Survey: Women, adolescents face loss of health services, jobs, information and technology during COVID-19

The experiences of over 30,000 people, mainly women and young people, were solicited in 43 Asian, African, Latin American and Caribbean countries through surveys, interviews, webinars and social media:

• Half of young people (544/1,088) surveyed in Latin America and the Caribbean feared technology problems during home schooling would affect future prospects
• A phone-based survey in Bihar (India) showed that 91% (1,042/1,150) of respondents said that COVID-19 and lockdown had an adverse impact on their income. 
• 60% (765/1,275) of pregnant women and new mothers in five Kenyan counties (Bungoma, Kiambu, Makueni, Murang’a and Nairobi) reported that COVID-19 had impacted their decision to seek care, either in terms of the location or frequency of care-seeking.  

Poor mental health, disruptions to education, loss of income and violence, are some of the worrying consequences of COVID-19, according to women and young people. The experiences of over 30,000 people, mainly women and young people, were documented in 2020 by organizations in Sub-Saharan Africa, Latin America and South Asia. They found that women and young people are carrying a heavy burden during the pandemic, exacerbating existing forms of bias and discrimination.

Leading civil society groups, including Amref Health Africa; the Centre for Catalyzing Change (C3); the Graça Machel Trust; International Planned Parenthood Federation Western Hemisphere Region (IPPFWHR); and Profamilia (Colombia) used surveys, interviews, social media and webinars to gain insights into the experiences of women and young people in India, and countries in sub-Saharan Africa, Latin America and the Caribbean. This information was used to inform their respective programme responses to COVID-19.

The partners came together with the PMNCH, the world’s largest alliance for the health and well-being of women, children and adolescents, in an online project entitled Finding Hope: Lived experiences of women, children and adolescents, in their own words.

“For C3, it was important to be part of this project,” said Aparajita Gogoi from the Centre for Catalyzing Change. “We believe that it is imperative that we un-package the complex implications of COVID-19 on women and girls. We need to listen to these narratives and help amplify the lived realities, so that when we strategize to re-build, we put women and girls in the center.”

Key findings

Finding Hope shows that across different contexts and regions, the reported experiences of women and adolescents are strikingly similar. Stress and anxiety are rooted in disruptions to daily activities, education and work, as well as restrictions on mobility and social interaction.

Concerns include:

• impact on mental health and wellbeing due to disruption of life
• limits on access to formal and informal education
• food insecurity
• loss of livelihoods
• lack of access to health information and services
• limitations to sexual and reproductive health and rights
• increased violence; and
• lack of safety and reduced agency
  

Finding Hope also highlights different strategies and approaches being implemented in different countries to address the significant challenges facing women and young people.

Across the world, COVID-19 hit first and hardest among the poorest, most vulnerable and marginalized communities in every survey region, revealing grave inequalities within societies and exacerbating existing challenges facing women and adolescents. This is especially true for those who live in rural and marginalized communities, or work in the informal sector.

Key findings on the impact of COVID-19

Finding Hope illustrates the heavy burden women and young people have carried during this crisis, with many common concerns echoed across different countries in different regions, from Africa to Asia to Latin America and the Caribbean. This suggests experiences of stress and anxiety are rooted in disruptions to daily activities, education and work, restrictions to mobility during lockdowns, and the need for physical distancing. Concerns raised by women and teens included:

• Impact on mental health due to disruption of normal life: COVID-19 and the ensuing quarantine and physical distancing measures have had a range of psychological impacts on people’s well-being. For example, many women, especially those working in the informal sector (e.g., in India and South Africa), reported feeling increased stress, anxiety and tension due to loss of income. In an online survey in Colombia, 67% of young women aged 18-29 (597/886) reported being concerned about the risk of anxiety or depression since the beginning of the pandemic. “Not being able to work as I used to has stressed me out. It makes me sad. Confinement affects me too”, 28-year-old woman, Colombia.
  
• Disruption to formal and informal education:  In a survey of youth networks in the Latin America and Caribbean region conducted by International Planned Parenthood Federation’s regional body, 50% (544/1,088) of 10-29-year-olds reported they faced challenges in pursuing their studies due to limited access to technology, such as computers or the internet. They feared these disruptions could affect their plans for future education. “I can’t go to school at all and I feel my life is just on standstill. Nothing is moving. I may never finish high school: who knows”, 18-year-old woman, South Africa.
• Loss of livelihoods and food insecurity: In a survey of community members in Bihar India, over 91% (1,042/1,150) reported that COVID-19 and lockdown had adversely affected their income. Women and young people in nine states of India reported that many families were forced to reduce the quantity and variety of their food to cope with job losses, food shortages and decreased financial resources. In Colombia, an online survey of more than 1,287 young people aged 18-29 found that 23% of young women and almost 21% of young men had lost their jobs during the pandemic, according to community organization Profamilia.
• Limited access to health information and services: A review of program data from five counties in Kenya (Kiambu, Makueni, Muranga, Bungoma, Nairobi) revealed a reduction in service utilization by approximately 30%. Inadequate knowledge about, and awareness of, COVID-19 is an ongoing challenge. In Latin America and the Caribbean, only 33% (2,908/8,811) of young people aged between 13 and 29 years knew how the virus was transmitted. In India, for example, frontline workers reported that all immunization services were suspended in early April 2020, except for certain vaccinations for babies delivered in health facilities. “I am worried because I’m not sure if I will find the facility open or if I will find nurses during delivery”, pregnant woman Bungoma county, Kenya.
• Violence: Extensive evidence has emerged about the rise of domestic violence during the pandemic; a UNFPA analysis from April 2020 estimated that a six-month lockdown could result in an additional 31 million cases of gender-based violence. Women and girls surveyed in nine states of India reported increased verbal, physical and sexual abuse in general during the pandemic, punctuated by even higher spikes when liquor shops re-opened. “When shops selling alcohol were closed, why did the government re-open them? Because when they sit jobless… they get drunk and create ruckus. It has a lot of effects”, adolescent girl, India.

Commenting on the findings, Marta Royo, Executive Director of Profamilia, said: “This work showed that, in different contexts and regions, the experiences of adolescent girls and young women during the pandemic are similar. To address them, governments, civil society, humanitarian organizations, NGOs and community-based organisations must consider in their response and recovery plans addressing gender inequality and the safety of women and adolescent girls, including child health, maternal and sexual and reproductive health services among essential services, and strengthening and reducing gaps in access to the internet and information technologies.”

Mitigating the impact of COVID-19

Collaborating organizations also identified a range of strategies and approaches being implemented in different countries to address the significant challenges facing women and young people. Some of the common strategies included:

• Government-led economic measures to stabilize household income, despite widespread loss of livelihoods;
• Inclusion of sexual, reproductive, maternal, newborn, child and adolescent health and nutrition (SRMNCAH+N) services in government essential service lists;
• Using digital tools and traditional media to reach diverse population groups with health messages and psychological support;
• Collective planning and implementation by civil society, humanitarian and non-governmental organizations, as well as self-help groups, frontline and community workers, to ensure the sustained provision of essential services to affected families and marginalized groups during lockdown.

Quotes from collaborating partners

“This study is proof of what we have consistently been saying: Women and children continue to bear the biggest brunt of the pandemic on all fronts, whether it’s their economic or social well-being. Women are overrepresented in many of the industries hardest hit by COVID-19, such as agriculture, food service, retail and entertainment, including representing over 70% of the health workforce, which is at high risk in the pandemic. Women, children, and the youth continue to be prioritized in our various programs across Africa to ensure that COVID-19 recovery efforts reach these critical demographics,” says Dr. Githinji Gitahi, Global CEO,  Amref Health Africa.

“Responding to the needs of adolescents, young people and women, from an intersectional feminist approach, requires meaningfully engaging with them in every action we take and decision we make,” said Jovana Rios Cisnero, Chair of the Board of IPPFWHR.  “This means doing nothing about them, without them. We are proud of being an ally promoting sexual and reproductive health rights and justice for all, especially women, girls and gender diverse people.”

“Women and women’s organizations should be at the heart of the COVID-19 response decision making and designing health and socio-economic policies and plans. An intentional focus on the lives and futures of women and girls is an essential part of breaking structural practices which have been marginalizing them. A system for collecting and disaggregating data needs to be put in place to ensure that the impact of the crisis on women is informing the redesign of fragile and inequitable socio-economic and health systems into fully inclusive, equitable ones,” noted Graça Machel, Board Chair of the Graça Machel Trust.

“Too often, policy decisions are taken in the absence of hearing directly from community members about what they need and want. The experiences and voices in the “Finding Hope” project shine a light on what really matters to women and young people. This information is vital not only for steering COVID-19 policy and programming now, but also for encouraging greater investments in community-based accountability systems to support post-pandemic recovery and resilience,” said Helga Fogstad, Executive Director of PMNCH, the world’s largest alliance on women’s, children’s and adolescents’ health issues, with more than 1,000 member-organizations.  “The work of partner organizations, synthesized in Finding Hope, give women and young people the opportunity to share their experiences. This is important not only in itself, but also to inform advocacy efforts for effective policy and programme measures with a view to address the immediate and long-term impacts of the crisis on women and young people,” said Ms Fogstad, noting that PMNCH organized a recent two-day global e-Summit on the need for greater equity in response and recovery measures for women, children and adolescents. Lives in the Balance, held on 17-18 May, invited global partners to share stories on inequity. These stories lend evidence of need in relation to the  PMNCH COVID-19 Call to Action, a seven-point agenda to improve financing, policy and service delivery for women, children and adolescents.

These seven asks are:  

1. Sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) services, supplies, and information and demand generation including for contraception, safe abortion, immunization, safe delivery, stillbirth prevention, and mental health;
2. Advancing sexual and reproductive rights and gender equality;
3. Quality care, including respectful and dignified care, and effective community engagement and redress mechanisms;
4. Recruitment, training, equal and fair pay, and safe working conditions, including protective personal equipment, for frontline health workers, notably midwives and nurses;
5. Social protections, including food and nutrition security, for marginalized and vulnerable groups and enhanced data to better understand and address disparities experienced by adolescents, refugees, the internally displaced, migrants, indigenous communities, persons living with disabilities, among others;
6. Functional, safe, and clean toilet and hand washing facilities and quality potable drinking water, with a particular focus on healthcare centers, schools, and centers for refugees and internally displaced persons; and
7. Prevention of violence against women, children and adolescents through education and protection programs.