Women’s Health and Wellbeing post COVID: A Case Study From Sub-Saharan Africa

Abstract

The Covid-19 pandemic swept across the globe causing hundreds of thousands of deaths, shutting down economies, closing borders and wreaking havoc on an unparalleled level. Countries around the world responded by enforcing nonpharmaceutical interventions in an attempt to flatten the curve and control transmission, morbidity and mortality as well as help ease pressure on healthcare systems. These interventions, though effective in flattening the transmission curve and easing pressure on healthcare systems, came with a heavy social and economic toll globally. Women and girls suffered greater impacts compared to men and boys. Loss of employment, economic distress, school dropout rates, intimate partner violence, as well as domestic violence were overexpressed among women and girls compared to men and boys. Low- and Middle-Income Countries, not being structurally resilient, are unable to quickly recover from such negative shocks. Little is still known as to how vulnerable populations such as women are recovering post pandemic regarding health and wellbeing. Drawing from Sen’s capability approach this thesis aimed to evaluate the differences in health and wellbeing among women in Kenya and Uganda post-pandemic compared to during the pandemic, and the determining factors. Health and wellbeing were operationalized using a wellbeing scale that measures the standard of living, General Health Questionnaire-12 that measures probable emotional distress, and perceived state of health relative to others of own age. 1:1 optimal pair propensity score matching was used to identify socio-demographically comparable participants from two cross-sectional surveys – done in 2021 and in 2023 in Kisumu, Western Kenya as well as in Mukono district, Central Uganda; hence producing two samples of 405 women in Kenya and 186 women in Uganda for each of the two timepoints. McNemar test was then used to compare health and wellbeing between the two timepoints while generalized estimating equations regression with exchangeable correlation structure was used to explore the factors associated with differences in health and wellbeing outcomes. The results show that probable emotional distress levels increased from 21.5% to 52.6% in Kenya but reduced from 88.2% to 61.8% in Uganda, and the proportion that reported poor/fair relative health increased from 25.7% to 35.6% in Kenya and from 25.7% to 35.6% in Uganda. Moreover, the proportion of women that perceived the quality of healthcare services in their community as poor/fair increased from 33.3% to 40.2% in Kenya and from 28.5% to 62.4% in Uganda. The accessibility of healthcare services was also increasingly being perceived as poor/fair in Kenya (23.2% to 29.4%) as well as in Uganda (29.0% to 67.7%). This research also found no significant differences in the proportion of women with health insurance post pandemic relative to during pandemic in both countries – Kenya (23.2% - 27.4%; p=0.196) and Uganda (2.7% - 3.8%; p=0.771). Wellbeing improved in Kenya but worsened in Uganda between the two timepoints – a worrying trend considering Ugandan women were much older, hence heightening their vulnerability. During the pandemic as well as post pandemic, women who were older, who lived in rental houses, who experienced high levels of water/Water Sanitation and Hygiene insecurity, and who lacked health insurance were likely to report poor health and wellbeing outcomes. Women in these categories were also more likely to report worsening health and wellbeing outcomes post pandemic relative to during the pandemic. Thus, recovering better from COVID-19 should involve ambitious plans that rebuild health, social and economic systems with a stronger focus on marginalized populations such as women and older persons. This research proposes that propensity score matching can be used to compare outcomes for samples from two repeated cross-sectional studies to help eliminate or reduce bias associated with differences in sample selection. To inform policy this research proposes that interventions should be focused on improving economic conditions, healthcare infrastructure, and water, sanitation and hygiene access with priority on the structurally vulnerable populations such as elderly women.