Driving gender-transformative policy change to improve women’s health equity in urban informal settlements

In 2019, the International Labour Organization estimated that 92% of female workers in developing countries work in the informal sector. The COVID-19 pandemic may have caused this number to rise to above 95%. Street vendors, domestic workers and factory workers make up the informal economy. Due to the absence of social benefits like insurance plans, pensions and paid leave, workers in this gray economy are subjected to subpar living and working conditions. Subsequently, most of these workers end up impoverished, with women being disproportionately affected.  

Women living in makeshift housing remain vulnerable to various forms of assault, disease-carrying pests and insects, water-borne illnesses, malnutrition, overcrowding in homes and neighbourhoods, structurally unsound homes and inaccessible healthcare services. The COVID-19 pandemic heightened these vulnerabilities, increasing women’s risk of COVID-19 infection.  Additionally, COVID-19 containment and treatment were highly challenging for residents of these settlements due to diminished access to healthcare services, inability to adhere to isolation and containment measures, and the lack of adherence to COVID-19 policies by many factories. 

In Uganda and Bangladesh, researchers supported by the Women RISE initiative are examining the strategies employed by women to cope with COVID-19-related work and health stresses that expose them to the aforementioned vulnerabilities, including HIV-AIDS. The evidence generated will support the development of co-designed interventions that are inclusive, sustainable and equitable gender-transformative solutions for recovery from COVID-19 and future health emergencies. 

Addressing the gendered impacts of COVID-19 is the focus of the Women RISE initiative, supported by IDRC, the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council. This initiative supports action-oriented, gender-transformative research on how women’s health and their work (paid or unpaid) intersect and interact in the context of preparing for, responding to and recovering from COVID-19. 

Reinforcing preparedness for infectious disease outbreaks in Bangladesh 

Researchers from the International Centre for Diarrhoeal Disease Research Bangladesh and the Hospital for Sick Children in Toronto, Canada are exploring the intersections between the work environment and lived experiences of working women. Their aim is to identify evidence-based interventions to manage and prevent infectious diseases. 

People, including factory workers, who live in urban and peri-urban informal settlements are significantly at risk of infectious diseases due to their working and living conditions. The existing scarcity of primary healthcare services increases the vulnerability of these population groups across gender, age and socio-economic strata. 

In Dhaka and Gazipur, insights from in-depth interviews, PhotoVoice exercises with working women and factory workers living in urban informal settlements, and focus group discussions with community health workers (CHWs) revealed that women in unstable employment needed to continue to work outside their homes during the pandemic due to a lack of social safety nets. They also had to grapple with increased exposure to COVID-19 due to lack of safety measures at their workplaces and homes. Since many working women live in shared accommodations in the slums, generally in a single room for the entire family, it was hard for them to isolate if they or someone was infected with COVID-19. 

In addition, the community had limited knowledge of COVID-19 as well as protective and hygienic measures, primarily attributed to a lack of education about infectious disease transmission and prevention. This knowledge gap and limited access to preventative resources left them more susceptible to infections. An inherent lack of trust in the healthcare system and the CHWs further hindered the early detection and treatment efforts, facilitating the spread of infections within the community. 

Researchers reviewed existing policies aimed at preparedness and response to COVID-19 which revealed certain gaps in addressing the challenges faced by urban slum dwellers. Government stimulus packages did not trickle down to grassroots workers who lost their jobs due to the pandemic. In the instances where policies were implemented, their implementation was inconsistent and provided limited social protection for all vulnerable populations. 

This Women RISE project is deliberately seeking the voice of these women. The methodology ensures the active involvement of urban poor working women and factory workers in identifying the challenges they faced during and after the COVID-19 pandemic and in co-creating solutions for health, gender equity and decent working conditions. 

Findings from this research will address structural and political gender inequalities that impact women's work and health, generating policy-relevant information and experience that can be beneficial to the regulation of working conditions and the private sector, formulate policies and strategies to prevent and manage future infectious disease outbreaks and pandemics, as well as alleviate economic shocks in Bangladesh and similar settings. 

Efforts to prevent HIV in women living in urban informal communities in Uganda 

Researchers from the University of Makerere, Afrislum Organization, the Uganda Aids Commission and the University of Waterloo in Canada are working to assess how changes in employment and economic status influenced risk and vulnerability to HIV among women living in urban informal settlements during and after the COVID-19 pandemic. The project examines the strategies employed by women in Kampala and Mbale to cope with COVID-19-related work stresses that expose them to HIV risk and vulnerability.  

The pandemic escalated pre-existing risk factors for these women, increasing their likelihood of contracting diseases, including HIV. The safety nets that would ordinarily protect women from entering into risky situations were reduced due to the lack of access to sexually transmitted infection and HIV prevention and treatments during the peak of the COVID-19 pandemic.  

In Uganda, some women from vulnerable groups who could no longer depend on their daily earnings from casual employment and, due to COVID-19 restrictions, resorted to engaging in risky behaviours to meet their basic needs (i.e., multiple sexual partners, getting married to supplement their well-being, etc.). In addition, access to healthcare became a challenge due to their own assumptions about who is entitled to receive such care and a lack of money to pay for healthcare services. 

Preliminary findings from this project’s research show a direct correlation between COVID -19, decreased income and increased unprotected sexual activity. Nearly 80% of the surveyed demographic did not have access to HIV services during the pandemic.  

“COVID-19 affected me so much especially when my man [spouse] ran away due to home demands. I got another man though I don’t know whether this man had HIV or not, but he would give me UGX 5000 [USD 1.50] or less and that is how I survive,” said a 31-year-old-female resident of Kagugube slum in Kampala, Uganda. 

Recovery interventions are necessary to support communities and vulnerable groups to recover from COVID-19 shocks. This Women RISE project aims to use its research findings to support policy changes to close pre-existing gaps in existing COVID-19 recovery interventions in Uganda as well as the current socio-economic and health needs of women living in urban informal settlements to safeguard them from HIV risk and vulnerability to future pandemics. 

Considering gender dimensions in preparing for future pandemics 

There is an urgent need to increase attention to gender dimensions in preparedness for future pandemics, especially in vulnerable communities where women are largely affected. Initiatives like Women RISE that support action-oriented, gender-transformative research on how women’s health and their work intersect and interact in the context of preparing for, responding to and recovering from pandemics will be crucial for improving the health and well-being of women. This research will also strengthen capacity for an equitable recovery and contribute to gender-transformative policies and interventions that advance preparedness for future health emergencies.  

Governments, working with communities and research partners, can support the provision of necessary infrastructure that provides access to clean water, sanitation and health facilities for makeshift dwellers in both rural and urban areas. Emergency risk governance should also be prioritized as it affects a community’s resource vulnerability and pandemic-time adaptation processes. 

Learn more about Women RISE at the 2023 CCGH  

More insights and lessons on these projects will be shared at the 2023 Canadian Conference on Global Health to be held in person and virtually from October 16 to 18, 2023 at the Westin Ottawa, in Ottawa, Canada.  

This annual conference brings together researchers, practitioners, policymakers and students from various disciplines and sectors to discuss pressing global health issues. It provides a platform for sharing knowledge, best practices and innovations in global health research, policy and practice.