Although Tuberculosis (TB) is a preventable disease, 10 million people fall ill with it every year. It is the world’s top infectious killer, killing about 1.5 million each year. While TB generally infects more men than women, it remains among the top five causes of death for women between age 15 and 44 in low- and middle-income countries; more than half a million women died of TB in 2013 and over 3 million women fell ill with TB.
Even with notable progress in the past decade, tuberculosis is still a public health concern in the WHO European Region. There are 30 countries considered to have a high burden of multidrug-resistant TB (MDR-TB) globally, nine are in the European region, and one in five MDR-TB cases globally was estimated to have occurred in the WHO European Region in 2015.
The vulnerability of women to TB is increased by co-infection with HIV, poverty, gender inequality, food insecurity, population growth, and social barriers to accessing health services. Women also face greater stigma and discrimination due to TB than men. Stigma and discrimination in some settings can mean women with TB are ostracized by their families and communities.
TB increases the risk of maternal and child ill-health. It has been linked to a six-fold increase in the risk of perinatal death and a doubling of premature birth and low birth weight. It is further believed that TB increases the risk of a child contracting HIV from an infected mother. Some studies show that in pregnant women living with HIV, TB increases the risk of maternal and infant mortality by almost 300%, TB thus creates orphans, impoverishes families, and adversely affects economic and social development.
Women who suffer from genital tuberculosis have additional risks; they are challenging to diagnose and have been identified as a cause of infertility in high TB-incidence settings, causing chronic pain and menstrual disorder. The well-being of children is linked to that of the mother, an infected mother can infect a child during the child’s development. Furthermore, if a parent acquires TB, their child may have to drop out of school to look after them or may have to financially support the family if the parent with TB is too ill to do so.
TB is a disease of poverty affecting vulnerable groups. The vast majority of TB deaths are in low-income countries where gender inequities are too common. Malnutrition and food insecurity can exacerbate the risk of TB disease; other threats such as rising tobacco use and diabetes among women also result in increased TB burden. TB mainly affects women when they are economically and reproductively active, the impact of the disease is also strongly felt by their children and families. Cultural and financial barriers can act as major obstacles for women seeking care resulting in delayed presentation and more severe illness. Travel and treatment costs can also limit women’s access to TB care. Women’s lack of independence, reduced decision-making power, and restricted mobility also constitute important limitations for seeking healthcare.
Addressing the challenges faced by women with TB
To achieve the SDG of eliminating TB by 2030, we cannot solely focus on epidemiology but also include other serious challenges at the level of communities. The TB response and the stakeholders must recognize that women, while also falling ill with TB, are largely impacted by its dire socio-economic context and can serve as powerful vectors of change to stem the tide of the TB epidemic.
There is a need for governments and partners to provide patient-centered care, pursue policies and systems that enable prevention and care, and drive research and innovations needed to end the epidemic and eliminate TB. Empowering women will be critical for the success of the Strategy and to reach the goal of ending the TB epidemic. More women in affected communities and women’s advocates need to be engaged in efforts to design and enhance access to TB services for women. TB prevention, diagnosis, and treatment should be put at the forefront of health interventions for women, particularly along their reproductive life cycle. Human rights and equity challenges should be effectively addressed while rolling-out the Strategy to ensure that socio-cultural barriers and stigma are effectively eliminated, providing women access to high-quality care, free of catastrophic costs and social repercussions.
In high burden countries, women are the main caretakers, who play a vital role in looking after the sick. They can be empowered to serve their communities and ensure that their family and community members get screened and helped to close the gap in pediatric TB. By supporting and empowering women, and by supporting TB interventions among women, we pave the way for better healthcare for all women and improve case finding overall.
For the TB epidemic to be reversed in the EECA region, there is a need to increase political and financial commitment from governments. Countries facing high TB burdens will have to increase their national expenditure on rational strategies to address the disease and its accompanying social conditions. Other countries in the region and the European Union (EU) must raise awareness of the emergency in the region and increase their own financial contribution to TB control.
Mobilize support at global and national levels to remove underlying risk factors and assure gender-equitable access, including gender-sensitive services for TB prevention, diagnosis, treatment, care, and support. TB preventive treatment should follow sound clinical judgment and assessment of risk and benefits.
There is a need to foster strategic partnerships and synergies across the health system. TB, HIV, maternal, neonatal, and child health programmes, and primary care services should collaborate to maximize the entry points to TB care for women and their families at all levels. TB care should be integrated into reproductive health services, including family planning, antenatal and postnatal care.
The reporting and recording of TB data should be improved by sex, age, including for TB treatment initiation and outcomes. Additionally, the implementation of integrated patient monitoring systems for HIV, PMTCT, and TB care should be promoted to capture data and ensure that follow-up of HIV and TB prevalence settings is successful.
This International Women’s Day, we would like to recognise the contributions of women in the fight against TB, and ahead of World TB Day, we call upon governments and stakeholders to engage women in ending TB.
Written by Caroline Anena, Coordinator TBEC
