Gender and the Impact of COVID-19 on Demand for and Access to Healthcare: Intersectional Analysis of Before-and-After Data from Kenya, Nigeria, and South Africa

Background: Global health emergencies can impact men and women differently due to gender norms related to healthcare, social, and economic disruptions. We investigated the intersectionality of gender with educational and socioeconomic factors in the impact of COVID-19 in Kenya, Nigeria, and South Africa.Methods: Data were collected by Opinion Research Business International using census data as the sampling frame. We used conditional logistic regression to estimate the change in access to healthcare after the pandemic among men and women, stratified by educational level. We also examined the change in demand for various healthcare services, stratified by self-reported experience of financial difficulty due to the pandemic.Findings: Among those who reported a need to seek healthcare in South Africa, there was statistically significant decline in the ability to see a healthcare provider during the pandemic among women but not among men; this gender gap was more evident in the group that did not have post-secondary education (OR=0.08, p=0.04 for women; no change for men) than for those with post-secondary education (OR=0.2, p=0.24 for women; OR=0.5, p =0.69 for men). South African women who were financially affected had a significant decline in seeking preventive care during the pandemic (0.23, p =0.04). No conclusive effects were noted in Nigeria or Kenya.Interpretation: In South Africa, the pandemic and its strict control measures have adversely and disproportionately impacted disadvantaged women, which has implications for the nature of the long-term impact as well as mitigation and preparedness plans.Funding: Bill and Melinda Gates FoundationDeclaration of Interest: None to declare.