16 March 2009

Women left out of TB care

Tuberculosis has a major impact on women's sexual reproductive health and the health of their children, which women generally care for.

The topic of tuberculosis (TB) rightly has our attention. Stories focus on informing the public about resistant forms of TB, providing accounts of patients’ flights from hospital, and exploring the very important susceptibility of people living with HIV.

Unfortunately, little attention is paid to women's unique vulnerability in the current discussion. Tuberculosis has a major impact on women's sexual reproductive health and the health of their children.

In sub-Saharan Africa, TB is threatening to unravel public health development gains around increased HIV awareness. Yet the solutions are not easy, particularly where they concern the wellbeing of women.

A myriad social and economic factors, as well as weaknesses in the health care system, inadequate laboratories, and high HIV infection rates, are fuelling the resurgence of TB. Food insecurity, poor sanitation and overcrowding contribute to the easy spread of the disease.

According to the World Health Organisation (WHO), although Africa has only 11% of the world's population, it accounts for more than a quarter of the global TB burden with an estimated 2,4 million TB cases and 540 000 TB deaths annually.

TB, HIV and pregnancy
For pregnant women living in areas with high TB infection rates, there are increased chances of transmission of TB to a child before and during delivery, or after birth. The disease, especially if associated with HIV, also accounts for a high incidence of maternal and infant mortality. A study conducted in South Africa revealed mother-to child-transmission of TB in 15% of infants born to a study cohort of pregnant women in which 77% were HIV-infected.

HIV infection increases the likelihood of active TB more than 50-fold. An estimated one-third of the 24,5 million people living with HIV (PLHIV) in sub-Saharan Africa also have TB.

Given the high numbers of women living with HIV in the region - the majority of people living with HIV in sub-Saharan Africa (61% or 13,1 million) are women - it is clear that they are the largest group at risk of developing active TB, and more likely to develop drug resistance.

Socio-economic factors
Even with the availability of TB drugs, women's socio-economic status and gender roles, including child-bearing and caring, puts them at high risk of both HIV and TB. For many women in the region, the costs required to access health care centres for TB treatment are usually out of reach due to poverty.

The social stigma associated with a TB diagnosis and its association with HIV forces both men and women to delay testing for the disease. In some cases, when men in marital relationships test positive for TB, they are likely to withhold the information, thereby increasing the likelihood of spreading the disease to partners and children.

Moreover, women in the region are largely responsible for the upkeep of the family, including looking after children, which may also affect consistent uptake of TB drugs. A woman infected with TB is very likely to spread the disease to young children.

And of course, when the children or family members do get sick, it is mostly women who care for them. Not only does this make these women more susceptible to infection if they are not already, but also takes them away from other activities, such as employment or businesses, that they rely on for income.

TB and women's sexual health
An additional concern for women is that the uptake of TB drugs interferes with contraceptive use, pregnancy, and fertility. According to researchers, Rimfampicin, a key component of TB treatment, can reduce the effectiveness of oral contraceptive pills and possibly other hormonal methods, such as implants, injectables and emergency contraception.

There is a need to align TB services and sexual reproductive health services, so that men and women know about the implications of the disease to their sexual lives and households.

Screening and treatment for TB in pregnant women at antenatal clinics must therefore be a major public health priority in the region. Information about TB needs to be an integral component of sexual reproductive health services, so that women and men are aware of the risks.

Just as importantly, since women are at the forefront of caring for people infected with TB, there is a need to ensure that these women are able to protect themselves, and their families, from infection.

There is need for huge financial, human, research and technological investments to fight the problem, but such investments will work only if they radically put women's health needs at the core. – (Masimba Biriwasha)

Masimba Biriwasha is the Africa Regional Campaigns, Communications and Policy Manager for Health & Development Networks. This article is part of the Gender Links Opinion and Commentary Service that provides fresh views on everyday news.

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Tuberculosis Centre

September 2008


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