Even if the spread of covid-19 and the tragic loss of life are brought to an end, the pandemic will sadly continue to have disastrous long-term consequences. The crisis has already had huge ramifications for social welfare and this will continue during the economic downturn that will follow, and many of the negative consequences, including financial instability, rising domestic violence and child abuse, loss of education and research opportunities, and rationing of vital health services, will disproportionately impact women. The UN states that the crisis exacerbates existing gender inequality and therefore all crisis responses must be gender responsive. Now, more than ever, is the time to advocate for wider societal gender and health equity goals. 

In the midst of a pandemic, the focus of health leaders and clinicians is on the “immediate” issues of saving lives and stopping viral spread, and the importance of gender may be overlooked. However, as the UN has highlighted, addressing gender inequalities in our response to covid-19 is more essential than ever. 

An opportunity has arisen for us to place higher societal value on frontline health and caregiver roles and to redress gender imbalance in leadership. It is vital women are visible and their voices are heard if we are to translate learnings from our frontline workforce into national and global response efforts. We must raise the profile of women leaders during this crisis to ensure that our current and future health and social care leadership adequately represents and protects the workforce and that the needs of the population are met.

Globally, women comprise 70% of the health and social care workforce, with a well-documented gender pay gap. Women also do three times as much unpaid domestic and care work at home as men.

During the pandemic frontline health and social care providers have not always had access to adequate personal protective equipment (PPE). This has been most acute in community medicine and social care where the majority of workers are women. In her bestselling book Invisible Women, Caroline Criado Perez highlights that protective work clothing is rarely designed for women’s bodies, so it is likely that some of the PPE worn by frontline health and social care workers has been designed for an “average white male” fit, meaning many of the female workers are wearing PPE which is not the appropriate fit so may not protect them adequately. This is further compounded by the fact that women, particularly those from black and minority ethnic backgrounds, are less likely to access training opportunities and speak out against injustices at work because of fear of backlash and discrimination.

Covid-19 clearly exposes the vulnerability of those at the intersection of gender and race; it is a disease which is causing the deaths of more ethnic minority patients in the US, and more ethnic minority key workers in the UK, due to social inequality and, particularly women from ethnic minorities, due to the higher proportion in lower paid frontline healthcare and caregiving roles. Working on the “front line” women from ethnic minorities are more likely to contract covid-19, suffer economic consequences and, as carers at home, have greater impact on their dependents and other vulnerable people in the community. 

Aside from the direct effects of covid-19 on infected patients, when health care services are overstretched and focused on one issue, access to essential services suffers. For women, this means a lack of basic reproductive healthcare which impacts two lives. Routine cervical cancer and breast cancer screening have been put on hold in the UK and many other countries; it is yet to be seen how many late cancer diagnoses will be made, treatments delayed, and lives shortened as a result. Women will suffer a simultaneous assault of unmet clinical needs, greater burden of care at home and loss of paid livelihoods.

On a global scale, women heads of state (who are vastly outnumbered by their male counterparts) are leading the way in terms of their response to covid-19. We know that diversity of leadership styles are crucial to produce better outcomes, however systematic gender biases leave women poorly represented at all levels of leadership. Germany, New Zealand, Iceland, Taiwan, Denmark and Finland all have female leaders who have responded with clarity, preparedness and compassion to the challenge posed by covid-19, as opposed to many of the male leaders around the world, whose machismo and economic focus led to a policy of downplaying the virus much to their populations’ detriment. Appropriate female representation in local, national and global leadership roles must be seen as key to effectively navigate this crisis and be at the heart of resilience and recovery.

One silver lining is that innovation is no longer seen as disruptive, as demonstrated by a multitude of new processes that have seamlessly sprung up, including the ability of the NHS to move from face-to-face clinical consultations to remote telemedicine in a matter of weeks. This is something that would have taken years to achieve prior to the pandemic. And never before have so many experts in so many countries focused simultaneously on a single topic, and with such urgency. Efforts of researchers to collaborate and remove bureaucratic barriers are producing scientific advances to fight this disease at unprecedented speed. We have seen change within the NHS and other global healthcare systems at a pace never seen before – surely the same can be achieved for gender equity if we focus our efforts and understand that it is imperative to make progress.

Addressing gender imbalance in leadership will ensure our caregivers and healthcare workers receive adequate recognition and protection, whilst performing vital roles which form the backbone of society. This pandemic has shown us that without health security, there is no societal security.  We must ask ourselves what kind of social settlement must be put in place to prevent existing gender inequalities from becoming more stark. We must quash any institutional discrimination preventing women from reaching leadership roles. By amplifying women’s voices so that they can be heard, society will emerge from this crisis stronger and offer a brighter future for everyone.

Nada Al-Hadithy, Oxford University Hospital

Rose Penfold, Guys and St Thomas’ NHS Foundation Trust 

Katie Knight, North Middlesex Hospital, 2018-19 National Medical Director’s Clinical Fellow, Lead Editor, paediatricfoam.com

Greta Mclachlan, NHS England

Lucia Magee, Guys and St Thomas’ NHS Foundation Trust 

Conflict of Interest: The authors NAH, RP, LM, KK and GM are co-founders of Women Speakers in Healthcare, an organisation committed to promoting gender balance at all healthcare conferences and events and which hosts the largest database of women speakers across health and social care in the UK.