Lara Dahan & Priya Kanayson :
Neglected tropical diseases affect more than 1 billion people worldwide, with those at risk concentrated almost entirely in low-resource settings in low-income countries. Although these diseases of poverty affect more men on a case-by-case basis, the longer-term impact of NTDs on women and girls may be more severe because of gender inequities.
Take, for example, school-age girls and adolescents, for whom the burden of NTDs is particularly acute. Even when a girl hasn’t contracted an NTD, she may be forced to drop out of school to look after family members with severe NTD morbidity, therefore limiting her long-term job prospects and economic independence.
Human Rights Watch has found that intersections between gender discrimination and poor access to education and health services were some of the primary factors fueling child marriage across sub-Saharan Africa, Bangladesh, Nepal, and Yemen. Achieving universal health coverage – which will enable everyone everywhere to access quality health services – therefore goes hand in hand with advancing gender equality.
For women, the disabilities and disfigurements caused by NTDs such as lymphatic filariasis and onchocerciasis often result in social stigma, which may lead to increased difficulty in securing job opportunities and marriage prospects. Studies frequently show that women living with these diseases describe feelings of embarrassment, shame, despair, and fear.
The Covid-19 pandemic hasn’t helped matters; rather, it has diverted attention and resources away from these diseases of poverty. Research shows that since the start of the pandemic, more diagnostic tests have been developed for Covid -19 than for all 20 NTDs in the last 100 years. Current indications also suggest that NTD funding is being cut due to shrinking economies and reductions in international assistance or the diversion of existing funding toward control of the pandemic.
If we want to eliminate NTDs by 2030, we need to adopt an integrated approach to disease elimination that promotes gender equity at its core. This means applying a gender equity lens in NTD program design and delivery to help improve service delivery for women and girls.
To do this, NTD programs must engage with other health programs related to maternal and child health services that can provide information to girls and women about NTD prevention and treatment. That said, where treatments are available, they aren’t always viable. For example, lymphatic filariasis and onchocerciasis, which can be treated via mass drug administration, cannot be treated during pregnancy. Different methods must therefore be developed to ensure that pregnant women can access treatment.
Moreover, as women and girls are affected by NTD-related stigma with greater consequence, additional support needs to be provided to manage mental health issues. A person-centered approach that takes into account well-being can help tackle this.
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Identifying and establishing support groups where women affected by NTDs, either directly or indirectly, can come together to share experiences are key steps. There is already evidence of this approach at work with “hope clubs” in Nigeria and Haiti, for example, which support patients with lymphatic filariasis. Mental health and physical health are inextricably linked, and addressing the stigma and discrimination associated with improving mental health is vital.
Finally, research also shows that NTD programs will benefit from employing more female community-directed distributors of drugs, most of whom are currently male.
Opinion: Why we need to focus on stigma and discrimination – 5 lessons from the NTD field
Stigma is one of the most important aspects of neglected tropical diseases, but it is often overlooked. This op-ed shares practical guidance to help aid workers and global health practitioners recognize and counter stigma and discrimination for people living with NTDs.
In marginalized communities that lack proper hygiene and sanitation, local health workers are the bedrock of community-based health services. Not only do female community-directed distributors challenge traditional gender roles by showing that women in endemic countries have a key role to play in the design and implementation of NTD programs, but research also shows that female CDDs are better able to reach and enroll remote or marginalized women in NTD programs.
It’s clear that a gender equity approach to disease elimination promotes more than just good health; it gives women and girls in resource-poor settings the opportunity to challenge sociocultural gender roles and gain economic independence. The sooner the NTD community identifies the intersections between good health and well-being, quality education, and gender equality, the quicker we can start identifying effective solutions that simultaneously solve for universal health coverage and gender equality.
Only by adopting an integrated approach to disease elimination – combining a gender equity lens with cross-disease, cross-border, and cross-sectoral approaches – will the NTD community eliminate diseases of poverty once and for all.
(Lara Dahan and Priya Kanayson work for the Global Institute for Disease Elimination, a new global health institute focused on accelerating the elimination of malaria, polio, lymphatic filariasis, and onchocerciasis).
