Effects of Covid-19 Pandemic on Women’s Mental Health: A Critical Review of Literature

Abstract

Although COVID-19 has affected both men and women, it seemingly has impacted on women’s mental health in peculiar ways, specifically in terms of varying forms of abuse such as increased gender-based violence (GBV), which dehumanizes women. Across the globe, women have been notable victims of gender-based violence, but the surge of COVID-19 has worsened the records of GBV. Therefore, this chapter provides a critical review of literature conducted through three database sites: Google Scholar, Research Gate, and Sage based on researches published across 2020–2022 (and other available data documents) in relation to the effects of COVID-19 on women’s mental health. Based on the reviewed articles, recommendations were made for strategic adjustment, particularly for policy makers and for women themselves to be more proactive in being agentive toward self-protection and advocacy.

1. Introduction

The COVID-19 pandemic has had a major impact on the mental health and well-being of many vulnerable groups [1] of which women are among those most heavily affected [2]. Although COVID-19 seems to hit men harder than women, based on the fact that fatality rate for men who have contracted virus is 60–80% higher than for women [3], its continual spread around the world has severely impacted on women [3, 4, 5]. This severe effect is largely manifested through lockdown situations, which apart from affecting women’s employability, have also exacerbated risks of violence, exploitation, abuse, or harassment against women [6]. The assumption regarding the severe effect of the pandemic on women is based on the fact that any global/national/local emergence is a risk factor that tends to escalate gender-based violence (GBV) [1, 4, 5], of which COVID-19 is no exception. In this perspective, United Nations Population Fund [7] in conjunction with European Parliamentary Forum for Sexual & Reproductive Rights [8] projected that gender-based violence has increased due to COVID-19 lockdown making it difficult for women to have safe shelter and support.

Hence, the reality is that the restriction of movement as governments’ containment measure to control the spread of the virus has compelled women/girls to spend longer period of time with their perpetrators, resulting in sustained experience of greater gender-based violence, exploitation, abuse, or harassment [3, 9]. Put in another form, the UNFPA has warned that women are more likely to face domestic violence behind closed doors during lockdown due to Government restrictions on movement, that is “the stay at home” measures to curb the spread of the disease, especially at a period when counseling and support services may be limited [10].

In this chapter, GBV is presented as the outcome of unequal and unjust social conditions based on gender relations [11], facilitated by the limited mobility during the COVID-19 safety protocol across the globe [9, 12, 13, 14]. Tentatively, the hub of the risk factor escalating the increased GBV experience for women is leveled on the nationwide lockdown safety protocol. Hence, this chapter focuses on exploring how confinement to the home environment has contributed to the increased gender-based violence that women encountered during the COVID-19 pandemic and its impact on their mental health.

As part of the presentation, the chapter makes some recommendations, proposing that women become more proactive in terms of self-protection. In addition, policy makers ought to device further ways of ensuring that perpetrators of GBV are re-oriented toward self-transformation in order to foster safer environment for promoting dignity for all.

2. The global narratives

Across the globe, there were increased narratives revealing incidences of GBV within the context of COVID-19 pandemic. The report from United States reflects that there was significant increase in gender-based violence and domestic violence during the period of COVID-19 lockdown. For instance, UN Women Australia global report emphasized that prior to the COVID-19 pandemic, one out of every three women/girls experienced gender-based violence, but during the pandemic, the situation worsened to one out of every two women/girls [15]. UN Women/UN Women Count report affirms such recordings indicating that women encounter GBV directly or indirectly during the COVID-19 pandemic [5]. Furthermore, UNFPA reported that although the lockdowns, curfews and other restrictions during the COVID-19 pandemic were measures taken to increase the safety of all, these measures were rather sources of increased risk of violence and death for women/girls [15]. The report went further to express that the number of women/girls aged 15–49 years who experienced sexual or physical violence by an intimate partner before the pandemic were 243 million across the globe [15]. But within the context of the pandemic, the figures have almost doubled [16, 17]. However, these figures may change after the pandemic, though that might not be certain.

The report emphasized that the exacerbating factors were due to security, health and money worries, cramped living conditions, isolation from abusers, movement restrictions, and deserted public spaces [15]. Whatever the reasons were, the essential fact is that women/girls’ mental health was gravely impacted upon and such is worrisome. In a more recent document, UN Women and UNDP report stated that COVID-19 has deepened a trio of interlocking crises that threaten women and girls around the world [4, 5], as could be seen in spiking levels of gender-based violence, steep losses of employment, and unmanageable increase on unpaid work care. Interestingly, these three levels of threats are very important. But this chapter strictly addresses the issue of increased levels of gender-based violence in terms of reviewing published research that reports gender-based violence during the pandemic and its impact on women’s mental health and what possible options women and the wider society ought to engage in, in order to tackle such a menace [18].

Focusing on global statistics, specific narratives across nations are not encouraging; for instance, the statistics from Brazil show an increased incidence of domestic violence to the tone of 40–50% during the pandemic period [19]. In France, in addition, the report says that there is a 30% increase, and the report from Spain indicates an 18% increase [20, 21]. Across the Arab world, it was noted that GBV rates increased during the COVID-19 pandemic in many Arabic countries such as Lebanon, Syria, Jordan and Iraq [22, 23, 24]. In the Palestinian context, it has been reported that 37% of women were exposed to violence, while 58.6% of them experienced psychological violence, 23.5% encountered physical violence, 11.8% had sexual violence, 54.8% encountered social violence, and 55.1% encounter economic violence [25]. For China, the police reports of domestic violence were three times higher in February 2020 compared to reports from the previous year [26]. In Africa, the story is not different, and the report expresses that there is increase in gender-based violence during the heat of the pandemic [12, 14, 27]. The situation in Nigeria reflects the global trend of increased gender-based violence. GBV is reported to have significantly increased since the lockdown began in the three most affected areas (Lagos State, FCT, and Ogun State) by March 30, 2020 [12]. The Lagos State Domestic and Sexual Violence Response Team [28] reported a threefold increase in the number of telephone calls received through their hotlines in 1 month. In particular, service providers have reported sharp increases in cases of intimate partner violence and domestic violence.

The reality is that, in the face of such daunting experiences, women/girls are caught in the continuous web of ever struggling for equity as expressed in SDG goals. Therefore, this chapter particularly focuses on exploring the different forms of gender-based violence women/girls encountered during the pandemic as reflected in published articles between the years 2020 and 2022. However, particular attention is paid to African context based on the author’s research interest and location.

3. Method

This chapter conducted a critical literature review of articles published between 2020 and 2022 aimed at exploring effects of COVID-19 on women’s mental health. Consequently, a systematic search was conducted across three databases, namely Google Scholar, Research Gate, and Sage using the search term COVID-19 and/or coronavirus or pandemic, women’s mental health, and gender-based violence including Africa. The rationale for focusing on Africa was based on the authors’ contextual location using index-term definitions, dwelling on the authors’ knowledge of the topic under investigation. The time parameters of the search were January 2020 to August 2022. Research Gate like Google Scholar is an aggregator database, referring to the fact that it includes content from various publishers (referring to different journals and databases). Thus, the rationale to opt for these two databases was based on the fact that they provide access to a large scope of work, which might have been excluded in more focused databases. Sage journals were included as it is a database that covers social and behavioral sciences, including our interest on women’s mental health and gender-based violence. We sourced 25 articles from Google Scholar, Research Gate had 13, and Sage had 8 articles. Articles were screened and only articles (and reports/reviews) that had these keywords in their titles or abstracts were considered in the current chapter. Articles that were duplicated in terms of being published in more than one database were merged. In this context, we opted for one instead of reviewing the two. Articles selected for retrieval were independently assessed by two authors for conceptual rigor. Two reviewers were included to avoid bias. Working together in pairs enable verification and contributed to apt possible level of methodological rigor. Statistically, the review included seven published articles in relation to women’s mental health and COVID-19, revealing how COVID-19 has facilitated varying degree of gender-based violence in Africa. The criterion for inclusion or exclusion of reviewed articles was based on content analysis of which article aligns itself with the thematic focus of the chapter. In addition, only articles focused on Africa were included (Figure 1).

Figure 1.

PRISMA flowchart of reviewed articles.

Based on the thematic analysis, the review is presented in one key theme of COVID-19 movement restriction and its implication for heightened gender-based violence and impact on women’s mental health. This one key theme is expressed via three sub-themes as follows: Women’s emotional and physical abuse, sexual abuse, and economic challenges.

4. Review report of gender-based violence during the COVID-19 pandemic

As stated earlier, the review from previous literature is presented in one board theme: Women confinement and gender-based violence during COVID-19 pandemic, reflecting women’s emotional and physical abuse, sexual abuse, and financial abuse. Generally, these three sub-themes captured some of the contextual confinement experience that women across Africa encountered during the COVID-19 pandemic, which by extension could be similar to the experiences of women across the globe. The reviewed articles were from Ethiopia, Nigeria, South Africa, and Tunisian. The findings are presented in Table 1. Reviewed Articles, reflecting the thematic summary findings of the reviewed articles with emphasis on how the movement restriction has led to heightened increase of gender-based violence during the COVID-19 lockdown.

S. No.	Authors	Title	Research design	Major findings	Sub-theme 1: Emotional abuse	Sub-theme 2: Economic	Sub-theme 3: Sexual	Intervention
1.	Ndlovu et al. (2022) [27]	COVID-19 impact on gender-based violence among women in South Africa during lockdown: a narrative review	Literature Review (Mini Review)	COVID-19 restricted movement heightened women’s experiences of gender-based violence	Psychological distress among GBV victims is exacerbated mainly by social isolation during the pandemic lockdown	Other factors that aggravate violence are economic-related as women were forced to remain in abusive relationship due to economic dependence	Heightened sexual abuse as perpetrators and victims are forced to spend long period of time together	Need to develop strategies and measures to protect victims. Government should offer free mental health counseling to victims.
2.	Dlamini (2021) [29]	Gender-Based Violence, Twin Pandemic to COVID-19	Literature review (symposium paper presentation)	Gender-based violence increased significantly in the face of COVID-19 pandemic lockdown safety measures.	Women experience heightened emotional/physical abuse in the face of lockdown measures to scrub further spread of COVID-19.	N/A	Equally women encounter greater sexual abuse during COVID-19 pandemic as they are forced to spend longer period of time with their perpetrators.	GBV requires multiprong/multi-stakeholder solution such as gender- budgeting. E.G.: engaging fiscal policy to address gender inequality. Secondly, civil society should create awareness regarding gender inequality.
3.	Sediri et al. (2020) [14]	Women’s mental health: acute impact of COVID-19 pandemic on domestic violence	Quantitative design, data collected from 751 Tunisian women	Increased GBV against women during the COVID-19 lockdown (from 4.4 to 14.8%; p < 0.001).	Psychological (emotional) abuse was the most frequent type of gender-based violence (96%)	Another form of violence that women experienced during this period was economic related (41%)	Physical abuse reflects 10%, which is linked to some kind of sexual abuse.	Strengthening strategies to protect women during periods of crisis, starting with family orientation to change mindsets for the perpetrators and victims of GBV.
4.	Allen (2021) [30]	COVID-19 and Sexual and Reproductive Health of Women and Girls in Nigeria	Literature review	Social distancing, self-isolation, quarantine and treatment had psychological outcomes that were not considered in the emergency response to the crisis in the case of Nigeria	Psychological (emotional) abuse for women and girls	Economic abuse surfacing in extreme hardship for girls and women	Sexual abuse that has resulted in unwanted pregnancies, particularly for girls.	Policy response to support/care for girls/women during crisis period.
5.	Groenewald et al. (2022) [31]	Adolescent sexual and reproductive health during COVID-19 pandemic: A mini review	Literature review focused on teenage pregnancy, sexual violence, abortion, and the barriers toward accessing SRH services during the pandemic (including contraceptives)	The literature highlighted increases in child sexual abuses in African countries during the pandemic.	Girls were emotional abused and exploited during the national lockdown restrictions.	Economic hardship arising from restricted movement left girls/women vulnerable to domestic violence, increased risk of sexual abuse and increased early marriages among girls.	Unwanted pregnancies as a result of sexual assaults on girls/women	Policy engagement to protect girls/women. Also, government to provide resources to care for teenage mothers
6.	Tadesse et al. (2020) [32]	Prevalence and Associated Factors of Intimate Partner Violence Among Married Women During COVID-19 Pandemic Restrictions: A Community-Based Study	Quantitative design, a community-base cross sectional study, sampling 617 Ethiopian women.	Findings indicate that the COVID-19 preventive measures, such as confinement have worsened the incidence of gender-based violence, particularly for women.	Results show that 22% of the participants have experienced heightened psychological (emotional) abuse emerging from GBV during the COVID-19 pandemic.	There was evidence of economic dependence, which makes women more prone to GBV abuses.	The participants have also encountered sexual abuse during the lockdown safety measures.	Government policy to promote gender equity aimed at eliminating violence against women beyond COVID-19 pandemic. In addition, accessibility of education for women should be promoted.
7.	Fawole et al. (2021) [12]	Home was not a safe haven: women’s experiences of intimate partner violence during the COVID-19 lockdown in Nigeria	Qualitative design: Case reports of women’s experiences of GBV during the COVID-19 pandemic lockdown measures.	The report identified that intimate partner violence (IPV) happened prior to COVID-19 pandemic but the severity increased during the lockdown.	Women were psychological (emotional) traumatized by their GBV abuses.	Women experienced untold economic deprivation that made them more vulnerable to GBV abuses.	Women also experienced sexual abuses.	Legal measures to prosecute the perpetrators Also societal response such as community involvement and advocacy are needed.

Table 1.

Reviewed articles.

5. Brief discussion of the reviewed articles

Literally, all the reviewed articles engaged the discourse of confinement to the home environment to describe women’s increased experience of gender-based violence during the COVID-19 pandemic [12, 14, 27, 29, 30, 31, 32]. In unison, all the seven articles (including other related reports) claimed that the safety protocol of lockdown imposed by government compelled men and women to spend longer period of time together at home, which heightened the incidences of gender-based violence. The popular argument is that the lockdown protocol has dual effect. On the one hand, it helped to control the rapid spread of the virus, by reducing the frequency of contracting the virus. But on the other hand, the limited mobility skyrocketed women’s experience of gender-based violence as men and women were forced to spend long hours together resulting to greater experience of GBV. Hence, the dominate reality is that women encountered an increased experience of GBV during the COVID-19 lockdown, which could have a lasting effect on their mental well-being. Accordingly, what follows is a summary of the predominate themes that the reviewed articles surfaced, reflecting psychological abuse embedded in emotional/physical abuses, sexual abuse and economic abuse, which all put together impacted on women’s mental health and well-being.

6. Women’s psychological abuse: emotional/physical abuses during COVID-19 lockdown safety protocol

Unanimously, all the reviewed articles affirmed that the COVID-19 safety protocol of restricted movement/lockdown worsen women’s experience of GBV [12, 14, 27, 28, 29, 30, 31, 32]. The argument is that COVID-19 pandemic and its associated safety protocol forced men and women to stay at home for longer period of time. In this context, the reality is that women who experienced violence of any kind could not even leave the house and/or seek support from others. One research narrative review based on exploring the impact of COVID-19 on South African women’s experience of GBV stated that, at the start of the lockdown in March 2020, 87,000 cases of GBV and interpersonal violence were reported, reflecting a significant increase compared to pre-COVID-19 space [28]. Although the authors emphasized that the reports did not indicate what type of interpersonal relationships or who the perpetrators were, they argued that men are often noted as the aggressors. They backed up their argument with South African President Ramaphosa’s concern during one of the COVID-19 progress report regarding seriousness of GBV and femicide, and his statement that at every three hours, a woman loses her life due to GBV in the country [28]. If a woman loses her life every three hours, such happening is horrendous and a pointer to the fact that COVID-19 has indeed facilitated heightened GBV experience for women, which no doubt impacts on their mental health and well-being. Another research finding focusing on Nigerian women’s experience of GBV during the COVID-19 pandemic reechoed the same increased reality of violence, reaffirming emotional and physical abuses [12]. In this perspective, the report reflected cases of how women have been threatened by their partners to be banished from the house and/or ostracized by their children. Such threats are sources of emotional torture for some of the women [12]. Another corroborating research finding confirms that women/girls in Nigeria were emotional tortured in the face of national lockdown, and the report clearly indicated that women/girls who were abused could not seek for help/support from others [31]. Certainly, it was in this context that some researchers have described the home as no longer a safe place to be [12]. In addition, a research report from Tunis also presents similar findings, indicating that women experience emotional torture during COVID-19 pandemic [14], which they describe as having psychological impact. In fact, the researchers claimed that 78% of cases recorded during the lockdown were de novo, meaning that these women were assaulted for the first time [14]. Hence, the researchers expressed that in Tunisia, the Ministry of Women, Family and Childhood reported that GBV during the COVID-19 pandemic rose sevenfold. These narratives were indicative of the daunting GBV experiences women across African nations have encountered, and implications will reflect on their state of mental health.

7. Women’s experiences of sexual abuse during the COVID-19 lockdown

Another devastating GBV experience that nearly all the reviewed articles reported were cases of sexual abuse during the COVID-19 lockdown. In most cases, the articles emphasized that incidences of sexual abuse arose as women encountered excessive sex demands from their partners based on the fact that they were confined to stay at home for long period of time. In regard, a sensational case report was made of a woman, who was sighted running away from her house onto the street nearly naked in the bid to escape from her husband, who according to her has had sex all night yet wanted some more [12]. The woman in her own views expressed that she has to run onto the empty street despite the lockdown restrictions because she did not want her husband to snuff out all the life in her. Furthermore, the same research reported that some women who resisted their husband’s excessive sex demands often times encounter physical beating [12]. Similar cases of sexual abuses were reflected in a mini-research review focusing on adolescent sexual and reproductive health during COVID-19 pandemic [29]. Hence, there is strong affirmation that sexual violence was on the increase across African nations during the lockdown restrictions and not only for women but also for girls and children [30]. In this regard, they reported that in Uganda, sexual violence was the “third most reported form of abuse contributing 20.1% of all the cases” [31]. Equally, their report indicated that Kenya had witnessed a significant increase of more than 80% in teenage pregnancies in 2020 compared to 2019 (Kenya Situation Report. Nairobi: UNOCHA Kenya, 2020 cited in [31]). Similarly, in Malawi, in 2020, an approximately 35% rise was noted in the number of teenage pregnancies among adolescent girls (Davies, 2020 cited in [31]).

In addition, they stated that sexual violence against girls had been reported across West of Africa including Benin, Cameroon, Côte d’Ivoire, Gambia, Ghana, Guinea, and Sierra Leone (Commonwealth Foundation [31]. In general, the dominant argument is that prevalence of sexual violence is associated with unwanted pregnancies including ever raising demand for abortion, and all of these impact on mental health and wellness of life [30]. Another study reported 22% prevalence of intimate partner sexual violence among Ethiopian women during the COVID-19 pandemic lockdown [30]. Therefore, there is evidence-based speculation regarding the risk factors associated with COVID-19 pandemic and increased incidences of GBV, and what is more worrisome is the type of impact such experiences make on women’s mental health.

8. Women’s economic abuse during the COVID-19 lockdown

Women economic abuse has been concurrently alleged to by all the reviewed articles, pointing to the fact that COVID-19 pandemic demean women’s economic power further than it used to be. In this context, a good number of the articles argued that women who used to struggle to run small entrepreneur business scales such as selling bean cakes and water among many others, suddenly discovered that the lockdown protocol prevented them from doing so [12, 29], which for some women has led to excessive financial dependence on their partners [28]. The resultant effect is that women were emotional and physically abused when they ask for resources that they partners could not afford to supply [12, 29].

One of the research projects reviewed narrated how the “stay at home” restriction order had forced a woman to remain in her boyfriend’s house for a long period of time and eventually there was shortage of food and the boyfriend locked up the woman in the house [12]. The boyfriend went out for hours, only to return in the evening drunk and physically attacked her. She sustained injury from the violence. Similar cases were reported by [12, 14] claiming that financial stress is one of the facilitating factors for increased GBV experiences for women. Other scholars argued that informal traders who depend on their partners for financial support have no alternative than to remain in abusive relationship in order to secure their daily bread [6, 27]. Hence, financial stress is represented through reduced income and bleak future because of restricted movement and retrenchment are potential catalyst flaming violence against women.

In the same vein, a case study report of a woman who during the pandemic lockdown asked the husband to collect N30,000 that a friend had sent to her from abroad but her husband after collecting the money, refused to relinquish the money to her [12]. Although the woman insisted amidst verbal insults from her husband to retrieve the money from him, that led to her leaving the house with her children in seek of safety in a relative’s house. Thus, she and her children became internally displaced for a time being and such is another form of emotional torture, directly or indirectly impacting on mental health. Consequently, it can be argued that economic stress forms part of the reason for further GBV experience during the COVID-19 pandemic. And in most cases, women/girls are always at the receiving end of being victims.

9. Recommendations

This chapter makes only two recommendations based on the vital issues raised within the reviewed articles: one for women to improve their level of proactiveness in the face of any adversity, particularly in sustaining a viable economic strength. The act of achieving proactiveness should be done through advocacy, which ought to promote self-efficacy and assertiveness. In addition, some form of psycho-education ought to be conducted while carrying out the advocacy programs. In order to achieve a viable level of proactiveness, women in particular need to be involved in conducting the advocacy process, wherein they (women) ought to create the awareness for and with themselves. Such advocacy can be championed by Ministry of Women Affairs (including women’s organizations) through media and faith-based channels.

The key aim of the awareness creation will be focusing on facilitating women’s ability to treasure the need to be resilient, which will include the act of self-efficacy, assertiveness, and independent, which can be achieved through psycho-education. This is based on the notion that depending on their partners for sustenance has resulted in varying abuses: be it emotional, physical, and/or sexual. It does not mean that women could end GBV by just being economic independence but rather such a stance will minimize the GBV abuses. In all, women may not be able to achieve much on their own without the help of men; therefore, the awareness creation ought to include soliciting the cooperation of men. Thus, the advocacy process has to factor in men as active participants (reflecting the act of communal (collective) involvement, which is usually Africa’s strategic step reflecting interdependence). The involvement of men could be achieved through media/faith-based channels, wherein men should be encouraged to appreciate women and perceive them as valued.

The second recommendation relates to policy makers, which strongly laid emphasis on the fact that women should be more agentic in protecting themselves from abuse by voicing out the experiences. In this stance, existing policies ought to be reviewed to include clauses that advocate for women’s proactiveness toward self-protection and economic independence. To achieve this stance, women in carrying out the advocacy process ought to continue to include aspects of creating the awareness that speaking out matters. In addition, policy makers should device means to ensure that the perpetrators of GBV are re-oriented toward self-transformation to promote a safer environment for all. Below is a diagram indicating the channel through which the intervention process could be achieved.

10. Intervention process

11. Conclusion

The effects of COVID-19 have impacted on women’s mental health due to an increased number of GBV during the national and international lockdown. It has impacted on women’s mental health in peculiar ways as varying forms of abuses such as increased gender-based violence (GBV), which dehumanizes women. Across the globe, women have been notable victims of gender-based violence, but the surge of COVID-19 has worsened the records of GBV, particularly in the face of home confinement. The chapter provides a critical review of literature based on published research across 2020–2022 (and other available data documents) in relation to the effects of COVID-19 on women’s mental health. Based on the reviewed articles, recommendations were made, reflecting the need for strategic adjustment, particularly for policy makers and for women themselves to be more proactive in being agentive toward self-protection.

Authors’ report

A total of seven articles were reviewed for analysis out of the 46 initially sourced articles. The delimiter for such choice was based on the chapter thematic focus of exploring COVID-19 pandemic and its associated impact on women’s mental health, particularly in Africa. The reviewed articles have been asterisked in the reference list. However, all the work as reflected in the reference list contributed vital information toward the chapter’s formulation and presentation.