Helena Wilcox

Helena Wilcox

Pandemic preparedness and response must be gender-inclusive to mitigate harms to women

13 December 2022

blonde woman wearing a face covering on public transport

Pandemics don’t impact everyone equally. Women were disproportionately affected by the measures introduced to curb the spread of COVID-19. So how can we do better in responding to future disease outbreaks?

The impact of pandemics on people mirrors the inequalities that already exist in society. People who have existing health conditions are at greater risk of severe disease. Those who are carers, either in healthcare settings or the community, are more exposed and at greater risk of infection. The broader social and economic impacts of disease outbreaks also affect people in different ways.

This has been observed during the Zika and Ebola outbreaks of recent years and – on a global scale – during the COVID-19 pandemic. The emergence of COVID-19 led to some of the most extensive public health measures being put in place across the world.


The impact of COVID-19 on women

In the initial phases of the outbreak, the Secretary-General of the United Nations stated: ‘COVID-19 could reverse the limited progress that has been made on gender equality and women’s rights’. Similar warnings were issued by senior leaders in global health who were concerned about the potential impacts of the disease, as well as associated public health measures, on women and gender equality.

The broader social and economic impacts of disease outbreaks affect people in different ways.


In 2021, I wanted to further understand the effects of the COVID-19 pandemic on women. I examined hundreds of policy documents using a Gender Responsive Pandemic Preparedness Framework, developed by the Gender and COVID-19 Working Group, to assess the extent to which women’s interests were considered as part of the UK government’s policy response. In fact, I found women’s interests had been given very limited consideration. I also found evidence of worsening inequalities for women in terms of mental health, gender-based violence, and economic and work-related issues.

As an example, in 2020, many women (who are already more likely than men to work part-time) took long-term leave or left their jobs to take care of children or meet other caring responsibilities. In the US, as many as 23% of women, compared with 13% of men, considered leaving the workplace; this effect was particularly strong for people with children under 10.

In the UK, women’s experiences of increased caregiving demands, domestic burdens and reduced employment (either by choice or enforced) contributed to a greater decline in women’s mental health than men’s during the pandemic, especially for women with babies and young children.

mum holding young daughter wearing a face covering

In 2020, many women (who are already more likely than men to work part-time) took long-term leave or left their jobs to take care of children or meet other caring responsibilities.


How has pandemic policy affected women historically?

Before COVID-19, the dynamic between disease outbreaks and the impact of policies on women was studied most extensively during the 2014–2016 Ebola outbreak in West Africa, the 2019 Ebola outbreak in the Democratic Republic of the Congo, and the 2015­–2016 Zika virus outbreak in parts of Central and South America. During the first of these Ebola outbreaks, maternal mortality in Sierra Leone rose, as maternity facilities closed while resources were diverted to support the emergency response, and women with a suspected Ebola infection were denied care. The impacts of Zika were disproportionately borne by women in a way that was heavily influenced by the causes of the disease, with women taking more responsibility for avoiding pregnancy or reducing the risk of infection while pregnant. Some women were also caring for infants who were exposed to the Zika virus in utero and consequently developed microcephaly. This contributed to a greater risk of mental health conditions among women.

These gendered dimensions of outbreaks are reflective of wider structural inequalities that systemically disadvantage or fail to prioritise and advance women’s interests. Such inequalities are exacerbated during outbreaks, and there is a clear role for policy in managing the potential impacts on gender equality.


How can we protect and improve gender equality in future crises?

Global guidance on gender-inclusive policymaking in outbreak preparedness, response and recovery is limited. This is perhaps reflective of broader structural inequalities and systemic barriers for women, including the unequal representation of women in leadership and government roles.

The UK experienced high rates of infection and death from COVID-19. However, the country was ranked as highly prepared for a pandemic in the Global Health Security Index 2019. The experiences and evidence from the past two years suggest that this did not translate into an effective and gender-inclusive public health response to COVID-19.

The long-term impacts of COVID-19 on women are likely to continue to emerge as the pandemic continues, and they may not be fully understood for years to come. This underscores the importance of taking women’s interests into consideration in policy- and decision-making during pandemic preparedness, response and recovery – both now and in the future.


The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.