Dangers of not knowing enough about COVID-19’s impact on women in Pakistan

According to UN Women’s data, as compared to their male counterparts, women in Pakistan and Bangladesh are less likely to receive information about COVID-19. This is attributed to a variety of reasons including limited access to the internet, limited cell phone ownership, and comparatively lower levels of education amongst women. According to the 2018 Global Digital Report, women in Pakistan are 37% less likely than men to own a mobile phone or have internet access.

Limited access to necessary information about COVID-19 puts, not only women, but also their families at higher risk of contagion. It also limits their access to essential services such as help-lines and online platforms in cases of health or financial crisis or violence. Since women are key players in the household and generally responsible for overseeing hygiene practices in the home, it’s essential that they have direct access to the information they need to protect themselves and their families against COVID-19.

According to the COVID-19 disaggregated data tracker for Pakistan, Pakistan confirmed 74 percent cases for men versus only 26 percent for women (as of 18 August, 2020). This alarming disparity in percentages is way off international statistics on COVID-19 cases, which display a relatively even   distribution amongst men and women.

Some reasons presented for why this might be the case in Pakistan are that men have greater representation in the labour-force across sectors (at a labour force participation rate of 77% compared to 21% for women), enjoy greater participation in congregations, and have more mobility compared to women.

Therefore, one possible explanation for a lower number of COVID-19 cases amongst women is their lower mobility in Pakistan resulting in reduced exposure to the virus. However, a more likely explanation is that women are not getting infected less but are simply being tested less for COVID-19.

Despite lower mobility, men predominantly live with women within the average urban household in Pakistan which usually houses about seven individuals in relatively small unventilated homes. This indicates that the risk of the virus spreading indoors is significant, making the factor of external exposure less relevant for observing infection rates between men and women.

In addition, data from the World Bank states that only 50% of women report participating in decisions concerning their own healthcare and nearly a third stating that the decision to allow them to seek healthcare depends on their husband.

Testing levels in Pakistan: Are men more likely to get infected?

Testing levels have fallen considerably in Pakistan, having a substantial impact on the number of recorded positive cases. Since September, Pakistan fell into WHO’s range for adequate testing (set at between 10 and 30 per confirmed case in a region). The total tests carried out so far in Pakistan (as of November 3) are 4,514,827 with 336,260 confirmed cases.

According to a report, COVID-19 took more men’s lives than women’s in the KP province of Pakistan. The WHO report said that coronavirus killed 798 men and 289 women in the province (as of 14 July, 2020), putting male fatality as a consequence of COVID-19 at 72 percent versus female fatality at 28 percent.

One reason given for why men are more prone to infection than women is that women tend to have stronger immune systems than men. A possible explanation for better immunity in women is that their bodies are created to fight off pathogens that threaten their newborn children.

According to Dr. Stephen Berger, an infectious disease expert and co-founder of the Global Infectious Diseases and Epidemiology Network, “Some of the underlying reasons why COVID-19 may be more deadly for men than women may include the fact that heart disease is more common in elderly men than in elderly women.” However, these differences still do not justify the stark difference in the number of cases between men and women in Pakistan.

Stuck between Covid-19 and domestic violence, where does a Pakistani woman stand?

The onslaught of the pandemic has brought with it enormous challenges for women, bringing about increased burdens of domestic work and unpaid care. Added to that, Pakistan has seen a surge in reported domestic violence cases of women, especially with women in the informal work sector. Government officials reported a 25% increase in domestic violence incidents during the lockdown across the eastern Punjab province of Pakistan.

The coronavirus has deepened gender inequalities in Pakistan, causing concern over the state of economic and social gains that women had fought hard to achieve. Over a quarter of Pakistani women have been laid off or suspended from their jobs in different sectors. Field reports indicate that pregnant women are in distress because they do not have access to community health workers running pre and post-natal services.

Some women cannot even obtain contraceptives that are required for family planning and health. Quarantine, isolation wards and other health facilities are not equipped well enough to take into account the needs of women and of other marginalized groups. There has been a reported lack of basic sanitation products and lack of toilet privacy as well in these facilities.

How to protect women moving forward

Pakistan has already been fighting a long struggle against widespread domestic violence, which has only been exacerbated during the COVID-19 pandemic. Apart from patriarchal notions of privacy attached to violence within the home, a lack of sensitisation on the part of officials and police in this regard further discourages women from reporting cases of domestic violence.

In light of these concerns, soon after the onset of the pandemic, the United Nations Office on Drugs and Crime launched an urgent call for action plan together with the government of Punjab. Assessing global trends of violence against women, they found that it was imperative that every government take urgent action to secure women’s safety during this pandemic. One concrete effort made by the Government of Pakistan has been the publishing of gender-disaggregated data on COVID-19 cases. This is one step towards achieving some representation of women during the COVID-19 pandemic.

Additionally, the Government of Pakistan, provincial Departments of Health and Provincial Disaster Management Authorities (PDMA) are developing resources to provide emergency services to women prone to gender-based violence in collaboration with UNFPA. The UNFPA support includes a socio-economic impact assessment of COVID-19 on reproductive health and health systems with a focus on family planning and reproductive health services.

A complete COVID-19 response strategy has to focus on women in managing this crisis. The COVID-19 testing strategy should include random testing of women where there are high proportions of male cases over women’s cases. This is supported by emerging evidence on the cost-effectiveness and viability of random testing, independent of gender.

It will be important to find community-based and household-based solutions to maintain social distancing in households to prevent disproportionately high infection rates among women. Data disaggregated by gender needs to be publicly available as currently planned to show variations by districts and allow for responses from the public and private sector to approach solutions with that information.

In studying the impact of COVID-19 on topics like health, food security, income loss, economic empowerment, and poverty, child health, domestic violence, remittances (domestic and international), or displacement, in the immediate or long-term, it is essential that women and other marginalized groups are well represented and included.

Research and COVID-19 response frameworks need to be designed to capture gender-disaggregated data, and to understand and explain differences in knowledge, behaviour, perceptions, and barriers faced by women.

This article is also available in Urdu and Sindhi