WHAMglobal Board Delves into COVID-19’s Disproportional Stressors for Women

JHF and WHAMglobal Board Chair Deb Caplan, MPA and speakers Sue Matthews, RN, MHScN, DPH, Tausi Suedi, MPH, Nadene Alhadeff, Wendy Leonard, MD, AAHIV, and Chen Shapira, MD.

 During the July Women's Health Activist Movement Global (WHAMglobal) board meeting, members explored how COVID-19 disproportionately burdened women globally. The pandemic created unforeseen caregiving pressures, forced women into educator roles for which they were unprepared, pitted professional against family responsibilities, created financial burdens, and added a layer of complexity to the safe completion of activities of daily living, all with the additional emotional stressors of isolation and fear.

Representing various countries, women communicated about efforts to overcome these emotional, financial, social, and medical challenges as the world moves into a new phase of the pandemic. This provided an occasion to inform and consider WHAMglobal's agenda for the fall and winter.

Chen Shapira, MD, co-founder and chief medical officer at Quai.MD, an artificial intelligence–based platform for personalized clinical pathways, spoke on the impact of COVID-19 in Israel. Dr. Shapira is an Israeli board-certified cardiologist with experience in both the hospital setting and the community sector. She is also board chair of Dosentrx, where she previously served as chief medical officer. Dr. Shapira has consulted in a variety of aspects of health care, including operations and process improvement.

Dr. Shapira noted that women working in Israel's education and health systems have been the most affected by the pandemic, with Orthodox women and single mothers bearing the greatest burden. Women lost more retirement savings and are experiencing a slower return to work, as well as reduced salaries. Israel's older population is feminized, and residents suffered from COVID-19 in long-term care similarly to the U.S. population. During the pandemic, 50% of women surveyed in Israel on their emotional state reported experiencing stress and loneliness and had 10% more visits in mental health clinics. Domestic violence also increased during quarantine periods. The rise in remote work has the potential to open doors to higher salaries for women, and men's exposure to women's home labor during the pandemic may provide a steppingstone to advocacy for equity.

Sue Matthews, RN, MHScN, DPH, CEO of The Royal Women's Hospital, spoke on the impact of COVID-19 on women in Australia. Dr. Matthews is a clinical associate professor at McMaster University, an assistant professor at the University of Toronto, and an adjunct professor faculty of health services management at Charles Sturt and Trent Universities.

Dr. Matthews discussed wrap-around services to mitigate stressors on women in Australia. The Australian government initially implemented progressive new policies on job assistance and free childcare, but these were poorly designed and ultimately failed to fully support women and were ended early. Casual workers and workers in industries with high female employment, such as local government and universities, were excluded. Australia experienced a 30% increase in domestic violence during the pandemic. In response, a program was launched to teach healthcare providers to see signs of domestic violence and how to act appropriately when a woman discloses. Dr. Matthews said that healthcare providers are seeing an increase in requests for later-term abortions because of fear or lack of access. In the second wave of COVID-19 in Australia, more than 35,000 healthcare workers in Victoria tested positive, and more than 75% were women, many working in aging care. As Australia recovers from the pandemic, the focus is on infrastructure and construction, but these are male-dominated workforces, Dr. Matthews reports.

Nadene Alhadeff, executive director of the Mum for Mum program at the National Council of Jewish Women of Australia, added thoughts on COVID-19's impact on women in Australia. Ms. Alhadeff has been leading this program since 2012, increasing its reach from 14 trained volunteers in 2008 to 170 volunteers today who are matched with isolated and vulnerable women transitioning to motherhood. Mum for Mum receives daily referrals and requests to volunteer.

Ms. Alhadeff noted that the biggest challenge new mothers and birthing persons have had during the pandemic is the barrier to having family visit after babies are born, a very important component of the postpartum experience for the cultures of many immigrants who live in Australia. Likewise, mothers and birthing persons have not been able to have the home visits they are used to from community health workers. The Mum for Mum program has been developing alternative methods for supporting women, including walks in parks and telehealth. Mum for Mum volunteers are well-trained to discuss challenges that arise after birth and the best ways to support the family. The volunteers tailor their approach for each birthing person, considering their cultural and communication needs. Mum for Mum has been promoting bystander trainings and partnering with organizations, including the Australia Israel Chamber of Commerce, to raise awareness of signs of reproductive coercion, Ms. Alhadeff said.

Wendy Leonard, MD, AAHIV, executive director of TIP Global Health, and Tausi Suedi, MPH, board chair and chief strategic advisor of Childbirth Survival International, then spoke on the impact of COVID-19 on women in African countries.

Dr. Leonard founded TIP in 2008 as a means of inspiring local health system innovation to provide high-quality health care to vulnerable people in resource-limited settings. She served as the first physician to volunteer for the Clinton Foundation's HIV clinical mentoring program in Rwanda and has continued to work as an educator and consultant to the healthcare providers in Ruli, Rwanda. Dr. Leonard currently is the director of Santa Cruz County's HIV Quality Management Program and has served as the county's tuberculosis controller since September of 2007. In this work, she has successfully collaborated with public health around HIV and TB care, including program design, management, and evaluation and individual patient care. Dr. Leonard previously served as president of the board of directors for the Santa Cruz AIDS Project, where she worked to expand HIV prevention, education, and care services to the Latino community.

Dr. Leonard shared that the pandemic has escalated maternal deaths in east Africa, and 50% of children are food insecure due to pandemic school closures, according to UNICEF. In Africa, nurses, who are primarily women, are more likely than other healthcare workers to be infected with COVID-19. Women also experienced higher levels of mental health issues. In Rwanda, dueling issues of infection and socioeconomic struggles characterized the pandemic. To combat the spread of COVID-19, TIP Global Health ensured that community health workers received personal protective equipment, education/awareness materials for their communities, and set up handwashing stations in homes to further increase hygiene. TIP created a digital tool to address contact investigation challenges, provided messages for community health workers on how to protect themselves, and gave community health workers megaphones to share public health messages with their communities. The community health workers in Rwanda are focused on addressing vaccine hesitancy, which is mainly among women.

Ms. Suedi has more than 15 years of global health experience. Her focus areas are rooted in purposeful and collaborative efforts to improve and strengthen quality of health services, resources, and information provided and delivered to benefit women, newborns, children, adolescents/youth, and the elderly in marginalized communities. In addition, she teaches global health at Towson University and the Center for Global Health in the Perelman School of Medicine at the University of Pennsylvania.

Ms. Suedi echoed the fact that COVID-19 increased vulnerabilities and worsened inequalities for women and girls. Pre-pandemic, at least 500 women died per day in African countries, due to preventable pregnancy and childbirth-related complications. This number quadrupled during the pandemic, and women were much less able to access services. There was a significant decline in the number of births with a skilled birth attendant present, and the number of unwanted pregnancies increased. Increased domestic violence, rape, child molestations, sex trafficking, and mental and emotional stress were reported. This especially affects the many women who lack access to basic resources necessary to flee abuse. Ms. Suedi suggested several mitigation strategies, including using lessons learned from Ebola outbreaks, ensuring that health workers (who are mostly women) have necessary resources and compensation, collaborating with birth attendants, and supporting community mental health services. Childbirth Survival International continues to work to support women to have successful birth, conducts food drives to address food insecurity, and holds vocational skills trainings, Ms. Suedi noted, and said that the Jewish Healthcare Foundation–supported initiative for childbirth health kits was vitally important.

In a closing discussion, the WHAMglobal board members focused on the widespread reports of increased domestic violence and considered how solutions for this might be integrated into the board's agenda. A recording of the discussion and materials are available here.

WHAMglobal Board members who attended include: Debra L. Caplan, MPA, Karen Wolk Feinstein, PhD, Carolyn Clancy, MD, Susan Dentzer, Lynn Eckhert, MD, MPH, DrPH, Christine Morton, PhD, Fleur Sack, MD, Nan Strauss, JD, Usha Raj, MD, and Laurie Zephyrin, MD, MPH, MBA. 

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