Published October 13, 2020
Tia Palermo, PhD, an associate professor in the Department of Epidemiology and Environmental Health, focuses her research on the effect of social policy on population health. She recently contributed to an issue brief for the International Food Policy Research Institute on the need for gender-sensitive social protections in low- and middle-income countries during the COVID-19 pandemic. In the following Q&A, Palermo discusses the topic and offers thoughts on how such protections could work even in countries like the United States.
Women and children may be [at] an increased risk of violence in the home as a result of social distancing. This is caused by several factors, some of which include increased time at home in enclosed quarters with family members who may perpetrate violence, being cut off from support networks, and increased economic insecurity and job loss, which may increase stress and trigger violence.
In addition, women and girls [in] middle- and low-income settings face exacerbated health-related risks as a result of the COVID-19 pandemic. Overburdening of health care systems is one concern. Previously, the Ebola outbreak in West Africa caused a reduction in health-care utilization, including for services related to facility-based deliveries, prenatal and postnatal care, family planning services, vaccination coverage, leading to a dramatic increase in maternal mortality.
Additionally, at the household-level, poverty drives poor physical and mental health, restricts access to healthcare, and may cause households to engage in adverse coping strategies. In the face of the economic crisis, households facing reduced income and increased food insecurity may decide to marry off an adolescent girl to reduce economic stress on the household.
Child marriage(1) is a violation of human rights in its own right, but is also linked to myriad poor health outcomes among the married adolescents and their future children. A unique aspect of the current pandemic is its reach around the globe, which has caused a worldwide economic downturn, which some experts argue may wipe out a decade of progress in global poverty reduction. This has critical implications for population health and gender equality outcomes.
High-income countries such as the United States also have room to improve the gender-responsivity of their social protection initiatives, defined as “the set of policies and programs aimed at preventing or protecting all people against poverty, vulnerability and social exclusion throughout their lifecycle, with a particular emphasis towards vulnerable groups.”(2)
In the United States, the pandemic has exposed many gaps in our social safety nets. Prior to the pandemic, the U.S. already spent less on social protection (excluding health) compared to other rich countries. For example, the U.S. spends approximately 2% of GDP on social protection for people of working age, compared to Belgium, Finland, Denmark, Spain and Sweden, which spend approximately 6-7% of GDP.
The U.S. is the only OECD [Organization for Economic Co-operation and Development] country that does not have a national paid maternity leave policy.(3)
Developing a cohesive, paid, national policy would increase gender-responsiveness of the U.S.’s social protection system. In terms of unemployment benefits in the U.S., those not eligible include domestic or part-time workers; independent contractors, freelance workers and gig workers; a high proportion of long-term unemployed who have exhausted their benefit entitlements; and some part-time workers.
Women are disproportionately in lower-wage, part-time and service-related jobs and therefore may be at increased risk of job loss and reduced income as compared to men during closures related to social distancing. The CARES Act, passed in response to the COVID-19 induced economic crisis, expands unemployment to some of these categories. This is a step in the right direction, but more permanent expansions to unemployment for these categories of workers could also increase the gender-responsiveness of social protection in the U.S.
In the brief, we also talk about how women shoulder a disproportionate share of the unpaid care burden, including domestic chores and caring for children, the sick, and the elderly. In the face of COVID-19, most parents are having to juggle full-time childcare with work and other activities. However, in normal times, parents in the U.S. lack affordable childcare, which often exacerbates gender inequalities in terms of decisions around labor force participation and, subsequently, income and economic security. In the face of COVID-19, the fact that a high proportion of healthcare workers are female in many settings has led some governments to implement gender-responsive components such as vouchers for free childcare for healthcare workers in their social protection responses.
In the U.S., political choices and public perceptions of who is deserving of support and who is not, as well as our American ideas of the need to “pull yourself up by your bootstraps,” have led to a limited and inadequate social safety net, where programs require many administrative burdens and conditions to qualify and maintain eligibility. It is possible that the widespread reach of the economic pain brought by the economic downturn, in combination with other related challenges such as maintaining continuous health care coverage in the face of job loss, will increase the public’s appetite for expanding social safety net programs.
Improving gender equity in the U.S. social protection system should include measures that increase access to continuous health insurance coverage, affordable childcare, quality schools for all children, paid parental leave, expansion of eligibility criteria for unemployment benefits, and more.
(1) Palermo worked with UNICEF colleagues examining child marriage as a consequence of the pandemic-related economic downturn and how one social protection program potentially reduced child marriage. Read initial findings from the study.
(2) Definition developed by SPIAC-B, the Social Protection Interagency Committee–Board. SPIAC-B is an inter-agency coordination mechanism composed of representatives of international organizations and bilateral institutions to enhance global coordination and advocacy on social protection issues and to coordinate international cooperation in country demand-driven actions.
(3) Under the Family and Medical Leave Act of 1993, maternity leave is unpaid as a general rule; however, subject to certain conditions, accrued paid leave (such as vacation leave, personal leave, medical or sick leave, or paid medical leave) may be used to cover some or all of the leave to which a woman is entitled under the Act. A cash benefit may be provided at the state level.