Dr Shereen El Feki
Hello, everyone. Greetings from Toronto. My name is Shereen El Feki and I’m an Associate Fellow with the Global Health Programme at Chatham House, and my work focuses on sexualities and masculinities in the Middle East and North Africa. I’m delighted to see so many of you on the call. We had quite a few registrations. Unlike some recent events, I’m glad to see that we haven’t been Tik Toked, so thank you for joining, so many of you. It’s extremely impressive that you retain this interest in the many dimensions of COVID-19 after months and months of media coverage and Zoom calls and the webinars and the up close and personal life experience during the pandemic.
Now, you may recall that, in the early days of COVID-19, there was talk, when the great and the good were succumbing to infection, that this pandemic – this disease is a great leveller. But, of course, it isn’t because really what the past months have shown us is that COVID-19 has really shone a bright light on existing inequalities and, depending on one’s age or wealth or race or ethnicity, profoundly affect our vulnerabilities and response to both the pan – the disease itself. but also the consequences.
So, in today’s session, we’re going to explore one of these dimensions, and that is how COVID-19 has affected men and women differently. Essentially, what we’re looking at is the gendered impact of COVID-19. Now, in the interests of full disclosure, I will have to say that we decided not to put gender and gendered impacts on the label of this webinar in the title because we know that gender can be a daunting term for some participants, particularly men, so I’m delighted to see, in the attendees’ list, so many men who’ve joined in, thank you very much. Please stay with us, this is gender without fear. So, over the next hour, we’re going to look at this complex issue of gender, sex and COVID-19, and there are so many ways that we can approach this.
So, what we’ve decided is to look at three main areas and, to do so, I’m delighted to welcome our panel of distinguished experts. Joining us from Cambridge, we have Sarah Hawkes. Sarah is the Director of the Centre for Gender and Global Health at University College, London. Sarah is going to guide us through the health dimensions of this landscape, what the pandemic has revealed, in terms of differences between men and women, when it comes to either side of COVID-19, as a patient and as a carer. Joining us from Austin, Texas, is Gary Barker. Gary is the Founding President and CEO of Promundo, it’s a pioneering group engaging with men and boys on gender equality in more than 50 countries. Gary is going to take us on a tour of COVID-19 on the home front, how the pandemic has affected men and women differently, in terms of work at home, unpaid care, and vulnerabilities, in particular the rising tide of gender-based violence. We also have the pleasure of welcoming Reema Nanavaty. Reema is based in Ahmedabad where she leads the Self-Employed Women’s Association. It has more than 1.5 million members across India. Reema is going to look at COVID-19 and the world of work. How the economic impact of lockdowns and closures and physical distancing and other measures have affected men and women differently, and particularly in the informal sector, where women have been hit especially hard.
Although we’re going to tackle each of these topics in turn, we fully appreciate that they are interrelated, and so Sarah and Gary and Reema are going to be weaving those connections for us, throughout the session. Another point, which is to do with the language, for ease of communication, we’re going to be talking about men and women, boys and girls, but just to note that we are fully LGBTQ inclusive, and we look forward to exploring these further dimensions of gender and sexual orientation and identity throughout the call today.
Now, this webinar is going to be divided into two phases. We like to think of it as wearing bifocals, if you like. So, we’re going to look down at first, for the first half of the call, at really what the past six months of the pandemic has shown us, in terms of inequalities between men and women. In the second half, we’re going to be looking ahead, to draw lessons learned, what to do and what not to do in addressing these issues moving forward, perhaps to the prospective second wave of COVID-19, but also our future lives in the shadow of crisis, climate change among them.
A word also now about the ‘Q&A’ function. So, although we’re not physically together, we do want to maintain a free and frank exchange of ideas, so we have this very handy ‘Q&A’ function. We’re going to have two rounds of question and answers. One at the end of the first part, the laying out the landscape of problems, and towards the end, after we’ve heard some of the concrete recommendations and steps forward, in terms of solutions. So, if you could please put – keep the questions coming throughout this session. In the ‘Q&A’ box, we’d be very grateful if you could also include your name and your affiliation. I will be reading out these questions. If your question is directed to a particular speaker, please do name them in the box, and also, there’s this very interesting function of the upvoting. You can actually like a question, so if someone’s raised a particularly pressing point for you, or if someone’s actually raised the – already entered the question that you wanted to ask, please press the like and it will rise to the list of priority questions.
We very much welcome your comments, not only in the Q&A section, but also, on social media, so if you’d like to tweet out on this event, fantastic, please use the #CHEvents. And, finally, this webinar is on the record and it is being recorded. So, to begin, Sarah, I’d like to start with you because you and your colleagues have been studying the differential vulnerabilities of men and women in a variety of health contexts and scenarios. So, really, I’d like to hear from you, please, essentially, how has COVID exemplified many of the differences between men and women that you’ve seen in other contexts, but also, how has it raised new differentials, presented new inequalities to address? Over to you, Sarah.
Sarah Hawkes
Thank you very much, Shereen, and thank you, again, for inviting me to talk with you today. I’m just going to share my screen so that, in the – just following the course of the true academia, I’m going to make some slides visible. As an academic, it’s very difficult to talk without PowerPoint. So, you – I mean, you’ve quite rightly pointed out that COVID presents a great way of trying to understand the impact of sex and gender on health outcomes. And what I’m about to present to you, over the next few minutes, I think the best way of seeing it is that COVID is an exemplar of how sex and gender play out in the – both the space of individual health and population level health problems, but it’s by no means unique. And it’s that intersection between what we see in COVID and what we know from underlying health conditions that I think gives us one way forward for addressing COVID and improving population health in the long-term.
So, just for clarity, I am just going to start by a very quick reminder as to what we mean by sex and gender, because it’s amazing to me how many of my own colleagues get this muddled up. So, at its simplest notion, the way of – best way of understanding sex is it relates to biology and it’s generally measured as binary categories, male, female. Gender, in contrast, is a much more complex social phenomenon, social construction, it’s a spectrum, it’s much more difficult to measure. And so, what I’m going to present to you is what does the sex-related data show about the impact of COVID, and if we apply a gender lens, in other words a social construction lens, to understanding differences in data, what do we see?
The first point is to realise that, actually, it’s quite difficult to know what the data on COVID shows, from a sex-disaggregated perspective, because there’s actually a minority of countries that tell us what the sex-disaggregated distribution of disease actually is. So, we’ve been collecting this data for the past three months. We are currently at the stage of having data from 115 countries that are sex-disaggregated, and by no means is all data sex-disaggregated. Only five countries, for example, tell us whether they’re testing men or women. 81 countries tell us whether the cases they find are in men or women. A very small number tell us about hospitalisations which, of course, represents disease progression, entry to ICU, disease severity, and then risk of death. But, once we understand that pathway of the disease itself, I’m not talking about secondary impacts, which I know will be greatly covered by Reema and Gary, but the actual disease itself, what can we learn from this data?
Well, what we see is that, when it comes to understanding the distribution of disease – of the virus across society, we’re actually not seeing much difference in rates of cases in men and women. In other words, there does not seem to be a big difference between the risk of being diagnosed as a case in men or women in the 81 countries. But, by the time we measured deaths and – well, first of all, if we measure disease progression into ICU admission and then, if we progress into deaths, we definitely see a sex-disaggregated distribution of disease, which is higher rates of death in men. And that holds across, I think, 56 of the 57 countries where we have data.
There would be – from a – from the perspective of sex and gender, there are a couple of ways of trying to explain why we’re seeing that difference and, from our perspective and the work that we do, we think that this is probably down to a mixture of both biology and social construction. There’s very good evidence to show that there are biological differences between men and women at hormonal and immunological levels that may be contributing to higher rates of risks in men in – right at the cellular level, in terms of issues like viral entry into cells. But, from the perspective of somebody who heads a centre for the study of gender and health, we’re also convinced that this is not just about biology, and the reason we’re convinced it’s not just about biology is the very strong association that we’re seeing, not from surveillance data like I just presented, but from in-depth studies in the peer-reviewed literature of the association between the presence of comorbidities, other diseases, and the risk of severe COVID infection and death. And, when we look at those comorbidities, the non-communicable diseases in particular, it’s that body of disease that we think are actually representations of the gendered nature of risk.
So, the reason we think that is that we’ve been working in this area for many, many years, showing that the distribution of comorbidities, of non-communicable diseases, in all societies is predo – is, if you look at the sex-disaggregated distribution, you see a similar kind of picture, as we see in COVID. These are particularly male-predominant diseases. And, from a gender perspective, why are they male-predominant diseases? Well, if we take one example, so tobacco smoking leads to the outcomes that I’ve just shown you in the previous slide, heart disease, lung disease, risk of stroke. If you look at this slide which, in blue, shows male smoking rates in young people in all regions of the world, this is a male behaviour. When you look at the social construction of why people smoke, it’s not difficult – you don’t have to be a gender specialist to see the male gender norms that predominate in the corporate sector to drive – to encourage smoking amongst young men.
So, I’d just like to finish by saying that we – I’m only able to present this dataset to you and this interpretation of the role that gender might be playing in those sex-disaggregated differences because we have the data available to us, and evidence really matters when it comes to identifying entry points for addressing the disease. And it – you know, it’s a tragedy that not every country has thought it important to even present data on who’s actually dying. But once we have that data available to us, then we really start to see that, in a disease like COVID, as across all of health, sex and gender play a very important role in risk, disease progression, and outcome, and identify where we can act to intervene in the short and the long-term. Thank you.
Dr Shereen El Feki
Terrific, Sarah, many thanks for laying the ground for us. We’re going to pick up on a number of those points in the Q&A and then the second half of this webinar. We’re now going to turn to Gary. Gary and his organisation, Promundo, have been at the forefront of looking at gender equality in the home, including household decision-making, unpaid care work, and GBV. Gary, what has the COVID-19 pandemic shown us about how this balance of power is playing out between men and women, boys and girls, in the home, and has it created new gender inequalities?
Gary Barker
Yeah, thanks, Shereen, and thanks for including me in this conversation. You know, I think, speaking of the issue of care work in the home and violence in the home, I mean, what I can affirm first off is that we don’t have data that is nearly as fast or at our fingertips, and so we’ve been doing some new data gathering to try to understand. I think a couple of, you know, big headlines that are important to put out there is that it is exacerbating some of the inequalities in the home and in terms of paid work. There’s been a couple of headlines in some countries saying things like, you know, policymakers waking up to inequality in working at the home, and I would say most low-income women have been saying, “Yeah, we’ve never slept,” in terms of those differences.
But, you know, what we do know, and I think it’s important just to put a couple of big headlines, is the number of children at home, in terms of school closure, the numbers are going – ranging from 60 to 90% of children who would have been in school are at home for their school hours. Global economic output decline, everybody knows some of those numbers, they’re going to range on this year, a decline from 6 to 9%, depending on second wave and all of that. It has mostly been women’s work affected in most countries. We know from data, for example, from Pew that families – I mean, some of that is about where work is cut or where work ends, but a lot of it has to do with household decisions, as men wages, historically, are in the range of 20% higher, countries – I mean, individuals make very clear decisions about favouring the higher income. And when we ask women and men about whose work is more important, there’s some data from Pew in April, during the – kind of, the first six weeks of the pandemic, where 40% of men agreed that they should have preference to women in the household, when jobs are scarce, and women’s approach – support for that were not far off. So, we know that households continue to make decisions, as well as being affected by which way – which jobs are cut.
We, together with Oxfam, carried out a very quick online survey that just results – we’re just now publishing them, some we published last week, some are still being written up. A sample of 6,385 women and men across five countries, the UK, US, Canada, Kenya, Philippines, obviously a huge range of countries, it was where we could carry it out quickly. A few big headlines. One, it’s clear how much care work has increased in the home, as children are home, as fewer adults are working outside the home, clearly the care work at home has increased. We can’t go out for food, many more things, and the burden clearly falling to women.
Not surprising, 43% of women surveyed across those five countries reporting feeling anxious, depressed, isolated, overworked or ill because of the increased care burden. Over half of women across those five countries say they’re spending more time on care tasks, and obviously – well, not obviously, what we know from previous settings or previous researches, that single mothers, women in poverty, women of ethnic and racial minorities, reporting the largest increase in care work. Men reporting some of that as well, we’ve got some numbers, for example, from the US, where we published last week. Men also reporting – 41% reporting that they feel an increase in anxiety and stress under COVID, but women still higher at 49%. 20% of women in the US – sorry, 20% of men in the US told us they were feeling unmotivated, were depressed, compared to 31% of women.
Interestingly, we’re also seeing stories of men reporting being more relaxed and happy, largely because they’re spending more time with their children. So, while this more time at home during unemployment or during remote working has a cost, it also brings some benefits and we are – I don’t know if I would say we’re hopeful, but I think, you know, we are seeing men living what it is to be at home, and men are doing more care work, the issue is, there’s a bigger – the overall increase has fallen predominantly on women, but we do, in both women’s accounts and men’s accounts, hear that men are doing more. So, I mean, I think we can think of it as the pie has increased. Men’s share of the pie hasn’t necessarily increased proportionately, but men are doing more hours of care work in most of the countries that we’ve looked at, and I think there’s data from other countries saying that, as well.
Let me shift a little bit, then, to gender-based violence, ‘cause I know we want to move quickly into questions. In terms of gender-based violence, the data is really hard, in terms of knowing have we seen an increase in reporting, are we seeing an increase in prevalence? We do believe that the conditions that drive, or that, at least, support and allow gender-based violence, men’s violence against women in the household setting, to increase have certainly increased during COVID. Social isolation, economic stress, we had data from previous economic downturns that find that a increase in male employment is associated with – that is, every 1% increase of male unemployment in some countries where we look, isn’t – is associated with a 2.5 increase – percent increase in men’s use of physical violence against a female partner.
Conversely, female unemployment is, in some countries, associated with decreases in men’s violence against women. We believe that has to do with men feeling women being docile and at home, doing what he wants, so to speak, associated with a decrease in violence. All of this tell us that, clearly, we believe that violence has increased under COVID. Loss of income, job insecurity, loss of mobility, all factors associated with a risk – increased risk of men’s violence against women. We’re both worried about what this means in the short run, but we’re also worried about an increase in gender-based violence in the long run.
We know, from evidence from more than 27 countries where we’ve carried out household survey data, or research, that is, on men’s use of violence against women, that the strongest single factor for an individual man’s use of violence against a female partner is whether he himself witnessed that violence growing up. So, with so many children at home, we know there’s a lot of children witnessing – and boys and girls witnessing violence. Women who witness violence growing up in the household are also themselves more likely, at a magnitude of 2.5 to three times more likely, to be in violent relationships later on. So, we’re both extremely concerned about the violence happening now, but also what it means, in terms of paying forward in future use and future victimisation by women.
And so, all of this – the issue is that – all the social isolation that COVID means, means that all of our interventions, as weak as they’ve often been in many countries, whether there’s are prevention or being able to offer psychosocial support and shelter and legal support for women, are all increasingly difficult during this moment of COVID. I want to stop there because I know we want to move into questions, but to say I can look at this both with a glass full and a glass empty. I think there is an increasing awareness, among policymakers, of what lockdown means, in terms of exposure to violence for women. I hope this carries forward.
I think I’m also slightly encouraged that men are doing more hands-on care work. Even though we’re not achieving equality in the proportion, the fact that men are doing more of this, I’d like to believe that, carrying forward, we might have more men sensitised to the need to support the things we need to do for an adequate care economy. Whether that will playout remains to be seen. I’m also encouraged that we saw an increase in support for more progressive policies, where we asked, as well, about your support for policies that would support care work and income support. We did see a slight uptake in the number of individuals who would support that, so I hope that increase in some progressive attitudes perhaps pushes against the very masculinist approaches that we’ve seen in some governments, and I won’t name names until later on. Thanks. Let me stop there.
Dr Shereen El Feki
Okay, thank you, Gary. We have a steady stream of questions coming in. Thank you very much to all of you. Please keep them coming. We’re now going to turn to Reema. Reema, take us through the impact of COVID-19 in the world of work, particularly in your context, for your members in the informal sector.
Reema Nanavaty
Thank you so much, and thank you for giving me the opportunity to bring the voices of the informal sector workers, especially the women workers, and I talk here on behalf of some 1.9 million women workers in India. I’m neither going to talk about any research that we’ve done, or about any survey, but this is all based on the real-life experiences of our members. Well, you know, the pandemic and the resulting lockdown and social distancing has directly, and in a very disruptive way, affected the work and income of the informal sector of women workers. This is a very alien concept, a lockdown and social distancing, for most of the informal sector workers. As you all know that they live in very, very small homes or in huts, in the slums, in the cities, or in the villages, and their families are quite large, anywhere from five members to 13 or 15 members. So, social distancing practically becomes, you know, extremely impractical or difficult for the women themselves.
An internal survey during the lockdown showed that 57 – 67% of our members, the informal sector workers, have lost their livelihoods. 74% could not afford even one meal a day, and 37% had reported that their children, who had started going to school, will have to be dropped out, and especially amongst them, the girls will be – the dropout rate for the girls will be even more. We also found that 35% of the members had to take loans to even manage their day-to-day survival because of the lockdown and the loss of work and income. I think it is going to take even much more longer for them to come out of it and rebuild and reconstruct their work and income and livelihoods.
Just yesterday, I was talking to one of our very young members [inaudible – 27:25] and she, you know, was telling me that she feels so helpless, very unfortunate, that, you know, her “widow mother supported me when she became a widow, when her husband passed away some five years ago, and today, in her old age, I’m not even able to support my mother. I don’t have any work for the last two months. We are eating only one meal of dry millet bread every day, trying to preserve the remaining stock of food,” ‘til she’s able to find work. In such a situation, how can we talk about nutrition or health or having care for her mother? “How do I feed my family? Just because we are poor, we do not have right to live?” This is not the story of one family or one household, this is the reality of the informal sector workers, which is 93% of the workforce in India.
However, I think the women in the informal sector are the hardest hit and when it comes to work and income, when it comes to livelihoods, when it comes to access to food, when it comes to access to healthcare, when it comes to access to nutrition. On top of it, we’re also experiencing that, because of this lockdown loss of work, there is immense frustration, anxiety and insecurity among the men and boys and, as a result of that, women are becoming victims of abuse and violence as well. Young adolescent girls have tremendous insecurity as well. So, I think we are experiencing that this has led to increase in the issues and challenges around gender inequality, gender pay gap, preferential employment of men over women. We are also seeing more distress. Women being displaced from work as the migrant workers are returning back to their villages, and therefore, women who used to find work as labourers in the fields or under the [inaudible – 29:51] programme, are now being displaced, giving preference to men for those kind of labour work.
So, these are some of the issues that we are grappling with, and I think what we have seen that, when it comes to informality, care work is not even counted as work, and our experience of – you know, over repeated disasters, one after the other, has always shown us that, for the poor, for the informal sector workers, work is a healer and, therefore, getting them work, getting them back to having hard cash income, would be of immense support to these women workers in the informal sector. I would stop here for more questions. Thank you.
Dr Shereen El Feki
Many thanks, Reema. So, yes, following your lead, we are going to turn to some of these questions. We have a question from Robin Gorner, this is for you, Sarah. “Sarah, do you have any sex-disaggregated data on people with long-haul COVID-19?” Anecdotal from the support groups I am part of suggests that there’s an increased proportion of women, among one in ten of us, living with long-term COVID-19. So, do you have any data on the long-term aspect of this? And, as Robin suggested, if there isn’t any data, could you possibly add this to your advocacy list? Over to you.
Sarah Hawkes
Well, thanks very much to Robin for the question, and the answer – just for clarification, the data that I presented is all data from national governments. So, we’re entirely reliant upon what it is that national governments put out or make available in the public domain. And so, the short answer is no, I don’t have that data, but we are very happy to add it to our advocacy, Robin, that that’s well noted, thank you.
Dr Shereen El Feki
Right. Question to Gary in particular, from Olympia Campbell. “Do you think it – when you’re talking about the rise of GBV, is this the emergence of what Olympia calls new abusers, or is this people who already have a history of GBV, engaging in it more so?
Gary Barker
Hmmm, yeah, that’s a good question. I mean, you know, we’re talking in households and cohabitating couples that were already together, so, on the one hand, we – there are other forms of violence that seem to be happening less, some forms of harassment in the workplace, some forms of sexual violence outside the home, maybe happening less because people are – many people, at least, are less likely to be outside. What we seem to – what we do know is that, often, yes, violence doesn’t typically fall out of the sky, that it’s not necessarily a man using the first time because of economic stress that’s happening, that other aspects were probably there before.
And what we are seeing is that the – in countries that have good protection systems that have allowed women to seek and get help when they’ve been survivors of violence from a male partner, those are working in very precarious ways, given what the lockdown means, in terms of particularly men able to control women’s access to services outside the home. And so, some programme staff are resorting to finding ways that they can use, provide apps, or that they can find opportunities, for example, when women are out doing shopping, of providing ways that women can ask for help that aren’t picking up the phone necessarily, when a male partner may be able to hear. So, all to say I think more of it is probably violence that at least some signs of it were there before, but we – you know, part of the issue is we simply don’t know.
We have looked at gather – we and many other partners have looked at whether data should be gathered at this moment, during COVID, in terms of women’s experiences of violence, or use of violence against children by both parents. We have decided not to, that, ethically, it’s quite fraught, in terms of asking questions that we need a woman to feel safe to be able to respond to, or children, for that matter, so there’s a lot of discussion happening ethically about even what kind of data we can gather. So, I think the – that was a long way to say we don’t know, but I think we believe that more of it is in couples where aspects of the propensity, or likelihood, or even some aspects of violence, were already there.
Dr Shereen El Feki
So, questions for you, Reema, from Anaporna Sharma. This is a question, in particular, about migrant workers. “Did – in India, have you seen that migrant workers – female migrant workers are suffering more from malnutrition or other consequences of the great move, and the lockdown and all this, more than their male counterparts?” And another very interesting question, “How are – when the migrants are returning to their villages, are the women supportive or critical of male migrants who are no longer in a position to be the breadwinner?”
Reema Nanavaty
Thank you. Yes, definitely, I think our assessment has shown that, amongst women, lack of access to food and therefore hunger and starvation, be it migrant women workers or even otherwise poor women workers, has been far more, almost up to 67%. When it comes to the returning migrant workers, of course, you know, the families have been shouldering – especially the women, who are being left behind, were shouldering the responsibilities of the family, as well as taking care of, you know, their farms or other means of livelihoods to sustain the families. And that’s why you also see that, in India, the participation of women in the workforce have been decreasing, and that was precisely one of the reasons. And on top of it, when you see that the migrant workers are returning, of course, you know, because, culturally, you don’t like to, you know, displease, or you are not wanting to be creating your family members coming back, but women who get displaced from work, with the returning migrant workers, and that’s adding to the stress on women, and also, reduction in their work and income both.
Dr Shereen El Feki
Great, we have a number of other questions. I will come back to them. I think we’re going to shift gear slightly and go from, sort of, outlining the problems to talking about some of the solutions that have emerged. So, Sarah, over to you. In terms of the issues that you’ve presented, what are you seeing on the ground that’s working, for example, to encourage governments to collect sex-aggregated data, to deal with some of these inequalities, and what more needs to be done, I mean, what are the priorities, looking ahead to the coming months?
Sarah Hawkes
Well, Shereen, I – it’s very – it’s actually very hard to say what works with governments. I mean, at the end of the day, you know, the data that I presented that is about the sex-disaggregated data that governments are putting out, that actually started for us as an exercise that we did in conjunction with CNN right back in March. And when we first started looking – you know, we had assumed that this was a dataset that the WHO would have available to them, for example. We assumed that, if we went to the WHO website, that the global health system would have kicked into action, and all of this data would be readily available on the web. And we were very surprised to discover that the data wasn’t there, despite the fact that we had hypothesised that we were going to see these big differences in the course of the disease between men and women.
And so, we – it – were contacted by a news organisation who said, “Well, don’t you think there’s a story to run there and shouldn’t we try and find some of the data?” and so that’s essentially what we did, and it – you know, it’s been fascinating, as people involved in academia, to work with the media initially on this, to dis – partly to discover how the media gets hold of data from governments when academics can’t or the WHO can’t get hold of the data. And, quite often, that simply involved phoning a press office and saying, “Could you give us the data ‘cause it’s not in the public domain?” and, lo and behold, a day later, the data would be there and available.
So, I think there’s probably a couple of things there. One is that, for us, you know, the absence of the data is just a reflection of the notion that the health and medical system still is not taking sex and gender seriously, despite decades of work in this area to show the importance, that, when it comes to putting out data, it’s still not disaggregated by the simplest measure. What we have discovered, over the ensuing three months, is that by doing constant advocacy with ministries, we can actually – it’s not like they don’t have the data, they definitely have the data there. They know who is dying, for example, they have a pretty clear record from hospital data as to whether it’s men or women that are dying. They’re not collating it and making it public, but when we ask for it, simply by emailing them, then they make the data available.
But, I mean, I think this talks to a much wider problem that we will face moving forward, which is that, you know, the academic, as far as I can work out from, sort of, you know, the long-term history of being able to understand academics, and there – I’m sure there are people in Chatham House better placed than me to address this issue, is that, you know, it has, kind of, uniquely hit a highly developed set of – countries with highly developed health systems. And, yet, still those health systems were seemingly unable to give us sex-disaggregated data. The UK only started presenting sex-disaggregated data at the very end of April. The US is still not presenting comprehensive sex-disaggregated data.
As the epidemic now is starting to move into South Asia, into Sub-Saharan Africa, across Latin America, our capacity to really capture the data is going to take a big nosedive because the surveillance systems simply aren’t there. You know, if we think of this – if we, kind of, step back and say, “What is it we want to know?” The last estimate that was published two years ago in The Lancet indicated that only one third of deaths in the globe ever reach a vital registration system. Two thirds of people who’ve died never reach official records and now we’re asking countries to capture quite comprehensive surveillance data of a global pandemic on top of that. So, you know, the answer is this is, this is – it’s not rocket science, it’s not – you know, it’s – in theory, it’s not a difficult set of data to collect. In practice, it is going to require a commitment to resource allocation.
Dr Shereen El Feki
Thanks, Sarah. Samira Ahmed’s also raised a very good point, that it’s not just sex-disaggregated data, we need to look again at the intersection of other factors, including – and including race and ethnicity. This is a multifactorial question. Gary, I’m going to pick up for the follow-on and looking – in terms of looking at steps forward, concrete examples of how to move in a positive direction. This is a question from James Buckley, which is actually picking up on Sarah’s point, about differences in health-seeking behaviours between men and women. “Can we characterise – can we say why this difference exists? What factors discourage men from seeking care sooner? And, in this regard, Gary, can you talk a little bit about the work at Promundo to actually encourage men, long before COVID came on the scene, men to actually seek out help, assistance and maintaining that?
Gary Barker
Yeah, and that’s also a data issue. I mean, there’s – there are not a lot of good studies on how much men seek health services compared to women. I mean, Sarah knows some of this data, of course, very well, in terms of where men show up in the health system. What we do know is that men tend to show up more in acute or in emergency care, less likely to show up in primary care. Some countries, we – most of the primary care that is accessed is accessed mostly by pregnant or parent or – by mothers or pregnant women. So, we do know that, you know, in terms of the healthcare system itself, often primary care focuses on a specific subset of women. So, some of the time, we don’t know whether – is it a behavioural issue that norms drive men not to seek primary care, or is it how primary care is set up? We have figured out in a few cases that, if we work better to get primary healthcare to try to engage men as well, that men’s health-seeking behaviour is not all that different when we actually try to set the systems up to do that.
We do know that, among young men, there are often patterns of playing through the pain, not seeking help when you need them, particularly around issues related to mental health. We’ve got some data in a few countries where some mental health issues, and that’s a key issue in this pandemic as well, that, in terms of depression, for example, those who are more likely to man – while rates may be similar, in terms of how many men and women tell us they experience a symptom of depression, that women are more likely to seek help. Is that tied up with masculine norms? We believe it is partly about that, of course, in terms of how we raise boys, and we’ve got some data that we’ve gathered on that, that the more men believed in a narrow set of views around what it means to be men, the less likely they are to seek help for some things.
So, clearly, norms are involved, but I think we can sometimes get overly simplistic about, you know, that it’s all about versions of manhood. I think it’s a combination of both. It is around norms, but it’s also how we set up, in gendered ways, primary healthcare. So, I – yeah, that will – that would be recommendations to health systems as to say, yes, pay attention to norms, let’s promote campaigns that try to change those norms. Sarah showed a slide there showing how much certain advertisers have been really good about playing in norms in negative ways. We’ve been less good about promoting equitable health-seeking norms among men, but I think we also need to look at how we set up the health system, in terms of how we gear where it reaches, how it invites, so that we can engage men in more proactive ways.
Dr Shereen El Feki
Hi, Reema, sorry about that. Yeah, coming to you about the questions of remote working. I mean, there’s been a lot of talk now that according to the opportunities working from home, the digital access, how this is opening up new opportunities for women. But, in the context of informal workers, where the nature of the work is hands-on, and also, in parts of the world where women simply don’t have access to online, to an online space, do you think that this shift could actually – to digital working, could actually exacerbate inequalities between men and women? And also, very interestingly, I know that your group has done some very interesting initiatives to try to use smartphones and other online methods to actually assist informal workers in the pandemic and looking ahead. Could you talk a little bit about the digital divide?
Reema Nanavaty
You’re asking me?
Dr Shereen El Feki
Yeah, most certainly am, yes.
Reema Nanavaty
Thank you. Definitely, I think the digital divide is there in a country like ours, and amongst men and women, definitely. Even if a family has a smartphone, it is always either with the man or with the boys in the family. So, when we have to immediately reach out to our members, we were first calling up the men, the husbands or the sons, and then requesting that if we could talk to their mothers. When we really wanted to listen to – you know, when they were going through anxiety or they were going through violence at home, the women would ask us to call, like, 5 or 4:30 in the morning, because that’s the time when she will be able to speak more freely, otherwise, in a small home, she’s all by herself. So, you definitely see that, you know, women only have a small window of time when she can have access to a smartphone, and then she can talk what she really wants to share, and – you know, or what she really thinks are the issues that she’s grappling with.
But, nevertheless, I think we don’t get bogged down by those kind of digital divides. Our whole work – our whole approach is that how do you make this pro-women, and especially pro-poor women? So, we immediately had our grassroot leaders, who all had access to smartphones, and these grassroot leaders would go and reach out to the women in their homes, in the slums or in the villages, and that’s how we connected. And we also made sure that whatever government entitlements these women were supposed to have, in terms of, you know, getting payments from the government or getting the ration from the public distribution system, how these grassroot leaders could make it available. And, also, we found that, you know, unless and until women have access to work and hard cash income, they will not be able to stand up and, you know, start thinking of rebuilding or what’s the way ahead, and how do they also therefore, you know, deal with the social issues that they were also facing.
So, we gave work to about 20,000 women in their homes to make masks, so women started stitching masks and then selling it either to the local government offices or to the local hospitals, you know, even in the villages, to the school, to the health frontline workers, who would work in their slums or in the villages. We also had women who were – everybody was at home, men, women, girls, boys, schoolchildren, everybody, and so women started making dried snacks at home. We made sure that we provided them with packaging materials, we provided them with certain protocols to maintain their hygiene, and women started selling those packets of snacks. We also had women making envelopes and, you know, carrier bags and everything because India wants to be a plastic-free nation. And that’s how, you know, 20,000 women and their households were able to meet with the challenges of lockdown.
And also, you know, now, or what India was hoping would be the future, already became a reality, and that was online. Not that many people would now be going to the shops or going to the market and buying, but people who want to be safe and therefore, online deliveries have to – and therefore, the challenge for us was that how do you connect the producers, the informal sector workers, the self-employed who are producers, to these online platforms? And I’m very happy to say that, in a short span of 50 days, we connected some 500 vegetable growers out in the rural areas to the urban consumers, and we were able to sell 30,000 kilograms of vegetables, creating an income of almost US $3,000 to these farmers as well. We also had women who were training to making bakery and confectionary items, who worked through their homes using commercial equipment, and they were taking online orders.
So, I think these are the kinds of approaches, but this is not enough. I think what is needed – the success of these initiatives has shown us that these informal sector workers, they do not want charity. What they want is an enabling access to finance and access to market, and we call – and which will help them nurture and scale up their tiny, tiny enterprises. We call it as the livelihood recovery fund, and this is what one has to work on.
I think the second aspect, which I think will really help these informal sector workers are – you know, we all are talking about healthcare and vaccines but, together with that, we do need to look at how do women have access to better nutrition, skills, good income, and life insurance. If we – how do we build a different society, which is not susceptible to disease and devastation in going forward in the future? If one member of the family’s sick, then the whole family gets affected, and this also has its implications on the community. Everything is interconnected and therefore, I think, when we talk about healthcare, everybody starts talking about Medicare, but we need to look at it from a holistic point of view of healthcare with nutrition, with skills, with good income, and insurance, and how could we build and nurture a healthy society and a community. Thank you.
Dr Shereen El Feki
Thank you. Thanks a lot for that, Reema. I’m going to wrap up the session with just one question that’s picking up on a point, which Gary so subtly alluded to, and this is male and female leadership. So, there’s been a lot of commentary now noting that it seems to be countries with female leaders who – which have mounted a more effective response to the pandemic. And, in fact, Michelle Bachelet brought up a very interesting point that, although less than 10% of countries around the world are led by women, in fact, if you look at the 15 – if you look at the top 15 countries, in terms of response to COVID measured by a variety of parameters, half of them are led by women. So, I’d like to ask each of our panellists, do you accept this argument that, actually, you know, there are these male and female styles of leadership and, in a crisis – ‘cause women are, quite frankly, the best men for the job? And, if you do agree with this, then how are we going to deal with the situation we have now, that if you’re looking in many countries, in terms of the pandemic – COVID-19 recovery, actually, women are very sparsely represented in the decision-making at various levels, in terms of coming out of this pandemic and looking ahead?
Sarah Hawkes
Shereen, it’s a really good question, and it’s obviously a very widely asked question, and, you know, is illustrated conversely by if you look at the top five death rates, you know, it’s India, Brazil, the US, Russia and the UK. You know, they’re – and you don’t need to be a Political Scientist to spot a bit of a trend and a pattern. But I – you know, I have to say, to be really frank with you, that, as somebody who grew up in 1980s UK, under the leadership of an incredibly strong woman heading the government, I’m not entirely convinced that simply swapping gender around at the top necessarily leads to changes in decision-making, as your outcome. I absolutely accept that there is a wonderfully, more diverse leadership, and in terms of more women than the norm, represented in countries that are doing well, as far as the – as dealing with the pandemic is concerned.
I think a really important question perhaps for people from Chatham House to reflect on, would be whether that’s actually a representation of the society rather than the leader. That it’s a certain kind of society that allows and supports the rise in leadership that is more inclusive, more all-embracing, more collegial, more engaged, rather than more authoritarian and, you know, represents poor public health responses. So, I – you know, in some ways, I’d turn the question on its head and say this is – in my opinion, this is less about the individual women leading and more about the kind of society that allows that kind of leadership to flourish, and what can we learn from that?
Dr Shereen El Feki
Yeah. Reema, over to you.
Reema Nanavaty
I would always say that, you know, we believe in collective leadership, so – but definitely, you know, you take a family as a unit, but under women’s leadership. So, where we see that – where women are leaders, it’s a community which is a nurturing community, it’s a society which also is a very nurturing and a futuristic society. So, I think the future is of women, and for women, and by women.
Dr Shereen El Feki
Thanks, Reema. Gary.
Gary Barker
You know, I agree with Sarah in the sense of, you know, it’s not just any women leaders, it has been progressive women leaders who have made a difference in this pandemic. Those that has been very far right-wing or right-leaning male leaders that have been part of the problem, in terms of many of the policies they’re implementing. So, it matters which women get elected just as it matters which men we are calling out or engaging in this. I think we certainly believe that we need full equality across all decision-making levels, whether it’s public health, where we’ve seen not enough women’s voices there, but, at the same time, I don’t want to let men off the hook, nor believe that we, as men, are indifferent to care and the suffering of others and being apathetic and connected and thoughtful. So, Promundo’s cause, of course, is engaging men to do fully half of the care work around the world. We believe that as men embrace care and we become better, more authentic, connected human beings, so I do think that we want to support and we believe fully in women’s leadership, and we want to also see ideas about manhood transformed, so that those differences are less exacerbated between us, that men can be caregivers and women can lead countries. That is what a fuller degree of equality would say, we both have to be able to do both of these things.
Dr Shereen El Feki
Well, on that note, I’m afraid we’re going to have to conclude this webinar. We’ve run out of time. We have so many excellent questions, and we’re going to try and follow-up with you on the chat or we’ll talk to our technical experts to see what we can do, because some of them are really, really thought-provoking, and we’d like to continue the conversation online. I want to thank our speakers: Sarah, Gary and Reema, for your wonderful contributions. I look forward to meeting our attendees and our panellists and continuing this discussion in person, in happier and healthier times. So, thank you to you all for joining. Please stay well, and goodbye.
Reema Nanavaty
Thank you and goodbye. Thank you.
