Medical authorities worldwide are struggling to contain the deadly Ebola virus wherever it breaks out, but one reality in the countries most affected is not receiving adequate attention. The outbreak is affecting girls and women more than boys and men - those who are infected as well as those who are not.
In Guinea, Liberia and Sierra Leone, women are 55 to 60 percent of those who have died, according to the United Nations Children's Fund (UNICEF). Officials in Liberia estimate that up to 75 percent of the deceased or infected are women. It is a historic pattern: in Sudan's 1979 Ebola outbreak, 69 percent of those affected were women, and many more women than men were affected in Uganda's outbreak in 2000-2001.
This is because women are often more exposed to Ebola risk than men. Women are the family caregivers who feed and clean the sick, exposing themselves in the process. Women are also the nurses and the maintenance and laundry workers in clinics and hospitals where infected people are treated, but they receive less support and protection than doctors, who are predominantly male.
Women are also the cross-border traders who go to weekly markets where hundreds of people congregate. When someone dies from Ebola, it is generally women who wash and dress the body - the regional tradition of respect for the dead often outweighing health workers' warnings that such bodies are highly infectious.
Women continue to suffer most from the collapse of overwhelmed health systems that are increasingly unable or refusing to treat all non-Ebola cases. Pregnant women are being turned away at health clinics, according to news reports, and many frightened doctors and clinic workers are staying home leaving their services unavailable. Women who do seek treatment for any need - and clinic workers themselves - often face stigma and isolation from family and friends who fear they may have been exposed at the care facility.
Despite the epidemic, an estimated 600,000 women will give birth in the next year in Guinea, Liberia and Sierra Leone, facing crumbling health systems that can no longer care for them. Even in better times, an estimated 6,180 women died of pregnancy- and childbirth-related causes in the three hardest-hit countries in 2013 - that's 17 women every day.
And, in the midst of the Ebola crisis, the UN Population Fund (UNFPA) reports that West Africa's recent gains in sexual and reproductive health care for girls and women are reversing. In Liberia, only 38 percent of pregnant women sought skilled birth attendance from May through August, down from 52 percent in 2013. Only 25 percent of mothers received postnatal care, compared with 43 percent in 2012, and 40 percent of mothers received the recommended four prenatal care visits, down from 65 percent last year.
In Guinea's most affected district, the use of family planning dropped 88 percent over the past year and delivery assistance fell by a third as women's use of health services plummeted. As a result, doctors in all three countries report that more pregnant women are dying from preventable causes like hemorrhage and hypertension, and the risk of unintended pregnancy is rising.
The situation has strong economic implications, as well as health impacts. Food production is likely to be affected as women fall ill because most smallholder farmers are women, especially in Sierra Leone. Border and quarantine restrictions will keep women traders from the markets that distribute food, reducing their income.
These grim facts mean that while women are the most affected by the Ebola crisis, they are also key to its solution. Any actions to control Ebola's spread must incorporate measures to deal with its outsized impact on women, taking into consideration their multiple roles as family caregivers, social actors and economic producers. For example, every dollar of spending on family planning alone saves at least $6 in costs associated with unintended pregnancies, unsafe abortions and maternal mortality - funds that could go to improve crisis response or basic infrastructure.
Ensuring women have access to basic health care, particularly sexual and reproductive health care, have rarely been met in Guinea, Liberia and Sierra Leone in the best of pre-Ebola circumstances, and are now even more critically important. While the world works urgently to contain the crisis and treat those infected with Ebola, we must recognize the long-term needs of the population most affected in order to help prevent further outbreaks - and that means investing in girls and women.