Dr. Harry Sangeet Jooseery,
Consultant on Gender, Sexual and Reproductive
Health and Communication

INTRODUCTION

The COVID-19 is today a global pandemic, creating havoc in all corners of the world. And yet the reputed Chinese astrologists predicted a “rat year” with a productive, prosperous and healthy transition from the yin to the yang! They could not see the arrival of such a fearful and deadly disease in Wuhan and the sudden and abrupt standstill of activities around the world. To date, more than 2.6 million people have been infected with COVID-19, killing more than 184,000 people worldwide. Fortunately, the death toll does not compare to that of the 1918-20 pandemic that took 2% of the world population. However, the economic downturn would be contagious, with disastrous impact worse than that of the 2008 economic downturn. Even if China rebounds, as it desires, it necessarily requires a return to normalcy in the rest of the world to facilitate transactions; which does not seem imminent even to the most optimistic. The economic cataclysm may persist for more than two years and with longer collateral damages.
Most of the pandemics in the past, including Ebola and HIV/AIDS have had disastrous effect on Africa, pushing the continent to the brim of poverty all the time. Africa all the time rose to stumble down again into the Sisyphus Dilemma. This time the pandemic hits severely Europe and America, putting those gifted with the most advanced health systems of the world, at their knees!

LOCKING DOWN GENDER-BASED VIOLENCE

While everybody would be affected by the pandemic, women would be the most serious casualties. As pointed out by the UN Chief António Guterres there are “nearly 60 per cent of women around the world work in the informal economy, earning less, saving less, and at greater risk of falling into poverty. As markets fall and businesses close, millions of women’s jobs have disappeared”. In the market for employment, women are sacrificed in the same manner as the voiceless goats, chickens and cows are slaughtered. Nobody would care whether during the pandemic, 70 per cent of frontline health and social workers were women; or that during lockdown, women have continued their home work as cooks, carers, nurses, laundry workers, gardeners, cleaners, etc.
Confinement also means that perpetrators and victims of violence are locked down engendering situational triggers. In China, police reported a 300% increase in intimate partner violence in Jianli County in February 2020 compared to the corresponding period in 2019. Women caught up in confinement with face-to-face exposure to perpetrators of crime and violence, are projected once again into the power dynamic trap of dysfunctionality in relationship and are condemned to face abuse and violence. Perpetrators can no more but rejoice at the golden opportunity. Virus-specific exploitative relationships related to misinformation, scare-tactics, controlled behaviours, withholding safety items and threatened forced isolation and indifference of partners exacerbate the plight of women.
The UN Chief on 10th April 2020 cautioned that “the uncertainty created by the pandemic may create incentives for some actors to promote further division and turmoil”. Sexual violence of women and children at home and opportunistic behaviour of others outside home are indeed frequent. During the Ebola pandemic in Africa health workers, taxi drivers and even burial agents pressured women into exploitative relationships in exchange of medical care, transport, food and other facilities. In Mauritius vegetable sellers and shop owners created artificial scarcity to overprice.
According to UN Women in ‘normal’ circumstances, 35% of women worldwide experience either physical and/or sexual intimate partner violence or sexual violence by a non-partner (not including sexual harassment) at some point in their lives. Some national studies show about that 70% of women experience physical and/or sexual violence from an intimate partner in their lifetime. The situation is worse with COVID-19. Recent statistics(1) from UK reveals a 700% increase in calls to its domestic violence helpline in a single day, while a separate helpline for perpetrators of domestic abuse seeking help to change their behaviour received 25% more calls after the start of the Covid-19 lockdown. In Mauritius no data is available to date as to the incidence of domestic violence since the lockdown, but a surge is expected. Kalpana Devi KOONJOO-SHAH​, the Minister of Gender Equality and Family Welfare on TV on Monday 13th April 2020 gave assurance of a 24-hours assistance to victims and pleaded for victims suffering “en silence” to voice out through the hotline service. This was indeed recomforting! The challenge is in turning the silent into outspoken.

OPPORTUNISTIC INTERVENTIONS

Women and children victims and at risk of gender-based domestic violence, including emotional hijack, sexual abuse and harassment are unfortunately lockdown in the national curfew and find it difficult to move away. Alternative accommodation for women and children at risk should be arranged immediately. Shelters are a critical component of a holistic response to survivors, as established in various international agreements, such as the 1995 Beijing Declaration and Platform for Action, which called on States to “provide well-funded shelters and relief support for girls and women subjected to violence, as well as medical, psychological and other counselling services and free or low-cost legal aid, where it is needed, as well as appropriate assistance to enable them to find a means of subsistence.”
Government-owned shelters for women and girls at risk and victims of violence could have been more proactive during confinement period in harbouring women and girls. Unfortunately, management of these shelters is still questionable. I have myself made proposals to the Ministry of Gender Equality and Family Welfare to professionalise these services since long. Today emergency shelters would have been ‘pandemic-safe’ abode for women and children at risk. Concurrently our unoccupied hotels could have been utilised as emergency shelters, engendering an opportunistic suspension of discomfort, trauma and pain to victims.
Proactively many countries of the world have earmarked substantial funding for the rehabilitation and protection of women and children in distress and in vulnerable situation in shelters. The Canadian government in line with the COVID-19 economic package on 18 March 2020 allotted $50 million funding for gender-based violence shelters and sexual assault centres. The Ministry of Gender Equality and Family Welfare in Mauritius should likewise grasp on opportunity and lobby with the Ministry of Finance, Economic Planning and Development for substantial funding to shelters from the COVID-19 Solidary Fund.
It is also now the opportunity to highlight the need for ‘self-quarantine’ of women in vulnerable situations. The health systems response should not only be concerned with those infected or at risk of being infected, but also with all those affected! Health care providers could have been trained to identify women and children at risk of violence at all testing and screening locations, provide first hand counselling and to make appropriate referrals.
Gender-based violence against women and children should be integrated into disaster risk reduction and preparedness, as well as pandemic preparedness. Preparedness efforts should incorporate gender lens throughout, ensuring women and children are included in preparedness processes and decision-making. The UN Chief rightly urges governments to put women and girls at the centre of their efforts to recover from COVID-19 and ‘that starts with women as leaders, with equal representation and decision-making power’(2). Unfortunately, in Mauritius representation of women in the National Communication Committee on COVID-19 set up by the PMO is negligible.
Only 2 (in their capacity as Permanent Secretaries from their respective Ministries) out of 10 members (20%) of the COVID-10 Solidarity Fund Managing Committee are women. The Ministry of Gender Equality and Family Welfare is not represented. A gender balanced team would have reassured the second half of the population of Mauritius.

ELECTIVE SEXUAL AND REPRODUCTIVE HEALTH CARE

Women may avoid seeking health services for physical abuse and injuries, for fear of possible infection. Pregnant women, those in distress, and with reduced abilities require specific attention from health service providers and emergency first responders. Unfortunately, they are either unavailable or inaccessible. Prevention of the spread of the disease and care of the virus-infected patients remain the priority of the day. The stress of the pregnant woman expecting impending delivery relates to anxiety and fear of herself or/and the new born being victim(s) of the disease.  Research has proved that as much as 80% of pregnant women feel some degree of fear, anxiety and worry over pain, health, safety and even death during birth (“fear of the unknown”). However, this is intensified with increased degree of uncertainty caused by the prevailing pandemic and many pregnant women develop tokophobia, a severe anxiety disorder with damaging casualties to the mother and the child. Special programme and guidance on caring for pregnant women with COVID-19 as well as information on caring for infants and mothers with COVID-19, intrapartum care (IPC) and breastfeeding is essential. Intentional efforts are needed from the Ministry of Gender Equality and Family Welfare to provide accessible points of assistance, immediate first responder resources and referral pathways to cater for the specific needs of sexually active women.
Unfortunately, as health systems are increasingly strained during the pandemic, sexual and reproductive health care services to women are often mischaracterized as ‘’non-essential’’ or “elective,” and thus de-emphasized with critical consequences. Similar to pandemics in the past, the consequences of the COVID-19 outbreak are felt mostly by the marginalized section in the country, including women and girls—particularly those with low-income and working in the informal sector, LGBTQI (Lesbian, Gay, Bisexual, Transgender, Queer and Intersex) individuals, people with disabilities, who depend almost entirely on public health facilities. The heath system crisis management has side-lined sexual and reproductive care and services. Similarly, when government took over the ENT hospital to cater for COVID-19 patients, nobody queried about the plight of the current ENT patients. The latter have not been eliminated by the virus! While we adapt to the ‘new normal’, we should ensure sexual and reproductive health and rights of women, and seek innovative approaches to address the gap. While we claim that no one should die of COVID-19, we should likewise ascertain that no women should die during pregnancy and childbirth.

FRAILTY, THY NAME IS MAN

SARS (Severe Acute Respiratory Syndrome, first identified in Southern China in 2003) had an overall death rate of about 10%, while MERS (Middle East Respiratory Syndrome, first identified in Saudi Arabia in 2012) killed about 33% of those infected. WHO estimates the death rate for COVID-19 to be between 3-4%. COVID-19, through frightening is comparatively a less killer disease. Gender wise, SARS fatality rate was 22% for males against 13% for females, MERS fatality rate was 32% for males against 26% for females, and for COVID-19 to date, based on statistics from China, USA, Italy and South Korea, the fatality rate is also higher for men. In New York as of 9 April 2020, more than 60% of over 6,200 total deaths have been men. In Mauritius, to date 90% of COVID-19 related deaths are men.
Sabra Klein, a scientist at Johns Hopkins Bloomberg School of Public Health in USA who studies sex difference in viral infections affirms that ‘‘being male is a risk factor” for viruses. Scientists are now convinced that sex differences in clinical data reflect a genuine male vulnerability to coronaviruses, rather than a bias in exposure (3). Biologically women are more equipped to face diseases. The predominant female hormone “oestrogen” is reported to increase the general immune system in females putting them at check against possible infections. Sex differences in immune function appear to start right out of the womb. Baby girls in the world are more likely to reach their first birthday than male new-borns, according to the World Health Organization. Globally, women outlive men by an average of six to eight years.
The WHO credits female longevity to an “inherent biological advantage”, as well as to healthier behaviour. Researchers have pointed out that most women, not all, have two X chromosomes, and the X chromosome contains most of the genes related to the immune system, and those with two X chromosomes have a wider diversity of immune responses. Hormonally connected, the X chromosome in women acts as a biological watchdog which reinforces their immunity systems and lowers their risk of infection. Men on the other hand, have a combination of X and Y chromosomes, with predominantly androgen hormone that biologically regulates their libido and determine the sex of an embryo, but which are not within their control… rendering them still powerless and frailty,

CONCLUSION

COVID-19 sends a strong signal to humanity: our survival rests on our degree of responsibility and the recognition of our interdependence. Men come from Mars, women from Venus but live together on Earth where all must be shared…equally and equitably. The way forward for women, especially those most affected by the confinement is through the application of a resilience framework that would enable them mitigate, adapt and recover from stress, trauma, anxiety and pain caused by COVID-19. This cannot be achieved without the adoption of an inclusive approach that takes on board all components of the society, including men; after all, gender matters!

References

1.Priti Patil, UK Home Secretary, at daily press briefing on COVID-19 on 10th April 2020

2.Video Message of UN Secretary General, 9 April 2020

3.Sex-Based Differences in Susceptibility to Severe Acute Respiratory Syndrome Coronavirus Infection Rudragouda Channappanavar,* Craig Fett,* Matthias Mack,† Patrick P. Ten Eyck,‡ David K. Meyerholz,x and Stanley Perlman*, 2017 Journal of Immunology