Gender and the impact of COVID-19 on demand for and access to health care: 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 health care and social and economic disruptions. We investigated the intersectionality of gender differences of the impact of COVID-19 on health care access with educational and socio-economic factors 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 health care after the emergence of the pandemic among men and women, stratified by educational level. We also examined the change in demand for various health care services, stratified by self-reported experiences of financial difficulty due to the pandemic. Results: Among those reporting a need to seek health care in South Africa, there was a statistically significant decline in the ability to see a health care provider during the pandemic among women, but not among men; this gender gap was more evident in those who did not have post-secondary education (odds ratio (OR) = 0.08, P = 0.041 among women; no change among men) than for those with post-secondary education (OR = 0.20, P = 0.142 among women; OR = 0.50, P = 0.571 among men). South African women financially affected by the pandemic had a significant decline in seeking preventive care during the pandemic (OR = 0.23, P = 0.022). No conclusive effects were noted in Nigeria or Kenya. Conclusions: 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.