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.
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.
Globally, two-thirds of the health and social care workforce are women.
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.
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
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,
and also because women are more likely to be employed part time
or in temporary or casual arrangements.
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.
Globally, women do more unpaid work than men.
Much of this is unpaid care work, of which more than 75% is done by women.
Unpaid care work contributes substantially to global economies, and is estimated to
be equivalent to 9% of the global gross domestic product.
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.
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
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.
Gender norms also define who and what is valued,
with the consistent undervaluing of many female-dominated occupations.
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.
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.
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.
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.
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.
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.
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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
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Finally, the underfunded and neglected domain of care work has been exposed by the
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
For unpaid carers, financial support and pension systems that acknowledge unpaid care
provision could offer protection from economic disadvantage.
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.