By Dyan Mazurana and the STOP Spillover Gender Action Team
Gender relations and social, economic, cultural, and political inequalities are fundamental causes of health inequity. Women, girls, sexual and gender minorities, and disabled people of all genders do not enjoy the same status, power, access to, and control over resources as able-bodied men. The impact of this gender imbalance has been studied in terms of many different outcomes such as education, income and average life span. However, little is known about the impact of gender on spillover risks, ongoing human-to-human transmission, and outbreak-related societal impacts.
Research shows that women, men, girls, and boys are all biologically susceptible to infection. However, the impact of and experience with emerging pathogens differs among each group.
For example, Ebola presents a significant threat to pregnant women, who when infected have higher mortality rates (between 74-100 percent vs approximately 50 percent in the general population). Pregnant women also experience fetal complications, with fetal loss estimated at nearly 100 percent. While for males, the Ebola virus can live in their sperm for a year or longer putting their sexual partners at risk of infection. For Lassa fever, pregnant women are almost three times more likely to die from Lassa fever infection than non-pregnant women with Lassa virus infections, particularly in the third trimester, according to studies from Nigeria, Sierra Leone, and Liberia.
Gender, age, and other social categories affect individuals’ behaviors that may increase risk of infection from emerging zoonotic pathogens. For example, bats infected with Nipah virus shed the virus in their saliva and urine, which can cause a spillover outbreak. Humans come into contact with the infected bat saliva and urine including through hunting, living near bat roosts, and in particular, the consumption of raw date palm sap or palm wine, which is a national delicacy in Bangladesh. Males also have more income to buy palm wine, which can be infected with the Nipah virus. Once infected, men can pass on the virus through direct contact and secretion of body fluids. Research found that “male patients infected about eight times as many people as did the female patients.”
The gendered, social, cultural, and economic determinants people face, as well as the society they live in and their ability to respond and act, affect their risk of spillover exposure, health-seeking behavior, and preventive and response measures. For example, food preparation, storage, and hygiene practices in the home are key potential sites for Lassa fever transmission. A 2011 baseline study of households in Bong and Nimba counties in Liberia found that only 1-2 percent of survey respondents were using any kind of improved storage methods of post-harvest food products. The most common practice was to store rice and cassava in the roof thatch above food preparation areas. Food insecure households were also less likely to use covered containers for water storage than middle and high food security households. A study of rural settlements in Bo district in Sierra Leone found that eating utensils and bowls are washed by young female household members the morning after use, after they are likely to have come in contact with feces and urine from nocturnal rodent activity. Due to their domestic responsibilities, women and girls, particularly those from more food insecure households, are at heightened risk of Lassa due to contact with infected food or inhalation of aerosols from dried rodent urine and excrement. However, rodent hunting for play by boys, pest control by men, and mice and rats as food sources for the entire family have been linked to higher rates of Lassa virus transmission. A study from Bo district found that hunting, preparation, and consumption of rodents is an opportunistic practice more likely to be carried out by men on farms as a means of pest control. This takes the form of killing rats with machetes after flushing them from grassy areas through bush clearing. Recognizing the extent to which zoonotic viruses affect women, men, girls and boys differently is a vital step toward understanding the drivers and impacts of zoonotic spillover on people and communities.
Gender also influences care-seeking behavior. In many countries, women are usually the primary care-givers and so make decisions about which child or elder family member to take for medical treatment or traditional healing. Adult men in the family may often wait until their sickness is severe to seek treatment. In addition, because the majority of caregiving and household duties fall to women and girls, there is an overall lack of time for women and girls to participate in health programs, research, outreach and education, and training in human and animal health best practices. Since health care seeking varies by culture, it is important that a gendered analysis of who seeks health care, in what form, when and why is critical to public health programs for spillover. Gender and age factors heavily influence causes, consequences, and management of infection by emerging pathogens and the efficacy of health promotion policies and programs.
How Can We Address Gender Gaps in Spillover Research?
Currently, there are too many gender, age and intersectional gaps in knowledge related to spillover risk of infection by emerging pathogens in high-risk animal or human populations and at high-risk animal-human interfaces. With the rare exceptions of COVID-19, HIV/AIDS and some research on Ebola, collective knowledge about the gender and intersectional drivers, risks and impacts of zoonotic spillover and resulting pandemics is very low.
To limit spillover risks, we need to:
- Engage in community-based participatory approaches with key stakeholders, including women and women’s groups, to ensure all voices are heard and included in identifying risk and coming up with solutions.
- Working alongside communities use participatory approaches to identify and collect gender, age, disability, and intersectional data and apply gender analysis to understand and shape responses to the full risks and impacts of the emergence of zoonotic spillover.
- Strengthen key stakeholders’ capacity to develop, analyze, validate, and implement gender-transformative, responsive, and culturally appropriate interventions within the context of addressing zoonotic spillover that are relevant to women, men, girls, boys and gender and sexual minorities.
- Support the use of the results of participatory actions (1-3) to help stakeholders develop and implement policies and strategies to understand and address the gender and intersectional-specific perceptions, risks, consequences and impacts of zoonotic disease spillover, amplification and spread.