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COVID-19 is continuing to cause serious issues, and one that has gotten a lot of attention is the substantially higher fatality rate in men.^[1]

This is a very serious issue, and may be influenced by a wide variety of factors. For example, men are more likely to have chronic diseases that worsen outcomes (such as heart disease, high blood pressure, and liver disease), and have a variety of differences in immune response compared to women.^[2][3][4][5]

Part of what we strive to do at Examine.com is shine a light on health issues that don’t get as much coverage, using peer-reviewed evidence. And over the past month, we haven’t seen much on certain health challenges that disproportionately impact women, and are exacerbated by the pandemic.

Of course, not all these issues are exclusive to women. Rather, women tend to face a higher stress and health burden from them, and rarely are they collectively discussed. Here are a few examples:

1. Invisible illnesses are especially difficult now

An invisible illness is simply a medical condition that isn't easily seen by others. Hence, it’s rare for anyone in your daily life to truly know what you’re going through.

The term usually refers to conditions that significantly impact daily life, and are complex and difficult to treat. Examples include fibromyalgia, chronic fatigue syndrome, endometriosis, depression, and migraine headache.

Unfortunately, not only are invisible illnesses more prevalent in women, but women’s health concerns are more commonly dismissed at doctor’s offices, such as with chronic pain.^[6][7]

Now, with the pandemic ongoing, it can be harder to diagnose and treat already difficult invisible illnesses. It’s not as easy to make doctor’s appointments and get transport to those appointments, and medical costs may be an issue if jobs are impacted.

Those invisible illnesses that occur only in women can be especially tough, because half the population will never be able to relate to those situations. For example, women with endometriosis reported significantly more pain and stress than women with migraine headaches, which is likely influenced by endometriosis not being well-known by society at large.^[8]

It’s hard having a condition like endometriosis or fibromyalgia, which nobody can see yet are life-disrupting. But having such a condition during a pandemic is especially difficult because of issues such as medical care considerations, overall stress levels, and limited finances.

2. Care work is underappreciated and stressful

Taking care of just yourself is hard enough. Add these in one or more of these stressors, and mental health can easily spiral downwards:

• School-age children are at home every day, while you're now working from home every day.

• You’re taking care of elderly parents, who have chronic conditions that would make COVID-19 complications more severe.

• Balancing your budget becomes difficult, as income is lower and costs are higher.

• You’re lacking enough free time and personal space to keep yourself sane.

Nearly 1.4 billion children are out of school or daycare worldwide, and the increased parenting responsibilities can get extremely complicated.^[9]

Before the epidemic, research showed that women spend at least 5-10 more hours per week on child and elder care, compared to men^[10][11] During the epidemic, those numbers may be even higher. Care work is both under-appreciated and difficult, adding a major source of stress to the lives of women around the world, especially when caring for children or parents with health conditions.^[12][13]

Care work has always been underappreciated, and women usually spend more hours on it. The epidemic can easily increase the amount of care work needed, which is a burden that’s likely to fall to women.

3. Female healthcare workers face extra challenges

It’s estimated that over 70% of healthcare workers in the US are women.^[14]

One study (from China, not the US) showed that female healthcare workers had more severe effects on mental health during the COVID-19 pandemic.^[15] A study from before the pandemic showed that female physicians (from countries around the world) are significantly more likely to commit suicide than women in general, while male physicians are significantly less likely to commit suicide than men in general.^[16]

Perceptions in the workplace can also present extra challenges. In one study, 76% of patients who encountered male physicians assumed that they were actually physicians, while only 58% assumed that female physicians were.^[17] Even among healthcare workers themselves, there’s a persistent belief that women are less committed to their medical careers, and are less effective as leaders.^[18]

Healthcare workers are literally saving the world right now. Women in healthcare face additional challenges that can compound already high stress levels.

4. Pregnancy and family planning are tough to navigate

There are several issues related to pregnancy during the pandemic.

First, if a woman was pregnant in the months leading up to the pandemic, the stress of giving birth will be compounded by the stress of being in a hospital during the pandemic. Not mention caring for an infant in a pandemic-stricken world.

While some reports suggest that newborns cannot be infected my mothers,^[19] others report that it may be possible.^[20]

Also, postpartum blues and postpartum depression already affects a substantial number of women,^[21] and those numbers are likely to go up during the pandemic.

The second issue relates to family planning. If a couple decides to have children, those plans may be altered during the pandemic, causing stress. The normal course of family planning may be interrupted.

For example, a positive pregnancy test may not cause the same emotional reaction now as before the pandemic. It's even possible that some women be less willing to obtain pregnancy tests or their preferred methods of birth control, due to increased logistical difficulties, compared to before the pandemic.

As if pregnancy and child rearing wasn't stressful enough, many women are doing it during a pandemic with several unknowns on the horizon. Postpartum depression may become even more of an issue.

5. Domestic violence is an even greater concern than usual

If a woman can't escape an abusive home environment because of physical distancing restrictions or financial dependence (or just lack of options for where to stay), domestic violence can erupt more easily.

Preliminary reports from around the world have suggested a 30% to 50% increase in domestic violence reports during the pandemic.^[22]

Informal support channels such as friend and family circles may be less available, in addition to formal channels such as therapy and support group meetups. Perpetrators may also be more likely to drink excess alcohol and consume illicit drugs during this stressful time, especially if job hours are reduced or eliminated, further increasing the chances for domestic abuse.

For victims of domestic violence, support systems and options are much more limited now.

Keep in mind that it’s quite possible to face more than one of the stressors on this list. When combined with other factors like inadequate sleep, overall stress levels can be substantial. So if you know someone who could use a friend to talk to, or support of any other kind, get in touch with them!