Recent data on gender differentials in COVID-19 case fatality rates (CFR) in India highlight deviation from global trends. The disaggregated data show higher CFR for women when compared to men.
This data must be put in context. Men tend to suffer from higher COVID-related co-morbidities like hypertension, as compared to women. This makes them more vulnerable to contracting the novel coronavirus. India is no exception to this worldwide trend. Men in India, on average, are also at a higher risk of contracting the disease owing to higher physical mobility and lifestyle choices – smoking for example. Women also tend to have a natural biological survival advantage over men. Yet, paradoxically, in India, the CFR for women is higher than that for men.
There is also compelling evidence to believe that the CFR differential is likely to be higher than revealed by studies. This can be explained by the gender differential in India’s vital registration systems. Data from the Office of the Registrar General show that non-registration of deaths among women is higher than that of men. Data from 2016, for instance, show that of the total deaths registered in the country, 55 per cent were of men and 38 per cent women. And when deaths of women are registered, the likelihood of registering the cause of death remains lower for them when compared to men. Against this background, it is plausible that the COVID-19 CFR gender gap is higher than documented.
What explains this gender-differential? A key factor is access to food and nutrition. Research shows that women are more likely to suffer from poor nutrition outcomes compared to men. NFHS 2015-2016 data indicate that as many as 23 per cent Indian women have a lower than normal BMI whereas only 63 per cent have some say in decisions regarding their healthcare.
Female infants, moreover, face a triple burden of undernutrition. First, they suffer from the carryover effects of maternal undernutrition. Second, research confirms a gender-bias in breastfeeding practices. Third, girl children are at a disadvantage in accessing nutrition, thereby affecting their survival outcomes. The poorer nutritional outcomes are tied to higher COVID-19 morbidity and mortality risk.
Empirical literature from India illustrates how women have less access to facility-based healthcare. Inpatient medical care can prove to be lifesaving, especially in severe cases of COVID-19. There is also evidence that families are less likely to travel long distances to provide healthcare to women
There is also a body of scholarship that highlights the gender differential in average health care expenditure (HCE) — HCE for men exceeds that for women by Rs 8,397. Families are less likely to opt for distressed financing to meet the healthcare needs of women. Apart from this double whammy of access and HCE, women are usually taken to a healthcare facility when their symptoms are severe, potentially increasing their mortality risk.
The unequal burden of unpaid care responsibilities on women in Indian households also reflects on their health. There is a strong chance that a recovering or recently recovered COVID-19 woman patient does not have the option of recuperating adequately because she is compelled to take on physically burdensome household responsibilities. In fact, as per the OECD, women in India, on average, spend five hours more than men on unpaid work.
It would be naïve to assume that centuries of discriminatory socio-cultural practices will not affect mortality patterns during the pandemic. As the country inches towards a vaccination drive against the novel coronavirus, it would be pertinent to ask if policymakers have a gender-focus approach to ensure equity in access to the preventive.
This article first appeared in the print edition on January 2, 2021 under the title ‘Virus in an unequal society’. The writer is a social policy researcher and analyst.
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