International Women’s Day

As women face greater hardship from the pandemic, governments must act to avoid entrenching inequalities

The theme of this year’s International Women’s Day is to ‘choose to challenge’ the world we live in by calling out bias and inequality where we see it. But with inequalities only heightened by the pandemic, women need more than warm words to avoid a backwards step

The UK Government’s decision not to exempt maternity leave from calculations for the Selfemployment Income Support Scheme has left thousands of women worse off than their male counterparts. It’s just one of the ways the pandemic has been harder on women.

Despite this choice specifically impacting women, the court recently ruled it was not discriminatory. Mrs Justice Whipple said the inequality was caused by new mothers earning less and was therefore “not caused by the measure but rather it exists independently”.

Speaking to BBC Women’s Hour afterwards, Pregnant Then Screwed founder Joeli Brearley – who brought the case – said: “Essentially, 70,000 vulnerable new mothers are financially penalised twice. Firstly, they take maternity leave and maternity allowance is £151 a week, which is one of the lowest payments in Europe and it’s certainly not enough to live on... And now they’re being financially penalised again for doing the most important and the most challenging job there is: raising the next generation.”

This gets to the heart of the problem faced by women – the pandemic has exacerbated preexisting inequalities, while government choices have done little to alleviate the extra pressure.

Lost income is a key concern. The sectors hit worst by lockdown, like retail, care and hospitality, are made up of predominantly women. The Women’s Budget Group found 30 per cent of women have been negatively affected financially by the pandemic, compared with 26 per cent of men. One in four people with caring responsibilities, the majority of whom are women, have struggled to pay bills.

Other disadvantages are also at play. Half of disabled people and a third of black people are behind on payments. Parents on the lowest incomes are nine times more likely to report being at risk of losing their jobs compared to those on the highest incomes.

And around 12 per cent of parents earning below £20,000 said they would have to take time off from work without pay if schools closed.

Mikaela, a mum-of-one from Ayrshire, even had to consider quitting her supermarket job at the start of the year. The job was only meant to be a temporary one, having been forced to shut up her massage business (twice) and facing the prospect of her husband Dave being put on short time.

She told Holyrood: “We sat there and thought, how do we pay our mortgage every month, it was that ‘oh my God’. So I got a wee job in Tesco. All good. In the summer I was allowed to reopen my massage business, which I did, but I kept my job in Tesco. We’ve now gone into lockdown two, my business shut again, I can live with that. But then my problem with the situation is although I’m a key worker, my husband was not a key worker and therefore we were not entitled to childcare.”

Until nurseriries reopened last week, the couple were relying on Dave’s dad to take care of their four-year-old while Mikaela worked, which “totally defeats the objective of us staying home and staying safe,” she said.

She added: “I feel like we’re almost forgotten, which up here is so strange because we have a female leader – a very strong female leader – and a very female oriented MSP group. There’s a lot of representation for women, but we seem in the pandemic to just have fallen back.”

This last point is echoed by Engender’s executive director Emma Ritch. The organisation published research last March based on other pandemics, warning failure to consider women as part of the crisis response would lead to ongoing impacts on equality and rights.

“Unfortunately, I think we saw a lot of the same patterns and a lot of the failure to focus on women that we see in other pandemics replicated with COVID,” Ritch says.

“The overwhelming experience, I think, has been the response just not quite meeting women’s needs. Things like the design of the furlough scheme that didn’t allow women to balance care and paid work, failure to introduce a part-time furlough scheme. They needed to get to grips with women’s unpaid care work and the amount that would skyrocket once state provision became impossible because of public health drivers. I think all of these things have really meant that women have seen unpaid work shoot up.”

Indeed, a paper published by two academics from the UCL Research Department of Epidemiology and Public Health found that during the first lockdown, women spent five more hours on housework and ten more hours on childcare than men. In addition, 20 per cent of mothers had had to reduce their working hours because of care responsibilities – yet only 10 per cent of fathers did the same.

A Pregnant Then Screwed survey also found 81 per cent of women needed childcare to be able to work, but over half did not have anything in place when schools and nurseries were shut.

And even for the frontline workers eligible for school placements, access was not always easy.

Satwat Rehman, director of One Parent Families Scotland, previously told Holyrood of a mother who had initially not qualified because the process had not been designed with single parents in mind.

Rehman said: “She was completing the form the local authority had produced for her to be able to access childcare, the hubs for key workers. She ticked she was a key worker. Then it asked if your partner was a key worker. But she had no partner. But nowhere on the form did it ask or say anything which was asking if you were parenting alone. It wouldn’t let her complete the form without ticking one of those boxes, so she ticked no. But then the assumption made was your partner’s not a key worker, therefore you don’t need the childcare.”

Meanwhile, those providing care for adults have also seemingly been forgotten – despite the number of unpaid carers growing to over one million in Scotland since March.

Fiona Collie, policy manager at Carers Scotland, said: “61 per cent of unpaid carers are women and they carry out around 60 per cent more unpaid work than men. Growth in numbers during the pandemic again reflected this gender split and, as the Equality and Human Rights Commission has said, the pandemic has reinforced existing gender imbalances with more women taking on care, often alongside increased childcare and home schooling, as services reduced.

“I feel like we’re almost forgotten, which up here is so strange because we have a female leader – a very strong female leader – and a very female oriented MSP group. There’s a lot of representation for women, but we seem in the pandemic to just have fallen back”

“On top of this, we know from early evidence from Citizens Advice of the economic toll of the pandemic, that carers are more likely to face redundancy and loss of employment – exacerbating the existing impacts of caring, particularly for women.”

The burden of care is also taking its toll mentally. One carer, quoted in Carers UK’S Caring behind closed doors: Six months on report, revealed: “I have struggled hugely being with my husband 24/7, unable to have a break from caring. There are times I think I can’t go on, but of course I have to. Sometimes I don’t want to wake up in the morning.”

Juggling care responsibilities with work has left many women and mothers feeling stressed, depressed and like they are failing to meet the demands of either.

Ritch explains: “All of that cumulatively is having an impact on women’s mental health. We know the so-called second shift – where women do the majority of housework and childcare after coming home from a day of paid work – is already not very good for women’s mental health. But the pressure that has been put on women, particularly the heads of single parent households, 95 per cent of whom are women, has just been extraordinary across the space of the year. We’ll absolutely be reaping long-term impacts in terms of anxiety, depression and other consequences for women’s mental health.”

A poll by Ipsos MORI found more women are struggling to stay positive day-to-day. Women have also been more concerned about the risk of the virus. Pre-pandemic there was a gender gap in mental health and early research indicates this may have widened because of the stress of care, financial insecurity and the fact frontline workers are mostly female.

But among all this bleakness, there is a glimmer of hope when thinking about recovery. Sara Cowan, coordinator of the Scottish Women’s Budget Group, suggests the shared experience of lockdown may encourage decision makers to really look at the pre-existing inequalities.

She says: “It does appear that there’s more interest and engagement in what’s going on because everyone has been part of the experience. For some people, for whom lockdown has been either quite a nice experience or a relatively comfortable experience, there is that feeling of appreciating that privileged place within society.

“What’s important for the recovery though is that it doesn’t reinforce and entrench the inequalities that were already there, but it looks to challenge those inequalities. I think that’s where the big opportunity is, it’s that the recovery and spending that’s part of the recovery can do concrete actions that will tackle inequality.”

One solution could be increased investment in the care economy. Cowan says: “Investing in jobs within care – childcare and adult social care – will generate more jobs that are likely to be taken by women. But also investing in those jobs and in the pay and conditions of the people in those jobs, so that those jobs don’t entrench more women in low paid jobs but help bring women into jobs that are paying the real living wage and going beyond that as well.”

She is also clear that support programmes POST-COVID must include sectors dominated by women, because historically recovery from recession has been driven by male-led sectors like construction.

Making sure this happens will involve governments taking the time to learn the lessons of COVID. Ritch explains this means thinking more about “gender mainstreaming” – making sure women’s lives are thought about when creating any policy – and building capacity for this.

What happens if this work is not done? Ritch says: “Already women have come to the end of their tether, their telling us, in terms of their capacity to juggle based on annual leave and the accommodations of their work. Women are likely to give up paid employment because of their multiple caring roles and because of a lack of flexible, good quality work and/or a furlough programme that meets their needs.

“We’re going to see, I think, a quite vicious unwinding of the progress that has been made to close the gender pay gap, for example. We’re going to see women less likely to be found in paid work, less likely to be found at senior levels and women, even those who’ve stayed in paid work, are saying ‘my career is suffering because I’m having to spend so much time during the working day making sure my young children are ok’. That unpaid work is just not being equitably shared within the household.

“We might be returning to much more of a kind of 1950s model of women – who do do the bulk of household – doing even more housework and unpaid work, and men being out there in the paid labour market.” •

“Health inequalities are linked to the invisibility of women’s experiences and the way we are not taken account of – it’s really striking how men are considered to be the default human in medicine,” Ritch says.

“Women are undertreated or the presentation of their disease isn’t appreciated by medical professionals. They wait longer for pain medication, they wait longer for cancer diagnoses, they are more likely to have their complaint put down to mental health, they are more likely to be disabled by a stroke [because they will wait longer than men to get treatment], and they are more likely to be diagnosed as having anxiety and that makes it harder for them to be taken seriously by other health professionals.”

Gender specialist Professor Kate Sang, director of the Centre for Research on Employment, Work and the Professions at Heriot-watt University, says this is self-perpetuating: gaps in research lead to gaps in medical education and that impacts on the way women are diagnosed, which in turn has an effect on their willingness to discuss their symptoms in future.

“It takes about seven years to get an endometriosis diagnosis and some of that is trying to be believed and get past a GP as gatekeeper,” Sang says.

“The stories I hear are of people going to their GP and being told it’s normal, it’s part of what being a woman is about, but because we don’t talk about what a normal period is who knows what that is?”

Endometriosis is a long-term health condition that sees tissue similar to the lining of the womb grow in places such as the ovaries and fallopian tubes, causing severe pain and in some cases leaving women unable to hold down a job or have children.

The charity Endometriosis UK says that, despite the illness affecting one in 10 women, it often goes undiagnosed because it is not well understood by health professionals. Yet it was not until 2015 that Scotland’s chief medical officer recommended specialist endometriosis centres be set up across the country and it was 2017 before England’s National Institute for Health and Care Excellence advised doctors to start listening to women when they complained about crippling period pain.

Sang, who recently conducted a study into how menstruation and the menopause impact on women’s working lives, believes such initiatives remain rare because the evidence needed to inform policymaking on

“Health inequalities are linked to the invisibility of women’s experiences and the way we are not taken account of - it’s really striking how men are considered to be the default human in medicine”

women’s health issues is so patchy. Unless funders begin to take an interest in women’s health it will remain that way, she says.

“Whenever I talk to funders they say the topic [being pitched] is important but not interesting,” she says.

“Whenever I talk to people about my research across industry, with individuals, with civil servants, they are all absolutely fascinated by it and think it should be funded, but when I go to a funder they keep coming back with ‘it’s just not interesting enough’.

“Policymakers, employers and governments all acknowledge that it’s super important, but they need a stronger evidence base in order to influence policy.”

Sang’s own research shows that the impact of funding such studies could be huge. In a paper recently published in the International Journal of Environmental Research and Public Health, she found that everything from a lack of adequate toilet facilities to embarrassment and shame about discussing menstruation, the menopause and associated pain was leading to women taking sick days from work and in some cases giving up employment altogether. If more was understood about their experiences, she says, policies could be put in place that would allow them to continue in work, benefiting not just the women involved but their employers and the wider economy too.

“The hope is to get people more interested in funding research because we need to know more about it so employers, governments and

trade unions can put better policies in place,” she says.

“If you look at the occupational health literature women don’t really feature outside pregnancy – what we know about occupational health is what we know about men’s occupational health.

“Women’s health at work is not really understood at all and I’d like to see a push to understand the role of gender more.”

For Ritch, a women’s health fund would be one positive way of beginning to redress the balance by funding the type of research that could then be used to better inform areas like medical education and health policy.

“That could close the gap on research for sex-specific conditions like endometriosis, but also non-sex-specific ones like heart disease,” she says.

“We really need to look at health budgets and identify where resource is going, who is benefiting, what the money is being spent on and what the outcomes are.

“The impact of something like endometriosis is staggering but it’s treated like a minor inconvenience.”

Berry believes investment needs to be far more wide-reaching, though, so the data that is already being collected on all health conditions can be properly collated and understood.

“In Scotland we don’t have a national data collection system so we don’t know what we don’t know,” he says.

“The NHS in Scotland has a number of health boards but typically there is no data sharing between them. They are independent legal entities.

“If someone from East Kilbride, which is covered by NHS Lanarkshire, goes into Glasgow and has chest pains they will go to A&E at Glasgow Royal Infirmary, which is run by NHS Greater Glasgow & Clyde. Their heart attack provider would be NHS Golden Jubilee, which is part of a special health board.

“Each hospital would have its own data but they wouldn’t know what happened to their patient when they moved on to the next board.

“It’s almost distressing to me because I know what we don’t know – we don’t have national data on heart attacks, the leading cause of death.”

Berry notes that the cost of creating such a system would be huge, not least because it would involve the commissioning of bespoke IT, something the public sector finds notoriously difficult to get right. But he believes it would bring benefits for education, because studies would have ready-made cohorts; for care, because those running studies would have a duty to respond to patients; and for the overall healthcare system, because gaps in knowledge would be filled in.

“Having [a means of collecting] national data would mean a significant investment, but look at the totality of the benefits and it would be an investment worth making – and we would know about the health differences between men and women,” Berry adds. •