Zika and Ebola had a much worse effect on women: we need more research to address this in future

Outbreaks of the Ebola virus – declared as a public health emergency in 2015 – and, more recently, Zika, had a disproportionate impact on women. In issuing emergency advice, international agencies acknowledged the different experiences of men and women during both crises.

But as we found in our recently published article in International Affairs, the advice they offered did not take into account women’s limited capacity to protect themselves from infection.

We found less than 1% of published research papers around the time of both outbreaks, and that related to the outbreaks, actually explored their gendered impact. Research that examines the gendered inequality of public health emergencies must be conducted to inform future international responses.

Exacerbating existing inequality

By the end of 2015, the three West African countries most affected by Ebola – Guinea, Liberia and Sierra Leone - had a total of 8,703 cases of the virus in women compared to 8,333 in men. But the sex tally of those infected does not reveal the social impact of the disease on local populations.

In October 2014, it was estimated more than 600,000 women would be giving birth in Liberia, Guinea and Sierra Leone over the next 12 months. In these countries, where maternal death rates are usually high, pregnant women were said to now be facing “the double fear of dying from Ebola and during childbirth”.

In addition, estimates published in the Lancet medical journal showed an extra 4,022 women would die annually in childbirth in the three affected countries as a result of a shortage of health care workers who had died from the virus.

Although the outbreak is over, women continue to be at risk of contracting the disease from unprotected sexual intercourse with men who were previously infected by Ebola.

Given Zika’s link to microcephaly – a condition where babies of infected women are born with small heads – the outbreak more obviously affected pregnant women than did Ebola.

During the outbreak’s initial phase, there was open discussion about the links between the geographical location of microcephaly cases and the women most affected. These women were more likely to be Indigenous and come from either urban poor or remote locations, as well as lack access to contraceptives and abortion.

The irony was noted: already marginalised women were being asked by governments to avoid pregnancy. This was without acknowledgement by these same governments of their own role in hindering women’s access to contraceptives, sex education and safe abortion practices in the first place.

Our study

In the case of both outbreaks, we were concerned about the lack of international bodies’ early discussion on how to support women to take preventive measures again the diseases. We wondered if lessons had been learnt from the Ebola outbreak to enable a different gender experience during the Zika outbreak.

To answer our question, we searched articles published in the Scopus journal database (covering 29 million abstracts in over 15,000 peer-reviewed titles from more than 4,000 publishers) for Zika– and Ebola–related pieces.

Between 1 January 2015 and 15 May 2016, just 21 articles of 608 publications explored the relationship between “Zika” and “human rights”. Two articles explored “human rights”, “gender” and “Zika infection”. But only one article talked about women’s risk of Zika infection due to gender inequality.

In the case of the Ebola outbreak in West Africa, using a date range from 1 January 2014 to 15 May 2016, we searched “Ebola” and “human rights”; “Ebola” and “gender”; “Ebola” and “human rights” and “gender”.

Of 4,236 articles published on Ebola in Scopus during this period, 335 examined Ebola and human rights; 14 examined gender relations in the context of the Ebola outbreak; and one examined the relationship between human rights, gender relations and the outbreak.

Why is this important?

The social and economic conditions affecting women’s options and ability to control their risk of infection has received comparatively little attention to that of the overall consequences of both outbreaks.

Even if women adequately protect themselves from infection and survive Zika and Ebola, they are still unlikely to have improved equitable health opportunities after these emergencies. Indeed, they face the risk of worse health and inequality.

More research examining the effect of gendered inequality of public health emergencies must be conducted to inform future international advice and responses, so those affected can survive the crisis without compounding existing inequalities.