Ebola is a Women’s Issue

November 11, 2014

By Theo Schall


The West African Ebola outbreak has hit the region’s women hard. In August, the Washington Post reported that across Guinea, Liberia, and Sierra Leone, women have comprised 55 to 60 percent of the dead. In Liberia, the government has reported that 75 percent of the deceased are female.


Many infectious diseases impact genders differently and not all place a heavier burden on women. Dengue fever, for example, has historically had a greater impact on men. Causes are usually rooted in a combination of sex and gender differences. Sex differences are the physical differences between male and female bodies, like hormones and different organs. Gender differences are variations in the social behavior of men and women, such as who works outside the home and who raises children. In the case of Ebola, the intersection of West African physical and social conditions is especially risky for women.


While the developing health infrastructures of Guinea, Liberia, and Sierra Leone have made great strides over the past few years, Ebola has overwhelmed capacity and undermined growth. The desperate need for more medical staff has been widely publicized. In the context of this overtaxed infrastructure, pregnancy puts Ebola patients in grave danger. Although over 800,000 women are expected to give birth in the region over the next twelve months, there’s often nowhere to take pregnant patients for adequate treatment, whether or not they have the virus. West African maternal mortality rates are already some of the highest in the world, but the region’s faltering maternity hospitals will not treat Ebola patients. Ebola treatment units rarely have staff with obstetric or midwifery training, while medical practitioners who take on patients with Ebola put themselves in greater danger of contracting the virus from patients whose blood and sweat is highly contagious.


Because the immune system changes during pregnancy, women can be more susceptible to infectious diseases and more prone to severe complications. Stories have emerged of poorly maintained maternity hospitals overrun with Ebola patients and mortality rates of nearly 100%. The limited evidence available does suggest that Ebola is more severe in pregnant women, presenting with more bleeding and neurological complications. Yet while anecdotal reports from caretakers and previous outbreaks suggest lower survival rates for pregnant women, there isn’t proof that pregnant Ebola patients fare worse than the general population. It’s possible that this is a self-fulfilling prophecy – that healthcare workers provide less support to pregnant Ebola patients, worsening their odds of survival.


Patriarchal gender roles have had a tragic impact on Ebola transmission. West African women are expected to be homemakers and caretakers. These roles are physically intimate and rife with potential exposure to infectious disease; women bathe wounds, wash clothes, nurse the sick, prepare food, attend births, prepare the bodies of the dead for burial, and exchange agricultural products in local marketplaces. The burden of informal nursing alone is heavy; African women and girls account for 66 to 90 percent of caretaking for people living with HIV/AIDS. In September, Urgent Action Fund-Africa, a pan-African feminist organization, surveyed Liberians and found high rates of female caretakers of Ebola patients. Without protective gear and training, this kind of intimacy is dangerous for West African women.


Professional nursing is also women’s work. This is hardly an African phenomenon – some 90% of American registered nurses are female. Medical staff have been particularly hard-hit by the Ebola outbreak, hundreds of whom have contracted and died of the virus. While many brave male doctors have sacrificed themselves to treat their patients, female nurses have risked just as much to die without the same level of international outcry.


The United Nations Sierra Leone Country Team, whose focus is on breaking the disease’s transmission chain, launched what it calls an “Ebola Gender Mainstreaming Strategy” in early October. Recognizing the burden of the disease on the country’s women, the UN team hopes to incorporate female leadership and planning at every stage of its work. This is a laudable, important step in the fight against the disease, and hopefully will help keep West African women safer and healthier in the coming weeks and months.

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Theo Schall

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