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      Reordering gender systems: can COVID-19 lead to improved gender equality and health?

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          Abstract

          COVID-19 has delivered a shock to existing gender systems that could recalibrate gender roles, with beneficial effects on population health. The economic arrangements, policy frameworks, and market forces that determine the distribution of paid and unpaid labour across society are powerful structural determinants of health. 1 The way that paid and unpaid labour is inequitably divided between men and women is central to the perpetuation of gender inequalities across the globe, and the ways that such divisions can be shifted or disrupted offer critical opportunities to modify the gender-differentiated effects of COVID-19 on health. Occupational gender segregation generates particular vulnerabilities for women in relation to COVID-19. 2 Globally, two-thirds of the health and social care workforce are women. 3 This includes occupations that are often undervalued and poorly paid, despite being essential in the pandemic response, such as aged-care and disability-support workers. 4 Being at the front line of the pandemic response places these women at risk of infection with severe acute respiratory syndrome coronavirus 2, as well as physical and psychological pressures. Less immediately tangible, but potentially more damaging, are the effects of economic contraction and job loss related to the COVID-19 pandemic. Evidence suggests there are likely to be more COVID-19-related job losses for women than men.2, 5 This differential exposure to job loss arises because women are more likely to be employed in sectors at high risk of impacts from COVID-19, 5 and also because women are more likely to be employed part time 6 or in temporary or casual arrangements. 5 Such employment arrangements are often precarious with fewer legal protections, meaning that women are particularly vulnerable to job loss during this pandemic, placing them at increased risk of the adverse health outcomes associated with unemployment. 7 Globally, women do more unpaid work than men. 8 Much of this is unpaid care work, of which more than 75% is done by women. 4 Unpaid care work contributes substantially to global economies, and is estimated to be equivalent to 9% of the global gross domestic product. 4 The unequal distribution of unpaid care work serves as a barrier to female labour force participation and is one way that gender inequalities are reinforced.4, 8 The COVID-19 pandemic exacerbates this in two main ways. First, women's caring for sick family members reduces their capacity to be in paid employment, and places them at increased risk of infection. Second, confinement at home due to work at home requirements and school closures may compound the unequal division of domestic tasks. Intensifying this situation, responsibility for schooling children at home may be disproportionately borne by women. 9 Gender-differentiated exposure to work and household stressors as they strive to fulfil paid and unpaid responsibilities contributes to poor mental health in women, including depression. 10 This inequitable division of paid and unpaid labour aligns with pervasive and entrenched gender norms that define women as caregivers—nurturing, self-sacrificing, and caring—and men as breadwinners. 11 Gender norms also define who and what is valued, 11 with the consistent undervaluing of many female-dominated occupations. 12 There is a risk that these female-caregiver and male-breadwinner norms could intensify the inequitable division and perceived value of paid and unpaid labour during the pandemic and future recovery. In previous economic crises, a retreat from gender egalitarian beliefs has occurred, with increasing support for the notion that men are more entitled to jobs than women. 13 How, then, can the COVID-19 pandemic be disruptive to the gender system? The gender norms and beliefs that help shape our gender systems are not immutable. 14 They can be transformed. Proactive policies related to exit from the COVID-19 pandemic should aim to redistribute a proportion of women's unpaid caring responsibilities to support female labour force participation. To do this, governmental and organisational policies must increase the opportunities for both women and men to combine paid employment and unpaid caring; policies that only target women may reinforce gender inequalities. Such policies should be supported by the provision of high-quality and affordable child care and elder care.8, 15 As COVID-19 shifts the ways in which we work, workplaces must enable women and men to work from home and share caring responsibilities. Workplace practices, policies, and culture regarding leave and flexible work arrangements are an important influence on fathers' abilities to combine work and caring responsibilities, underscoring the importance of gender-neutral approaches to leave and flexible working. 16 Normalising men's sharing of caring and household responsibilities is also essential for the redistribution of unpaid care. Initiatives should include non-transferable parental leave entitlements with income replacement for both fathers and mothers, as is available in some northern European countries. 17 In Norway, of the 49 weeks of fully compensated parental leave that parents are entitled to, a proportion of non-transferable leave is specifically assigned to each parent. 18 This use-it or lose-it approach has led to a substantial upswing in the number of fathers taking parental leave. Normative acceptance of this at the individual and workplace levels is reinforced and achieved through the non-transferable conditions of this leave. 18 © 2020 NiP studio/Shutterstock 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Finally, the underfunded and neglected domain of care work has been exposed by the COVID-19 pandemic, 5 highlighting the importance of recognising the value of paid and unpaid care provision. Redressing the underpayment and poor employment conditions of many female-dominated occupations, particularly those that provide paid care including health care, is vital. Accurate quantification of unpaid care should be a priority, and estimates should be incorporated into macroeconomic analyses to enable the assessment of gender-differentiated policy effects. 4 For unpaid carers, financial support and pension systems that acknowledge unpaid care provision could offer protection from economic disadvantage. 19 The COVID-19 pandemic has temporarily reshaped our domestic and working lives and could sow the seeds for change to advance gender equality, and deliver long-term health benefits. Effective policies that target normative and structural drivers of gender inequality could parlay the upheaval caused by COVID-19 into enduring changes to gender systems that will ultimately benefit the health and wellbeing of all.

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          Most cited references 11

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          Who cares? assessing generosity and gender equality in parental leave policy designs in 21 countries

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            The health consequences of unemployment: the evidence.

            Mathers and Schofield, from the Australian Institute of Health and Welfare, review recent studies, including Australian research, on the health effects of unemployment and the mechanisms by which unemployment causes adverse health outcomes. The relationship is complex: ill-health also causes unemployment, and confounding factors include socioeconomic status and lifestyle. However, longitudinal studies with a range of designs provide reasonably good evidence that unemployment itself is detrimental to health and has an impact on health outcomes--increasing mortality rates, causing physical and mental ill-health and greater use of health services.
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              Towards an integrated approach for the analysis of gender equity in policies supporting paid work and care responsibilities

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                Author and article information

                Contributors
                Journal
                Lancet
                Lancet
                Lancet (London, England)
                Elsevier Ltd.
                0140-6736
                1474-547X
                19 June 2020
                19 June 2020
                Affiliations
                [a ]Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
                [b ]School of Social and Political Sciences, University of Melbourne, Melbourne, VIC 3010, Australia
                Article
                S0140-6736(20)31418-5
                10.1016/S0140-6736(20)31418-5
                7304958
                © 2020 Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                Medicine

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