Africa – US Ebola Response: Strategies for Women and Girls

Janet Fleischman

November 4, 2014

Many of us remember the HIV/AIDS prevention mantra “ABC” – Abstinence, Be faithful, use Condoms – but I recently heard a new “ABC” message emanating from the Ebola crisis: Avoid Body Contact, a chilling message for the epidemic ravaging West Africa.

While prevention messages are critical, a lesson from the struggle against HIV/AIDS is that women’s and girls’ risk of infection is compounded by gender disparities and inequalities, and many U.S. programs lost precious time before realizing that A, B, and C were often not within a woman’s or girl’s power to control. Similar concerns might apply to the Ebola crisis. As the United States mounts its emergency assistance to combat Ebola, these lessons should be applied from the start; targeted strategies to address the realities and vulnerabilities that women and girls face are key to an effective and sustainable response.

The importance of gender strategies in U.S. health and development programs has received bipartisan support: the Bush administration ultimately developed gender strategies to reach women and girls with HIV/AIDS prevention, care, and treatment, and the Obama administration accelerated the development of gender policies and guidance for all U.S. government agencies. The evidence supporting these approaches is strong: gender norms and inequalities increase women’s and girls’ risk of HIV, maternal mortality, and gender-based violence, and reduce their access to family planning, education, and economic empowerment. Investments in these areas result in better health outcomes and produce broader social and economic returns.

A gender focus is essential for an effective response to the current crisis. Ebola is not only a public health catastrophe, it is also unleashing devastating secondary effects on economic and social development, all of which have harmful implications for women and girls. Recognizing and addressing the gender dimensions of the crisis is necessary for both the emergency response and for longer-term reconstruction.

An immediate priority is the need for accurate data to inform decision-making. This means the collection of sex-disaggregated data about Ebola infections and deaths, which is currently not publicly available. The data that has been disseminated is not always reliable and is sometimes contradictory, making it difficult to determine whether and where the epidemic is having a disproportionate effect on women and girls.

What we do know is that this crisis is having a particular impact on pregnant women. Health facilities are overwhelmed with Ebola patients and health workers are often afraid to treat women who are bleeding or hemorrhaging, which can be associated with complications of pregnancy. The broader impact of the Ebola crisis on maternal and reproductive health services has raised widespread concerns that women are dying at home from complications of pregnancy and childbirth. The disintegration of the health systems will haunt these countries for years to come and will have to be a central focus of reconstruction efforts.

Another component of the Ebola response should involve the investigation of reported abuses against women and girls, and support for the capacity of national governments and civil society to monitor and protect human rights. Reports from the region raise fears about sexual violence and exploitation of women and girls by male Ebola survivors – the virus has been found in semen for up to three months so abstinence is recommended during that period – or by men exploiting girls who are orphaned or women widowed by Ebola. With the schools closed, girls may now be at higher risk for teenage pregnancy and child marriage. In addition, property and inheritance laws may discriminate against women and girls affected by Ebola, with some reports of Ebola widows being shunned by their families and denied the ability to inherit their husband’s property.

These human rights violations were not created by Ebola, but reflect long-standing abuses and inequities faced by women and girls that may be exacerbated by the current crisis. This is precisely why mechanisms to investigate and address abuses should be incorporated into the U.S. response, including training programs and long-term rebuilding plans.

Another area of concern in the Ebola crisis is ensuring women’s participation in communication and decision-making. As the principal caregivers in most communities, and the majority of nurses and healthcare workers in the affected countries, women will be central to breaking the chain of transmission and protecting their communities. To be effective, communication and response strategies should be developed by engaging with women in communities and women’s organizations. As more community-based isolation and care becomes part of the Ebola response, effective and locally appropriate strategies designed with women’s input will be essential for successful outcomes.

Like the AIDS crisis, Ebola reveals the fault lines in societies, with marginalized groups often at heightened risk. We know that women and girls suffer disparate impacts in health and humanitarian crises, and that addressing their needs is critical to a sustainable response. The intensity of the Ebola emergency should not obscure those facts; the U.S. government agencies – the Department of Defense, the U.S. Agency for International Development, and the U.S. Centers for Disease Control and Prevention – should build on lessons from past crises and implement proactive strategies that help women and girls live as safely and productively as possible in the midst of the Ebola crisis and empower them to become agents for rebuilding their shattered countries.