Contextualising gender intersectionality with the COVID-19 pandemic

Objectives: To explore the association of gender inequality index (GII) with healthcare access and quality index (HAQI) for the male to female ratio of confirmed COVID-19 cases. Study design: Secondary analysis of COVID-19 cases with GII and HAQI datasets. Methods: Data for sex-disaggregated COVID-19 cases were collected from Global Health 50/50, for GII from the United Nations Development Programme (UNDP) and for HAQI from the Institute for Health Metrics and Evaluation (IHME). We used Spearman's correlation in SPSS version 23 to evaluate the association between the variables. Results: Cambodia had the highest male to female ratio (M:F) of 4.08:1, followed by Pakistan (M:F = 2.85:1) and Nepal (M:F = 2.69:1). We observed a positive correlation between GII and M:F ratio (Spearman's rho = 0.681, P-value <0.001) and a negative correlation between HAQI and M:F ratio (Spearman's rho = -0.676, P-value <0.001). Conclusions: Countries with institutionalised gender disparities and poor healthcare access and quality tend to have higher M:F ratios of confirmed COVID-19 cases; thus, highlighting underutilisation of testing services, influenced by multiple individuals, social and policy factors. Robust gender-based data are required to understand disparities throughout the continuum of care and to devise gender-responsive pandemic strategies. (C) 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.