Understanding the impact of the COVID-19 pandemic and its control measures on women and children: A Zimbabwean case study

Tinotenda Taruvinga^1,2*Rudo S. Chingono²Mandikudza Tembo^1,2Ioana D. Olaru^1,2Kenneth Masiye³Claudius Madanhire^2,3Sharon Munhenzva^2,3Sibusisiwe Sibanda^2,3Lyton Mafuva^2,3Natasha O'sullivan^4,5Abdinasir Y. Osman^4,6,7Kevin Deane⁴Tsitsi Bandason²Manes Munyanyi⁸Annamercy C Makoni⁹Solwayo Ngwenya^10,11Karen Webb³Theonevus T. Chinyanga³Rashida A. Ferrand^1,2Justin Dixon^12,2Katharina Kranzer^12,13,2David Mccoy^14,4

• ¹London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
• ²The Health Research Unit Zimbabwe, (THRU-Zim), Biomedical Research and Training Institute (BRTI), Harare, Zimbabwe
• ³Organisation for Public Health Interventions and Development (OPHID) Harare, Zimbabwe, Harare, Zimbabwe
• ⁴Queen Mary University of London, London, United Kingdom
• ⁵MRC Epidemiology Unit, Cambridge, United Kingdom
• ⁶The Royal Veterinary College Department of Pathobiology and Population Sciences Camden Campus, London, United Kingdom
• ⁷Ministry of Health, Mogadishu, Somalia
• ⁸Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
• ⁹City of Harare Health Services Department, Harare, Zimbabwe
• ¹⁰Mpilo Central Hospital, Bulawayo, Zimbabwe
• ¹¹National University of Science and Technology Faculty of Engineering, Bulawayo, Zimbabwe
• ¹²London School of Hygiene & Tropical Medicine, London, United Kingdom
• ¹³Division of Infectious Diseases and Tropical Medicine, LMU University Hospital,, LMU Munich, Germany
• ¹⁴United Nations University, Shibuya,, Tokyo, Japan

The Coronavirus Disease 2019 (COVID-19) posed significant health policy challenges, particularly for low-income countries, where policymakers faced both direct threats from the virus and social and economic harm owing to lockdown measures. We present a holistic contextualized case study of the direct and indirect impacts on women and children, highlighting disparities across socioeconomic, age, and gender groups. We utilized multiple data sources, including primary and secondary data from 28 in-depth interviews, six focus group discussions, and 40 household interviews, as well as data from government reports, District Health Information Software version 2 (DHIS2), and published research. A conceptual framework was devised to hypothesise causal pathways and guide the analysis of results. The findings indicate that the pandemic not only had's direct effects, such ason morbidity and mortality, and but also more severe indirect impacts, including job losses and limited access to healthcare, including maternal and child healthcare services, due to measures put in place to control it, which were exacerbated by well-known but inadequately considered preexisting political and economic challenges. The most severe indirect effects on health services availability and wider livelihoods fell on the poorest segments of society, further widening the age and gender inequalities. The pandemic and its infection control measures have adversely affected the delivery of healthcare services. Policymakers have faced significant challenges in managing the direct and indirect harm of COVID-19, including short-and long-term effects and their unequal distribution across society. We conclude that the indirect effects of COVID-19 were at least as harmful, if not more so, than the direct impacts, especially for women and children. In the future, it is highly recommended to establish specific protocols and guidance for maternal and child health service access, including strategies that reduce barriers to social support.