By Mary Hodgson
There seems to be no biological sex difference regarding vulnerability to Ebola virus disease, yet it is estimated that as many as 75% of Ebola fatalities are women. What are the factors contributing to the disproportionate effect of the Ebola epidemic on women? Are responses to Ebola gender sensitive? Can female engagement and empowerment save lives?
In an ideal world, the Ebola Virus Disease (EVD) wouldn’t have killed nearly 12,000 people between 2014 and 2016 in West Africa. It wouldn’t prey on the vulnerable, killing 60-70% of infected individuals that get caught up in the destructive trail of an epidemic. Its devastating impact wouldn’t be aggravated by the fragility of health systems, failing to provide the most basic needs for their citizens. Ebola wouldn’t have an unfair disproportionate effect on women’s mortality rate. Ideally, no-one would die. But women shouldn’t be at a greater risk of death, just for being women.
Women have increased exposure to the virus, as the primary caregivers in their homes, communities and health facilities. In traditional family structures, women care for the children and men and as a consequence are more likely to contract the virus through contact with symptomatic bodily fluids, such as vomit, faeces or blood.
Women working in hospitals tend to be typically stationed as nurses, midwives or cleaners; “lower-grade” staff. Alongside the increased contact to infected individuals, they are often not provided with suitable protective gear, which comparably is given to the male doctors and “higher-grade” staff. The heightened occupational and domestic exposure, caring for affected individuals, contributes to the uneven gender demography of Ebola cases. Societal roles are a defining part of the unbalanced mortality, but tradition also plays are role, with burying practices typically performed by women.
During an Ebola crisis, most local health facilities close resulting in limited access to reproductive and maternal care. Additionally, Ebola places a stigma on remaining healthcare facilities, with many choosing to avoid seeking aid out of fear of becoming sick. The reduced access to care during Ebola epidemics poses a threat to the lives of mothers and infants. Whilst there is some evidence suggesting pregnant women that fall ill with Ebola have higher rates of miscarriage or neonatal mortality, this is not comparable to the lives of mothers and infants lost due to complications resulting from a lack of medical intervention. Furthermore, Ebola can be contracted by sexual transmission (via semen) and women have little control of sexual behaviour, protection and abstinence in countries affected by Ebola.
Apart from the direct impact Ebola has on women, female caregiving also has cascading indirect effects. Young females are a particularly vulnerable demographic by virtue that if children are orphaned, girls usually are the ones to drop out of school and take on the parental role. The upsurge in sick people during an epidemic result in women relinquishing their education and jobs, preventing them from being able to provide for their family. Women struggle to rebuild and recover as they have less chance for future opportunities due to the missed education and experience which is replaced by caregiving. On a larger scale, women are often smallholder farmers, thus food production is diminished and adds to food security threats.
Engagement of women is critical to reducing the outbreak of Ebola. In the Democratic Republic of the Congo (DRC), Mama Mwatatu walks two hours across Beni to host her biweekly radio show. Mama works with the World Health Organisation (WHO) to reassure and educate her listeners, providing technically correct answers to the worried mothers and women of Beni. The ‘rumour mill’ of Ebola is thought to have caused more damage, and with no cure, healing myths often spread the disease further and prevented sick individuals from getting the medical attention they needed. Nicknamed as Mother Counsellor of Beni, she has built trust allowing her to educate and inform, dispelling incorrect rumours. In the DRC, women have made up over two thirds of Ebola cases in their most recent outbreak. Mama reported women resisting help after feeling alienated by male responders speaking another language. Mama believes the efforts for involvement and engagement of women leaders in the Ebola epidemic are paying off; they are trusted and listened to by the locals. Women are understanding the disease better, limiting transmission and improving infection control.
It is essential to eradicate the gender differences by recognising the value of women’s lives. The solutions need to be gender sensitive, with a focus on women’s unique roles during an outbreak. Appropriate care for women and children needs to be established, which can handle the additional stress on resources, services and people in future crises. Education, engagement and empowerment of women is also essential to protect them.