Intersectionalities in primary health care during the COVID-19 pandemic: work, gender, and classAbstract
The study analyzed the labor challenges (both professional and domestic) faced by Primary Health Care professionals during covid-19, using an intersectional approach. Six focus groups were conducted with 42 professionals, resulting in two empirical categories. "Turn on a dime at the health unit" revealed work overload, especially for women. Professional hierarchies shaped work experiences. Female doctors maintained their exclusive roles, while nurses and community health workers also took on operational tasks. "Juggling the second shift" highlighted the increase in domestic responsibilities for all women, regardless of profession or social class. The intersections of social class and gender showed that in the professional sphere, class differences translated into hierarchy; in the domestic sphere, they produced inequalities in the distribution of care. The global social and health crisis did not alter the naturalization of oppression in gender and class relations.
Keywords
Gender; Primary Health Care; Covid-19; Work
Resumo
O estudo analisou os desafios laborais (profissional e doméstico) enfrentados por profissionais da Atenção Primária à Saúde durante a Covid-19, utilizando abordagem interseccional. Foram realizados seis grupos focais com 42 profissionais, resultando em duas categorias empíricas. "Se vira nos 30 na UBS", revelou a sobrecarga de trabalho especialmente para mulheres. As hierarquias profissionais modificaram as experiências de trabalho. As médicas mantiveram suas funções exclusivas como enfermeiras e agentes comunitárias e assumiram também funções operacionais. "Malabarismo na segunda jornada", destacou o aumento das responsabilidades domésticas para todas as mulheres, independentemente da profissão ou da condição de classe. As articulações entre classe social e gênero mostraram que, no espaço profissional, as diferenças de classe se traduziram em hierarquia; no doméstico, produziram desigualdades na distribuição do cuidado. A crise social e sanitária global não alterou a naturalização de opressões nas relações de gênero e classe.
Palavras-chave
Gênero; Atenção primária à saúde; Covid-19; Trabalho
Resumen
El estudio analizó los desafíos laborales (profesional y doméstico) enfrentados por profesionales de la Atención Primaria de la Salud durante la COVID-19, utilizando un abordaje interseccional. Se realizaron seis grupos focales con 42 profesionales, resultando en dos categorías empíricas. “Arréglatelas como puedas en la UBS” reveló la sobrecarga de trabajo, especialmente para las mujeres. Las jerarquías profesionales modificaron la experiencia de trabajo. Las médicas mantuvieron sus funciones exclusivas, mientras que las enfermeras y las agentes comunitarias asumieron también funciones operativas. “Malabarismo en la segunda jornada” subrayó el aumento de las responsabilidades domésticas para todas las mujeres, independientemente de la profesión o condición de clase. Las articulaciones entre clase social y género mostraron que, en el espacio profesional, las diferencias de clase se tradujeron en jerarquía; en el área doméstica produjo desigualdades en la distribución del cuidado. La crisis social y sanitaria global no alteró la naturalización de opresiones en las relaciones de género y clase.
Palabras clave
Género; Atención primaria de la Salud; COVID-19; Trabajo
Introdução
In the last decades of the 20th century, changes occurred in the relative positions of men and women, in their experiences and in the understanding of gender roles. The break with essentialist and biological views of women’s identity and its analysis from a relational perspective enabled the understanding of gender as a category of analysis of power relations in contemporary societies1-3.
The study of gender positions, in their connections with identities and oppressions, has made it possible to highlight tensions between changes and continuities in hierarchical patterns that imply disadvantages in the relative position of women in both the public and private spheres1,4.
In theoretical debates and political activism, the category of gender has been criticized by black and socialist feminists in relation to the supposed universality of women’s identity. This perspective obscures a plurality of gender experiences based on different social, class, ethnic, and racial affiliations1,4.
In the face of more complex proposals that sought to understand women’s experiences and needs in their differences, based on systems of inequality built around social class, ethnicity, sexuality, generation, among others, the male-female binary model began to be questioned and problematized from current perspectives1,3,4.
Analytical tools called intersectionalities consist of proposals to problematize inequalities situated in specific contexts. According to Pisciteli3, various analyses differ from each other, based on concepts of power and agency of subjects, understood as the ability to act under social and cultural influence. Crenshaw5 proposes that gender, class, and race operate as systems of domination and oppression that, when articulated with each other, determine identities constructed through the effects of social subordination. Other approaches highlight dynamic and relational aspects of social identity.
Brah6 proposes analyzing difference, rather than gender, as an analytical category. For her, discursive constructions around difference and power distributions affect the unequal positioning of subjects in the global sphere. From this perspective, difference refers both to inequality, oppression, and hierarchy, as well as to diversity and democratic forms of political action.
In this context, the COVID-19 pandemic has caused intense and abrupt transformations in all dimensions of social life on a global scale7. In the health sector, the imposition of new risks, insecurity, and a significant increase in fear, among other factors, have greatly changed the ways in which healthcare is managed, including sectors ranging from primary care to public policy and forms of daily and domestic care8.
During the health crisis, in addition to these changes, social contradictions have become even more acute1,7. The normalization of the excessive workload faced by women, as well as the lack of care they received, highlighted a gap in research on how the intersections between gender, race, and social class affected healthcare workers.
The objective of this study is to analyze the perspective of health professionals on the work challenges (professional and domestic) faced during the pandemic, from an intersectional perspective.
Method
This study uses a qualitative, exploratory, descriptive, and analytical approach, incorporating the dimensions of meaning and intentionality as elements inherent to social acts, relationships, and structures, to understand the work experiences of Primary Health Care (PHC) professionals during the COVID-19 pandemic9.
The study was conducted from September to November 2022 in Basic Health Units (BHUs) based in São Luís, Maranhão, a city divided into nine health districts. The Family Health Strategy (FHS) covers approximately 60% of the population, with around 200 teams. With an estimated population of 1,115,932 inhabitants in 2023, it has a Human Development Index (HDI) of 0.768 and a Gini Index of 0.536, indicating considerable income inequality.
The units were intentionally selected based on the criterion of diversity of setting: location in different health districts; being a reference (or not) for the care of flu-like syndromes; having one or more family health teams; location in rural and urban areas; having (or not) a dental health team; having obtained different results in the external evaluation of the 3rd cycle of the Program for Improving Access and Quality of Primary Care (PMAQ-AB)9; having implemented (or not) the Saúde na Hora (Walk-in clinics) program.
Managers were contacted to schedule visits and present the selection criteria for research participants. Thus, all categories of higher education, nursing technicians, and Community Health Workers (CHW), preferably those who were active during the pandemic, were included. The CHW were nominated by the manager, two or three per unit. Those who held leadership, management, and/or administrative positions were not included in the research.
The in-person Focus Groups (FG) took place at a single time in each of the six UBS, in a room reserved by the unit’s management and on agreed days and times. Professionals were offered the possibility of not participating, without any prejudice. The total sample was 42 professionals.
The research team consisted of six members, namely: three professors in the field of Public Health (a physician, a dental surgeon, and a social scientist), two of whom had experience in qualitative research and alternated the coordination of the FG, while the third contributed to the observations of the participants’ nonverbal language; and three graduate students who took turns recording the beginning of the speeches to assist with transcription and observation.
At the beginning of each FG, there was a presentation of the research and the team to the participants. Next, the research instruments were presented, namely: a sociodemographic profile questionnaire and the Free and Informed Consent Form (FICF). The group interview followed a script that aimed to capture the professionals’ perceptions of their daily work and home life during the pandemic and post-vaccination period.
Participants were informed that participation was voluntary. One CHW refused to participate. On average, each FG lasted 2 hours, totaling 11 hours and 25 minutes of recording and 192 pages of transcription. The FGs were recorded, transcribed, and coded by a single researcher. For data analysis, Bardin’s10 technique of thematic content analysis was used.
From a theoretical point of view, the pandemic enabled reflections on the links between gender, care, and work in crisis situations. In the field of healthcare, recognition of work was more focused on specialized hospital care, to the detriment of primary care. From this perspective, some questions emerged to guide the analysis of the narratives, namely: in domestic life, did ambivalence about the value of work, forms of care, and the attribution of responsibility represent changes or continuities in gender roles, situated around the sexual division of labor? Did the differences between men and women increase or decrease inequalities? Do gender hierarchies contribute to shaping affective, occupational, and other patterns? How does the intersectional approach make it possible to articulate axes of oppression, but also of compromise, negotiation, and suffering?1,3,4.
This study is an excerpt from the project “The COVID-19 pandemic and its effects on health management and care in the SUS,” submitted and approved by the Research Ethics Committee of the University Hospital of the Federal University of Maranhão, under CAAE 35645120. 9.0000.5086 and opinion number 4.234.296, dated 08/25/2020.
To ensure anonymity, the names of the participants were replaced by the initials of their professional category (M-doctor; E-nurse; A-CHW; T-nursing technician; C-dentist; F-pharmacist); the number referring to their position in the FG, followed by the UBS number. The interviewees signed the FICF.
Results and discussion
Of the 42 professionals who participated in the FGs, 39 were women. The median age of the participants was 44.5 years. Of these, 32 lived with a partner, 8 were single, and 2 were divorced. Of the participants, 22 self-identified as brown, 7 as black, and 13 as white.
Twenty-one professionals were CHWs, 11 were nurses, 7 were doctors, 2 were nursing technicians, 1 was a dental surgeon, and 1 was a pharmacist. The median length of service at the CHW was 13 years, and the professional category that had been working the longest was CHW (Table 1).
The analysis of the FGs allowed us to understand the experiences and the relationship between work and home life of professionals who lived through the critical moments of the pandemic. Based on the reports, two categories were identified: “Se vira nos 30 na UBS” (Turn on a dime at the BHU) – jargon used in a television program as a synonym for the ability to adjust to new circumstances quickly, creatively, and without many resources – addresses the changes that occurred at the BHU and the challenges of work overload, lack of equipment, fulfillment of professional duties, the fear of becoming infected and spreading the disease, and the suffering caused by the loss of colleagues; and “Juggling the second shift,” which highlights the increase in working hours added , due to household and family care (without a support network or school for children), as well as the insecurity caused by the risk of transmitting the virus to family members and the prejudice they suffered.
Turn on a dime at the BHU
This category highlights how the fast pace of the pandemic, mass illness, high demand at BHUs, stress, uncertainty, and fear impacted healthcare professionals. The changes, however, were described differently by professionals from different categories.
Only women’s narratives made up this empirical category. The inequalities reported are related to the link between professional category and skin color. Higher-level categories have fewer black/brown-skinned people.
Work overload was associated with performing multiple functions in addition to usual responsibilities. Due to staff shortages, nurses took on other roles, such as cleaning assistant, kitchen assistant, and receptionist.
In my opinion, there was overload. I even became a cleaning assistant, I did everything, I was a kitchen assistant, I was everything. Me and the few who were left. So, we spread ourselves across other sectors. There was a time when I was in medication, reception, and in control of the bathroom because I had the key and couldn’t leave it dirty. (E-3-1)
In the view of the medical participant, the Public Administration used the suspension of labor rights to impose uninterrupted work on professionals, using this maneuver to manage human resources during the health crisis.
It wasn’t said here, but we were prohibited from taking vacations and leave. Those who had already taken it, had already authorized it, had to come back. We went a year or two without being able to take vacations. (M-3-2)
Understanding overload from a multifaceted perspective makes it possible to incorporate different perceptions about working conditions, whether due to legal restrictions or the requirement to take on different roles during that exceptional moment.
This situation highlights how the intersection of gender and professional category resulted in specific inequalities: in the hierarchical organization of health work, nurses and CHWs faced challenges related to their professional status and working conditions, in addition to being overburdened with extra tasks11,12.
Thus, intersectionality shows that it is not only the fact that they are women that determines this overload, but also their position within institutions, revealing the complexity of gender inequalities in the workplace13.
During the COVID-19 pandemic, certain professional categories in the health field were more impacted than others. CHWs and Endemic Disease Control Agents faced greater difficulties in accessing protective resources and work support supplies, accentuating feelings of fear and insecurity in the performance of their work activities14,15.
At the same time, nursing professionals experienced long working hours, high exposure to biological risks, and an intensification of physical and mental illness, at levels higher than those observed in other categories of the healthcare network16.
Working conditions were seen as precarious. There was a lack of personal protective equipment, the pace of work was intense due to high demand, and the increase in hours worked caused enormous physical exhaustion and increased the risk of illness.
I arrived at 7:00 a.m. and had no set time to leave, and due to the high demand, many professionals ended up getting sick. (E-1-3)
It was like a war, especially because there was a shortage of supplies! It was trying to do a lot with very little and being scared! (M-1-2)
The emphasis on work overload is present in the reports of doctors, nurses, and CHWs. The situation described as a “war,” highlighting the scarcity of resources to perform their work and the fear caused by the imposed reality, appears in the report of the medical professional, although her work was performed exclusively in the office, which differentiates her from the other professionals.
In the health field, medicine occupies a dominant position, related to the recognition of legitimate knowledge and authority in clinical decisions17. Therefore, medical autonomy, in addition to the ability to make independent clinical decisions, encompasses the ability to maintain a position of dominance within the field of health18.
These differences point to a distribution of responsibilities within health teams that express hierarchical relationships based on the recognition of competence in decision-making within the doctor-patient relationship19.
The fear expressed by the professionals went beyond concern about their own contamination, extending to the potential risk of transmitting the infectious agent to other patients, which generated critical reflections on the quality and safety of the care provided. The fear expressed by doctors from different BHUs, located in neighborhoods of different social classes, revealed, with the same intensity, the insecurity and discomfort they felt when performing their work:
It was a two-way street. Just as we were afraid of being infected, people were also afraid, [...] we closely monitored complicated cases and at the same time had to treat them, protect ourselves from getting infected... it was very scary. (M-1-10)
The constant fear related to personal contamination and transmission of the virus to family members was reported in a survey of nurses20. It was observed that professionals from all categories faced significant emotional challenges, such as intense emotional exhaustion, fear of imminent infection, and work overload.
The fear of being infected at work caused these professionals to go against what is recommended for proper care, distancing themselves from users due to the uncertainty of possible infection by the virus. Some performed a ritual before the patient entered the room, including using alcohol on all surfaces and positioning the chair further away to maintain distance. In addition, the double use of Personal Protective Equipment (PPE) was reported, namely two caps and two masks, with the expectation of increasing the barriers to imminent contact with the virus and thus increasing their protection. At times, these professionals bore the costs of PPE or intensified hand hygiene while caring for the same patient, even curtailing their physiological needs, such as going hours without drinking water, so as not to remove their masks.
In the past, we would say to the patient: lean here. Nowadays, before the patient enters, I move the chair away ... and I felt embarrassed. […] I would put a plastic cap under the disposable cap, which I thought was quite waterproof. (M-3-8)
I used to say to my mother: ‘Mom, I’m going into the eye of the storm!’. […] So, for me, every day I came home, I considered it a victory. (E-5-3)
Tension, nervousness from colleagues working without masks. I even argued with one because I didn’t accept it and she wanted to keep her mask here on her chin. (A-5-4)
Although fear was a common feeling among professionals, coping strategies varied according to professional category. The narratives of the doctor, nurse, and Community Health Workers (CHW) reveal different experiences in the context of the pandemic.
The doctor expressed discomfort with the changes in safety practices, even though she had greater control over the environment and could impose physical limits. In contrast, the nurse described her work at the BHU as a daily struggle amid overcrowding and continuous exposure to risk. The CHW highlighted conflicts related to non-compliance with health regulations, showing little legitimacy in the eyes of other professionals.
Although risks and precautions are anchored in contexts that produce concrete situations of vulnerability, they also have a symbolic and subjective dimension related to the meanings and perceptions attributed to these experiences. The notion of risk is intrinsically polysemic and, because it belongs to the field of cultural matrices, it takes on different meanings according to the symbolic systems in which it is mobilized21.
The difference between the reports prompts reflection on hierarchies, autonomy, working conditions, and access to resources during the pandemic, revealing inequalities among health professionals working in BHU.
Dall’Ora22 listed several factors that cause physical and emotional suffering among professionals, highlighting: long hours and work overload; high pressure for results; low autonomy in work organization; conflictual relationships among team members; little training; low supply of inputs; and job insecurity.
All narratives that addressed feelings such as fear and insecurity, in addition to fatigue and overload in care, were told by women. The men, although present in the research, did not express emotions or experiences in this regard. The absence of mention of suffering, the silence in the face of pain and vulnerability can be understood as resulting from gender hierarchies in the modeling of male affective patterns21,23.
Juggling the second shift
This category encompasses the effects of the pandemic in the private sphere, particularly the repercussions of professional work on family dynamics and domestic support networks. It also includes the gender implications of the sexual division of labor and care, especially with regard to caring for children, the elderly, and sick people in the home environment.
Healthcare professionals, in addition to spending more time in physically and emotionally exhausting work, also took on more domestic tasks and intensified family care.
They lived in intense fear of transmitting the pathogen to their family group, especially when they lived with elderly people. To reduce the risks, they created ways of “decontamination.” In the FGs, the professionals described what they called “cleaning rituals” that they performed before entering their homes. Workers from different professional categories set aside a bathroom for their exclusive use outside the home, among other strategies, to prevent their families from becoming ill:
And the pressure I felt was when I got home, there was an elderly person at home, who was my mother, I had to do that whole washing ritual, which also put a lot of pressure on me and made me feel guilty if I passed it on to someone. (E-5-3)
They were almost kicking me out of the house. When I came in, I had to enter through the backyard, take a shower, I don’t know what... no one even wanted to come near me! My room was completely isolated, but it was very strange! (M-1-2)
Faced with contradictory “pressures” between the responsibilities linked to professional ethics and caring for her elderly mother, the nurse expresses the suffering and challenges she faced during the pandemic. The analysis of this report can shed light on the tensions imposed on a female contingent that makes up the healthcare workforce, based on the articulation between axes of oppression, commitment, and suffering.
Flávia Biroli4 argues that the sexual division of labor is a central element in the production of gender inequalities. She points out that this form of work organization has linked women to responsibility for care work, both in the domestic and professional spheres, resulting in overload and limitations on their autonomy. As a result, this pattern is sustained by gender stereotypes that relate attributes constructed as inherent to women, linking them to notions of care and a supposed “natural” willingness to devote themselves to others, bringing the family and professional spheres closer together1.
The fear of going home and infecting their families was one of the main problems reported by healthcare workers. Perceiving themselves as a danger to their families or a means of transmitting a serious and unknown disease created obstacles between the professionals and their families, to the point that they avoided affection and physical contact with them.
I was afraid to kiss my husband on the mouth, […] seriously, I thought I had COVID all the time and would pass it on to him. (A-3-3)
For me, what stood out and I remember now was going three months without a hug, right, three months without a hug, not even my daughter who lives with me had the courage to come and hug me. My other daughters, my other children, my grandchildren, no one hugged me. For me, that was terrible. (M-3-4)
Gender stereotypes reinforce that caregiving is a feminine attribute, and recognition for this (unpaid) work manifests itself in the form of affection. The refusal of physical contact revealed that, even though they took care of everyone, they were not taken care of1,4.
Added to the suffering caused by long and exhausting working hours are the responsibilities of caregiving in the family environment. Without a support network, unable to rely on domestic workers, without access to daycare/schools, and maintaining distance from family members, these women took on even more daily tasks:
There was an aggravating factor. So, we had to let go of the people who worked in our house, right, I had to let go of my secretary. So, in addition to my work coming here, I had to do the housework, and I had no one to help me! So, it was an extra burden. (E-3-3)
The COVID-19 pandemic acted as a leveling factor among various professional women and intensified existing inequalities in the field of domestic care, imposing a new configuration on women’s routines. Both women who relied on domestic workers and were forced to dismiss them24 and those who did not have this support faced an even greater burden, as they were left without any support network, accumulating the demands of professional work with domestic and family tasks25,26.
One study found that healthcare professionals who lived with their families were more prone to moderate to extremely high levels of stress, especially related to childcare, and reported greater difficulty in balancing work demands with family responsibilities. In the analysis adjusted for risk variables, it was observed that female physicians were almost three times more likely to show positive signs of burnout compared to their male colleagues27.
The pandemic has widened gender inequalities in the workplace and, in the private sphere, has highlighted the unequal division of labor1,3,4. According to the data collected in this study, 76% of the women interviewed were married or living in a stable union, while all the men interviewed cohabited with partners. Even so, none of them demonstrated this duality between domestic and professional life.
According to the IBGE (2019), women devote more time to domestic work and family care than men. Among those who worked formally, women performed an average of 18.5 hours per week of domestic activities, while men devoted 10.3 hours28.
Before the pandemic, data from IBGE (2019) already indicated that women accumulated more hours of domestic work and care than men, even in similar occupational situations. During the health crisis, this inequality intensified. The professionals interviewed reported a significant increase in both their professional workload and domestic responsibilities.
Despite the overload of work, as well as increased tension and fear, these professionals suffered prejudice when wearing their BHU uniforms in public spaces. In their reports, there were complaints about neighbors’ discontent with sharing common spaces in condominiums or residential buildings with health professionals. Professionals reported how challenging it was to manage people’s reactions:
[doctor reporting on comments from neighbors] everyone commented: this is absurd, and they still get in the elevator. And people were afraid, afraid to come near. Look, I was terrified. (M-3-5)
Then I would come home and my husband would be at the door with the trash bag ready. And the neighbors would be looking at me. During this pandemic, I felt like I was dirty all the time. (CHW-3-3)
Outside of health facilities, professionals were seen as a threat to the community. The doctor and the CHW reported different forms of prejudice during the pandemic. Neighbors viewed the doctor with suspicion and fear because of her work. The CHW felt “dirty all the time” and therefore took extreme measures of protection and isolation, such as avoiding social and family interactions. Working in health facilities was associated with the transmission of the disease.
Mary Douglas29, when discussing the notions of dirt and purity as symbolic constructs, associates the “impure” with a threat to social and moral boundaries. Health professionals, previously socially valued, came to symbolically occupy the place of “danger” because they crossed boundaries between the “contaminated environment” (BHU) and the domestic and collective space.
Even with all the care and safety measures, some professionals were infected and transmitted the disease to family members. This significantly affected interpersonal relationships.
My mother caught COVID, [...] and my brother was intubated and still suffers today. She was never extubated. Both her lungs are compromised, neither of them work anymore, she breathes with machines, and now they’re saying... and it’s been almost three years. This traumatizes people, because they think, they react, and they feel... I’m guilty, they’re going to blame me. (M-3-5)
The responsibility for care, attributed to women, goes beyond practices and techniques; there is a moral weight, which includes guilt, that falls on them, revealing an asymmetry that shapes the persistence of gender inequality25.
As discussed by Rezende30 (2006), fear and guilt are not just individual responses to risky situations, but culturally shaped emotional experiences that emerge within specific social contexts.
This reality made no distinction between those who occupied different positions in the labor market. Whether doctors, nurses, or CHW, they all experienced the same challenge: balancing the strenuous demands of work with the demands of home, and in most cases, at the expense of their physical and mental health. This common experience reinforces how gender issues permeate professional differences.
The sexual division of labor affected women broadly and profoundly during the health crisis1. During the pandemic, women from different social classes faced overload when balancing professional work and family care, albeit in different contexts.
Limitations and strengths of the study
Data collection took place in 2022, when the pandemic had already cooled down, as reflective and emotional distancing from professionals was expected. The inaccuracy demonstrated between the events that occurred in the 1st and 2nd waves revealed the permanence of suffering that has not yet been overcome. As it was a remarkable event in people’s lives, the narratives carried an emotional charge.
Few men participated in the focus groups, consistent with the high number of female professionals in PHC. The group interview may have been a factor inhibiting male participation and the expression of feelings and emotions. The fact that this was an intentional sample limits the generalization of the results, but it sheds light on the division of tasks and the work overload of women in relation to men during the pandemic.
The analysis of the intersection between gender, work, and care carried out in this study did not consider the dimension of race. The interviews did not reveal any themes identified as inequalities related to race. The study focused on experiences related to the trade-offs, conflicts, oppression, and compromises reported regarding professional work and domestic responsibilities during the health crisis. However, it is possible that latent, unspoken conflicts were not perceived. A more in-depth analysis of the intersection between gender and race could further enrich the understanding of the experiences of healthcare professionals.
The strengths of the study are the triangulation of professional categories and the inclusion of BHU from all health districts in the municipality, increasing the variability of situations experienced by the participants. The study addressed the effects of the pandemic on the professional and private lives of health workers, filling a gap in the literature. And, by focusing on PHC, this research considers aspects of the pandemic beyond the experiences of professionals in hospitals and ICUs.
Final considerations
The social and health crisis caused by the COVID-19 pandemic has brought about changes, but it has also highlighted and deepened inequalities in terms of gender and class.
In Primary Health Care, this study revealed work overload in stressful conditions in health units, due to increased demand for care and a shortage of resources. The analysis highlighted how the intersection of gender and professional category created specific inequalities, such as greater exposure to risk and the burden of other work tasks for nurses and CHWs, compared to doctors.
While in the professional sphere, social class promoted a certain advantage among women, in the family sphere, it was gender that marked inequality. In private life, the pandemic exacerbated an unfair distribution of care faced by professionals who also took on increased work and responsibility for caring for their homes and families.
The study reveals the need for debates and policies that address issues of care, gender, and class, because despite the achievements of social movements, there are still obstacles to gender equality and social justice. The clashes over the sexual division of labor, care, and responsibilities assigned to women reveal that inequalities harm women’s lives, as social relations are articulated around the axes of commitment, affection, oppression, and suffering. Inequalities significantly compromise democracy, as it is realized in public and private spaces.
-
Funding
This work was carried out with support from the Coordination for the Improvement of Higher Education Personnel - Brazil (Capes) - Funding Code 001.
Data Availability
Research data is only available upon request.
References
- 1 Brandão ER, Alzuguir FCV. Gênero e saúde: uma articulação necessária. Rio de Janeiro: Editora Fiocruz; 2022.
- 2 Scott JW, Louro GL, Silva TT. Gênero: uma categoria útil de análise histórica de Joan Scott. Educ Realidade. 1995; 20(2):71-99.
- 3 Piscitelli A. Interseccionalidades, categorias de articulação e experiências de migrantes brasileiras. Soc Cult. 2008; 11(2):1-13.
- 4 Biroli F. Gênero e desigualdades: limites da democracia no Brasil. São Paulo: Boitempo; 2018.
- 5 Crenshaw K. Documento para o encontro de especialistas em aspectos da discriminação racial relativos ao gênero. Rev Estud Fem. 2002; 10:171-88.
- 6 Brah A. Diferença, diversidade, diferenciação. Cad Pagu. 2006; (26):329-76.
- 7 Santos BS. La cruel pedagogía del virus. Coimbra: Edições Almedina; 2020.
- 8 Lerner K, Aisengart R. Covid-19 e tempos de crise: entre o risco e o cuidado. Saude Soc. 2024; 33:e240309pt.
- 9 Macinko J, Harris MJ, Rocha MG. Brazil's National Program for Improving Primary Care Access and Quality (PMAQ): fulfilling the potential of the world's largest payment for performance system in primary care. J Ambul Care Manage. 2017; 40:S4-11.
- 10 Bardin L. Análise de conteúdo. São Paulo: Edições 70; 2011.
- 11 Gomides LM, Abreu MNS, Assunção AA. Desigualdades ocupacionais e diferenças de gênero: acidentes de trabalho, Brasil, 2019. Rev Saude Publica. 2024; 58:13.
- 12 Souza DO, Silva MP, Souza VA, Reis LP, Ferreira LM, Santos AEM, et al. O trabalho de Enfermagem a partir da experiência de enfermeiras da linha de frente contra Covid-19: na trilha da precarização. Interface (Botucatu). 2023; 27:e230021.
- 13 Rios F, Lima M. Lélia Gonzalez: por um feminismo afro-latinoamericano - ensaios, intervenções e diálogos. Rio de Janeiro: Zahar; 2020.
- 14 Fernandez M, Lotta G, Corrêa M. Desafios para a Atenção Primária à Saúde no Brasil: uma análise do trabalho das agentes comunitárias de saúde durante a pandemia de Covid-19. Trabalho Educ Saude. 2021; 19:e00321153.
- 15 Lotta G, Fernandez M, Correa M, Wenham C, Nunes J. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020; 396(10248):365
- 16 Hoedl M, Bauer S, Eglseer D. Influence of nursing staff working hours on stress levels during the COVID-19 pandemic: a cross-sectional online survey. HeilberufeScience. 2021; 12(3/4):92-8.
- 17 Donnangelo MCF. Medicina e sociedade: o médico e seu mercado de trabalho. São Paulo: Hucitec; 1975.
- 18 Schraiber LB. O trabalho médico: questões acerca da autonomia profissional. Cad Saude Publica. 1995; 11(1):57-64.
- 19 Ribeiro JM, Schraiber LB. A autonomia e o trabalho em medicina. Cad Saude Publica. 1994; 10(2):190-9.
- 20 Ramos AR. Medos vivenciados pelos profissionais de enfermagem durante a pandemia de Covid-19: revisão de literatura. Res Soc Dev. 2022; 11(17):e219111739184.
- 21 Neves EM. Antropologia e ciência: uma etnografia do fazer científico na era do risco. São Luís: Edufma; 2008.
- 22 Dall’Ora C, Ball J, Reinius M. Burnout em enfermagem: uma revisão teórica. Hum Resour Health. 2020; 18(1):1-17.
- 23 Das V. Aflição: saúde, doença, pobreza. São Paulo: Editora Unifesp; 2023.
- 24 Stock TO, Bortolotto CC, Amaral MA, Arruda GM. Violence against women in the Covid-19 pandemic: a systematic review. Physis. 2024; 34:e34037.
- 25 Duarte LFD. Indivíduo e pessoa na experiência da saúde e da doença. Cienc Saude Colet. 2003; 8(1):173-83.
- 26 Furtado F, Andriolli C. Mulheres, Covid-19 e a lógica patriarcal: análise sobre o trabalho das mães docentes. Cad Pagu. 2023; (68):e236806.
- 27 Civantos AM, Bertelli AA, Longo KM, Sipaúba MN, Trevizani LS, Quintero CA, et al. Mental health among head and neck surgeons in Brazil during the COVID-19 pandemic: a national study. Am J Otolaryngol. 2020; 41(6):102694.
- 28 Instituto Brasileiro de Geografia e Estatística. PNAD Contínua. Rio de Janeiro: IBGE; 2019.
- 29 Douglas M. Purity and danger: an analysis of concepts of pollution and taboo. London: Routledge; 2003.
- 30 Rezende CB, Coelho MC. Antropologia das emoções. Rio de Janeiro: Editora FGV; 2010.
Edited by
-
Editor
Stela Nazareth MeneghelStela Nazareth Meneghel https://orcid.org/0000-0002-7219-7178
-
Associated editor
Catarina DelaunayCatarina Delaunay https://orcid.org/0000-0001-9679-0681
