Covid-19 hit women harder than men in India, unlike most of the world

The covid-19 pandemic may have impacted India more severely than previously estimated, with the life expectancy of women, certain social groups and younger demographics experiencing the most severe declines.

Previous mortality estimates during the covid-19 pandemic in India relied on official death records. Yet lockdowns disrupted this system, which already underreported deaths in women and children even before the pandemic. It doesn’t collect certain information like caste or ethnicity either, says Sangita Vyas at Hunter College in New York.

So Vyas and her colleagues gathered information on deaths in India from the National Family Health Survey. This country-wide survey asks participants whether anyone in their household died in the past four years and if so, to provide data like the person’s date of death, age and gender – only including options for men and women.

The researchers analysed data from more than 765,000 participants who completed the survey in 2021. They found that deaths in 2020 were about 17 per cent higher than in 2019. If similar increases occurred across the country, that indicates almost 1.2 million excess deaths in 2020 – eight times the official number of covid-19 deaths in India in 2020 and 1.5 times the World Health Organization’s estimates, according to the study.

Between 2019 and 2020, overall life expectancy at birth declined by more than 2.5 years in the sample, compared with a 1.5-year decline in the US during the same period. Life expectancy changes differed by gender, age and social group, too.

For instance, it fell about three years in women compared with just over two years in men. This contrasts with global trends, which show men had greater increases in mortality than women during the covid-19 pandemic. “These unique patterns in India can likely be explained, at least in part, by gender inequality,” says Vyas.

Prior research shows Indian households spend less on healthcare for women relative to men, so the pandemic may have amplified these pre-existing disparities, says Ridhi Kashyap at the University of Oxford, who was a co-author on the study. Strict lockdowns also hindered access to maternal healthcare, potentially increasing maternal mortality rates, she says.

Unlike in other countries, life expectancy declines observed in this study were largely driven by deaths in younger demographics. Increases in mortality among women and girls under 20 years old contributed approximately one year to the decline in life expectancy in 2020 – roughly the same amount as deaths in women between ages 60 and 79.

“We think that those increases in mortality are coming from indirect effects of the lockdown in India,” says Vyas. The effects could include disrupted access to childhood vaccines and treatments for tuberculosis, which is a leading cause of death in India.

There were also stark differences between social groups. High-caste Hindus experienced a 1.3-year decline in life expectancy, while those who were Muslim or belonged to a lower caste saw 5.4-year and 2.7-year declines, respectively.

Public health experts have long been aware of India’s health inequities, yet these findings highlight the magnitude of those disparities, says Vyas. “Seeing how different populations are impacted differently is important for developing policy responses,” she says.

However, the study had limitations. Due to disruptions during lockdown, the survey respondents only came from 14 of India’s 36 states and union territories, and the sample was demographically representative of only about one-fourth of India’s population. Also, the study didn’t look into cause of death. “We can only speculate on why these patterns may be,” says Kashyap. “But we can’t say conclusively what is causing them.”