Impact of the COVID-19 Pandemic on the Wellbeing of Tribal Women of Reproductive Age in a Rural Remote Region: An Observational Study

Background COVID-19 pandemic caused unprecedented impact on society globally. Present study was conducted to explore hardships experienced by rural women of reproductive age in remote area. Methodology Community-based cross-sectional observational study included 2500 randomly selected tribal women between ≥20 to ≤49 years, residing in 140 villages and consenting to participate. Face-to-face interviews of participants were conducted for 15-30 minutes using semi-structured questionnaire regarding sufferings during COVID-19 pandemic. Results of 2500 women interviewed, majority (57.7%) were 20-29 years old, with lower education (48.1%), agriculture laborer (45.4%), of lower economic class (48.8%). Of all participants 24.4% reported change in meals, 18.2% change in work and working environment, 52.1% change in health care. Of total, 40.8% reported physical violence (PV), 52.1% reported increased PV during pandemic, majority (66.7%) by husbands, 39.4% suffered sexual violence (SV), 38.5% reported increased SV during pandemic. Modes of PV were mostly slapping or hitting or kicking. Of all, who suffered PV, and SV, majority informed to their family members, but only 12.1% and 7.4% of those who suffered PV and SV respectively informed police and 66.1% and 41.5% suffering PV and SV sought healthcare. Socio-demographic factors like age, education, economic class, occupation had significant relationship with sufferings of women during pandemic. Conclusion: Pandemic had significant impact on rural women’s lives, 40.8% and 39.4% of women respectively were found to have suffered PV and SV at home during COVID-19 pandemic. It is therefore necessary to generate awareness, formulate laws and policies for protection of women during such pandemics.

COVID-19 pandemic caused an unprecedented impact on society across the globe [1]. The pandemic has affected people around the world with increased social, economic, physiological, and psychological hardships for everyone [2]. It has intensified human sufferings, weakened the economy, disrupted the lives of billions worldwide, with a profound impact on health, economic, environmental, and social aspects of life [3]. The COVID-19 pandemic has placed tremendous pressure on health systems across the globe, not only because of its direct effects but indirectly also [4]. Health inequalities have always existed in different regions, and the pandemic has further exacerbated these disparities, resulting in varying levels of illnesses, their severity and mortality rates [5, 6]. National responses to the pandemic have varied between countries and even among provinces within a country. These differences depended on various factors, including the COVID-19 burden, public awareness, available resources, infrastructure, and human resources [7, 8]. Rural populations in developing countries live with limited resources, and the pandemic has severely impacted their lives, leading to extreme hardships and struggles for survival, particularly for women. The lack of resources has driven them into financial crises on both personal and familial levels. Work suspensions due to lockdowns aimed at preventing the spread of coronavirus contributed to a severe financial crisis specially to rural communities [9, 10]. 

Objective

A community-based study was done to explore the hardships experienced by rural women of reproductive age during the COVID-19 pandemic in a remote area.

Study design: Observational cross-sectional study

Study setting and duration: The study was conducted over a period of one year in a total of 140 tribal villages in remote, forestry, and hilly region. These villages were around the village with the health facility, the study center.

Inclusion criteria: Randomly 15 women, between ≥20 to ≤49 years of age selected from each village and willing to undergo a personal interview were enrolled as study participants, considering some villages were small and some large.

Exclusion criteria: Women <20>49 years, not willing to be a part of the study were excluded. 

Sample size: Calculated sample size was 2500 with 95% confidence and 2

Of all the women interviewed, majority (57.7%) were of 20-29 years of age, educated up to primary level (48.1%), agriculture laborer by occupation (45.4%), belonging to lower economic class (48.8%) and had one or two births (57.8%), and they reported that their lives significantly changed during COVID-19 pandemic. Of these 2500 women, 609 (24.4%) reported change in their meals due to lockdown, loss of family members employment, problems in agriculture, and poverty. 456(18.2%) reported change in their work and working environment due to lockdown and loss of jobs, 1303(52.1%) reported change in health care as many were not able to reach hospitals for various ailments due to lockdown. There was lack of health facilities with financial constraints also. The remaining 132(5.3%) women reported other changes like mental health, fear of infection, insecurity, change of homes due to shifting to other places when jobs were lost, school drop-outs of children, etc.

Of 2500 women, a total of 1019 (40.8%) reported physical violence (PV) at their homes during the pandemic, of which 531(52.1%) reported increase in PV during pandemic compared to pre-pandemic period. Of these 1019 women, 680 (66.7%) reported PV by their husbands, 221(21.7%) by father- and brother-in laws, 100 (9.8%) by mother- and sister-in laws and remaining 18(1.8%) by uncles, aunts, cousins. Table 2 depicts the relationship between the various socio-demographic features of women and PV at home by family members (Table 2). When interviewed about the frequency and mode of physical violence at home, of 1019 women, 885 (86.8%) reported occasional episodes of PV whereas 134 (13.2%) reported regular PV at home. The majority (86.1%) reported slapping, hitting by hands or kicking as the most common modes of PV followed by hitting with bar rods or burning (12.5%) and the remining 1.5% reported other means like hitting with brooms, foot wares, utensils, etc. The majority of these sufferers belonged to 20-29 years of age, having low education, were agricultural laborers by occupation, and belonged to low economic class. Table 3 depicts the relationship of socio-demographic features of women with the frequency and mode of PV suffered at home (Table 3). Of all the women who suffered PV, 878(86.2%) informed someone, including family members (85.6%), police (12.2%), and others like neighbors, friends, and distant relatives (2.3%) (Table 4). Of these 1019 women, only 580 (66.1%) had to seek healthcare with 74.1% of them from Subcentres (SC) or Primary Health Centres (PHC), 23.3% from Sub-district hospital (SDH)/District hospital (DH), and remaining 2.6% from private hospitals or dispensaries. The relationship of the action taken and health care sought for PV suffered at home and demographic factors is shown in table 4 (Table 4)

Table 1: Changes in Every Day Life During COVID-19 Pandemic

*Small Scale, (Food, Shoes making, Bamboo items) Industry, Welding Workshop, Brick furnace, **Everyone said their lives got affected, P: Previous viable births.

Table 2: Physical Violence at Home During COVID-19

*Small Scale, (Food, Shoes making, Bamboo items) Industry, Welding Workshop, Brick furnace. P: Previous viable births.

Table 3: Physical Violence Frequency and Mode at Home

*Small Scale, (Food, Shoes making, Bamboo items) Industry, Welding Workshop, Brick furnace, P: Previous viable births.

Table 4: Action Taken for Physical Violence

*Small Scale, (Food, Shoes making, Bamboo items) Industry, Welding Workshop, Brick furnace *SC – Subcentre; PHC – Primary health care; **SDH – Sub-district hospital; DH –District hospital, P: Previous viable births.

Furthermore, of the total of 2500 women interviewed, 985(39.4%) reported sexual violence (SV) at their homes during the pandemic with 379 (38.5%) reporting increase in SV compared to pre-pandemic period. Of these 985 women, 796 (80.8%) reported SV by their husbands, 120 (12.2%) by father- and brother-in laws, and remaining 69 (7.0%) by uncles, cousins, etc. Of these 985 women, 922(93.6%) reported occasional attempts of SV whereas 63 (6.4%) reported regular attempts by family members. Table 5 depicts the relationship between the socio-demographic features of women and SV at home (Table 5). Of all the women who suffered SV, 742(75.3%) informed someone, including family members (90.6%), police (7.4%), and others like neighbors, friends, and distant relatives (2.0%) (Table 6). Of these 985 women, 409(41.5%) sought healthcare-related help too with 92.7% from SC or PHC, 5.6% from SD/DH, and remaining 1.7% from private hospitals or dispensaries. The relationship of the action taken and health care sought for SV suffered at home and demographic factors is shown in table 6 (Table 6).

Table 5: Sexual Violence at Home

*Small Scale, (Food, Shoes making, Bamboo items) Industry, Welding Workshop, Brick furnace, P: Previous viable births

Table 6:Action Taken for Sexual Violence

*Small Scale, (Food, Shoes making, Bamboo items) Industry, Welding Workshop, Brick furnace, *SC – Subcentre; PHC – Primary health care; **SDH – Sub-district hospital; DH –District hospital, P: Previous viable births.

Overall, in the present study of 2500 women interviewed, almost everyone reported change in their lives during COVID-19 pandemic, either in meals, work or health care. Of all, 40.8% of women suffered PV at home with the majority (66.7%) by their husbands and 39.4% women suffered SV with the majority (80.8%) by their husbands. A significant relation was reported between young age, lower education, labor occupation, and low economic class of women with PV and SV suffered at home during the pandemic (p Less than 0.05). Furthermore, of all the women who suffered PV, 12.1% informed the police, whereas in case of SV only 7.4% of women informed the police. The majority of the women informed their family members about the PV and SV faced at home. Furthermore, of 1019 women who suffered PV, 66.1% sought healthcare from SC/PHC/SDH/DH/private dispensaries or clinics, compared to 41.5% women who suffered SV.

From the outbreak of COVID-19 pandemic, the emerging data from all over the world has revealed an increase in all sorts of violence against women and girls, particularly domestic violence known as “Shadow Pandemic” [12]. According to a recent survey conducted by United Nations in 13 countries, COVID has made things worse for most of the women. Women reported that the most common form of violence faced during pandemic was verbal abuse (50%), followed by sexual harassment (40%), physical abuse (36%), denial of basic needs (35%) and denial of means of communication (30%). Furthermore, seven in 10 women surveyed believed violence against women was common in their community. Of every 7 in 10 women reported increase in domestic violence during the pandemic, and 3 in 5 reported increase in sexual harassment rate in public [13].

The present community-based study was conducted to explore the hardships experienced by rural women in remote areas during the COVID-19 pandemic. Young women between 20-29 years, with less education, agricultural laborers, with many births and belonging to low economic were the ones who suffered the maximum during pandemic in terms of change in home environment, work as well as meals. They were also the ones who suffered the maximum PV and SV at the hands of their husbands and relatives. Of 2500 women interviewed, 40.8% suffered PV with the majority (66.7%) by their husbands, and 39.4% women suffered SV. The most common mode of PV suffered at home was slapping or hitting or kicking. Majority of women who suffered PV and SV informed their family members about the incident, but it was reported that only 12.1% of those who suffered PV and 7.4% who suffered SV informed the police. Furthermore, 66.1% women who suffered PV and 41.5% who suffered SV sought healthcare from SC/PHC/SDH/DH/private dispensaries or clinics.

A similar study from Ethiopia revealed that the livelihoods of 88.89% of households were severely impacted by the pandemic. The pandemic had a significant effect, compelling households to halt their livelihood activities [14]. A study revealed that during the pandemic, the indigenous population worldwide faced some of the most challenging conditions, including lack of awareness, limited availability of non-farm activities, insufficient nutritional facilities, inadequate health infrastructure, restricted access to forest areas, and a reliance on herbal medicines [15]. A recent study in the United Kingdom revealed that the pandemic disproportionately affected women. These findings underscored the gendered experiences of the COVID-19 pandemic [16]. Similar to the present study, many recent studies reported a significant rise in the intimate partner physical and sexual violence against women and children during the COVID-19 pandemic [17,18]. A similar study indicated an increase in family violence during the pandemic, driven by factors such as disaster-related instability, economic stress, reduced support options, and heightened exposure to exploitative relationships. Additionally, social isolation measures implemented globally to curb the spread of COVID-19, confined people in volatile family situations at their homes. This isolation further exacerbated their personal and collective vulnerabilities while limiting accessible and familiar support options [19]. Another recent study from the United States revealed an increase in SV and PV during the early stages of the pandemic. According to the survey, 18% of participants reported experiencing IPV. Among these, 54% said the level of victimization remained the same since the COVID-19 outbreak, 17% reported it worsened, and 30% said it improved [20]. In the present community-based study in remote villages, the numbers were much higher. Also, PV and SV as such was not uncommon and it further increased. Additionally, health care was affected a lot.

The present community-based study depicts the impact of COVID-19 pandemic in the rural women of India. The pandemic had significant impact on the everyday lives of women, 40.8% and 39.4% of women were found to have suffered PV and SV at home respectively during the COVID-19 pandemic, with the majority by their husbands.  They also reported increased PV and SV during pandemic compared to pre-pandemic period. Some did inform about the PV and SV at home to their family members, only 12.1% of those who suffered PV and 7.4% who suffered SV, informed the police. Demographic features like age, education, occupation, and socio-economic status did influence on the burden of PV and SV against women during the COVID-19 pandemic. It is therefore necessary to generate awareness and modes for the protection of women during pandemics.

Funding

There was only a little honorarium for research assistant. 

Conflicts of interest/competing interests

Authors have no conflicts of interest to disclose.