Virus in an Unequal Society

Context: Recent data on gender differentials in COVID-19 Case Fatality Rates (CFR) in India highlight deviation from global trends, where women are more vulnerable to COVID-related co-morbidities

Reasons for higher COVID-related co-morbidities in men (around the world)

• Higher physical mobility and lifestyle choices.
• Men have low natural biological survival compared to men.

Reasons for higher CFR for women in India:

• Centuries of discriminatory socio-cultural practices.
• Low access to food and nutrition: National Family Health Survey (NFHS) 2015-2016 data indicate that as many as 23 % of Indian women have a lower than normal Body Mass Index (BMI).
• Low decision making power: According to NFHS 2015-2016 data, only 63 % have some say in decisions regarding their healthcare.
• Female infants face a triple burden of undernutrition: Carryover effects of maternal undernutrition, the bias in breastfeeding, and disadvantage in accessing nutrition.
• Less access to facility-based healthcare: less likely to travel long distances for healthcare; Treatment is availed very late: After symptoms are severe, potentially increasing their mortality risk.
• Gender differential in average health care expenditure (HCE).
• Unequal burden of unpaid care responsibilities: Woman patient does not have the option of recuperating adequately due to household work.
  • As per the Organisation for Economic Co-operation and Development (OECD), women in India, on average, spend five hours more than men on unpaid work.

Conclusion: The CFR differential is likely to be higher than revealed by studies as there is gender differential in India’s vital registration systems. E.g. Women death and causes are less likely to be reported comparing to men.