Apart from exposing the glaring gaps in our healthcare system, the COVID-19 pandemic has also highlighted the need for a gender lens in policy making. All over the country, women have been 
disproportionately affected by the pandemic and the lockdowns. Women’s experiences and concerns during the pandemic, particularly with respect to their health, were highlighted by Jashodhara Dasgupta, Chairperson, SAHAYOG, Lucknow. She 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 and public spheres, and concluded with recommendations on policy approaches that could help change this unfortunate narrative.
During the onset of the pandemic, with a sudden halt in income from already 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. Women, girls and children, including the old, sick, and pregnant, began their arduous journeys, walking hundreds of kilometres. Many women lost their lives or their babies owing to unsafe deliveries on the highways. Although the government announced policy support in response, it was inadequate and too late—pensions to old people were increased by a mere Rs 333 over the Rs 500 already provided per month, which often also reached too late; though food security was given priority, it was inadequate especially for migrants and the marginalised without any documentation.
The situation was not easy for women that could afford to stay home during the lockdowns either. With all family members at home, combined with decreased incomes and food insecurity, women bore the brunt and were eating last and lesser. It was also significantly more difficult for women facing sexual assault or gender-based violence to seek help. They were also unable to access healthcare and reproductive health products such as menstrual hygiene products, contraceptives, and abortion services, as they were not included in the ‘essential services’ category. Consequently, 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 as ‘maternalism’, ‘selfless service’, or love, 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, but also a greater burden of care roles on women with children at home.
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A time-use survey by the NSSO found that women spend three times as much time in unpaid domestic work for household members, with over 80 per cent of women in India spending about 5 hours per day on such work. Therefore, state investments must be substantially increased in childcare, elderly care, and care of the sick and disabled, to reduce the burden on women and enable them to engage in other forms of productive work.
Similarly, even in the formal health sector, although 85 per cent of the total workforce comprises women, only 17 per cent of doctors are women, revealing that women mostly take up roles as nurses and assistants whoare in closest contact with patients in clinical contexts. 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 –as ASHA and Anganwadi workers and helpers (ANW/ANH). Particularly during the pandemic, nearly 3.5 million women healthcare workers took up community surveillance, referral and tracking roles, spending long working hours in unsafe conditions without appropriate personal protection equipment (PPE), poor compensation, and even facing hostility from communities. The State, despite being the primary employer, takes no responsibility for their social protection or fair compensation. Over the past few years and recently in 2020, several protests 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 public healthcare and ICDS.
While examining the intersectional disadvantages and social determinants, Ms Dasgupta highlighted, Dalit, Adivasi, minority groups and resource-poor families are forced to migrate out of their villages as they face local discrimination and exclusion and face sudden crises or unforeseeable displacement. When they reach cities, they are already deprived and desperate, willing to take precarious, low paid or even unsafe jobs as they generally do not require documentation or qualifications. Not surprisingly, such employment is exploitative and offers no social protection. 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.
Policy responses to such crises should focus on two points: Firstly, in India, over 95 per cent 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 address the needs of such marginalized and vulnerable groups without demanding documents. Secondly, the vulnerable, including pregnant women, breastfeeding women, gender-diverse individuals, the elderly, disabled and the destitute, could benefit from additional support from the Union budget through steps such as emergency cash transfers, pensions, and substantive maternity allowance equivalent to 50 per cent of minimum wages. Enhancing food security in cereals and proteins, ensuring effective functioning of community kitchens, and providing take-home-rations are also efforts in the right direction.
Enabling local women leadership when it comes to local implementation and monitoring is also crucial for us to actively view women as agents.
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During the pandemic, as the unregulated and dominant private healthcare system continued to focus on maximising profits out of panic, the PMJAY scheme was unable to protect the poor from out-of-pocket health expenditures. Public health expenditure is extremely inequitable and ranges from Rs 600 to Rs 10,000 per capita per year. This calls for more regulation of the private sector, increases in the public health budgets, and equitable per capita investment for the provision of universal healthcare services. It is also necessary to pay fair wages to frontline workers, along with social protection and formal recognition of their work. 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, ANW, ANM. During emergencies and crises, violence-response efforts, shelter services, and mental health services also ought to be included under essential services and be made available to women in community settings. It is important to explore what gender-responsive policy making could look like and how we can design relief packages that recognise intersectional disadvantages.
(Note: Excerpts from the webinar “Women and Health: Concerns during COVID-19 organised by the Gender Impact Studies Center (GISC) at Impact and Policy Research Institute, the Delhi Post, and GenDev Centre for Research and Innovation).
