Gendered health inequities and policy silences: Insights from deliberative dialogues on unpaid care and domestic work in sub-Saharan Africa

The disproportionate allocation of unpaid care and domestic work (UCDW) to women remains a major structural barrier to their health, one that was severely exacerbated by the COVID-19 pandemic. This research draws on four Deliberative Dialogues (DDs) conducted with community members and policymakers in Uganda and Kenya to examine how UCDW was experienced, politicized, and imagined as a site for transformation. We propose an integrated conceptual framework that utilizes the ILO's "5 Rs" (Recognize, Reduce, Redistribute, Reward, and Represent) as a scaffold to operationalize necropolitics, feminist political ecology, and ecosocial theory. Our findings reveal that the state's failure to recognize UCDW and reduce the time and energy women spend on it, through adequate infrastructure, transformed the home from a space of safety into a "pathogenic environment" where infrastructure deficits and infection risks converged. This is a form of slow violence that becomes biologically incorporated as illness. While participants articulated clear pathways for redistribution and reward, these demands were often met with resistance, including threats of gender-based violence, highlighting the contested nature of gender-transformation in UCDW. We conclude that Deliberative Dialogues function as a vital mechanism of representation and helps bridge the gap between lived experience and policy silence. The paper offers specific recommendations for a gender-transformative recovery that addresses the spatial and structural determinants of care.