Pan American Health Organization · 2020
Gender-responsive guidance for health emergency and disaster response during COVID-19 for public health professionals and emergency responders.
- Issuer
- Pan American Health Organization
- Edition
- 2020
- Audience
- Public health professionals, emergency response teams, health policymakers
- Evidence
- Expert consensus with epidemiological data from PAHO surveillance
- Reviewed
- 20 Oct 2026 · GMJ
What this guideline says
GMJ summary
This PAHO document provides key considerations for integrating gender equality into COVID-19 and health emergency response. Based on data from over 1 million confirmed COVID-19 cases in the Americas (520,417 female, 507,494 male) as of 8 May 2020, the guidance addresses how gender-based inequalities, combined vulnerabilities, and unequal access to information create different needs across populations during health emergencies.
The document outlines specific vulnerabilities: women and children are nearly 14 times more likely to die in disasters than men; women face higher risk of gender-based violence during emergencies, with reports indicating a 25–35% increase in emergency calls related to violence against women during COVID-19 lockdowns in Latin America and the Caribbean; men over 60 show overrepresentation in COVID-19 mortality; and LGBT persons experience increased discrimination in emergency settings.
Key considerations are organized across four domains: institutional-level gender equality (ensuring gender balance in response teams, deploying gender experts); understanding context through sex- and age-disaggregated data; ensuring participatory approaches with diverse community groups; and protecting gender-specific needs including addressing women’s dual burden of paid and unpaid healthcare work, preventing gender-based violence as an essential service, and maintaining sexual and reproductive health services.
Key points
For clinicians — doses and thresholds as stated in the guideline
- COVID-19 data from the Americas (as of 8 May 2020) showed 520,417 confirmed cases among females and 507,494 among males, with highest case numbers in the 50–59-year age group (184,713 cases) and lowest in 0–9-year-olds (18,505 cases)
- Reports indicate a 25–35% increase in emergency calls related to violence against women during COVID-19 lockdowns in Latin America and the Caribbean
- Women and children are nearly 14 times more likely to die in a disaster than men
- Gender balance of COVID-19 emergency response teams should be evaluated, with availability and deployment of one or more gender experts
- All data should be disaggregated by sex and age to understand gender dynamics of COVID-19, including testing outcomes, transmission rates, morbidity and mortality, hospitalization rates, and access to health services
- Prevention of and response to gender-based violence must be included as essential services in COVID-19 plans and responses, especially in the context of stay-at-home policies
- Sexual and reproductive health services must remain accessible with special attention to elimination of hidden or prohibitive costs and access barriers to post-rape care during COVID-19 response
- Protective mechanisms must be established in all shared spaces and quarantine/isolation facilities to maintain dignity, including provision of lighting and privacy for outdoor or temporary toilet/bath facilities
COVID-19 total cases by age and sex in the Americas as of 8 May 2020
Table extracted from the guideline
| Grand Total | 0–9 | 10–19 | 20–29 | 30–39 | 40–49 | 50–59 | 60–69 | ≥70 | |
|---|---|---|---|---|---|---|---|---|---|
| Grand Total | 1,027,911 | 18,505 | 30,151 | 142,190 | 178,785 | 173,181 | 184,713 | 139,214 | 161,172 |
| Female | 520,417 | 8,718 | 15,157 | 75,090 | 89,607 | 86,711 | 91,910 | 66,047 | 87,177 |
| Male | 507,494 | 9,787 | 14,994 | 67,100 | 89,178 | 86,470 | 92,803 | 73,167 | 73,995 |
Source: Pan American Health Organization, Key Considerations for Integrating Gender Equality into Health Emergency and Disaster Response: COVID-19. Reproduced in summary form.
From the guideline
Verbatim
“Implement measures to ensure that the prevention of and response to gender-based violence are included as essential services in COVID-19 plans and responses, especially in the context of stay-at-home policies.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked extensively with WHO on health systems strengthening in Georgia, I recognise that this guidance addresses critical gaps in our emergency preparedness. Georgia's COVID-19 response demonstrated capacity for rapid mobilisation, but we must honestly assess whether our Incident Management System includes systematic gender analysis and dedicated gender expertise at decision-making levels. The finding that women and children are 14 times more likely to die in disasters, combined with the documented 25–35% increase in domestic violence calls during lockdowns in the Americas, should prompt our Public Health Institute to review whether gender-based violence services were adequately maintained as essential services during our own restrictions. The recommendation I would stress most to Georgian colleagues is the imperative for sex- and age-disaggregated data in all surveillance systems—not only for COVID-19 but for earthquake preparedness, flood response, and our ongoing tuberculosis and hepatitis programmes. One realistic implementation challenge is that establishing this infrastructure requires investment in data systems and training that competes with immediate clinical care priorities, yet without it our emergency response will remain blind to differential impacts across our population.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 20 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guidance is highly relevant given the region’s vulnerability to multiple hazards (earthquakes, floods, conflicts) and ongoing COVID-19 response challenges. Georgian health emergency response systems should consider integrating gender expertise into national and regional emergency management teams, establishing sex- and age-disaggregated surveillance for all health emergencies, and ensuring that gender-based violence prevention is maintained as an essential service during lockdowns and quarantine measures. The document’s emphasis on participatory approaches with diverse community groups—including ethnic minorities, LGBT persons, and rural populations—aligns with Georgia’s need to address health equity across its diverse regions, from Tbilisi to Adjara, Samtskhe-Javakheti, and conflict-affected areas. National programmes should assess current capacity for gender-responsive emergency planning, particularly around sexual and reproductive health service continuity, protection of predominantly female healthcare workforce, and culturally appropriate communication strategies in minority languages.
Questions this guideline answers
Quick answers
Why is gender-disaggregated data important in COVID-19 response?
Sex- and age-disaggregated data reveals how COVID-19 differentially impacts populations. While prevalence appears similar by sex (520,417 female vs 507,494 male confirmed cases in the Americas), mortality data show men over 60 are overrepresented in deaths. Disaggregated data on testing outcomes, transmission rates, hospitalization, and access to services is essential to guide targeted country responses and identify gender-based vulnerabilities and barriers to care.
How has gender-based violence changed during COVID-19 lockdowns?
In Latin America and the Caribbean, reports indicate a 25–35% increase in emergency calls related to violence against women during COVID-19 lockdowns, leading to greater demand for shelter and support services. The guidance emphasizes that prevention of and response to gender-based violence must be included as essential services in COVID-19 plans and responses, especially under stay-at-home policies.
What specific risks do women healthcare workers face during COVID-19?
Women face a dual burden of paid and unpaid healthcare work in the home, with increased risk and exposure to COVID-19 as frontline health workers and caregivers. The guidance recommends adopting measures to protect frontline health workers at all levels of health networks (public and private) and addressing unfavorable mental health outcomes in women as key frontline healthcare workers and care providers.
How should emergency response teams be structured to address gender equality?
Emergency response teams should evaluate their gender balance, including in senior positions, and ensure the availability and deployment of one or more gender experts. Organizational policies should mainstream gender equality into all components of the COVID-19 response, including women's leadership, and institutional capacities should be built in gender and COVID-19 response involving national and local level groups (women, community leaders, NGOs).
Related on GMJ
Interconnected resources
Dictionary of Public Health
GMJ News coverage
- UK flu and COVID-19 surveillance data to May 2027 shows continued monitoring amid seasonal trendsOct 2026
- Community Health Workers Boost COVID-19 Testing Among Formerly Incarcerated PeopleAug 2026
- Adverse Childhood Experiences in Rural India: Why Western Frameworks Fall ShortSep 2026
- Mental Health Disorders Now Leading Global Disability Cause as Cases Approach 1.2 BillionJun 2026
Quality & accreditation
Other guidelines on this topic
- Care for health workers exposed to the new coronavirus (COVID-19) in health facilities
- Considerations for the Implementation and Management of Contact Tracing for Coronavirus Disease 2019 (COVID-19) in the Region of the Americas
- Reliance for Emergency Use Authorization of Medicines and Other Health Technologies in a Pandemic (e.g. COVID-19)
- Ethics guidance for the use of scarce resources in the delivery of critical health care during the COVID-19 pandemic
- An Overview of Current Social Distancing Measures and Required Evidence for Determining Optimal Time for Relaxing Such Measures
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Status
- Current
- Published
- 2020-01-01
- Scope
- Gender equality considerations for COVID-19 and health emergency response
- Audience
- Public health professionals, emergency response teams, health policymakers
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus with epidemiological data from PAHO surveillance
- Record history
- Created 20 Oct 2026 · updated 20 Oct 2026 · next check Apr 2027
Pan American Health Organization. Key Considerations for Integrating Gender Equality into Health Emergency and Disaster Response: COVID-19. Washington, D.C.: PAHO; 2020. (PAHO/IMS/COVID-19-20-0029).GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
Was this article helpful?
