Effects of the West African Ebola Epidemic on Health Care of Pregnant Women: Stigmatization With and Without Infection

Abstract

Following the end of the Ebola virus outbreak in West Africa in March 2016, the lingering effects of stigma on Ebola survivors, as well as children orphaned by the disease, have become evident. However, there was little scholarly attention paid to stigma while the outbreak was still active. This chapter explores the effects of stigmatization on the health care services that pregnant women, both with and without Ebola, were able to access and receive during the outbreak. We propose three primary ways in which stigma operated to reduce pregnant women’s access to health care services during the outbreak: (1) Women and their relatives were afraid to go to health facilities for fear of being infected with Ebola while there, i.e., stigmatization of health care facilities; (2) Health care workers frequently died due to their occupational exposure to EVD while caring for others, i.e., they were stigmatized as carriers or transmitters of Ebola; and (3) Pregnant women themselves were refused services at health facilities due to fears that they were infected with Ebola, i.e., the physiological processes of birth, which involve high levels of potential for exposure to bodily fluids, led to health care workers’ stigmatization of these women when they sought services during pregnancy or, particularly, at the time of giving birth. In several of the countries that experienced the worst of the outbreak, women already faced some of the world’s highest rates of pregnancy-related death even prior to the advent of the epidemic. We argue that the high fatality rate for pregnant women with Ebola, the drastic effects of the epidemic on countries’ health care workforce, and the inherent messiness of birth, all coalesced to create heightened discrimination and stigma around seeking care during pregnancy and birth.