India: Gender Distanced From COVID-19 Policy Measures?
It took the COVID-19 pandemic little over a few weeks to expose India’s longstanding and deep social disparities. We know that the novel coronavirus, while infecting people indiscriminately, affects them differently.
To illustrate, the overall impact of COVID-19 on women, girls, transgender, and other non-binary persons is vastly different from men. Add to this, the elements of caste, class, different abilities, and religion, the effect of COVID-19 on some people, and certain communities is further compounded.
It is imperative that policies and measures in response to the pandemic are formulated using a lens that focusses on people’s social vulnerabilities to uplift their health and livelihood along with the economy. One of them is gender.
While there is no current research worldwide on the role of sex and gender on the health outcomes of people diagnosed with COVID -19, experience from earlier outbreaks of Ebola and Zika viruses suggests that both sex and gender are key drivers of risk and response to infection and disease. The High-Level Panel on Global Response to Health Crisis, set up by the United Nations (UN) Secretary-General in 2015 to draw lessons from Ebola response, recommended the need for countries to incorporate a gender dimension in any outbreak preparedness and response efforts. It specifically recommended that policy responses need to consider the critical role women play as primary care-givers along with the economic impact of a pandemic on their situation, and their inclusion at all levels of planning and implementation.
But how gender-inclusive have India’s policies been so far? Let’s take a look.
A one size and type of shoe does not fit all. To think and believe so leads to gender blindness. A gender-responsive COVID-19 policy is one that takes into consideration the needs, roles, and interests of not just men but also women and other gender aiming to curb the inequality and discrimination that some may have faced historically.
In India, even though attempts have been made to become gender-responsive, the policy measures for COVID-19 health crisis continue to remain largely inadequate.
This piece sheds light on the policies of the Government of India vis-a-vis
(a) Violence against women
(b) Reproductive and sexual health
(c) Healthcare workers, unpaid care workers and informal and formal sector workers
(d) Transgender persons
VIOLENCE AGAINST WOMEN
According to the National Commission for Women, there has been a distinct increase in cases of domestic violence during the lockdown imposed by the central government to curb the spread of COVID-19. With women and girls locked in with their abusers, UN Women has termed violence against women and girls as a ‘shadow pandemic’ to the novel coronavirus.
On 25 March, the Ministry of Women and Child Development issued a notification for the continued operation of one-stop crisis centres, helpline, and other institutional machinery. What was missing, however, was a large scale mass communication for the public, declaring women’s safety as an essential service with precise information for survivors on accessing crisis response service providers.
Prevention of and protection from gender-based violence is an integral part of the national response to the pandemic, which also takes into account the social and cultural factors. Such measures would include the following:
- Mass awareness and consistent communication of the fact that increased pressure on individuals and families owing to economic, social and mental health impact brought on by lockdown does not justify gender-based violence, must be ensured.
- Community responses and civil society organisations’ provision for critical support services must be enabled.
- Information about preventive and protective services of police, helplines, shelters, protection officers and counsellors and its ready access to survivors of gender-based violence, must be ensured.
- Sufficient budgetary, infrastructure, and people resources, including filling up of vacancies, if applicable, must be made available to relevant departments.
- In view of recurring lockdowns, restrictions on movement should be eased for women and children fleeing abuse.
- Access to medical services including the collection of forensic evidence must be ensured for survivors of gender-based violence.
- National helpline data must be made publicly available for observation, research, and analyses.
REPRODUCTIVE AND SEXUAL HEALTH
The alarming rate at which COVID-19 has been spreading in India has further debilitated India’s already weak public health system. This has gravely affected pregnant women and girls who are now facing further limitations on their access to healthcare, thereby increasing risks of maternal mortality and morbidity. Since March 2020, pregnant women have faced challenges in accessing maternity care and skilled medical care to give birth because of the diversion of healthcare staff and resources to the COVID-19 response.
According to the New Indian Express, a survey of the Health Management Information System, maintained by the Ministry of Health and Family Welfare demonstrates that there has been a 43% drop in institutional deliveries since March 2020. This is not only worrying but dangerous to women’s reproductive health as it pushes back on safe deliveries. While issuing guidelines may help, it must also be ensured that reproductive and sexual health services are treated as essential services.
Stressful working environments leading to ‘unprofessional behaviour’ by healthcare workers and lack of resources have been found to facilitate the mistreatment of women during child birth. According to the Special Rapporteur on Violence against Women, people giving birth should also be protected from obstetric violence during the pandemic.
The impact of the pandemic has also restricted women and girls’ to access menstrual hygiene products, due to increased costs of materials, reduced production, and blockages in supply chains. In addition, items such as sanitary napkins, tampons, and related hygiene products have not been designated as essential goods. The probability of restrictions on freedom of movement related to COVID-19 measures has led to an increase in women’s and girls’ challenges to access water and other sanitation facilities and may lead to an increase in stigma and other harmful practices related to menstruation.
The Economic, Social and Cultural Rights Committee in its April 2020 statement recommends that states lift “all value-added tax” and subsidize costs of hygiene products during the pandemic to ensure its widespread access.
A gender-inclusive COVID-19 policy response must take into account the following:
- Reproductive and sexual health including gynaecology and obstetrics must be treated as essential services and mass publicity on access and availability of such essential goods must be ensured.
- Access to sexual and reproductive health services and goods, especially ones that are time-sensitive such as contraception, pregnancy care and treatment, labour and delivery services, abortion, post-abortion care, and miscarriage treatment must be ensured.
- Continuous access to medical care and support services for survivors of sexual violence must be ensured, considering that women and girls are exposed to increased domestic and sexual violence owing to lockdown and travel restrictions.
- Prevention and treatment of HIV and other sexually transmitted infections must be ensured.
- Closing of inter-state borders must not restrict the flow of necessary and essential reproductive health medicines.
SECTORAL IMPACT ON WOMEN
Healthcare Workers – Women at the frontline of COVID-19 response
Worldwide, according to the World Health Organisation (WHO), 70% of the global health and social sector employs women. In India, the nursing profession is almost exclusive to females, while community healthcare work is completely exclusive to females. The latter includes more than 1 million ASHA workers[i] and over 2.6 million Aanganwadi workers (AWWs) and helpers. This constitutes a largely female work force at the frontline of COVID-19 treatment and prevention.
The COVID-19 related work performed by ASHA workers, Auxiliary Nurse Midwives (ANMs) and AWWs (Aanganwadi Workers) exposes them to the virus with little protection in terms of safety equipment and social security. Their additional work includes conducting door to door surveys, identification of individuals in households who show symptoms of coronavirus, educating people about taking necessary precautions, monitoring movement of migrants, contact tracing and gathering travel histories of residents and other data.
In the process, as reported, for the ASHAs, the regular and essential reproductive and sexual health services have taken a backseat. There is a dearth of calcium and iron medicines that are considered key to the reproductive and sexual health of women.
Considered as ‘volunteers’, ASHAs are paid ‘honorarium’ and ‘task-based incentives’. As such, if they are unable to carry out their regular work, they only have the COVID-19 incentive of Rs. INR 1000 (USD12) per month to fall back on.
While ASHAs and Aanganwadi workers brave out their COVID-19 related duties, their long-standing demand to gain status as formal employees of the health system, receive better remuneration and social security measures, continues. The nature of the appointment and incentive-based remuneration of ASHAs and Aanganwadi workers is a low-cost resource to governments and essentially subsidises the healthcare budget, at their cost.
A gender-responsive policy measure must consider the following:
- Childcare facilities and/or relaxation of duty hours for healthcare workers who are single parents/ sole caretakers of older persons at home must be ensured.
- Additional remuneration to community frontline healthcare workers (ASHA, ANMs, AWWs) for COVID-19-related work, including for transportation for going out of their regular work areas, must be provided across all states.
- Treatment and compensation for loss of work in the event of contracting COVID-19 as part of healthcare workers’ interface with the community must be provided.
- Medical insurance for COVID-19 related treatment of all healthcare workers and their immediate families should be provided in addition to existing COVID-19 related death insurance for healthcare workers.
- Personal Protective Equipments (PPE) for all healthcare workers must be timely provided.
Unpaid Care Work – Women at the home front
Care work at home includes performing the daily chores of home care such as cooking, cleaning, and other daily essentials, child care, elderly care, along with ensuring the general well-being of the entire family. Care work is not remunerated and usually falls within the ambit of women’s work at home due to the stereotypical gender roles in the society. Even though essential and central to everyone’s daily living, care work contribution to economies is highly undervalued. The 2020 Economic Survey finds that 60% of women in India in the age bracket of 15-59 years, which is also considered the productive years are engaged in full-time housework.
In ordinary times, globally, women and girls were found to do on average three times more unpaid and domestic work than men and boys. In the present day pandemic, with the initial complete lockdown and now partial lockdown of many services, women are bound to be disproportionately burdened with added work at home. Remote learning of school-going children adds to this extra work.
For girls in crisis, long term impact on lives and livelihoods of poor families could lead to girls dropping out of school, with an increased possibility of early marriage.
Working remotely for single women with child care and elderly care is a challenge. Even for women with familial support, who work remotely – managing home and working, while taking care of children and older persons is additional work. However, there has been no word in the policies or guidance from the government regarding flexibility in working hours for women with home duties and child care.
In addition, a gender-affirming and concerted policy push is required to address the deep-seated discriminatory gender roles at home which are guided by patriarchal beliefs, practices, and attitudes. Mandatory paternity leaves for fathers, in general, is a way to ensure their involvement and also make inroads in sharing the burden at home. At present, while there is a mandated 15 days paternity leave for central government employees, the private sector is given undue flexibility in deciding its own rules regarding this. The Paternity Benefit Bill which was introduced in 2017 was not passed. In the absence of any legislation, paternity leave is left as a ‘best practice’ among private sector companies and not a basic minimum standard, generally ranging from five to 15 days.
The low worth placed on women’s health as legitimised by the response of the Government is bound to adversely impact the psychosocial, physical and mental health of women and girls both in the short and longer-term, thus deepening the gender inequality and undoing the progress made so far.
Therefore, the following must be ensured:
- Consistent and wide communication of the importance of shared-work must be ensured.
- Guidelines for employers relaxing total working hours and/or having flexible hours for women working remotely must be drafted by the Government and incorporated by employers.
- Guidelines to schools for easing the workload of students as a consideration for parents, especially mothers, managing home and remote working in lockdown, must be incorporated. This will also factor in the possible situation of a lack of electronic devices required for remote/online learning. When schools re-open, states must devise innovative methods to prevent school dropouts.
- As a long term pro-gender policy response, paternity leave must be provided for fathers across all sectors, including adoptive fathers. Recognition and monitoring of unpaid care work must be undertaken through mass education.
- The impact of cutbacks in essential public services and infrastructure investments, which are an important means of relieving households of unpaid care burdens must be tracked.
Women in Formal and Informal Labour market: a livelihood fallout
As of 2019, women comprised 21% of India’s total labour force participation, a constant decline from 32% from 2015. Ninety four per cent of these women are engaged in informal sector jobs, of which 20% are in urban jobs. According to the Centre for Monitoring Indian Economy, 91 million small traders and wage labourers lost their jobs in March and April. The high rate of attrition in the work force stands to further reduce the bare minimum participation of women.
Lesser number of jobs is likely to increase people’s readiness to work on lower remuneration. The relaxation of labor laws in states of Uttar Pradesh, Madhya Pradesh, Gujarat, Rajasthan, and Karnataka are also detrimental for women in the formal workforce. Longer working hours, possible suspension of maternity benefits, unsafe working conditions, and other repercussions only add to the various challenges that women face in ensuring full participation in the labor force.
The pre-pandemic gender pay gap of 35.4% meant that women would only earn 64.6% of what men earn for the same jobs. With lesser jobs for both men and women, women are more likely to be further underpaid or pushed out of jobs.
According to the notification of Ministry of Rural Development’s notification of 23 March, the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) wage increase under the Pradhan Mantri Garib Kalyan Package (PMGKP) of INR 20 (USD 0.27) per day with effect from 1 April 2020, was already in the offing with or without the outbreak of COVID-19. In fact, the proposed wage increase by the Central Government is lower than in many states. Moreover, the proposed benefit of INR 2000 (USD 26.75) annually, assumes that a worker will get 100 days of work throughout the year. Considering that MGNREGA has more women beneficiaries, this provision will adversely impact women.
Further, the Pradhan Mantri Garib Kalyan Package (PMGKP), announced by the Central Government to help the poor deal with the economic crisis during the COVID-19 pandemic provides INR 500 per month (USD 6.68) to the Pradhan Mantri Jan Dhan Yojana (PMJDY) women account-holders through their Jan Dhan accounts. While the measure is welcome as an initial support for families considering the loss in livelihood for women engaged in the informal sector, the package is grossly inadequate. Moreover, the reach of Jan Dhan accounts for its projected beneficiaries is in itself questionable. According to a study conducted by Azim Premji University, as many as 64% of the vulnerable households did not possess Jan Dhan accounts. Most of these households had workers from the informal and unorganized sector earning less than INR 10,000 (USD 133.60) per month.
A gender-inclusive policy response must address the concerns of informal sector workers, particularly women, and consider the absolute decimation of the daily wage earner’s livelihood during the pandemic.
It must take into account the following:
- Adequate direct cash transfer for poor families in the hands of women to assist families in tiding over the initial impact from livelihood loss must be ensured.
- The beneficiary reach for direct cash transfers should extend beyond Jan Dhan account holders by collating information from MGNREGA, Pradhan Mantri Ujjawala Yojana and Public Distribution System (PDS) among others.
- The one-time ex-gratia support of INR 1000 per month (USD 13.36) for older persons, differently-abled, and widows provided under PMGKP is grossly inadequate and must be increased in amount and extended over a period.
TRANSGENDER AND INTERSEX PERSONS
The transgender and intersex community has historically been socially distanced. The pandemic has further compounded their challenges in accessing food, shelter and medicines and the lockdown has dwindled their livelihood options.
A majority of the community continues to depend on begging, offering blessings during traditional celebrations in exchange for alms and sex work to earn a living. After the lockdown, their work has come to a grinding halt along with their daily income. However, polices of the central government and various state governments in response to the pandemic have been silent on provisions for the community.
A gender-inclusive policy needs to at least consider the following:
- Access to free food ration, irrespective of the availability of documentation, must be ensured.
- Direct cash transfers must be made to the community without prejudice, irrespective of identity documentation.
- Access to healthcare, including non COVID-19 related treatment and medication, antiretroviral therapy for HIV+ patients, gender-affirming surgeries, and other healthcare services like hormone therapy must be ensured without discrimination.
- Separate quarantine facilities for transgender and intersex persons must be made available if the transgender persons choose to avail such facilities.
- The right of individuals to self-identify their gender must be ensured.
- Formal education and skill development of transgender and intersex persons must be ensured.
The disruption brought on by COVID-19 in terms of health, livelihood, food security and social protection for people will be better known in the coming times. What we know now is that disasters and pandemics affect people disproportionately.
Women, girls, transgender and intersex persons are experiencing specific and adverse impacts of the COVID-19 pandemic. As an immediate policy measure, the lockdown in its suddenness posed a safety concern for women and children who were either traveling – alone or with low resources and support. The underlying environment of violence against women and girls, added to their vulnerability. For any further emergency measures, prior notice must be given to the public for ensuring their readiness and designated ‘women-only’ transportation for women must be started to ensure their safety.
With over 550 COVID-19 related deaths daily on an average in the last one month, it is essential to understand who stands to face the harshest consequences. For governments to introduce evidence-based gender-inclusive policies, it is imperative to document disaggregated information on people infected with COVID-19 and make this information publicly available.
India needs to act beyond guidelines with targeted and specific provisions that will advance gender rights and equality and not regress on the progress made so far. No one is safe until everyone is safe.
[i] ASHAs or Accredited Social Health Activists are community health workers tasked to deliver health prevention in communities and link them with the health care sector. Their job is considered as ‘volunteers’ and are paid ‘honorarium’ plus task-based incentives.
Author: The paper was written by Reena Tete, Manager, Gender and Identity-based Violence at Amnesty International India
The above paper was sent to the National Commission for Women and various other decision-making bodies from Amnesty International India.