Tuberculosis: An Unchecked Killer of Women
Tuberculosis (TB), an airborne infectious disease, is the third leading cause of death for women worldwide. In 2010, 3.2 million women developed TB and approximately 320,000 women died as a result. TB affects women mainly during their economically and reproductively active years, causing a substantial burden on children and families. Despite TB's immense and unique impact on women, little attention is paid to the disease as a women's health issue. The global health community, policymakers, and women's advocates should recognize TB as a critical burden for women around the world, and work together to eliminate it as a major cause of sickness, death, and social marginalization.
What is the nature and magnitude of TB Among Women?
- TB is the third leading cause of death among women of reproductive age (15-44), disproportionately affecting pregnant women and the poor. Poverty is a major factor for developing active TB disease. Because women account for 70 percent of the world's poor, women in developing countries are disproportionately affected by the disease.1
- TB places pregnant women and their babies at risk. Women with TB are twice as likely to give birth to a premature or low-birth-weight baby and four times more likely to die in childbirth. The risk of infant death also greatly increases.
- Pregnant women with HIV and active TB face higher risks of maternal mortality.[1]
- Mother to child transmission of TB is estimated to be 15% within three weeks of birth. Women living with HIV and TB stand an increased risk of transmitting HIV in utero.[2]
- TB progresses more quickly in women of reproductive age then in men of the same age group.
What risk factors are specific to women?
- Women who are infected with TB bacteria are more likely to develop infectious TB disease than men, but are less likely to access a qualified health provider. Factors of stigma, low socio-economic status, and lack of education cause significant delays in the diagnosis and treatment of TB in women.[3]
- Social factors contribute to the disparity in case detection between men and women. A study in Pakistan reported that many women either felt uncomfortable or misunderstood how to produce the mucus sample needed for a TB diagnosis.
- In developing countries, women often cook indoors in very confined spaces using biomass fuel such as wood or animal dung. Studies show that women who cook with these fuels are more likely to develop active TB.
- Women living in poverty are at an increased risk of being sold into the sex trade. Women and girls who engage in sex work are at an increased risk of contracting TB from clients. This risk is exacerbated by their confined living conditions and susceptibility to HIV.
What social and economic consequences to women and TB face?
- Socially, the stigma of having TB falls more heavily on women than men. In some communities, a positive diagnosis may force women into divorce or, if unmarried, create difficulty in finding a marriage partner.
- TB mostly affects women in their economically and reproductively active years, causing substantial burden on women and their families. Women suffering from TB are often unable to care for their children and have trouble performing household chores. Children are often forced to leave school to care for ailing parents and relatives.
- Women with TB are often too ill to engage in work outside the home, leading to a loss of wages.
- However, studies show that once in treatment women are more likely to complete their treatment than men are.[4]
What must be done?
- TB programs should work to remove barriers to access, reduce delays, and improve the diagnosis and treatment of TB in women.
- Further research and investigation is needed to understand the inadequacies of diagnosing and treating TB in women, including research on gender sensitive treatment options.
- TB and infectious disease advocates and maternal and child health advocates must work better together on a common agenda to eliminate stigma, impact policies and programming, mobilize resources, and ultimately eliminate TB's impact on women.
- TB screening, prevention, and treatment should be part of HIV, reproductive health, and maternal and child health services.
For more information see ACTION’s publication Women and Tuberculosis: Taking Action Against a Neglected Disease
[1] Women and AIDS, 2010, Tracking TB and HIV in Women: An Urgent Agenda
[2] WHO, 2010, The Global Plan To Stop TB, 2011-2015
[3] Women and AIDS, 2010, Tracking TB and HIV in Women: An Urgent Agenda
[4] WHO, 2010, The Global Plan To Stop TB, 2011-2015
