Statement on the Ebola Crisis

Public Statement by the Association of Reproductive Health Professionals on the Ebola Crisis

December 17, 2014
Washington, DC

The Association of Reproductive Health Professionals urges world leaders, policy makers, and health professionals to respond swiftly and compassionately to the humanitarian crisis in West Africa as a result of the Ebola Virus Disease (EVD) outbreak.

As a nonprofit, trans-disciplinary association representing over 12,000 members, ARHP promotes reproductive health education and policies based upon rigorous science, proven clinical practices, and sound public health measures to ensure the best health care for women, men, and families.

Since the initial outbreak in March 2014, EVD has spread rapidly throughout the countries of Liberia, Sierra Leone, and Guinea and claimed over 6,100 lives – reflecting an average EVD case fatality rate of 50%. Even those who are not infected are facing bleak daily lives and futures. Social networks have been destroyed by the loss of family members, workers, and community members. The economy and education system have come to a halt. Food is scarce. Thousands of children have been orphaned.

The significant loss of health care workers in West Africa has decimated already fragile health care delivery systems. Nurses and doctors who continue to work do so at risk of alienation from their colleagues, community, and even family members. Many are scared to provide hands-on treatment to patients, particularly in the absence of adequate personal protective equipment, for fear of contracting EVD.

ARHP is particularly concerned about the impact of EVD on access to reproductive health services in West Africa. The crippled health workforce has left pregnant women at risk in a region that already suffers one of the highest maternal mortality rates in the world. Pregnant women appear to be at a higher risk of severe EVD related illness than the general population, including the risk of fetal loss and pregnancy-associated hemorrhage. According to the United Nations Population Fund (UNPFA), more than 800,000 women are expected to give birth in the next 12 months. Of these, more than 120,000 are at risk for experiencing life-threatening complications without emergency obstetric care.

The Ebola virus has been detected in breastmilk, although the risk of contracting EVD through breastfeeding is not clear. Lactating mothers without access to formula must make difficult decisions regarding the risk of EVD transmission versus infant illness or possibly death from dehydration.

For those who are not currently pregnant, disruptions in health care threaten access to contraceptive supplies and put women at risk for unintended pregnancies. In Sierra Leone, Liberia, and Guinea, abortion laws are severely restrictive. We fear that an increased rate of unintended pregnancy will result in more women undergoing unsafe, illegal abortions with an associated increase in maternal morbidity and mortality.

We are gravely troubled by the impact of “aversion” behavior, such that those who have had any contact with EVD-infected individuals have been treated with suspicion and isolated in their own communities. In countries across the world, including in the United States, immigrants and health care workers coming from West Africa have faced intense stigma, including loss of jobs and housing, denial of public services, and verbal and physical harassment. This stigma has been driven by public misconceptions about the Ebola virus and its mode of transmission, which have been further fueled by sensational media coverage and misleading statements by political leaders.

We condemn the wanton use of “blanket quarantine” policies and travel restrictions, which are ineffective, not grounded in scientific evidence, and significantly deter health care workers from traveling to West Africa to join relief efforts.

The impact from EVD is, and will continue to be, devastating in a region already struggling to recover from civil war, widespread poverty, and illiteracy, unless there is an immediate and large-scale response from the global community.

To end the Ebola crisis, meet the reproductive heath needs of West African women, and stop the stigmatization of West Africans and healthcare workers, ARHP supports the following:

1. Creation of incentives to recruit health workers within West Africa and from other countries to increase the workforce capacity
2. Immediate funding to distribute supplies, including vital personal protective equipment, and support services necessary to isolate index cases, treat victims, and prevent further transmission of EVD in West Africa
3. Investment of resources and capital to develop robust health care response systems in West Africa to prevent and mitigate future medical crises
4. Immediate funding to meet the needs of reproductive health services of women and mothers in countries affected by Ebola
5. Institution and adherence to guidelines regarding screening, monitoring, and movement of persons with potential Ebola virus exposure that are consistent with those of scientifically-based medical organizations, including the Centers for Disease Control and Prevention and the World Health Organization
6. Immediate funding to pursue Ebola drug and vaccine development
7. Promotion and enforcement of zero tolerance, anti-harassment policies, particularly in schools, institutions of higher learning, health care facilities, and workplaces, to protect the civil rights and livelihoods of those at risk of stigmatization related to EVD

Sources

Jamieson DJ et al. What obstetrician-gynecologists should know about Ebola: A perspective from the Centers for Disease Control and Prevention. Obstet Gynecol 2014; 0: 1-6.

http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/index.html Accessed December 8, 2014

http://www.unfpa.org/public/home/news/pid/18503 Accessed December 8, 2014.

http://www.cdc.gov/vhf/ebola/hcp/guidance-maternal-health.html. Accessed December 8, 2014.

http://www.worldbank.org/en/news/press-release/2014/09/17/ebola-economic-impact-serious-catastrophic-swift-response-countries-international-community-world-bank. Accessed December 8, 2014.

Approved by ARHP’s Board of Directors on 12/17/14.