Intended for healthcare professionals


Precarious work and the covid-19 pandemic: the need for a gender equality focus

BMJ 2023; 380 doi: (Published 30 January 2023) Cite this as: BMJ 2023;380:e072872
  1. Tania L King, associate professor1,
  2. Humaira Maheen, research fellow1,
  3. Yamna Taouk, research fellow1,
  4. Anthony D LaMontagne, professor2
  1. 1Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria 3010, Australia
  2. 2Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria 3220, Australia
  1. Correspondence to: T L King tking{at}

Tania King and colleagues argue that lessons learnt from previous crises and an explicit focus on gender should shape responses to reduce inequalities in job losses and sustained employment precarity after the covid-19 pandemic

Key messages

  • Precarious employment is a key social determinant of health, and, globally, women are more likely than men to be employed precariously

  • Women are at greater risk of job loss and sustained employment precarity after the covid-19 pandemic, with consequential effects on their health and wellbeing

  • Social and employment protection strategies that consider the gendered implications of responses to covid-19 have the potential to protect and advance gender equality

  • This will create fairer labour markets and may ultimately define the foundations of a healthier society

The covid-19 crisis emphasised gender gaps in social protection systems. The International Labour Organisation says that this is largely attributable to women’s higher rates of precarious and informal work in combination with lower labour force participation and higher rates of unpaid care.1 Job losses during the pandemic have been experienced worldwide. Precarious workers—people whose work is characterised by unfavourable work conditions such as employment insecurity, a lack of rights and protections, and low income2—were the first to lose their jobs when the labour market contracted, were redeployed back into the workforce when needed, and then laid off again.3

Across most contexts women are more likely to be precariously employed than men4567; they are more likely to work casually or part time or work in jobs with fewer benefits and protections, and with lower remuneration.6 Many women embrace precarious employment arrangements after having children because it enables them to re-enter the labour force with the flexibility to manage caring responsibilities. But they can get trapped in an ongoing cycle of precarious employment, exacerbated by fragmented employment histories and increasing age, and limiting their ability to get more secure employment.8 This is considered to underpin persistent gender inequalities across societies, contributing to social and health inequalities.56

Unfortunately, precarious forms of work are appealing to many businesses and employers who can more flexibly adjust labour resources in response to market changes and demands, thus saving on employment costs. These arrangments shift the costs of doing business away from employers, organisations, and businesses onto individual workers.9 For small business operators, this is particularly advantageous—they do not bear the risk of taking on a continuing or permanent employee, and they do not have to pay entitlements such as sick leave, annual leave, and superannuation.

As companies and organisations continue to recover from the economic shock of covid-19, there is ongoing pressure to reduce costs to maintain competitiveness.10 Governments worldwide face a key challenge in seeking policy solutions that balance the needs and concerns of businesses and employers with the needs and health of workers. The 2007-09 global financial crisis taught us that economic and social recovery that inflicts the least harm to health is driven by policy responses that attend to gender inequalities and that prioritise fair and decent work. We argue that applying a gender lens to economic recovery from covid-19 could create a fairer labour market and, ultimately, enable us to achieve a more egalitarian society.

Covid-19, job loss, and gender

In the third quarter of 2021, global working hours were 4.7% lower than in the last quarter of 2019—estimated to be equivalent to about 137 million full time jobs lost worldwide.11 These job losses disproportionately affected women, who accounted for 47.6% of 2020 employment losses, despite representing 38.9% of the employed population before covid-19.11

The gendered patterning of job loss during the pandemic has been ascribed to several factors, including the concentration of women in sectors hardest hit by shutdowns, such as the accommodation and food service and retail sectors.12 But there are two other linked factors. Firstly, women’s over-representation in precarious employment arrangements made them more easily dispensable. Secondly, intensified unpaid caring responsibilities during the pandemic were disproportionately borne by women (to the detriment of their mental health),13 precipitating labour force withdrawal for many women.12

Migrant workers, low skilled workers, and young people are also more likely than others to be precariously employed.14 Gender intersects with these social categories and axes of inequality1415 to amplify the experiences and effects of precarious employment. Immigrant women, for example, are over-represented in precarious roles.15 Traditional gender ideologies might cause some immigrant women to retain primary responsibility for household tasks, so there is considerable pressure on women to juggle these competing demands.15

Health effects of precarious employment

Precarious employment is recognised as a key social determinant of health.16 In 2019, a systematic review and meta-analysis of longitudinal studies found evidence of an association between precarious employment and adverse effects on mental health.17 This was supported by a 2022 systematic review and meta-analysis, which found that persistent precarious employment (for a period of at least 12 months) was associated with poorer mental health and poorer self-rated health.18

A 2022 Swedish registry study of over 1.5 million people examined trajectories of precarious employment over five years and found that constant precarious employment (as well as constant borderline precarious employment) was associated with increased risk of stroke and myocardial infarction among men.19 Constant low or very low income was associated with increased risk of stroke and myocardial infarction in both men and women.19

For other health outcomes, particularly mental health, adverse effects of precarious employment might be greater for women owing to a complex set of factors that intertwine, including gendered divisions of paid and unpaid labour, conceptualisations of what the normative worker is, and patriarchal power structures.20 In Germany, for example, a 2020 prospective longitudinal study of 587 employed women found that precarious working conditions and psychosocial work stress experienced during pregnancy were associated with symptoms of maternal postpartum depression eight weeks after delivery.21

Occupational health risks, including exposure to covid-19, were also elevated among precariously employed workers during the pandemic22 because they tend to work in client facing roles and are less able to work from home (for example, hospitality and aged care). Because most precarious workers are only paid when they work (they are not entitled to paid sick leave), they are less able to stay away from work when unwell—thus bringing health risks not only to themselves but also to others.

What can we learn from the global financial crisis?

The 2007-09 global financial crisis precipitated the “great recession,” the worst global recession since the Great Depression. Millions of people worldwide lost their jobs, with precarious workers similarly disproportionately affected. Effects of the crisis were apparent across a range of different health outcomes. Time-trend analysis of suicide rates in England found that about 1000 excess suicides occurred in 2008-10; approximately two fifths of the recent increase in suicides among men (increase of 329 suicides, 126 to 532) were attributed to increased unemployment.23 The associated debt crisis and unemployment rates in Greece led to the worsening of several health outcomes, with an increase in suicides, violence, HIV infections, and drug use, and a decline in self-rated health.24 Also of concern, the health effects were disproportionately borne by the most socioeconomically disadvantaged people across European countries,25 and health inequalities seemed to widen.26 In Australia, suicide rates increased among both employed and economically inactive or unemployed men and economically inactive or unemployed women.27

Responses to crises make a difference to recovery, which was apparent in the way that recovery varied across countries after the global financial crisis. In the United Kingdom, austerity measures are estimated to have contributed to 231 707 excess deaths between 2010 and 2018; most of these were in areas where the financial impact on households was greater than average.28 In contrast to many other countries around the world, the crisis had little to no effect on health outcomes in Iceland, where substantial investment in social protection and initiatives to return people to employment were implemented.29 Another study of European responses to the crisis found that public expenditure on active labour market programmes seemed to moderate the association between unemployment and suicide.30 On the whole, prioritising social and employment protection over austerity seemed to mitigate adverse health risks.29

The effects of the global financial crisis were also patterned by gender. Men were the most affected early in the crisis in terms of job losses. But men recovered more quickly economically, re-entering the workorce while women experienced delayed and persistent effects on employment. This is partly attributed to state responses to the crisis that lacked a gender lens. In many countries, early recovery measures focused on male dominated sectors that had been most immediately affected by the crisis, such as building and construction. Austerity measures imposed in subsequent years did not consider gender31 and tended to exert the biggest effects on women.32 A key focus of austerity policies was on reducing public sector costs, where more women are employed.33 Measures in many countries included salary cuts or pay freezes, hiring freezes, reduced collective bargaining rights, and reduced staffing.33 Many countries also reduced the provision (or increased costs) of services and programmes that supported women’s labour force engagement,32 such as childcare, elder care, and family support benefits.33 The lesson is clear: failing to apply a gender lens to responses to the global financial crisis responses delayed women’s economic recovery and stalled gender equality.

Analysis of mental health trends in the years before and after the global financial crisis in the UK shows a distinct deterioration in the mental health of men at the start of the recession in 2009.34 Throughout the recession (2009-11) and the period of austerity (2011-14), however, population mental health for men improved, returning to pre-recession levels in 2012. For women however, there was little shift in mental health in 2009-10, but there was a substantial deterioration in mental health throughout the period of austerity.34

Despite the damage wrought by the global financial crisis, most countries failed to take meaningful action to limit precarious employment and to protect workers. Rather, the crisis led to an increasing reliance on precarious employment arrangements.3536 Longitudinal evidence indicates that the proportion of workers precariously employed increased in the US between 1988 and 20167 and in Europe between 1995 and 2015.35 Thus, a greater proportion of workers (and a higher proportion of women) entered the covid-19 economic crisis already highly vulnerable to job loss, poverty, and consequent poor health because of their precarious work arrangements.

Social and employment protection mechanisms provide some means of mitigating the public health consequences of economic crises. To prevent the further erosion of employee rights and the regression of gender equality, social protection mechanisms must pay attention to those who are precariously employed.

Recovering and reshaping labour markets with a gender focus

The latest estimates from the International Labour Organisation suggest that women’s employment recovery has been slower than that of men and that a partial rebound observed in women’s employment in late 2021 and early 2022 was largely driven by informal employment—that is, many women returned to informal employment.37 Actively tackling the gendered effects of employment and social policies38 is important in reducing health risks and ensuring equitable economic and employment recovery. Health effects lag behind the economic effects of crises—the fact that the health costs of the global financial crisis were still being calculated before covid-19 tells us that we will be reckoning the health and social costs of the covid-19 economic shock for many years to come. Investing in employment and social protection systems, including improving protections and conditions for precarious workers, will bolster economic recovery and prevent the adverse effects of precarious employment on mental and physical health. Investment alone, however, is not enough. The post-pandemic challenge for governments is to distribute limited funds in a way that responds to immediate health and economic needs but also protects and reinforces the foundations for future health and wellbeing. Given women’s disproportionate representation in precarious work, responses to the pandemic—economic, health, and social—must have an explicit gender focus.

We know from the global financial crisis that social protection mechanisms can prevent some of the adverse health effects of recession. Countries that protected or invested in employment and social protection rather than austerity navigated the crisis with fewer adverse health effects than countries that relied heavily on austerity.29 In addition to protections and support for precarious and temporary workers, covid-19 responses must also attend to the social structures and forces that make precarious work seem to be the only option for many women. Some measures could include ensuring fairer pay, better working conditions, and better employment protections (such as rights under workplace law) for occupations and sectors that are dominated by women and typically under-valued. Active labour market programmes are essential to support employment, particularly the re-entry of women who exited the workforce during covid-19 to take on caring and family responsibilities. The circumstances in which casual work is appropriate must be codified, with ongoing monitoring to prevent the exploitation of workers.

Policies, both at the organisational and governmental levels, are also needed to support both men and women to share caring and employment roles; we must ensure the availability of parental leave for both fathers and mothers and enable men to take on primary care leave. Well paid, non-transferable parental leave for fathers and mothers, such as that available in a growing number of countries, has been shown to be most effective in supporting and encouraging fathers’ uptake of parental leave.39 Precautions should be taken, however, to ensure that single parent families (most of whom are headed by women) are not disadvantaged by such initiatives.40 These should be supported by the provision of quality, low cost, or universal childcare. Capitalising on the opportunities that covid-19 presents to enable broader participation in the labour force—for example, in terms of flexible or remote working, is also important. Finally, it is vital that commitment to gender equality is maintained and not scaled back as part of austerity measures. Such commitment should be demonstrated through the ongoing funding (and not curtailing) of ministries, organisations, and departments that are focused on monitoring and driving gender equality policy and initiatives—in both public and private sectors.

Many countries around the world implemented and trialled innovative solutions to the economic, social, and labour force upheaval caused by covid-19. Some of these strategies and reforms mark an ideological and fiscal shift from previous approaches and contribute to delivering income protection or supporting women’s labour market participation. In Germany for example, the kurzarbeit (short term worker) scheme was broadened to include non-standard and temporary workers, where women are over-represented (noting that it did exclude some categories of unprotected workers).38 The Australian state of Victoria insitituted a “sick pay guarantee” for precariously employed workers.41 Also in Australia, childcare, usually expensive and unaffordable for many families, became free for several months, enabling parents, particularly women, to remain employed or search for work. In Finland, compensation for income lost due to unpaid leave from employment was implemented to compensate parents who had taken unpaid leave to care for children during school and childcare closures.42 Unfortunately, many initiatives were temporary, but what is heartening is that their rapid implementation shows that when there is the will, governments can act quickly to implement effective policies and programmes.

Attending to intersecting axes of disadvantage, such as migrant status, ethnicity, and disability in addition to gender, is critical in creating covid-19 responses that could seed and sustain fairer work arrangements in the future. Strategies to do this could include extending protections including sick leave and pay to migrant and casual workers, groups who were commonly ignored in covid-19 responses around the world.43


The indirect health consequences of the covid-19 pandemic’s effect on employment will continue to accrue for many years. Given women’s differential exposure to precarious employment and their disproportionate experience of job losses owing to covid-19, they are at particular risk of experiencing sustained health consequences. The global financial crisis taught us that an explicit gender focus must frame responses to covid-19. We have the opportunity to advance gender equality and create fairer labour markets that will ultimately define the structures of a fairer and healthier society.


  • Patient involvement: No patients were involved in this work.

  • Contributors and sources: The authors collaborated on a grant submission related to the subject area. All authors have contributed widely to the literature on gender equality and employment conditions as social determinants of health. The idea for this paper came through discussion between TK, HM, YT, and ADL. TK drafted the manuscript and all authors made contributions of intellectual content and edits and approved the final draft. TK is guarantor. The views expressed here do not necessarily represent the views of the employing organisations.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and have the following interests to declare: TLK is a recipient of an Australian Research Council Discovery Early Career Researcher Award (DE200100607). This project was also supported by an Australian Research Council Linkage Project Grant (LP 180100035).