GIVING WOMEN HEALTHCARE WORKERS A FIGHTING CHANCE

Gender-responsive policies and practices can support men and women on the frontlines of the Covid-19 crisis

Imagine going to war with no rations, with boots that are too big, a rifle that might not fire and the lingering fear that your family will not be supported if you’re injured or killed. Fighting under such conditions would be near-intolerable; and yet, it’s what we are asking of our healthcare workers every day, and especially of women on the frontline.

Today, women represent 70% of workers in the health and social sector[1]. As Covid-19 spreads, we are not only asking them to face the same challenges that have limited women for decades and disproportionately weigh on women in healthcare, we are asking them to fight for our lives while overstretched and under-equipped. When we write the history of the Covid-19 crisis, it will be the story of these women who – in spite of those challenges – defeated this terrible disease.

Pandemics show the cracks in a strained healthcare system

We knew healthcare work was difficult and hazardous – even before the pandemic – amid the many biological, physical and mental difficulties professionals can experience.[2] What’s more, shortages of healthcare workers are putting demand on strained systems, and these women are being asked to do more with less. (Literally, the global gender pay gap in healthcare is nearly 30%.)[3]  

For women, their duties don’t end at the hospital door. Globally, women perform 76.2% of total hours of unpaid care work, more than three times as much as men.[4] During a pandemic they may absorb the responsibility for childcare when there are school closures, as well the expectation that they’ll take care of others in the household when they get sick, including elderly parents who are most vulnerable to infections like Covid-19.

It’s a double bind. If couples don’t share the load, and women healthcare workers don’t have access to childcare support, they can be forced to choose between taking care of their families, protecting their health, and their duty to support the health of their global community.[5] The Irish Nurses and Midwives Organisation, for example, has urged their Irish government to provide childcare for health service workers as nurseries and creches have closed.[6]

Similarly, the Royal College of Nursing in Wales has called for more widespread and faster testing for nurses to ensure they don’t unknowingly spread the infection to their families – a constant worry for these practitioners.[7] Indeed, though men are more likely to die from Covid-19 according to initial data, women are more likely to be in situations that could lead to infection. Nurses’ levels of exposure are higher than doctors because they tend to be more closely involved with the intimate care of patients.’[8]

This, of course, calls for protection. And even non-medical professionals are now familiar with the masks, gloves and other safeguards used by doctors and nurses when treating patients – known collectively as Personal Protective Equipment, or PPE. Prior to the pandemic, the ‘designed for/by men’ of this material was already a dangerous inconvenience for women practitioners. Examples of oversized scrubs and ill-fitting masks were pointed out by British author and activist Caroline Criado Perez. Women healthcare professionals told her of the difficulties of finding PPE in their sizes,[9] and we are now seeing the deadly consequences that a lack of such equipment has on healthcare workers and patients.

Finally, with an extremely high incidence of work-related mental illness, serving as a frontline healthcare worker is deeply taxing.[10] Excessive workloads, poor management support and the stresses of shift work create poor mental health outcomes at the best of times.[11] The pandemic has deepened these difficulties. In the face of limited resources, these workers are called upon to choose who lives and who dies.

This can cause ‘moral injury’: the shame and wounded conscience that comes with having committed what one considers to be a moral transgression. The concept is often used in discussion of military veterans, and can lead to depression, PTSD and suicide.[12] Just as with military veterans, proper mental health support is vital both in preparing frontline workers for the difficulties they will face, as well as enhancing follow-up support.

Meeting the needs of frontline workers

Eventually, we will emerge from this tragic chapter in the history of global health policy. But what will we have learned? For decades, we have reduced obstacles and invisible biases[13] that are holding women back in a range of areas – from home life to professional life and leadership. This doesn’t just create better lives for women, it is also vital to the resistance of our civilisation against the shock of a pandemic.

We will know that the strength of our civilisation is based not just on the strength of our soldiers, but on material and moral support, as well as the understanding that we extend to our healers and carers. Multiple institutions have a role to play in supporting those on the frontlines of Covid-19. More than ever there is a need to come together as an international community; to manage this pandemic effectively and ensure the physical, emotional and socio-economic well-being of our world. With that, we are calling on our Women’s Forum community and those beyond to adopt gender-responsive policies and practices to support the resilience of men and women through this time of crisis; and in particular, to support women healthcare workers as they continue to battle for the health and safety of our population.

• Our call to companies:

• Adopt gender-focused strategies to better understand challenges facing women healthcare workers.

• Encourage a more gender-equal healthcare workforce when it comes to positions of leadership.

• Support frontline healthcare workers[14] in the form of training, grants and leadership programmes.

• Ensure that producers of PPE directly address the ‘designed for men’ challenge and create masks, scrubs and other forms that work for women.

• Our call to leaders and health systems:

• Provide adequate mental health support for front-line workers, both in preparing them for the challenges that they will face, as well as adequate follow-up care.

• Make sex-disaggregated data a central aspect of response to better measure who is benefitting most and who may be left behind.

• Give women fundamental leadership roles in global health security and prevention systems at different levels.[15]

• Our call to governments:

• Enact policies that support women healthcare workers’ access to housing support and childcare.

• Strengthen social assistance to workers affected by the crisis, including compensation arrangements and work reduction for those who fall ill.

• Include representatives of healthcare workers in emergency planning arrangements.

• Ensure procurement contracts for public health systems require gender-responsive resourcing for PPE.

• Recognise the incidence of PTSD among healthcare workers and craft appropriate responses in partnership with healthcare.

The world is already seeing extraordinary stories of women having a positive impact on the global struggle against Covid-19. We invite you to share your stories of women’s leadership and resilience.

Photo credit: ‘Simon Davis/DFID’.

[1] The Lancet: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60497-4/fulltext

[2] WHO: Gender equity in the health workforce

[3] WHO: Gender equity in the health workforce

[4] ILO: Care economy

[5] Many frontline healthcare workers worry about going home and infecting other family members, yet in China, for example, hospitals do not have room to house doctors and nurses – causing many healthcare workers to camp out in their garages, on the streets etc.# The majority of nursing assistants in Chen’s situation are now worried about where they will stay once their quarantine period is over since the hospitals they work and live at are still full of Covid-19 patients.

[6] RTE: https://www.rte.ie/news/coronavirus/2020/0331/1127611-inmo-childcare/

[7] WalesOnline: https://www.walesonline.co.uk/news/health/coronavirus-covid-19-ppe-nurses-18038864

[8] WEF: The coronavirus fallout may be worse for women than men. Here’s why

[9] Invisible Women – Caroline Criado Perez

[10] DOH: The Mental Health of Health Care Professionals

[11] Prevalence and factors associated with poor mental health among healthcare professionals in low- and lower-middle-income countries: a systematic review protocol

[12] BMJ: Managing mental health challenges faced by healthcare workers during covid-19 pandemic

[13] UNDP: Bias & backlash

[14] J&J: Our Commitment to Frontline Health Workers Battling COVID-19

[15] The Lancet: The gendered impacts of the outbreak