Background The Covid-19 pandemic is straining healthcare systems in the US and globally, which has wide-reaching implications for health. Women experience unique health risks and outcomes influenced by their gender, and this narrative review aims to outline how these differences are exacerbated in the Covid-19 pandemic. Observations It has been well described that men suffer from greater morbidity and mortality once infected with SARS-CoV-2. This review analyzed the health, economic, and social systems that result in gender-based differences in the areas healthcare workforce, reproductive health, drug development, gender-based violence, and mental health during the Covid-19 pandemic. The increased risk of certain negative health outcomes and reduced healthcare access experienced by many women are typically exacerbated during pandemics. We assess data from previous disease outbreaks coupled with literature from the Covid-19 pandemic to examine the impact of gender on women's SARS-CoV-2 exposure and disease risks and overall health status during the Covid-19 pandemic. Conclusions Gender differences in health risks and implications are likely to be expanded during the Covid-19 pandemic. Efforts to foster equity in health, social, and economic systems during and in the aftermath of Covid-19 may mitigate the inequitable risks posed by pandemics and other times of healthcare stress.

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The purpose of this study was to analyze the impact of easy access to alcohol and exposure to alcohol advertisements on women's alcohol consumption, reproductive history, and health and social outcomes in an urban and rural site in South Africa. Method: Trained fi eldworkers conducted face-to-face interviews with 1,018 women of childbearing age in the Moot, Mamelodi, and Eesterus areas of the City of Tshwane (Gauteng province) and in the rural Cederberg, Bergrivier, and Swartland municipalities (Western Cape province), recruited through random sampling and stratified cluster random sampling, respectively. Multivariate logistic regression analyses were conducted, stratified according to the urban and rural sites and controlled for four demographic factors. Results: In Tshwane, complications in the last pregnancy (odds ratio [OR] = 7.84, 95% CI [1.77, 34.80]), interpartner binge drinking (OR = 6.50, 95% CI [3.85, 10.94]), and community drinking (OR = 7.92, 95% CI [4.59, 13.65]) were positively associated with alcohol accessibility. Interpartner violence (OR = 4.16, 95% CI [1.99, 8.70]) and community drinking (OR = 3.39, 95% CI [2.07, 5.53]) were positively associated with exposure to alcohol advertisements. In Western Cape, community drinking (OR = 10.26, 95% CI [4.02, 26.20]) was positively associated with alcohol accessibility, whereas ability to pay for health care (OR = 0.48, 95% CI [0.24, 0.96]) was inversely associated. Hazardous drinking on the Alcohol Use Disorders Identification Te st (AUDIT; OR = 2.26, 95% CI [1.03, 4.95]) and CAGE (OR = 4.51, 95% CI [1.30, 15.61]), interpartner violence (OR = 1.69, 95% CI [1.04, 2.76]), and community drinking (OR = 3.39, 95% CI [2.07, 5.53]) were positively associated with exposure to alcohol advertisements. Conclusion: Easy access to alcohol and exposure to alcohol advertisements are positively associated with adverse health and social outcomes. Although further studies are needed, these fi ndings lend support to emphasizing upstream policy interventions to limit access to alcohol and advertisements.

Objectives Malnutrition affects 25% of women in Ethiopia. We are conducting a study to determine the impact of a prenatal nutrition intervention on maternal and infant health in Ethiopia. The objective of this formative study was to better describe dietary practices among pregnant women and community members in rural Ethiopia prior to initiation the parent study. Methods This formative study was conducted from October-November 2018 among pregnant women and community members in the rural Amhara region of Ethiopia, prior to the “Enhancing Nutrition and Antenatal Infection Treatment (ENAT)” study [ISRCTN15116516]. 28 in-depth interviews (IDIs) were conducted among 16 pregnant women and 12 community members. IDIs were recorded, transcribed, and translated. We used a grounded theory approach and inductive reasoning for content analysis of interview transcripts. Results Fasting norms in the Ethiopian Orthodox religion had a significant impact on dietary behaviors which occurs for more than 200 days annually. Community members indicated that fasting during pregnancy is common and is also supported and encouraged by religious leaders and community members. Accordingly, women adhered to fasting restrictions during pregnancy, and many women maintained a vegan diet under direction of local religious leaders. Furthermore, many women reported restricting dietary intake in pregnancy to prevent growth of the fetus because of the concern for obstructed labor. A women's diet depended on her husbands’/family earnings and household food preferences. Sharing of meals is a cultural norm; the husband is served first, with the remaining portions to the pregnant women/children. Pregnant women in the area also reported regular consumption of a locally brewed alcohol (“tella”), as it is believed to have lower alcohol levels. These findings demonstrate the impact of traditional and cultural beliefs on dietary decisions amongst pregnant women in this population. Conclusions Reduced food intake in pregnancy is common in this population, due to fasting, reduced appetite, and food restriction to avoid pregnancy complications. Context-specific interventions are needed, and this formative work will inform the future delivery and education regarding nutrition interventions in rural Ethiopia. Funding Sources Bill & Melinda Gates Foundation (OPP1184363).

This anthropological study explores why more women in the rural Sierra Madre region of Chiapas, Mexico birth at home rather than at the hospital. Between January and May of 2014, the primary investigator conducted in-depth, semi-structured interviews with twenty-six interlocutors: six parteras (home birth attendants), nine pregnant women, four mothers, four healthcare providers, and three local government leaders. Participant observation occurred in the health clinic, participants' homes, and other spaces in a community with a population of 1,188 people. Drawing from narrative analysis, the findings suggest that women face structural obstacles to accessing high-quality childbirth care, which lead them to give birth at home instead of the hospital. These obstacles include financial barriers in obtaining facility-based care and poor quality of care, such as mistreatment in the facility. The study highlights the importance of centreing community narratives in healthcare programming in order to bridge the implementation gap between women in rural communities, healthcare workers, and policymakers.