Gender Dimensions of Ebola Outbreak
NIAID - Ebola Virus CC BY 2.0

Gender Dimensions of the Ebola Outbreak: A Cycle of Fear for Pregnancy and Childbirth

The Ebola outbreak has been sending shockwaves of fear and chaos throughout West Africa and the rest of the world for almost a year. The World Health Organization reported 8,997 cases and 4,493 deaths in 7 countries as of Oct. 17. (1). Cases are doubling every month, with Guinea, Liberia and Sierra Leone still struggling to control the virus. After 21 days of incubation, Ebola can result in organ failure and massive internal bleeding for those infected. With no known cure and transmission through contact with bodily fluids, it is likely to remain a dangerous issue for the foreseeable future (2).

Lack of preparation, resources and training, among other reasons, have led to considerable human rights violations in recent months related to the Ebola outbreak. In the hardest-hit countries, neighborhoods have been subject to unannounced quarantines, restricting or even eliminating access to food and clean water (3). Health centers in these countries are overwhelmed to the point of inadequate care, while there are no discernable systems in place to educate people on how to prevent infection by the disease. Between those who are infected, their families, and their surrounding communities, hundreds of thousands of people are affected by these issues. However, the fight against Ebola has had unique and devastating consequences for women in particular.

UNICEF asserts that over half of the victims of Ebola are women (4). Guinea’s Ministry of Health reported that women make up 54% of Ebola cases. In Sierra Leone, women account for 59% of Ebola deaths while in Liberia, it’s 75%. One of the main reasons women are at greater risk for Ebola has to do with the traditional roles they play in their communities. In most cases, women are responsible for caring for the sick and washing bodies before burial. Most of the medical staff charged with treating Ebola patients are women, specifically nurses. Despite the important role that women play in caring for the ill and tending to the dead, there are no programs that specifically reach out to women to provide them with the information and tools they need to prevent infection (5). At the launch of the UN Gender Mainstreaming Strategy, Dr. Muriel J. Harris of the University of Louisville School of Public Health warned:

“Gender equality is an issue of development effectiveness and not just a matter of political correctness or kindness to women… The strategy must incorporate the lessons learned from the outbreak of HIV/AIDS and must equally focus on the rebuilding of our education, research, physical, economic and health infrastructure, post-Ebola, to ensure the safe primary and tertiary care for pregnant and lactating women and children…”(6)

Just as women are primarily responsible for ensuring the good health of their children and family, they are also the key to ensuring that sick people have access to proper treatment. Lack of faith and trust in health facilities hindered successful Ebola treatment in the 1970s, and continues to be an issue now. Whether a sick or loved one is taken to an Ebola treatment center is determined by the thoughts and feelings of their primary care provider, largely women. The right to information about the spread and treatment of the virus is essential for successful eradication.

Fear and distrust of health facilities has also created additional health concerns related to, but not directly caused by, the Ebola virus. Many pregnant women fear that going to the health center will increase their changes of contracting the disease (7). This fear is legitimate, as pregnant women run a much greater risk of contracting the Ebola virus because they have to repeatedly come into contact with health workers who may also be treating Ebola patients (4). Expectant mothers are opting to stay home rather than visit hospitals to check on the health and progress of their pregnancies. According to Babatunde Osotimehin, executive direction of the United Nations Population Fund (UNFPA):

“I have information that in Sierra Leone, that we’ve had to cut back on almost 50 percent of the consultations for pregnant women… That has implications for their ability to do even routine things, but more importantly when a Cesarean is needed [and] when they need active care.” (7)

In Liberia, the number of women receiving early-pregnancy prenatal care has dropped from 49% to 25% from May to August (7). Compared to last year, babies delivered by a qualified birth attendant dropped 14%, according to the WHO (8). Women who do seek medical attention may be unable to receive it, as health facilities are overwhelmed by the crisis. Liberia, Guinea, and Sierra Leone are all in the top 15 for maternal mortality rates globally (9), while the three countries also average 65.91 infant deaths per 1000 live births (10). These numbers were released before the Ebola crisis began stretching local health facilities to their limits. With an estimated 800,000 women expecting to give birth in the next 12 months (1), these numbers could lead to devastation. Dr. Osotimehin gave strong words on the topic:

“The situation for pregnant women in Ebola crisis countries is devastating. Gains in maternal health and family planning are being wiped out and women are desperate for information and services to protect their health and that of their babies.” (1)

Restrictions to movement are also a major deterrent for women to access proper medical care. In an effort to contain the virus, quarantines are also containing people in need of medical attention. Many hospitals have closed, giving women no opportunity to seek out help during labor (3). Juli Switala, a pediatrician with Doctors Without Borders, is working in a small town in Sierra Leone. She said that in her village, an enforced curfew prevents people from driving motorbikes after 7pm. This common form of transport is the only way many women who go into labor in the evening would be able to get to a clinic. Police checkpoints that test for Ebola symptoms also leave people afraid to travel, for fear they might be found to have a fever (2).

Even women who are able to seek medical attention for their pregnancy might not be welcome by medical workers. Since the virus is spread through contact with bodily fluids, a woman giving birth would be a likely candidate in spreading the disease to health workers and other patients. Some doctors in the most severely hit areas have decided it’s not worth the risk, and refuse to operate on pregnant women (2). Dr. Switala’s team is one of many that has made the decision to turn pregnant women away:

“It’s very difficult to be the gynecologist who is making the decision to do a Caesarean section where there is going to be a lot of blood and a lot of body fluids, and you are putting your staff and team at risk if you do this…” (2)

According to the head of ActionAid, Korto Williams, many women in Liberia end up giving birth alone because the people around them fear they may have Ebola. She says you can find YouTube videos of women giving birth alone in the street in Monrovia, Liberia (11).

Community members and healthcare workers alike are afraid, and the fear is not unwarranted. Healthcare workers are the most likely people to contract the virus, and many of those who became infected contracted the disease from their patients (7). Of the American healthcare workers who became infected, one was working with sick pregnant women at the time in Liberia. Many health workers lack the protective equipment necessary to guard themselves from infection and can’t justify the risk of helping a woman in labor (12).

One husband shared his wife’s story of giving birth to twins on the side of the road in Monrovia (12). After being turned away by 4 medical facilities, she delivered in the street, with strangers forming a human barrier using their clothes. Duworna Monibah, a nurse assistant, was passing on a motorcycle, and stopped to help deliver the baby.

“When I arrived at the scene, the first baby was already out and the second was not lying properly. I forgot that there was something called Ebola. All I thought about was saving the woman and her babies’ lives. I immediately asked for plastic shopping bags as there were no gloves.” (12)

Even if healthcare workers don’t fear working with pregnant women, they might not have the resources or the time. With facilities being overwhelmed by Ebola cases, pregnancy checkups and even labor are often not considered a medical priority. In Liberia, women are being denied entrance to hospitals because they don’t have Ebola (8). According to the UNFPA, more than 120,000 women who are in need of pregnancy, delivery, postnatal, and emergency obstetric care could die from complications if these services aren’t provided (1). In Liberia, a Washington Post Reporter saw a woman in labor sent away from the new JFK maternity ward to the Ebola treatment center because she couldn’t prove she was Ebola-free. When she arrived at the Ebola treatment center, she was denied entry, because there was no evidence she had Ebola (7).

A coalition of aid charities recently warned that in Ebola-ridden countries, the risk of women dying while giving birth could be as high as 1 in 7 (11). The head of ActionAid in Liberia called this estimate the “worst case scenario,” but also added:

“We have to do more to … stop this coming true. We have to ensure that pregnant women get the care they urgently need or we will see the rate of maternal deaths skyrocket.” (11)

The Ebola epidemic has formed a cascade of human rights violations throughout Guinea, Liberia, and Sierra Leone, especially in regards to access to medical services. Even those who are lucky enough to avoid contact with Ebola are instead concerned about dying from other medical issues that strained health facilities are not equipped to tackle. Malaria, typhoid, dysentery and complications from childbirth are the most likely issues (4). Through the many roles that women serve in their communities, whether it be as a health worker, head of household, caregiver or mother, all seem to create a threat to health that is more risky and intense than other demographics. In his latest discussion with the press about the Ebola crisis, Dr. Osotimehin grimly stated:

“The reality is that pregnant women are facing a double threat – dying from Ebola and from pregnancy or childbirth, due to the devastating impact of Ebola on health workers and health systems… Ebola is not only killing those infected, but also those affected. Pregnant women and girls are at greater risk.” (1)

The overwhelming effect that the Ebola crisis has had on the quality of health in the affected countries cannot be denied. Corinne Dufka, senior researcher at Human Rights Watch, thinks that handling the crisis is an impossible task for countries to face alone:

“Given the tragic magnitude of this epidemic, the affected governments cannot and should not be expected to fulfill the right to health on their own.” (4)

Dufka believes the way to restore the right to health in the affected countries is two-fold: one, the international community must take the lead in enabling successful relief structures within these countries; and two, the local governments must be transparent in their response to the crisis and maintain high standards of respect for human rights (4).

References

References

  1. UN News Centre, ‘UN Chief: Urgent Global Action Needed as Ebola Continues Deadly Rampage.’ (Our World, United Nations University, 17 October 2014) <http://ourworld.unu.edu/en/un-chief-urgent-global-action-needed-as-ebola-continues-deadly-rampage> [20 November 2014]
  2. Christopher Toricha, ‘Ebola Crisis Puts Pressure on Human Rights.’ (Associated Press, The Big Story, 15 October 2014) <http://bigstory.ap.org/article/eed2a556bead474885de6ab3206f11f9/ebola-crisis-puts-pressure-human-rights> [20 November 2014]
  3. Shobana Ananth and Jacqueline Hansen, ‘What does Ebola have to do with human rights?’ (Amnesty International, Amnesty Canada Blog, 10 November 2014) < http://www.amnesty.ca/blog/what-does-ebola-have-to-do-with-human-rights> [15 November 2014]
  4. Human Rights Watch, ‘West Africa: Respect Rights in Ebola Response.’ (Human Rights Watch News, 15 September 2014) <http://www.hrw.org/news/2014/09/15/west-africa-respect-rights-ebola-response> [15 November 2014]
  5. UN Women, ‘Ebola Outbreak Takes Its Toll On Women.’ (UN Women News, 02 September 2014) < http://www.unwomen.org/en/news/stories/2014/9/ebola-outbreak-takes-its-toll-on-women> [15 September 2014].
  6. UN Women, ‘UN Launches Ebola Gender Mainstreaming Strategy in Sierra Leone.’ (UN Women News, 30 October 2014) <http://www.unwomen.org/en/news/stories/2014/10/ebola-gender-mainstreaming-strategy-in-sierra-leone> [15 November 2014]
  7. Adam Taylor, ‘Pregnant Women at Risk of Becoming Collateral Casualties to Ebola Epidemic.’ (The Washington Post WorldViews Blog, 26 September 2014) <http://www.washingtonpost.com/blogs/worldviews/wp/2014/09/26/pregnant-women-at-risk-of-becoming-collateral-casualties-to-ebola-epidemic/> [20 November 2014]
  8. Robbie Couch, ‘How Pregnant Women are Becoming Victims of the Ebola Outbreak.’ (The Huffington Post, 30 September 2014) <http://www.huffingtonpost.com/2014/09/30/ebola-outbreak-pregnant-women_n_5901816.html> [20 November 2014]
  9. CIA World Factbook, ‘Country Comparison: Maternal Mortality Rate.’ (Central Intelligence Agency Library) < https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html> [20 November 2014]
  10. CIA World Factbook, ‘Country Comparison: Infant Mortality Rate.’ (Central Intelligence Agency Library) < https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html> [20 November 2014]
  11. Kate Kelland, ‘1 in 7 Pregnant Women at Risk for Death in Ebola-Hit Countries: Charities.’ (The Huffington Post, 10 November 2014) <http://www.huffingtonpost.com/2014/11/11/pregnant-women-ebola_n_6136536.html> [20 November 2014]
  12. Calixte Hessou, ‘Pregnant in the Shadow of Ebola: Deteriorating Health Systems Endanger Women.’ (United Nations Population Fund News, 20 October 2014) <http://www.unfpa.org/news/pregnant-shadow-ebola-deteriorating-health-systems-endanger-women> [20 November 2014]

About Courtney Malcom

Courtney studied anthropology at Washington State University in the USA. She graduated with a master’s degree in evolutionary anthropology in May 2014, after studying maternal and infant behavior and health in the Central African Republic. She now resides in southern Ethiopia, where she is collaborating with local development workers to establish an NGO with the mission promote access to healthcare services for vulnerable individuals.

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