I wrote about how COVID19 affects women and men differently in Nigeria for The Daily Trust earlier this week.

COVID-19 has taken the world by storm. In months, it has crossed borders and brought economies to a near halt. Although most of humanity is affected, COVID-19 and related government measures are increasing existing inequalities when it comes to age, class, gender, disability, income, geography and other factors. The last few weeks have already shown us that women and men are impacted very differently in Nigeria.

We know people with pre-existing conditions (such as asthma and diabetes) and the elderly are more at risk if they contract COVID-19, as are people in conflict affected areas who may not have had proper nutrition and healthcare for a while, leaving them with weakened immune systems.

What has been under-reported is how health outcomes vary according to gender. Worldwide, more men than women have died of the disease. We do not yet know why this is the case. It could be due to sex-based immunological differences. Gendered differences in how women and men act, for example men being more likely to smoke or less likely to wash their hands, is another possible explanation. An alternative reason is men’s higher rates of chronic illnesses such as cardiovascular disease, hypertension and lung disease, all of which we know increase risk.

Nigerian women’s and girls’ lack of access to healthcare has always been life-threatening. It is even more so now.

Whether you are diagnosed, properly treated and recover also depends on gender. Accessing good quality healthcare is difficult for almost everyone in the country but women and girls particularly struggle. They are less able to afford hospital bills. Particularly in northern Nigeria, husbands may prevent them from going to clinics, especially if there are only male health workers there. They are also more likely to have disabilities, which also makes going to clinics difficult.

Moreover, although everyone is talking about COVID-19 at the moment, Nigerians continue to get sick for other reasons. Despite being ill, many people are scared to go to hospital for fear of infection. Focus on COVID-19 is also resources from other areas, for example access to family planning, ending maternal mortality or immunising children. This is dangerous. In Sierra Leone, more women died of obstetric complications than Ebola and rates of maternal mortality increased by 70 percent during the outbreak.

Government restrictions economically impact women more.

Everyone’s jobs and incomes are affected. People cannot go to work. Even in states not under lockdown, restriction on inter-state travel has affected trade and markets. Street children risk being stigmatised and criminalised and have more difficulties in finding food, water, and shelter.

Even before the pandemic, women in Nigeria earned less than men. They were more likely to live in poverty. They were less able to get credit and build up savings that could take them through times of economic hardship. Most people working in the informal sector in Nigeria are women. In states with movement restrictions, their livelihoods are on hold as they can no longer sell in markets or by the roadside. In the formal sector, women are more likely to be in precarious positions and may be the first to lose jobs or not paid if their companies are affected. Lack of livelihoods may force women and girls to engage in sex work in return for money, food or shelter or to eat food last and least – ways of coping already seen in parts of Nigeria with high levels of food insecurity such as Borno and Zamfara.

Restrictions have also increased women’s care work. As more people are at home and given gender roles, assign housework to women and girls, their tasks have increased. To follow government advice on hygiene and handwashing, women and girls will need to spend more time finding clean water, a burden that often falls on them. School closures have led children to stay at home, further adding to women’s burdens. Women also provide care to family members who fall sick – either of COVID-19 or other illnesses that are untreated as people fear going to health clinics.

Women and girls are trapped in increasingly violent situations – with no end in sight.

All over the world, government restrictions have led to increased violence against women and girls. In China, police reports of domestic violence tripled during the lockdown. In the UK, at least 16 women were killed by men in the first three weeks of the lockdown. Less than 36 hours after the start of the lockdown, the Lagos State Domestic and Sexual Violence Response Team had already received more calls to its telephone hotline, requiring them to start two new telephone lines to cope with this increase.

As families spend all their time together in a context of fear and economic stress, arguments have increased. Men are engaging in new, more frequent and more violent abuse against wives, girlfriends and children. Women and children are trapped, with no respite through time away from the house and less access to family, friends and colleagues who could support them.

Services that support survivors of violence, already underfunded before COVID-19, are struggling to cope with this increased demand, particularly given lockdown conditions. Those who work for them are not automatically exempted from movement restrictions, so find it difficult to reach those experiencing violence. They also face difficulties knowing where to house them given physical distancing measures in place to prevent spread of infection.

The impact on women is stark but women and gender analyses are missing from the decision table.

Despite all of this, women remain excluded from COVID-19 decision making. It is not yet clear why countries with women leaders, from Bolivia and Namibia to Nepal and Taiwan, are doing better than their neighbours at limiting the spread of infection but there is a wealth of evidence that shows having a balance of women and men in leadership leads to more effective governance.

To date, government healthcare, economic and other measures do not take the impact of COVID-19 on women and girls seriously. As the numbers of confirmed cases continue to increase and COVID-19 spreads across the country, this needs to change.