Women in Africa account for a slightly smaller proportion of Covid-19 infections and deaths than men although a health expert cautions that access to testing and reluctance to being treated in hospitals could mean that women’s cases are undercounted.

Unveiling findings of a preliminary analysis of COVID-19 gender-specific epidemiological data in 28 African countries, the World Health Organization (WHO) on Thursday revealed that women account for about 41% of African COVID-19 cases. However, there was a large range from 31% for cases in Niger to over 57% in South Africa.

“In most countries, women are somewhat less likely to die from COVID-19 than men,” WHO stated. 

In Côte d’Ivoire, the case fatality ratio stands at 0.4% for women compared with 0.5% in men, while in the Democratic Republic of the Congo it is 2.2% versus 2.7%. In Seychelles, it is 0.1% for women against 0.5% in men, although the country has only had 13 COVID-related deaths.

This is despite the fact that women account for a large part of the health workforce and are thus at higher risk of infection. 

“In Africa, more than 95,000 health workers have been infected with COVID-19. In Seychelles, women account for 71% of health worker infections, 64% in Eswatini, 55% in Cote d’Ivoire and 54% in Senegal,” the WHO reported.

“Other studies report that men are significantly more likely to suffer severe effects of COVID-19 and more likely to have pre-existing conditions, explaining the slightly lower fatality rate seen in women,” the report stated.

Noting the need for further analyses to determine the factors behind the gender disparity, the report suggested that biological, behavioural or social factors could be responsible. 

However, Nigerian public health expert Bayo Ajala noted that the trend could be as a result of fewer women getting tested and unable to abandon their family duties to be at isolation centres.

“Many people are getting over COVID-19 even without any intervention. For women, in many African countries, they are the pillars of families and the household cannot survive without them. Maybe they are not getting tested for their details to be captured in the official data,” he told Health Policy Watch in Ibadan, Nigeria.

Women at higher risk of gender-based violence

But while fewer women appear to have been infected than men, the WHO noted that school closures during the COVID-19 crisis led to “an increase in teenage pregnancy and unintended pregnancies in many countries”. “Additionally, staying out of school for an extended period usually led to greater likelihood of engagement in risky sexual behaviour and increased sexual violence and exploitation. Also, women and girls are increasingly becoming victims in the spike of domestic violence fuelled by economic hardship as millions of people are pushed into extreme poverty.”

According to Matshidiso Moeti, the WHO Regional Director for Africa. “the aftershocks of the COVID-19 pandemic on women and girls have been profound, leaving many grappling with heightened risks to their health and safety”. 

“Our response must go beyond the clinical aspects of the pandemic and address the hidden crises that risk causing long-term effects to lives and livelihoods.”

According to WHO preliminary analysis of 22 countries, 10 reported a rise in maternal deaths between February and July 2020 compared with the same period in 2019, with the highest increases reported in Comoros, Mali, Senegal and South Africa. 

“Nine of the 22 countries reported a decline in births in health facilities and an increase in complications due to abortions,” WHO stated.

Oulimata Sarr, UN Women Regional Director for Central and West Africa, called for efforts to promote “positive masculinity”, involving men in addressing issues affecting women. 

“At UN Women, we are convinced that to be able to bring about change, people want to leapfrog into the future. We need to enroll the men, and those men, we call them our HeforShe. Those are really our champions who might be on decision-making tables where we are not and who will take full responsibility for a fair and just world that gives equal opportunity to men and boys and girls and women,” Sarr said.

As Africa joins the rest of the world to celebrate International Women’s Day on 8 March, Moeti said efforts should be geared towards closing the gender gaps by designing services in a people-centered way. 

“And taking into account inequity, and gender-driven inequity as well in the design of policies from financing health for designing our systems for health insurance for making sure that the approaches to improving access to services take into account all people,” Moeti concluded.