Throughout global societies, women’s roles place them at the epicenter of risk from disease outbreaks and epidemics. This is true everywhere, but especially so in poor countries with health systems unprepared to meet the ever-surging demands of a public health emergency.
The interaction between gender roles, disease transmission, and socio-economic stability reach a perilous tipping point in epidemics; failing to address that interaction will result in deficient strategies for outbreak prevention and control, and in massive setbacks for women’s health, and development gains. Unless global health security measures help us understand the impact of emerging diseases on women, nations and the world will remain vulnerable to pandemics.
Women as caregivers and sentinels
Usually the ones to care for sick family members at home, women are exposed to pathogens that spread from person-to-person. Women and girls, typically responsible for childcare, touch and embrace small children who have little immunity from past illnesses and easily pass along infections. SARs, Ebola, avian influenza, and Nipah virus have forged deadly routes via caregiving. Women are important community surveillants as they are likely to be the first to recognize unusual patterns of illness. If women are informed about the signs of emerging communicable disease threats, and empowered to report them, then women can a powerful local role in keeping outbreaks from spreading.
In domestic roles, women collect water and firewood, and do laundry standing in polluted water, exposing themselves to diseases such as cholera and schistosomiasis. Women usually take care of poultry in backyard farms, and bring them to wet markets, practices that influence the zoonotic risk of avian influenza. As farmers, workers, and entrepreneurs, women are a crucial agricultural resource. They help feed their families and whole communities and help fuel the local economy.
Also in most countries, the vast majority of all healthcare workers, particularly nurses and midwives, are female, working on the frontlines of disease outbreaks. According to a WHO report, not only are these women exposed to more infectious diseases, they often function without the training or decision-making authority to initiate emergency precautions in healthcare settings. If they are powerless to enact safety protocols, they cannot protect patients and themselves from person-to-person spread of infectious pathogens. New resistant disease strains like MRSA and multi-drug resistant tuberculosis can thrive in healthcare environments. What pandemic strains might slip through the cracks because female health workers are not empowered to enforce infection control policies?
What crises have shown us
During an infectious disease emergency, pregnant women are at serious risk. Maternal services are often disrupted and those that are operating do so unsafely; pregnant women have contracted SARs and Ebola in healthcare settings. Influenza has a more severe course during pregnancy and some emerging infections harm the fetus, as Zika continues to tragically remind us. Some diseases can cause pregnancy-related complications and miscarriage, and obstetrical procedures may further spread pathogens. Lactation may also endanger newborns. Chikungunya, leptospirosis and dengue fevers are some infections that can be transmitted through both pregnancy and breast milk. Where midwives perform maternity care outside of formal settings, pregnant women may be at greater risk during outbreaks.
In West Africa, Ebola’s lethal legacy for women will be felt for years to come. The epidemic decimated the already scarce healthcare workforce, killing doctors, nurses and midwives by the hundreds. With fewer health workers, the World Bank has warned of an additional 4,000 maternal deaths and 14,000 child deaths each year in Guinea, Liberia, and Sierra Leone. According to the World Bank, Ebola has erased 15 to 20 years of progress in maternal and child health in those countries.
We can act now
Ensuring that we reach and empower women to address emerging disease challenges requires strong political commitment and investment from countries and civil society partners. It’s the job of countries to take immediate steps to improve their outreach and awareness efforts to women on the risk of infectious disease, including transmission, recognizing warning signs, and how to report suspected infectious diseases adequately and quickly. It’s the duty of civil society organizations to galvanize, and compel governments to include a wide-focus on women in national preparedness planning.
When we respect and support the health and rights of women, we keep health systems, households and communities safe, and the whole of society functioning when new diseases threaten our security.