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African women face Ebola triple jeopardy

Patriarchal gender roles leave the riskiest tasks to female health workers

November 7, 2014 2:00AM ET

Nearly a year into the Ebola crisis ravaging West Africa, the deadly disease has spread far beyond the region, reaching Spain, Germany, France, Australia and the United States. As Mali becomes the latest nation to record a death from Ebola, at least 4,951 have perished, and 13,567 cases have been reported, almost all in Liberia, Guinea and Sierra Leone. Buried in the media reports on the staggering infection rates and deaths is the plight of Ebola’s voiceless victims: African women.

To be sure, front-line responders, regardless of gender, have fallen victim to the Ebola epidemic. But female nurses have become the disease’s invisible prey. Women account for 55 to 60 percent of the deceased in the current epidemic, according to UNICEF. The percentage of female victims in Liberia stands at 75 percent.

The feminization of epidemics is not new to African female caregivers. For example, African women have been disproportionately affected by the HIV/AIDS epidemic. As a result, today more women than men are living with HIV/AIDS, accounting for nearly 60 percent of infections. Women and girls shoulder the bulk of the burden in caring for people living with HIV/AIDS, accounting for two-thirds to 90 percent of caregivers for people living with HIV in Africa.

Similarly, women were disproportionately affected during previous Ebola outbreaks. A 2007 study by the World Health Organization on the 2003 Ebola outbreak in the Congo and Gabon found that men deliberately made use of the social custom that women care for the sick in order to avoid contact with patients.

Cultural expectations

The stubborn intersectionality of disease, female caregivers and culture is rearing its head once more. As with HIV/AIDS, Ebola is disproportionately killing our grandmothers, mothers and sisters, in part because of their cultural roles and expectations as caregivers.

African women are culturally revered, honored and almost glamorized for their caregiving roles. As a result, the social burden of caregiving falls solely on their backs. They are expected to trade at the market and across borders and perform household duties such as cooking, feeding, bathing and cleaning open wounds and washing soiled clothes and linens, all while not wearing any form of protective clothing. In remote areas, where there is a lack of information about the disease, when Ebola patients die, women still perform the traditional rites of preparing the corpses for burial — a high-risk activity that is mostly conducted with bare hands.

That’s not all. African women are also traditional birth attendants, putting them at a greater risk of contracting the deadly virus. These caregiving roles naturally extend to the hospitals where women predominantly serve as nurses and cleaners. Unfortunately, even at these institutions, women are not provided with sufficient protective gear compared with the protection given to male doctors and other high-ranking hospital personnel, who are widely considered the experts, thus deserving more protection (and visibility).

It is imperative that caregiving responses to Ebola are gender-sensitive and recognize the value of women’s lives over the misplaced dictates of our cultures.

In September, Urgent Action Fund–Africa, a pan-African feminist and women’s-rights organization, conducted a rapid assessment survey in Liberia to explore the effects and gender dimensions of the Ebola epidemic. The survey was critical to gaining a gendered perspective on some of the psychological, social and economic shifts that Ebola has created and on the local responses to the outbreak. Our assessment confirmed high rates of female caretakers.

Conducted by Florence Baingana, a Ugandan feminist, physician and psychiatrist, the survey paints a grim and troubling picture of the unspoken narrative of the triple jeopardy of Ebola, female caregivers and culture. Her dispatches highlight harrowing stories — narratives of phantom homes, of entire families’ demise, of bereaved families’ desire to traditionally bury and honor their loved ones and of women seeking cultural recognition for their caregiving roles.

To be sure, the traditional notion of female caregivers is not an exclusively African phenomenon. Around the world, there are more female caregivers than male ones. For example, more women than men provide caregiving in the United States. More than 90 percent of registered nurses in the U.S. are women, according to the U.S. Department of Labor.

Ebola’s effect on female caregivers is not limited by culture or geography either. Last month two female nurses in Texas — Nina Pham and Amber Vinson — contracted the deadly virus after treating Thomas Eric Duncan, the first Ebola patient diagnosed in the United States. Similarly, Teresa Romero Ramos tested positive for Ebola in early October after caring for two infected priests at a hospital in Madrid.

Gender-sensitive response

In the past, African women have used their position as caregivers to demand rights and privileges that uplift their status and conditions. In the current epidemic, however, cultural expectations have gone too far assigning value to caregiving, at the expense of the women’s lives. In most African countries, culture and patriarchy reinforce each other. For example, it is a taboo for men to care for the sick when there are women around. Division of labor is so ingrained in people’s way of life that it’s impossible to dislodge and to have whole societies unlearn values that dictate the order of their lives. In fact, our assessment found that male doctors often left the most infectious tasks female nurses to handle, such as cleaning patients’ vomit, blood and urine.

Female caregivers understand the priority placed on eradicating the disease. However, it is imperative that caregiving responses to Ebola are gender-sensitive and recognize the value of women’s lives over the misplaced dictates of our cultures. Women are already facilitating dialogue between global health experts and local caregivers, including traditional healers, using indigenous knowledge, wisdom and their unique status. These skills and agency should be encouraged. Organizations working to combat the Ebola outbreak should employ various modes of communication — including community dialogues, radio, television and social media — to involve women in the effort to raise awareness about the disease and to share risk mitigation measures. Global health officials must also engage the majority of caregivers in ongoing discussions about prevention and eradication.

Education campaigns should take into consideration cultural norms, values and practices on the care of the sick and dead. Authorities must provide proper guidelines on how to go about caring for the sick and how to protect against the virus without disempowering the community. Caregivers must also be given appropriate community-based psychosocial and reintegration support. While there is a need for psychosocial support to the isolated and quarantined, more attention should be given to the overburdened mostly female caregivers who have been working nonstop throughout this crisis. 

Ndana Bofu-Tawamba is the executive director at Urgent Action Fund–Africa.

The views expressed in this article are the author's own and do not necessarily reflect Al Jazeera America's editorial policy.

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