By: Pauline Capdevielle, Amaranta Manrique de Lara, María de Jesús Medina Arellano

Source: Blogs BMJ

This year’s International Women’s Day was a historic occurrence in Mexico. Tens of thousands of women took to the streets on the eighth and then chose to vanish on the ninth. Each day in its own way, the so-called 8M and 9M were meant to raise awareness about femicidal violence, and the foundation of structural violence against women on which it stands.  Women all across the country sought to generate a widespread debate at different levels in society, and called for active commitment from key stakeholders and decision-makers.  But while we marched through the streets in Mexico, the rest of the world was beginning to become paralyzed by a virus which has claimed over 60,000 lives, confining individuals and families to their homes, and overwhelming already fragile health systems. And in this unprecedented situation, girls and women find ourselves caught between a rock and a hard place of two public health crises – the pandemic and gender-based violence – in a country where misogyny seems part of our cultural heritage.

Social distancing measures, such as shelter-in-place orders, have become essential to counteract the rapid spread of SARS-CoV-2. Besides seeming incompatible with the socioeconomic reality in Mexico, isolation and confinement at home are extremely concerning for women’s safety. In our country, domestic violence is the most prevalent form of violence against women, and a considerable number of femicides are perpetuated in family, couple or friendship environments. Further, these situations of at-home violence can be exacerbated during a pandemic. On the one hand, stress and economic uncertainty are triggers; on the other, confinement pulls women away from support networks. It’s imperative that we implement public programs to respond to these issues in the current context. We need to ask questions like: how am I supposed to call for help during forced coexistence with my aggressor? A possible solution might be mobile apps habilitated to serve as panic buttons, but these would also come with a number of limitations, considering that socioeconomic status is a contributing factor to violence.

Another consequence of confinement is that it highlights the existing inequality, based on misogynistic stereotypes, in the distribution of unpaid labor (household chores and care). This inequality is normalized to such an extent that the Mexican president, López Obrador, publicly stated that women at home would have no issue looking after the health of elders, affirming that men tend to be “more detached”. During quarantine, most women will be responsible for: increased household chores; caring for children, including aid in schoolwork and education due to schools closing down; tending to family members with any physical or mental disability; caring for the elderly; and, in some cases, looking after family sick with COVID-19. On top of this, a lot of women will also take on professional responsibilities, in a labor market where they have to deal with increased job insecurity and lower salaries. All of this can generate anxiety, chronic fatigue and mental exhaustion, which in the long run can permanently affect women’s emotional, mental and physical health.

It must be stressed that women make up most of the healthcare workforce; additionally, they make up the majority in other positions deemed essential (e.g. domestic workers, cleaning staff, cashiers at supermarkets and drugstores), where they face increased exposure to contagion. Beyond the risk of contracting COVID-19, women’s right to health is compromised in many different ways during the pandemic. For example, some media in Mexico have made irresponsible and inaccurate statements about the utility of some drugs like hydroxychloroquine, not taking into consideration how they are essential to maintain the health and lives of thousands of women, who are more susceptible to develop chronic diseases such as rheumatoid arthritis and lupus. Panic-buying prompted by misinformation has left a lot of women without health-sustaining drugs, women who are already part of an at-risk group for COVID-19 due to their existing conditions. We must ask ourselves if media and government are responsible for this shortage and, if it turns out that these drugs are a viable treatment for COVID-19 – we hope they are – how decisions will be made to distribute these scarce resources.

Medical resources and health staff being diverted to face the crisis will also affect women’s sexual and reproductive health, in this country where rates of obstetric violence are already high. For example, no special protocols have been defined to tend to pregnant women, protecting them from COVID-19 while seeing to their usual needs before, during and after childbirth. Such an oversight could lead to increased maternal mortality rates.

Similarly, nothing has been said about access to emergency services for victims of sexual violence, such as safe means to interrupt a pregnancy resulting from rape. To clarify, there’s a federal norm which ensures women’s right to abortion when they’ve suffered sexual assault. Additionally, each state in Mexico has its own legislation of permitted abortion causes, for example when the woman’s life is endangered, the presence of congenital abnormalities or, in the case of Mexico City and the state of Oaxaca, abortion on request during the first trimester. Following each legislation, the provision of abortion services must be ensured in a timely manner, given that these procedures cannot be postponed and should be considered urgent. Overall, women’s right to health is linked to their rights to life, free development of personality, human dignity, and sexual and reproductive freedom. All of these constitute undisputed human rights which cannot be discarded by any measure of exceptionality, even in the face of scarcity in the health sector.  Women’s independence is inextricably linked to control over our bodies and our reproduction, and any argument to justify taking away that right is undeniably discrimination against women.

Among everything that has happened, this pandemic has managed to highlight and exacerbate the existing inequalities and flaws in our social structure. Even though the 8th of March and our march seem like another lifetime, our demands remain current, now more than ever. The topics we have discussed about women’s access to health, justice and a life free of violence must be fundamental issues in any and every plan to face this crisis. Yes, we are all worried about the pandemic and what’s to come, but we must remember that the structural violence women face every day remains in itself a public health crisis. Indeed, while we face this virus physical distancing, women are stuck at home with their aggressors. While the health system struggles to provide life-sustaining services, eleven women are still dying every day in this country just for being women. The government must not consider this a secondary issue, because women sure do not have the option of forgetting.

Paper title: Pandemias con mirada de mujeres (forthcoming in Nexos, www.nexos.com.mx)

Authors: Pauline Capdevielle¹, Amaranta Manrique de Lara², María de Jesús Medina Arellano³

Affiliations:

¹ Institute of Legal Research at UNAM, member of the ONG Colegio de Bioética in Mexico.

² Fulbright fellow, collaborator of the Bioethics, Health and Biolaw research group at the Institute of Legal Research at UNAM,

³ Institute of Legal Research at UNAM, member of the ONG Colegio de Bioética, member of the Council Board of the National Commission of Bioethics in Mexico and member of the board of directors of the International Association of Bioethics (IAB).

Competing interests: None declared.

Source: Blogs BMJ

The COVID19 pandemic and ethics through the eyes of women