International Women’s Day reminds us of the need to fight inequality to end TB

‘Be bold for change’ is the theme for this year’s International Women’s Day and on this day highlighting and celebrating the lives of women around the world, Past President of The Union, Dr E. Jane Carter reflects on the lives of women and their children cruelly affected by tuberculosis (TB).

“The largest age group affected by TB is the age of reproductive years. The intersection between reproductive health and TB is a major crossroads for women in the world today. Women with extra-pulmonary TB are twice as likely to have a low-birth-weight or premature baby and are four times more likely to die in childbirth. Symptoms of TB in pregnancy are often masked by the pregnancy itself leading to delays in diagnosis. Diagnostics such as Chest radiographs are routinely not offered to symptomatic, at risk, pregnant women.

“The mother who is diagnosed with TB - often late in her pregnancy or thereafter - faces the terrible prospect of passing the disease on to her child, not only by merely being ill herself during the pregnancy but by the act of holding her child “too close” during breastfeeding while she herself is contagious. What choice is this for a new mother? Estimates place maternal transmission of TB at 15 percent. It is frightening enough for a young woman to receive the diagnosis but imagine telling her she has also caused her baby to be ill?

“The adversities women face are not just biological, they are also socio-economic. In some societies, particularly in low- to middle income countries, women have fewer educational opportunities, less access to economic resources and face increased stigmatisation compared to men.

“I personally remember a couple who came into the clinic together with their beautiful twin girls, three months old. It was the mum’s last visit – she was cured of her laryngeal TB diagnosed in the first trimester of pregnancy - I thought it was a day for celebration and we had presents for the girls. She burst into tears and I asked why? She told me she was so relieved to have been diagnosed in a different country than that of her birth. Her family would have forced her to divorce and leave her husband with her “terrible” diagnosis but we had treated her with kindness and kept her family together. She still feared the family would find out and send her away. They still had not told either grandparents.

“No women should face that stigma- but they still do.

Saira, 27, was diagnosed with MDR-TB, and this led to her family disowning her. Nevertheless, she has beaten MDR-TB and can now carry on caring for her son and daughter in Mumbai. Photo: Javier Galeano

“The fate of women and children are always tied together. From my work in Kenya, I know that families of smear positive TB patients are told to bring in their children, particularly the vulnerable children like babies under five, for evaluation for Isoniazid Preventive Therapy. The major barrier to bringing those children for evaluation appears to be the cost of transport – less than one USD. Even when the transport is paid for, the child is less likely to come for evaluation if the index case is male. Socio-economic factors continue to limit the lives of woman and children to access quality TB care. In addition, the decades long practice to bar pregnant women and children from clinical trials has also served to render their care an extrapolation algorithm, rather than evidenced based science.

“We, the TB community, must ‘Be Bold for Change’ on this day. 3.5 million women and 1 million children – the number who will fall ill with TB this year - demand and deserve our attention today. SDG 3 (to ensure healthy lives and promote well-being for all, at all ages) and SGD 5 (to achieve gender equality and empower all women and girls) should be part of all human rights.

“Let’s be bold on International Women’s Day and say the time is now. Zero TB deaths in women and zero TB deaths in children should not be a Bold Goal – it is the Right goal.”