Written September 7, 2014
There is a song sweeping through Liberia produced by Samuel "Shadow" Morgan and Edwin "D-12” Tweh. It is called “Ebola in Town,” and laments the horrors of the outbreak to a dance beat being felt through the streets of the country’s capital.
“That thing that in town it quick to kill
That me scary-o
E B O L A
Ebola
Ebola in town.”
Shadow and D-12’s fears are justified. The numbers for the ongoing Ebola epidemic in West Africa are staggering. Since Ebola’s explosive emergence in December 2013, the death toll has reached 2,100. But the outbreak has taken on another disturbing dimension not mentioned in the song: reports from the United Nations Children’s Fund and teams on the ground believe that women alone constitute 55% to 75% of the infected.
The public health world is not shocked.
Demographic vulnerabilities during pandemics are not a new phenomenon. In the U.S., campaigns during the flu season regularly identify the young and elderly as the most vulnerable. Smiling doctors on posters and in TV advertisements encourage quick vaccination visits to local pharmacies and health centers. This is easy enough to promote, as asking families to take an extra step to protect a child or a parent does not normally evoke fear or resistance. Yet when a disease tends to afflict one sex over the other, particularly women, there is evidence to suggest that the situation becomes more complicated.
Looking at the case of HIV/AIDS, the World Health Organization reports that in sub-Saharan Africa, women constitute 60% of the population living with the virus, with most cases being contracted through unprotected sex. Among a variety of reasons, custom in these communities often prevents women from refusing or asking to use a condom. Similar traditional gender expectations are killing women in the Ebola crisis. Rather than through unprotected sex, the Ebola virus is believed to be more commonly spread through daily contact with infected bodily fluids such as saliva, urine, vomit, and feces. In the areas where the outbreak is present, women tend to fulfill the role of caretakers to the ill, food preparers, and dish and clothing washers. Many work as midwives and nurses, and also have key roles in preparing the deceased for funerals. Ebola’s frighteningly unique characteristic as a hemorrhagic fever is that its victims can bleed from the eyes, ears, and nose. The sick may also have bloody vomit and diarrhea. Considering the domestic duties that girls and women are expected to carry out, it is clear why they are making up the majority of infections.
However, the danger for women extends beyond the numbers alone.
While working in Cameroon as a health educator from 2011 to 2013, I lived in a rural community where a young woman’s value fell the more she was educated and the longer she waited until marriage. This was a small part of a wider value system that not only regarded women as less than men, but also disproportionately scrutinized them. A sick woman would often arouse more questions, suspicion, and ultimately, gossip than a sick man. When female survivors of Ebola begin to return home, they may soon be facing a dangerous uphill battle. Stigmatization has already complicated the Ebola outbreak, as health workers and the first wave of survivors are being ostracized in their communities. Women may now have the potential to be the most vulnerable group of survivors in the months to come.
“Ebola in town
Don't touch your friend
No kissing
No eating something
It's dangerous!”
In the midst of this epidemic where over half are not expected to survive, it is unreasonable to ask that resources be diverted immediately to tackle gender norms. But when this crisis is over, it will be prudent for governments to engage their citizens in a conversation that addresses how women were disproportionately affected in this disaster. It will be crucial for these dialogues to recognize that while there is no value in having an epidemic that equally afflicts men and women, there is immense value in taking a horrific situation and using it to come up with ways to ensure that everyone, especially the most vulnerable, are protected in the future.
Perhaps Shadow and D-12 can even write another song about it.