World Health Day: Dealing With A ‘Pandemic Of Inequality’

Covid-19 has presented not just a health emergency but also a socio-economic crisis owing to its far-reaching consequences on the economic, demographic and social fronts, prompting many to refer to it as generating a ‘pandemic of inequality’. The migrant exodus triggered by the sudden lockdown in March, 2020 turned a health emergency into a humanitarian crisis. The concomitant economic slowdown has set India’s progress back by decades. Covid-19 has wreaked havoc in the educational, health and livelihood sectors and in other areas of social development, impeding the country’s progress towards the realization of India’s commitments to the United Nation’s Sustainable Development Goals 2030 (SDGs).

The Covid-19 crisis amplified pre-existing gender gaps and the asymmetric power-relations between men and women. Even prior to the pandemic, the impact of social norms could be seen over the life-cycle of women, in terms of sex selective practices, low literacy and high school completion, malnutrition, early and forced marriages, teenage and unwanted pregnancies, lack of agency, low workforce participation, and gender-based violence.

According to the recently released World Economic Forum’s Global Gender Gap Index 2021, which provides an assessment of the gender gap in 156 nations, India’s ranking dropped 28 places to 140, making it the third-worst performer in South Asia, far behind Bangladesh and Nepal. India ranks among the bottom five countries in the health and survival sub-index.

Women’s lack of agency to exercise their reproductive choices and inadequate access to health services were exacerbated as a result of the pandemic. There was an overwhelming focus on treatment for Covid-19, often at the expense of other essential health services, including family planning and maternal health. Limited mobility during the lockdown also reduced access to health services. While ASHAs were at the forefront of India’s Covid-19 response, which additionally greatly overburdened them with responsibilities over and above their regular duties.

Several studies, projections and reports have warned us of the adverse health impacts of the pandemic. A recently published review in the Lancet global health journal has acknowledged that unequal digital access in low and middle income countries made remote consultations less feasible leading to disruption in preventive antenatal care for vulnerable populations. The unmet need for family planning services is already high in India and disruption in health services may have far-reaching consequences.

Projections suggest that as a result of the pandemic and disruption in essential health services, 26 million couples in India will have no access to contraceptives. The inability to access contraceptives during the lockdown is likely to result in an additional 2.4 million unintended pregnancies in India. Close to 2 million Indian women will be unable to access abortion services due to Covid-19. The lifting of the lockdown and a slow easing of restrictions have lowered barriers for access, but the situation is still far from the pre-Covid-19 scenario.

Emergency situations, such as the Covid-19 pandemic, require the health system to reorganize itself and prioritise the differential needs of vulnerable populations. In order to respond to the long-term consequences of Covid-19 as well as prepare ourselves for similar situations in the future, there is an urgent need to enhance budgetary allocations for health to reach 2.5 percent of GDP, as envisaged in the National Health Policy 2017. This will not only strengthen the public health system but also help reduce out-of-pocket health expenditures.

Greater investments in public health and prioritizing universal health coverage will make India’s response to health emergencies more robust by strengthening free or subsidized testing, treatment and vaccination along with provision of uninterrupted essential health services for the most vulnerable and marginalized groups.

A comprehensive, gender-inclusive health systems response to address family planning service provision during emergency situations is imperative in order to prevent unwanted pregnancies and additional maternal and reproductive mortality and morbidity. Greater investments in capacity building of frontline workers during and beyond the pandemic is required, given that they represent the first and often only point of contact with the public health system for rural women.

Alternate models for outreach services which leverage technology, such as telemedicine services also need to be explored further. A public health responses to violence must include psychosocial support and  redressal mechanisms for survivors of violence should be a priority. There is an urgent need to invest in social and behaviour change communication (SBCC) programmes that address regressive social norms which have an impact on the health outcomes of vulnerable populations, particularly women. Effective SBCC strategies have the power to challenge conventions and hierarchies which determine women’s status in the family, community and society at large. 

As the government realigns its policies and programs in the wake of Covid-19 and prepares for future pandemics, we must recognize that without greater gender equality and a greater focus on equity, India will fail to achieve its health and development goals.

(The author is executive director, Population Foundation of India. Views expressed are personal, and do not necessarily reflect those of Outlook Magazine)