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Understanding the Personal Relationships and Reproductive Health Changes of Female Survivors of Ebola Infection in Liberia

  • Christine L. Godwin
  • Alexandria Buller
  • Margaret Bentley
  • Kavita Singh
Chapter
Part of the Global Maternal and Child Health book series (GMCH)

Abstract

This chapter examines the perceived impact of Ebola on the intimate relationships and reproductive health of female Ebola survivors in Liberia. Although the area of Ebola survivor research has grown greatly over the last few years, very few studies have focused on the unique consequences that Ebola survivorship can have on women. This study consisted of in-depth interviews with 69 female Ebola survivors from Montserrado, Lofa, and Bong Counties of Liberia. The chapter reports preliminary findings on relationship outcomes among these women, as well as changes in menstruation and pregnancies post-Ebola. Although experiences varied greatly across the study participants, nearly half of the women reported that the relationship that they were in at the time of their infection with Ebola had ended due to either death of partner from Ebola or abandonment by the partner. Women also reported experiences with stigma and social rejection, both among existing and new male partners. Many of the participants also reported changes in timing, frequency, and consistency of menstruation.

Keywords

Ebola virus disease Ebola survivor Stigma Intimate relationships Sexual behavior Immune privilege Post-Ebola syndrome Pregnancy Miscarriage Stillbirth Menstruation Amenorrhea Libido Viral persistence Liberia Reproductive health Abandonment Ebola treatment unit Social rejection 

References

  1. Arwady, M. A., Garcia, E. L., Wollor, B., Mabande, L. G., Reaves, E. J., Montgomery, J. M., et al. (2014). Reintegration of Ebola survivors into their communities—Firestone District, Liberia, 2014. MMWR Morbidity Mortality Weekly Report, 63(50), 1207–1209. Retrieved November 4, 2017, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6350a7.htm.PubMedGoogle Scholar
  2. Bausch, D. G. (2015). Sequelae after Ebola virus disease: Even when it’s over it’s not over. Lancet Infectious Diseases, 15(8), 865–866. Retrieved March 31, from, http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)70165-9/fulltext.CrossRefGoogle Scholar
  3. Center for Disease Control and Prevention. (2015). Ebola survivors questions and answers. Retrieved November 5, 2017, from https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/survivors.html.
  4. Dahl, B. A. (2016). CDC’s response to the 2014–2016 Ebola epidemic—Guinea, Liberia, and Sierra Leone. MMWR Supplements, 65(3), 12–20. Retrieved October 30, from, https://www.cdc.gov/mmwr/volumes/65/su/su6503a3.htm.CrossRefGoogle Scholar
  5. De Roo, A., Ado, B., Rose, B., Guimard, Y., Fonck, K., & Colebunders, R. (1998). Survey among survivors of the 1995 Ebola epidemic in Kikwit, Democratic Republic of Congo: Their feelings and experiences. Tropical Medicine & International Health, 3(11), 883–885.CrossRefGoogle Scholar
  6. Deen, G. F., Broutet, N., Xu, W., Knust, B., Sesay, F. R., McDonald, S. L. R., et al. (2017). Ebola RNA persistence in semen of Ebola virus disease survivors - Final report. New England Journal of Medicine, 377(15), 1428–1437. Retrieved March 31, 2018, from http://www.nejm.org/doi/full/10.1056/NEJMoa1511410.CrossRefGoogle Scholar
  7. Fallah, M. P., Skrip, L. A., Dahn, B. T., Nyenswah, T. G., Flumo, H., Glayweon, M., et al. (2016). Pregnancy outcomes in Liberian women who conceived after recovery from Ebola virus disease. Lancet Global Health, 4, e678–e679. Retrieved March 31, 2018, from, http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30147-4/fulltext.CrossRefGoogle Scholar
  8. Fischer, W.A., Brown, J., Wohl, D.A., Loftis, A.J., Tozay, S., Reeves, E., et al., (2017). Ebola virus ribonucleic acid detection in semen more than two years after resolution of acute Ebola virus infection. Open Forum Infectious Diseases, 4(3), ofx155. Retrieved November 19, 2018, from https://academic.oup.com/ofid/article/4/3/ofx155/4004818.
  9. Gbarmo-Ndorbor, A. (2017). Number of Liberian Ebola survivors [online]. E-email to Christine Godwin (chrissylgodwin@gmail.com) 2017 March 13 [cited 2017 November 5].Google Scholar
  10. Ghose, T. (2017). Ebola may linger in men’s semen for more than 2 years. Live Science. Retrieved November 18, 2018, from https://www.livescience.com/59996-ebola-virus-stays-in-semen-for-years.html.
  11. Grout, L., Martinez-Pino, I., Ciglenecki, I., Keita, S., Diallo, A. A., Traore, B., et al. (2015). Pregnancy outcomes after a mass vaccination campaign with an oral cholera vaccine in Guinea: A retrospective cohort study. PLoS Neglected Tropical Diseases, 9, e0004274. Retrieved November 5, 2017, from http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004274.CrossRefGoogle Scholar
  12. Hewlett, B. S., & Amola, R. P. (2003). Cultural contexts of Ebola in northern Uganda. Emerging Infectious Diseases, 9(10), 1242–1248. Retrieved March 31, 2018, from https://wwwnc.cdc.gov/eid/article/9/10/02-0493_article.CrossRefGoogle Scholar
  13. Karafillakis, E., Jalloh, M. F., Nuriddin, A., Larson, H. J., Whitworth, J., Lees, S., et al. (2016). Once there is life, there is hope Ebola survivors’ experiences, behaviours and attitudes in Sierra Leone, 2015. British Medical Journal Global Health, 1(3), e000108. Retrieved March 31, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5321361/.Google Scholar
  14. Lee-Kwan, S. H., DeLuca, N., Adams, M., Dalling, M., Drevlow, E., Gassama, G., et al. (2014). Support services for survivors of Ebola virus disease-Sierra Leone, 2014. MMWR. Morbidity and Mortality Weekly Report, 63, 1205–1206. Retrieved March 31, 2018, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6350a6.htm.PubMedPubMedCentralGoogle Scholar
  15. Mate, S. E., Kugelman, J. R., Nyenswah, T. G., Ladner, J. T., Wiley, M. R., Cordier-Lassalle, T., et al. (2015). Molecular evidence of sexual transmission of Ebola virus. New England Journal of Medicine, 373(25), 2448–2454. Retrieved March 31, 2018, from http://www.nejm.org/doi/full/10.1056/NEJMoa1509773.CrossRefGoogle Scholar
  16. Qureshi, A. I., Chughtai, M., Loua, T. O., Pe Kolie, J., Camara, H. F., Ishfaq, M. F., et al. (2015). Study of Ebola virus disease survivors in Guinea. Clinical Infectious Diseases, 61(7), 1035–1042.CrossRefGoogle Scholar
  17. Rabelo, I., Lee, V., Fallah, M. P., Massaquoi, M., Evlampidou, I., Crestani, R., et al. (2016). Psychological distress among Ebola survivors discharged from an Ebola treatment unit in Monrovia, Liberia–A qualitative study. Frontiers in Public Health, 4, 142. Retrieved November 1, 2017, from, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931229/.CrossRefGoogle Scholar
  18. Sissoko, D., Duraffour, S., Kerber, R., Kolie, J.S., Beavogui, A.H., Camara, A-M., et al. (2017) Persistence and clearance of Ebola virus RNA from seminal fluid of Ebola virus disease survivors: a longitudinal analysis and modelling study. The Lancet Global Health, 5(1), e80-e88. Retrieved November 19, 2018, from https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30243-1/fulltext?code=lancet-site.CrossRefGoogle Scholar
  19. Sossou, M. A. (2002). Widowhood practices in West Africa: The silent victims. International Journal of Social Welfare, 11, 201–209.CrossRefGoogle Scholar
  20. Tolley, E. E., Ulin, P. R., Mack, N., Robinson, E. T., & Succop, S. M. (2016). Qualitative methods in public health: A field guide for applied research (2nd ed.). Hoboken: Wiley.Google Scholar
  21. Wilson, H.W., Amo-Addae, M., Kenu, E., Ilesanmi, O.S., Ameme, D.K., Sackey, S.O. (2018). Post-Ebola syndrome among Ebola virus disease survivors in Montserrado County, Liberia 2016. BioMed Research International, Article ID 1909410, https://doi.org/10.1155/2018/1909410. Retrieved November 19, 2018, from https://www.hindawi.com/journals/bmri/2018/1909410/.CrossRefGoogle Scholar
  22. World Health Organization. (2015a). WHO meeting on survivors of Ebola virus disease: Clinical care of EVD survivors. Meeting Report, Freetown, Sierra Leone. Geneva: World Health Organization. Accessed 8 December 2017.Google Scholar
  23. World Health Organization. (2015b). Interim advice on the sexual transmission of the Ebola virus disease. Retrieved October 30, 2017, from http://www.who.int/reproductivehealth/topics/rtis/ebola-virus-semen/en/.
  24. World Health Organization. (2015c). Ebola virus disease in pregnancy: Screening and management of Ebola cases, contacts and survivors: Interim guidance. Retrieved October 20, 2017, from http://www.who.int/csr/resources/publications/ebola/pregnancy-guidance/en/.
  25. World Health Organization. (2016a). Interim guidance: Clinical care for survivors of Ebola virus disease. Geneva: WHO. Retrieved October 20, 2017, from apps.who.int/iris/bitstream/10665/204235/1/WHO_EVD_OHE_PED_16.1_eng.pdf.
  26. World Health Organization. (2016b). Ebola situation reports—Archive. Retrieved October 25, 2017, from http://www.who.int/csr/disease/ebola/situation-reports/archive/en/.
  27. World Health Organization. (2016c). Clinical care for survivors of Ebola virus disease. Interim guidance. Retrieved October 30, 2017, from http://www.who.int/csr/resources/publications/ebola/guidance-survivors/en/.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Christine L. Godwin
    • 1
  • Alexandria Buller
    • 2
  • Margaret Bentley
    • 3
  • Kavita Singh
    • 1
  1. 1.Department of Maternal and Child HealthGillings School of Global Public Health, University of North Carolina at Chapel HillChapel HillUSA
  2. 2.Global Studies DepartmentAbilene Christian UniversityAbileneUSA
  3. 3.Department of NutritionGillings School of Global Public Health, University of North Carolina at Chapel HillChapel HillUSA

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