Summary: “Our responsibility is to call attention to the fact that there’s an invisible crisis happening,” says John Welch of Partners in Health in this week’s podcast. “Ebola is a huge issue for women’s health.” In Liberia, where Welch recently returned from working to strengthen and open new Ebola clinics, the deadly epidemic has decimated a national health system weak from decades of conflict and chronic poverty, he says. As health infrastructure crumbles and doctors are killed, already-limited funding is being diverted to contain the virus, leaving pregnant women with fewer options than any time in recent history. “Everyone wants to talk about Ebola, but…before this outbreak, only 50 percent of women in Liberia had access to skilled birth attendants,” he says. “The estimate is now that’s down around 30 percent.” Similarly, says Welch, access to prenatal care and malaria treatment – 40 percent and 50 percent respectively before the crisis – has dropped to 25 percent. The crumbling of these and other services has reversed progress made by Liberia’s Ministry of Health. “All of that advancement is gone,” says Welch. Given that across the afflicted West African countries 800,000 women are expected to deliver in the next 12 months and an estimated 1.2 million already lack access to family planning, it is essential that clinics recommence the provision of essential services as soon as possible, he says. Safe Delivery Nearly Impossible “Seventy percent of Ebola patients are women,” says Welch, “and that’s because they’re the caretakers; they’re the ones who stay by the side of their family member, who provide those traditional burials and try to provide for the dignity of their family.” Women face a higher likelihood of death not only because Ebola poses serious health risks throughout the course of pregnancy (rather than just in the third trimester like most hemorrhagic fevers), but because it creates such a risk for those who could help them, says Welch. “Safe delivery is virtually impossible at the moment. The volume of blood and amniotic fluid that a health care worker is exposed to puts them at enormous risk,” he says. That risk has fanned fears among health workers, leading to the shuttering of some clinics and leaving those that remain open severely understaffed. Several NGOs working in Ebola-affected areas in Liberia estimate the mortality rates of infected pregnant women to be between 96 and 100 percent (the mortality rate nationwide is around 41 percent, according to recent World Health Organization estimates). Even women who are not infected struggle to deliver safely; the symptoms of miscarriage and complications like eclampsia are nearly identical to those of Ebola, Welch says, and test results to determine if someone is infected take days – far longer than expecting mothers can survive without undergoing Caesarean sections. There are those working to find a way to test women for Ebola more quickly, he says, but humanitarian groups and the ministries of health should also focus their energies on rebuilding the very fundamentals. “The Ebola response has to be tied to health system strengthening, so we don’t have to see this again.”
