Ebola, Women, and the Risk of Care

by Robert Wyrod

Watching the Ebola crisis unfold, I’ve found myself both fascinated and horrified by the differences in the fates of those infected. Here in the United States, the story has been the seemingly miraculous recovery of infected patients, with the tragic exceptions of Thomas Eric Duncan, the Liberian who died in Texas in October, and Martin Salia, the Sierra Leonean who died in Nebraska in November. While in West Africa, even as treatment improves, we are still seeing images of men, women, and children left to die alone on clinic floors and city streets.

Yet these stark and unsettling differences belie a striking global similarity in Ebola infections—women’s heightened risk of contracting the virus. And the factor driving this pattern is the way the work of caring for the ill intersects with gender in places as different as Monrovia, Dallas, and Madrid.

In this outbreak, only three people have been infected with Ebola while outside of West Africa: two in Dallas, Texas and one in Madrid, Spain. All three are nurses who were infected while caring for a patient who contracted the virus in West Africa, and all three are women. These three infections all occurred within days of each other in October, exposing the lack of preparedness on the part of the hospitals where these women worked.

These women nurses were all placed on the front lines of care work that proved extraordinarily risky, and all three are lucky to have recovered. In contrast, the doctors, aid workers, and journalists who traveled to West Africa and became infected—nearly all of whom are men—voluntarily placed themselves at risk. Ironically, their work has often been framed as heroic altruism, while the dangerous labor of their domestic counterparts is rarely glorified.

The fact that the three domestic care workers who were infected are women is hardly surprising. A comprehensive 2010 survey by the Health Resources and Services Administration found that 93 percent of registered nurses in the United States were women (although 41 percent of high-status nurse anesthetists were men). In the United Kingdom, nurses who are men are only slightly more common, making up 11 percent of nurses, according to the Nursing & Midwifery Council. The fact that the two infected Dallas nurses, Amber Vinson and Nina Pham, are women of color is also indicative of the growing percentage of U.S. nurses who are from minority racial and ethnic groups.

In West Africa, the intersection of gender and care work is also placing women at risk of infection. In many African countries, the combination of a very limited health infrastructure and gender norms that, like in the West, label most care work as feminine mean women are expected to look after and support sick family members, neighbors, and friends.

This is something I’ve witnessed first-hand in my own research on gender and AIDS in Uganda. In the community health clinic where I did fieldwork, all the nurses were women. So too were the community volunteers who went door-to-door to check on those too sick from AIDS to visit the clinic. The vibrant support group at the clinic for HIV-positive people: nearly all women. And in the homes of friends and acquaintances who were caring for HIV-infected relatives—again it was women providing the care.

The Ebola crisis has brought some attention to how the global gendering of care work affects African women. In August, the Liberian government reported that women made up 75 percent of Ebola deaths at that point. UNICEF also highlighted the fact that 55 to 60 percent of Ebola deaths in Guinea and Sierra Leone were women.

For Ndana Bofu-Tawamba, executive director at the Nairobi-based feminist organization Urgent Action Fund-Africa, these figures are the problematic flipside of cultural notions which revere women’s care giving as an embodiment of feminine honor. And as Lauren Wolfe rightly observes in Foreign Policy, such gender differences in susceptibility to disease are hardly unexpected, yet there is little done to mitigate such burdens until the gendered toll from the latest outbreak becomes glaringly evident.

With the growing attention to how gender intersects with Ebola in West Africa, there is reason to hope that more can be done to address the paradoxes African women face in wanting, and needing, to care for sick loved ones. Yet we should also be concerned with how gender relations shape care work in the United States. The women who are on the front lines of epidemics bear disproportionate risks. We should be thinking of ways to better value and compensate such necessary, and often dangerous, labor.

Robert Wyrod is an Assistant Professor in the Women’s Studies Department at the University of Michigan. His book, Privilege in a Plague: AIDS and the Remaking of Masculinity in Africa, is forthcoming from the University of California Press.