The Parallel Pandemic: The Disproportionate Impact of the Mental Health Crisis on Women

This is part one of a two-part series on the global mental health crisis and potential solutions. Content Warning: This article includes a discussion of mental health issues.

Introduction

Mental health became a prominent topic of conversation at the 2021 Tokyo Olympics when Simone Biles, one of the most decorated gymnasts of all time with a combined total of 32 Olympic and World Championship medals, withdrew from the team event finals and the individual all-around competition citing mental health concerns. Likewise, just a few months ago, Naomi Osaka, a renowned tennis player, withdrew from the French Open citing depression and anxiety. While these Olympic athletes represent a particularly niche subgroup, their voices speak to broader, systemic issues around women and mental health. The timing of their statements highlights how the global mental health crisis is not only informed by identities such as gender and race but is also exacerbated by the COVID-19 pandemic.

From essential and frontline healthcare workers to sports legends, the COVID-19 pandemic is disproportionally affecting women’s mental health and widening the treatment gap. Structural inequalities have been exposed, shining light on how gender and health emergencies are deeply entangled. These effects are only intensified for those with intersectional, socio-economic pressures.

With a health care workforce that is predominantly female, the dominance of men in global health decision-making, and the general stigma around mental health, Sophie Harman et al. write in their article: “Gender can…determine who gets sick and how, and who makes decisions in a health emergency and who performs the front-line response, and who suffers the long-term consequences of an outbreak.” This blog post (1) examines how gendered labor dynamics exacerbated by the pandemic have harmed women’s mental health and (2) proposes potential solutions around service delivery to combat this crisis. In the next blog post of this series, the Health Finance Institute (HFI) explores mental health in the context of public-private partnerships.

Gendered Labor Dynamics

Public health responses to COVID-19 and government-issued policies such as lockdown orders have had far-reaching consequences on society, such as magnified mental health concerns, increases in domestic violence, and delays in treatment for various medical conditions. Many of these negative effects have been largely placed on women, who have experienced a substantial loss of income and, referencing the graphic below, reduced paid work hours during the first peak of the pandemic in the US. Relatedly, according to the Center for American Progress, mothers in the US must now consider leaving the labor force and reducing work hours to take on caretaking responsibilities, leading to an estimated $64.5 billion per year in “lost wages and economic activity.” Structured gender norms, paired with disruptions in childcare and schooling due to the pandemic, predispose women to absorb additional household labor that manifests in loss of paid employment and income. The graphic below illustrates how in the early months of the pandemic, mothers of dual-parent households working from home saw their household and childcare hours proliferated. This resulted in mothers, compared to fathers, having the scale back their working hours to meet these additional demands. Whereas, considering unpaid work before the COVID-19 pandemic, “women spent an average of 4.1 hours per day performing unpaid work, while men spent 1.7 hours — that means women did three times more unpaid care work than men, worldwide.”

The COVID-19 pandemic has hindered and even reversed women’s progress in the workforce. Although there has been greater gender parity in the workforce in recent years, we have not seen a change in basic worker protections within the gendered roles of the political economy. Elements such as insufficient childcare, inadequate paid leave, and the gender pay gap affect women’s long-term economic outcomes, and consequently the economic recovery. According to UN Women, 80% of domestic workers are women, and “a staggering 72 per cent of domestic workers have lost their jobs” due to the pandemic. Without both immediate and long-term action to childcare infrastructure, single mothers and dual-parent households alike cannot fully participate in the workforce. This hurts countries’ goals to achieve continued economic growth and to protect and advance gender equity.

Simultaneously, women represent 70% of the global health workforce, 90% when social workers are included and have taken on the additional responsibility of combating the pandemic as frontline workers. However, when far-reaching decisions around healthcare are made, women are left out of the conversation. In fact, women only represent 25% of senior decision-making roles, with women in LMICs holding less than 5% of senior positions.

Mental Health Effects

The gender dynamics that play into worrying about contracting COVID-19, job loss, childcare loss, and frontline work are some of the many ways that the pandemic may be influencing mental health. In the Asia-Pacific region, 66% of women saw their mental health directly impacted by COVID-19, compared to 58% of men. A study conducted by Kisley et al. found that the psychological distress experienced by health provides during an outbreak can take a lasting toll; up to three years after an outbreak. This begs the question: what service delivery strategies should be implemented to combat this evolving crisis?

Mental Health Services and Potential Strategies in Lower-, Middle- and High-income Countries

The COVID-19 pandemic has hampered the delivery of mental health services around the world, making viable access to treatment evermore critical. From the UN Women report cited earlier, women are finding more barriers to seeing a doctor with 60% of women experiencing longer wait times. Consideration as to how to improve access to care should be examined in all settings, globally. In her Lancet article, Global mental health and the COVID-19 pandemic, Lola Kola lays out two compelling strategies for addressing global mental health treatment in the wake of COVID-19:

1. Task shifting: In resource-constrained contexts, task shifting can help mitigate workforce capacity, allowing for a more comprehensive approach to mental health care. As globally, women make up 70% of health workers and first responders, task-shifting directly links to alleviating their burden in an already critically understaffed sector. If implemented, task shifting allows for trained health specialists to deliver mental health care support outside of specialist settings, by facilitating mental health engagement at all levels of the care system. This enables a flexible workforce to deliver healthcare in a variety of settings, which results in improving access to treatment and services.

2. Digital health technology: Digital health technology presents the potential to increase access and coverage in hard-to-reach areas. Mobile phones can aid in delivering mental health information on prevention, help reduce stigma-related barriers, as well as facilitate access to training, supervision, and support among care providers. Making health records available remotely can even be used in supporting patient recovery in cases of severe mental illness such as psychosis. Digital health technologies provide a personalized, efficient, and cost-effective way to recruit patients and provide easy access to care by direct delivery of treatment.

Although high-income countries (HICs) dominate the digital innovations space, according to International Telecommunication Union 2020 Measuring Digital Development report, there is high mobile-broadband network coverage in developing countries (92.2% 4G/3G users). Particularly, widespread accessibility is key to empowering women. While mobile phone ownership by women is reported as on parity with men, the caveat remains that there still exists a large internet gender gap in developing countries (gender parity score of 0.87 overall, 0.54 for Africa; target parity is a value of 1).

Conclusion

During the COVID-19 pandemic, global health systems were ill-prepared to address the rising prevalence of mental health problems, resulting in a substantial treatment gap for those with mental health conditions, particularly in LMICs. To close these gaps globally, task shifting and digital delivery of mental health services should be prioritized to improve essential mental health coverage and encourage the efficient use of the available resources and technology. Lack of gender, racial, geographical, and socio-economic status representation, as well as excluding expertise that comes from disciplines outside of health, silences important perspectives.

In the months to come, the psychosocial burden of COVID-19 will manifest in substantial increases in adverse mental health. These effects are not only present in the short term but must be addressed as infrastructural issues in the years to come as well. The aftereffects of COVID-19 will have a significant impact on labor dynamics and who bears the burden of unpaid household work and care. Furthermore, the mental health impact and trauma of being at the frontlines of crises will remain after the outbreak itself. Efforts to respond to these mental health needs present an important opportunity to build on what we know and advance progress in achieving mental health objectives.

Without substantive research, advocacy, and policy reform around mental health funding, the psychosocial burden of COVID-19 will continue to disproportionately affect women after the pandemic ends. At the Health Finance Institute (HFI), we are committed to building health economic models for underemphasized noncommunicable diseases to strengthen the case for public and private investment in addressing these diseases — and the next blog post in this mental health series will explore different financing solutions to the mental health crisis.

Written by Claire Dziewicki, Omar Khan, Jenna Patterson, graphic produced by Isabel Hardy

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