Unhealthy Bias

The COVID-19 pandemic has variously been called the “great equaliser”—by the singer Madonna as well as Andrew Cuomo, the governor of New York—and a “social leveller,” by the public-health historian David Rosner. The grim reality, based on data from the United Nations and the World Bank, suggests it is anything but. The infection may hit just about anybody, but the pandemic has exacerbated existing social inequalities. In India, the migrant and refugee crisis reflects this grim reality. But less obvious is how unevenly the pandemic has affected men and women. The UN now calls gender inequality the “shadow pandemic.”

India ranked 150 out of 153 countries in the health-and-survival parameter of the global gender-gap index in 2019–20. The global gender-gap means that women are less likely to have access to healthcare and control over decision-making with respect to their health. In India, until April, 76 percent of all reported COVID-19 cases were in men and 24 percent in women. By comparison, countries across the world tended to have a 50-50 split in the percentage of cases across gender. Does this mean that Indian women are peculiarly immune to the coronavirus? Probably not. It is far more likely that women simply are not reaching hospitals and getting tested as often as men.

The gender gap exists not only amongst healthcare recipients, but also across the table, amongst healthcare providers. The medical profession occupies this strange schism where it largely ignores the needs of its women workers while relying excessively upon them. Misogyny and patriarchal attitudes during medical training, at work and in the community, means that women in healthcare earn less, are less likely to advance in their careers, quit more frequently to care for their families, have poorer health and face burnout more often than their male counterparts. This was before the pandemic set in. Things are even worse now.

Women comprise seventy percent of healthcare workers and caregivers currently involved in the global response to the pandemic across the world, according to UN Women. In India, however, this is inverted, with the National Sample Survey in 2011 and a World Health Organization report in 2015 finding that women make up only around 38 percent of all healthcare workers in the country—17 percent of all registered doctors and 83 percent of all nurses and midwives in the country. Despite unequal numbers on paper, women in India undertake the bulk of COVID-19 care duties, both in the healthcare profession and in the community. Most support staff—hospital attendants, cleaning staff, cooks and laundry—are also women. This disparity has new meanings and implications for health care in India.