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Ebola crisis: the unequal impact on women and children's health
Clara Menéndezemail, Anna Lucas, Khátia Munguambe, Ana Langer
There seems to be no biological sex difference regarding vulnerability to Ebola virus disease,1 yet many sociocultural and health-care-related factors increase the risks for women in the Ebola outbreak in west Africa.
First, the worsening of suboptimal access to reproductive and maternal health care in the Ebola crisis countries is posing a major threat to the lives of mothers and infants.2 Second, women are the primary caregivers in their homes, communities, and health facilities and, as such, assist most infected individuals, which puts them at an increased risk of contracting the virus. Moreover, traditional burial practices, typically performed by women, can also place them at higher risk.3 Finally, there is evidence of sexual transmission of Ebola after individuals recover from the infection.4 Since women have little control over sexual behaviour including abstinence or protected sex, this represents an additional source of increased exposure to the virus.
All pregnant women require good quality and timely health care, without which outcomes can be fatal.5 More than 1·3 million pregnancies are estimated to occur annually in Guinea, Sierra Leone, and Liberia (734 000, 382 000, and 221 000, respectively).6 Under normal circumstances, many of these women do not receive the care they require, owing to access barriers and weaknesses of health systems. These obstacles have significantly increased since the start of the outbreak, as health facilities have closed and overwhelmed health-care staff lacking clear protocols turned pregnant women away. Additionally, fear of transmission and stigma against potentially infected individuals at the community level have made access to care for pregnant women even more difficult. Women with obstetric haemorrhage, in particular, often do not receive appropriate care owing to Ebola-related discrimination, the complex management required, and their high mortality rate.
Although there is not enough evidence about the biological mechanisms through which the Ebola virus aggravates maternal and perinatal health, studies have shown that Ebola-infected pregnant women have high rates of miscarriage and a 100% neonatal mortality.7 Health systems, social, and biological circumstances result in pregnant women with Ebola and their newborns ranking low among the priorities of overwhelmed health-care facilities.
First, the worsening of suboptimal access to reproductive and maternal health care in the Ebola crisis countries is posing a major threat to the lives of mothers and infants.2 Second, women are the primary caregivers in their homes, communities, and health facilities and, as such, assist most infected individuals, which puts them at an increased risk of contracting the virus. Moreover, traditional burial practices, typically performed by women, can also place them at higher risk.3 Finally, there is evidence of sexual transmission of Ebola after individuals recover from the infection.4 Since women have little control over sexual behaviour including abstinence or protected sex, this represents an additional source of increased exposure to the virus.
All pregnant women require good quality and timely health care, without which outcomes can be fatal.5 More than 1·3 million pregnancies are estimated to occur annually in Guinea, Sierra Leone, and Liberia (734 000, 382 000, and 221 000, respectively).6 Under normal circumstances, many of these women do not receive the care they require, owing to access barriers and weaknesses of health systems. These obstacles have significantly increased since the start of the outbreak, as health facilities have closed and overwhelmed health-care staff lacking clear protocols turned pregnant women away. Additionally, fear of transmission and stigma against potentially infected individuals at the community level have made access to care for pregnant women even more difficult. Women with obstetric haemorrhage, in particular, often do not receive appropriate care owing to Ebola-related discrimination, the complex management required, and their high mortality rate.
Although there is not enough evidence about the biological mechanisms through which the Ebola virus aggravates maternal and perinatal health, studies have shown that Ebola-infected pregnant women have high rates of miscarriage and a 100% neonatal mortality.7 Health systems, social, and biological circumstances result in pregnant women with Ebola and their newborns ranking low among the priorities of overwhelmed health-care facilities.
http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70009-4/fulltext
