Supporting women’s recovery from the impact of the COVID-19 pandemic on their lives, livelihoods and health
Women’s livelihoods were disproportionately affected during the height of the COVID-19 pandemic. They experienced heightened insecurity due to loss of income and an intensified risk of gender-based violence. They also grappled with the burden of increased unpaid care responsibilities for their families due to COVID-19-imposed lockdowns on schools, closing of non-essential workplaces and caring for sick family members.
In rural South Africa, the aftermath of COVID-19 left the women of Kwelerha, a small town, struggling with depleted incomes and the rising costs of goods to sustain their trade and informal sector businesses. To support their families, these women, especially those that did not have access to government assistance, took up alternative income sources like home gardening, selling cooked food, livestock farming and running spaza shops (informal convenience shop businesses usually run from home).
The pandemic also widened the gap in access to routine healthcare services for women in rural South Africa, making already difficult situations entirely unsurmountable during COVID-19. Mandy,* a 60-year-old woman living in a rural area of the Eastern Cape, had her leg amputated in 2021 following a diagnosis of unstable diabetes. This left her unable to work and solely reliant on a disability grant from the government to survive. She is faced with multiple challenges from high transportation fees to get to the nearest medical facility 40 km from her home for her check-ups, medication and physiotherapy sessions, to gaining approval for a prosthetic leg to enable her to move around without assistance or a wheelchair.
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.
Enabling women’s empowerment and ability to build back better in rural South Africa
In South Africa, the Ukuvula Isango project, implemented by the Human Sciences Research Council, South Africa and McGill University, Canada, focuses on the pre-, during and post-pandemic impact of COVID-19 on the livelihoods and health statuses of rural women and their communities, like Mandy and the women of Kwelerha mentioned above.
Social distancing restrictions and reduced income due to COVID-19 induced job loss and restricted women’s ability to access healthcare services. In some communities, services from mobile clinics either completely stopped or drastically reduced to the point where community health demands could not be met. This lack of access to routine health services, like contraception, antiretrovirals (ARVs) and blood pressure medication, increased women’s susceptibility to infections, unplanned pregnancies and worsening health conditions.
However, the pandemic saw many rural women in the Eastern Cape finding ways to adapt to their current realities and improve their well-being and livelihoods. In many cases, women took up subsistence farming for household consumption and to deal with rising food insecurity in their communities.
“I started livestock farming. I have pigs and chickens, but having chickens is risky in this community because people steal them. The crime in this community is discouraging because you only grow your livestock for other people, pigs are not really at risk of being stolen because pigs make a lot of noise, and it is easy to identify a pig other than a chicken. I also plan to start a garden so that I can harvest vegetables from the garden and save money from buying vegetables every month,” said Vuyiswa, a 71-year-old woman from Tuba village, Eastern Cape.
In addition to the direct effects on livelihoods and access to health services, the pandemic also had cascading effects on rural women as a result of reverse migration (urban to rural areas), drug use, rising rural crime, gender-based violence and decreasing service delivery.
This project aims to support the identification and generation of solutions and actions by local women and other stakeholders and partners to “rebuild better,” especially in the field of public health and livelihood spheres.
Building resilience to health emergencies in Kenya through empowering women
In Kenya, the Chamas for Change (Chamas) project, led by Moi University and the University of British Columbia, is studying the impact of Chamas, a community health volunteer-led program that engages women in pregnancy and the first 1,000 days of their children’s lives, to determine whether participation in its programs mitigates the effects of the COVID-19 pandemic on women’s and children’s health and economic well-being.
Changing gender relations starts at the individual and community level. With the aim of institutionalizing inclusive approaches in COVID-19 responses, this project’s methodology was designed with support from a Community Advisory Board (CAB) to ensure the inclusion of the community’s voices and perspectives over the lifetime of the project.
The CAB comprises representatives from relevant community groups including community health promoters (volunteers), adult and adolescent women who participated in Chamas, father groups, department of education, department of health and other relevant community groups. The CAB ensures the inclusion of diverse perspectives in project implementation and provides insights into approaches that will be most effective in engaging with the community at a larger level. The CAB supports the development of tools, advises on the best approach to disseminate information, which languages and colloquial terminologies should be used, and the mediums through which the community should be engaged, using an equity-centred approach.
This approach also empowers members of the CAB who have demonstrated increased confidence in their roles as change agents in their communities and elevated their understanding about how and why gender dimensions are key to design of effective, inclusive pandemic responses.
“As the chair of the Community Advisory Board [CAB], I have witnessed the growth and transformation of the CAB since it was set up in December 2022 to be the voice of the community, to ensure the study meets the communities’ needs, to provide recommendations on study implementation and dissemination of study findings,” says Dr. Mbithi, Trans Nzoia county. “The CAB has also provided an opportunity for key stakeholders in the education sector and Chamber of Commerce to better understand our health interventions and the roles they can play. For instance, we are collaborating with the education sector to re-enroll teenage mothers back to school for those who are willing and to Technical and Vocational Education Training Institutions (TVETs) for those who choose to gain skills.”
Chamas seeks to address the inequities that drive maternal and infant mortality in Kenya by scaling the Chamas program across four counties in Western Kenya. This solution combines best practices from women’s health and microfinance programs to create an integrated service delivery platform that is low-cost, community-run, independently sustainable and culturally acceptable. This intervention builds community empowerment and facilitates processes of accountability using community health volunteer-led women’s Chamas during pregnancy and early childhood. Central to this approach is the holistic integration of health, social and financial literacy to improve health outcomes in a three-year mentored program.
The project will collect quantitative and qualitative descriptions of the effects of the pandemic on social and gender equity as well as key health, psychosocial and financial outcomes. With the project’s inclusive methodology and early-on engagement with decision-makers, its findings will guide the scale-up of the Chamas program to improve the health and well-being of women and strengthen equitable recovery, gender-transformative policies and preparedness for future health emergencies.
Watch a video [in English only], prepared by Chamas for Change, showing how the project helped a pregnant adolescent.
Developing evidence-informed policy for women and seniors’ health and well-being in Kenya and Uganda
In Kenya and Uganda, the Write-Life project, led by the Community Health Support program (COHESU) and the University of Waterloo, is studying women’s perceptions of their empowerment between work (both paid and unpaid) and their health throughout the COVID-19 pandemic and across their life course.
The project identifies how the pandemic affected women across different age groups in different ways. Where young women and girls were faced with issues like teenage pregnancy due to interrupted education, older women dealt with the increased burden of reverse migration, where family members dealing with job loss moved back to their rural homes and became dependent on the care of their matriarchs.
“We’ve found that the impact of COVID-19 is one that will take generations to undo. School is a safe haven for girls, and the pandemic increased the number of out-of-school girls in Uganda, resulting in an increased incidence of teenage pregnancies. This, coupled with the lack of free basic education in Uganda means an increased burden of care on matriarchs in rural Uganda,” says Dr. Susan Elliot, professor and co-principal investigator. “Government interventions need to go beyond response and focus on helping vulnerable populations to properly recover from COVID-19 shocks. We will engage policymakers in deliberative dialogues to co-produce interventions that are locally, culturally and geographically appropriate to the context.”
These projects in South Africa, Kenya and Uganda demonstrate Women RISE’s commitment to supporting evidence-based, gender-transformative policy change to ensure women can adapt and thrive following COVID-19 and during future pandemics.
The evidence generated will support the development of a co-designed, locally relevant intervention package that encompasses inclusive, sustainable and equitable gender-transformative solutions for COVID-19 recovery and future health emergencies.
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.
*Mandy is not the real name of the participant.