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Reform of mental health services: An urgent need and a human rights imperative

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Already in the early stages of the COVID-19 pandemic, the World Health Organisation (WHO) was warning that substantial investment in mental health services was necessary to avert a mental health crisis. The evidence for the devastating impact of the pandemic on mental health is now overwhelming. The reasons for this are clear: the pandemic caused fear and anxiety for everyone, and many of us had to face illness, grief over lost family members, insecurity and loss of income. In addition to this extraordinary burden placed on our mental health, we were cut off from our usual support networks, friends and families, while the pandemic was also disrupting the delivery of existing mental health services themselves.

Not everyone has been affected in the same way by the pandemic, and mental health is no exception here. Among others, the mental health of certain demographics such as older persons, children and adolescents, and women, as well as that of disadvantaged groups such as persons with disabilities, LGBTI people and migrants has been affected more compared to the general population. For example, in a statement I co-signed with the UN Independent Expert on Sexual Orientation and Gender Identity and numerous other human rights experts, we alerted states to increasing mental health problems for LGBTI people, in particular youth, notably as a result of having to shelter with family members who were unsupportive of or hostile towards their LGBTI identity.

I recently published an Issue Paper entitled “Protecting the right to health through inclusive and resilient health care for all” in which I set out twelve recommendations. These include universal health coverage (of which mental health services are an essential component), more equality and dignity for patients, more participation and empowerment in relevant decision-making, the promotion of transparency and accountability throughout policy cycles, and better health communication policies. Since the right to health is defined as the right to the highest attainable standard of physical and mental health, these recommendations naturally apply to mental health care as well. Some recommendations, however, are more specific to mental health, such as those related to the need to ensure that mental health services are accessible to all when needed, of appropriate quality and affordable, to transition from an institutional to a community-based model and to eliminate coercive practices in mental health services.

Mental health systems: a longstanding source of human rights violations

While the additional strain generated by the pandemic is new, the mental health situation and lack of services has been a neglected human rights crisis in Europe for a long time. Despite the suffering and economic burden caused by mental health problems, mental health spending in the WHO European region was estimated to amount to only 1% of total health expenditure in 2019, and the majority of that expenditure was channelled towards mental health hospitals. In a very important report in 2017, the UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health was already raising the alarm over the fact that “the arbitrary division of physical and mental health and the subsequent isolation and abandonment of mental health has contributed to an untenable situation of unmet needs and human rights violations”.

In my Issue Paper on health, I called on governments to pay attention to the essential social determinants of health in order to rebuild more inclusive and resilient health care systems, notably social protection, living conditions, working environment and education. These are all the more relevant for mental health, since mental well-being is determined not only by individual attributes but also by the social environment which can prevent, cause or aggravate mental health problems. In recent decades, a human rights-based, holistic and psychosocial understanding of mental health has been emerging, but this approach still faces a lot of resistance in many of our member states, where a reductionist, biomedical paradigm remains prevalent. Further problems identified in the aforementioned report of the Special Rapporteur are power asymmetries in mental health policies and services, and the biased use of evidence in mental health. In combination, these reinforce a vicious cycle of stigmatisation, disempowerment, social exclusion and coercion.

In order to rise to the challenge posed by the pandemic for mental health services, it is essential to reform them, as well as relevant laws and policies, urgently and from the ground up. As with health policy generally, the imperative to prevent human rights violations must be the guiding principle behind these reforms.

The human rights of persons with mental health problems or psychosocial disabilities (i.e. disabilities arising from the interaction between a person with a mental health condition and their environment) are routinely violated in two significant ways. Firstly, their human rights continue to be violated by mental health services themselves, notably because they often display a tendency towards paternalism, coercion and institutionalisation. Secondly, affected patients may not have access to the care they need to achieve the highest attainable standard of health. In this connection, we should bear in mind that this right depends on the realisation of many other human rights, notably those enshrined in the UN Convention on the Rights of Persons with Disabilities (CRPD).

Coercion: a persistent source of human rights violations

In a recent report on its visit to Bulgaria, the European Committee for the Prevention of Torture (CPT) documented how patients in psychiatric hospitals were subjected to widespread and systematic ill-treatment at the hands of staff: they were slapped, pushed, punched, kicked, beaten with sticks, chained to beds and medicated without consent. While this example is particularly horrific, we should not forget that similar institutions, and the underlying approach taking coercion for granted, are still common in the majority of our member states, as demonstrated, for example, in recent exposés on the situation of psychiatric hospitals in Malta. My own Office has addressed human rights violations caused by such institutions in a large number of member states, including in an intervention before the European Court of Human Rights.

Why is this still accepted in 2021? Historically, fear, rejection and isolation have been our default response to persons with mental health problems. The ingrained fear and stigma of mental illness is still very strong, fuelling prejudice and the narrative that persons with mental health problems pose a danger to themselves and to society, against all available statistical evidence to the contrary – persons with mental health problems are in fact far more likely to be victims of violence than perpetrators. Mental health laws that normalise closed institutions and forced treatment confirm and reinforce these prejudices. Furthermore, while there is ample evidence that coercive treatment may lead to substantial trauma and that fear of coercion can actually deter persons experiencing mental ill-health from seeking help, there appears to be little scientific evidence to substantiate the supposed benefits of forced treatment.

In 2019, the Parliamentary Assembly of the Council of Europe unanimously adopted a groundbreaking Resolution calling on member states to end coercion in mental health, pointing to the fact that the number of persons subjected to coercion was still growing in Europe. It noted that so-called safeguards to prevent excessive use of coercion had not reduced but, on the contrary, seemed to have increased coercion, for example in France following a reform in 2011: what is defined as last resort in legislation often becomes the default approach, especially when resources are scarce. The corresponding report presented to the Parliamentary Assembly also reflects my observations concerning the marked differences in the level of involuntary placements between countries, but also between different regions of the same country or even from one hospital to another, suggesting that the main cause of coercion is not the inherent dangerousness of persons or therapeutic necessity, but an institutional culture that confines more out of prejudice or habit. This interpretation is supported by research.

In my address to the Parliamentary Assembly prior to the adoption of this Resolution, I drew attention to how my own country work allowed me to see first-hand the vicious circles caused by a mental health approach based on coercion, which perpetuates the isolation of the very persons who need the support of their community the most, fuelling more stigma and irrational fear. The lack of community-based, voluntary mental health services also results in even more coercion and deprivation of liberty.

I have also shared my observation that safeguards supposed to protect persons from arbitrariness and ill-treatment are reduced to mere formalities because they operate in a legal system where persons with mental health problems do not even have a chance to have their voices heard, owing to the profound power asymmetry between the patient and physician in most mental health settings. Judges almost invariably follow the opinion of the psychiatrist over the wishes of the patient, when the law provides for such a possibility. At their worst, such safeguards do little more than ease the conscience of those who are in fact taking part in human rights violations.

My position on coercion in psychiatry and the Resolution of the Parliamentary Assembly should be seen against the background of a growing consensus within the international community to consider involuntary measures without the informed consent of persons with mental health problems as human rights violations, or even as possibly amounting to torture. This is in large part due to the paradigm shift operated by the CRPD when it entered into force in 2008, and the efforts of civil society, in particular of persons with lived experience of mental health problems and psychosocial disabilities, to have their say in policy-making. As a result, a growing number of relevant international and national human rights bodies are now calling for an end to coercion and its replacement by community-based treatment options based on consent. This approach is slowly making headway in the medical community as well, as can be seen in the growing body of WHO guidance to states to reduce coercion, establish community-based alternatives and integrate mental health into primary care. Similarly, the World Psychiatric Association issued a position statement on the need to reduce coercion in October 2020.

This revolution is rooted in the CRPD and it would be a mistake to cling to older Council of Europe standards that place the bar lower. In this context, it is regrettable that work is still continuing in the Council of Europe on a draft Additional Protocol to the Oviedo Convention that reflects an outdated, biomedicine-driven approach reducing mental health to mental disorders and empowering physicians to forcibly confine and treat persons without consent, with virtually no limit being set on the duration of this placement or the treatments to be used. The vagueness of the definitions in this text and the trust in the judgement of a single physician, which appears misplaced given the human rights violations we are still witnessing on a daily basis, could easily give the impression of sanctioning even the worst kinds of human rights abuses in psychiatry. The opposition of the Parliamentary Assembly, several UN bodies including the treaty body of the CRPD, the unanimous protests of representative organisations of persons with psychosocial disabilities and my own opposition to this initiative have so far been ignored.

I call on member states to stop supporting such initiatives at international level, which may create confusion and become a stumbling block to necessary progress in advancing the human rights agenda when it comes to mental health. If new international standards do not nurture the paradigm shift from institutional to community-based care, and from coercive to consent-based care, they should at least do no harm by muddying the waters.

The way forward

A number of member states have started reviewing their mental health legislation in the light of these considerations, for example in Ireland and in the UK. What I found particularly positive with these two examples is the commitment to engage with civil society, and in particular users and providers of mental health services. Initiatives by representative organisations of persons with psychosocial disabilities to promote more inclusive policy-making, for example in the ongoing trialogue in Germany, are also to be commended. The active participation of persons with lived experience of using mental health services in defining policies, in particular, is a sine qua non condition of successful mental health reform, as their exclusion from the debate so far has allowed human rights violations to continue unchecked for as long as they have. This is also a general obligation under Article 4(3) of the CRPD.

The realisation of the right to full enjoyment of the highest attainable standard of mental health depends on the realisation of many other crucial human rights. In particular, member states need to conduct the necessary reforms of their mental health legislation in parallel with reforms in two crucial areas affecting core rights enshrined in the CRPD: legal capacity (Article 12) and the right to live independently and be included in the community (Article 19). Mental health care that truly respects the autonomy, dignity, will and preferences of service users is simply not possible so long as legal systems continue to tolerate substituted decision-making or segregation in institutions. Ongoing legal capacity reforms in our member states are very important in this respect. States must ensure that persons with mental health problems or psychosocial disabilities, including children, never lose their say on decisions involving their health, if necessary by providing the appropriate supports for decision-making, in order to ensure that mental health care is provided on the basis of free and informed consent. For as long as involuntary measures remain a reality, it is also crucial to ensure full access to justice to challenge any decision, an area where there are also some good practices, for example in the Netherlands.

As for institutions, I refer to the longstanding recommendations of my Office to put an end to their use, starting with immediate moratoria on future placements. Experience shows the crucial importance of closing large psychiatric hospitals where persons are involuntarily placed. To take one example, Italy was a pioneer in this respect by initiating a process of gradual closure of psychiatric hospitals from 1978, replacing them with alternatives closer to the community. While Italy is also facing a number of problems regarding the use of coercive measures in psychiatric establishments that still need to be addressed, it should be thought-provoking that the rate of involuntary placements in Italy today appear to be lower, by orders of magnitude, than in neighbouring states.

Reduction of coercive practices in psychiatric services, including the use of restraints and forced medication, and their progressive elimination should be another immediate priority. As mentioned above, the institutional culture and habits largely determine the prevalence of such measures. For example, my predecessor recommended to Denmark in 2013 that recourse to coercion in psychiatry be drastically reduced, and I was happy to note that a psychiatric centre in Ballerup had managed to put an end to the use of restraints as a first in the country, by training staff on conflict management and increasing physical activity for residents, without augmenting medication, for the benefit of both patients and staff.

The ultimate goal must be to replace institutions and a coercion-based mental health system by a recovery- and community-based model, which promotes social inclusion and offers a range of rights-based treatments and psychosocial support options. These can take many different forms and many models exist including, for example, support provided by peers or a support network, patient advocates/personal ombudspersons, advanced planning, community crisis resolution or open dialogue. It is also crucial to deconstruct the lingering stigma associated with seeking help for mental health problems, whether this is done in the school environment, at the workplace or in primary healthcare centres, through targeted awareness-raising and outreach. Only then can mental health services, as an integral part of primary care, be universally available to individuals throughout the entire life cycle. Once more, true involvement of persons with lived experience in the design, implementation, delivery and monitoring of these services is crucial.

Member states can take inspiration from several compilations of promising practices at the European and global levels, as well as ongoing projects and research conducted into community-based delivery of recovery-oriented mental health services, such as the RECOVER-E project running in Croatia, Montenegro, North Macedonia, Bulgaria and Romania. I am also conscious of the potential impact of new technologies on mental health care, which represent both opportunities and serious risks for human rights, and I refer to my general recommendations concerning human rights and artificial intelligence.

In this context, I encourage states to pay special attention to the mental health of children and adolescents, not least because of the extraordinary strain that the COVID-19 pandemic has placed on them. Lockdown measures and prolonged school closures have deprived them, more than other groups, of their usual routines, while exposing them to isolation and an increase in violence and abuse. We should not forget that childhood and adolescence are crucial periods for life-long mental health. Mental ill-health experienced in the formative years of one’s life, for example as a result of adversities or trauma, affects brain development and the ability to form healthy relationships and life skills. Children and adolescents therefore need non-bureaucratic access to mental health support, as early as necessary and as least invasively as possible, without any shame attached. Institutionalisation of children, on the other hand, has a devastating impact on childhood development. We also need to bear in mind that suicide was one of the leading causes of death among adolescents in the European region even before the pandemic, which makes recent evidence of a marked increase in anxiety levels, depression and self-harm among young people particularly alarming. In order to prevent future burdens on mental health systems, it is crucial to expand our capacities for early psychosocial interventions for children by building on innovative and community-based child mental health services, rather than pursuing the worrying trend of ever-increasing use of psychotropic medication on children.

Mental health reform is an extremely challenging task for all our member states, given the complexity of the issues and the huge gap between agreed international standards and the reality on the ground. This, however, makes it all the more urgent. Let us turn the current challenge of the pandemic into an opportunity, by thoroughly transforming mental health services in Europe, with human rights as our guide and compass.

Council of Europe

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New Social Compact

Debunking Magical realism through Marquez’s “A Very Old Man with Enormous Wings”

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There are few names in the Latin American literature, which it comes to famous novels and short stories, Columbian writer Gabriel Gracia Marquez is one of them. Throughout Latin America, he is popular with the name Gabo and was one of the intellectual literary writers of the 20th century. For his tremendous work, he received the Neustadt International Prize for Literature in 1972 and Nobel Peace Prize for literature in 1982. During his literary journey, he has written numerous acclaimed novels such as One Hundred years of Solitude published in 1962 and Love in the Time of Cholera, which was published in 1985. His popular writing style is often known as magical realism, which later emerged as a major literary movement in Latin American literature. He has also written numerous famous short stories, and among them “A Very Old Man with Enormous Wings” is very popular in Latin American. The American Review published it in 1995 in the Spanish language. The title of the story “A Very Old Man with Enormous Wings” tells the story of a shadowy old man, who one day appears in the family courtyard. The old man was not an ordinary person, because he was having some strange characteristics such as an enormous pair of wings, which was a new thing for the people, who were living in town. Hence, with the magical depiction of old man character, the author explains the conflict the ordinary people encounters concerning their cultural belief. Moreover, the whole story is written from the context of third-person narrator.

On the other hand, the presence of an old man character with huge wings represents the Magical realism of the author. Throughout the story one of the most interesting thing about the old man character is that after his appearance in the family court people began viewing him as a normal human being. But for some, he was different from the normal man because he got the huge wings that make him look like an angel, who is dressed like a rag-picker. The major character in the story is Pelayo and Elisenda in whose yard, the mysterious old man first appears. In the story, the author describes the strangeness of this old man in these words “His huge buzzard wings, dirty and half-plucked, were forever entangled in the mud. They looked at him so long and so closely that Pelayo and Elisenda very soon overcame their surprise and in the end found him familiar”. This clearly shows, though initially Pelayo and Elisenda found him a strange creature but, after the closer contact, they began viewing as a normal human being just like them. Nonetheless, the old man with mysterious wings was still a strange creature for the other people in town.

When Pelayo and Elisenda brought the old man to the physician in the town, the physician took the advantage to examine the physical uniqueness of this old man. For the physician, the old man was a new thing for him, because throughout, his carrier, the doctor has encountered something like him. As the author writes about the physician; “What surprised him most, however, was the logic of his wings. They seemed so natural on that completely human organism that he couldn’t understand why other men didn’t have them too”. Similarly, when Pelayo and Elisenda informed their neighbor about the mysterious old man, the neighbor tells them that he is an angel. This scene in the story explains how an individual thinks and feels when he/she encounters something different, mysterious, and strange. Moreover, this also explains the limitation of the human mind and the lack of knowledge about different things. This happens, at one moment the couple decides to get rid of the old man and even planned to kill him because they thought he might be a curse. Later, they change their plan and decides to imprison him and in prison, the mysterious old man suffers severe abuse and mistreatment.

Soon after the imprisonment of the old man, the people began whispering stories about the old man. Some villagers began perceiving him as an angel, while the other considered him as evil, who is God’s curse on the village. In this respect, the story The very old man with enormous wings Marquez is a mixture of compassion and sadness. Because the couple Pelayo and Elisenda wanted to get rid of him but the old man refuses to leave them until their life is transformed. As it is written in the bible “Do not be forgetful to entertain a stranger, you could be entertaining an angel”. The real reason, why the old man was a stranger to the couple and villagers because he was unattractive and he was having huge wings that embarrassed them. Throughout the story, the people in the town curse him and makes fun of him, but the old man never fights back because he is compassionate and he understands the fact that he cannot speak their language. Overall the whole story demonstrates the context of bad and good human nature because seeing the beauty is one thing while ignoring a person based on the fact that he is ugly is weary.

In contrast, the central theme of Gracia Marquez’s “The very old man with enormous wings Marquez” is the Coexistence of compassion and cruelty, which explains the feeble response of selfish and greedy humans towards those,  who are different, strange, ugly, and weak. For instance, the major characters in the novel the couple Pelayo and Elisenda imprison the old man and abuse him, and even they planned to kill him because he was ugly and weak. But once they thought, they could benefit from the old man by showcasing him in the village, they decide to keep him to accomplish their appetite for money. In a nutshell, the moral of the story was religious has always been a shallow set of beliefs, which ignore the principles of morality. Hence, the treatment of the old man in the town after his appearance in the family yard clearly shows that people in the story are faithless having inconsistent faith.

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New Social Compact

Women Rights in China and Challenges

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Women rights and gender discrimination have been a problem for many years in china. Various restrictions were imposed on women to suppress them in society. Income discrepancy and traditional gender roles in country aim to place women inferior as compared with their male counterparts.

There are diverse sectors where women face discrimination. Women of the past and present in china have dealt with unfair employment practices. They have had to jump over the unnecessary hurdles just to keep up with their male counterparts in the society. The Chinese government claims to better prioritize the promotion of gender equality but in reality it does not seem appropriate to say that there is not a single department of life where women are not being suppressed. In jobs, mostly men are preferred over women at high positions. There are a number of contextual examples which demonstrates this discrepancy in the status of women throughout china, and whilst there has been a great deal of the popular sphere, others have been brutally repressed by a government dominated by male families. For example, women who have children do not always receive support from their pay when maternity leave.

China’s history has seen a higher focus on men being the core of not just their families but also they play crucial role in in overall country’s growth and development. Post Confucius era, society labeled men as the yang and women as the yin. In this same vein, society views Yang as active, smart and the dominant half. This compared with Yin, which is soft, passive and submissive. These ideologies are not as prominent today but persist enough that there is a problem.

The tradition begins at birth with boys being the preferred children compared to girls in China. A consensus opinion in the country is that if one has a male child versus a female child, they believe the son will grow into a more successful member of the family. The sons are more likely favored because the issue of pregnancy is a non-factor and they can choose almost any job they desire. Of course, this is something that does not support efforts for gender equality nor women’s rights in China.

A survey done just last year found that 80% of generation Z mothers did not have jobs outside of the home. Importantly, most of those surveyed were from poorer cities. The same survey found that 45% of these stay-at-home mothers had no intention of going back to work. They simply accepted their role of caring for the house. Gender equality and women’s rights in China have shifted toward cutting into the history of patriarchal dominance within the country.

Women’s Rights Movement in China

Since the Chinese government is not completely behind gender equality in China for women, the feminist movement is still active and stronger than ever. In 2015, the day before International Women’s Day, five feminist activists were arrested and jailed for 37 days. They were just five of an even larger movement of activists fighting against the traditional gender role ideology that has placed females below males. These movements have begun to make great progress towards gender inequality within the country. From 2011 to 2015, a “12th Five Year Plan” had goals of reducing gender inequality in education and healthcare.

The plan also was to increase the senior and management positions and make them accessible for women to apply for said positions. Xi Jinping, the current President of the People’s Republic of China, has proclaimed that the country will donate $10 million to the United Nations Entity for Gender Equality and the Empowerment of Women. During the next five years and beyond, this support will help the women of China and other countries build 100 health projects for women and children. March 1, 2016, the Anti-domestic Violence Law of the People’s Republic of China took effect. This law resulted in the improvement in legislation for gender equality in China. In June of that year, ¥279.453 billion was put forth toward loans to help women, overall.

‘’There are a number of contextual examples which demonstrate this discrepancy in the status of women throughout China, and whilst there has been a great deal of progress made in some elements of the popular sphere, others have been brutally repressed by a government dominated by male influence.

Mao Zedong’s famously published collection of speeches entitled ‘the little red book’ offers a glimpse into the People’s Republic’s public policy in relation to women, as Mao himself is quoted as saying ‘Women hold up half the sky’ and more overtly.’’

In order to build a great socialist society, it is of the utmost importance to arouse the broad masses of women to join in productive activity. Men and women must receive equal pay for equal work in production. Genuine equality between the sexes can only be realized in the process of the socialist transformation of society as a whole.

The china has been widening the gender discrimination gap in the society through legalized way and there is desperate need to raise the voices in gender equality.

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New Social Compact

Gender Pay Gaps during Pandemic: A Reflection on International Workers’ Day 2021

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Men, rather than women, have been disproportionately affected by job losses over time. Nonetheless, the harsh reality of this pandemic recession has shown that women are more likely to be unemployed. As a matter of fact, women have lost substantial jobs as a result of increased childcare needs caused by school and daycare closures, which prohibit many women from working, and as a result of their employment being concentrated in heavily affected sectors such as the services sector (hospitality business, restaurant, retail outlets and so on). According to a study by Alon et al, women’s unemployment increased by 12.8 percent during the first period of Covid-19 (from March 2020), while men’s unemployment increased by just 9.9 percent. Changes in job rates (which include transfers into and out of the labor force) follow the same trend, with women experiencing a much greater drop in employment than men during the recession. Similar trends have been seen in other pandemic-affected countries.

In Southeast Asia, where informal workers account for 78 percent of the workforce, women make up the majority of blue-collar employees. In Indonesia, the Philippines, Cambodia, Laos, and Myanmar, women make up a substantial portion of the domestic workers, despite having a low contractual working status in informal settings. They are underpaid as a result of the pandemic, and the Covid-19 recession has reduced their importance in the workplace. Indonesia as one of the countries which affected by pandemic also experienced similar thing, with two-thirds of the female population in the active age group (between 15 and 64 years old), Indonesia is supposed to have tremendous potential for accelerating its economic development, but the truth is the opposite due to the never-ending pandemic. Since the pandemic began, many employees, mostly women, have lost their jobs or had their working hours shortened. Of course, their daily wages are affected by this situation. Besides, the wage gap between men and women also widens from March 2020 to March 2021, with women in the informal sector receiving up to 50% less than men, clearly resulting in discriminatory practices.Despite the fact that Indonesia ratified the International Labor Organization’s (ILO) Convention No. 100 on Equal Remuneration in 1958, fair and equal salaries have remained unchanged until now, and the legislation seems to have been overlooked and inapplicable in a pandemic situation.

Furthermore, the issue is not resolved at that stage. Apart from the pandemic, both formal and informal workers are exposed to various work systems and regulations. Women may have similar experiences with low wages and unequal payment positions in both environments, but women who work in the formal sector have the capacity, experience, and communication skills to negotiate their salaries with their employers, while women who work in the informal sector do not. Women in informal work face a number of challenges, including a lack of negotiation skills and a voice in fighting for their rights, particularly if they lack support structures (labor unions). Furthermore, when it comes to employees’ salaries, the corporate system is notoriously secretive. Another issue that continues to upset women is the lack of transparency in employee wages. Despite the fact that the national minimum wage policy is regulated by the government, only a small number of female workers are aware of it.

Overcoming Gender Pay Gaps within Pandemic Condition

In the spirit of International Workers’ Day 2021, there should be an organized and systematic solution to (at the very least) close the wage gap between men and women in this pandemic situation. International organizations and agencies also attempted to convince national governments to abolish gender roles and prejudices, however this is insufficient. As a decision-maker, the government must ‘knock on the door’ of companies and businesses to support and appreciate work done disproportionately by women. Furthermore, implementing transparent and equitable wage schemes is an important aspect of significantly changing this phenomenon. Real action must come not only from the structural level (government and corporations), but also from society, which must acknowledge the existence of women’s workers and not undervalue what they have accomplished, because in this Covid-19 condition, women must bear the “triple burden” of action, whether in productive work (as a worker or labor), reproductive work (as a wife and mother), and also as a member of society. Last but not least, women must actively engage in labor unions in order to persuade gender equality in the workplace and have the courage to speak out for their rights, as this is the key to securing fair wages. And when women are paid equally, their family’s income rises, and they contribute more to the family’s well-being.

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