Discussion: Gender differences in COVID-19 attitudes and behavior

By: Anjali Mediboina

Final Year Student, ASRAM

A while ago, I had the opportunity to attend a Journal Club Meeting organised by JAMSA (Journal of Asian Medical Students’ Association) and hosted by AMSA Indonesia. The meet called for active participants, who could present any research that interested them. While searching for papers I could present, I came across an original research paper, “Gender differences in COVID-19 attitudes and behavior: Panel evidence from eight countries” by Vincenzo Galasso, et al[1]. 

The title immediately caught my eye; till then, I had never considered that there could be a gender component in the compliance with the COVID-19 protocols, and this line of thinking intrigued me. 

About the Study:

This was a longitudinal study that measured the behavior of people over time, including their thoughts, feelings, and emotions[2](i.e. a panel survey), and collected data from 8 countries: Australia, Austria, France, Germany, Italy, New Zealand, the United Kingdom, and the United States. The study asked questions such as:

• How serious they expected the health consequences of COVID-19 to be in their country. 
• Whether they agreed with several public policy measures discussed or already implemented (such as closing schools; stopping public transportation; closing borders; mandated mask usage in public, etc.).
• Their current level of compliance with the COVID-19−related health and social distancing rules.

The survey also collected a wide range of sociodemographic and attitudinal factors.

Broadly, the study found that: 

• Women are more likely to perceive COVID-19 as a very serious health problem, to agree with restraining public policy measures, and to comply with them. 
• Differences in beliefs and behavior between men and women are smaller among younger individuals and increase as people become older.
• The gender difference in compliance with health and social distancing measures is smaller among people with a higher income.
• There was no significant difference across different levels of education.

The authors of the paper also speculated that these gender differences could be correlated with the higher rates of infections and deaths due to COVID-19 in men, and also, the more effective response to the pandemic by women-led countries, such as Germany and New Zealand, as compared to USA and Brazil.

My Observations

After going through the study, my initial thoughts were in agreement with it; I did notice that the men in my immediate family were not as serious about the virus when compared to the women. At the same time, I did notice that the men with younger children, pregnant wives, or elderly dependents with co-morbidities (paralysis, cardiac patients, etc.) were extremely cautious and concerned about the virus.

I then proceeded to ask my friends and colleagues about their thoughts- did they think there was a difference in the way people in India followed the COVID-19 measures based on gender?

To my surprise, I was met with a resounding “No.”

A majority of them felt that (in India) the aspect of gender in terms of behaviors towards the COVID-19 protocols is something that is not relevant at all. Their line of reasoning was that everyone was equally reckless, both women and men. They also pointed out that rather than gender, there are many more factors that do influence the behaviors and attitudes, such as:

• Time: People initially followed the COVID-19 measures at the start of the pandemic, but the compliance decreased with the course of time.
• Level of awareness: many might not have been as aware of the impacts of the virus; a friend gave the example of her mother, whose only information regarding COVID-19 came from the discussions in the family. 
• Cases of exposure to the virus within the family: Many pointed out that those who had seen the firsthand effects of the virus- the isolation, ill-effects to health and the deaths- tended to take the virus more seriously than others.
• Location: Others mentioned that in areas and localities where the virus prevalence was low, there would naturally be less compliance with the precautionary measures. 

Many also felt that the only time gender could be considered is with regard to the rates of exposure; they pointed out that in India, it is usually the men in the family who have to go out for work and buy groceries and necessities, and therefore had a greater risk of contracting the virus. 

Other Literature 

Armed with two sides of the argument, I decided to do a quick literature search to see if there were any similar studies. I used Google Scholar and PubMed, with the following keywords:

[gender based+behavior+covid]; [gender based+behavior+covid+india].

I found multiple studies based in Saudi Arabia that explored the topic; for example, “Prevention Knowledge and Its Practice Towards COVID-19 Among General Population of Saudi Arabia: A Gender-based Perspective” by Freah Alshammary et al[4]. found that women not only carry better knowledge, but their practicing behavior is far better than the male respondents. 

Another study “Anxiety, Self-Compassion, Gender Differences and COVID-19: Predicting Self-Care Behaviors and Fear of COVID-19 Based on Anxiety and Self-Compassion with an Emphasis on Gender Differences” by Mohsen Mohammadpour, et al[5]. in Kemensah, Iran also found that there was a significant relationship between social distancing and gender; women are more likely to observe the social distancing, which can be due to a variety of reasons, such as women’s greater responsibility or more significant concern about the disease and its transmission to family members.

A review by Róbert Urbán et. al[6]. entitled “Who complies with coronavirus disease 2019 precautions and who does not” also noted that in almost all studies, men and the younger population showed less adherence[to the protocols]. 

Coming to literature from India, I could only find one study: “Gender specific differences in COVID-19 knowledge, behavior and health effects among adolescents and young adults in Uttar Pradesh and Bihar, India” by Jessie Pinchoff et al[7]. To my surprise, this particular study had results completely opposing whatever I had read till now: “While most participants had high awareness of disease symptoms and preventive behaviors, there was variation by gender. Compared to men, women were seven percentage points (pp) less likely to know the main symptoms of COVID-19. Among women, there was variation in knowledge by education level, urban residence, and household wealth. Women were 22 pp less likely to practice key preventive behaviors compared to men.”

Do note that 70% of the respondents of this particular study were women.

Conclusion

Here, I suppose it must be mentioned that only one paper is available on this subject in India, and that too, the data was collected at the start of the lockdown. Nevertheless, the findings of the study corroborated with the general feelings and observations of my peers. 

I find it quite interesting that the same social norms created an exact opposite observation with respect to COVID-19 lockdown in India. I believe that these opposing views stem from two things: 

1. The literacy gap that still prevails: The NSO released a report entitled ‘Household Social Consumption: Education in India’, as part of the 75th round of National Sample Survey (July 2017 to June 2018)[9]. It reported that while literacy rates went up, male literacy rate was higher (84.7%) than the female literacy rate (70.3%).

This gap not only exists between men and women, but also between the youth and elderly, with only 42.7% of adults in India in 2015 being literate[10]. As pointed out by Tanushree Chanda in her paper, “Literacy in India: The gender and age dimension[11]”, ‘the progress that India has made in the realms of child and youth literacy often gets offset by its poor performance in the literacy of older adults.’ 

2. The social norms in India: This was something that was mentioned in a paper published in 2009, regarding the H1N1 infection[12]: aside from higher literacy rates, men had more social interactions through employment, and therefore had more knowledge about the H1N1 virus.

Even now, a similar trend can be seen, as noted in the paper by Jessie Pinchoff et al., and was also pointed out by several of my friends: in general, men in India go out more and therefore are more aware. Whereas, women tend to stay in their homes (in 2019, data showed that only 21% of women contribute to the workforce[13]) thus limiting their social interactions and information about the outside world. 

I’ve always been interested in the effects of sex and gender on our behavior and thoughts. In fact, the effects of gender on social behaviors is the subject of a wide variety of papers, most popularly, Alice H. Eagly’s “Sex differences in social behavior: A social-role interpretation[14]”, which traces the roots of gender based differences in behavior to the social norms and roles expected by men and women. 

The effects of these societal expectations can clearly be reflected in the behavior and attitude towards the COVID-19 protocols, as evidenced by the above mentioned papers.

I would say that more literature on the subject (with respect to India) is definitely required; The information obtained would be essential in helping the government and NGOs create more targeted information campaigns. Also, these studies would bring about more awareness and promote more discussions on gender norms and their effects on people. Either way, it will be extremely beneficial in ensuring that health equity is sustained.

References

1. Galasso V, Pons V, Profeta P, Becher M, Brouard S, Foucault M. Gender differences in COVID-19 attitudes and behavior: Panel evidence from eight countries. Proceedings of the National Academy of Sciences. 2020 Nov 3;117(44):27285-91.
2. What is a panel survey? | SurveyMonkey [Internet]. SurveyMonkey. [cited 22 August 2021]. Available from: https://www.surveymonkey.com/market-research/resources/panel-survey/
3. Locher J. Masked and unmasked pedestrians walk along the Las Vegas Strip, Tuesday, April 27, 2021, in Las Vegas. [Internet]. 2021 [cited 2 September 2021]. Available from: https://apnews.com/article/cdc-mask-wearing-guidance-d373775ddcf237764c19ff9428b59634
4. Alshammary F, Siddiqui AA, Amin J, Ilyas M, Rathore HA, Hassan I, Alam MK, Kamal MA. Prevention knowledge and its practice towards COVID-19 among general population of Saudi Arabia: a gender-based perspective. Current pharmaceutical design. 2021 Apr 1;27(13):1642-8.
5. Mohammadpour M, Ghorbani V, Khoramnia S, Ahmadi SM, Ghvami M, Maleki M. Anxiety, self-compassion, gender differences and COVID-19: predicting self-care behaviors and fear of COVID-19 based on anxiety and self-compassion with an emphasis on gender differences. Iranian Journal of Psychiatry. 2020 Jul;15(3):213.
6. Urbán R, Király O, Demetrovics Z. Who complies with coronavirus disease 2019 precautions and who does not?. Current Opinion in Psychiatry. 2021 Jul;34(4):363.
7. Pinchoff J, Santhya KG, White C, Rampal S, Acharya R, Ngo TD. Gender specific differences in COVID-19 knowledge, behavior and health effects among adolescents and young adults in Uttar Pradesh and Bihar, India. PloS one. 2020 Dec 17;15(12):e0244053.
8. Telangana Today. Telangana imposes Rs 1000 penalty on not wearing face masks [Internet]. 2021 [cited 2 September 2021]. Available from: https://telanganatoday.com/telangana-imposes-rs-1000-penalty-on-not-wearing-face-masks
9. Household Social Consumption: Education in India [Internet]. Mospi.nic.in. 2018 [cited 29 August 2021]. Available from: http://mospi.nic.in/sites/default/files/publication_reports/Report_585_75th_round_Education_final_1507_0.pdf
10. India Elderly literacy rate, 1970-2020 – knoema.com [Internet]. Knoema. [cited 29 August 2021]. Available from: https://knoema.com/atlas/India/topics/Education/Literacy/Elderly-literacy-rate
11. Chandra T. Literacy in India: the gender and age dimension. Observ Res Foundation. 2019 Oct 31;322.
12. Kamate SK, Agrawal A, Chaudhary H, Singh K, Mishra P, Asawa K. Public knowledge, attitude and behavioural changes in an Indian population during the Influenza A (H1N1) outbreak. The Journal of Infection in Developing Countries. 2010;4(01):007-14.
13. Labor force participation rate, female (% of female population ages 15+) (modeled ILO estimate) | Data [Internet]. Data.worldbank.org. [cited 30 August 2021]. Available from: https://data.worldbank.org/indicator/SL.TLF.CACT.FE.ZS
14. Eagly AH. Sex differences in social behavior: A social-role interpretation. Psychology Press; 2013 May 13.