbirth in Brazil: social activism, public policies and providers' training.Reprod Health Matters. 2018; 26: 19-35Crossref PubMed Scopus (41) Google Scholar Indeed, four decades of the HIV response have revealed that approaches addressing discriminatory social and gender norms and power structures are effective in improving women's agency and sexual and reproductive health and rights.20UNAIDSSeizing the moment: tackling entrenched inequalities to end epidemics.https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdfDate: 2020Date accessed: July 4, 2021Google Scholar The UN and the Mexican and French Governments convened the Generation Equality Forum, with the most recent held in Paris on June 30 to July 2, 2021, to make concrete commitments to act on and resource gender equality and women's rights. Investments of US$40 billion were announced by governments and public sector institutions, UN entities, philanthropy, and the private sector.21UN WomenGeneration Equality Forum concludes in Paris with announcement of revolutionary commitments and global acceleration plan to advance gender equality by 2026. Generation Equality Forum.https://forum.generationequality.org/news/generation-equality-forum-concludes-paris-announcement-revolutionary-commitments-and-globalDate: July 2, 2021Date accessed: July 4, 2021Google Scholar The UN is where the technical meets the political. It has a key leadership role in working with partners to bring evidence-based solutions together to promote healthy living and wellbeing for all as part of the 2030 Agenda for Sustainable Development. As representatives of UN agencies, the UN Special Rapporteur on the Right to Health, and civil society partners, we commit to leveraging the full power of our collective influence, access, and resources. We are seizing the opportunity to apply our collective knowledge and learning to focus efforts on strategies that have made change happen. First, we will reinforce and sustain our institutional capacity to deliver gender equality by increasing gender expertise in health, especially at senior levels. We will commit core financial resources to this agenda. Our organisations delivered results when our gender equality strategies were adequately resourced, and priority actions were central in our organisations' core programmes of work.13Lopes CA Allotey P Vijayasingham L Ghani F Ippolito AR Remme M What works in gender and health? Setting the agenda. UNU-IIGH, Kuala Lumpur, Malaysia2019Google Scholar, 22Gupta GR Oomman N Grown C et al.Gender equality and gender norms: framing the opportunities for health.Lancet. 2019; 393: 2550-2562Summary Full Text Full Text PDF PubMed Scopus (142) Google Scholar Second, we commit to obtaining sex-disaggregated data from our programmes and member states for priority health indicators. Data provide a powerful and empowering visibility to gender inequalities. Despite decades of guidance requiring health data to be sex-disaggregated, this basic requirement for informed decision making is still far from being the norm.23WHOAddressing sex and gender in epidemic-prone infectious diseases. World Health Organization, Geneva, Switzerland2007Google Scholar The COVID-19 pandemic has shown that the health sector can do more to prioritise gender equality. Only 48% and 36% of 199 countries reported sex-disaggregated data on COVID-19 cases and deaths.24Global Health 50/50The COVID-19 Sex-disaggregated Data Tracker: April update report.https://globalhealth5050.org/wp-content/uploads/April-2021-Data-tracker-update.pdfDate: 2021Date accessed: July 4, 2021Google Scholar Third, we will continue to leverage the expertise and capacity of feminist civil society to support the design, implementation, and monitoring of health policies, programmes, and community-centred solutions and hold our institutions accountable to our commitments.25Sen G Iyer A Chattopadhyay S Khosla R When accountability meets power: realizing sexual and reproductive health and rights.Int J Equity Health. 2020; 19: 111Crossref PubMed Scopus (17) Google Scholar Innovative partnerships forged during the COVID-19 pandemic between governments, civil society, and the private sector have mitigated some disruptions in essential services, delivered essential commodities, supported survivors of violence, and brought justice to those unfairly persecuted.20UNAIDSSeizing the moment: tackling entrenched inequalities to end epidemics.https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdfDate: 2020Date accessed: July 4, 2021Google Scholar To drive structural change, voices from feminist civil society are needed at decision-making tables in clinics, communities, and our institutional governance structures. Finally, to control COVID-19 and mitigate its impacts, we need to tackle the structural determinants of gender inequality—eg, political participation and economic systems—and the intersections with other inequities. To do this effectively, we must join forces with social justice movements. Cross-movement activism had a pivotal role in the global HIV/AIDS response and ensuring access to HIV treatment in countries such as South Africa and Brazil.26Patterson D London L International law, human rights and HIV/AIDS.Bull World Health Organ. 2002; 80: 964-969PubMed Google Scholar Therefore, our commitment to gender equality during this pandemic goes hand in hand with our commitment to global COVID-19 vaccine equity.27Georgieva K Ghebreyesus TA Malpass D Okonjo-Iweala N A new commitment for vaccine equity and defeating the pandemic. International Monetary Fund. Views & Commentaries, June 1, 2021https://www.imf.org/en/News/Articles/2021/06/01/a-new-commitment-for-vaccine-equity-and-defeating-the-pandemicDate accessed: July 4, 2021Google Scholar Global vaccine inequity currently defines the global pandemic response. It is a moral and a public health failure that 75% of the 3·47 billion COVID-19 vaccine doses administered by July 12, 2021, were administered in only ten countries.28Our World in DataCOVID-19 vaccine doses administered.https://ourworldindata.org/grapher/cumulative-covid-vaccinationsDate: 2021Date accessed: July 14, 2021Google Scholar A feminist response requires immediate sharing of knowledge, transfer of technological know-how, scale up of manufacturing, and the waiver of intellectual property protections for COVID-19 vaccines, as well as responding to gender-related barriers during vaccine deployment, including access for pregnant women. This approach will be essential if we are to have a fighting chance to prevent the erosion and reversal of hard-won health and gender equality gains. We declare no competing interests. The views expressed in this Comment are personal and do not necessarily reflect the views of the UN. This online publication has been corrected. The corrected version first appeared at thelancet.com on August 5, 2021 This online publication has been corrected. The corrected version first appeared at thelancet.com on August 5, 2021 Department of ErrorFisseha S, Sen G, Ghebreyesus TA, et al. COVID-19: the turning point for gender equality. Lancet 2021; 398: 471–74—In this Comment, part of the fourth sentence of the first paragraph is corrected to read "increasing risk of child marriages and female genital mutilation" and the Mexican Government is now included at the start of the first sentence of the sixth paragraph to read "The UN and the Mexican and French Governments convened the Generation Equality Forum, with the most recent held in Paris…" These corrections have been made to the online version as of Aug 5, 2021, and the printed version is correct. Full-Text PDF