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What do we know about women and COVID-19 in low- and middle-income countries from the peer-reviewed literature?

By Anita Raj, Nabamallika Dehingia, Anvita Dixit and Lotus McDougal

The literature on COVID-19 is shockingly vast when you consider that most nations have been contending with the impact from the virus for only about six months at most. Based on this literature, there are a few recognized cross-national findings with regard to risk and severity of impact, and one of the most well-recognized findings is that related to sex.

Men are significantly more likely than women to experience severe complications from COVID-19, including death. Evidence supports that higher odds of COVID-19 complications among men is biobehavioral in nature, affected by sex (e.g. women may mount a more adaptive immune response than men) and by social construction of gender (e.g., masculinity norms may result in men being less likely than women to engage in protective behaviors such as mask use or hand washing). However, the pandemic is harming women and girls, too, and differentially than is seen for men and boys, as noted in a recent Lancet paper on gender and COVID-19. The evidence-base is building in this area, but it remains emergent and requires more attention.

A quick google search of “COVID-19 and Gender” yields more than 26,000 papers as of 27 August 2020, suggesting a vast literature to guide our understanding on this issue. However, as part of our work at the Center on Gender Equity and Health at the University of California San Diego, an ongoing review of the peer-reviewed literature, pre-prints, and working papers (limited to English language papers focusing on at least one low- or middle-income country, with primary data analysis and a complete methods section) has yielded 157 eligible papers as of this same date.

This review is being conducted as part of EMERGE – an initiative focused on building the quality and quantity of gender equality and empowerment measures and data globally. A bibliography of research and summary of findings is available on our EMERGE- Gender and COVID-19 webpage. Rapidly available, high-quality data for decision-making is of vital importance in responding to the COVID-19 pandemic; this quality is often controlled by the process of rigorous, scientific peer-review. Recognizing the sometimes diverging timeframes of these needs, we include pre-prints and working papers in this review. 

What does the published literature say?

One hundred and fifty-seven papers offering empirical evidence on gender and COVID-19 in low- and middle-income countries is excellent, given that papers date back only to the past six months and require available data on a pandemic that we are still actively working to understand. However, 41% of the papers (65) are from China, and only 14 articles from Sub-Saharan Africa, limiting the geographic range of our understanding. Further, peer-reviewed publications were almost exclusively limited to health rather than economic or social outcomes, likely due to greater rapidity of publications in medicine and public health relative to the social sciences, including economics; social science research is largely represented through working papers to date.  

Findings from our review offer the following key insights supported across multiple studies and national settings:

These findings clearly demonstrate the importance of including mental health as well as domestic violence supports as part of health programme responses for COVID-19, gender-specific considerations for economic policies designed to reduce the financial impacts of the pandemic, and opportunities for women’ leadership politically and economically for pandemic management. At the same time, we continue to see numerous areas recognized as in need, but with limited data to guide the response.

Areas with limited data

  • The issue of unpaid labor and disproportionate increases in domestic labor burdens for women under lockdown and social distancing circumstances is becoming well-documented, but less clear is whether more traditional restrictive gender norms are potentially increasing due to the current situation.
  • With regard to violence against women, few emerging studies have pointed to women and girls’ experiences of violence and abuse under lockdowns, though there is a lack of geographical representation as well as inadequate information regarding social protections against such abuse.
  • Women and girls likely have more limited access to key women and girls’ health and hygiene products and services. Yet, we found no data on whether and how women and girls are getting reproductive health services and menstrual products, for example.

Building a gendered response to COVID-19 requires robust evidence on gender and COVID-19. While we are at a good starting place for this work, we need greater expansion of research by geography and topic, and we need greater advocacy of use of the research to ensure that women and girls do not fall further behind because of this pandemic.