Gender Violence, Racial Justice, and Health Inequities

Gender violence (GV) refers to any form of violence, harm, or abuse that is perpetrated against a person based on their gender or gender identity. GV encompasses various types of violence, including physical, sexual, and psychological violence, as well as stalking and other forms of harassment. GV can occur within intimate relationships, families, and communities or by the state and its institutions. GV is a global pandemic affecting individuals across societies, social classes, and cultures (UN, 1993; Wirtz et al., 2020). Trans and gender non-conforming individuals face a greater risk of experiencing gender violence (GV) due to their gender identity, expression, and sexuality. There is a higher prevalence of violence against trans people of color, particularly Black trans women, and this group is disproportionately affected by fatal violence (Human Rights Campaign, 2020; Wirtz et al., 2020).

The impact of COVID-19 on marginalized communities, alongside global anti-racism protests, has sparked conversations about racial justice and health inequity. The World Health Organization defines health inequities as “systematic differences in the health status of different population groups. These inequities have significant social and economic costs both to individuals and societies” (WHO, 2018). These differences are reflected in epidemiological measures such as life expectancy, infant mortality, and maternal mortality, as well as in other health indicators of the population (George et al., 2023; Woolf et al., 2019). Inequities are also apparent within the healthcare system, including biases, prejudices, and stereotypes among healthcare providers, racial biases in clinical decision-making tools, and policies and structures that limit access to quality care (Hardeman et al., 2020). Health inequities, which arise from systemic issues like oppression, power imbalances, and discrimination, are avoidable, unjust, and not inherent to individuals. They are influenced by societal norms, policies, and institutions, leading to disparities in health outcomes and access to healthcare services. Structural inequities refer to societal, institutional, and systemic factors such as racism, sexism, classism, ableism, xenophobia, homophobia, and transphobia. These factors prioritize particular identities regarding fair access to health resources and outcomes. Policies that perpetuate disparities at different levels, from local organizations to communities, counties, states, and nations, significantly shape structural inequities. These inequities are systemic, reflecting unequal distribution and access to resources, opportunities, and privileges that impact health and well-being (Braveman et al., 2022).

Health justice is essential for addressing health inequities by emphasizing the need to recognize and dismantle the root causes of disparities in healthcare access and outcomes. “As a movement, health justice seeks to recognize and build the power of individuals and communities affected by health inequities to create and sustain conditions that support health and justice” (Wiley et al., 2022, p. 637). It promotes distributive justice, referring to the ethical principle concerned with the fair allocation of resources among diverse members of a community (Shaibu et al., 2021). This principle prioritizes collective interests in universal healthcare access and integrates public health goals within healthcare decision-making. Through transdisciplinary collaboration, advocacy for systemic change, and community empowerment, health justice frameworks aim to create conditions that support health and justice for all individuals. This inclusive approach is crucial in addressing and dismantling the deeply entrenched systems of oppression that serve as barriers for oppressed groups, preventing them from accessing and receiving quality healthcare (Wiley et al., 2022).

The COVID-19 pandemic has sharply emphasized the need for a health justice framework that demands immediate legal and policy responses. It emphasizes that disparities in COVID-19 infections, disease outcomes, and access to healthcare were stark and linked not only to healthcare system discrimination and inequity but also to broader structural and institutional inequities. It is essential to address the underlying causes of health inequities, such as unequal access to healthcare, employment, housing, and education for historically marginalized and minoritized groups due to social and economic policies. Advocates for health justice prioritize distributive justice, ensuring that public investments in healthcare and public health are distributed equitably based on need. It is also imperative to engage with critical perspectives and empower communities to lead the efforts in addressing health inequities, particularly during the COVID-19 pandemic (Powell, 2021; Wiley et al., 2022).

The COVID-19 pandemic has aggravated existing inequities and has significantly impacted gender violence (GV). Throughout the COVID-19 pandemic, there has been a notable increase in GV cases, emphasizing the urgent need for measures to protect historically marginalized groups from the double impact of COVID-19 and GV. According to a 2020 UN Women report, there has been a significant increase in gender violence (GV) during the pandemic. The report states that during the lockdowns implemented in response to COVID-19, the number of women and girls between the ages of 15 and 49 who experienced sexual and physical violence perpetrated by an intimate partner (GV) was no less than 243 million worldwide. The report also highlights countries where GV cases have surged during the pandemic. For example, France reported a 30% increase in domestic violence cases since the lockdown, while Cyprus and Singapore saw a 30% and 33% increase in helpline calls. Argentina reported a 25% increase in emergency calls for domestic violence cases since the beginning of the lockdown. Government authorities, women’s rights activists, and civil society partners in Canada, Germany, Spain, the UK, and the USA have also reported increasing reports of domestic violence during the crisis (UN, 2020). The report mentions that essential services responding to GV experienced increased pressure due to the escalation of violence during the pandemic. For instance, in Australia, a survey revealed that 40% of frontline workers reported requests for help by survivors, and 70% reported that the cases received have increased in complexity during the COVID-19 outbreak (UN, 2020).

Racialized Disaster Patriarchy

In this section, we will explore the idea of racialized disaster patriarchy in connection with the effects of COVID-19 and gender violence (GV). Naomi Klein (2005) introduced the term “disaster capitalism,” and Rachel Luft (2016) further developed this concept by introducing the idea of racialized disaster patriarchy (Luft, 2016) as a framework for understanding the political economy of disasters. This term encompasses the “political, institutional, organizational, and cultural practices that converge before, during, and after disaster to produce injustice.” Racialized disaster patriarchy “links the intersectional experience of disaster to the experience of recovery and the politics of the grassroots social movement for a just reconstruction” and explores how multiple systems of oppression, including racism, capitalism, and patriarchy, intersect and intensify during and after disasters (Luft, 2016, pp. 1-2). Racialized disaster patriarchy, as applied to COVID-19, manifests in several ways, including the disproportionate impact on historically marginalized communities, the rise in gender violence, the unequal access to healthcare, the deepening of economic disparities, and the limited representation and decision-making power.

Intersectionality emphasizes the importance of considering multiple forms of discrimination and oppression together rather than in isolation (Crenshaw, 1989). Pre-existing social, historical, economic, and political inequalities influence who is most affected by disasters such as COVID-19. For instance, women and people of color often have less access to resources and support, making them more vulnerable during crises. These interconnected vulnerabilities demonstrate that disasters do not occur in a vacuum but exacerbate existing disparities. Institutional and governmental responses to disasters can reinforce these inequalities. Policies and practices that do not consider the specific needs of marginalized groups can worsen their vulnerabilities, and most often, emergency response measures might fail to address the safety needs or the economic realities of communities. Amid disasters, the breakdown of social structures and the stress of crises can lead to a surge in violence.

Additionally, the isolation and economic stress caused by disasters can amplify domestic violence and other forms of GV (Bailey et al., 2017). In a 2021 article, Laster Pirtle and Wright emphasize the connections between structural racism and gender oppression in contributing to race and gender inequities during the COVID-19 pandemic. The article stresses the importance of using an intersectional analysis to comprehend the unique challenges women of color face, particularly Black women. Various studies and reports included in the article illustrate the disproportionate impact of COVID-19 on marginalized communities, particularly Black, Indigenous, Pacific Islander, and Latinx Americans, leading to higher rates of COVID-19 cases and deaths compared to White Americans. The data clearly reveal racial/ethnic health inequities, and there is a consensus that structural racism plays a significant role in these disparities. The article further explores how structural gendered racism manifests in different aspects of life, including the home, work, and healthcare. In the home, women of color, especially those experiencing intimate partner violence, faced additional challenges during the pandemic. Stay-at-home orders trapped many individuals with their abusers, resulting in a significant rise in domestic violence cases.

Additionally, women of color have been disproportionately affected by the pandemic, bearing the burden of invisible labor, such as mothering, caregiving, and household responsibilities, which has had a detrimental impact on their mental and emotional well-being. In healthcare settings, women of color experience institutional and interpersonal gendered racism, which affects the quality of care they receive. Provider biases based on race, ethnicity, and gender contribute to the health disparities women of color experience and their invisibility in the healthcare system while being mistreated and denied appropriate care during the pandemic (Laster Pirtle & Wright, 2021). In terms of work, women of color are overrepresented in essential jobs but are often not adequately compensated for their essential labor. They face occupational and employment stratification due to historical structural racism and racial capitalism. The exclusion of undocumented workers from receiving financial aid packages further intensified the economic vulnerabilities faced by communities of color.

Trans and gender non-binary people have also experienced increased discrimination and violence during the pandemic. Lockdowns and economic pressures have limited their access to gender-affirming healthcare and safe spaces, leading to heightened mental health issues and exposure to GV. A 2022 study provides a comprehensive analysis of the impact of the COVID-19 pandemic on discrimination and violence against LGBTQ+ communities. The study shows that various subpopulations within the LGBTQ+ community, including disabled people, immigrants, and those with lower socioeconomic status, experienced equal or higher levels of discrimination and violence. The study concludes that in addition to the upheaval caused by the COVID-19 pandemic, LGBTQ+ individuals globally continue to experience ongoing systemic discrimination and violence perpetrated by government representatives, policymakers, and healthcare providers (Adamson et al., 2022).

Hate crimes against Asian Americans sharply increased across the United States during the COVID-19 pandemic. In 2020, hate incidents against Asian Americans, and particularly Asian American women, surged by nearly 150 percent. By the end of July 2020, over 2,000 anti-Asian hate incidents were reported. Asian Americans faced COVID-related discrimination, including micro-aggressions and life-threatening physical assaults. On March 16, 2021, eight people, including six Asian American women, were murdered at an Asian-owned business in the greater Atlanta area (Stop AAPI Hate, 2022). According to Stop AAPI Hate, by the end of March 2021, over 6,600 hate incidents were reported to the tracking organization (Stop AAPI Hate, 2021). The anti-Asian rhetoric used nationally by the Trump administration was part of a long history of racism, xenophobia, and state-sponsored violence targeting Asian and Asian American communities and a carceral system that is historically and inherently responsible for violence against Black, Indigenous, and people of color (BIPOC) communities and women.

In a study published in 2022, researchers found that experiences of everyday racial discrimination are a significant risk factor for worsening mental health outcomes among Asian Americans affected by the global COVID-19 pandemic’s social consequences (Kaplan, 2023). The study suggests a strong link between Asian American self-reports of racial discrimination and depression, social anxiety, sleep disorders, and suicidal thoughts in this population. These results, along with similar studies, show that the COVID-19 pandemic has negatively affected the mental well-being of this community (Lee et al., 2022). Violence perpetrated by law enforcement officials is closely linked to historical and collective violence against historically marginalized groups. The American Public Health Association (APHA) has acknowledged law enforcement violence as a public health issue (APHA, 2018). For instance, Black men are nine times more likely to be killed by police officers than White men. During the COVID-19 pandemic, shelter-in-place and social distancing orders have often disproportionately affected disadvantaged Black and Brown communities, highlighting a pronounced disparity. State actions to enforce quarantines, such as the use of ankle monitors, tracking apps, and facial recognition, disproportionately target impoverished individuals and BIPOC communities (Kaplan & Hardy, 2020).

Migrants and refugees, including those undocumented, have faced severe economic and social pressures during the pandemic. Many have lost jobs and faced housing insecurities, making them more susceptible to exploitation and violence. The disruption of global trade and travel restrictions left many people in vulnerable situations without access to support networks or legal protections. An example of a refugee population most impacted by COVID-19 is the Rohingya, a Muslim ethnic minority group from Myanmar. The Rohingya have faced persecution and violence in Myanmar, particularly in the Northern Rakhine State, which has forced many of them to flee their homes. They are considered one of the most persecuted people in the world. The Rohingya refugees have sought shelter in neighboring countries, particularly in Bangladesh, where they live in overcrowded refugee camps. An estimated 1.2 million Rohingya refugees are staying in 34 camps outside Cox’s Bazar, a district in southeast Bangladesh. These refugees face numerous challenges, including poor living conditions, lack of access to healthcare, and limited economic opportunities (Chattoraji et al., 2021).

A 2022 article by Chowdhury et al. discusses the challenges faced by Rohingya refugees living in camps in Cox’s Bazar in accessing sexual and gender violence (SGV) services during the COVID-19 pandemic. It highlights the impact of government-imposed lockdowns and restrictions on the availability and utilization of services. The findings indicate an increase in SGV incidences among Rohingya refugees; however, survivors faced barriers in reporting and accessing services, including fear of contracting COVID-19, limited access to service centers and mobile phones, lack of trust or safe spaces, and misinformation. Healthcare providers also faced challenges in delivering SGV-related services, such as restricted access to the camps, difficulties maintaining confidentiality, communication and telehealth issues, and conflicting donor expectations (Chowdhury et al., 2022).

Disabled Oracles and COVID: Devaluing Marginalized Bodies and Minds

Even before the coronavirus pandemic, systems have always tried to kill and oppress marginalized people. Attempts to repeal the Affordable Care Act. Human gene editing. Wildfires in California. Voluntary power shutoffs by PG&E. Medicaid work requirements. Public charge rule. These crises and assaults reconfirm who is considered disposable and unworthy of assistance, resources, attention, and treatment. This time feels different for me with the very real threats of health care rationing and shortage of ventilators for critically ill patients in the United States.

(Wong, 2020)

Alice Wong, a disabled activist, writer, editor, and community organizer based in San Francisco and the founder and director of the Disability Visibility Project, brings attention to systematic inequities facing marginalized communities long before COVID-19. Wong highlights devaluation and inequities within ableist systems.

Disability activist Finn Gardiner (2020) emphasizes the harmful consequences of devaluing marginalized bodies and minds, which leads people in positions of power to treat their lives as expendable. This devaluation is rooted in systemic and societal disregard for the worth and importance of individuals from marginalized communities, often fueled by intersecting systems of oppression.

It is essential to stress the importance of using intersectional approaches to address health inequities and dismantle harmful systems of oppression and violence. We need to acknowledge and confront these harmful dynamics, advocate for a change in power structures, and dismantle systems that perpetuate the devaluation of marginalized lives. This involves prioritizing the voices and experiences of marginalized communities, advocating for their rights and well-being, and working towards a more fair and inclusive society that respects the lives of all individuals, regardless of their social identities.

What is a marginalized body? Marginalized bodies are those that are deemed “less than” by society at large: women’s bodies, trans people’s bodies, disabled people’s bodies, fat people’s bodies, old people’s bodies, Black and Brown people’s bodies. Marginalized bodies fail to conform to a stated or tacit ideal, whether that ideal is thinness, youth, or gender conformity. (2020)

Intersections Between Experiences of Long COVID and Intimate Partner Violence

The World Health Organization defines Long Covid as “the continuation or development of new symptoms three months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least two months with no other explanation” (WHO, 2022). The National Academies of Sciences, Engineering, and Medicine (NASEM, 2024a) recently published a report providing a working definition of the disease. This report is grounded in scientific papers and the experiences of individuals affected by Long Covid. Additionally, a second report from 2024 details the effects of Long Covid on individuals’ bodies, lives, and daily activities (NASEM, 2024b). The report states,

Long COVID can result in the inability to return to work (or school for children and adolescents), poor quality of life, diminished ability to perform activities of daily living, and decreased physical and cognitive function for six months to 2 years or longer after the resolution of acute infection with SARS-CoV-2. Increased number and severity of long-term health effects correlates with decreased quality of life, physical and mental (p. 218).

There exists a significant gap in research regarding the intersections between Long Covid and intimate partner violence. Such research requires immediate attention to better understand and tackle the potential impact on individuals and communities. Fitz-Gibbon et al.’s (2024) survey explored the unique experiences of 28 Australian COVID survivors who had also experienced intimate partner violence (IPV). The report aimed to recognize the intersections of ableism, chronic illness, and gender violence. The participants expressed the struggle of losing control over their health, which subsequently led to a loss of control over their safety within their relationships. The report states,

Aligning with previous research on chronic illness and experiences of IPV, this study illustrates how chronic health conditions, in this case, long COVID, dramatically shape the nature, prevalence, and impact of abuse experienced by victim-survivors. Of the 28 victim-survivors who participated in this study, one-quarter said they experienced partner abuse for the first time in their relationship following their long COVID diagnosis. For those victim-survivors who had experienced abuse in their relationship prior to their long COVID status, roughly half said that the abuse changed in severity following their diagnosis, and one-third said it changed in frequency. Nearly 70 percent said the types of abusive behaviors perpetrated by their partner changed following their diagnosis. The abusive behaviors reported in this study illustrate how perpetrators often weaponize health conditions to perpetrate abusive and controlling behaviors within relationships. Taken together, the experiences of the victim-survivors in this study underscore that experiences of IPV are highly contextual, and they illustrate how perpetrators can utilize a deterioration in a person’s health to inflict new and intensified forms of abuse within relationships.

(Fitz-Gibbon et al., 2024, p. 34)

Movement-Building Responses to COVID-19:
Collective Protection to Address Underlying Structural Inequities

The root causes of gender violence (GV) stem from interconnected forms of structural violence. Racial and ethnically minoritized groups, LGBTQIA+ individuals, and disabled people often face higher rates of GV due to intersecting forms of discrimination and oppression. The COVID-19 pandemic has magnified existing risks of gendered and racialized violence, harm, and abuse. The exclusion of marginalized communities and women’s organizations perpetuates racial and gender inequalities and hinders the development of effective, inclusive, and accessible humanitarian and public health systems. Discussing the work of Just Associates (JASS), a feminist movement support organization that strengthens the leadership and organizing capacity of community-based women networks in Southern Africa, Southeast Asia, and Mesoamerica; Okech et al. (2022) argue that the response to disease outbreaks, including COVID-19, has disproportionately ignored gender and lacks a comprehensive power analysis accounting for gender, age, disability, ethnicity, and other intersecting factors. The insufficient intersectional response is apparent in the disparity between addressing local issues and priorities and meeting the demands of funding agencies and donors. There is also a lack of comprehension of gender and human rights-based approaches to program planning and implementation, which leads to these communities being viewed only as victims rather than active participants in transformative change. A collective protection framework was developed from feminist movement-building work in JASS’s three regions as a response to the increasing violence targeted at Women Human Rights Defenders (WHRDs) and the need for strategies to protect and empower women in collectives.

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Further Learning

Cannon, C. E. B., First, J., Ranjit, Y., & Houston, J. B. (2024). U.S. changes in intimate partner violence during the COVID-19 pandemic. Journal of Loss and Trauma, 30(3), 396–413. https://doi.org/10.1080/15325024.2024.2366877

Eger, H., Chacko, S., El-Gamal, S., Gerlinger, T., Kaasch, A., Meudec, M., Munshi, S., Naghipour, A., Rhule, E., Sandhya, Y.K., & Uribe, O.L. Towards a feminist global health policy: Power, intersectionality, and transformation. PLOS Glob Public Health, 2024 Mar 7;4(3):e0002959. doi: 10.1371/journal.pgph.0002959. PMID: 38451969; PMCID: PMC10919653. https://pmc.ncbi.nlm.nih.gov/articles/PMC10919653/

Roy, A. (2020, April 3). The pandemic is a portal. Financial Times.