Ten. A number typically used to define a perfect woman. However, in the era of a global pandemic, women are more associated with an imperfect reality. Ten defines the number of recommendations proposed by the North Carolina Council for Women Advisory Board after interviewing a diverse set of women affected by the COVID-19 pandemic.
The Council’s report, “Exploiting Inequity: A Pandemic’s Gendered and Racial Toll on the Women and Families of North Carolina,” analyzed the effects of COVID-19 on women in North Carolina, with a lens on women of color [1]. Members of the all-female advisory board knew from personal experiences and news reports that suffering was apparent. However, additional testimonials would make the case. The Council identified a range of diverse subjects across the state, including rural areas, and began a process of discovery, surveying these real people about how the pandemic was affecting their lives. We gathered firsthand accounts of women managing change in everyday life as they knew it.
Echoing the sentiments of many of the women we spoke to, Vivette Jeffries-Logan, an equity consultant and member of the Occaneechi Band of the Saponi Nation, said, “In any Indian community, if you ask, ‘how does anything get done?’ it lies with the women” [1].
Our research demonstrated the staunch reality that North Carolina, like many other states, was unprepared to protect the needs of its most vulnerable population: low-income, uninsured women from low-wealth communities. Women and mothers, many living in food deserts, were now forced to quarantine, with limited access to education, work, temporary safety, and healthy food options.
Let’s reflect for a moment on how the pandemic exacerbated existing social and economic inequities and disrupted progress toward equity for women’s quality of life in our state. Women in North Carolina represent 52% of the state’s COVID-19 cases and 49% of deaths [2]. In line with other health disparities, the virus has taken a disproportionate toll on Black and Latino North Carolinians. Black North Carolinians make up 22% of our state’s population but account for 30% of the virus’s deaths [2]. Latino individuals account for only 10% of our population but comprise 31% of COVID-19 cases in the state [2].
During our research, we heard from Roxana, a small business owner and single mother who is also caring for her elderly mother with health issues. They reside in the rural town of Warsaw, in Duplin County, where the uninsured rate for people under 65 is 22% [3]. We learned the plight of her business clients. They work in meatpacking or other manufacturing, make below a living wage, and during the peak of quarantine were expected to go to work, often tightly packed alongside people with the virus. Many of them are mothers who also face child care barriers, as daycare centers faced closings or staff shortages due to sick employees with no insurance.
No reflection is complete without acknowledging the direct impact of the lack of Medicaid on women in the state. The Council’s report reminds us that outside of employer-based coverage, North Carolina is one of only 12 states to not expand Medicaid, leaving many low-income North Carolinians uninsured, with women and women of color disproportionately affected [1]. The issue of Medicaid expansion has been pushed to the forefront as the pandemic has disproportionately impacted women and communities of color. Without health insurance, single mothers, pregnant women, interpersonal violence victims, and those with mental health issues are left particularly vulnerable [4]. Additionally, according to the North Carolina Department of Administration’s Andrea Harris Social, Economic, Environmental, and Health Equity Task Force (2020), the choice to not expand Medicaid has resulted in a loss of $39.6 billion in federal Medicaid funding and $11.3 billion in hospital reimbursement [5].
With all the loss experienced during the COVID-19 crisis, many consider depression and grief the “new” disability. This is the sobering reality of the physical, mental, and emotional effects of the pandemic.
Who cares?
If there is care for the economy, and if there is concern for a healthier, safer North Carolina, listen to the voices of the women in our state, who are in a state of crisis. From the impacts of poor health, poor living conditions, and low wages to child care woes, senior care issues, and stress, our economy remains at risk. However, solutions exist. Invest in our state’s most precious resources: women, among them mothers, educators, frontline workers, first responders, child care providers, and home economists.
Recommendations include achieving universal health care coverage; mandating paid leave; protecting public health; sustaining CARES Act levels of funding through the American Rescue Plan, benefitting victims of domestic violence and sexual assault and providing emergency support for child welfare; adequately protecting and compensating essential workers; and supporting female, Black, Indigenous, Latino, and other people-of-color business owners. The “Exploiting Inequity” report also recommends taking steps to protect youth, some of the most at-risk members of the community, by developing a coherent, statewide strategy for safe and effective schooling.
To further assess what’s needed for women’s full economic participation, a closer look at access to health insurance coverage, educational attainment, and business ownership is necessary. The Council for Women explores these factors that lead to economic progress in its “Poverty and Opportunity” Report, to be released in January 2022.
The NC Council for Women & Youth Involvement is also committed to achieving equity by advocating for policy changes to improve wellness and the quality of life for women and families. Learn more about the status of women in North Carolina at the Council for Women & Youth Involvement website [6].
Acknowledgments
Disclosure of interests. A.T. is chair of the NC Council for Women Advisory Board. No further interests were disclosed.
- © 2022 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.
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