Being a Woman at the Epicentre of an Ebola Epidemic

[This post was written by Clara Menéndez & Anna Lucas, director and coordinator, respectively, os ISGlobal's Initiative of Maternal, Child and Reproductive Health]

"Women’s role in West African communities has also placed them in the front line for possible contagion." The scientific evidence tells us that the Ebola virus does not discriminate between men and women—that it affects both sexes equally. However, the epidemic is having a more negative impact on women’s health . Today, on International Women’s Day, it would be remiss of us not to draw attention to this issue and outline the main causes.

Besides the factors that always threaten the health of the most vulnerable women and girls in developing countries, particularly because of the issues that affect their access to maternal and reproductive health services (sociocultural, economic and physical barriers, lack of quality care, etc.), in the parts of West Africa most affected by the Ebola outbreak the risks have only increased. In Sierra Leone, Liberia and Guinea Conakry, at the epicentre of the epidemic, a large proportion of health clinics closed and in the centres that that were still operating, the greatly depleted and overwhelmed health personnel often refused to treat pregnant women. The main reasons for the problem are the lack of clear protocols and fear of contagion, especially in cases involving obstetric haemorrhage, one of the leading causes of maternal death. In a region where, according to some estimates, some 1.3 million pregnancies will occur in 2015, this denial of care poses a serious threat to these women.

"The Ebola crisis has wiped out the advances in maternal and reproductive health that the international community and the affected countries had managed to achieve" Women’s role in West African communities has also placed them in the front line for possible contagion. Traditionally, women are the primary caregivers in the home and also in the community. Women are responsible for caring for their own families and for the patients admitted to local health centres. They are also responsible for performing the funeral and burial rites practiced in the affected areas, which include washing the corpses. These tasks increase women's risk of exposure to the virus, which is spread by person-to-person transmission through either direct contact (with the organs, blood, secretions or other bodily fluids of an infected person) or by indirect contact with materials that have been contaminated by such fluids. Furthermore, in communities where the low status of women is such a clear reality, where gender-based violence and child marriage are widespread and women have little capacity to negotiate abstinence or safe sexual practices, the possibility that Ebola will be transmitted sexually is another added risk.

Over a short period, the Ebola crisis has wiped out the advances in maternal and reproductive health that the international community and the affected countries had managed to achieve with such great effort. Advances that included ensuring that half of all births—the time of greatest risk for women—were attended by trained health professionals and that one-third of women had access to information about contraception and contraceptive methods, which made it possible for them to prevent pregnancies or space births. Today, the lack of emergency obstetric care and family planning services and the interruption of immunization programmes is confirmation that the Ebola crisis has turned the clock back on more than a decade of advances in women’s health in these countries. What is more, the current collapse of the health systems in these three countries has decimated the human and material resources available to treat patients with other preventable diseases such as pneumonia, diarrhoea and other infectious diseases very prevalent in the area, including malaria—still the most common cause of illness and death in the region. This means that indirect mortality rate arising from the epidemic will be much higher than that caused directly by Ebola.

"After the current crisis, the priority will be to concentrate all efforts on addressing the issues that made it possible for this epidemic to reach such devastating proportions in such a short time" How can we prevent this situation from happening again? After the current crisis, the priority will be to concentrate all efforts on addressing the issues that made it possible for this epidemic to reach such devastating proportions in such a short time. The first task will be to tackle the problem of the fragile health systems that still exist in countries that are not providing for the most basic needs of their citizens. Investing in more robust and efficient health systems is a global public health issue; the aim must be to improve infrastructures, equipment, medical supplies and personnel as well as information systems, financing and governance to ensure that, in the medium term, these systems can meet the basic health care needs of women and children and the general population. At a time when the international community is redefining its goals for development in the coming years, prioritizing this issue in the development agenda is an ethical imperative if we are to end the preventable deaths of women and children in future crises.