CoronaUganda #3: Carrying the World on Her Shoulders – The Potential Impact on Health in Uganda, a gender perspective

While SARS-CoV-2 continues to wreak havoc across the globe, here in Uganda we are conducting assessments to identify its potential impacts’ with special focus on gendered dimensions. Many of these impacts are sprouting out of the movement restrictions imposed and recently extended for an additional 21 days.

It is important to plan around these possible outcomes that will affect already vulnerable groups that include women and girls, people living in poverty, social minorities, refugees and migrants, and people with immune-compromising illnesses like HIV.

We have already been receiving reports of some of the devastating impacts play out in real-time. Pregnant women giving birth on roadsides. People decrying their inability to access health services and critical medication. Lack of food and increasing food insecurity (helped along by the second wave of the locust invasion destroying crops). Large increases in reports of sexual and gender based violence.

There are a plethora of gendered impacts, so I have decided to make this the first in a series, to better explain each area of concern. Today, we focus on health impacts.

Restrictions=Grave Health Consequences

While I already alluded to the serious consequences for pregnant women, the restrictions translate into risks for the population as a whole who now must navigate getting special permission from a single local government official in each district (the RDC) to reach health facilities. People must call the RDC to get him or her to come and collect them in his/her authorized vehicle to transport them to a health facility for medical attention. Some RDCs are simply unavailable or lack the fuel or will to come to their rescue. Ambulances, too, are few and often unresponsive to calls.

This translates into people generally not getting the medical attention they need whether for emergency needs or simply to access medications, like anti-retroviral meds to control HIV viral load. This could lead to spikes in the rates of maternal and child mortality, as well as higher transmission rates of HIV and deaths. One area of concern affecting HIV-positive pregnant and lactating women is the potential for increases in mother-to-child transmission.

People are also at greater risk of dying from common illnesses like malaria. There was meant to be a nationwide malaria net distribution kicking off in mid-April which has been suspended indefinitely. Furthermore, my team has seen that women and children tend to be at greater risk for malaria infections simply because families have too few nets and these tend to be used more by men (when they are used).

Community dialogue on malaria prevention (before social distancing)

Children, also, are vulnerable to missing important immunization appointments compromising their long-term health. Elderly people and people with disabilities can already be socially isolated and lack mobility – the restrictions will affect their ability to access care and social services, negatively impacting their physical and mental health.

Gender Constructs that Increase Risk

Women and children are particularly at risk because of their lower decision making power in households, which serves as an ever-present barrier to being able to make decisions or access money to use health services in some families. When we were still allowed to conduct field activities unimpeded, we came across a case of a father who would not allow his children to go to a health clinic, despite them feeling very unwell. Through GWED-G’s community workers, the village health team finally were able to screen the family and it turned out that the father and his three children were suffering from TB.

Nutrition and hygiene sensitization (before social distancing)

With women’s role as primary caregivers they tend to make up the majority of health care users in northern Uganda meaning more interactions with healthcare workers and time spent at facilities not physically distancing, putting themselves and their children at risk of contracting the virus. Their traditional caregiving roles for family members, including children, elderly and those suffering illnesses at home also elevate risks of contracting (and transmitting) the virus.

Females on the Frontlines

Across the world, women make up the majority of healthcare workers meaning they are the frontlines of combatting the coronavirus. The Government recently announced, seemingly without concern, that they had just 10% of the required Personal Protective Equipment (PPE) required. Furthermore, there has been no mention of providing gender sensitive PPE (meaning gear that fits properly to best protect) nor the provision of feminine hygiene materials to ensure female health workers can continue providing life-saving care safely.

As women are key workers in the health sector, the potential for increases in the stigmatization of health care workers is concerning. We have seen much stigma (and violence) faced by workers in DRC during this ongoing Ebola crisis. Frontline workers risk experiencing violence and harassment from communities that fear being exposed to the virus. Relatedly, we have already seen verbal backlash of housing patients in health care facilities to-date.

We must not overlook, too, the real physical and mental well-being impacts of female health workers who may experience an increased caregiving burden – caring for patients at work and family members at home leading to more physical and emotional strain from overwork.

Midwife talking about safe delivery at facility

Violence & the Virus at the Well

Lack of access to water has been a long-standing concern in Uganda. For the many who have limited access to running water, #WashYourHands can amount to a slap in the face. Sanitizers are often unavailable to buy in most villages and, when available, unaffordable. Water collection points can be at a large distance from people’s homes. Not to mention that in most Western countries, we have running water in our homes and may lament having to wash our hands so frequently! Imagine travelling kilometres by foot to get 10 to 20 litres of heavy water only to have to do that several times a day to keep large families clean, purifying for drinking, and for cooking as well. All accomplished under the hot African sun.

Refugees, Internally Displaced Persons and street-connected people also have limited access to water. Women and girls, especially, are the traditional water bearers in these lands. Meaning the burden is placed squarely on their shoulders. Being advised to wash your hands every 30 minutes amounts to a constant back and forth between home and well. Even the thought of it is exhausting. Importantly, still, most of these water collection points have poor hygiene conditions. There is no station to disinfect the taps after use – increasing the potential for contracting the virus for its users.

Water collection points are also a pre-existing site of violence. Indeed, the most recent comprehensive report on violence against children notes that 9.1% of girls and 5% of boys aged 13 to 17 years that experienced sexual violence were violated at bodies of water in the last 12 months (UNICEF 2018[1]).

Going through a GBV referral pathway

Let’s Not Forget About Sex

Increasingly, the government and development organizations are looking at ways to divert funds or retrofit current projects to address the looming COVID-19. This means ongoing projects are at risk of being starved of funds to reach their crucial mandates.

One area that suffered during the previous Ebola crisis (Sierra Leone) was the provision of sexual and reproductive health services. We must look to the lessons learned from these crises. School closures and confinement (like what are taking place currently in Uganda) lead to increases in sexual activity – particularly for adolescents. This translates into sharp increases in unplanned, unwanted, and teenage pregnancies because of lack of access to and information about family planning.

The consequences here could proliferate in unsafe abortions, child neglect, and again higher risk of maternal and infant mortality. We must push for the continued provision of these services as they are lifesaving and necessary.

In Summary…

People in Uganda are already severely hurt by the measures taken by the government, and will likely suffer for a long time. Vulnerable people, including but not only women and children, who are already victims of violence and deprivation in more “normal” times, will likely suffer even more.

Fortunately, there are organizations like GWED-G who have fought to bring these issues to the forefront and will continue to do so as we take aim at mitigating these impacts. Tune in later to read more about other potential impacts…

Family planing event (before social distancing)