Ebola and Pregnant Women: A Tragedy to Be Addressed in Recovery Plans

We know that the Ebola pandemic is causing a social and humanitarian crisis in several West African nations. What is now emerging is that it is a catastrophe, perhaps even a death sentence, for pregnant women.
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Ebola continues to spread. The fight against this pandemic in West Africa appears to have mixed results. Today, the U.S. Homeland Security Department lifted Ebola-related screening for travelers from Mali. In Liberia, newly reported cases dropped from roughly 300 per week in September to fewer than 100 a month later. The good news continues in Guinea, where the case count has stabilized. Yet, also today, the World Health Organization reported that at least 8,153 people have died in the Ebola outbreak in West Africa. This U.N. agency estimates that total number of confirmed deaths from the disease is 20,656 in the three most affected nations -- Sierra Leone, Liberia and Guinea. The mortality rate for the current Ebola crisis is estimated to be 39 percent. Liberia has the highest number of people infected -- 7,780 cases.

We know that the Ebola pandemic is causing a social and humanitarian crisis in several West African nations. What is now emerging is that it is a catastrophe, perhaps even a death sentence, for pregnant women.

Throughout the outbreak, the virus has had a disproportionate toll on women. According to U.N. Women, women and girls account for more than 55 percent of reported Ebola cases, though some estimates place this number as high as 75 percent. This gendered impact occurs because women and girls are most often primary caregivers to their families. If any of these women are pregnant, the situation is dire.

Pregnant women infected with Ebola face a perilous situation. A study of a 1995 Ebola outbreak in the Congo indicated that almost all infected pregnant women died from the virus. One possible reason for this tragedy could be that pregnant women, because they have partially compromised immune systems, are more vulnerable to the virus. When these women survive to give birth, they invariably pass the virus to their new baby, who is likely to be stillborn. Moreover, spontaneous abortions are also more likely amongst pregnant women with Ebola.

Furthermore, pregnant women with Ebola are actually being turned away from care for fear of contamination. The severe bleeding caused by Ebola is intensified during labor. Because of this copious amount of bleeding, the chances for contamination are even greater than usual, causing health care workers to be more reluctant about treating pregnant women.

The situation hardly improves even when pregnant women with Ebola are admitted for care. Health care workers, faced with a dangerous situation and a patient who is perceived to be less likely to survive, focus their limited resources on others. This becomes a self-fulfilling prophecy. Pregnant women are seen as being less likely to survive and are then seen as a lower priority. As a result they are more likely to succumb to the virus.

But what about pregnant women who don't carry the virus? The news remains grim.

One in seven women in countries hit by Ebola could die in pregnancy or childbirth. Pregnant women in Ebola-stricken nations suffer the consequences of an overburdened health system. Many hospitals are closed; those that are open frequently turn people away out of fear that new patients carry the virus. Fear of contagion from health care workers is also keeping pregnant women from seeking proper medical care. The United Nations Population Fund (UNFPA) estimates that in Guinea, Liberia and Sierra Leone more than 800,000 women will give birth in the next twelve months. Of these women, more than 120,000 could die of complications in pregnancy and childbirth.

Long before the current Ebola outbreak, these stricken West African nations had some of the highest maternal mortality rates in the world. Recent policy changes in these countries, however, made health care more accessible for pregnant women and mothers, and improvements were evident in women's health. But Ebola has been a setback to such progress -- a great tragedy among a myriad of tragedies.

What can be done to ensure that pregnant women in Ebola-stricken nations don't face an almost certain death sentence?

Last month, Ebola-stricken countries urged the United Nations to develop a plan that would help them recover from the outbreak. The United Nations Secretary‑General Ban Ki‑moon has stated that "The social and economic impact has been broad and deep. It will long outlast the outbreak itself. The three most affected countries have experienced significant development setbacks."

The international community now has the opportunity to rebuild health systems in West Africa so that they can withstand future public health disasters. As Liberian President Ellen Johnson Sirleaf stated, "even when this outbreak is over we must prepare for other diseases to take hold." Before the virus hit, President Sirleaf added, the country had "barely 50 doctors to care for a population of 4.4 million." In large parts of Sierra Leone, women have been unable to find a medical provider to perform Caesarean sections because many of the local doctors have died from Ebola. If situations like this are not rectified, women in the region will suffer long after the current Ebola crisis has been defeated.

Global recovery efforts should focus on rebuilding health systems that address the needs of women. Health centers should integrate women's reproductive health care. Not only have women lacked access to family planning services and information, but they have also been unable to find prenatal care during the outbreak. Pregnant women should have access to all necessary obstetric care. Doctors, nurses, and midwives should be trained and deployed to the hardest-hit areas- - especially rural areas far removed from cities such as Monrovia or Freetown. Personal protective equipment must be provided so that medical professionals feel comfortable doing their jobs and patients are willing to accept health care. Safe services must be re-established, and broad outreach plans should be developed to encourage individuals to seek out the care they need.

The scope of this Ebola outbreak is unprecedented. It has cast a long and dark shadow over the lives of millions of people, especially pregnant women. To emerge from this darkness, we must ensure that long-term recovery plans recognize the needs of women and include reproductive health care.

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