Gender and Health: The economic and social impact of Tuberculosis on women

In some parts of the world TB has been eradicated, but low detection rates and poor treatment rates are still an issue in developing countries. Early detection and effective cure protocol are important determinants of disease control but notification rates are higher in men than women in most countries as lack of mobility, poverty, and heavy workload of women restrict access to health care facilities. 

The 2010 mHealth Summit took place from November 8-10th in Washington, D.C. It explored 'ways mobile technology can increase the access, quality and efficiency of healthcare to millions of families around the globe'. The Summit in particular addressed sustainable healthcare solutions to help people who do not currently have access to medical information or treatment. The Global Strategy for Saving Lives through Innovation session highlighted key innovations for improving maternal and child health, including the Maternal and Newborn mHealth Initiative that has been adopted as a programme in the Global Strategy. Despite decades of effort, risks related to the gender dimension of health are still dramatically relevant. This article by Saida Ahmed suggests that a gender-based approach to different diseases and a gender sensitive health education together with women's active participation to health care planning and implementing process, can be an effective way to address this issue.

The economic and social impact of Tuberculosis on women By Saida Ahmed*

Background 

Globally it is estimated that tuberculosis kills more than 1 million women each year, and 646 million of women and girls are infected. Epidemiological studies show differences in men and women in the prevalence rate and the progression from infection to disease, incidence, and mortality due to TB (Diwan & Thorson, 1999). In some parts of the world TB has been eradicated, but low detection rates and poor treatment rates are still an issue in developing countries. Early detection and effective cure protocol are important determinants of disease control but notification rates are higher in men than women in most countries (Borgdorff & Nagelkerke, 2000) as lack of mobility, poverty, and heavy workload of women restrict access to health care facilities. TB in women may have an adverse effect on families and households, sensibly reducing the economic development of societies. 

Stigma and Discrimination

Tuberculosis is linked with poverty, because of its relation with weakened immune system due to poor nutrition as well as tendency of living in crowded homes. TB marginalizes people both from a social and an economic point of view, experiencing social isolation both within their own family and outside of it. In addition, sufferers encounter stigma and discrimination, leading to a delayed diagnosis and treatment. The stigma of disease and the resultant discrimination impacts TB control programmes, because a patient afraid of being identified as a sick person is likely to delay proper treatments (Baral & Karki, 2007). The stigma attached to TB has even more hostile consequences for women, which may influence the prevalence and prognosis of TB and its social implications (Long, Johansson, Diwan, & Windkvist, 2001). Sick women face the risk of divorce, or they have to accept their husbands taking a second wife. More frequently they are literally ostracized from their families until the end of the treatment. By contrast, men suffering from the same disease are usually pampered by and receive care from their wives (Hudelson, 1996).

Women and Health Services

In medical literature it is often mentioned that women access health services less than men and, most probably, women do not identify their needs or find it difficult to defeat social and cultural barriers in relation to finding health services. Women in developing countries have less education, a weaker socio-economic status than men, which lowers womenís access to economic resources. In Vietnam, for instance, patient delay (time onset from first diseases symptoms until first visit a doctor or a hospital), is the same for both sexes, but doctors delay is much more significant towards women than men. A long delay in treatment is often poorly understood as a dramatic risk factor. Delay in accessing health services for women is attributed to the subordination of women in the family economic strategies, where the husband is busy controlling large family expenditures and taking part in village affairs. For these reasons men are perceived to have more exposure to risk factors because of their work and roles in society. Health care workers frequently share these beliefs concerning gender and risk, so doctors are less observant about women's symptoms (Long et al., 1999). As a result women consult more traditional healers than men, creating more delays in diagnosis and treatment of TB (Connolly & Nunn, 1966).

Social and Economic Factors

TB impacts the economic productivity of women as it mainly affects young adults between the ages of 15-49. Social, economic and cultural factors seem to influence gender differentials in the infection rate. These factors are related to tradition and also based on sexual division of labor. Causing them to neglect their household chores and parental duties, women sickness may impact household routines. Sick men mainly worry about a loss of wage, while women are concerned about rejection and divorce, and unmarried women worry about their opportunities of marriage being reduced (Hudelson, 1996). A study in Thailand discovers how disease-related costs have an impact on TB diagnosis and treatment, especially in low-income households (Kamul-ratanakul, Sawert, Kongsil, & Lertmaharit, 1999). The authors strongly recommend the implementation of free care policies, and decentralization of services in order to reduce costs for these patients. Floyd, in his article, mentions that improving health care in general, and controlling TB in particular, can lead to a positive impact on the economic growth and, with a domino effect, consequently contribute to increasing investments in the health sector (Floyd, 2003).

Conclusions

In developing countries, women experience difficulties in accessing health care, due to poverty and lack of information. In order to reduce TB rates, among women in particular, more political will and financial resources are required. Governments and NGOs need to find strategies to solve the adverse effect that economic disparity has on the proliferation of TB. This disease is a threat not only for women but also their children and society as whole. In addition, more gender-sensitive research is needed in TB control programmes, to identify and inform communities of the true problems concerning women and TB. Dealing with the gendered dimension of this disease is not yet an easy task as women situation is very peculiar in terms of behaviour, social roles, and expectations within a social, economic, and cultural context. WHO is promoting the use of Direct Observed Therapy Short-course (DOTS): one of the five elements of the DOTS strategy is the 'Supervised swallowing', or directly observed therapy (DOT), where health workers or trained volunteers watch the patient take his or her treatment, meaning that patients have to visit the health worker or vice versa. Both these alternatives may impact differently on women and men and may be difficult for women - who have little extra time and poor economic resources - to comply with. That's why DOT may be less effective for women (Diwan & Thorson, 1999). A gender based approach to tuberculosis and related control programmes will help understand the disease itself and thus eradicate it; a gender sensitive health education together with womenís active participation to health care planning and implementing process, can be an effective way to address the issues of stigma and discrimination and overcome existing barriers.

* Saida Ahmed (Dr.) was born in Mogadishu and graduated as Medical Doctor from the Somali National University. She has been training and working in Somalia and in Italy and she is currently attending a Master in Public Health Leadership at the University of Alberta in Edmonton, Canada.

Related Event: The 2010 mHealth Summit "...brings together leaders in government, private sector/industry, academia and not-for-profit organizations to share information and experiences related to the intersection of mobile technology, health research and policy." (UNWire)

More from the Web: 

World Health Organization Gender and tuberculosis: a comparison of prevalence surveys with notification data to explore sex differences in case detection,  Borgdorff and Nagelkerke