Caregiving: A Perpetual Gender Inequity Issue Uncontested

Portrait of Kasomo Kavira, caregiver at the Ebola Treatment Centre, North Kivu Region, Democratic Republic of Congo. Photo by Vincent Tremeau / World Bank
By: Olivier Mbarushimana Nshuti, MBBS/MGHD Class of 2025
This essay was awarded third place in UGHE’s student essay writing competition on “Gender Equity Issues during Pandemics”

Throughout decades, the world has been driven by cultural perceptions and understandings that allusively prioritized people’s gender, race, or ethnicity over their shared humanity. Though the world has embraced great advances in terms of understanding, few beliefs and traditions lacking evidence-based proof continued to prevail. In some of the present-day activities and threats like global pandemics, specific roles are still expected from either a certain gender or race. Focussing on gender, one of the ways these forms of inequity and role-assigning manifest in health care is through caregiving. Other than parental caregiving to children, caregiving entails helping older, sick, or disabled family members and friends (Family Caregiver Alliance, 2009). A caregiver can be paid personnel, especially a nurse, or an unpaid friend, relative, or any other person who does the caring. Over 70% of global caregiving hours are provided by women and girls (World Economic Forum, 2020). This percentage expectedly rises during pandemics where there is an increased need for caregivers due to rising numbers of those infected by the virus, or suffering its ramifications. During pandemics, caregiving is more than gendered; it is a form of overlooked inequity that perpetually puts millions of women’s lives under continuous threat of health, social, and economic disadvantage. 

Gendered caregiving should be contested further if we are to halt its associated repercussions, including health impairments, financial crises, and death. It should be the responsibility of health organizations to advocate for and devise powerful policies that will instill in people the idea of gender equity, which, in turn, can serve to put an end to social injustice and offer a greater opportunity for the global well-being of all. Considering millions of women who lose jobs, fall victim to mental illnesses, acquire infections, or die compared to men during pandemics, it would be no mistake to argue the presence of gender inequity in caregiving. 

Having dramatically high case frequencies and fatality rates of women during pandemics in which sex is not a risk factor, appears alarming by itself. Considering the Ebola outbreak, in Nigeria, women made up 55% of Ebola cases, and 56.6% of contacts traced (Fawole et al., 2016). In the Congo Ebola outbreak, out of 3,049 confirmed and probable cases, 70% of cases were children under 18 and women (Elliott, 2019). According to data from the World Health Organization (WHO), women and girls aged 11 and older have contracted Ebola at a higher rate than men and boys in the same age range (Elliott, 2019). Astonishingly, WHO mentioned that there was no biological sex difference regarding vulnerability to the Ebola virus disease (Menéndez et al., 2015).Leaders and policymakers around the world need to ask themselves why would women be more susceptible than men to Ebola if there is no biological risk factor associated with being either gender.

The WHO publication mentioned that in most societies women are more likely than men to be caregivers for the sick in both health-care settings and at home (WHO, 2007, p. 9). In this capacity, women are more exposed than men to infectious agents, often those transmitted through contacts like Ebola and severe acute respiratory syndromes (SARS) like coronavirus disease (WHO, 2007). This discrepancy is valid according to various research,  but questionable. Which research designated that caregivers, including formal paid caregivers like nurses, and informal caregivers namely family members, relatives, or friends, should be women? 

Worldwide, women represent around 70% of the health workforce, the majority being nurses, but earn on average 28% less than men (Boniol et al., 2019). As of April 2017, according to the Kaiser Family Foundation, there are 333,350 male nurses in the USA, equating roughly 9% of the cumulative nursing workforce. According to the U.S. Census Bureau, despite being the minority, male nurses earn more than their female counterparts on average (Statistic Stats, 2019)

Health workers set up COVID-19 tests at Charlotte Maxeke Hospital in Johannesburg, South Africa. Photo by Michele Spatari/AFP via Getty Images

These statistics are not coincidental, they are a sign of cultural one-sided and gendered paid caregiving. The observed predominance of female nurses is not due to any natural suitability, but rather the fact that western culture essentially excluded women from most important professions seen as masculine (Best Colleges, 2017). In addition, the gender salary gap for nurses in the same profession proves the presence of inequity in caregiving. Since most hospital-based caregivers are women nurses, women are the most exposed to infections during pandemics especially when no treatment or vaccine is available. Being paid less compared to their male colleagues regardless of their majority exposes women to a worse financial disadvantage. As a result, they are unable to cater sufficiently to the needs of their families including food, especially during interventions like social isolation especially within pandemics-  where they mostly rely on savings for living. Though paid caregivers are disadvantaged, informal caregivers who according to the World Economic Forum (2020) constitute half of the unpaid workforce in health care, suffer the most from caregiving-associated repercussions in terms of health, social, and economic status. 

Consistently to past studies, contemporary research highlights the domination of women in unpaid caregiving. The US and Europe have 65 and 100 million unpaid family caregivers respectively (World Economic Forum, 2020). In the United States, 65% of unpaid family caregivers are estimated to be women (Gausman & Langer, 2020). While men also provide assistance, female caregivers tend to spend more time providing care than male caregivers (21.9 versus 17.4 hours per week). Furthermore, women are likely to assist with more difficult caregiving tasks, such as toileting and bathing, while men are more likely to assist with finances or arrange for other care (Family Caregiver Alliance, 2012).

Apparently from various researches, informal caregiving also appears gendered. Having women make up the majority of caregivers, explains their increased risk and vulnerability to some non-sex-based epidemics like Ebola. In contrast, for coronavirus disease of 2019 (COVID-19), The Conversation (2020) shows men being more vulnerable, not necessarily at risk, because of their adjustable lifestyles, while women, despite being more immune genetically compared to men, they still get highly infected as a result of caregiving responsibilities they cannot avoid.  Across the European Union, 80% of care is provided by informal carers, the majority being females (Eurocarers, 2017). This might explain why Nkangu et al., (2017) argued that the risk of transmission (during pandemics) is found to be higher for those caring for the sick at home. Lockdown is likely to increase this risk since more people gather in families than usual. During pandemics, home carers are mostly informal caregivers either because most families in developing countries cannot afford a paid caregiver, or because they cannot work due to lockdown. 

The most frightening challenge for informal caregiving is lack of training. Nkangu et al. (2017) argued that little attention is paid to informal caregivers when designing health programs within a specific context. Due to their poor protection skills, informal caregivers get more exposed to infections in various ways including needle injuries, contact, etc. Women caregivers also tend to have exacerbated physical ailments associated with caregiving such as chronic fatigue, sleeplessness, stomach problems, and weight change (Navaie-Waliser et al., 2002). During the lockdown, informal caregivers cannot rely on paid professionals in the home, school, or daycare, placing layers of additional stress that most often fall on women (World Economic Forum, 2020). This level of panic from caregiving was argued by Navaie-Waliser et al. (2002) to affect women’s mental health adversely than men. As a result, their social life is threatened, and takes a toll emotionally, especially when patients die within their care, and they can be subject to social comments and accusations.

Economically, informal caregivers are also disadvantaged. A Global Carer Survey found out that approximately 12% and 21% of unpaid caregivers had to give up their job and had their job negatively affected respectively, because of their caregiving role (Caregiver Action Network & Care Australia, 2017). Those statistics are from western countries; statistics from Africa remain rare. This means that a lot of other caregivers’ challenges are left untracked. Notedly, women are economically disadvantaged when compared to men. Data from Europe show that the vast majority of male carers also work full-time, whereas only half of women carers are able to work full-time largely because their caregiving hours are about double those of men (World Economic Forum, 2020)

Given this level of disadvantage, women suffer disproportionately, not because of responsibility, passion for caregiving, or free will, but rather due to a biased culture and the socially-determined implications of their gender. What if things were different and women’s rights were fully respected and not determined by culture? A recent study by McKinsey showed that enabling women to reach their “full potential” and play an identical role in labor markets to men, would mean an increase of as much as $28 trillion, or 26%, to global annual GDP by 2025 (World Economic Forum, 2020). These data are a witness for the burden and limits we are putting on development as we stick on culture and deny women to realize their potential. 

If we are to halt the perpetual health inequities like gendered caregiving, collaboration and paradigm shifts are needed. It is time that we devise policies that are devoid of biases and unfair cultural favors such as salary gaps, and neglect of informal caregivers, that become disadvantageous to women especially. 

From the past experience, as we manage incoming pandemics, thorough policies that will transform gendered caregiving into shared caregiving are needed to promote health equity. We should prioritize health equity because its presence will foster the development that the world has sought for decades, and more importantly protect the world from various threats against socio-economic welfare and overall well-being of humanity. 



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