How did Covid-19 affect women’s autonomy and access to healthcare in Pakistan?

3 September 2021

Ali Cheema, Sarah Khan, Shandana Khan Mohmand

#Inclusion #Covid-19

With Pakistan facing a fourth wave of the Covid-19 pandemic and new restrictions being imposed in major cities, research from the IDS-led Action for Empowerment and Accountability programme sheds new light on the gendered impacts and experiences of the pandemic in urban Pakistan. This final analysis, drawing on data from a household survey conducted with men and women in Lahore last autumn, finds that women faced greater constraints at home as a result of men spending more time at home. There are also alarming consequences for how women access basic healthcare.

A female doctor and her female patient in a healthcare setting in Pakistan. Credit: USAID Pakistan

In our last blog on the gendered impact of Covid-19 in Lahore, we pointed out that the pandemic has led to a worsening of an already skewed division of housework burdens. What are some other ways in which the health and economic shock of the pandemic has disproportionately affected women’s lives?

We continue to explore data from a phone-based survey with men and women from nearly 1,500 households in Lahore during September and October 2020, as part of the Action for Empowerment and Accountability programme, to answer this question and reflect on its implications. Our findings provide evidence that women’s increased burden of housework during the pandemic is accompanied by a loss of freedom within the home and constrained access to maternal healthcare services.

Loss of freedoms within their homes

A number of studies in the last year have established that as families became confined to home due to closures and reduced mobility, intra-household dynamics shifted, sometimes in quite severe ways. An especially pernicious effect is increased domestic violence (this was sadly a global phenomenon, described as “the shadow pandemic” by UN Women). Even where there was a drop in reported cases, social workers feared that it was because women had lost the freedom within their homes to be able to report abuse or speak to outsiders about this.

We did not ask our respondents about domestic violence because, as we pointed out in an earlier blog, women’s privacy in responding to questions may be compromised during phone interviews. However, drawing on measures developed by the EMERGE project (Evidence-based Measures of Empowerment for Research on Gender Equality), we asked female respondents questions about ways in which they have had to adapt in daily life as a result of men being at home more often.

Key findings

  • 94% of households in our phone survey reported that men were now spending more time at home than usual because of lockdowns or job losses. 64% of women respondents said that this has led them to change how they dress at home in the past couple of months.
  • 60% said they are less able to do things for entertainment, like watch what they want on TV.
  • 53% said that they do not speak on the phone with their parents or other family members for as long as they used to pre-pandemic (Figure 1 below).

Figure 1: Everyday restrictions faced by women during Covid-19

In addition to shouldering a disproportionate burden of housework, women in Pakistan faced the loss of everyday freedoms in the home due to the greater presence of men during the pandemic. While this may not be as egregious as greater exposure to domestic violence, which we are unable to measure, it certainly speaks to a pattern of women having lower control over their lives during this time.

Impact on women’s access to healthcare

Women’s access to healthcare services also seem to have been constrained during the pandemic. More than 1 in 3 of women who needed pre- or post-natal care in the household during the pandemic, did not visit a doctor or the hospital. Most of them said this was because lockdowns limited their mobility, or because of a lack of money, or because of a fear of the virus. Our regression results verify this – women are more likely to forgo pre- and post-natal visits in households that have experienced a larger, adverse income shock, or where there is a greater perception of pandemic-related health risks.

These findings are particularly worrying, not only for health reasons but for two other implications that they may have. First, women’s visits to clinics and hospitals represent one way for state services to access women in distress during a crisis. Second, it demonstrates women’s limited access to even the most essential services when their mobility is constrained because of state regulations like stay-at-home orders, or because of financial concerns, or a higher perception of COVID-19 related health risks.

These findings have highlighted the need to focus on women’s unequal status at home, and on how social inequities within their own homes can expose women to heightened health risks during a crisis, and to a loss of control over their own everyday lives.

Ali Cheema, LUMS and IDEAS, Pakistan

Sarah Khan is Assistant Professor, Department of Political Science, Yale University and a Graduate Researcher at the Institute of Development and Economic Alternatives.

Shandana Khan Mohmand, Cluster leader and Research Fellow, MHRC