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Lessons in Care – learning from women on the frontlines of pandemic response

By guest contributor Julia Smith

At last month’s UN High Level Meeting on Pandemic Preparedness, Marie-Claire Wangari from Women in Global Health noted, “Women have put their lives on the line to save us during the pandemic. We will not ask them now to return to gender inequality and business as usual.”

During 2020 and 2021, while conducting research for the Gender and COVID-19 Project, I had the privilege of speaking with nearly 200 women on the frontlines of the pandemic in Canada, including nurses, doctors, custodial staff, family caregivers and teachers. Interviewees described a lack of care for those in frontline, feminized professions, which were occurring in a high-income country with a well-established public health system, and few excuses for such neglect – particularly as the federal government defined its response as feminist and gender-based.

Women’s voices

Those health workers whose work was not considered essential often couldn’t access basic necessities required to keep themselves and those they cared for safe. For example, despite presiding over 25% of births in British Columbia, Canada, midwives were not considered essential by the government. This meant they did not have access to the same financial aid, government supply chains or supportive services other health workers received.  One midwife shared,

“We have no PPE. We’re actually begging our clients to supply us. We have no quarantine pay, no hazard pay. We are really struggling here. And we really want to keep offering our care because we’re keeping healthy people out of the hospital.”

Even those who did enjoy essential status spoke of the disconnect between public displays of hero-worship and lack of basic necessities to do their jobs.  A nurse working in a COVID-19 ward expressed frustration:

“We’re healthcare heroes, but no. We’re not actually treated as heroes by our actual employer. Like not like you want to be treated like a hero. If like you’re expected to work on your break and all these other things that we’re expected to do – we don’t even have access to coffee and tea, or a fridge.”

Women reported that their experiences were shaped by their multiple and overlapping social positions related to race, ethnicity, ability, age, income, and other factors. For immigrants and single parents, multiple burdens were often impossible to reconcile with paid care work, particularly considering the risk of infection frontline work entailed. A newcomer, early childhood educator reported that she gave up her job because,

“I was scared I was going to get sick from the air because at that time like they say it’s very powerful, it’s going to kill you and I was afraid.  . . . Because my fear is that like if I get sick, who is going to look after my son, because I don’t have no one. I don’t have family or relatives and – of course, if I’m sick, not one of my neighbours is going to look after my son because they don’t want to get sick either, they are single moms too.”

Because this mother quit, as opposed to being laid off, she did not qualify for the income support offered to those who lost work due to the pandemic, and so faced significant financial hardship.

The most disheartening experiences reported by the women I interviewed were about the mental health toll of frontline work. Those working in long term care, where over 43% percent of COVID related deaths in Canada occurred, spoke of overwhelming grief:

“We were losing residents that you become very close with. Even though I’m a housecleaner. We were really hit hard. You become part of their family. Even when they do pass – before COVID-19 hit you were going to these residents’ funerals. Because you’re part of them. And they say you’re not supposed to be part of them, you’ve got to separate. How can you? You work day in and day out with these people . . . I hold a very, very big spot in my heart for all of them.”

Many noted that the mental health services  were inadequate. Those with low incomes and precarious employment couldn’t afford counselling, and/or didn’t have access to technology or private spaces to engaged in virtual counselling. Some women couldn’t find services in their preferred language. Those caring for others at home simply didn’t have the time. Respondents expressed frustration that mental healthcare was positioned as a personal, as opposed to employer or collective, responsibility. One nurse vented,

“People need to stop telling me to do self-care and take care of myself because I don’t have the frigging time to take care of myself and taking a bath is not going to cure the pandemic.”  

The way forward

Despite such hardship, the women I spoke with were powerful and resourceful. Nurses convinced management to provide additional PPE for their colleagues who were pregnant and had vulnerable dependents, midwives successfully advocated to be able to continue to provide homebirths, women physicians created support groups, and early childhood educators fought to be recognized as essential. 

They also provided suggestions, some of which are fundamental necessities; for example, ensuring childcare corresponds to healthcare workers’ work schedules.  Others require more complex changes, such as shifting away from top down emergency management to leadership based on consultations.  The fact that these recommendations come from a high-income country with at least some formal commitments to gender equality, indicate that even in a best-case scenario, women were put on the frontline without adequate support and so paid with their own time, energy, finances and wellbeing.

These lessons can be applied on a global scale: Pandemic response that empowers, instead of exploits, women healthcare workers, requires more than just increased financing and feminist declarations (though these are key first steps) – it requires systems level change that acknowledges and seeks to mitigate the legacies of patriarchal systems of oppression. If global health leaders are going to address gender inequality in the health and care workforce (as is alluded to in the Political Declaration of UNGA High-level Meeting on Pandemic Prevention, Preparedness and Response), they need to include both specific actions and goals, and  real commit to moving away from ‘business as usual’.  

Julia Smith is an Assistant Professor in the Faculty of Health Sciences, at Simon Fraser University in Canada, and Health and Social Inequities Theme Lead at the Pacific Institute on Pathogens, Pandemics and Society. Her book, Conscripted to Care: Women on the frontlines of the COVID-19 Response was published by McGill-Queens University Press in 2023. During 2020-22, she co-led the Gender and COVID-19 Project, and continues to serve on the steering committee for the Gender and Public Health Emergencies Working Group. Julia’s research centres around the social, political and commercial determinants of health, often applying an intersectional feminist and critical political economy lens to better understand the intersections between policy fields and how they structure health inequities.

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

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